The CT findings of acute thyroiditis and acute suppurative thyroiditis

Although acute thyroiditis often has a distinctive clinical presentation, this relatively uncommon entity can occasionally be confused with other inflammatory processes. In general, the earlier the diagnosis of acute thyroiditis is established, the lower is the frequency and severity of its attendant complications. Computed tomography (CT) is an extremely useful modality in establishing the diagnosis early because it can evaluate iodine content of the thyroid gland and provides more accurate mapping than ultrasound and nuclear medicine techniques. Three patients with acute thyroiditis--two with suppuration--are presented and the CT findings and clinical aspects of this disease are reviewed.     

Inflammatory pseudotumor of the maxillary sinus in a 15-year-old boy.

Inflammatory pseudotumor is a benign neoplasm composed of fibroblasts, histiocytes, and inflammatory cells. Its occurrence in the paranasal sinuses is rare. We report a case of a 15-year-old boy with a maxillary sinus inflammatory pseudotumor that simulated an aggressive neoplasm on CT scan.     

Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT.

Computed tomographic (CT) scans and magnetic resonance (MR) images obtained in 24 patients with cervical lymphadenopathy were retrospectively and blindly evaluated by two readers for the presence of central nodal necrosis (CNN) and extracapsular nodal spread (ENS). The CT studies were all enhanced, and the MR images were obtained with short repetition time (TR)/echo time (TE), long TR/double echo, and enhanced short TR/TE fat-suppressed sequences. Each MR imaging sequence was interpreted separately and then collectively. Sixty lymph nodes were identified with CT. Sensitivity for CNN was 16%-67% with the unenhanced MR pulse sequences, 50% with enhanced sequences, and 83%-100% with CT. The most accurate reading of MR images for CNN was with the unenhanced T1-weighted and T2-weighted images (86%-87%); the accuracy of CT was 91%-96%. The accuracy of MR imaging for detecting ENS was maximal with T1-weighted images (78%-90%). Gadolinium-enhanced, fat-suppressed images did not improve accuracy in evaluating CNN or ENS. CT is currently more accurate than unenhanced or enhanced MR imaging in detecting CNN or ENS.     

Adenosquamous carcinoma of the facial bones,skull base,and calvaria: CT and MR manifestations.

A 62-year-old woman had proptosis of the right eye, decreased visual acuity of the left eye, and no other focal neurologic deficits. She had a grand mal seizure 1 month before admission. The CT and MR studies showed extensive bone destruction of the margins of the right orbit, the floor of the middle cranial fossa, the right cavernous sinus, and much of the calvaria. There was considerable dural disease and tumor in the right orbit, paranasal sinuses, and scalp, as well as mucoceles of the left ethmoidal sinus with desiccated secretions. The diagnosis was adenosquamous carcinoma, an aggressive tumor related to both squamous cell carcinoma and adenocarcinoma.     

Kissing intrasellar carotid arteries in acromegaly: CT demonstration

Acromegaly is a disease with protean manifestations that are well described in the literature. One finding infrequently encountered is aneurysmal dilatation of the internal carotid arteries and their branches. A case is presented, with CT documentation, in which the enlarged cavernous portions of the internal carotid arteries prolapsed into the sella turcica and enlarged it. Frontal bossing, frontal sinus enlargement, a dense cortical calvarium, prominent inion, and proptosis secondary to extraocular muscular enlargement were findings also present in this patient. The sella CT appearance has brought the term "kissing intrasellar arteries" to mind to suggest the diagnosis.     

Surgical therapy of chronic mastoiditis with cholesteatoma.

One hundred fifty-seven ears treated surgically for chronic mastoiditis with cholesteatoma are reviewed. The selection of an operative procedure ("canal wall up" or "canal wall down") was dictated by the extent of pathologic indications in relation to the size of the patient's mastoid. The incidence of recurrent or residual cholesteatoma, the hearing results, and the frequency of visits required for mastoid cavity care are reported.     

Case report. The iron rim sign.

A chronic cystic cerebral hematoma occurred in the frontal lobe and mimicked both clinically and radiographically a frontal sinus mucocele. A rim seen on multidirectional tomography and unenhanced computed tomography was presumed to be composed to calcium. However, electron microscopic analysis revealed the rim to be composed almost entirely of iron from hemosiderin breakdown products. This is the first such report of an "iron rim" that we could find in the literature.