Cervical ecchordosis physaliphora: CT and MR features

We report a case of cervical ecchordosis physaliphora in an elderly man who presented with hemihypoaesthesia and contralateral hemiparesis. MRI showed a well defined, non-enhancing extradural mass lesion on the dorsal surface of the odontoid process of the axis. The lesion was of intermediate signal intensity on T1 weighted images and of low signal intensity on T2 weighted images. CT showed a small bony defect on the adjacent cortex of the odontoid process. Recognition of the imaging features of ecchordosis physaliphora is helpful in suggesting the diagnosis and differentiating the lesion from chordoma.     

Abdominal actinomycosis associated with intrauterine device: CT features

Abdominal actinomycosis is a severe and progressive peritoneal infection, due to an anerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrauterine device (IUD) is a well-known risk factor in young women. We report two cases of pelviperitoneal actinomycosis appearing in two young women with acute low abdominal pain. Abdominal CT demonstrated multiple solid or encapsulated peritoneal masses with marked contrast enhancement and infiltration of the adjacent mesenteric fat. Laparoscopy confirmed the presence of intraperitoneal abscesses which contained Actinomyces israelii. High doses of amoxicillin and clavulanic acid (Augmentine) were given and following CT scan after 2 and 6 weeks showed a slow, but complete, resolution of the lesions. Although the radiologic presentation of actinomycosis is nonspecific, the diagnosis should be raised in the presence of pseudotumoral mesenteric infiltration, particularly in young women with an IUD. Abdominal CT is a useful method for diagnosis and for follow-up.     

Mediastinal hemangioma: radiographic and CT features in 14 patients

PURPOSE: To characterize the imaging features of mediastinal hemangioma. MATERIALS AND METHODS: The authors retrospectively reviewed chest radiographs and computed tomographic (CT) scans from 14 patients with mediastinal hemangioma. RESULTS: Most mediastinal hemangiomas manifested as well-marginated masses at CT. Three masses had punctate calcifications, and one had phleboliths. Five masses were of heterogeneous attenuation at unenhanced CT. Ten of 11 (91%) hemangiomas were of heterogeneous attenuation at contrast material-enhanced CT, and the following four patterns were observed: central (n = 6, 60%), mixed central and peripheral (n = 2, 20%), peripheral (n = 1, 10%), and nonspecific (n = 1, 10%) increased attenuation. Central increased attenuation was observed more frequently after administration of a bolus of contrast material than after slow infusion. CONCLUSION: Hemangiomas should be considered in the differential diagnosis of well-marginated mediastinal masses that have heterogeneous attenuation on CT scans, show central enhancement after administration of contrast material or contain punctate calcification.     

Cerebral paragonimiasis in early active stage: CT and MR features

OBJECTIVE: Diagnosis of cerebral paragonimiasis in its early active stage is important because curative chemotherapy is possible. Accordingly, this study was undertaken to evaluate the CT and MR features of early active cerebral paragonimiasis. MATERIALS AND METHODS: We retrospectively reviewed the CT scans (n = 29) and MR images (n = 7) of the brain in 20 patients between 7 and 59 years old who had cerebral paragonimiasis in the early active stage. The diagnosis was based on a positive antibody test by enzyme-linked immunosorbent assay (ELISA) for paragonimiasis in serum and CSF. The diagnosis was confirmed surgically in seven patients. RESULTS: The most common and characteristic imaging finding was a conglomerate of ringlike enhancing lesions (grape-cluster appearance) with surrounding edema in one cerebral hemisphere in 11 patients (55%). Other nonspecific findings included a solitary ringlike lesion (n = 4) or irregular enhancing lesions (n = 2), localized hemorrhage with (n = 3) or without (n = 2) enhancing lesions, and a poorly defined non-hemorrhagic, nonenhancing lesion (n = 1). CONCLUSION: CT and MR findings of clustered ring-enhancing lesions, seen in approximately half of the cases of early cerebral paragonimiasis, are suggestive of cerebral paragonimiasis.     

Macrocystic serous cystadenoma of the pancreas: CT and endosonographic features

Defects in stomatin, alpha-adducin, and beta-adducin have been implicated in erythrocyte disorders of cation permeability. We performed linkage analysis of the genetic loci for these proteins in a large kindred with xerocytosis (dehydrated hereditary stomatocytosis). Using polymerase chain reaction-based genotyping techniques, all three loci are excluded as disease gene candidates.     

Clinical features and outcome in disseminated mycobacterial diseases in AIDS patients in Taiwan

OBJECTIVE: To describe and compare the clinical features and outcome of disseminated tuberculosis (TB) and Mycobacterium avium complex (MAC) disease in AIDS patients. DESIGN: Prospective cohort study. SETTING: A 1800-bed university teaching hospital, the largest centre for HIV/AIDS patients in Taiwan. METHODS: From July 1994 through June 1997, a standardized protocol was used to record the demographic and clinical features in all hospitalized HIV-infected patients, and to perform routine studies and invasive procedures for diagnosis of disseminated mycobacterial diseases. To compare the survival, control patients were selected from the HIV-infected patients hospitalized in the same hospital during the same study period, and had similar age, sex, CD4+ cell counts and antiretroviral therapy regimens. RESULTS: A total of 22 cases of disseminated TB and 15 cases of disseminated MAC were identified. Disseminated TB and MAC occurred in patients with similarly low CD4+ cell counts (median, 23 versus 5 x 10(6)/l; P = 0.08). The clinical features favouring disseminated TB included night sweats, peripheral lymphadenopathy, acid-fast bacilli in sputum smears, chest radiographic findings of hilar enlargement, and lack of prior AIDS-defining illnesses. Hepatosplenomegaly, elevated serum alkaline phosphatase (more than twice the upper limit of normal), elevated serum gamma-glutamyl transpeptidase (more than three times the upper limit of normal), and leukopenia favoured disseminated MAC. The patients with disseminated TB survived much longer than patients with disseminated MAC (mean survival, 96 versus 22 weeks, P = 0.008) but had a similar outcome to control patients (P = 0.60). CONCLUSION: Disseminated TB and MAC are distinguishable by clinical features in AIDS patients with similar immunocompromised states. Those features may facilitate diagnosis and selection of specific therapeutic regimens. Disseminated TB was not associated with a shortened survival period in AIDS patients when they completed anti-TB treatment. In contrast, disseminated DMAC was associated with shortened survival despite treatment with potent regimens. These results may emphasize the importance of prophylaxis for MAC in this population.     

肺硬化性血管瘤的CT影像学特点

Objective: The aim of the study was to analyze the CT morphology features of pulmonary sclerosing hemangiomas (PSHs) and improve the diagnosis ability of this disease. Methods: The 18 cases of pulmonary sclerosing hemangioma (PSH) confirmed by operation and histopathology from August 2002 to May 2009 were collected, including 17 females and 2 males, aged from 19 to 60 years old, with an average age of 43 years. All the cases underwent plain CT scan, among them,16 cases received enhanced CT scan. Results: The 18 cases had isolated mass. Mean long-axis diameter of these lesions was (2.7 ± 1.3) cm (range, 1.9-4.2 cm). Of all cases, 5 cases (27.8%) were round in shape, 9 cases (50%) were oval, 4 cases (22.2%) were lobulated, and 14 cases (77.8%) were smooth margin. The air meniscus sign was in 2 cases (11.1%), and the halo sign in 3 cases (16.7%). Two cases (11.1%) contained small nodular calcification, the remaining 16 cases (70%) were homogeneous density, the CT density of the masses ranged from 24-47 HU, and the mean value was 35 HU. Sixteen cases received enhanced scan, the welt vessel sign was in 8 cases (44.4%),1 case showed less enhancement, 5 cases showed marked homogeneous enhancement and 10 cases showed intense and patchy heterogeneous enhanced. The CT density of the enhancing masses ranged from 60-110 HU, the mean value was 35 HU, and the net enhancement value was 14-80 HU, the mean value was 55 HU. Conclusion: PSH should be considered in middle-aged female whose CT found that single round or oval pulmonary nodules, with smooth margin, or associated with the air meniscus sign, the halo sign, or the marked enhancement.     

Laryngeal papillomatosis: immunologic and viral basis for therapy

The distressing nature of laryngeal papillomatosis and lack of clinical progress in its treatment are reviewed. Presently accepted and investigative methods of therapy are reviewed with special attention being given to immune therapy. Support for the concept of a viral etiology is discussed and other etiologic agents considered. Known and possibly significant roles of wart virus antibodies are discussed and the importance of complex interplay between maternal and fetal immune systems explored as a possible explanation for some puzzling aspects of laryngeal papillomatosis. Finally, a proposed experimental design is outlined, the purpose of which is to provide a useful animal model to investigate immune changes in laryngeal papillomatosis, as well as effects of surgical or medical therapy.     

Pediatric laryngeal papillomatosis: our experience (three cases)

Three cases of juvenile laryngeal papillomatosis were treated at our hospital between 1984 and 1994. Papillomas were excised in all patients because of upper airway obstruction. Two were given alpha interferon as complementary treatment. Two patients are asymptomatic after years of follow-up and one is still taking alpha interferon.     

Adult-onset subacute sclerosing panencephalitis: case reports and review of the literature

Temperature was measured during drilling in bovine cortical bone specimens. A surgical drill fitted with a custom-designed speedometer and mounted on a drill press was used to drill holes at one speed, 49,000 rpm, and at forces in the range of 1.5 to 9.0 N. The resulting temperatures were recorded by thermocouples placed at various locations. The distribution of maximum local temperature rise (delta T) was best fitted by the function delta T = aR-b, where R is the distance from the center of the drilled hole and a and b are constants that were found by regression analysis. It was also found that the temperature increased with force, up to about 4.0 N, and then decreased at forces greater than that because of decreased drilling time. A separate series of tests revealed that temperatures were higher in the longitudinal direction than in the circumferential direction; this difference was attributed to the anisotropic thermal properties of bone.     

CT features of calcifications in abdominal malignant fibrous histiocytoma

Driven by the need for a readily available, non-immunological tissue that possesses many of the characteristics of normal human skin, tissue-engineered skin has been developed. For over a decade, laboratory grown or processed skin has been under investigation and, in some cases, available as an alternative to autologous grafts. Apligraf, derived from neonatal foreskin and bovine type I collagen, is the first bi-layered living skin equivalent approved in the US and other countries for use in venous ulcers. Apligraf is effective both in the treatment of refractory venous ulcers and for acute wounds such as surgical excision sites and split thickness donor sites. Apligraf is safe and is not clinically rejected. Its ultimate fate is not known, so it may well work to aid healing in a variety of ways including graft 'take' and as a stimulus for healing.     

Adult-onset nemaline myopathy: a case report and review of the literature

Nemaline (rod) myopathy is a congenital muscle disease with a wide spectrum of phenotypes, ranging from forms with neonatal onset and fatal outcome to asymptomatic forms. An adult-onset variant is characterized by large numbers of rod-containing myofibers, numerous rods per affected myofiber, and the absence of specific structural abnormalities typical of other muscle diseases. Few cases fulfilling these criteria have been described in the literature. Rare cases have had an associated inflammatory component, and the majority of these have occurred in patients with an underlying immunologic disorder. We present an unusual case of an immunologically competent 65-year-old man with late-onset nemaline myopathy, who was previously diagnosed with an inflammatory myopathy based on a muscle biopsy that contained chronic inflammation. His symptoms consisted of a 2-year history of progressive proximal muscle weakness; his family history was unremarkable. A neurologic examination confirmed the presence of bilateral proximal muscle weakness, normal sensation, and decreased upper and lower extremity reflexes. Creatine kinase levels were normal, and electromyographic findings indicated a myopathic process. A modified trichrome stain of the right biceps muscle revealed granular, basophilic, centrally located rods in the atrophic myofibers. Ultrastructurally, these myofibers contained osmiophilic rectangular structures with a latticelike appearance typical of nemaline myopathy. This case illustrates that adult-onset nemaline myopathy, although rare, should be considered in the differential diagnosis of an inflammatory myopathy.     

Benign pulmonary nodule: morphological features and contrast enhancement evaluated with contiguous thin-section CT

The morphological changes in 54 benign lung nodules, including 8 histologically proven nodules of tuberculoma, 10 of focal organizing pneumonia (FOP), 1 of lung abscess and 35 other benign nodules, were evaluated with contiguous thin-section (3mm) CT. In addition, incremental dynamic studies were carried out in 25 of these nodules. The three-dimensional shapes of the nodules were found to be quite varied and were classified into four types: (A) round mass (n = 18), (B) polygonal mass with concave or straight margins (n = 20), (C) oval or band-like mass extending along the bronchovascular bundle (n = 7), (D) oval mass attached to the pleura with broad contact (n = 9). Forty-two (78%) of the 54 nodules were located along the bronchovascular bundle. The maximum increments in CT values over 20HU were observed after contrast enhancement in 18 (72%) of the 25 benign nodules, among which all tuberculomas showed little or no contrast enhancement. The number of small vessels quantified microscopically in teh center of the nodules were minimal in tuberculomas with little enhancement and plentiful in lesions of FOP and abscess which showed marked enhancement. Our results suggest that the differentiation between benign and malignant pulmonary nodules is not possible simply on the basis of the degree of contrast enhancement. Therefore, morphological features and the anatomical relation to the bronchovascular bundles should also be taken into consideration in the diagnosis of pulmonary nodules.     

Pediatric respiratory papillomatosis: prognostic role of viral typing and cofactors

Children with recurrent respiratory papillomatosis vary greatly in their clinical disease course. Many have mild disease with eventual remission while others present with an early aggressive airway obstructive course. This study consisted of 24 pediatric patients whose specimens underwent polymerase chain reaction analysis for cytomegalovirus (CMV), herpes simplex virus (HSV), and human papillomavirus (HPV) type. Nineteen of 24 specimens contained enough DNA for this study. None of the specimens were found to contain DNA from HPV-16, -18, -31, -33; CMV; or HSV, which contrasts with our previous findings in adults. Ten patients were infected by HPV-11 and seven of these underwent tracheotomy because of an aggressive tumorigenic clinical course. Nine patients were infected by HPV-6 alone of whom only two required a tracheotomy (P = 0.05, Fisher's Exact Test). The early airway obstructive course associated with HPV-11, however, had no bearing on achieving eventual disease remission, with decannulation achieved in eight of nine children.     

Deep benign fibrous histiocytoma of the knee: CT and MR features with pathologic correlation

Magnetic resonance imaging and pathologic findings in a 28-year-old patient with a giant deep benign fibrous histiocytoma in the popliteal fossa of the right knee are described. The MR imaging findings include a well-delineated oval mass with low signal intensity on T1-, and high signal intensity on T2-weighted, images, and marked peripheral contrast enhancement. To the best of our knowledge, this is the first report on the MR findings in this entity.     

Hepatocellular carcinoma: CT and MR features after transcatheter arterial embolization and percutaneous ethanol injection

PURPOSE: To investigate the reliability of computed tomography (CT) and magnetic resonance (MR) imaging in the evaluation of the response of hepatocellular carcinoma (HCC) to transcatheter arterial embolization (TAE) followed by percutaneous ethanol injection (PEI). MATERIAL AND METHODS: Between January 1991 and November 1992, 20 patients (15 men and five women, aged 53-73 years [mean, 64.6 years]) with 31 HCC lesions underwent CT and MR imaging before and after treatment with combined TAE and PEI. RESULTS: Twenty-seven tumors, which were hypointense on post-treatment T2-weighted images and on gadolinium-enhanced T1-weighted images, were seen to be necrotic at biopsy. In four cases of incomplete necrosis, viable tumor was hyperintense on T2-weighted images and was enhanced after administration of contrast material. CT provided a larger spectrum of imaging features as a result of the presence of both hyperattenuating areas (caused by retention of iodized oil) and hypoattenuating areas (due to ethanol-induced necrosis). CONCLUSION: CT and MR imaging findings proved useful in the evaluation of the response of HCC to combined TAE and PEI.     

Mediastinal and hilar lymphadenopathy due to Pneumocystis carinii infection in AIDS patients: CT features

Smoking, alcohol, and familial background are considered major cofactors in the cause of oral cancer. The purpose of the present study was to determine the relationship between ethnic origin and oral cancer in the Israeli Jewish Population. Data were collected during the years 1970 to 1980 from 342 dental records of patients in Israeli hospitals. Results showed a male/female ratio of 2:1. Of 264 patients with clearly determined ethnic origin, 72% were Ashkenazi, 15% Sephardi, and 13% Eastern ethnic origin. The relative prevalence showed that the risk of the Ashkenazi group to develop oral cancer was at least twice as high as the other two ethnic groups. The increase in occurrence of oral cancer with age in each ethnic group was highly significant (p < 0.001). The most common type of malignancy was squamous cell carcinoma (95%) with 99% of this malignancy occurring in patients in their sixth and seventh decade. A significant (p < 0.02) relationship between site of involvement and ethnic origin was also noted. The tongue was the leading site in the Ashkenazi and Sephardi groups, whereas the lip and alveolar ridges were the most affected sites in the Eastern ethnic group.     

Congenital esophageal stenosis owing to tracheobronchial remnants: a case report

A 3.5-year-old girl who had congenital esophageal stenosis caused by tracheobronchial remnants without esophageal atresia or tracheoesophageal fistula is presented. The diagnostic difficulties are discussed.