Ultrasound case of the day. Well-differentiated lymphocytic lymphoma.
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Humans↗
Biomedical subjects
A Shirkhoda
Publications and source records attributed to A Shirkhoda.
Budd-Chiari syndrome complicating pre-eclampsia: diagnosis by magnetic resonance imaging.
A 25-year-old primigravida with third-trimester pre-eclampsia developed severe right upper quadrant pain, marked serum aminotransferase elevation, and disseminated intravascular coagulation after cesarean delivery. Computed tomography of the liver showed a right hepatic abnormality that on magnetic resonance imaging had the appearance of hemorrhage; partial thrombosis of the right hepatic vein extending to the inferior vena cava was also seen. Anticoagulation was begun and the patient completely recovered; follow-up imaging 8 months later was normal. This case suggests that nonfatal forms of Budd-Chiari syndrome may complicate pre-eclampsia; predisposition to partial venous outflow obstruction in the pre-eclamptic patient may be pathogenetically related to disseminated intravascular coagulation. This entity may be clinically confused with, or misdiagnosed as, spontaneous hepatic hemorrhage, with or without capsular rupture. In such circumstances, magnetic resonance may be diagnostically useful.
Adult↗
The calcaneus: normal and abnormal.
The calcaneus is the largest tarsal bone. Many congenital and acquired disorders affect the bone. Primary disorders arise in the calcaneus itself, whereas secondary disorders arising in the neighboring soft tissues extend into and affect the calcaneus indirectly. Among the primary lesions, congenital, traumatic, infectious, hematologic, neoplastic, and other miscellaneous disorders constitute the majority, whereas various arthritides and soft-tissue neoplasms that arise adjacent to the bone constitute the important secondary calcaneal disorders. Radiographic features of many disorders of the calcaneus are disease-specific and thus diagnostic. This article describes a wide spectrum of calcaneal disorders and illustrates their salient radiographic features. This knowledge should facilitate radiographic diagnosis of various calcaneal disorders encountered in clinical practice.
Bone Diseases↗
Diagnostic pitfalls in abdominal CT.
Many factors result in suboptimal performance of abdominal computed tomography (CT) or inaccurate interpretation of the images. Improper technique, observers' errors, and lack of clinical information are major contributors to misdiagnoses. Because of inadequate oral administration of contrast material, normal structures (eg, bowel) may remain unopacified and simulate tumors. Repeat scanning with additional contrast material and sodium bicarbonate, at selected levels, and perhaps with changes in patient position often reveals the true nature of pseudotumors in the gastrointestinal tract. Dynamic CT of the liver, performed during contrast material injection, yields the best results. Occasionally, reconstruction of axial images in coronal or sagittal planes helps delineate normal sectional anatomic variations of the diaphragm and liver and avoid misdiagnosis of pseudomasses. Volume averaging can cause problems when the section thicknesses are larger than the lesions (eg, small hepatic cysts) or structures are very close (eg, kidney and spleen); repeat CT with thinner sections is needed to obtain accurate attenuation values or delineate normal anatomic relationships. The gallbladder, spleen, and pancreas can change position due to prior surgery and raise suspicion of a mass unless clinical history is known. Familiarity with these and other pitfalls described herein should lead to accurate interpretation of CT scans.
Diagnostic Errors↗
Osteosarcoma: MR imaging after preoperative chemotherapy.
The authors reviewed 76 magnetic resonance (MR) images of 38 patients with osteosarcoma treated with preoperative chemotherapy (intraarterial cisplatin with or without systemic chemotherapy). Histologic maps of the surgical tumor specimens in 33 cases were correlated with either late-chemotherapy or postchemotherapy MR images. There were four MR patterns--dark, mottled or speckled, homogeneous, and cystic--that corresponded to different amounts of tumor matrix, granulation tissue, hemosiderin deposits, fluid-filled cysts, and residual viable tumor. Nested foci of residual viable tumor could not be specifically identified, although tumor progression or skip metastases were accurately depicted in four patients. Other findings included (a) peritumoral edema in the soft tissues and intramedullary space that shrank with chemotherapy, (b) chemotherapy effect in the surrounding soft tissues, (c) a dark rim around the extramedullary component of the tumors corresponding to a collagenous capsule continuous with the periosteum, (d) development of metaphyseal hemorrhages and bone marrow infarcts, and (e) intramedullary vascular channels.
Adolescent↗
Lymphoma of the solid abdominal viscera.
Lymphomas of the solid abdominal viscera include hepatic (both primary and secondary), splenic, and pancreatic lymphomas. The use of the various diagnostic imaging modalities in each of these lymphomas is discussed, and the imaging appearance of each is described.
Hodgkin Disease↗
Pancreatic carcinoma masquerading as renal cell carcinoma.
Three cases of pancreatic carcinoma that arose in the tail and extended into the adjacent left kidney are presented. Because of misleading symptoms and radiographic features, the tumors were misdiagnosed as primary renal tumor. In most cases, computed tomography (CT) provides the correct diagnosis and prevents unnecessary surgery.
Adenocarcinoma↗
Circumferential perirenal urinoma mimicking nephromegaly on urography.
Four cases of circumferential perirenal urinoma in patients with cancer are described. Intravenous urography showed evidence of apparent renal enlargement. In 1 case, opacification of extravasated urine was dense enough to be seen on the urogram, and the diagnosis was confirmed by computed tomography (CT). In the other cases, sonography followed by CT diagnosed urinoma, after tumor invasion had been suggested because of the pseudonephromegaly. Ureteral obstruction was demonstrated in all cases, due to retroperitoneal adenopathy in 1 case and to pelvic tumor in the other 3. Sonography or CT is required for the diagnosis of circumferential perirenal urinoma mimicking nephromegaly urographically.
Adult↗
CT and MR imaging of malignant germ cell tumor of the undescended testis.
Preoperative localization of the impalpable undescended testis is necessary to facilitate proper surgical planning. There is an increased incidence of malignant change in the undescended testis; demonstration of malignancy before surgery will significantly alter the treatment. We describe the computed tomographic (CT) and magnetic resonance (MR) findings in 2 patients with malignant change in an intraabdominal testis. The CT scan revealed lesions with areas of low density, 1 of which had focal calcifications; MR revealed lesions of predominantly low or intermediate signal intensity on both long and short TR/TE images, with some areas of very high signal on both sequences. After initial management with chemotherapy, the residual tumor was surgically resected. In neither instance was residual normal testis demonstrated. Both CT and MR are ideal methods of examining malignant transformation of the undescended testis, because of their ability to characterize the internal structure of the organ and, in the case of MR, its capacity for multiplanar imaging. They are almost of equal value except for the ability of CT to identify calcification and of MR to diagnose hemorrhage.
Adult↗
Clinical and radiological correlation of retroperitoneal metastasis from nonseminomatous testicular cancer treated with chemotherapy.
Forty patients with retroperitoneal metastasis from nonseminomatous testicular cancer treated with chemotherapy were retrospectively studied to (1) evaluate the predictive value of mass size as detected by computerized tomography (CT) as an indicator for postchemotherapy surgery and (2) determine the factors that influence relapse. Patients received two further courses of chemotherapy after their serum biomarkers became normal and computed tomography indicated a complete response or presence of a residual but stable mass. We found that patients with initial metastases less than 2 cm had a low frequency (14%) of residual masses after chemotherapy, vs. 59% for those with masses of 2-5 cm and 75% for those with masses of greater than 5 cm (P = 0.03). Of 22 patients with primary embryonal carcinoma, three of seven (43%) with residual masses after chemotherapy had mature teratoma at surgery. Six patients had small (1-2 cm) residual abnormalities that were not removed, and three of these patients relapsed. In conclusion, increasing size of retroperitoneal metastasis by CT scan predicts for increased likelihood of a residual mass after chemotherapy; patients who have a residual mass greater than or equal to 1 cm require retroperitoneal lymphadenectomy after chemotherapy, whether the tumor histology is embryonal carcinoma or teratoma. The role of surgery for patients who have residual retroperitoneal masses less than 1 cm after chemotherapy could not be determined from our study.
Antineoplastic Combined Chemotherapy Protocols↗
Peroneal nerve dysfunction as a complication of lateral meniscus repair: a case report and anatomic dissection.
A case report is presented in which a complete peroneal nerve palsy complicated lateral meniscus repair. The meniscal repair was performed using the combined method of arthroscopically placed inside-out needles and a posterior incision to view their exit. A cadaver limb was then used to examine the anatomy of lateral meniscus repair. Needles used for meniscus repair were passed into the posterior horn of the lateral meniscus using the inside-out and the outside-in methods. Computerized axial tomography (CAT) was then used to establish the proximity of the needles to the peroneal nerve in the posterolateral corner. The inside-out needles were dangerously close to the peroneal nerve. The outside-in needles had a larger margin of safety. The posterolateral corner was then dissected to verify and photograph these relationships.
Arthroscopy↗
Leiomyosarcoma of the renal vein: radiologic pathologic correlation.
Leiomyosarcoma of the renal vein is a rare neoplasm occurring more commonly in women. On sectional imaging it is difficult to differentiate from other primary retroperitoneal tumors. Here is a case report of a right renal vein leiomyosarcoma in a 40-year-old man. The ultrasound findings are described and the magnetic resonance imaging, computed tomography, and angiographic findings are illustrated and correlated with the pathologic findings.
Adult↗
Extraosseous Ewing's sarcoma. Computed tomography evaluation before and after chemotherapy.
Fourteen patients with extraosseous Ewing's sarcoma were evaluated by computed tomography (CT) and conventional radiography. The sites of involvement were in the lower extremities (six cases), the chest wall (four), pelvis (two), and the paravertebral region (two). In seven cases, the initial contrast-enhanced CT disclosed a necrotic soft tissue mass in four, two of them with peripheral enhancement. In three cases, the mass was homogeneous and did not enhance. CT enabled us to detect the size of the mass, the integrity of adjacent bone and medullary cavity, and to determine the presence or absence of metastases. CT was useful for evaluation of the patients' tumor response to treatment. In three of four patients treated with chemotherapy, CT showed evidence of a dramatic initial response. In one patient who was resistant to chemotherapy, surgical methods were required.
Adolescent↗
Osteosarcoma metastatic to the kidney.
Two clinically silent renal metastatic lesions from primary osteogenic sarcoma were first detected on radionuclide bone scan. A needle biopsy performed under the guidance of abdominal ultrasonography confirmed the diagnosis. Prior to nephrectomy, further definition of the metastatic lesion was attained using enhanced computed tomography. A review of the English literature revealed only six previous cases of metastatic osteosarcoma detected in the kidney prior to autopsy.
Adolescent↗
The many faces of neuroblastoma.
Neuroblastoma is a common tumor in childhood. It arises in the adrenal gland or in various extraadrenal primary sites of the sympathetic chain. Clinically, it may present as an abdominal mass or as disseminated metastatic disease. We studied 52 patients with neuroblastoma, and the typical and unusual radiographic features of the disease are presented.
Adrenal Gland Neoplasms↗
Radiologic features of eosinophilic granuloma of bone.
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Bone and Bones↗
Clinical and radiologic staging of locally advanced and inoperable bladder carcinoma.
Twenty-seven patients with locally advanced and inoperable bladder carcinoma (LABCa) were referred for chemotherapy. All were staged by cytoscopy, examination under anesthesia, and computed tomography (CT), and 18 also had bipedal lymphangiography (LAG). In 16 patients (56%), there was agreement between the clinical and the CT staging of the primary bladder tumor. In four of these 16 patients, CT detected lymphadenopathy in three and demonstrated pelvic bone invasion in one. Of the remaining 11 patients, CT underestimated the local extent of the bladder tumor in nine and overestimated in two. Lymphangiography was abnormal in nine patients (50%), in four of whom the abnormality was not seen on CT scan. Among the ten patients with normal LAG, six had abnormal pelvic nodes detected by CT. The LAG affected the overall staging of the tumor in five patients (16.6%). The total incidence of nodal metastasis as seen on CT, LAG, or both was 72%. Although CT and LAG may not add significantly to the clinical staging of the primary tumor in LABCa, they will affect the overall staging of the tumor by detecting lymphadenopathy. Accurate staging of these patients is important because, with aggressive chemotherapy, some of these patients might become candidates for more radical treatment such as surgery or radiotherapy.
Adult↗
The adrenal glands: plain film, excretory urographic, and angiographic findings.
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Adrenal Gland Diseases↗