Biomedical subjects
Publications and source records attributed to F V Coakley.
Ectopic cervical salivary tissue may present as a discharging sinus if a duct system and cutaneous orifice are present. Where described in previous reports these openings have been located along the anterior border of sternomastoid or in the anterior triangle, making this a differential diagnosis of a branchial sinus. We report on a patient who presented with an ectopic salivary gland in the posterior triangle of the neck.
The aim of this study was to determine the aetiology of solitary hot spots in the ribs found at bone scintigraphy in patients with known extraskeletal malignancy. A group of 34 patients whose bone scans showed a solitary hot spot in a rib were identified retrospectively over a 4-year period. They all had a known extraskeletal malignancy. Aetiology of the rib hot spot was established in 26 patients based on a review of clinical features, radiographic findings and clinical follow-up. In eight cases it remained indeterminate. In 14 (41%) cases, the rib lesion was malignant in origin, 9 were due to metastasis and 5 due to direct spread from intrapulmonary malignancy. In 12 (35%) cases, it was benign. In the remaining 8 (24%) cases, the aetiology was indeterminate. In the subgroup of 14 hot spots confined to the anterior rib end, 5 (36%) were due to malignancy, 4 (28%) were benign and 5 (36%) were indeterminate. We conclude that solitary hot spots in the ribs of patients with known extraskeletal malignancy undergoing bone scintigraphy are frequently (41%) malignant in origin. This also applies when the hot spot is in the anterior rib end (36% malignant). Thus, such hot spots are far more sinister than previously reported and require careful clinical and radiographic evaluation.
This work was carried out to assess the frequency of frank rupture of the tibialis posterior tendon (TPT) in RA and to determine if other pathology in the tendon can be correlated with foot deformity. Clinical, radiographic and ultrasonographic signs of TPT pathology were assessed bilaterally in 28 patients with RA and hindfoot involvement. The degree of hindfoot pain, the single-heel-rise test and the tibiocalcaneal angle were assessed clinically. The talometatarsal angle was measured on lateral weight-bearing radiographs. Tendon continuity and thickness were noted on sonography, both in the study group and in a control group of 14 patients. The TPT was significantly thinner in those rheumatoid patients with an abnormal single-heel-rise test when compared to those patients with a normal test (P < 0.001) and to the control group (P < 0.001). The mean thickness in patients with an abnormal test was 1.6 mm, in patients with a normal test it was 2.3 mm and in the controls it was 1.9 mm. In the rheumatoid group thinning of the tendon was significantly correlated (r = -0.33, P < 0.05) with heel valgus as assessed by the tibiocalcaneal angle. It was also significantly correlated (r = 0.31, P < 0.05) with pes planus as assessed by the talometatarsal angle. Only one case of frank rupture of the TPT was identified. There were also significant correlations between TPT thickness and patient age, disease duration and steroid therapy, such that tendon attenuation was associated with increasing age, longer disease and steroid usage. There was no association between TPT thickness and the degree of hindfoot pain.(ABSTRACT TRUNCATED AT 250 WORDS)
Rosai-Dorfman disease is a rare disease characterized histologically by proliferation of histiocytes and has clinical features suggestive of a lymphomalike disease. Lymph nodes and extranodal sites might be involved, but renal involvement is rare. We present computed tomographic findings in three cases of renal involvement by Rosai-Dorfman disease. Two cases showed renal hilar masses and one case showed subcapsular hypodense infiltration. Renal involvement by Rosai-Dorfman disease has a characteristic appearance and should be included in the differential diagnosis of renal hilar masses or subcapsular hypodense infiltration.
Bacillus Calmette-Guerin was administered through the ileal conduit of a 63-year-old man with upper tract recurrence of transitional cell carcinoma. Subsequent computed tomography showed bilateral renal masses, which were granulomatous at pathologic examination. The bacilli likely reached the kidneys via proven ileoureteral reflux. Patients with reflux may benefit from antituberculous prophylaxis.
Two cases of non-Hodgkin lymphoma (NHL), one AIDS related, with hepatic involvement manifesting as infiltrating mass-like periportal intrahepatic low attenuation on CT are described. One case demonstrated mass effect with compression of adjacent bile ducts causing jaundice. NHL should be included in the differential diagnosis of mass-like periportal intrahepatic low attenuation lesions.
PURPOSE: We sought to determine the accuracy of helical CT in the detection of pulmonary metastases. METHOD: Four anesthetized dogs with metastatic osteosarcoma underwent helical CT with a collimation of 5 mm, a pitch of 2, and a reconstruction interval of 5 mm. All macroscopically evident metastases were recorded at autopsy. CT images were independently reviewed by 10 radiologists and compared with pathologic results. Alternate slices in the dog with the most metastases were microscopically examined in their entirety. RESULTS: Pathologic examination of the lungs revealed 132 macroscopically evident pulmonary metastases, of which 74 (56%) were detected by at least one reader. Forty-four of the 99 (44%) metastases of < or = 5 mm in diameter were detected by at least one reader compared with 30 of 33 (91%) metastases of > 5 mm in diameter (p < 0.0001). The 10 readers reported a total of 107 false positives. Complete microscopy of alternate slices in the dog with the most metastases (n = 68) revealed an additional 38 micrometastases of < or = 3 mm in diameter. None of the 32 micrometastases of < or = 1 mm were detected by CT. CONCLUSION: Helical CT has some limitations in the detection of pulmonary metastases.
PURPOSE: The purpose of this work was to compare the efficacy of fat-suppressed and non-fat-suppressed fast spin echo (FSE) endorectal MRI in the detection of extracapsular extension (ECE) of prostate cancer by experienced and inexperienced readers. METHOD: Seventy-nine patients with biopsy-proven prostate cancer underwent axial FSE T2-weighted endorectal MRI of the prostate prior to radical prostatectomy. Twenty-one patients were imaged with frequency-selective fat suppression, and 58 were imaged without fat suppression. All images were retrospectively and independently reviewed by two readers of different experience levels who were blinded to clinical and pathological findings. Readers assessed the presence or absence of ECE on a 5 point scale for each side of the prostate, and step-section pathology was used as the standard of reference in all patients. Receiver operating characteristics analysis was used to compare the performance of fat-suppressed and non-fat-suppressed images by both readers. RESULTS: ECE was present in 33 of 79 (42%) patients. The more experienced reader demonstrated better diagnostic performance (p < 0.05) than the less experienced reader in terms of sensitivity and area under the ROC curve (Az) for MRI without fat suppression. Use of frequency-selective fat suppression did not result in any significant improvement in diagnosis of ECE compared with MRI without fat suppression for either the experienced (Az 0.81 vs. 0.79) or the inexperienced (Az 0.76 vs. 0.68) reader. CONCLUSION: Even when reader experience is considered, use of frequency-selective fat suppression did not significantly improve the diagnosis of ECE by MRI. The decision to use fat suppression and the selection of a fat suppression technique can be left to the discretion of the individual reader.
Pelvic varices in women consist of tortuous and dilated parauterine and ovarian veins and have a characteristic appearance at CT and MRI. Imaging is critical in the evaluation of pelvic varices, both to prevent confusion with other conditions and because pelvic varices may be secondary to serious underlying pathology. Additionally, primary pelvic varices are associated with the pelvic pain syndrome, and patients with the pelvic pain syndrome may benefit from therapeutic venous embolization. Secondary pelvic varices are rarely associated with pelvic pain.
PURPOSE: The purpose of this work was to determine the association of renal agenesis with the different types of mullerian duct anomalies (MDAs). METHOD: A 5 year retrospective review of MR records identified 57 patients with MDAs. Associated renal anomalies were correlated with the various types of MDAs. RESULTS: Renal agenesis was found in 17 (29.8%) of 57 patients. No other renal anomalies were identified. Renal agenesis was more frequent in patients with uterus didelphys (13/16 cases). Renal agenesis was also seen in patients with uterine agenesis (2/5 cases) and unicornuate uterus (2/7 cases). All 11 cases of obstructed uterus didelphys were associated with renal agenesis ipsilateral to the side of the obstructing transverse hemivaginal septum. CONCLUSION: Renal agenesis is more commonly seen in uterus didelphys than in other types of MDAs. Renal agenesis in patients with uterus didelphys is often ipsilateral to an obstructing, transverse, hemivaginal septum.
The MR appearances of two cases of vaginal leiomyoma are described. Both patients presented with a periurethral mass; one patient presented during pregnancy. MRI allowed precise anatomic localization of the masses and confident preoperative characterization in both cases.