Biomedical subjects
Publications and source records attributed to I Pandolfo.
Adenocarcinoma is an uncommon gastrointestinal malignancy. Fiberoptic duodenoscopy is the diagnostic procedure of choice, allowing direct visualization as well as biopsy of the neoplasm. Conversely, in the vast majority of cases, CT is unable to demonstrate the duodenal tumor. We describe a technical procedure that has permitted CT visualization of a small ampullary tumor in two cases.
The CT halo sign has been described as the CT finding of a low-attenuation zone surrounding a pulmonary nodule. It is an early clue to the diagnosis of invasive pulmonary aspergillosis. We describe a case of CT halo sign associated with a pulmonary tuberculoma. Therefore, we think that a diagnosis other than invasive pulmonary aspergillosis should be considered in the presence of the CT halo sign in immunocompetent patients.
OBJECTIVE: We retrospectively reviewed CT and pathologic examinations in resected nodular bronchioloalveolar carcinomas (BACs) to correlate the histology with the appearance of the nodules on preoperative thin section CT images. MATERIALS AND METHODS: Thin section CT scans of 11 patients with nodular BAC were reviewed by two observers. In each case, size, tumor-lung interface, and internal characteristics of the nodule were recorded and correlated with histopathologic examinations. RESULTS: Computed tomography showed a large bronchus leading to or contained within the nodule in 36%; spiculated, lobulated, or irregular borders in 82%; pleural retraction in 36%; internal inhomogeneity in 45%; and a zone of intermediate attenuation surrounding a higher attenuation nodule and separating it from the surrounding lung parenchyma (the CT halo sign) in 18% of the 11 BACs. In two lesions internal serpentine radiolucencies could be seen. Histopathologic studies showed this correlated with the air-containing glandular spaces of the tumor. CONCLUSION: The CT halo sign and serpentine radiolucencies should be added to the list of the CT findings of nodular BAC. However histologic examination is required to confirm the diagnosis of BAC.
PURPOSE: We retrospectively reviewed a series of proven lung metastasis to evaluate the frequency and CT features of metastases showing an air-space (lepidic) pattern of growth. METHOD: CT examinations of 65 patients with proven lung metastasis from GI carcinomas were reviewed by three observers. Four CT features were used to classify lesions as air-space metastases: (a) air-space nodules; (b) parenchymal consolidation containing air bronchogram and/or showing angiogram sign; (c) focal or extensive ground-glass opacities; and (d) nodules(s) with a "halo" sign. RESULTS: Six of 65 patients showed air-space metastases: three from pancreatic carcinoma, two from colonic carcinoma, and one from jejunal carcinoma. In one case, metastasis appeared as extensive parenchymal consolidation associated with ground-glass opacities; in one as an area of ground-glass opacity; in one as an extensive parenchymal consolidation with air bronchogram; in one as parenchymal consolidations with angiogram sign and multiple nodules, some of these with halo sign; in one as air-space nodules and patchy air-space consolidations; and in one as a solitary nodule with halo sign. CONCLUSION: Our study shows that air-space lung metastasis from GI carcinomas is uncommon but not rare. On CT as well as microscopically, differential diagnosis between air-space metastasis and bronchioloalveolar carcinoma may be impossible.
Mucinous cystadenocarcinoma (MCA) is a rare tumor that is considered to be a cystic variant of mucin-producing lung adenocarcinoma. MCA expands grossly by storing mucus and contains few neoplastic cells. We present the CT images of three patients with MCA and correlate them with pathologic specimens. The CT findings of MCA include a uniform low-attenuation, focal thickening of the cystic wall and enhancing septa.
Breath-hold MR urography (MRU) is being used with increasing frequency to evaluate urinary tract pathology. Although multiple studies have documented the accuracy of breath-hold MRU in the evaluation of obstructive uropathy, pitfalls associated with this technique may result in diagnostic errors. This essay illustrates both technical and interpretive pitfalls of MRU and suggests strategies for their recognition and avoidance.
PURPOSE: The presence of a pulmonary consolidation with a signal intensity comparable with that of the static fluid on heavily T2-weighted MR images has been named the "MR white lung sign." This sign has been described in mucinous bronchioloalveolar carcinoma (BAC). Our purpose was to establish the frequency and significance of this sign in pulmonary consolidations of varied causes. METHOD: In this prospective study, 83 patients with pulmonary consolidation underwent MR examination between January and December 1999. Segmental or lobar consolidations were due to pneumonia without central obstruction (n = 22), pneumonitis with central obstruction (n = 21), cicatricial atelectasis (n = 8), passive atelectasis (n = 10), radiation pneumonitis (n = 8), mucinous BAC (n = 5), infarction (n = 3), bronchiolitis obliterans organizing pneumonia (n = 3), nonmucinous BAC (n = 2), and lymphoma (n = 1). The MR white lung sign was considered present when the signal intensity of a pulmonary consolidation was comparable with that of the static fluid on heavily T2-weighted images obtained with MR hydrography sequences. Interobserver agreement, sensitivity, and specificity of the white lung sign in diagnosing mucinous BAC were calculated. RESULTS: The MR white lung sign was present in 7 (8%) of 83 consolidations, including 5 (100%) of 5 cases of mucinous BAC and 2 (10%) of 21 cases of obstructive pneumonitis. The frequency of the white lung sign was 100% in mucinous BAC and 2.6% in consolidations due to other causes. The difference was statistically significant (p < 0.05). CONCLUSION: The white lung sign is an uncommon finding in pulmonary consolidations evaluated with heavily T2-weighted sequences. However, the sign is characteristic of mucinous BAC and adds specificity to the radiologic diagnosis.
Explore the source record for details and available documents.
We report a case of sinonasal sarcoidosis with perineural spread along the trigeminal and vidian nerves in which primarily MR imaging but also CT allowed excellent visualization of this infiltration.
Recent advances in the pathophysiology of the nasal cavity and paranasal sinuses and the development of endoscopic equipment and techniques have led to a new "functional" surgical management of chronic or recurrent sinusal conditions. The ostiomeatal complex is a narrow and intricate passage way providing aeration and mucus clearance from anterior ethmoid sinus, maxillary sinus and frontal sinus. CT, allowing the detailed demonstration of normal and abnormal patterns of the ostiomeatal complex, permits accurate preoperative planning, which has reduced the number of surgical complications. Ostiomeatal complex anatomy and the corresponding CT features are analyzed, as seen in 85 patients with or without rhinosinusal inflammatory lesions. The CT technique with coronal and axial scans and electronic parasagittal reconstructions, is also reported. Finally, the images obtained on different CT planes are compared, as proposed by other authors.
Explore the source record for details and available documents.
The enhancement of ascites following a high dose of contrast medium has been recently described. The CT behavior of 26 peritoneal, pleural or pericardial effusions has been studied in 23 patients after the administration of a high dose of urographic contrast medium. The effusions were enhanced in all patients but one. No difference between malignant and non-malignant effusions could be observed with ionic and non-ionic contrast medium. Low molecular weight of the urographic contrast medium (600-800 daltons) can explain the free passage of the solute through peritoneum, pleura, and pericardium. The knowledge of such a phenomenon is mandatory to avoid misdiagnosing hematic effusion or urinary-peritoneal fistula.
More than 60% of the patients with recurrent rectal carcinoma complain of pain after radical surgery. Pelvic carcinomatous neuropathy (PCN) is a frequent cause of pain in such patients. Although the effectiveness of radiotherapy in the palliative treatment of local recurrences of rectal carcinoma is well recognized, its results in PCN are less known. The authors have evaluated the results of high-energy radiotherapy in 12 patients with recurrent rectal carcinoma and PCN, who were treated with doses between 35 and 55 Gy. Although the survival of these patients is always poor, about 50% of them achieved a significant and prolonged palliative result by radiation treatment. In patients with PCN, CT is an effective tool to detect recurrences, define their volume and relationship to critical organs, show sites of neural involvement, and optimize radiation treatment planning.
The CT findings in 24 patients with clinically evident carcinomatous neuropathy from pelvic soft tissue involvement are described. Computed tomography is mandatory to differentiate carcinomatous pelvic neuropathy from other causes of pelvic neuropathy as well as to plan radiation treatment.
To better define the normal anatomy and pathologic features of the pterygoid canal, 100 normal subjects and 38 patients with disease of the paranasal sinuses, nasopharynx, and base of the skull were studied with pluridirectional tomography. Particular attention was given to the normal radiographic appearance of the pterygoid canal as well as to its anatomic variants and its relationship to the paranasal sinuses. Three radiographic signs of involvement of the pterygoid canal were detected: disappearance, enlargement, and narrowing. Moreover, a brief correlation between pluridirectional tomography and CT was made. Diagnostic accuracy in evaluating the bony lesions is the same with both techniques, but CT is superior to pluridirectional tomography in evaluating involvement of the soft tissues.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The parapharyngeal space is a fat-filled region situated deep in the head between the basicranium and the oral floor. It can be divided in two parts: the prestyloid and the poststyloid space. The mandibular nerve is contained in the prestyloid space, while the carotid artery, jugular vein, IX, X, XI, XII cranial nerves, cervical sympathetic chain and junctional lymph nodes are situated in the poststyloid compartment. The normal CT anatomy and CT findings in 22 patients with proven lesions of the parapharyngeal space are described. Three different groups of neoplastic processes can be distinguished: primary tumours, secondary tumours and enlarged lymph nodes. The nature of the lesions developing in the parapharyngeal space can be diagnosed by CT in many cases.