Biomedical subjects
Publications and source records attributed to J M Shugar.
The hyoid-laryngotracheal complex (HLTC) is a mobile, flexible unit that can be deviated by adjacent neck masses. We present two cases of thyroid disease in which a clinically "silent" lesion rotated the HLTC to an abnormal position. The abnormal location of these normal structures was clinically mistaken for the primary pathology. The essential role that computed tomography plays in the workup of these unusual cases is discussed.
The clinical and radiographic presentation of salivary gland sarcoid is presented. Computed tomographic sialography is a more sensitive method for detecting the multiple discrete granulomas of sarcoid than is conventional sialography. This appearance is distinctly different from that of the autoimmune salivary diseases with which it can be clinically confused. The differential diagnosis of salivary sarcoid is presented.
Histologic, clinical, and radiographic presentations of the autoimmune salivary gland diseases are reviewed. The punctate and globular sialographic changes observed actually reflect penetration of contrast material through the uniquely diseased glandular ducts and not sialectasis, as was previously thought. "Pseudosialectasis" is suggested as a more accurate term. The progressive cavitary and destructive patterns seen on sialography appear to reflect complications of secondary infection rather than the specific pathology of these diseases. Conditions causing recurrent enlargement of the parotid gland or development of a multinodular gland include chronic sialadenitis, the sialoses, the granulomatous diseases, primary neoplasms, and metastatic tumors. Although they appear similar clinically, many of these diseases can be differentiated sialographically, and such a radiographic approach is presented.
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Non-traumatic cerebrospinal fluid rhinorrhea is uncommon. Review of the literature revealed that 45% of cases are high pressure leaks and 55% of cases are normal pressure leaks. Meningoencephaloceles are very rare occurrences in the latter category and we present the third reported case occurring in the frontal sinus. Radiographically this lesion appeared as a mucocele because of its expansile nature, however non-traumatic mucoceles have not been associated with cerebrospinal fluid rhinorrhea. The only non-osseous expansile lesion of the paranasal sinuses found to be associated with this complication is the meningioencephalocele.
The computed tomography (CT) appearance of mucoceles involving the ethmoid sinuses is presented. A classification based on the growth patterns of these mucoceles is proposed, and a differential diagnosis for each group is suggested. The unique CT appearance of the ethmoid polypoid--mucocele is described for the first time, and the radiographic definition of a mucocele is discussed.
Antral mucoceles are more common than previously reported and probably represent 10% of all paranasal sinus mucoceles. The majority are primary, involve the entire sinus, and result from inflammatory, allergic, or malignant disease. Postoperative mucoceles involve only a portion of the antrum and have a different etiology and appearance. A review of the radiographic findings in antral mucoceles is presented, and a rare mucocele of a septated antral compartment in an otherwise normal sinus is reported. The various causes, roentgen appearances, and the differential diagnoses are discussed.
Squamous cell carcinoma is aggressive, destroying surrounding bony margins. The radiographic finding of an expansile mass is rarely if ever caused solely by squamous cell carcinoma, and it should prompt the radiologist to question either the pathological diagnosis or the coexistence of a mucocele. Surgery prior to radiotherapy or chemotherapy is suggested.
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A case of primary chordoma of the maxillary sinus is presented. The embryology of the notochord is reviewed and it is suggested that the frequently used adjective "ectopic" is a misnomer. The literature of primary paranasal sinus chordomas is reviewed and the clinicopathological features described. It is emphasized that these lesions can mimic other benign and malignant processes both clinically, radiographically and histologically. The treatment and prognosis is more favorable than the more common craniocervical chordoma.
Lesions involving the base of the skull can be divided into primary and secondary disease processes. The primary group consists of bone lesions more often seen elsewhere in the skeletal system while the secondary group consist of those lesions extending to the base of the skull by direct extension from adjacent intracranial or extracranial sites. The purpose of this paper will be to arrive at a classification of skull base lesions based on the roentgen localization of the disease process. The base of the skull because of its anatomically variable curvature can be difficult to evaluate on good quality conventional radiographs. In addition to the changing angles of the bone itself, the overlying soft tissues of the pharynx and neck only serve to further conceal areas of bone pathology. The advent of polytomography and CAT scanning has greatly aided the evaluation of this region which clinically is extremely difficult to assess. In some instances invasive modalities such as angiography and posterior fossa myelography are necessary to define the lesion. With these diagnostic methods available, rather than discovering classical patterns of disease, a variety of disease processes have been found that radiographically mimic each other. Similarly, on a purely clinical basis, many of the disease entities present in a similar fashion. It is only by a combined approach that an intelligent differential diagnosis can be offered.
Meningiomas localized within the middle ear and mastoid which have no intracranial component are rare tumors. Three patients with meningiomas which were thought to involve only the middle ear were treated surgically, were followed for two to six years and were thought to have been cured. However, when computerized axial tomography became clinically available, these patients were examined using this radiographic technique. Unexpectedly, all three patients were found to have a large intracranial meningiomatous extension. A review of the literature reveals only 13 primary meningiomas; these case reports are summarized. It was noted that definitive tests for an intracranial extension of the meningioma were performed in only 2 of the 13 cases. Therefore, in view of our recent clinical experience, it is recommended that a patient presenting with a middle ear meningioma should have a computerized axial tomographic examination of the head to detect the possible presence of a clinical silent intracranial involvement.
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From day 12 to 16 of gestation a highly circumscribed zone of cellular degeneration has been observed in the otocyst of more than 50 normal rats. This zone appears to be produced by selective or programmed cell death, and results in the elimination of unneeded cellular elements. That cells in this zone are also selectively destroying subcellular organelles as a first step in specialization is also discussed. Programmed cellular death has long been known in other systems and is often an obligatory companion to cellular specialization. The ear now joins the long list of organs which demonstrate this phenomenon.
Only 4% of peripheral nerve sheath tumors of the head and neck occur in the paranasal sinuses. The most commonly involved sinus is the maxillary antrum and the most common histologic type is benign schwannoma. Two new cases of schwannoma occurring in the sphenoid and maxillary sinuses are reported. The clinical pathologic, and radiographic features of these lesions are reviewed.
Two cases of thyroid-related papillary adenocarcinoma are presented. Both patients had clinically benign neck masses that were clearly separated from the thyroid gland. In both cases the thyroid gland was normal to clinical evaluation, CT, and 99mTc scanning. One patient had an occult thyroid carcinoma with a solitary metastatic node in the lateral neck, and the other patient had a rare carcinoma in a suprahyoid thyroglossal duct cyst that had been previously misdiagnosed as a cystic hygroma.
Phlebectasia of the internal jugular vein (IJV) is a rare entity with only 25 cases having been reported. Clinically this condition presents with enlargement with a Valsalva maneuver and decrease at rest. Venography, anteriography, and ultrasound have previously been used to diagnose this unusual cause of neck mass. We present a case in which CT confirmed the clinical diagnosis and in which there was an incomplete ipsilateral duplication of the IJV. This is only the second case reported of IJV phlebectasia and duplication.
An avascular, contrast enhancing intraosseous petrous apex mass was discovered on CT in a patient with prior colonic carcinoma and acute myelocytic leukemia. A normal bone scan made metastasis unlikely and surgery revealed a neuroma. The differential diagnosis is discussed.