Biomedical subjects
Publications and source records attributed to R G Peyster.
Enlargement of the superior ophthalmic vein (SOV), although usually considered a sign of carotid-cavernous fistula, may be found with other disorders. Patients with Graves orbitopathy, orbital pseudotumor, and a parasellar meningioma as the cause of an enlarged SOV as seen on computed tomography are discussed.
The optic nerves are well demonstrated by high-resolution computed tomography. Involvement of the optic nerve by optic gliomas and optic nerve sheath meningiomas is well known. However, nonneoplastic processes such as increased intracranial pressure, optic neuritis, Grave ophthalmopathy, and orbital pseudotumor may also alter the appearance of the optic nerve/sheath on computed tomography. Certain clinical and computed tomographic features permit distinction of these nonneoplastic tumefactions from tumors.
A postlaminectomy pseudomeningocele is a spherical, fluid-filled space with fibrous capsule lying dorsal to the thecal canal in the laminectomy opening that occasionally develops after surgery. Eight cases were found in 400 symptomatic postlaminectomy patients undergoing computed tomographic examination. The contents are of cerebrospinal fluid density and may or may not have demonstrable communication with the subarachnoid space. Whether they are the cause of symptoms is conjectural; none of these eight patients had surgical removal.
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An investigation of the relationship between breast parenchymal patterns and breast cancer prevalence in a large referral population is presented. Mammograms were assigned to one of four categories according to our interpretation of Wolfe's classification. Cancer prevalence for the four patterns was similar when uncorrected for age,, and was very high compared to that in the general population. Under age 50, the prominent duct pattern (P2) was associated with a very high relative cancer risk and DY carried a smaller increased risk. After age 50, prevalences for the patterns were nearly equal. Relationship between these findings and epidemiology of breast cancer are discussed and suggestions made for utilizing parenchymal patterns to guide examination frequency.
Xeroradiographic evaluation of the axilla is useful in the presence of mammary carcinoma, as radiographic examination of this area can be highly accurate in predicting its malignant involvement if certain strict criteria are employed. The ability to diagnose nodal metastases with near certainty has important implications for treatment planning and prognostication.
A case is reported of an extra-abdominal desmoid tumor presenting as an axillary tail breast mass. This represents the third reported case and the first description of the roentgenographic findings of this entity. That this tumor can be confused with carcinoma of the breast is emphasized.
Male breast disease, although overshadowed by its female counterpart, is still a problem which often comes to the attention of the radiologist. The major importance of mammography is differentiating unilateral gynecomastia from cancer. We now recognize four xeroradiographic patterns of gynecomastia: (1) increased ducts only; (2) ductal hyperplasia mimicking adenosis; (3) small ducts with stromal proliferation; and (4) fatty replacement only. These reflect the duration of the process. Gynecomastic masses are central, smooth, and most important, extend from the nipple outward, usually bisecting the midplane. Ducts may be visible. Carcinoma is usually central, dense, with irregular spiculated margins and, unlike gynecomastia is rarely in the midplane of the nipple, although it can be retroareolar in location. There may be concomitant skin changes or lymphadenopathy seen on the xerogram and these never occur in gynecomastia. There are numerous etiologies for gynecomastia, and these have been discussed in detail. It is thought that the radiologist should be aware of the pathophysiology of male breast disease and understand its significance.
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The authors describe the first case of giant intracranial aneurysm in a child with tuberous sclerosis. The subject of vascular disease in this condition is reviewed.
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Postcontrast CT of the head may be a useful screening technique for identifying an aneurysm within an intracerebral hematoma. This could avoid unnecessary angiography with its attendant morbidity in inoperable situations and obviate initial arteriography in patients whose surgery is to be delayed.
Although certain tumors such as retinoblastoma have a known familial pattern of transmission, the familial occurrence of pineoblastoma has not been reported previously. We report pineoblastomas occurring in a mother and daughter and suggest that this type of tumor may have an inheritable mode of transmission.
A sixth nerve neuroma arising within the cavernous sinus is reported. This is the third sixth nerve neuroma cited in the world literature and the first to have CT demonstration. The unusual CT enhancement characteristics excluded the more common cavernous sinus masses and suggested the correct diagnosis preoperatively.
Two cases of CT-documented extraocular muscle atrophy are presented. Unilateral atrophy was observed in a patient with a lesion of the cavernous sinus. Atrophic extraocular muscles were noted bilaterally in a young woman with "ophthalmoplegia plus" (probable Kearns-Sayre syndrome).
A sixth nerve schwannoma arising in the region of the pons and midbrain is reported. The magnetic resonance and CT characteristics are discussed.
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