Hamartoma of the thoracic wall.
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A case is described in which an unusually large parathyroid adenoma was visible on the plain chest radiograph taken during the investigation of hypercalcaemia. This was diagnosed preoperatively and a scheme is suggested whereby such a disgnosis can now readily be made. The differential diagnosis is discussed ant the literature is reviewed.
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Mesenchymoma (hamartoma) of the chest wall is an extremely rare tumour presenting in early infancy or fetal life. Pleural, pulmonary, and lymph node metastases developed in a young man with malignant mesenchymoma of the chest wall. The tumour had several characteristics that differ from the mesenchymoma reported from the other parts of the body.
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In order to assess the role of computed tomography (CT) in radiotherapy treatment planning, tumors were localized by conventional techniques and with CT using an EMI CT5005 scanner. CT scans were obtained under conditions simulating radiotherapy. A comparison between the two localizations was made, and detailed results are given. Forty-seven of 123 patients had their treatment plan altered, implying that, provided information is obtained and used correctly, CT can play a significant role in radiotherapy treatment planning.
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Desmoid tumors are characterized by proliferation of fibroblastic cells that arise from the fascia or aponeurosis of muscle. They are most commonly found in the abdomen of adults, arising from the anterior abdominal wall, mesentery, or retroperitoneum. At sonography, desmoids have variable echogenicity, with smooth, well-defined margins. On contrast-enhanced computed tomographic scans, the tumors are generally high attenuation (relative to muscle) and have either ill- or well-defined margins. At magnetic resonance imaging, desmoids have low signal intensity relative to muscle on T1-weighted images and variable signal intensity on T2-weighted images. There are no specific imaging features to distinguish desmoid tumors from other solid masses. The diagnosis of desmoid tumor should be considered in patients with an abdominal mass, a history of abdominal surgery or injury, or Gardner syndrome.
After treatment of cervical carcinoma, recurrent disease may be observed in multiple sites at imaging. Both typical and atypical manifestations of recurrent disease occur. Typical manifestations of recurrent cervical carcinoma involve the pelvis and lymph nodes. Pelvic recurrences may be observed as masses involving the cervix and uterus, vagina or vaginal cuff, parametria, bladder, ureters, rectum, or ovaries and may result in fistula formation or hydronephrosis. Nodal recurrence may be identified as enlarged pelvic and retroperitoneal nodes. Atypical manifestations of recurrent cervical carcinoma are being recognized with greater frequency due to the use of intensive pelvic radiation therapy, the evolution of improved imaging techniques, and the more frequent use of imaging as a means of surveillance. These atypical manifestations may involve the solid organs of the abdomen (focal masses) as well as the peritoneum, mesentery, and omentum (implants); gastrointestinal tract (obstruction, fistula formation, ischemia); chest (metastases to the lung parenchyma, pleura, and pericardium); bones (destructive lesions); and other sites. Familiarity with the imaging features of recurrent cervical carcinoma in these anatomic locations will facilitate prompt, accurate diagnosis and treatment.
Magnetic resonance (MR) imaging was compared with computed tomography (CT) in 13 children with mediastinal abnormalities. CT and MR provided comparable information regarding the presence and size of the mediastinal lesions. The MR imaging technique that was most reliable in detecting a mass was a T1-weighted spin-echo pulse sequence. MR better discriminated mediastinal masses and enlarged nodes from vascular structures and was more sensitive than CT in detecting intraspinal extension. However, CT demonstrated calcification and bronchial abnormalities not seen on MR images. It is concluded that MR may be more helpful than CT in evaluating posterior mediastinal tumors, since there is a likelihood of intraspinal extension. In other cases, however, CT continues to be the procedure of choice to supplement plain radiography in children with suspected mediastinal neoplasms.
Chest radiographs and chest computed tomography (CT) scans were compared in 203 patients with newly diagnosed Hodgkin disease. The incidence of positive findings was tabulated from six intrathoracic lymph node groups, lung parenchyma, pericardium, pleura, and chest wall. The discordant cases were assessed to determine impact on clinical management. The CT scans provided additional evidence of disease involvement, ranging from 0% to 15% at each of the designated anatomic sites. Treatment was altered in 9.4% of all patients (19 of 203), including 13.8% (nine of 65) of those undergoing radiation therapy alone and 8.2% (ten of 122) of those undergoing combined-modality treatment. We conclude that routine chest CT examinations are valuable in the clinical management of those patients for whom radiation therapy is planned.
A characteristic small subcutaneous soft-tissue mass can be seen on the computed tomographic scans of patients after removal of Hickman catheters. The mass is indistinguishable from subcutaneous metastatic deposits seen with a variety of malignant tumors. This potentially confusing finding can be differentiated from true metastatic disease by the characteristic location of the subcutaneous nodule in the second or third anterior intercostal space, along the midclavicular line, and by the absence of other subcutaneous masses.