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Retroperitoneal malignant fibrous histiocytoma: the angiographic and computed tomographic features of an unusual tumor.

Malignant fibrous histiocytomas are uncommon retroperitoneal soft tissue tumors. We report a case of a malignant fibrous histiocytoma of the retroperitoneum that was anmgiographically hypervascular and indistinguishable from renal cell carcinoma. Computerized tomography of the abdomen demonstrated extensive psoas muscle infiltration by tumor. This feature may be useful in differentiating a renal cell carcinoma from a primary retroperitoneal sarcoma.

Adenocarcinoma↗

Computed tomography: a three-dimensional study of the nasal airway.

1. Accurate volume measurement of the nasal airway based upon computed tomography images sequentially generated along the length of the airway is possible. 2. The cross-sectional area of the airway at any position along its length can be determined. 3. The most constricted part of the airway is not necessarily at the location of the turbinates. 4. Details of hard- and soft-tissue anatomy not otherwise discernible can be detected with computed tomography imaging.

Cephalometry↗

The radiologic findings in posterior mediastinal chordoma.

A 14-year-old girl with a posterior mediastinal chordoma is described. Computed tomography is helpful in defining the extent of the soft tissue mass. Osseous changes related to the presence of the chordoma are described. A review of the pertinent literature is presented.

Adolescent↗

[Ultrasonographic, CT, and MRI findings of chest wall hydatidosis].

The chest wall is an uncommon localization for hydatid disease even in countries where echinococcosis is endemic. Only isolated sporadic cases have been reported in the literature. We reviewed retrospectively 15 patients who underwent surgery for chest wall hydatid disease. Various imaging techniques were used for diagnosis of our cases. These included chest radiograph, thoracic ultrasonography, computed tomography and magnetic resonance imaging. Hydatid cyst involved soft tissues (n=5), ribs and vertebrae (n=5), ribs (n=4) and sternum (n=1). Imaging techniques were of value for diagnosis (radiographs and sonography) and for evaluation of the extent of involvement (CT and MRI). Chest wall hydatidosis requires surgical treatment but recurrence is frequent.

Adolescent↗

[Comparison of sonography of the soft tissues of the neck with computerized tomography and magnetic resonance].

Ultrasound B-scan, computed tomography and magnetic resonance imaging are currently used in the diagnosis of head and neck tumours. Screening of head and neck tumours should be performed by high resolution B-scan. Its high diagnostic sensitivity, minimal imaging artifacts, real-time recording and its minimal costs are outstanding features. CT is superior in imaging of bony structures; on the other hand, MR is superior in demonstrating site, border and topography of tumours and lymph nodes. Postoperative and/or post-irradiation follow-up of head and neck tumours should be done by sonography which allows differentiation of oedema, scars and tumour recurrence. The parapharyngoscopic sonography, echography, CT and MR can deliver different aspects in planning of neck surgery. An adequate diagnostic schedule is presented.

Adult↗

A case of solitary neurofibroma of the nasal dorsum: resection using an external rhinoplasty approach.

A 7-year-old girl had suffered from progressive swelling of the nasal dorsum over 2 years. Computed tomography and magnetic resonance imaging showed a large soft tissue density in the nasal dorsum. Tc-99m DTPA cisternography and brain SPECT showed a restricted mass in the nasal dorsum without intracranial connection. The mass was resected using an external rhinoplasty approach, and the pathologic diagnosis was of neurofibroma. Furthermore, the nasal dorsum was identified as the origin of the neurofibroma without the stigma of neurofibromatosis. Here, we present this case and discuss the clinical and pathological aspects of neurofibroma arising in the nasal dorsum.

Child↗

Objective outcome analysis of soft shell helmet therapy in the treatment of deformational plagiocephaly.

Deformational plagiocephaly, cranial asymmetry secondary to positioning, continues to be a leading cause of head shape abnormalities in infants. Treatment recommendations include nonintervention, positioning therapies, and helmet therapy. Although most agree that surgical intervention is rarely indicated, the ideal therapy is not agreed on. Some even debate the necessity of treatment, especially third-party payers. The purpose of this prospective study is to use an objective outcome analysis tool, computerized tomography, to assess the efficacy of a soft shell helmet therapy. Sixty-nine children with a diagnosis of deformational plagiocephaly were enrolled in this study to assess the success of a soft shell helmet for the correction of cranial asymmetry. Computed tomography scanning was done before therapy and 6 months after the initiation of therapy. Three-dimensional reconstructions of these scans were reformatted into a standardized orientation by utilizing the nasion (radix), frontozygomatic suture lines, and posterior aspect of the foramen magnum. Intracranial volumes were calculated on a quadrant basis, and asymmetry was evaluated with regard to the hemispheres (left versus right) and the posterior quadrants. Thirty-four children (27 boys and 7 girls) completed the study protocol. The side involved was the right in 62% of cases and the left in 38%. Mean age at the initial scan was 6.3 months, and mean age at the follow-up scan was 14 months. Mean duration of helmet therapy was 7 months. Compliance with therapy was average to above average in 88% of the children and poor in 12%. There was a 36% to 54% improvement in asymmetry in the compliant patients over the 6-month study period. Soft shell helmet therapy is an effective technique to decrease cranial asymmetry based on objective outcome measurements. Additionally, it is cost-effective, with the total cost of therapy for the helmet and office visits ranging from 600 dollars to 700 dollars. This therapy compares favorably with other more expensive and time-consuming therapies that have been reported in the literature.

Cephalometry↗

Radiology of infiltrating angiolipoma.

Infiltrating angiolipomas are rare benign soft-tissue neoplasms that are locally aggressive and require wide surgical excision. Of 10 patients studied, five showed serpiginous densities intermixed with fat on plain films. Six radionuclide bone scans showed uptake by the soft-tissue lesion. Eight angiograms demonstrated poorly marginated, very hypervascular lesions. Computed tomography (CT) in five patients yielded excellent visualization of predominantly low density lesions that invaded and replaced skeletal muscle. The combination of angiography and CT indicated the specific diagnosis and demonstrated the size, extent, and vascularity of the tumors.

Adult↗

[Histiocytosis X of the petrous pyramid in adults. X-ray computed tomographic and MRI aspects].

Two cases are reported of histiocytosis X in young adults, both confined to the petrous bone. In one case the clinical signs were those of a progressive facial palsy, developing over 3 years; the other case had pulsatile tinnitus with clear otorrhoea and symptoms of vestibular deficiency. Computed tomography showed extensive bone destruction by a soft-tissue density process which enhanced strongly after iodinated contrast injection. Magnetic resonance imaging (T1 weighted sequences before and after intravenous gadolinium injection) confirmed the presence of a mass lesion in the petrous bone with contrast medium uptake which showed cystic areas within it: it also showed the absence of extension through the dura mater by the intracranial component which remained extradural. It confirmed the patency of arteries and veins, so enabling a differentiation to be made between histiocytosis X and advanced glomus tumours.

Adolescent↗

Direct longitudinal computed tomography of the forearm.

A method is outlined for obtaining direct longitudinal computed tomograms of the forearm using a conventional total body scanner. A case is described in which longitudinal scanning helped define a soft tissue tumor of the forearm and thereby assisted in surgical planning.

Adolescent↗

Influence of lining design of three processed soft denture liners on cushioning effect.

The purpose of this study was to evaluate the influence of the lining design of a soft denture liner on its cushioning effect, using a free drop test and an accelerometer. The peak instantaneous acceleration value was computed. The materials tested were SuperSoft(R) (SS), Kurepeet-Dough(R) (KD), and Molloplast-B(R) (MB). Soft denture liners 2 mm in thickness were placed in test denture bases using three different configurations. Specimens were tested at 24 h and at 180 days after storage in distilled water at 37 degrees C. A three-way ANOVA was used to analyse the data (P=0.05) and Tukey intervals were computed. It was found that all three materials were effective in reducing the impact force. The lining design that had the soft denture liner extended to the periphery of the denture base demonstrated the greatest shock absorbability of all the tested designs. A silicone denture liner using lining design 1 was the most effective in reducing the shock transmitted to the denture bases.

Acceleration↗

Primitive neuroectodermal tumor of the orbit.

A 10-year-old girl developed a lump in the lateral aspect of the right eyebrow over a 3-week period. Computed tomography and magnetic resonance imaging revealed a soft-tissue mass in the superolateral aspect of the right orbit associated with zygo-maticofrontal bone erosion and hyperostosis. An incisional biopsy specimen was studied using light microscopy, immunohistochemical staining, and electron microscopy, resulting in a diagnosis of peripheral primitive neuroectodermal tumor. The results of an extensive evaluation for systemic involvement were negative. The patient was subsequently treated with chemotherapy and radiation therapy. Primary primitive neuroectodermal tumor of the orbit is rare. The differential diagnosis and the diagnostic features of this entity are discussed herein.

Child↗

Vascular masses in the middle ear.

High resolution computed tomography (CT) is of great value in demonstrating soft tissue masses in the middle ear cavity. However, tissue characterisation even for vascular masses after contrast enhancement has proved disappointing. Differentiation therefore depends upon the site and anatomical configuration of the mass, and in many cases angiography is mandatory for diagnosis. Examples of high ectopic jugular bulb, glomus jugulare and glomus tympanicum tumours and aberrant internal carotid artery are presented and their differential diagnosis considered. The value of CT and more traditional techniques, particularly lateral tomograms to show the spur of bone between the jugular bulb and internal carotid artery, are discussed.

Carotid Artery, Internal↗

[The computed tomography of malignant otitis externa].

Computed tomography was performed preoperatively in 20 patients suffering from malignant external otitis. The CT findings were nearly completely confirmed by the intraoperative findings. A circumscribed or diffuse thickening of the cartilaginous wall of the external auditory canal and an inflammatory infiltration of the subtemporal fossa are, in combination, most suspicious signs of malignant external otitis. Computed tomography enables detailed information on the extension of the pneumatic system and the grade of involvement of bones and soft tissues in malignant external otitis. A modified classification of malignant external otitis based on computed tomographic findings is proposed.

Adult↗

Elastofibroma dorsi: benign chest wall tumor.

Elastofibroma dorsi was diagnosed in seven patients at the Columbia-Presbyterian Medical Center between 1976 and 1986. The ages of the patients ranged from 6 to 79 years (mean 49.3 years). No sex predominance was seen. Five cases of unilateral subscapular tumor and two cases of bilateral masses were identified. Four patients had pain with arm motion, and the remaining patients were free of symptoms. A nonencapsulated soft tissue mass elevating the scapula was identified by computed tomography. Incisional biopsy was performed in all cases, followed by local excision of the tumor. On gross examination, these lesions were firm and rubbery. Histologic evaluation demonstrated a slightly hypercellular fibrous tissue that contained variable numbers of fragmented elastic fibers. All patients with symptomatic tumors had complete relief of their pain after the operation. No recurrences were observed. Clinically, elastofibroma may mimic sarcoma and fibromatosis (extraabdominal desmoid tumors). Whether elastofibroma is a true neoplasm or a reactive fibrous lesion that produces not only collagen, but also abnormal elastic fibers, has been the subject of controversy and remains undetermined.

Adolescent↗

Glial choristoma in the middle ear and mastoid bone: a case report.

Heterotopic brain tissue usually involves extracranial midline structures of the head and neck such as nose, nasopharynx, and oral cavity. Its occurrence in the non-midline structures, including middle ear, is rare. We described a 50-yr-old-man with heterotopic glial tissue in the middle ear and mastoid bone. The patient presented with progressive hearing loss for 8 yr. There was no history of congenital anomalies, trauma, or ear surgery. Computed tomography revealed a mass-like lesion with soft tissue density occupying the middle ear cavity and mastoid antrum. At the operation, a gray-white fibrotic mass was detected in the epitympanic area. Mesotympanum and ossicles were intact. The patient underwent left simple mastoidectomy with type I tympanoplasty. During operation, definite cranial bone defect or cerebrospinal fluid leakage was not found. Histologically, the lesion was composed of exclusively mature, disorganized glial tissue with fibrovascular elements in a rather loose fibrillary background. Glial tissue showed diffuse positive reaction for glial fibrillar acidic protein and S100 protein on immunohistochemical study.

Audiometry↗

Efficacy of magnetic resonance imaging in 139 children with tumors.

One hundred thirty-nine children with neoplasms were studied using magnetic resonance imaging (MRI). This procedure was as accurate as computed tomography in predicting tumor histology, except that MRI was unable to detect small areas of tumor calcification. Magnetic resonance imaging could accurately identify the organ of origin of tumor masses and differentiate soft tissue from fat, fluid, or hemorrhage. In addition, MRI was helpful in planning surgery in many cases: It was better than computed tomography in defining the size and extent of soft-tissue tumor masses. It was accurate in defining the extent of the spread of bone sarcomas in the bone marrow. Without requiring the injection of intravenous contrast agents, it accurately defined displacement, encasement, or invasion of major abdominal blood vessels by Wilms' tumors and neuroblastomas. As a means of evaluating pediatric neoplasms, MRI is noninvasive, painless, and well tolerated by children, and it uses no radiation.

Adolescent↗