Alicia Nachtigal

Sonographically Guided Percutaneous Needle Biopsy of Soft Tissue Masses With Histopathologic Correlation

Objective. The purpose of this study was to evaluate the accuracy of sonographically guided percutaneous core biopsy of soft tissue masses. Methods. We retrospectively reviewed the medical records of patients who underwent sonographically guided biopsy of soft tissue masses at our institution during a 50‐month period. Core biopsy histopathologic results were compared with surgical or clinical follow‐up. Results. One hundred eighty‐three patients, 76 male and 107 female, with a mean age of 48.5 years were included in the study. Thirteen patients had more than 1 biopsy, and the total number of biopsies performed was 196. Five patients were lost to follow‐up. Biopsy results were diagnostically accurate in 174 (91%) cases. Thirteen biopsies were inconclusive. No complications occurred. The overall sensitivity, specificity, positive predictive value, and accuracy in separating malignant from benign lesions were 97%, 99%, 99%, and 98%, respectively. Conclusions. Sonographically guided core needle biopsy is an accurate and safe means to obtain tissue samples for the histopathologic diagnosis of soft tissue masses. It obviates the need for open biopsy and should be performed routinely for treatment planning.

Clinically unsuspected foreign bodies: the importance of sonography.

Objective. To show the value of sonography in the detection of clinically unsuspected foreign bodies appearing as soft tissue masses. Methods. High‐resolution B‐mode and color Doppler sonography was performed in 288 patients referred with superficial soft tissue masses over a period of 2 years. Results. In 8 lesions in 6 patients, sonography showed small curved or linear echogenic structures surrounded by hypoechoic masses characteristic of foreign bodies with granulation tissue. One lesion had increased vascularity on color Doppler sonography. Patients were referred for other imaging studies, including magnetic resonance imaging, computed tomography, and bone and labeled red blood cell scintigraphy, which did not add relevant information. Three patients underwent surgery; foreign bodies were found in 2, and infected granulation tissue was found in 1. Spontaneous resolutions and no growth of the lesions were seen in the other 2 patients. Conclusions. The possibility of a foreign body should be considered when scanning soft tissue masses even in the absence of a relevant clinical history. Once a foreign body is diagnosed, no further workup is indicated.

Isolated spontaneous dissection of the celiac trunk in a patient with bicuspid aortic valve

Isolated spontaneous dissection of celiac trunk is a rare entity. The spontaneous dissection of the visceral artery occurs without aortic dissection. The most consistent presenting symptom is acute onset abdominal pain. Complications consist of ischemia, aneurysm formation, and rupture. We report an exceptional case of an isolated spontaneous dissection of the celiac trunk which occurred in a 49 year old male with a previously undiagnosed bicuspid aortic valve (BAV). We also describe the classical appearance in different imaging modalities with a particular emphasis on multidetector computed tomography, and discuss the clinical manifestation and its relationship to BAV.

Giant colon diverticulum: clinical and imaging findings in 17 patients with emphasis on CT criteria.

PURPOSE The purpose of the study was to review the clinical and radiologic features of giant colonic diverticulum (GCD). METHODS Medical records of 17 patients with GCD on computed tomographic (CT) examination were reviewed. RESULTS CT examination revealed the GCD in all patients as a predominantly gas-filled structure communicating with the adjacent colon. Thirteen patients showed a gas-filled structure on abdominal radiograph. The mean GCD diameter was 7 cm. Most diverticula were found in the sigmoid colon. Associated diverticulosis was present in 71% of patients. CONCLUSION Our experience suggests that GCD can often be diagnosed on the basis of the characteristic radiographic and CT findings in these patients.

Computed tomographic diagnosis of traumatic fetal subdural hematoma.

Intrauterine subdural hematoma (SDH) is a rare event; maternal trauma, especially during the last trimester of pregnancy, is the best documented cause of fetal SDH. We report an extremely rare case of fetal SDH due to maternal trauma diagnosed by multidetector computed tomography. We also discuss the clinical and imaging features of fetal SDH which can be used to assist in diagnosis with emphasis on CT criteria.

Diagnosis of gallbladder perforation by ultrasound

PURPOSE The aim of this study was to identify possible pitfalls in the sonographic evaluation of perforated gallbladders. METHODS This is a retrospective analysis of sonograms of 11 patients diagnosed by surgery or pathology with perforated gallbladder. Sonograms were evaluated for multiple sonographic features. RESULTS Only three patients (27%) were diagnosed correctly with gallbladder perforation by ultrasonography prior to surgery. Gangrenous cholecystitis was reported in 10 cases (90%). Visualization of a wall defect was demonstrated in only five cases (45%) and was associated with a focal echogenic soft-tissue mass. CONCLUSION Missed perforations by ultrasound may partially result from technical inadequacies.

Giant omental hemorrhagic cyst presenting as acute hemorrhagic anemia in a 21-month-old infant.

Abstract An omental cyst is a very rare pathology, especially in small infants. Children generally present with abdominal distention with or without a palpable mass. The mass may be huge, simulating ascites. The most common presentation in children is that of a small-bowel obstruction. The differential diagnosis includes intestinal duplication cyst, ovarian, choledochal, pancreatic, splenic, or renal cysts, hydronephrosis, cystic teratoma, hydatid cyst, and ascites. We describe the clinical presentation, imaging features, surgical treatment, and postoperative course of a 21-month-old female infant with a congenital giant omental cyst. This entity is extremely rare but should be included in the differential diagnosis in similar cases.

Mitral annulus caseous calcification imaged with 64-slice MDCT

A 70-year-old woman with a previous cerebrovascular accident underwent routine TTE to assess her cardiac morphology and function. She was found to have mild mitral valve regurgitation with severe m...

Sonographic Diagnosis of Complicated Cholecystitis.

Early detection of the complications of cholecystitis is important for clinical management, yet only a small percentage of patients have a correct diagnosis before surgery. The purpose of our study was to identify sonographic findings that are associated with complicated cholecystitis.

The diagnostic accuracy of pericolonic fat extension and attenuation for colorectal tumors

OBJECTIVE To evaluate the utility of quantitative analysis of the extension and attenuation of pericolonic fat in the local staging of colorectal cancer (CRC) using multi detector computed tomography (MDCT). MATERIALS AND METHODS This was a retrospective study of 110 patients who were operated due to pathologically proven CRC from January 2007 to January 2010, and who underwent preoperative MDCT of the abdomen and pelvis with administration of intravenous contrast material and image acquisition during the portal venous phase. The mean age was 69 years (range of 38-90 years). Pathological reports were reviewed for TNM staging. All MDCT studies were reviewed by two certified radiologists for maximal and minimal tumor diameter, extent of the infiltrated pericolonic fat (measured in mm), attenuation of the infiltrated pericolonic fat (measured in Hounsfield units), and attenuation of normally appearing fat next to the tumor. The sensitivity and specificity of these parameters in detecting patients with ≥ T3 CRC were calculated. RESULTS The overall sensitivity, specificity, and accuracy of pericolonic fat infiltration in detecting patients with ≥T3 stage were 95% (95% CI, 89.0-98.7%), 20% (5.8-43.7%), and 81.9% (74.7-89%) respectively. The mean extent and attenuation of the infiltrated pericolonic fat, in addition to the maximal tumor diameter, were higher in the ≥T3 group (p<0.05). By defining threshold values to these parameters, the positive predictive value for detecting ≥T3 stage tumors approaches 100%. CONCLUSION Quantitative analysis of pericolonic fat increased the accuracy of MDCT in the detection of local tumor spread in CRC.