Chung-Chueng Tsai

CT findings at lupus mesenteric vasculitis

Purpose: To describe the spectrum of early CT findings of lupus mesenteric vasculitis (LMV) and to assess the utility of CT in the management of this uncommon entity. Methods: Abdominal CT was performed within 1–4 days (average 2.2 days) of the onset of severe abdominal pain and tenderness in 15 women with systemic lupus erythematosus. Prompt high-dose i.v. corticosteroid was administered in 11 patients after the CT diagnosis of LMV was made. CT was performed after abdominal symptoms subsided. Results: Eleven cases revealed CT features suggestive of LMV including conspicuous prominence of mesenteric vessels with palisade pattern or comb-like appearance (CT comb sign) supplying focal or diffuse dilated bowel loops (n=11), ascites with slightly increased peritoneal enhancement (n=11), small bowel wall thickening (n=10) with double halo or target sign (n=8). Follow-up CT before high-dose steroid therapy revealed complete or marked resolution of the abnormal CT findings. Conclusion: CT is helpful for confirming the diagnosis of LMV, especially the comb sign which may be an early sign. Bowel ischemia due to LMV is less ominous than previously expected, and the abnormal CT findings were reversible when early diagnosis and prompt i.v. steroid therapy could be achieved.

Gas-containing liver abscess: radiological findings and clinical significance

Sixty-two cases of verified gas-containing pyogenic liver abscess were reviewed to study the radiological and clinical prognostic factors. A mortality rate of 37.1% (23 cases) was observed. Among these patients, the survival time of 13 patients with alveolar gas pattern or pneumoperitoneum (6.15±7.36 days) was significantly shorter than that of the other 10 patients (17.70±13.32 days) despite immediate diagnosis and aggressive treatment. The poor radiological prognostic signs were: (1) alveolar gas pattern and pneumoperitoneum as viewed on radiographs; and (2) globular configuration, shaggy margin, alveolar internal structure, and total gas content on computed tomographic (CT) scans. High serum creatinine and glucose levels and a short time to diagnosis were the poor clinical prognostic factors. The aggressive treatment did not change the outcome. We conclude that, in addition to the clinical evaluation, meticulous radiological study of the abscess morphology should be done in cases of gas-containing liver abscess in an effort to provide further aggressive treatment for those patients with poor radiological prognostic signs.

Sonography and computed tomography of a gossypiboma and in vitro studies of sponges by ultrasound case report

A case of retained surgical sponge was imaged by ultrasound and computed tomography (CT). Sonography revealed a hypoechoic mass with areas of high echoes and acoustic shadowing. An experiment revealed that the high echoes were attributed partly to the presence of numerous interfaces of sponges. The sonographic detection of a mass with high echoes casting acoustic shadows should alert radiologists to the possibility of retained surgical sponges even if there is no gas or calcification on CT scans.

Persistence of both proatlantal arteries with absence of vertebral arteries

SummaryA case of bilateral persistence of the proatlantal arteries with absence of both vertebral arteries proved by angiography is reported.

Thoracic neurilemomas: an analysis of computed tomography findings in 36 patients.

On computed tomography (CT), neurilemomas have generically been described as well-defined, round masses with heterogeneous contrast enhancement. The CT scans of 38 surgically proven thoracic neurilemomas in 36 patients were reviewed to characterize further the CT features of this tumor, with an emphasis on different enhancement patterns. Unenhanced CT was available in 32 patients; 10 tumors appeared isodense, and 22 tumors appeared slightly hypodense compared with chest wall muscle. Except for an intraosseous neurilemoma of the T8 vertebral body, which mimicked bone metastasis, the tumors could be categorized into five different patterns on CT after contrast enhancement. Twenty tumors (54.1%) revealed diffuse, but amorphous and inhomogeneous enhancement. Seventeen (45.9%) tumors appeared as masses with multiple hypodense or cystic areas. Of these 17, the pattern was somewhat radial enhancement (n = 6, 16.2%), peripheral enhancement with a large central hypodense area (n = 5, 13.5%), homogeneous hypodensity (n = 5, 13.5%), and central enhancement with peripheral hypodensity (n = l, 2.7%). Appreciation of various CT manifestations is important in the diagnosis of this tumor.

Computed tomography of an exophytic gastric hemangioma with torsion and intratumoral hemorrhage

A case of exophytic gastric hemangioma with intratumoral bleeding due to torsion of the tumor pedicle is reported. A radiograph showed a mass without phleboliths. Computed tomography (CT) demonstrated a 14-cm mass with high densities due to hemorrhage, which was contiguous to the stomach and extended to the pelvis. The tumor showed no remarkable enhancement on post-enhanced CT due to torsion of the tumor pedicle.

MR imaging of thoracic neurilemmomas

Magnetic resonance (MR) imaging features of 15 thoracic neurilemmomas were analyzed. Morphologically, five tumor patterns could be identified on MR imaging including: inhomogeneous masses (n = 8), thick-walled multiloculated masses (n = 2), thick-walled central cystic masses (n = 2), homogeneous cystic masses (n = 2) and a target pattern mass (n = 1). The signal characterization of thoracic neurilemmomas was variable, usually brighter on T2-weighted images, hyper- to hypo-intense on T1-weighted images and always enhancing. Histopathologically, the inhomogeneous masses were characterized by irregular distribution of hypercellular Antoni A and hypocellular Antoni B tissues with variable degrees of cystic, hemorrhagic, myxoid and hyaline degenerative changes. Enlargement of the cystic areas led to the development of thick-walled multiloculated masses while confluence of these cystic areas produced a central cystic pattern. Extensive myxoid or hyaline degeneration yielded homogeneous cystic tumors. Peripheral fibrinous changes and central Antoni B stroma contributed to a target pattern. Appreciation of the protean MR manifestations and understanding of the underlying histopathological changes of thoracic neurilemmomas are helpful in the diagnosis of this tumor.

Solitary hepatic Burkitt lymphoma presenting as acute pancreatitis

A 14-year-old boy was admitted with a 3-week history of worsening postprandial epigastralgia. On physical examination, there were epigastric tenderness and hepatosplenomegaly. The serum amylase, lipase, alkaline phosphatase and the Cam/Ccr ratio were abnormally high. Sonography revealed a solitary hypoechoic mass in the right lobe of the liver; the pancreas was hypoechoic and swollen with dilatation of the pancreatic duct. The CT after contrast (Fig. 1) confirmed the sonographic findings. Celiac angiography showed mass effect with few tumor vessels (Fig. 2). Exploratory laparotomy followed by right-hepatic lobectomy was performed. The liver specimen revealed a well-encapsulated and grayish white tumor mass 17 cm in maximal diameter. The pathologic diagnosis was Burkitt lymphoma. After surgery, the symptoms subsided, and subsequent ultrasound and serum enzyme levels indicated the resolution of acute pancreatitis. The patient was followed at clinic for further work-up and chemotherapy.

Wall defect as a sign of urinary bladder rupture in sonography.

Bladder injuries resulting from blunt trauma are classified as contusion, extraperitoneal rupture, or intraperitoneal rupture.1 Diagnosis of bladder rupture is usually established by retrograde cystography. We report a case of intraperitoneal rupture of the urinary bladder de. tected by real-time sonography and confirmed by surgery. It revealed a defect of the wall at dome. Furthermore, during bolus injection of distilled water into the bladder through a Foley catheter, turbulent flow and microbubbles were seen in the extravasated fluid collec· tion. We advocate real-time sonography as a primary imaging modality in patients with hematuria that follows abdominal trauma.

Cortical renal leiomyoma with extension to renal pelvis

We describe a case of renal leiomyoma in a 21-year-old woman who presented with flank pain and hematuria. Urographic and computed tomographic (CT) studies revealed a large right renal mass with polypoid outgrowth protruding into the renal pelvis. Cortical renal leiomyoma with this radiographic manifestation is extremely rare.