Dennis K. Heaston

CT appearance of adrenal cortical carcinoma

The computed tomographic (CT) findings in eight patients with proven primary adrenal cortical carcinoma are presented. The tumors ranged in size from 9 to 22 cm in diameter and all exhibited central necrosis. Contrast enhancement was irregular in all cases and associated tumor calcification was present in three cases. The CT appearance of a huge adrenal mass with central necrosis is typical of adrenal cortical carcinoma hut can occasionally he seen with pheochromocytoma or a large metastasis to the adrenal gland.

Computed tomography in the detection of abdominal metastases from malignant melanoma.

Malignant melanoma is an unpredictable and often virulent cutaneous malignancy. Although computed tomography is the most sensitive method for detection of intrathoracic metastases, its value in the assessment of abdominal spread has not been fully defined. We evaluated the sites of CT-identified metastases in 70 patients with pathologically confirmed malignant melanoma. Results were correlated with Clarks level, Breslow thickness, site of the primary, and clinicopathologic stage. CT detected enlarged abdominal or pelvic lymph nodes in 75% of patients with Clarks level 5 lesions but only in 24% and 33% of those with level 3 and 4, respectively. Patients with deep primary lesions of the lower extremities had a high frequency of pelvic node metastases. Liver and splenic metastases were detected in up to 25% of patients with level 4 or 5 melanoma. Adrenal and subcutaneous metastases were frequently discovered as were unsuspected nodules at the lung bases.

Case report. CT guided thin needle aspiration of adrenal blastomycosis.

ABSTRACT The first case of adrenal abscess due to North American blastomycosis detected by computed tomography is reported. Computed tomography also permitted thin needle verification of a 5 cm adrenal mass and expedited treatment of the patients fungal induced hypoadrenalism.

CT differentiation of thoracic aortic aneurysms from pulmonary masses adjacent to the mediastinum

Paramediastinal masses adjacent to the aorta require a diagnostic evaluation to differentiate between tumor and aneurysm. It has been suggested that neoplasm may enhance sufficiently to be confused with a vascular structure or that a clot filled aneurysm may simulate a neoplasm by not filling with contrast medium. Five patients, two with thoracic aneurysms, two with malignancy, and one with a malignancy and an aortic dissection, are presented in whom bolus injection computed tomography (CT) was able to distinguish between aneurysm and mass. The CT examination also accurately visualized the point of communication of the aneurysm with the aorta, defined the relationship of the aneurysm to vital mediastinal structures for planning surgical resection, and helped plan the approach for percutaneous transthoracic needle aspiration when tumor was suspected. Bolus injection CT represents a rational alternative to aortography for mediastinal paraaortic masses.

Computed tomography of extracranial chloroma

The computed tomographic appearance in two cases of extracranial soft tissue chloroma is presented. In both patients, the chloroma preceded the diagnosis of leukemia. Computed tomography demonstrated a homogeneous soft tissue mass with a density similar to skeletal muscle. Recognition of chloromas is important, since they are locally invasive but respond well to radiation therapy.

Recurrent rectal carcinoma in an asymptomatic patient.

Pelvic recurrence is a common cause of symptoms and mortality in patients who have undergone surgical resection of rectal carcinoma. Diagnosis by physical examination and standard radiologic techniques is usually only possible when the recurrence becomes symptomatic because of its advanced state. Previous reports have documented the ability of computed tomography (CT) to depict accurately pelvic recurrence of rectal carcinoma in the symptomatic patient. Surgical resection of recurrence is usually noncurative but appears to result in a more prolonged survival if performed in the asymptomatic patient. We report a case of pelvic lymph node recurrence suggested by CT and confirmed by CT guided needle biopsy in an asymptomatic patient. Diagnosis of recurrence at this early stage by CT, supplemented with CT guided biopsy, may offer the patient an increased chance of survival following surgical resection.

CT demonstration of subcutaneous venous collaterals.

Subcutaneous collateral veins were identified by computed tomography (CT) in 12 patients. These were seen as enhancing round or tubular structures surrounded by subcutaneous fat, and most were associated with occlusion of a major vein in the abdomen or thorax. The CT appearance of deep vein occlusions included an intraluminal thrombus with an enhancing rim, a mass replacing the nonvisualized vein and distortion of the vein by an adjacent mass. The subcutaneous fat was examined on the CT scans of 50 patients not suspected of having deep venous occlusions. The appearance of normal subcutaneous structures and the differential diagnosis are discussed.

Diagnosis of lithokelyphos by computed tomography.

An incidental stone child, lithokelyphos, presented as an undiagnosed abdominal mass in a woman with cervical cancer. Lithopedion formation is an uncommon result of an abdominal pregnancy. The types of lithopedions as well as their method of formation and clinical features are reviewed. In addition, the computed tomographic features of lithopedions are presented.

Computed tomographic detection of gas within spontaneously necrotic tissue

Computed tomography (CT) is a widely accepted modality for the detection, localization, and potential therapeutic drainage of abdominal abscesses. The CT demonstration of extraluminal gas within the abdomen usually signifies the presence of an abscess. We report two cases of nonpurulent spontaneous tissue necrosis which simulated a gas containing abscess on CT. The significance of a gas-containing mass detected by CT must be interpreted cautiously since this appearance is not necessarily pathognomonic of a drainable abscess. Confirmation of purulent material within a suspected abscess collection requires documentation by percutaneous aspiration or surgery.

Radiographic manifestations of thoracic malignant melanoma

The importance of the thoracic cavity to the patient with malignant melanoma is rivaled only by that of the integument, since even though most melanomas originate in the skin, such intrathoracic structures as the lungs and heart determine their eventual outcome as they disseminate [85]. The filtering function of the lungs in particular to snare free-floating foci of malignant tissue is well known [31]. Of the 14 100 projected new cases of malignant melanoma to be diagnosed in 1980, approximately 4600, or one person in three, will die of the disease within five years [122]. Half of these people will succumb to cardiorespiratory failure due to replacement of their normal tissue by secondary tumor [100]. Pulmonary infection resulting directly from metastatic disease or its treatment will claim several hundred more individuals. Various autopsy series showing an incidence of cardiac and pulmonary metastases in advanced cases up to 64% and almost 90% respectively suggest an even greater role of the thorax in patient survival [5, 65].