Gerald F. Abbott

Combined Clinical and Computed Tomographic Diagnosis of Primary Lacrimal Fossa Lesions

We studied 39 patients who had solid mass-lesions primary in the lacrimal gland by computed tomography and reviewed their clinical histories. Twenty-three patients had either inflammatory conditions (16 cases) or lymphoid tumors (seven cases), with average symptomatic periods of less than a year. In this group, soft-tissue contour analysis in the axial and corneal projections demonstrated diffuse, compressed, and molded enlargements of the lacrimal gland in an oblong fashion, and there were no associated bone defects. Sixteen parenchymal benign or malignant tumors (six benign mixed tumors, one schwannoma, and nine malignant epithelial tumors) exhibited rounded or globular soft-tissue outlines and were frequently associated with contiguous bone changes. The benign tumors had smooth encapsulated outlines at their margins, whereas the malignant tumors displayed microserrations indicative of infiltration. The patients with the benign mixed tumors had had symptoms, on the average, for more than a year, whereas those with epithelial malignancies became symptomatic or had a preexisting benign mixed tumor that became exacerbated in periods of less than six months. Contour analysis of the soft-tissue mass depicted in coronal and axial tomograms is a valuable adjunct that leads to more accurate preoperative diagnosis when combined with a radiographic search for bone changes and the clinical history. Once a diagnosis regarding the presumptive lesional family has been made preoperatively, corticosteroid therapy may be instituted for acute inflammation and biopsies through the eyelid should be performed for suspected chronic inflammations, lymphoid lesions, or epithelial malignancies. A lateral orbitotomy without prior biopsy should be performed for rounded, well-encapsulated masses of long duration that are likely to be benign mixed tumors.

Combined Clinical and Computed Tomographic Diagnosis of Orbital Lymphoid Tumors

Abstract Computed tomography has made it possible to make a strongly presumptive preoperative diagnosis of orbital lymphoid tumors, particularly when the radiographic findings are analyzed in conjunction with the clinical features. Twenty-six patients (with 27 orbital lymphoid tumors) had an average age of 57 years and had painless swelling or low-grade proptosis averaging 7.5 months in duration. The computed tomographic findings were highly characteristic. Almost all of the tumors had a retrobulbar or superior orbital component. In both the coronal and axial planes, distinctive growth patterns and contourings were discovered. The lesions molded themselves to preexisting orbital structures without eroding bone or enlarging the orbit. Against the bone, globe, and muscle edges, the lesions featured smooth, sharply demarcated contours with abruptly acute or perpendicular angulations, whereas a streaky profile became apparent as they irregularly infiltrated the retrobulbar fat, reflecting involvement of microfascial structural elements. No distinguishing differences were discovered in the growth patterns of the benign and the malignant tumors

The angioarchitecture of colonic diverticula. Significance in bleeding diverticulosis.

The intramural distribution of the vasa recta of the colon and particularly their relationship to diverticula were investigated in a group of operative and postmortem specimens using intra-arterial barium-gelatin injections, followed by high resolution radiography, microdissections, and histologic sections. Detailed study demonstrated a large arterial branch arching immediately over the dome of the diverticulum. Multiple short branches are displaced intimately around the body and neck of the sac. A pathogenetic relationship between bleeding colonic diverticulosis and the distinctive angioarchitecture is strongly indicated.

Necrotizing Enterocolitis with Pneumatosis Intestinalis in Systemic Lupus Erythematosus and Polyarteritis

Pneumatosis intestinalis was encountered in association with fatal necrotizing enterocolitis in systemic lupus erythematosus (SLE) and polyarteritis nodosa. The radiologic identification of mottled, bubbly, and linear collections of intramural intestinal gas distinguish this ominous complication from benign pneumatosis cystoides intestinalis. In the setting of intestinal vasculitis due to SLE or polyarteritis nodosa, these characteristic radiologic features indicate necrotizing enterocolitis. Since corticosteroids may mask clinical progression of the intestinal lesion, radiologic evaluation is essential in the overall management of the patient with intestinal vasculitis.

Common and Uncommon Manifestations of Wegener Granulomatosis at Chest CT: Radiologic-Pathologic Correlation

Wegener granulomatosis is an uncommon necrotizing vasculitis that classically manifests as a clinical triad consisting of upper and lower airway involvement and glomerulonephritis. Other less frequently involved organ systems include the central and peripheral nervous system and large joints. The diagnosis is based on a combination of clinical and laboratory findings. Because thoracic involvement often predominates, chest radiographic findings are often the first to suggest the diagnosis. However, chest computed tomography (CT) has superior sensitivity and specificity for evaluation of the airways, lung parenchyma, and mediastinum, particularly with the use of multiplanar reformatted and three-dimensional images. Common pulmonary radiologic findings include waxing and waning nodules, masses, ground-glass opacities, and consolidation. Airway involvement is usually characterized by circumferential tracheobronchial thickening, which can be smooth or nodular. Pleural effusions are the most common manifestation of pleural disease and can result from primary involvement or be secondary to renal failure. Mediastinal lymphadenopathy is a nonspecific finding and is usually reactive. Uncommon thoracic radiologic manifestations include involvement of the heart and great vessels. CT is the imaging modality of choice for diagnosis, surveillance, and follow-up in patients with Wegener granulomatosis.

A Radiologic Review of the New TNM Classification for Lung Cancer

OBJECTIVE In 2009, a new TNM staging system was published by the International Union Against Cancer and the American Joint Committee on Cancer. The new edition will encompass non-small cell lung cancer, small cell lung cancer, and bronchopulmonary carcinoids. This article will review many important changes that have been made in the revised staging system. CONCLUSION It is important that radiologists learn the new system and understand the reasons for the changes to provide more accurate clinical staging.

Haustral Anatomy and Pathology: A New Look: I. Roentgen Identification of Normal Patterns and Relationships

The distinctive haustral contour of the colon is provided by three bands of longitudinal muscle, the taenia mesocolica (TM), taenia omentalis (TO), and taenia libera (TL). The haustral sacculations are thus organized into three easily identifiable rows: TM-TO, TO-TL, and TL-TM. The haustral rows have specific anatomic relationships to extraperitoneal and intraperitoneal structures and mesenteric attachments. This organization of the haustral pattern can be routinely demonstrated and precisely identified.

Imaging Pulmonary Infection: Classic Signs and Patterns

OBJECTIVE The purposes of this article are to describe common and uncommon imaging signs and patterns of pulmonary infections and to discuss their underlying anatomic and pathophysiologic basis. CONCLUSION Imaging plays an integral role in the diagnosis and management of suspected pulmonary infections and may reveal useful signs on chest radiographs and CT scans. Detected early, these signs can often be used to predict the causative agent and pathophysiologic mechanism and possibly to optimize patient care.

Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is the most common primary malignancy of the pleura and is associated with asbestos exposure in approximately 80% of patients. The patient prognosis is poor, with a median survival of 9-17 months after diagnosis. However, improved survival and decreased morbidity and mortality have been demonstrated when the diagnosis is made in the early stages of disease and specific treatment strategies are implemented. A staging system that focuses on the extent of primary tumor (T), lymph node involvement (N), and metastatic disease (M) has been devised by the International Mesothelioma Interest Group and emphasizes factors related to overall survival. Radiologists should recognize the manifestations of MPM across multiple imaging modalities, translate these findings into the updated staging system, and understand the effects of appropriate staging on treatment and survival. Computed tomography (CT) remains the primary imaging modality used to evaluate MPM and efficiently demonstrates the extent of primary tumor, intrathoracic lymphadenopathy, and extrathoracic spread. However, additional imaging modalities, such as magnetic resonance (MR) imaging of the thorax and positron emission tomography (PET)/CT with fluorodeoxyglucose, have emerged in recent years and are complementary to CT for disease staging and evaluation of patients with MPM. Thoracic MR imaging is particularly useful for identifying invasion of the chest wall, mediastinum, and diaphragm, and PET/CT can accurately demonstrate intrathoracic and extrathoracic lymphadenopathy and metastatic disease.

Imaging of small airways disease.

Small airways disease includes a spectrum of inflammatory and fibrotic pulmonary diseases centered on the small conducting airways. High-resolution computed tomography plays a key role in the detection and classification of small airways disease and, when combined with relevant clinical and pathologic findings, leads to a more accurate diagnosis. The imaging manifestations of small airways disease on high-resolution computed tomography may be direct or indirect signs of small airway involvement and include centrilobular nodules and branching nodular (tree-in-bud) opacities, or the demonstration of mosaic attenuation that is typically exaggerated on expiratory computed tomography. This article reviews the normal anatomy and histology of bronchioles and the clinical, pathologic, and imaging features of small airways diseases.