Irwin M. Feuerstein

Sinusitis in HIV-1 infection

PURPOSE To determine the clinical and radiographic characteristics of sinusitis in patients with human immunodeficiency virus type 1 (HIV-1) infection. PATIENTS AND METHODS A retrospective study was performed that identified all HIV-1-infected patients with sinus radiographs, sinus computed tomograms, or magnetic resonance imaging of the head between 1982 and 1989 (n = 145). Medical record review detailed the clinical course and laboratory parameters in all patients. RESULTS Eighty-nine patients had radiographic evidence of sinusitis; 75 patients had adequate clinical data and comprise the study group. Acute sinusitis was seen in 10 patients (13%), while all 75 patients had mucosal thickening indicative of chronic sinusitis. Fifty patients (67%) were symptomatic with fever, nasal congestion or discharge, and headache being the most common symptoms; nineteen patients (25%) were asymptomatic when their radiographs showed active disease. The mean CD4 count for the group was 276 cells/mm3; 32 (43%) had CD4 counts less than or equal to 100 cells/mm3. Twenty-three patients (31%) received antibiotics orally, parenterally, or both. CONCLUSIONS Sinusitis appears to occur frequently in HIV-infected patients, is often asymptomatic, may be recurrent or refractory, and may be associated with declining immunocompetence in HIV-infected patients.

Widespread visceral calcifications in disseminated Pneumocystis carinii infection: CT characteristics

A case of disseminated Pneumocystis carinii infection is presented. Calcifications of similar character were found by CT in the lymph nodes, spleen, liver, and kidneys. Biopsy of a calcified axillary lymph node demonstrated necrotizing granulomatous lymphadenitis, with Pneumocystis organisms and dystrophic calcifications clustered centrally within the granulomas.

Perirenal cobwebs: the expanding CT differential diagnosis.

Although initially described as representing collateral venous structures, perirenal cobwebs may be due to a variety of benign and malignant conditions. Six representative cases illustrating the broad differential diagnosis are presente.

Hypertrophied Thyroid Tissue in a Thyroglossal Duct Remnant

A 37-year-old woman was evaluated for a neck mass. This was located in the midline below the hyoid bone. Thirty-three years had elapsed since she had undergone subtotal thyroidectomy for hyperthyroidism. Eight years prior to examination, the patient had discontinued her thyroid maintenance medications. She had discovered the mass eight months prior to examination. Thyroid scan (Fig. 1) showed intense uptake in the mass. At operation the mass was attached to the midportion of the hyoid bone by a small fibrous band, as is usual in a thyroglossal duct remnant. Biopsy results showed diffuse thyroid hyperplasia. Thyroglossal duct remnants are known to harbor cysts or thyroid carcinoma, but growths of compensatory hyperplastic tissue are unusual.

Evaluation of STIR imaging as a complement to spin-echo MR and CT of the porta hepatis/hepatoduodenal ligament

Short TI inversion-recovery (STIR) imaging provides specific advantages over standard spin-echo (SE) MR sequences by producing additive effects of T1 and T2 brightening of pathology and suppression of the signal from surrounding fat. We retrospectively evaluated 12 patients with abnormalities, primarily neoplastic, of the porta hepatis/hepatoduodenal ligament (PH/HdL) with CT and MR imaging, including SE and STIR imaging. Masses on CT were of slightly decreased density compared to liver and seen in contrast to surrounding fat in the PH/HdL region. On MR, T1-weighted images provided comparable anatomic detail to CT, with masses clearly distinguished from surrounding fat due to the low signal intensity of masses as compared to fat. T2-weighted images clearly depicted intrahepatic lesions because of their high signal intensity relative to liver. Increased signal in extrahepatic lesions made them less distinctly seen from surrounding fat. STIR images best demonstrated tumor relative to fat. In six cases, CT was equivalent in demonstrating pathology to the best MR sequence. At least one MR sequence demonstrated pathology better than CT in 6 of 12 cases. In five of these six cases, the STIR sequence was better than CT. Thus, MR, particularly STIR imaging, provides a useful technique in imaging of PH/HdL pathology.

Semierect computed tomography of the abdomen using the Imatron ultrafast CT scanner.

Computed tomography of the abdomen was successfully performed in the semierect position on an Imatron C-100 ultrafast CT scanner. Investigations of gravitational effects on masses or air and/or fluid collections are other potential uses for semierect scanning.