James J. Sell

Epithelioid hemangioendothelioma of bone.

Abstract Neoplasms of bone can arise from any of the cellular elements that constitute osseous tissues. Although tumors of vascular origin are not uncommon, the vast majority are benign. A rare malignant vascular tumor – epithelioid hemangioendothelioma of bone – classifically affects young males and produces osteolytic lesions involving the cortex and cancellous bone of the lower extremities. We present a case with these findings, as well as such unusual findings as cervical spine instability and lesions affecting no fewer than 45 different bones. We conclude that epithelioid hemangioendo-thelioma should be investigated by skeletal survey because (1) osteolytic lesions involving more that 50% of the cortex present a serious risk for pathologic fracture and (2) the natural history of multicentric epithelioid hemangioendothelioma is more indolent than its solitary counterparts

Granulomatous amebic encephalitis caused by acanthamoeba

Abstract Infections arising from free-living amebae are rare. They generally cause recognizable disease only in chronically ill, debilitated patients who are immune suppressed. Only about 70 cases of granulomatous amebic encephalitis have been reported. We present an unusual case of granulomatous encephalitis in a 35-year-old man. Neurologic examination and laboratory tests were inconclusive. CT demonstrated bilateral low-density areas with mild mass effect in the cortex and subcortical white matter, which showed increased signal on T2-weighted MRI. Craniotomy and brain biopsy revealed granulomatous encephalitis with acanthamoeba organisms. Though nonspecific, imaging can support the diagnosis of amebic encephalitis and direct biopsy.

Distinguishing Hantavirus pulmonary syndrome from acute respiratory distress syndrome by chest radiography : Are there different radiographic manifestations of increased alveolar permeability ?

Hantavirus infection may cause diffuse air space disease, termed hanta-virus pulmonary syndrome (HPS). The authors sought to determine if chest radiographs could differentiate HPS from typical acute respiratory distress syndrome (ARDS). The authors identified patients with either HPS (n = 11) or acute ARDS (n = 32) and selected the earliest chest radiograph showing diffuse airspace disease, and a chest radiograph taken 24 to 48 hours previously. Thoracic and general radiologists first viewed the chest radiograph showing diffuse air space disease, and ranked the likelihood that each case represented HPS versus ARDS. Afterward, readers viewed earlier chest radiographs and rescored each case. Receiver operating characteristic (ROC) curves from both scoring sessions were generated. The mean areas under the ROC curves for the entire group was 0.83 ± 0.12 initially, and improved to 0.87 ± 0.09 (p < 0.05) after viewing prior chest radiographs. Receiver operating characteristic curves of thoracic radiologists described greater areas than those of general radiologists both before and after viewing prior chest radiographs; 0.95 ± 0.01 versus 0.78 ± 0.08 (p < 0.05) and 96 ± 0.02 versus 0.80 ± 0.05 (p < 0.05). The mean sensitivity and specificity of chest radiograph interpretation for HPS was 86 ± 13% and 74 ± 11%, respectively. Chest radiographs can differentiate HPS from ARDS. Accuracy is improved by the use of serial radiographs and more highly trained readers. The chest radiograph findings may represent differences in the extent of alveolar epithelial damage seen in HPS and ARDS.

Angiographic Pattern Change in Fibromuscular Dysplasia A Case Report

Fibromuscular dysplasia (FMD) is an angiopathy that commonly affects the renal arteries but may affect other medium to large arteries, including the carotid artery. It has a variety of angiographic appearances, the most common of which is a string-of-beads pattern consisting of a segment of alternating stenoses and dilatations. This case documents that these patterns are not necessarily fixed. An initial angiogram in a patient with neurologic symptoms shows a string-of-beads pattern in the carotid artery. Later, this pattern is seen to convert to a smooth tubular form on follow-up arteriography. FMD may present angio graphically as a dynamic process.

Gorham's syndrome. Correlative imaging using nuclear medicine, plain film, and 3-D CT.

The authors present a case of Gorhams syndrome involving the mandible in a 52-year-old man demonstrated by multiple imaging modalities. Gorhams Syndrome (diseappearing bone disease, massive osteolysis) is a rare idiopathic disorder of bone characterized radiographically by progressive bony resorption. The process is usually monostotic in the initial phase with involvement of adjacent bones by direct spread across joint spaces. The clinical course is unpredictable with spontaneous arrest of the osteolysis being common

CT demonstration of a giant adrenal endothelial cyst of the angiomatous subtype

Adrenal cysts are uncommon lesions with only approximately 300 having been reported to date. Histologically, they are heterogeneous in nature with angiomatous endothelial cysts being quite rare. The computed tomography of a woman with a very large cyst of this variety displayed thin walls with a few septations and foci of soft tissue within. The possibility of a large cystic mass originating from the adrenal gland must be considered in the diagnosis when a large abdominal mass is encountered.

Arteriography with Portable DSA Equipment

Fifty-one arteriograms were obtained outside of the radiology department with portable digital subtraction angiographic equipment. Thirty-five studies were performed in the emergency room, 12 in the operating room, and four in the intensive care unit. There was a significant decrease in the time interval from arrival in the emergency room to arteriogram completion for examinations performed in the emergency room with portable equipment, compared with those performed in the radiology department. One of the 51 examinations yielded questionable results and was repeated with the conventional screen-film technique. Accurate angiographic diagnoses can be obtained by means of portable equipment in a variety of hospital locations.