Manorama Berry

Computed Tomography of Vertebral Tuberculosis: Patterns of Bone Destruction

A retrospective analysis was performed of CT scans of 30 consecutive patients with a clinical suspicion or diagnosis of spinal tuberculosis. Four patterns of bone destruction were noted, namely, fragmentary, osteolytic, subperiosteal and well-defined lytic with sclerotic margins. The fragmentary type was most common (47%). Intervertebral disc destruction was always associated with contiguous vertebral body destruction. Associated paravertebral soft-tissue masses were seen in all patients. Epidural extension of disease was seen in 66% and showed a very good correlation with neurological signs on clinical evaluation. Bone fragments were detected in the epidural soft-tissue mass in 65% of patients with epidural extension of disease. CT appearances of bone destruction are highly suggestive of tuberculous osteomyelitis in about half the patients.

Sonographic findings in grade III dengue hemorrhagic fever in adults

Sonography has been used to evaluate children with dengue hemorrhagic fever, but to our knowledge no such studies have been conducted with adults. We present the sonographic findings in 40 adults with severe (grade III) dengue hemorrhagic fever (DHF).

Tru-Cut biopsy of mediastinal masses guided by real-time sonography

Twenty-five patients with mediastinal masses, arising in the anterior, middle and posterior mediastinum but in contact with the chest wall, underwent ultrasound (US) guided biopsy with a Tru-Cut needle to obtain a core biopsy specimen from the mass. In all these patients adequate tissue was obtained for a histopathological diagnosis and no major complications were observed. The advantage of core biopsy over fine needle aspiration cytology in mediastinal masses is that accurate histopathological differentiation, and classification of carcinomas and lymphomas is possible. The advantage of performing real-time US guided biopsy is that puncture of the lung and mediastinal vascular structures is avoided.

Bony ankylosis of the temporomandibular joint: a computed tomography study.

Bony ankylosis of the temporomandibular joint is a disabling disease that almost invariably manifests itself in the first two decades of life. CT of the temporomandibular joints was performed in 50 patients--axial CT in 2 and coronal CT in 48--of whom 43 (86%) had received trauma to the joints. New bone of variable form and thickness was observed in 64 joints (the involvement was bilateral in 14 patients). These joints were classified into one of two categories: type I, medially angulated condyle with deformed articular fossa and a mild-to-moderate amount of new bone formation; and type II, no recognizable condyle or fossa but instead a large mass of new bone. Type I was etiology-specific and seen only when trauma was the antecedent, whereas type II was a sequelae of either insult. A pseudofracture in the new bone was seen in 49 (77%) joints. Six joints showed subtle deformities but no new bone. Since coronal CT fully characterizes the lesion at acceptable radiation exposure levels, it appears to be valuable in the preoperative workup of these patients.

Esophageal and gastric vasculature in children with extrahepatic portal hypertension Evaluation by intravenous CT portography

PURPOSE To compare the findings related to esophageal/gastric varices and congestive gastropathy on intravenous computed tomography (CT) portography (CTP) and upper gastrointestinal endoscopy (UGIE) in children with extrahepatic portal venous obstruction (EHO) presented with hematemesis. METHODS/MATERIALS Fifty pediatric patients (age < 15 years) with EHO (initially diagnosed on abdominal ultrasound) presented with hematemesis and underwent UGIE and intravenous CTP using a helical CT scanner. Axial sections of 2 mm each were obtained with a collimation of 2 mm and a table feed of 3 mm. CTP findings on these axial sections were compared with UGIE (gold standard). RESULTS The sensitivity of CTP for detection of esophageal varices, gastric varices, and gastropathy was 32/33 (97%), 38/40 (95%), and 30/32 (93%), respectively. CTP showed false positivity as well, which was 5/17 (29%), 2/10 (20%), and 13/17 (76%) for esophageal varices, gastric varices, and gastropathy, respectively. On follow-up UGIE, the endoscopic features appeared in 14/19 (74%) of false positive patients. Therefore, false positivity for all the parameters on CTP when compared to the initial UGIE represented the changes in vasculature before they were endoscopically manifest. CONCLUSIONS CTP was likely to pick up changes in esophageal and gastric vasculature earlier than UGIE in children with EHO presented with hematemesis.

Hepatic granulomas due to visceral larva migrans in adults: appearance on US and MRI

Visceral larva migrans is a syndrome characteristically involving children with a history of pica, and usually presents with fever, abdominal pain, tender hepatomegaly, and hypereosinophilia. Hepatic granulomas of visceral larva migrans are rare in adults. We describe three adult patients with hepatic lesions which on histopathology demonstrated characteristic granulomas of visceral larva migrans. All patients had abdominal sonograms and two had additional MR scans of the liver. Both ultrasound and magnetic resonance imaging demonstrated characteristic appearances which have not been described previously (viz., ill-defined central necrotic areas surrounded by concentric thick walls and perifocal edema in the liver parenchyma).

Primary tubercular abscess of the spleen

A 12-year-old boy with localized tubercular abscess of the spleen is presented. The diagnosis was established on histopathologic examination. Treatment consisted of splenectomy and postoperative antitubercular therapy.

Diffuse pneumocephalus due to meningitis: CT findings

Diffuse pneumocephalus due to infection by gas forming organisms is very unusual. We report computed tomography (CT) findings of such a case in an infant withClostridium meningitis.

Ventriculo-peritoneal shunt presenting with recurrent pleural effusion: Report of a new complication

Ventriculo-peritoneal shunts for hydrocephalus are reported to have a number of complications. We describe an unusual complication not previously listed.

The unusual imaging appearance of primary retroperitoneal teratoma: report of a case.

Primary retroperitoneal (RP) teratoma is a rare entity which has a distinctive imaging appearance. We describe herein the case of a 25-year-old man in whom a RP teratoma was found to have an extremely unusual imaging morphology by ultrasound and computed tomography (CT). The tumor was resected and histopathological examination confirmed the diagnosis of primary benign RP teratoma.