Neela Lamki

Computed tomography of complicated cholecystitis

Reported are 10 patients with surgically verified acute cholecystitis and its complications. Of these 10 patients, 6 (60%) had atypical clinical presentation so that cholecystitis was not the primary diagnosis being considered before computed tomography. Common computed tomography findings included gallbladder wall thickening (100%), pericholecystic fluid (80%), gallstones (50%), and air in the gallbladder lumen and wall (20%). An awareness of the computed tomography appearances can be helpful in the diagnosis of complicated cholecystitis even when the clinical presentation is atypical.

Massive hepatic necrosis in the hellp syndrome: Ct correlation

We present a patient with toxemia of pregnancy and the HELLP syndrome [hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP)] resulting in massive hepatic necrosis. Cross-sectional imaging, including sonography, computed tomography, and nuclear medicine, was instrumental in the diagnosis and differentiation from hepatic abnormalities of other pregnancy related entities especially acute fatty liver of pregnancy.

ADENOMYOMATOUS HAMARTOMA CAUSING ILEOILEAL INTUSSUSCEPTION IN A YOUNG CHILD

Abstract An unusual case of adenomyomatous hamartoma of ileum leading to ileo-ileal intussusception in a 22-month-old child is reported.

Aggressive infantile fibromatosis : pulmonary metastases documented by plain film and computed tomography

Aggressive infantile fibromatosis, one of the juvenile fibromatoses, is generally considered a benign lesion, but it does tend to recur locally because of its invasive nature. Distant metastases are considered rare. This case report documents pulmonary metastases arising 2 years after resection of the primary lesion from the thigh of an infant. This is the seventh reported case of distant metastasis from aggressive infantile fibromatosis. Computed tomography of the original lesion as well as the metastases are presented.

Metastasis to the bladder from pancreatic adenocarcinoma presenting with hematuria

Pancreatic adenocarcinoma infrequently involves the urinary tract. Hematuria may result from either direct invasion of the kidneys or from metastases to the urinary tract. The bladder may be involved in the late stages from metastases, but rarely is it associated with hematuria since mucosal involvement is very unusual. We report a second case of bladder metastases and hematuria as a presenting symptom of pancreatic carcinoma.

Abdominal cryptococcoma in AIDS: a case report

Cryptococcosis is a recognized opportunistic pathogen in the acquired immune deficiency syndrome. Although central nervous system infection and disseminated cryptococcosis is common in acquired immune deficiency syndrome, localized infection is rare. We present a case of massive retroperitoneal and mesenteric adenopathy in a male homosexual patient with acquired immune deficiency syndrome with clinical and radiologic features suggestive of lymphoma. However, this was proven pathologically to represent cryptococcal infiltration of the lymph nodes. Our experience indicates that Cryptococcus neoformans should be included in the differential diagnosis of massive abdominal adenopathy in the acquired immune deficiency syndrome.

THE RADIOLOGY OF THE THORACIC MANIFESTATIONS OF AIDS

The thoracic manifestations of AIDS have undergone a gradual metamorphosis, partly due to more awareness about the disease leading to earlier diagnoses and partly due to the fact that research has produced more effective prophylaxis as well as treatment for these patients. Many patients now demonstrate partial or complete clinical response which prolongs the length and quality of life of individuals positive for the Human Immunodeficiency Virus (HIV+). Also, with the large number of infected individuals coming to medical attention, and the years of experience in diagnosing and treating these AIDS patients, we now recognize not only the usual but also less usual manifestations of thoracic illnesses in AIDS, including infections, non-infectious diseases such as HIV associated Lymphocytic Interstitial Pneumonia and the neoplasms associated with AIDS. A section will be devoted to HIV infection in children. We will finish the article with a discussion of the current role of Nuclear Medicine in the diagnosis of HIV associated thoracic diseases. These topics are the subject of this article.

HIDA and pseudosplenomegaly in hydatid cyst and amebic abscess of liver.

Tc-99m-HIDA and related compounds have been universally accepted for studying the hepatobiliary system. The authors describe yet another use of HIDA documented by three case reports. HIDA is taken up by the hepatocytes and not by the reticuloenthothelial system. Two patients are described, one with hydatid cyst and the second with amebic abscess of the liver, in whom splenomegaly was diagnosed clinically and confirmed by ultrasonography as well as by Tc-99m-tin colloid scan. HIDA imaging proved the spleens to be normal. A displaced right lobe of the liver in one case, and an enlarged left lobe in the other, led to this erroneous diagnosis, which the authors term “pseudosplenomegaly.” In the third patient, HIDA not only clarified the extent of the spleen, but also revealed a “cold” area in the left lobe of the liver. This was missed by the colloid scan because of the position of the “cold” area.

Abdominal Approach to Pelvic Sonography

Sonography is an imaging modality that utilizes high-frequency sound waves. The sound waves are produced by a crystal within the transducer, a hand-held device that is placed in contact with the area of the body to be scanned. Gel is placed on the patient’s skin to ensure good transmission of sound into the body. Each time the sound beam strikes tissue interfaces, an echo will be produced and displayed on a monitor as a dot (either black or white), the intensity of which corresponds to its brightness. The combination of innumerable echoes gives a textural and anatomic representation of the structures scanned.