Robert C. Sarno

Cystic lymphangiomas: CT diagnosis and thin needle aspiration

Cystic lymphangiomas of the retroperitoneum are rare benign tumours (Castellino & Finkelstein, 1975) which have previously been difficult to diagnose by conventional radiographic techniques (Hamilton & McInerney, 1981). These tumours have been evaluated by several modalities: computed tomography, ultrasound, thin needle aspiration, and lymphangiography and in one case a correct diagnosis was suggested preoperatively (Radin et al, 1983). We describe two cases of cystic lymphangioma of the retroperitoneum demonstrated and diagnosed by computed tomography and thin needle aspiration. The first case was proven to be a cystic lymphangioma at surgery. The second case, after its CT demonstration and thin needle aspiration, was managed conservatively and followed by computed tomography. In the appropriate clinical setting, conservative management of these benign tumours might well be considered.

Computed tomography in tarsal coalition.

The limitations of routine radiography of the feet in demonstrating tarsal coalitions are well known. Even with the use of multiple projections of the foot, tarsal coalitions may escape detection. Computed tomographic examinations of the feet were performed in persons suspected of having tarsal coalitions. The CT images were obtained in both the longitudinal and axial axes of the foot. Results of these examinations suggest the longitudinal projection to be most helpful in demonstrating talonavicular coalitions and the axial projection in demonstrating talocalcaneal coalitions. The history, pathology, and other imaging modalities of tarsal coalitions are reviewed.

Computer assisted tomography of urachal abnormalities.

Three examples of urachal abnormalities are presented: two urachal cysts and one urachal carcinoma. These cases demonstrate the value of computed tomography in detecting urachal abnormalities, particularly if there is no communication between the bladder and the urachal remnant. The embryonic development of the bladder is discussed, particularly with reference to the development of urachal abnormalities.

Arthroscopic treatment of medial meniscal avulsion fractures

The meniscal ossicle is an infrequent radiographic finding in humans. It has long been recognized in relation to trauma to the meniscus. Previous theories as to the etiology of these ossicles have been that they are vestigial or result from metaplastic change in an area of injury. We present four patients with meniscal ossicles associated with a longitudinal tear of the medial meniscus. The origin of the ossicle was an avulsion of the insertion of the posterior horn of the medial meniscus. Arthroscopic resection in these patients resolved their symptoms.

Bullous change by CT heralding metastatic sarcoma

The association of spontaneous pneumothorax with metastatic osteosarcoma is well known. Small blebs and bullous change can be easily detected in the lungs by computed tomography. In patients with known sarcomas, blebs and bullae may appear as the first or early manifestation of metastatic disease (or concurrent with the disease) as illustrated by the three patients presented here with three different types of sarcomas. The literature has been reviewed as to the etiology of spontaneous pneumothoraces occurring in metastatic sarcomas and the relationship of bleb and bullae formation to these spontaneous pneumothoraces is discussed.

CT scanning in septic sacroiliac arthritis or periarticular osteomyelitis.

Two cases are presented which demonstrate the utility of CT scanning in the evaluation of patients with septic sacroiliitis. The importance of making an early diagnosis in such patients is noted and the roles of various other modalities are related to that of CT scanning.

Computed tomography differentiation of pyelonephritis and renal infarction

Acute renal infarction and acute pyelonephritis can have identical clinical presentations. Most of the computed tomography findings seen in acute renal infarction are similar to those in acute pyelonephritis, except for the characteristic cortical rim sign seen in acute infarction. This finding differentiates these two disorders. This sign may be subtle and not appreciated unless searched for diligently with appropriate computed tomography imaging at varying window settings with particular attention to the subcapsular region.

Detection of Bacterial Endocarditis with lndium-111 Labeled Leukocytes

Bacterial endocarditis in a patient with dense mitral annular calcification secondary to renal failure and hyperparathyroidism was detected by indium-111 labeled leukocyte imaging. Although the gallium-67 image was negative, echocardiography subsequently confirmed the diagnosis.

A case of biliary atresia and polysplenia. Evaluation by hepatobiliary scintigraphy.

A 5-week old jaundiced female underwent hepatobiliary scintigraphy using technetium-99m disofenin. Early images suggested right-sided cardiac activity. A nearly symmetric, bilobed liver with left-sided predominance was discovered. No biliary ducts, gallbladder, or small bowel activity were demonstrated up to 24 hours postinjection. Laparotomy confirmed situs inversus, polysplenia, and extrahepatic biliary atresia.

Solubilized xenon 133 lung scintigraphy

Lung scanning using solubilized xenon 133 can provide important information concerning both pulmonary perfusion and ventilation. This technique proved valuable in establishing the diagnosis of congenital lobar emphysema in a 7-month-old baby.