Suppiah Balachandran

Lymphoepithelial cyst of the pancreas

Lymphoepithelial cyst of the pancreas is a rare lesion which may mimic a pancreatic pseudocyst or mucinous cystic neoplasm. To our knowledge, this lesion has never been reported in the radiologic literature. We present a patient with lymphoepithelial cyst of the pancreas, and we discuss the radiographic and pathologic findings.

Value of thyroid carcinoma imaging after therapeutic doses of radioiodine.

Thyroid carcinoma scans in the immediate post-therapy period after therapeutic doses of l-131 for well-differentiated thyroid carcinoma showed additional lesions in ten of 24 (42%) patients or on 13 of 42 (31%) occasions, whereas the corresponding pretreatment diagnostic scans done with a small test dose failed to reveal the lesions. In four patients, lesions were only discernible on the regional rectilinear scan views and not on the total-body images. The value of post-therapy scans and the importance of obtaining the regional views are emphasized.

Relative roles of radionuclide scanning and radiographic imaging in eosinophilic granuloma

Twenty-four skeletal lesions were studied in seven patients with eosinophilic granuloma by radiographic skeletal surveys and radionuclide bone imaging. The radiographs detected 22 (92%) of these lesions and missed only two, whereas the scintiscans identified only 16 (67%) of these lesions, and missed eight. Radiographic skeletal survey and radionuclide bone imaging are complementary procedures in detecting bone lesions in bone marrow disorders, including eosinophilic granuloma. Use of either method alone is fraught with the danger of missing bone lesions of eosinophilic granuloma.

Postoperative atrophy of abdominal wall musculature : CT demonstration

Eleven cases in which CT demonstrated severe unilateral atrophy of abdominal wall musculature were reviewed. All patients had undergone surgery on the ipsilateral side 6 months to 28 years prior to CT. The patterns of muscular atrophy correlated well with the type of incision made and the nature of surgery performed. Denervation injury resulting from surgical incision is the most likely explanation for this finding on CT. Normal innervation of abdominal wall muscle groups is discussed, and the relationship of unilateral muscular atrophy to previous surgical incision is emphasized.

Postoperative atrophy of posterolateral chest wall musculature : CT demonstration

We review five cases in which CT demonstrated severe unilateral atrophy of the latissimus dorsi muscle. In four of these cases, similar findings were also seen in the inferior portion of the serratus anterior muscle. All patients had undergone thoracic surgery on the ipsilateral side 10 months to 3 1/2 years prior to CT. All patients had undergone posterolateral thoracotomy, including one who had undergone successive right and left posterolateral thoracotomies. The most likely explanation for the CT finding of atrophy is denervation injury resulting from surgical incision. We discuss normal innervation of the posterolateral chest wall musculature, with emphasis on the relationship of unilateral atrophy of posterolateral chest wall musculature to previous surgical incision. Index Terms: Muscles, atrophy—Thorax—Surgery—Thoracotomy—Computed tomography.

Tumoral calcinosis: scintigraphic studies of an affected family

Tumoral calcinosis is a rare, familial ectopic calcification syndrome associated with hyperphosphataemia. A family in which seven of 13 siblings had demonstrable, clinical, radiological and pathological findings of tumoral calcinosis was evaluated. The purposes were to compare the efficacy of bone scintiscans with serum phosphorus determination in detecting subclinical disease early in asymptomatic siblings and to assess therapeutic results in affected family members following initiation of phosphate depletion therapy. History, physical examination, serum calcium, serum phosphorus and bone scintiscans were performed in 12 of 13 siblings. All the affected siblings had markedly elevated serum phosphorus levels and abnormal bone scintiscans while the unaffected siblings had normal serum phosphorus levels and normal bone scintiscans. All the siblings, affected and unaffected, were normocalcaemic. After initiation of phosphate depletion therapy, gross changes in the appearance of lesions were detected on bone scintiscans. Serum phosphorus levels likewise showed a modest decline, although still remaining in the hyperphosphataemic range. In conclusion, bone scintiscans and serum phosphorus determinations are equally sensitive in detecting subclinical disease. However, the scintiscans are helpful in assessing not only the extent of the disease, but also whole-body and regional changes following any therapeutic interventions.

Scintiscans of two siblings with tumoral calcinosis.

Seven of 15 siblings were affected by tumoral calcinosis, a rare ectopic calcification syndrome. Case reports and scintigraphic findings of two affected siblings are presented. Bone scintiscanning may be useful in determining both initial extent of the disease and prognosis after treatment.

Unilateral septic sacro-iliitis: Importance of the anterior view of the bone scan

Two cases of unilateral septic sacro-iliitis are reported. Importance of the anterior view of sacroiliac joints on the radionuclide bone scan is stressed. Limitation of the posterior view in evaluation of sacroiliac joints may lead to misdiagnosis and false negative results in unilateral sacro-illiac disease.

Localization of Tc-99m-MDP in amyloidosis of the breast.

Visualization of amyloid deposition in breasts by bone scanning agent Tc-99m-MDP is presented. Marked deposition of amyloid in the intercellular spaces between fat cells is believed to be responsible for the appearance seen on the bone scan of this patient.

Indium-111 leukocyte uptake in neoplasms

Uptake of In-111 leukocytes by tumors may lead to a false diagnosis of abscess. Differentiation of tumor from abscess is an especially important problem in the brain. A patient with a metastatic brain lesion that showed In-111 WBC uptake was studied. Subsequently, 19 tumor sites were studied in 16 patients who had variety of neoplasms. In nine sites, histologic examination of biopsy or autopsy material showed granulocytic, lymphocytic, or macrophagic infiltration, and six of these had In-111 leukocyte uptake. Three sites had brain metastases, and uptake occurred variably in a variety of other tumors. Uptake of In-111 leukocytes by tumors must be recognized as a diagnostic hazard using this method for detection of suspected abscesses, which may be especially confusing in a patient with cancer.