Terrence C. Demos

Congenital and acquired lung hernias

Lung hernia is defined as a protrusion of lung parenchyma beyond the confines of the musculoskeletal thorax. Lung hernias can be classified according to location (i.e., cervical, thoracic, or diaphragmatic) and etiology. Approximately 80% of reported cases of lung hernia are acquired, usually related to trauma or surgery. Symptoms are few, infrequent, and vague. A painless, local, and inconstant bulging is evident on physical examination. The diagnosis of a lung herniation is accomplished using chest radiographs in the most cases. Surgery is usually reserved for large hernias or incarcerated hernias.

Evaluation of image quality using 1 : 1 pitch and 1.5 : 1 pitch helical CT in children: a comparative study.

ObjectiveThe objective of this study was to compare the quality of 1∶1 and 1.5 ∶1 pitch helical contrast-enhanced thoracic and abdominal CT images in children who cannot cooperate for breath holding.Materials and methodsThis is a retrospective study of 33 contrast-enhanced CT examinations in 11 children of 0–4 years of age. All children had an initial CT study using 1∶1 pitch helical scanning followed over the next 6–36 months by one to four CT examinations with 1.5∶1 pitch. Radiation dose with the two techniques was measured with a pencil Ionization chamber.ResultsThe two techniques provided comparable overall image quality. There was 33 % less radiation dose with 1.5∶1 pitch helical scanning.ConclusionThe 1.5∶1 pitch helical CT provides comparable quality images and a smaller radiation dose than 1∶1 pitch in examining children aged 0–4 years.

Enlarged peroneal process with peroneus longus tendon entrapment.

Abstract A 50-year-old man was treated conservatively for chronic bilateral ankle pain for several years. Plain radiographs obtained following exacerbation of symptoms showed bilateral enlarged peroneal processes. CT and MRI demonstrated bony detail of the unusual processes and also showed isolation of the peroneus longus tendons and associated tendinitis and partial tears.

Primary angiosarcoma of the abdominal aorta: a case report and literature review (aortic angiosarcoma)

Fewer than 140 cases of aortic sarcoma have been reported with only 34 classified as angiosarcoma. These rare malignancies most often mimic aortoiliac occlusive or aneurysmal arteriosclerotic disease both clinically and on imaging studies, and the large majority are unexpected and diagnosed pathologically on a surgical specimen or at autopsy [1–5]. A 42-year-old woman who presented with low back pain and claudication was shown by CT and angiography to have infrarenal aortic occlusion. Angiosarcoma was an unexpected pathologic diagnosis based on tissue removed during aortobifemoral bypass surgery. Pre and postoperative CT and angiography are presented along with a review of the literature.

Computed tomography in traumatic defects of the diaphragm

Two patients with traumatic diaphragmatic defects visible on computed tomography are presented. The diagnosis was delayed for several years in both patients. The diagnosis of these acquired diaphragmatic defects is often difficult. Computed tomography can lead to earlier diagnosis by demonstrating the defect in some patients when radiographic studies are not diagnostic.

Mycobacterium intracellulare infection of the shoulder and spine in a patient with steroid-treated systemic lupus erythematosus

Atypical mycobacterial infections of bone are rare. A patient with systemic lupus erythematosus treated with steroids developed an M. intracellulare infection of the shoulder and spine. These infections are insidious and diagnosis is difficult. Marked involvement of one joint, large effusion, or aspirated small synovial fragments suggest an atypical tuberculous joint infection.

CT diagnosis of idiopathic aneurysms of the thoracic systemic veins.

Three patients with idiopathic aneurysms of the superior vena cava, left innominate vein, and inferior vena cava are presented. The advantages of CT over other diagnostic modalities are discussed.

Normal excretory urography in patients with primary kidney neoplasms

The records of 65 consecutive patients discharged from the hospital with a diagnosis of primary parenchymal neoplasm of the kidney were reviewed. Four of the 65 patients had neoplasms which were not detected by excretory urography. The 4 undetected lesions included 3 renal cell carcinomas and 1 oncocytoma. All of these lesions projected from the anterior or posterior surface of the kidney, and all 4 were clearly demonstrated by computed tomography. Normal findings on an excretory urogram do not completely exclude a neoplasm of the kidney. When there is strong clinical suspicion of a renal neoplasm, computed tomography should be the initial examination or should be done even if the urogram has shown normal findings.

Multifocal vascular lesions of bone: imaging characteristics.

Abstract Objective. Multifocal vascular processes which arise in bone are a very inhomogeneous class of diseases. Four of these processes are derived from endothelial precursors, however, and share a similar radiographic spectrum. These four entities are reviewed in order to clarify their imaging patterns and the diagnostic utility of imaging modalities. Methods. Eight cases of cystic angiomatosis, multifocal hemangioma, hemangioendothelioma and angiosarcoma presenting to a tertiary referral center over a 7-year period were reviewed. The medical literature was also reviewed for information concerning the imaging of these processes. Results. All four diseases produced radiolucent defects on plain radiographs with variable margination reflecting the aggressiveness of the lesions. Computed tomography was used to examine five patients and provided supportive, though generally non-diagnostic, information in the five cases in which it was performed. Radionuclide bone scintigraphy, as reported in the literature, underestimated the extent of skeletal involvement in all eight cases, though some lesions were identified. Radionuclide imaging with labeled red blood cells, performed in three cases, did not add any information, which is contrary to some reports in the literature. Magnetic resonance imaging proved the most sensitive for identifying lesions, although the imaging characteristics were not diagnostic. Conclusions. Plain radiographs are the mainstay for imaging multifocal endothelial processes. Radiographs provide information on aggressiveness, multifocality and distribution of lesions. Computed tomography provides similar information. Magnetic resonance imaging often detects additional lesions. The insensitivity of radionuclide bone scintigraphy is surprising. Reports of unique deposition of radionuclide in tagged red blood cell scanning has been reported to support the diagnosis of vascular lesions, but it did not do so in these cases.

Traumatic longitudinal disruption of the carpus

Traumatic longitudinal disruption of the carpus is a rare injury that usually occurs through a weak point between the third and fourth metacarpals and the capitate and hamate. Three cases are reported; all injuries were work related and occurred with a broad crushing injury to the hand and wrist. Two patients were treated by fasciotomies, a carpal tunnel release, and excision of a fractured hook of the hamate. The third patient was treated with carpal tunnel release and percutaneous pinning of a wide diastasis. Despite the return of wrist motion, pinch and grip strength remained below normal range in all three patients at follow-up examinations.