Yul Lee

Cervical tuberculous lymphadenitis : CT findings

Objective Cervical tuberculous lymphadenitis (CTBL) is still an important cause of neck mass in many countries. The purpose of this study is to analyze the CT findings of CTBL and compare them with those of malignant lymphadeno pathies and pyogenic abscesses in the neck. Materials and Methods We retrospectively reviewed the CT scans of 32 CTBLs, 25 malignant lymphadenopathies, and 12 pyogenic abscesses in the neck. Attenuation value, enhancement pattern, and surrounding fat plane were evaluated. Results The CT findings of CTBL were classified into four types: type 1, homogeneous soft tissue density; type 2, central low density and peripheral rim enhancement with relative preservation of surrounding fat planes; type 3, multilocular central low densities and peripheral rim enhancement with obliteration of surrounding fat planes; and type 4, large confluent low density with peripheral rim enhancement and loss of lymph node architecture. Among the 32 cases of CTBL, type 3 was most frequently noted (59.4%) followed by type 2 (21.9%), type 4 (15.6%), and type 1 (12.5%). The enhancing rim of CTBL was usually thick and irregular in contrast to some malignant lymph nodes showing thin and regular rim enhancement. The degree of surrounding fat plane obliteration was less in type 4 CTBL than in pyogenic cervical abscess. Conclusion Cervical tuberculous lymphadenitis usually shows a central low density and peripheral rim enhancement that tends to be thick and irregular compared with a malignant lymphadenopathy. Multilocular low densities with peripheral enhancement and a large confluent low density with less degree of fat plane obliteration than a pyogenic abscess are suggestive features of advanced CTBL.

Tuberculous abscess in retromammary region: CT findings.

PURPOSEnOur goal was to evaluate CT findings of tuberculous abscess in the retromammary region of the breast.nnnMETHODnFour patients with tuberculosis extending from the retromammary region to the pleura were examined by CT and the findings were evaluated. All cases were also examined with mammography and two cases were evaluated with sonography. Diagnosis was confirmed by acid-fast bacillus stain, culture, and histologic examination.nnnRESULTSnMammography showed relatively smoothly marginated, round mass density in two cases, nodular density in one, and focal bulging of the pectoral wall in one. A sonogram demonstrated in two cases a fistulous connection from the heterogeneous, fluid-containing lesion with floating internal debris in the retromammary region to the thoracic cavity. In all four cases, CT showed relatively smoothly marginated, inhomogeneous, hypodense lesions with surrounding rims of the cold abscess type. A direct fistulous connection from the retromammary lesion through the thoracic wall into the pleura was seen in two cases. Destroyed rib fragments within the abscess were noted in two cases.nnnCONCLUSIONnA tuberculous abscess in the retromammary region usually showed on CT a focal, smoothly marginated, inhomogeneous, hypodense lesion with a surrounding enhancing rim. A direct fistulous connection with the pleura or a destroyed rib fragment in the abscess as revealed by CT can be helpful in the differential diagnosis of other infectious types of retromammary abscess.

Factors Affecting the Efficacy of Ultrasound-Guided Vacuum-Assisted Percutaneous Excision for Removal of Benign Breast Lesions

This study was designed to evaluate the effectiveness of complete removal and factors affecting the presence of a residual mass and complications after ultrasound‐guided vacuum‐assisted percutaneous removal of benign breast lesions.

MR imaging of shaken baby syndrome manifested as chronic subdural hematoma

Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanced MRI revealed diffuse dural enhancement.

Bronchus-Associated Lymphoid Tissue (BALT) Lymphoma of the Lung Showing Mosaic Pattern of Inhomogeneous Attenuation on Thin-section CT: A Case Report

The authors present a case of histologically proven bronchus-associated lymphoid tissue (BALT) lymphoma of the lung in a patient with primary Sjögrens syndrome that manifested on thin-section CT scan as a mosaic pattern of inhomogeneous attenuation due to mixed small airway and infiltrative abnormalities

An Immunoglobulin G4-Related Sclerosing Disease of the Small Bowel: CT and Small Bowel Series Findings

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

CT and US findings of ovarian torsion within an incarcerated inguinal hernia

Inguinal hernia is relatively common in children. Although inguinal hernia is not frequently encountered in girls in comparison to boys, there are occasional cases of uterine or ovarian herniation in female indirect inguinal hernia. Incarcerated ovary in hernia sac has the risk of torsion and strangulation. We present an 8-year-old girl with painful mass in her left groin. With computed tomography (CT) and ultrasonography (US), we made the diagnosis of ovarian strangulation within an incarcerated inguinal hernia. Since ultrasound is primarily used for evaluation of groin mass, CT findings of an incarcerated inguinal hernia is rarely reported.

Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

Objective Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. Materials and Methods We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. Results The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Conclusion Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

Intra-Appendiceal Air at CT: Is It a Useful or a Confusing Sign for the Diagnosis of Acute Appendicitis?

Objective To investigate the significance of intra-appendiceal air at CT for the evaluation of appendicitis. Materials and Methods We retrospectively analyzed 458 patients (216 men, 242 women; age range, 18-91 years) who underwent CT for suspected appendicitis. Two independent readers reviewed the CT. Prevalence, amount, and appearance of intra-appendiceal air were assessed and compared between the patients with and without appendicitis. Performance of CT diagnosis was evaluated in two reading strategies: once ignoring appendiceal air (strategy 1), and the other time considering presence of appendiceal air as indicative of no appendicitis in otherwise indeterminate cases (strategy 2), using receiver operating characteristic (ROC) analysis. Results Of the 458 patients, 102 had confirmed appendicitis. The prevalence of intra-appendiceal air was significantly different between patients with (13.2%) and without (79.8%) appendicitis (p < 0.001). The amount of appendiceal air was significantly lesser in patients having appendicitis as compared with the normal group, for both reader 1 (p = 0.011) and reader 2 (p = 0.002). Stool-like appearance and air-fluid levels were more common in the appendicitis group than in the normal appendix for both readers (p < 0.05). Areas under the ROC curves were not significantly different between strategies 1 and 2 in reader 1 (0.971 vs. 0.985, respectively; p = 0.056), but showed a small difference in reader 2 (0.969 vs. 0.986, respectively; p = 0.042). Conclusion Although significant differences were seen in the prevalence, amount, and appearance of intra-appendiceal air between patients with and without appendicitis, it has a limited incremental value for the diagnosis of acute appendicitis.

Morphologic classification of congenital short pancreas on multidetector computed tomography.

Objective The objective of this study was to assess the imaging characteristics and classify congenital short pancreas on the basis of morphologic features on multidetector computed tomography (MDCT) and to determine the associated diseases and congenital anomalies of each type. Methods We conducted a retrospective search from 2006 to 2012 using the keywords “short pancreas,” “agenesis or hypoplasia of the dorsal pancreas,” or “hypoplasia of the ventral pancreas.” Clinical data and images were analyzed; finally, 24 patients with congenital short pancreas were included in this study. Imaging features of the 3 types of congenital short pancreas and their associated anomalies on MDCT were evaluated. Results Congenital short pancreas was classified into type 1 (agenesis or hypoplasia of the dorsal pancreas): no congenital anomaly but presence of diabetes mellitus (45%); type 2 (agenesis or hypoplasia of the pancreatic uncinate process): intestinal malrotation (100%); and type 3 (combined hypoplasia or agenesis of the uncinate process and dorsal pancreas): a spectrum of various congenital anomalies, including abdominal heterotaxy and abnormal spleen (100%). Conclusions Recognizing the spectrum of agenesis or hypoplasia of the pancreas and morphologic classification of congenital short pancreas on MDCT may help radiologists detect and understand disease associated with congenital short pancreas.