[Comparisons of pulmonary and sinonasal lesions in patients with cystic fibrosis. Evaluation using computerized tomography]

INTRODUCTION

Cystic fibrosis is a recessive genetic systemic exocrinopathy caused by a variety of mutations in the cystic fibrosis transmembrane conductance regulator gene (CFTR). The disease is characterized by alterations of the secretions, which become thickened and viscous. Both the paranasal sinuses and the lung parenchyma are involved in all cases. The aim of this study was to assess a correlation between the rhinosinusal and lung parenchyma changes in cystic fibrosis patients.

MATERIAL AND METHODS

Eighteen patients (11 men and 7 women, age range: 8 to 22 years) were examined with chest HRCT and sinonasal low dose CT. Lung symptoms were found in all patients; 13 of them, also affected with rhinosinusal symptoms, had been examined with ENT and nasal endoscopy. The other 5 patients, without rhinosinusal symptoms and previously examined with ENT, were evaluated as control group. Chest CT was performed with the high-resolution technique, 2 mm slice thickness and 10 mm table feed. Rhinosinusal CT was performed with the low dose technique, acquiring contiguous 2-4 mm thickness coronal sections. The CT patterns were analyzed by two radiologists and scored as slight, medium and diffuse involvement of both districts.

RESULTS

No statistically significant correlation between lung and sinonasal damage was found in our study. Parenchymal lung involvement appeared more severe than sinonasal involvement in 14/18 patients. The retention of secretions in the paranasal sinuses, even if limited, was demonstrated in all symptomatic and asymptomatic patients.

CONCLUSIONS

The absence of correlation between pulmonary and sinonasal damage and more generally, the different severity of cystic fibrosis can be caused by different allele mutations of the cystic fibrosis transmembrane conductance regulator gene, the most frequent of which is Delta F-508.

The role of the ostiomeatal unit anatomic variations in inflammatory disease of the maxillary sinuses

OBJECTIVE

The purpose of the study was to determine the correlation between bony anatomic variations of the ostiomeatal unit (OMU) and chronic maxillary sinusitis. The study was based on the hypothesis that the mucosal contact caused by the variations represents the critical factor in increasing the risk of maxillary sinusitis.

MATERIALS AND METHODS

Thin section high resolution computerised tomography (CT) examinations of the paranasal sinuses in 73 consecutive patients with 113 anatomic variations of the OMU were retrospectively reviewed. The following CT features were assessed: (1) Type of anatomic variations, (2) presence of a mucosal contact in the OMU and (3) presence of maxillary disease. Statistical evaluation was carried out using chi 2-test.

RESULTS

The following bony anatomic variations were found: Concha bullosa (67 cases), abnormalities of the uncinate process (18 cases), Haller's cells (24 cases) and large ethmoidal bulla (four cases). Only 52 of the 113 anatomic variations were associated with ipsilateral maxillary disease (mucosal thickening, mucous retention cysts, polyps, retained secretions). Of 113 variations, 44 caused a mucosal contact, 35 of these were associated with maxillary abnormalities, while in nine cases there were no pathologic changes. Of 69 variations, 17 did not cause mucosal contact (P < 0.05).

CONCLUSION

Our data shows that, in the presence of anatomic bony variations, a contact between the mucosal surface of the OMU is valuable in predicting the likelihood of a maxillary inflammatory disease.

[The angiogram sign in lung consolidation: what is its diagnostic value?]

The angiogram sign in chest CT is the demonstration of normally enhanced pulmonary branches within hypoattenuating lung parenchyma consolidation. In a retrospective review of the chest CT exams performed in a 2-year period, we identified the angiogram sign in 10 patients with lung consolidation; the diagnosis was central lung tumor with obstructive pneumonia in 4 patients, bronchioloalveolar carcinoma in 2 patients, postirradiation fibrosis in 1 patient, tuberculous pneumonia in 1 patient, lung lymphoma in 1 patient and metastasis from pancreatic tumor in 1 patient. The diagnosis was made with cytology and/or surgical specimen in 9 patients and with clinical-radiologic follow-up in 1 patient. The density, air and mucous bronchogram and the volume loss in the consolidated lung were also considered. The consolidated lung density was < 30 HU in 5 patients-one bronchioloalveolar carcinoma, one metastasis from pancreatic carcinoma and 3 obstructive pneumonia cases-, while it was > 30 HU in the extant 5 patients. The air bronchogram sign was observed in 4 cases-one bronchioloalveolar carcinoma, one metastasis, one postirradiation fibrosis and one lung lymphoma-, while a mucous bronchogram was observed in 3 patients with obstructive pneumonia. Lung volume was reduced only in 2 patients-one obstructive pneumonia and one postirradiation fibrosis. In our opinion, the CT angiogram sign must be considered a poorly specific sign, because it can be found in many pathologic processes, both benign and malignant. If associated with the other features of lung consolidation, the CT angiogram sign can help diagnose, together with clinical findings and the patient's history, the pathologic condition. Particularly, the angiogram sign within a hypoattenuated lung consolidation area can be found in obstructive pneumonia, while the angiogram sign within a hypoattenuated consolidation with an air bronchogram probably indicates a mucinous carcinoma with lipidic growth.

Spontaneous hemoperitoneum from a giant multicystic hemangioma of the liver: a case report

We describe a rare case of hemoperitoneum due to spontaneous rupture of a giant cavernous hemangioma of the liver. CT demonstrated both the intraperitoneal hemorrhage and the hepatic lesion, which showed an atypical multicystic appearance. Furthermore, CT showed the site of rupture of the hemangioma.

Air-space pattern in lung metastasis from adenocarcinoma of the GI tract

PURPOSE

We retrospectively reviewed a series of proven lung metastasis to evaluate the frequency and CT features of metastases showing an air-space (lepidic) pattern of growth.

METHOD

CT examinations of 65 patients with proven lung metastasis from GI carcinomas were reviewed by three observers. Four CT features were used to classify lesions as air-space metastases: (a) air-space nodules; (b) parenchymal consolidation containing air bronchogram and/or showing angiogram sign; (c) focal or extensive ground-glass opacities; and (d) nodules(s) with a "halo" sign.

RESULTS

Six of 65 patients showed air-space metastases: three from pancreatic carcinoma, two from colonic carcinoma, and one from jejunal carcinoma. In one case, metastasis appeared as extensive parenchymal consolidation associated with ground-glass opacities; in one as an area of ground-glass opacity; in one as an extensive parenchymal consolidation with air bronchogram; in one as parenchymal consolidations with angiogram sign and multiple nodules, some of these with halo sign; in one as air-space nodules and patchy air-space consolidations; and in one as a solitary nodule with halo sign.

CONCLUSION

Our study shows that air-space lung metastasis from GI carcinomas is uncommon but not rare. On CT as well as microscopically, differential diagnosis between air-space metastasis and bronchioloalveolar carcinoma may be impossible.

Subcapsular renal spread of a pancreatic pseudocyst

In pancreatitis, the fluid collection may extend to unusual sites and organs and form a pseudocyst. We present US and CT findings of a pancreatic tail pseudocyst extending into the subcapsular space of the left kidney.

[Computerized tomography in the assessment of obstructive jaundice caused by hepatic hydatid cysts]

This paper reports on the CT findings of obstructive jaundice caused by hydatid cysts of the liver, which are an unusual event occurring in 5-10% of cases. Thus, only a few reports can be found in the literature dealing with the CT features of this syndrome. Eight patients with obstructive jaundice were selected from 87 patients with hydatid disease of the liver and examined with CT. The CT diagnosis of rupture into the largest bile ducts is based upon the demonstration of hepatic hydatid cysts together with intrabiliary hydatid sand, membranes and scolices and/or the identification of parietal discontinuity with communication between the cyst and the biliary tree. Rupture into the largest bile ducts was demonstrated in 7 patients. The following CT patterns were observed: 1) intrahepatic biliary tract dilatation (all cases); 2) extrahepatic biliary tract dilatation (6 cases); 3) cyst wall interruption (5 cases--in 3 of them the communication between the cyst and the dilated bile duct was demonstrated); 4) daughter cysts, fragmented membranes or hydatid sand in the biliary tree (5 cases); 5) hydatid material in the gallbladder (1 case) and, finally, disappearance of the daughter cyst visible on a previous CT examination (1 case). In another patient, the diagnosis of compressive jaundice without biliary communication was suggested because a bulky hydatid cyst was found near the hilum of liver. CT findings were confirmed with ERCP or at surgery. CT failed to reveal small tears with minute biliary radicles, which are usually asymptomatic, whose diagnosis could be made only with preoperative cholangiography. Hydatid cysts of the liver can cause obstructive jaundice because of main bile duct compression or of large bile duct perforation with consequent passage of hydatid material into the biliary tree. This complication should be promptly managed surgically to avoid potentially fatal complications, which makes a preoperative diagnosis essential.

[Computerized tomography in the assessment of metastatic facial adenopathy]

The facial lymph nodes are classified in five groups: mandibular, buccinator, infraorbital, malar and retrozygomatic nodes. This paper reports the CT appearance of neoplastic involvement of these nodes, an unusual and not well documented event. The CT examinations of 62 patients with a history of primary or recurrent cancer of the epidermal structures of the face, oral cavity and sinonasal region were retrospectively reviewed to assess the presence of facial adenopathy. Nine cases of neoplastic involvement of facial nodes were found. Most commonly the buccinator nodes (4 cases) were involved, the infraorbital, mandibular (2 cases) and retrozygomatic nodes (1 case) being less commonly involved. No malar nodes were found. Neoplastic involvement of these nodes was caused by squamous cell carcinoma in 6 cases, by adenocarcinoma in 2 cases and by a lymphoma in 1 case. Normal nodes could not be confidently identified on CT studies. CT diagnosis of neoplastic involvement of facial nodes is based on the presence of a nodular lesion which lies along the lymphatic pathways of the primary neoplasm in an anatomically compatible location. CT diagnosis of facial nodes is very important for treatment planning if the nodes are deep or at a distance from primary cancer. This is especially true for retrozygomatic and buccinator nodes.

Turcot's syndrome: a new case in the first decade of life

A case of Turcot's syndrome is described in an 8-year-old girl. Turcot's syndrome is a rare hereditary disease in which malignant glioma of the central nervous system is associated with colonic polyposis. The patient initially presented with a left parietal glioblastoma diagnosed by computed tomography (CT), and was subsequently found to have nonfamilial colonic polyposis.

[Computerized tomography in gaseous hypotonic duodenography in the study of the pancreatico-duodenal area]

This study was aimed at assessing the role of CT-hypotonic gaseous duodenography in the study of the pancreatic-duodenal region. Forty-two patients with malignancies in this region were examined with CT of the upper abdomen followed by CT-hypotonic gaseous duodenography (30 pancreatic head cancers, 7 main bile duct and 5 ampullary lesions). In 20 of 28 cases of pancreatic head carcinoma, CT-hypotonic gaseous duodenography yielded more pieces of information than baseline abdominal CT and was also more useful in small pancreatic head cancers, < 4 cm diameter. In 4 of these patients, CT-hypotonic gaseous duodenography better demonstrated the pancreatic lesions which conventional CT had demonstrated poorly. In contrast, CT-hypotonic gaseous duodenography was less useful in main bile duct carcinomas, depicting focal duodenal infiltration in only 1 of 7 cases. In all ampullary tumor patients (5/5), CT-hypotonic gaseous duodenography demonstrated intraduodenal lesions. The authors conclude that CT-hypotonic gaseous duodenography is a useful technique to investigate small pancreatic head cancers and the method of choice to demonstrate ampullary lesions.

[The computed tomographic semeiotics of rhino-sinusal inflammatory pathology]

Recent advances in "functional" endoscopic surgical techniques require the radiologist to understand the anatomy and pathophysiology of the nose and paranasal sinuses as well as their normal and abnormal CT patterns. Endoscopy and CT are complementary procedures, but in the evaluation of the extent of chronic inflammation and in the demonstration of possible associated local and regional complications, the latter method has become the imaging technique of choice, providing a detailed map for the functional sinus surgeon and replacing plain radiography. The authors reviewed a personal series of 322 coronal thin-slice CT examinations of the paranasal sinuses relative to 169 patients with chronic or acute sinusitis and polyposis. The main CT findings of sinusitis (mucosal thickening, fluid retention, mucous cysts, bone alterations, mucoceles and polyposis) and their complications are reported. Finally, ostiomeatal conditions are considered, particularly the obstruction of ducts and ostia which provide aeration and mucous clearance from the paranasal sinuses.

[Computerized tomography in the evaluation of anatomic variations of the ostiomeatal complex]

This work was aimed at showing the main anatomical variations in the ostiomeatal complex which are usually depicted by CT. A hundred and thirty CT exams including 59 normal cases (45.4%) and 71 cases of chronic sinus disease (54.6%) were reviewed. The following anatomical variations were considered: concha bullosa, middle turbinate, septum, uncinate process and bulla changes, Haller cells and agger nasi cells. Anatomical variations were demonstrated in 69 patients--31 normal subjects and 38 patients with chronic sinusitis. The incidence of every anatomical variation was investigated and the results were compared with literature data. Excluding agger nasi cells, which were seen in nearly all patients, the most common variations were concha bullosa and septal spur and deviations, while the least common variations were those in the middle turbinate and uncinate process.

[The normal topographic and CT-tomographic anatomy of the ostiomeatal complex]

Recent advances in the pathophysiology of the nasal cavity and paranasal sinuses and the development of endoscopic equipment and techniques have led to a new "functional" surgical management of chronic or recurrent sinusal conditions. The ostiomeatal complex is a narrow and intricate passage way providing aeration and mucus clearance from anterior ethmoid sinus, maxillary sinus and frontal sinus. CT, allowing the detailed demonstration of normal and abnormal patterns of the ostiomeatal complex, permits accurate preoperative planning, which has reduced the number of surgical complications. Ostiomeatal complex anatomy and the corresponding CT features are analyzed, as seen in 85 patients with or without rhinosinusal inflammatory lesions. The CT technique with coronal and axial scans and electronic parasagittal reconstructions, is also reported. Finally, the images obtained on different CT planes are compared, as proposed by other authors.

MR findings in thyroglossal duct cysts: report of two cases

Two patients with thyroglossal duct cysts have been studied with CT and MR. The typical CT feature of these cystic upper-neck lesions are depicted in literature, conversely MR findings are not well known. The homogeneous high intensity on T1-weighted images, higher than simple cyst or fluid, is the most typical feature of the thyroglossal cyst.

Tumors of the ampulla diagnosed by CT hypotonic duodenography

Adenocarcinoma is an uncommon gastrointestinal malignancy. Fiberoptic duodenoscopy is the diagnostic procedure of choice, allowing direct visualization as well as biopsy of the neoplasm. Conversely, in the vast majority of cases, CT is unable to demonstrate the duodenal tumor. We describe a technical procedure that has permitted CT visualization of a small ampullary tumor in two cases.

Mediastinal pseudotumor due to passage of ascites through the esophageal hiatus

Ascites can extend from the peritoneal cavity into the posterior mediastinum through the esophageal hiatus. This mediastinal fluid can simulate the appearance of a mediastinal tumor. Demonstration of hiatal hernia and continuity between the thoracic and abdominal fluid assist in establishing the correct diagnosis.

[Optimization of the radiographic technic in parotid sialography. Experimental findings and clinical evaluation of the selection of the film-screen combination]

A suitable choice of film-screen combination is certainly the essential condition for achieving diagnostically reliable results together with the benefit of a low dosage for the patient. In parotid sialography, the choice of one particular film-screen combination depends on the different thickness of various glandular areas and on the particular anatomical site of the gland which inevitably causes the superimposition of the thinnest canalicular ducts with the adjacent areas. We have therefore performed an experimental-clinical study in order to evaluate the combination which can guarantee the most elevated diagnostic increase. The analysis of the results shows useful indication as far as the use of mammographic systems is concerned. These allow more diagnostic information together with a sufficiently low dosage for the patient.

Computerized tomography in amyotrophic choreo-acanthocytosis

CT has been performed in five patients affected by amyotrophic choreo-acanthocytosis (ACA) and bicaudate diameter, bicaudate index and frontal horn/bicaudate ratio (FH/CC) have been evaluated. Findings have been confirmatory of caudate nuclei atrophy as shown by previous ACA autopsy reports, but did not differ from Huntington's chorea CT picture. There was no correlation between CT measurements and age, illness duration or degree of hyperkinesia in contradistinction to that reported for Huntington's chorea.