Increased lymphatic flow from the liver in different intra- and extrahepatic diseases demonstrated by CT

Increase in the production of hepatic lymph is a compensatory mechanism known to occur in cirrhosis, neoplasia of the liver, biliary obstruction, and right-sided cardiac decompensation with elevated hepatic venous pressure. In hepatic lymphostasis, dilated hepatic lymphatics are reflected on CT as low attenuation rims--perivascular lucencies (PVLs)--surrounding the portal veins and the intrahepatic vena cava. In this study, CT scans of the livers of normal controls and patients in each of the four disease categories mentioned above were evaluated for the presence of PVLs; the presence/absence of PVLs was correlated with other CT findings and various biochemical and pathophysiologic parameters. The PVLs were seen with some frequency in patients in each of the four disease categories (12-52%) but in none of the normal controls. In patients with tricuspid incompetence, the presence of PVLs correlated perfectly with the presence of mottled enhancement of the hepatic parenchyma (evidence of sinusoidal stasis). The presence of PVLs was associated with elevation of certain biochemical parameters, but no common biochemical marker was observed across the disease categories. Perivascular lucencies on CT reflect altered hepatic lymphatic dynamics; in the absence of impaired efferent lymph drainage, they reflect increased lymphatic flow. However, the sensitivity of the finding--the relationship of the presence/absence of PVLs on CT to the degree of alteration of the lymphatic dynamics--has yet to be assessed.

Perivascular low attenuation zone at CT of liver transplants. A follow-up study

A follow-up study of 30 liver transplant patients confirmed that periportal and pericaval rims of low attenuation found at CT reflect hepatic lymph stasis. The perivascular rims are found coexistent with acute allograft rejection, but are not correlated with acute rejection, immunosuppressive agents (cyclosporin A), or intercurrent infection. Disappearance of the perivascular low attenuation zone in our material coincided with normalization of liver biochemistry probably associated with reestablishment of lymphatic drainage. Like previous reports on experimental hepatic lymph stasis, our study thus indicates that lymph stasis may have harmful effects on human liver allografts.

Rheumatic disease of temporomandibular joint with development of anterior disk displacement as revealed by magnetic resonance imaging. A case report

A 34-year-old woman with known rheumatic disease (psoriatic arthritis) in joints other than the temporomandibular joint (TMJ) developed condylar posterosuperior destruction and anterior disk displacement of the right symptomatic TMJ during a 7-month period, as revealed by magnetic resonance imaging. A theory is proposed that destruction of the posterior attachment by pannus was the main reason for the disk displacement, although the pannus formation itself could not be depicted. Follow-up studies also indicated the potential of magnetic resonance imaging to demonstrate fluctuation of inflammatory changes in the TMJ.

Rheumatic disease of the temporomandibular joint: MR imaging and tomographic manifestations

Thirty-six temporomandibular joints (TMJs) in 28 symptomatic patients (aged 14-40 years) with rheumatic disease (mostly rheumatoid arthritis) were studied with magnetic resonance (MR) imaging and hypocycloidal tomography. MR images of four TMJs were normal. Another four TMJs showed internal derangement. Of the 28 TMJs presumed to show rheumatic disease involvement (26 with condylar destruction or deformation), 23 showed abnormal disk structure--five showing severe disk destruction and 18 showing less severe abnormalities (inhomogeneous structure, fragmentation, poor delineation, and severe flattening). MR images showed bone abnormalities in 27 of the 36 TMJs, and tomography showed abnormalities in 25 of the 36 TMJs. Good agreement between the two imaging modalities regarding surface irregularities was found. However, MR imaging demonstrated more extensive bone abnormalities than did tomography in 11 TMJs. The potential of MR imaging for depicting bone and soft-tissue abnormalities associated with rheumatic TMJ involvement was clearly demonstrated.

Carcinoma of the hypopharynx: CT staging

The CT examinations of 42 patients with carcinoma of the hypopharynx were analyzed. Tumor site of origin and detailed patterns of extent and spread were noted and a T and N classification attempted. The results were compared to findings achieved by palpation, mirror examination, laryngoscopy, and hypopharyngoscopy. Computed tomography yielded valuable information concerning submucous tumor extension and cartilage involvement. The additional information obtained by CT led to upstaging 29% of the cases to a higher T level and 36% of the cases to a higher N level.

Focal changes of the spleen in one case of Gaucher disease--assessed by ultrasonography, CT, MRI and angiography

Focal lesions of the spleen in one case of Gaucher disease are demonstrated by ultrasonography, CT, MRI and angiography. The sonographic and angiographic features differ from the findings presented in previous reports. The Gaucher manifestations in the spleen as demonstrated by CT, do not seem to have been reported previously. An earlier report on the MR findings in the liver and spleen in this disease did not disclose any focal abnormalities. In this case, ultrasonography and MRI revealed a targetlike configuration of the focal lesions. An attempt is made to analyze the more complex patterns disclosed by MRI against the background of the manifestations by the other imaging modalities and previous reports.

Radiological examination of the nasal cavity

The complex anatomy of the interior of the nose presents a challenge in radiological imaging. Several radiologic modalities applied in the assessment of anomalies and pathologic changes in the nasal cavity are presented, illustrated by reference to various cases. The excellent ability of computed tomography to reveal valuable information concerning both benign and malignant lesions is emphasized. Magnetic resonance imaging has further extended the possibilities in diagnosis because of its high soft-tissue contrast resolution and multiplanar imaging capabilities.

CT findings in benign expansions of the larynx

The CT findings in six patients with benign laryngeal expansions are reported. Although CT in laryngeal carcinomas has been extensively dealt with in the literature, little mention has been made of benign conditions. The CT appearances of expansions due to chondroma, tuberculosis, hypertrophic lingual tonsilla, fluid-filled laryngocele, aberrant thyroid adenoma, and chronic granulomatous inflammation are described.

Radiological appearance of the ampulla of Vater

The localized dilatation below the confluence of the bile and pancreatic ducts is known as the ampulla of Vater. The purpose of the present study was to delineate the radiological features of the choledochopancreaticoduodenal junction, with special reference to ampullar formation in this region. This was done by specimen radiography and review of the films from 255 examinations with endoscopic retrograde cholangiopancreatography. Full evaluation was possible in 200 cases. Ampullar dilatation was observed in only 9 (5.1%) of the 175 patients with a common terminal opening. No ampullar dilatation was observed in the 25 patients with separate openings of the duct. The appearance in the presence of ampullar dilatation is described. The distal end of the common bile duct, below its confluence with Wirsung's duct, has been known as the ampulla of Vater for nearly 130 years. This is a most important diminutive region of the human body, but there is little in the literature concerning its radiological presentation. In this report a radiological study is presented on the choledochopancreaticoduodenal junction.

Staging of carcinoma of the palatine tonsils by computed tomography

In a retrospective study of 24 patients with biopsy-verified tonsillar malignancies, the tumoral staging by CT and by clinical examination were compared, applying the criteria of the 1983 edition of the International Union Against Cancer; the T classifications corresponded well. The N classifications, however, differed, as CT showed more advanced lymph node disease than indicated by clinical examination. Involvement of the jugulodigastric node was diagnosed equally well by CT and by palpation. Computed tomography revealed more suspect nodes than palpation in the rest of the anterior chain and in the posterior triangle.

Calcifications of the palatine tonsillary region: CT demonstration

The scans of 100 consecutive patients referred for computed tomographic examinations that included the oropharynx were reviewed with regard to calcifications of the palatine tonsillary region. Calcifications were found in 20% of the female patients and 13% of the male patients. Ten patients had one calculus, and six had two or more. The sizes of the calculi ranged from 1 to 7 mm. Tonsillary calculi must be included among the diagnostic possibilities when survey radiographs of the neck show soft-tissue calcifications.

The early manifestation of Yersinia colitis demonstrated by the double-contrast barium enema

A 19-year old female with a bloody, diarrheal illness of acute onset where Crohn's disease primarily was suspected is presented. The double - contrast barium enema revealed multiple, diffusely scattered aphthous erosions of the colonic mucosa: the rectum was scarcely affected. Biopsies taken by endoscopy demonstrated nonspecific inflammatory changes of the mucous membrane. However, routinely taken stool cultures revealed an infectious colitis due to Yersinia enterocolitica. Our case demonstrates the necessity to consider Yersinia enterocolitis in the radiographic differential diagnosis when the diagnosis of Crohn's disease or ulcerative colitis seems obvious.

Carcinoid infiltration and fibroplastic changes of the mesentery as a cause of malabsorption

The presentation of carcinoid involvement of the mesentery is described, with clinical manifestation of severe malabsorption: angiographically it resembled retractile mesenteritis. The special biologic activity of the carcinoid cells inducing fibroblastic activity with secondary alterations of vascular, lymphatic and neural structures of the mesentery is discussed in relation to the altered physiology and morphology of the intestine, causing the clinical picture of sprue.

The angiographic features of tumor infiltration of the greater omentum

The angiographic findings of a metastatic neoplasm of the greater omentum are presented, and a survey of the angiographic features of previously reported omental tumors, primary and metastatic, is given. The angiographic pattern seems to be quite uniform with no specific relation to the histologic origin of the tumors and angiography is probably at the present time the best diagnostic modality.

Gastrointestinal lymphoma with total involvement of the gut--report of one case

One case with the roentgenologic demonstration of total primary gastrointestinal lymphoma is presented, to the author's belief as the first in the radiologic literature. Special attention is also paid to the manifestations in the esophagus and the stomach.

Pancreatic cystadenoma. Angiographic and histologic findings illustrated by two cases

Two cases of pancreatic cystadenoma are presented, demonstrating the typical angiographic and histologic pattern as given in previous literature. Although computed tomography and ultrasound examinations may be useful [11], angiography seems to play a decisive role in establishing the diagnosis, demonstrating the localization and extent of the tumor, and permitting the possible differentiation of benign and malignant lesions.