The computed tomographic appearances in chronic berylliosis

Computed tomography (CT) of the thorax was performed in eight patients with chronic berylliosis. The pulmonary CT features were variable and included pulmonary nodularity, and patterns consistent with upper lobe fibrosis or diffuse interstitial fibrosis. Mediastinal or hilar lymphadenopathy was shown in three cases. CT clearly demonstrates the pattern and distribution of pulmonary and mediastinal involvement in chronic pulmonary berylliosis but the appearances are non-specific.

Massive pleural effusion: an unusual presentation of Castleman's disease

Giant lymph node hyperplasia (Castleman's Disease) is a rare cause of pleural effusion. We report the case of a 51 yr old West Indian male, who presented with a recurrent massive pleural effusion, due to a tumour arising from the pleura. He underwent parietal pleurectomy and subtotal excision of the tumour. Histological analysis of the specimen showed the features of multicentric Castleman's disease. Nine months following surgery he remains well, with no recurrence of the effusion.

Massive pleural effusion: an unusual presentation of Castleman's disease

Giant lymph node hyperplasia (Castleman's Disease) is a rare cause of pleural effusion. We report the case of a 51 yr old West Indian male, who presented with a recurrent massive pleural effusion, due to a tumour arising from the pleura. He underwent parietal pleurectomy and subtotal excision of the tumour. Histological analysis of the specimen showed the features of multicentric Castleman's disease. Nine months following surgery he remains well, with no recurrence of the effusion.

The computed tomographic appearances in pulmonary artery atresia

Isolated pulmonary artery atresia is an uncommon congenital abnormality. Plain radiography and ventilation/perfusion lung scintigraphy may suggest the diagnosis but pulmonary angiography has traditionally been recommended for confirmation. The computed tomographic (CT) appearances of four patients with isolated atresia of a pulmonary artery are described. In each case the atretic segment of the abnormal vessel could be identified. Other CT findings included reduction of volume of the involved hemithorax, increased density of the affected lung, a small hilum, and an abnormal pulmonary vascular pattern thought to be due to the collateral systemic arterial supply to the intrapulmonary branches of the atretic pulmonary artery. The diagnosis of isolated pulmonary artery atresia can be made using dynamic, contrast enhanced CT without recourse to more invasive procedures.

The sonographic appearances in postpartum thyroiditis

During the postpartum period about 50% of women with circulating thyroid autoantibodies develop a transient autoimmune thyroiditis. To determine the sonographic appearances in postpartum thyroiditis (PPT), serial ultrasound (US) scans of the thyroid were performed in 135 postpartum women who were divided into three clinical groups: Group 1, 37 antibody positive subjects who developed PPT; Group 2, 28 antibody positive subjects in whom thyroid function remained normal; Group 3, 70 antibody negative controls. Thyroid hypoechogenicity was observed in 14/31 patients (45%) who were scanned between 4 and 8 weeks postpartum and who subsequently developed PPT (Group 1) compared with 4/24 patients (17%) in Group 2 (P less than 0.05) and 1/65 patients (1.5%) in Group 3 (P less than 0.001). In antibody positive patients, the positive predictive value of an abnormal scan during this period was 78%. Between 15 and 25 weeks postpartum thyroid hypoechogenicity was present in 32/37 patients (86%) in Group 1 compared with 11/28 patients (39%) in Group 2 (P less than 0.001) and 2/70 patients (3%) in Group 3 (P less than 0.001). Sonographic abnormality persisted beyond 32 weeks postpartum in 36/41 antibody positive patients (87%) who had exhibited thyroid hypoechogenicity earlier during the study and who had late scans. The characteristic US appearance in PPT is thyroid hypoechogenicity. The role of sonography in the prediction, diagnosis and follow up of patients with PPT is discussed.

Computed tomographic assessment of patients following radical surgery for malignant mesothelioma

Serial computed tomographic (CT) scans of the thorax and upper abdomen were performed in eight patients following radical surgery (pleuro-pneumonectomy) for diffuse malignant mesothelioma of the pleura. The post-operative appearances included a well defined membrane lining the pleuro-pneumonectomy space in seven cases; in two cases this resembled the original tumour. In six patients there was upward abdominal visceral displacement on the side of the surgery due to diaphragmatic resection; this resulted in contralateral mediastinal shift in four patients. One patient required a diaphragmatic prosthesis which produced a distinctive CT appearance. CT suggested recurrent mesothelioma in five cases. Although two patients had evidence of intrathoracic recurrence, in three patients the only feature was the non-specific finding of abdominal ascites. The normal CT appearances after pleuro-pneumonectomy should be recognized to facilitate radiological interpretation. With careful application CT is of value for the assessment of recurrent disease in patients following radical surgery for malignant mesothelioma.

Case report: gastroduodenal intussusception--an unusual cause of pancreatitis

Gastroduodenal intussusception is a rare complication of polypoidal gastric tumours, and it has not previously been described as a cause of acute pancreatitis. We report a case of an endoscopically, radiologically and histologically proven intussuscepting gastric leiomyoma presenting with biochemical evidence of acute pancreatitis. The radiological appearance is illustrated and possible mechanisms for the pancreatitis are discussed.

Computed tomography of the brain: does contrast enhancement really help?

The contribution of intravenous contrast medium to the final diagnosis was assessed in 300 patients undergoing routine axial computed tomography (CT) of the brain. Two-hundred-and-twelve patients presented with symptoms or signs suggesting focal intracranial pathology and 88 with non-focal features. A total of 110 post-contrast scans were abnormal. The differential diagnosis was altered in 15 patients (5%) following contrast enhancement, 13 of whom presented with focal symptoms and signs. In three patients with normal plain scans and symptoms and signs suggesting focal intracranial pathology abnormalities were only seen after contrast medium and in only one was the lesion surgically treatable. In a further 15 patients (5%) contrast enhancement increased the certainty of the diagnosis that had been made on the uncontrasted scan. We feel that when the uncontrasted scan is normal contrast enhancement is only helpful in a limited number of patients with symptoms and signs suggesting focal intracranial pathology. Contrast enhancement is still important in differentiating abnormalities seen on the unenhanced scan even with modern high resolution CT scanners.

An appraisal of CT pulmonary density mapping in normal subjects

Modern computed tomographic (CT) scanners have post-processing facilities which allow pixels within a selected density range to be highlighted. It has been suggested that using this technique to highlight regions of low CT density (-900H to -1000H) can locate and quantitate areas of pulmonary emphysema. To establish the variability of the lung density map in normal subjects this technique was used in 17 patients with no evidence of structural lung disease on full respiratory function testing. Mean CT lung density varied from -770H to -875H (overall mean -817H). The percentage cross-sectional area in the low density range -900H to -1000H varied from 0.6% to 58% (mean 15.3%). In two further groups of 12 subjects the influence of CT slice thickness and intravenous contrast administration on the lung density map was evaluated. The use of narrower collimation led to an increase in mean cross-sectional area within the low density range from 9.6% to 16.1% (P less than 0.05). The use of intravenous contrast led to a reduction in mean cross-sectional area within the range from 8.9% to 3.3% (P less than 0.01). There is considerable variability in the lung density map of normal individuals and the method is also dependent on radiographic technique. These factors should be taken into account when considering the use of CT lung density mapping for the assessment of pulmonary disease.

Hyperdense middle cerebral artery: incidence and quantitative significance

The hyperdense middle cerebral artery sign (HMCAS) is recognized as a CT finding that indicates thrombus or embolus within the middle cerebral artery. The incidence and significance of this sign are quantitatively evaluated in 50 patients entered into experimental drug studies for treatment of cerebral infarction.

Radiologists and endoscopy: a survey of the attitudes and intentions of radiologists in training

A postal survey of senior registrars in radiology in this country was carried out to assess attitudes towards radiologists taking part in endoscopy services. One hundred and ninety-six senior registrars from 37 training centres recognised by the Royal College of Radiologists completed the questionnaire (a response of 74%). Thirty-nine per cent of respondents had some practical experience of endoscopy before commencing training in radiology. Twenty-eight per cent of respondents declared a major interest in gastrointestinal radiology. Sixty four per cent felt that radiologists should perform endoscopy (87% in the case of those with a major interest in gastrointestinal radiology). Thirty-seven per cent were interested in providing, or participating in, an endoscopy service after obtaining a consultant post. Despite this level of interest, only 18% of respondents felt that they had adequate access to endoscopy training and only 3% were aware of the training recommendations of the British Society, of Gastroenterology.

Oesophageal tears during pneumatic balloon dilatation for the treatment of achalasia

Fifty-eight contrast studies of the oesophagus, performed in patients shortly after balloon dilatation for the treatment of achalasia, were reviewed for evidence of perforation. Forty-nine examinations (85%) were normal and nine studies (15%) were abnormal. Three main radiological patterns were observed. Complete rupture of the oesophagus occurred in two cases. Incomplete tears of the oesophageal wall were present in seven cases: in one patient there was a linear mucosal tear while in six patients there was a localised outpouch or diverticulum. All patients with abnormal contrast studies were successfully managed conservatively. The range of radiological appearances of the distal oesophagus following balloon dilatation should be recognised to avoid unnecessary surgical intervention.

The sonographic features and implications of fetal pleural effusions

Pleural fluid was detected by ultrasound in three fetuses as an anechoic area surrounding the echogenic fetal lung. In one fetus the underlying lung was small, immobile and of abnormal contour; death occurred in the neonatal period and the lung was found to be hypoplastic. In two other fetuses the lungs appeared sonographically normal, being mobile with normal contours. Both survived, one following spontaneous intra-uterine resolution of the effusion and the other after early neonatal intervention prompted by the antenatal diagnosis. Sonography can detect pleural fluid in utero and may permit differentiation between normal underlying lung and pulmonary hypoplasia. We recommend serial scanning to detect early adverse effects of pleural effusion upon the fetus and to plan management changes.