Imaging and Clinical Findings of Xanthogranulomatous Inflammatory Disease of Various Abdominal and Pelvic Organs: A Pictorial Essay

Xanthogranulomatous (XG) inflammatory disease is a rare benign disease involving various organs, including the gallbladder, bile duct, pancreas, spleen, stomach, small bowel, colon, appendix, kidney, adrenal gland, urachus, urinary bladder, retroperitoneum, and female genital organs. The imaging features of XG inflammatory disease are nonspecific, usually presenting as a heterogeneous solid or cystic mass. The disease may also extend to adjacent structures. Due to its aggressive nature, it is occasionally misdiagnosed as a malignant neoplasm. Herein, we review the radiological features and clinical manifestations of XG inflammatory diseases in various organs of the abdomen and pelvis.

A Thrombus within an Interventricular Membranous Septal Aneurysm Leading to Cerebral Infarction: A Case Report

Interventricular membranous septal aneurysms are rare. Since these aneurysms can lead to complications such as obstruction of right ventricular outflow and thromboembolism, the detection of this aneurysm has clinical significance. Herein, we report a case of an interventricular membranous septal aneurysm with an internal thrombus thought to be the cause of a cerebral infarction.

[Primary Malignant Peripheral Nerve Sheath Tumor of the Pulmonary Vein: A Case Report]

Primary masses rarely originate from the heart and great vessels, and a malignant peripheral nerve sheath tumor (MPNST) is extremely rare. A 76-year-old male with pleural effusion underwent contrast-enhanced computed tomography, which revealed a hypoattenuating mass involving the right pulmonary vein and left atrium. Ultrasonography showed that the mass originated from the right pulmonary vein. Surgical resection confirmed an MPNST that originated from the pulmonary vein. We report the first Korean case of a primary MPNST originating from the pulmonary vein. We have also described the radiologic findings suggestive of a pulmonary vein mass.

Immunoglobulin G4-Related Lung Disease with Waxing and Waning Pulmonary Infiltrates: A Case Report

Immunoglobulin G4 (IgG4)-related lung disease can have various clinical courses. To our knowledge, reports of IgG4-related lung disease with waxing and waning pulmonary infiltrates only are very rare. A few lung nodules and ground glass opacities were incidentally found in a pre-operative evaluation in a 36-year-old female. The lung lesions showed waxing and waning in the follow-up chest CT. She underwent a surgical biopsy, and IgG4-related lung disease was confirmed.

Imaging Findings of Axillary Granular Cell Tumor in a Patient with Breast Cancer History: A Case Report

Granular cell tumors (GCTs) are rare soft tissue tumor, originating from neural or perineural cells. We present a case of axillary GCT in a 69-year-old woman with breast cancer history and discuss the various radiologic findings. US revealed a circumscribed oval heterogeneous iso- and hyperechoic mass in the left axilla. Chest CT showed a well-defined, oval, and mildly enhancing mass in the left axilla on the lateral aspect of the pectoralis muscle. A final diagnosis of GCT was made through US-guided core needle biopsy. Follow-up US showed no significant changes in the axillary GCT. Familiarity with GCT may facilitate early diagnosis and subsequent management.

Swyer Syndrome: A Case Report

Swyer syndrome is a rare form of primary amenorrhea resulting from gonadal dysgenesis. It is characterized by the presence of a female phenotype with a 46, XY karyotype. In our case, CT scans revealed the absence of the uterus and bilateral ovaries of the 16-year-old female patient. Calcific nodules were found in both inguinal areas, which were suspected to be calcified atrophic testes. A chromosomal study confirmed the diagnosis of Swyer syndrome. Herein, we report a rare case of Swyer syndrome.

Impact of radiation dose on the detection of interstitial lung changes and image quality in low-dose chest CT - Assessment in multiple dose levels from a single patient scan

PURPOSE

To assess image quality and detectability of interstitial lung changes using multiple radiation doses from the same chest CT scan of patients with suspected interstitial lung disease (ILD).

METHOD

Retrospective study of consecutive adult patients with suspected ILD receiving unenhanced chest CT as single-energy dual-source acquisition at 100 kVp (Dual-split mode). 67% and 33% of the overall tube current time product were assigned to tube A and B, respectively. 100%-dose was 2.34 ± 0.97 mGy. Five different radiation doses (100%, 67%, 45%, 39%, 33%) were reconstructed from this single acquisition using linear-blending technique. Two blinded radiologists assessed reticulations, ground-glass opacities (GGO) and honeycombing as well as subjective image noise. Percentage agreement (PA) as compared to 100%-dose were calculated. Non-parametric statistical tests were used.

RESULTS

A total of 228 patients were included (61.2 ± 14.6 years,146 female). PA was highest for honeycombing (>96%) and independent of dose reduction (P > 0.8). PA for reticulations and GGO decreased when reducing the radiation dose from 100% to 67% for both readers (reticulations: 83.3% and 93.9%; GGO: 87.7% and 79.8% for reader 1 and 2, respectively). Additional dose reduction did not significantly change PA for both readers (all P > 0.05). Subjective image noise increased with decreasing radiation dose (Spearman Rho of ρ = 0.34 and ρ = 0.53 for reader 1 and 2, respectively, P < 0.001).

CONCLUSIONS

Radiation dose reduction had a stronger impact on subtle interstitial lung changes. Detectability decreased with initial dose reduction indicating that a minimum dose is needed to maintain diagnostic accuracy in chest CT for suspected ILD.

Clear Cell Sarcoma-Like Tumor of the Gastrointestinal Tract with Peritoneal Metastasis in a Young Adult: A Case Report with Literature Review

Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSLTGT) is a rare malignant mesenchymal tumor of the gastrointestinal (GI) tract with a high probability of local recurrence and distant metastasis in young adults. To the best of our knowledge, only seven case reports have described the imaging findings of a CCSLTGT originating from in the small intestine in English literatures so far. Therefore, we report the imaging findings of a CCSLTGT that occurred in the small intestine of a 22-year-old female and summarize the imaging findings of the previous reports.

Insidious Onset Multifocal Chest Wall and Spinal Abscess Caused by Previous Candidemia: A Case Report

Abscess formation due to Candida albicans infection is extremely rare. Radiological diagnosis of an atypical abscess at an uncommon site is challenging. In this study, we present a case of insidious onset multifocal chest wall and spinal abscess after candidemia in a young woman in the intensive care unit due to postpartum bleeding.

CT Findings of May-Thurner Syndrome in Diffuse Idiopathic Skeletal Hyperostosis: A Case Report

May-Thurner syndrome (MTS) is a rare cause of deep vein thrombosis. Several cases of MTS because of various causes have been reported. However, MTS due to osteophytes in patients with underlying diffuse idiopathic skeletal hyperostosis (DISH) has not been reported in English literature, to the best of our knowledge. Here, we present the CT findings of MTS in patient with DISH.

Radiologic Findings of Mesonephric-Like Adenocarcinoma of the Uterine Corpus: A Case Report

According to the 2020 World Health Organization classification, mesonephric-like adenocarcinoma (MLA) is newly categorized as a subtype of endometrial carcinoma and remains a relatively unknown disease owing to its rarity. To the best of our knowledge, radiological findings of MLA have not been reported in the English literature. The uterine MLAs show a worse clinical prognosis and a more aggressive biological behavior than the usual endometrial carcinoma. Herein, we present the imaging findings of a 65-year-old female with a MLA in the uterine corpus. The tumor was a solid endometrial mass with deep myometrial invasion, poor contrast enhancement, and moderate diffusion restriction.

Added Value of Structured Reporting for US of the Pediatric Appendix: Additional CT Examinations and Negative Appendectomy

Purpose

This study aimed to determine the incremental value of using a structured report (SR) for US examinations of the pediatric appendix.

Materials and Methods

Between January 2009 and June 2016, 1150 pediatric patients with suspected appendicitis who underwent US examinations of the appendix were included retrospectively. In November 2012, we developed a five-point scale SR for appendix US examinations. The patients were divided into two groups according to the form of the US report: free-text or SR. The primary clinical outcomes were compared between the two groups, including the rate of CT imaging following US examinations, the negative appendectomy rate (NAR), and the appendiceal perforation rate (PR).

Results

In total, 550 patients were included in the free-text group and 600 patients in the SR group. The rate of additional CT examinations decreased by 5.3% in the SR group (8.2%, p = 0.003), and the NAR decreased by 8.4% in the SR group (7.8%, p = 0.028). There was no statistical difference in the appendiceal PR (37.6% vs. 48.0%, p = 0.078).

Conclusion

The use of an SR to evaluate US examinations for suspected pediatric appendicitis results in lower CT use and fewer negative appendectomies without an increase in appendiceal PR.

Hematoma-Filled Pneumatocele after CT-Guided Percutaneous Transthoracic Needle Lung Biopsy: Two Case Reports

CT-guided percutaneous transthoracic needle biopsy (PTNB) plays a key role in the diagnosis of pulmonary abnormalities. Although the procedure is considered safe and effective, there exists a potential for complications, such as pneumothorax, hemorrhage, hemoptysis, air embolism, and tumor seeding. However, pneumatoceles after CT-guided PTNB have been rarely reported. Herein, we report two cases of pneumatoceles that developed immediately after PTNB for primary lung cancer. A pneumatocele filled with hematoma should be considered in cases with a newly developed nodule along the needle tract during short-term follow-up CT after PTNB.

Radiologic Review of Small Bowel Malignancies and Their Mimicking Lesions

Because of their small size, small bowel malignancies are often easily missed when radiologists read CT images, which can lead to errors in the normal small bowel due to their similar enhancement to the small bowel or non-specific enhancement. In addition, small bowel malignancies are sometimes mistaken for masses of other origins, such as the uterus, rectum, or omentum. In this article, we describe various small-bowel malignancies, their mimicking lesions and the typical and atypical features on CT imaging along with their clinical manifestations.

Adaptation of Deep Learning Image Reconstruction for Pediatric Head CT: A Focus on the Image Quality

Purpose

To assess the effect of deep learning image reconstruction (DLIR) for head CT in pediatric patients.

Materials and Methods

We collected 126 pediatric head CT images, which were reconstructed using filtered back projection, iterative reconstruction using adaptive statistical iterative reconstruction (ASiR)-V, and all three levels of DLIR (TrueFidelity; GE Healthcare). Each image set group was divided into four subgroups according to the patients' ages. Clinical and dose-related data were reviewed. Quantitative parameters, including the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), and qualitative parameters, including noise, gray matter-white matter (GM-WM) differentiation, sharpness, artifact, acceptability, and unfamiliar texture change were evaluated and compared.

Results

The SNR and CNR of each level in each age group increased among strength levels of DLIR. High-level DLIR showed a significantly improved SNR and CNR (p < 0.05). Sequential reduction of noise, improvement of GM-WM differentiation, and improvement of sharpness was noted among strength levels of DLIR. Those of high-level DLIR showed a similar value as that with ASiR-V. Artifact and acceptability did not show a significant difference among the adapted levels of DLIR.

Conclusion

Adaptation of high-level DLIR for the pediatric head CT can significantly reduce image noise. Modification is needed while processing artifacts.

Left Atrial Appendage Aneurysm: A Case Report

Left atrial appendage aneurysm (LAAA) is a rare heart anomaly caused by congenital dysplasia of the pectinate muscle or by an acquired pathological condition of the mitral valve or cardiac muscle. It is often incidentally discovered during chest CT or echocardiography as an abnormal dilatation of the LAA. LAAA is associated with life-threatening complications and most patients require surgical treatment. Therefore, it is important to evaluate associated complications as well as precise diagnoses. This report presents the case of a surgically confirmed LAAA in a 53-year-old female. We also discuss the pathophysiology of LAAA and significant findings related to mortality that can be detected on CT and MRI.

Comparison of Radiation Dose and Image Quality between the 2nd Generation and 3rd Generation Dual-Source Single-Energy and Dual-Source Dual-Energy CT of the Abdomen

Purpose

We compared the radiation dose and image quality between the 2nd generation and the 3rd generation dual-source single-energy (DSSE) and dual-source dual-energy (DSDE) CT of the abdomen.

Materials and Methods

We included patients undergoing follow-up abdominal CT after partial or radical nephrectomy in the first 10 months of 2019 (2nd generation DS CT) and the first 10 months of 2020 (3rd generation DS CT). We divided the 320 patients into 4 groups (A, 2nd generation DSSE CT; B, 2nd generation DSDE CT; C, 3rd generation DSSE CT; and D, 3rd generation DSDE CT) (n = 80 each) matched by sex and body mass index. Radiation dose and image quality (objective and subjective qualities) were compared between the groups.

Results

The mean size-specific dose estimation of 3rd generation DSDE CT group was significantly lower than that of the 2nd generation DSSE CT (42.5%, p = 0.013) and 2nd generation DSDE CT (46.9%, p = 0.015) groups. Interobserver agreement was excellent for the overall image quality (intraclass correlation coefficient [ICC]: 0.8867) and image artifacts (ICC: 0.9423).

Conclusion

Our results showed a considerable reduction in the radiation dose while maintaining high image quality with 3rd generation DSDE CT as compared to the 2nd generation DSDE CT and 2nd generation DSSE CT.

MRI Findings in a Rare Case of Myxofibrosarcoma in the Anterior Mediastinum

Myxofibrosarcoma is one of the most common soft tissue sarcomas in elderly patients. It often occurs in the extremities, trunk, and retroperitoneum. However, it is rarely observed in the mediastinum, and only a few cases have been reported in the literature. Herein, we present the imaging findings, with an emphasis on the MRI results, of a surgically confirmed anterior mediastinal myxofibrosarcoma in a 66-year-old male.

Petrous internal carotid artery aneurysm rupture induced by Eustachian tube catheterisation: case report

BACKGROUND

Petrous internal carotid artery aneurysms are very rare vascular lesions, which may present with otalgia and life-threatening massive otorrhoea.

CASE REPORT

An 84-year-old woman presented at a local otolaryngology clinic with progressive otalgia due to an acute exacerbation of chronic otitis media. She was referred with left-sided massive otorrhoea following Eustachian tube catheterisation. She suffered another massive otorrhoea with epistaxis during left-sided ear cleaning at a clinic visit. Contrast-enhanced computed tomography and computed tomography angiography revealed a left-sided aneurysm and adjacent stenosis at the left internal carotid artery. Coil embolisation of the petrous internal carotid artery aneurysm was performed with percutaneous transluminal angioplasty followed by dilatation of the stenosis.

CONCLUSION

Computed tomography angiography should be performed immediately when a patient reports massive otorrhoea. Endovascular occlusion is a treatment option as it avoids complications of open surgical ligation procedures.

Immunoglobulin G4-Related Lung Disease Mimicking Lung Cancer: Two Case Reports

Immunoglobulin G4 (IgG4)-related disease is a rare systemic fibroinflammatory condition characterized by elevated serum IgG4 levels and infiltration of IgG4-positive plasma cells in various organs. IgG4-related lung disease shows varied radiologic features on chest CT. Patients usually present with a solid nodule or mass mimicking lung cancer; therefore, distinguishing between IgG4-related disease and other conditions is often challenging. Additionally, co-existing radiologic findings of IgG4-related lung disease may mimic metastasis or lymphangitic carcinomatosis of the lung. We report two cases of histopathologically confirmed IgG4-related lung disease mimicking lung cancer. Chest CT revealed a solid nodule or mass with ancillary radiologic findings, which suggested lung cancer; therefore, IgG4-related lung disease was radiologically indistinguishable from lung cancer in both cases. Measurement of serum IgG4 levels and clinical evaluation to confirm involvement of various organs may be useful to establish the differential diagnosis. However, surgical biopsy evaluation is needed for confirmation.

Imaging Findings of Peripheral Arterial Disease on Lower-Extremity CT Angiography Using a Virtual Monoenergetic Imaging Algorithm

Peripheral arterial disease (PAD) is common in elderly patients. Lower-extremity CT angiography (LE-CTA) can be useful for detecting PAD and planning its treatment. PAD can also be accurately evaluated on reconstructed monoenergetic images (MEIs) from low kiloelectron volt (keV) to high keV images using dual-energy CT. Low keV images generally provide higher contrast than high keV images but also feature more severe image noise. The noise-reduced virtual MEI reconstruction algorithm, called the Mono+ technique, was recently introduced to overcome such image noise. Therefore, this pictorial review aimed to present the imaging findings of PAD on LE-CTA and compare low and high keV images with those subjected to the Mono+ technique. We found that, in many cases, the overall and segmental image qualities were better and metal artifacts and venous contamination were decreased in the high keV images.

Progressive Massive Fibrosis Mimicking Lung Cancer: Two Case Reports with Potentially Useful CT Features for Differential Diagnosis

Progressive massive fibrosis (PMF) with atypical findings is often misdiagnosed as lung cancer. Atypical features of PMF have been described in some reports; however, these reports only introduced their cases with a short literature review. We report two cases of solitary PMFs with no underlying simple pneumoconiosis or rapid growth at atypical location that were mistaken for lung cancer. We also suggest the useful CT findings to aid in the differential diagnosis.

Rapid Development of Diffuse Myocardial Calcification in a Patient after Recovery from Sepsis and Renal Failure: A Case Report

Myocardial calcification can develop owing to several conditions. It is a rare complication following sepsis and renal failure. We report a case of rapid development of left ventricular mid-wall calcification observed using CT and cardiac MRI in a patient after recovery from sepsis and acute renal failure.

Renal Epithelioid Angiomyolipoma with Epithelial Cysts Mimicking Cystic Renal Cell Carcinoma: A Case Report of Combination of Two Rare Entities

Renal angiomyolipomas (AMLs) are typically solid tumors, but there have been few reports of a rare cystic variant of AML. AML with epithelial cysts, where the epithelial cyst has a cuboidal epithelial lining, account for the majority of them. Next, epithelioid AML (EAML) with cystic changes due to hemorrhage and necrosis, which is composed of epithelioid cells with abundant eosinophilic cytoplasm, have also been reported. These rare cystic types of AML can be mistaken for other cystic tumors, such as cystic renal cell carcinoma, in preoperative imaging. We report the imaging findings of a rare case of EAML with epithelial cysts.

Ectopic Adrenal Adenoma in Renal Sinus: A Case Report

The kidney is a rare site of ectopic adrenal adenoma. To the best of our knowledge, some cases of ectopic adrenal adenoma have been found in the kidney, but few of these cases explain the CT and MRI findings of the lesion. We reported a case of ectopic adrenal adenoma in the left renal sinus. A 47-year-old male patient underwent abdominal CT for routine health check-ups, which revealed a 1.2 cm enhancing mass in the left renal sinus. The MRI showed a signal drop of the mass in T1 weighted in- and opposed-phase, which indicates fat components. The mass was confirmed as an ectopic adrenal adenoma after surgery.

Radiological dimensions of the Eustachian tube in patients with adhesive otitis media

OBJECTIVE

This study aimed to analyse the computed tomography parameters for effective ventilation in patients with adhesive otitis media.

METHODS

Twenty-six patients with unilateral adhesive otitis media were included in the study. The patients' temporal bone computed tomography images were retrospectively reviewed. Eustachian tube length and diameter were measured. Mastoid pneumatisation and middle-ear size were evaluated by measuring petroclival and Eustachian tube-tympanic cavity ventilation angles.

RESULTS

The average Eustachian tube length was 38.4 mm and 38.9 mm in adhesive otitis media and healthy ears, respectively. The Eustachian tube diameter of the adhesive otitis media ears (1.47 mm) was significantly narrower than that of the healthy ears (1.83 mm). There were no significant differences in the angles between adhesive otitis media and healthy ears.

CONCLUSION

A narrow Eustachian tube diameter was associated with developing adhesive otitis media. Measuring Eustachian tube diameter is simple and can be routinely performed when examining temporal bone computed tomography images for Eustachian tube function evaluation.

Pictorial Essay: Understanding of Persistent Left Superior Vena Cava and Its Differential Diagnosis

Persistent left superior vena cava (PLSVC) is a rare congenital, thoracic, and vascular anomaly. Although PLSVCs generally do not have a hemodynamic effect, several types of PLSVC and some cardiac anomalies may manifest with clinical symptoms. The presence of PLSVC can render catheterization via left subclavian access difficult when placing a pacemaker or central venous catheter. As such, recognizing a PLSVC that is typically incidentally discovered can prevent complications such as vascular injury. Differentiating vessels found in a similar location as PLSVC is necessary when performing thoracic vascular procedures. This pictorial essay explains the multi-detector CT findings of a PLSVC, and provides a summary of other blood vessels that require differentiation during thoracic vascular procedures.

Pulmonary Multinodular Epithelioid Hemangioendothelioma with Mixed Progression and Spontaneous Regression during a 7-Year Follow-Up: A Case Report and Review of Imaging Findings

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular tumor of borderline or low-grade malignancy, and its prognosis is unpredictable. Herein, we describe the case of a 47-year-old asymptomatic female with a diagnosis of multinodular PEH. During a 7-year follow-up, the nodules with large size and high 18F-fluorodeoxyglucose uptake in the initial study showed progression with increasing sizes; however, most small nodules (size < 1 cm) demonstrated spontaneous regression with peripheral rim or nodular calcification. The patient underwent surgical resection for an enlarged nodule. Of note, it is unusual for an individual to have mixed progression and regression concomitantly, which may be helpful in predicting the prognosis.

Atypical Manifestation of Primary Hepatocellular Carcinoma and Hepatic Malignancy Mimicking Lesions

Hepatocellular carcinoma (HCC) can be diagnosed noninvasively on multiphasic CT and MRI based on its distinctive imaging findings. These features include arterial phase hyperenhancement and washout on portal or delayed phase images. However, radiologists face significant diagnostic challenges because some HCCs exhibit atypical imaging characteristics. In addition to many HCC-mimicking lesions, such as arterioportal shunts, combined HCC-cholangiocarcinoma, intrahepatic cholangiocarcinoma, and hemangioma present a challenge for radiologists in actual clinical practice. The ability to distinguish HCCs from mimickers on initial imaging examinations is crucial for appropriate management and treatment decisions. Therefore, this pictorial review presents the imaging findings of atypical HCCs and HCCs mimicking malignant and benign lesions and discusses important clues that may help narrow down the differential diagnosis.

A Pictorial Review of Radiologic Findings of Foreign Bodies in the Thorax

Thoracic foreign bodies (FBs) are serious and relatively frequent in emergency departments. Thoracic FBs may occur in association with aspiration, ingestion, trauma, or iatrogenic causes. Imaging plays an important role in the identification of FBs and their dimensions, structures, and locations, before the initiation of interventional treatment. To guide proper clinical management, radiologists should be aware of the radiologic presentations and the consequences of thoracic FBs. In this pictorial essay, we reviewed the optimal imaging settings to identify FBs in the thorax, classified thoracic FBs into four types according to their etiology, and reviewed the characteristic imaging features and the possible complications.

Imaging Features and Interventional Treatment for Liver Injuries and Their Complications

Liver injury is a common consequence of blunt abdominopelvic trauma. Contrast-enhanced CT allows for the rapid detection and evaluation of liver injury. The treatment strategy for blunt liver injury has shifted from surgical to nonoperative management, which has been widely complemented by interventional management to treat both liver injury and its complications. In this article, we review the major imaging features of liver injury and the role of interventional management for the treatment of liver injury.

A Case of Coronary Sinus Atresia with a Total Anomalous Cardiac Venous Drainage to the Left Atrium without Persistent Left Superior Vena Cava: Imaging Findings on Cardiac CT

The coronary sinus (CS) is the venous drainage system of the heart. CS ostium atresia is a rarely seen cardiac malformation. Congenital atresia of the CS is usually found together with persistent left superior vena cava (LSVC) and other cardiac malformations. However, isolated congenital atresia of the CS is very rare. We present a rare case of isolated congenital atresia of the CS connecting the left atrium and coronary veins without persistent LSVC in a 58-year-old female.

Gallbladder Metastasis of Renal Cell Carcinoma: A Case Report

The gallbladder (GB) is a rare site of renal cell carcinoma (RCC) metastasis. To the best of our knowledge, only a few reports of CT findings of GB metastasis exist in the literature. Herein, we report a case of histologically proven GB metastasis of RCC in a 55-year-old male who underwent CT for an intraluminal polypoid mass simulating a primary GB lesion.

Accuracy and complications of percutaneous transthoracic needle lung biopsy for the diagnosis of malignancy in patients with idiopathic pulmonary fibrosis

OBJECTIVES

To determine the accuracy of CT-guided percutaneous transthoracic needle lung biopsy (PTNB) for the diagnosis of malignancy and the associated complication rates in patients with idiopathic pulmonary fibrosis (IPF).

METHODS

This retrospective study included 91 CT-guided PTNBs performed in 80 patients with IPF from April 2003 through December 2016. Data regarding patients, target lesions, procedures, complications, and pathological reports were collected, and the final diagnosis was made. The diagnostic accuracy, sensitivity, specificity, percentage of nondiagnostic results, and complication rates were determined. Multivariable logistic regression analyses were performed to identify risk factors for nondiagnostic results and major complications.

RESULTS

Three biopsies (technical failure [n = 2] and undetermined final diagnosis [n = 1]) were excluded from the diagnostic accuracy calculation. The diagnostic accuracy, sensitivity, and specificity were 89% (78/88), 90% (62/69), and 84% (16/19), respectively. The percentage of nondiagnostic results was 34% (30/88). Lesion size ≤ 3 cm (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.5-31.2; p = 0.001) and needle tip placement outside the target lesion (OR, 13.7; 95% CI, 1.4-132.2; p = 0.02) were risk factors for nondiagnostic results. The overall and major complication rates were 51% (46/91) and 12% (11/91), respectively. The presence of honeycombing along the path of the needle (OR, 11.2; 95% CI, 1.4-89.1; p = 0.02) was an independent risk factor for major complications.

CONCLUSIONS

CT-guided PTNB shows a relatively reasonable accuracy in diagnosing malignancy in patients with IPF. The complication rate may be high, especially when the needle passes through honeycomb lesions.

KEY POINTS

• In patients with idiopathic pulmonary fibrosis (IPF), CT-guided percutaneous transthoracic needle lung biopsy (PTNB) showed a relatively reasonable accuracy for the diagnosis of malignancy. • Target lesion size ≤ 3 cm and biopsy needle tip placement outside the target lesion were risk factors for nondiagnostic results of CT-guided PTNB. • The complication rate may be high, especially in cases where the biopsy needle passes through honeycomb lesions.

The Spectrum of CT Findings of COVID-19 Pneumonia: Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair

Purpose

To analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19).

Materials and Methods

From February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study. A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher's exact test.

Results

Predominant CT patterns were AAI pattern (87%) in the early hospital period group (0-10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson's chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher's exact test). No fibrous changes in the lesions were observed on follow-up CT scans.

Conclusion

The serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.

Surgical considerations during cochlear implantation: the utility of temporal bone computed tomography

OBJECTIVE

This paper describes the construction of portals for electrode placement during cochlear implantation and emphasises the utility of pre-operative temporal bone three-dimensional computed tomography.

METHODS

Temporal bone three-dimensional computed tomography was used to plan portal creation for electrode insertion.

RESULTS

Pre-operative temporal bone three-dimensional computed tomography can be used to determine the orientation of temporal bone structures, which is important for mastoidectomy, posterior tympanotomy and cochleostomy, and when using the round window approach.

CONCLUSION

It is essential to create appropriate portals (from the mastoid cortex to the cochlea) in a step-by-step manner, to ensure the safe insertion of electrodes into the scala tympani. Pre-operative three-dimensional temporal bone computed tomography is invaluable in this respect.

Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy

OBJECTIVE

To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy.

METHODS

This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans.

RESULTS

Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05).

CONCLUSION

Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.

Primary Extracranial Fibrous Meningioma of the Maxillary Sinus: A Case Report and Literature Review

Meningioma is a common neoplasm of the central nervous system; however, primary extracranial meningioma of the paranasal sinus, especially the maxillary sinus, is rare. We report a case of primary extracranial meningioma (fibrous type) of the maxillary sinus and present a literature review of the imaging features that correlate with fibrous meningioma.

Retroperitoneal Bronchogenic Cyst Located in the Presacral Space: A Case Report

Bronchogenic cysts are rare congenital anomalies that are most frequently found in the mediastinum along the tracheobronchial tree, especially in the posterior aspect of the superior mediastinum. Bronchogenic cysts have also been reported in intrapulmonary, intrapericardial, abdominal, and retroperitoneal locations. Herein, we report a case of a retroperitoneal bronchogenic cyst in the presacral space. The patient was diagnosed based on a post-operative histopathological examination.

Lymphomatoid Granulomatosis Involving the Lung and Brain in a Child: A Case Report

Lymphomatoid granulomatosis (LG) is a rare B-cell type angiocentric lymphoproliferative disease that can progress to extranodal lymphoma with high mortality. It most commonly affects the lungs, although extrapulmonary systems, including the brain and skin, can also be involved. LG in pediatric patients has been very rarely reported in the literature with limited imaging features. Herein, we report a pediatric case of LG involving the lung and brain with characteristic imaging findings.

Synovial Sarcoma of the Anterior Chest Wall: A Case Report

Synovial sarcoma is a malignant soft tissue tumor that usually involves the extremities, particularly near the knees; a synovial sarcoma originating in the chest wall is extremely rare. We describe a 26-year-old woman diagnosed with a synovial sarcoma originating in the chest wall, based on CT and MRI findings. Contrast-enhanced CT images revealed a small, well-defined enhancing mass with calcification, in the subpleural area. This lesion was initially diagnosed as a benign tumor; however, the patient developed sudden severe pain with spontaneous bleeding and hemothorax, suggesting the possibility of malignancy. MRI revealed a multilobulated mass with a fluid-fluid level, which characterizes a synovial sarcoma.

Pulmonary Adenofibroma Manifesting as Two Nodules in Different Lobes of the Lung: A Case Report

Pulmonary adenofibroma is a rare tumor, with a few reported cases in the literature. Radiologically, the lesion appears as a solitary pulmonary nodule in most cases, and the multiplicity of this disease entity is extremely rare. We present an unusual case of pulmonary adenofibroma in a 71-year-old woman manifested as two nodules in different lobes of the lung on CT. Histopathological and immunohistochemical examinations are needed to establish the definitive diagnosis of pulmonary adenofibroma.

Delayed diagnosis of a primary intraosseous squamous cell carcinoma: A case report

Primary intraosseous squamous cell carcinoma is a rare malignant central jaw tumor derived from odontogenic epithelial remnants. Predominantly, it affects mandible, although both jaw bones may be involved. This report describes a 60-year-old man who was initially misdiagnosed with a periapical infection related to the right lower wisdom tooth. After four months, the patient presented to a private dental clinic with a massive swelling at the right side of the mandible. Panoramic radiographs and advanced imaging revealed a lesion with complete erosion of the right ramus, which extended to the orbital floor. A biopsy from the mandibular angle revealed large pleomorphic atypical squamous cells, which is the primary microscopic feature of a poorly differentiated squamous cell carcinoma.

Keratocystic odontogenic tumor: case report with CT and ultrasonography findings

Keratocystic odontogenic tumor (KCOT) is a benign odontogenic tumor with a potentially aggressive and infiltrative behavior. KCOT is most commonly occurred in mandible and demonstrate a unilocular, round, oval, scalloped radiolucent area, while large lesions may appear multilocular. An important characteristic of KCOT is its propensity to grow in an antero-posterior direction within medullary cavity of bone causing minimal expansion. Definitive diagnosis relies on histological examination. In this report, a KCOT that had an expansion both buccal and lingual cortical bone is described including its features in computed tomography and ultrasonographic exams. The lesion was removed surgically via an intraoral approach under local anesthesia and histologically reported as a KCOT.