Percutaneous Treatments for Persistent Bronchopleural and Alveolar-Pleural Fistulae.

Percutaneous glue embolization was investigated as a treatment for bronchopleural fistulae (BPFs) and alveolar-pleural fistulae (APFs) associated with persistent air leak. Seven consecutive patients with persistent air leak were treated with percutaneous glue embolization of the BPF/APF from both iatrogenic and spontaneous causes. Treatment was performed using direct n-butyl cyanoacrylate (nBCA) glue injection for discrete, visible fistulae (n = 4), fibrin glue spray for suspected tiny multifocal leaks (n = 2), or both (n = 1). The number of treatments required per patient was 1 (n = 3), 2 (n = 3), or 3 (n = 1). Technical success was achieved in all cases. Follow-up showed resolution of all air leaks, with mean chest tube removal at 7.1 days after the embolization. The follow-up duration ranged from 2 to 47 months. No significant procedure-related morbidity, mortality, or recurrence was encountered. Percutaneous treatment for persistent BPFs and APFs showed good efficacy in this small case series and warrants further investigation.

Correction to: Magnetic resonance imaging features of the superior cervical ganglion and expected changes after radiation therapy to the head and neck in a long-term follow-up.

In the article "Magnetic resonance imaging features of the superior cervical ganglion and expected changes after radiation therapy to the head and neck in a long-term follow-up", one of the author names, K Chokkappan, was spelled incorrectly.

Rapidly Developing Subdural Empyema in an Adult with Sinusitis: A Neurosurgical Threat Alert.

Subdural empyema (SDE) is collection of pus in the potential space between the dura and arachnoid layers of the meninges. Leading causes of SDE are sinonasal and otomastoid infections. Commonly affecting patients in the second and third decades, SDE could have a fulminant course with immediate complications and delayed morbidities including hydrocephalus, focal deficits, and epilepsy.

High-Resolution Computed Tomography Imaging in Conductive Hearing Loss: What to Look for?

Conductive hearing loss (CHL) is caused by the disruption of the sound conductive chain that, in turn, may be due to diseases of the external and middle ear. High-resolution computed tomography (CT) is the imaging modality of choice to evaluate CHL because of its excellent spatial resolution. Along with clinical and otoscopic findings, CT also helps in the diagnosis and preoperative planning. This pictorial review aims to illustrate the CT features of common conditions causing CHL that may arise from the external and middle ear, as well as highlights some of the key imaging features that are helpful in management.

Clinics in diagnostic imaging (174). L5 vertebral superior facet osteoblastoma (OB).

A 25-year-old man presented with chronic low back pain and occasional radiation to the right lower limb. Magnetic resonance imaging and computed tomography (CT) of the lumbar spine showed an osteolytic expansile lesion with a central sclerotic nidus in the right superior facet of the L5 vertebra and surrounding marrow oedema. The diagnosis of osteoblastoma was made based on imaging findings and confirmed after CT-guided biopsy. Radiofrequency ablation of the lesion was successfully performed. The patient tolerated the procedure well and showed symptomatic relief. The imaging features and management of osteoblastoma are discussed.

Review of diagnostic uses of shunt fraction quantification with technetium-99m macroaggregated albumin perfusion scan as illustrated by a case of Osler-Weber-Rendu syndrome.

Bilateral pulmonary arteriovenous malformations (AVMs) are rare and are often associated with the hereditary hemorrhagic telangiectasia (HHT/Osler-Weber-Rendu) syndrome. We present a woman who presented with neurological symptoms due to a cerebral abscess. On further evaluation, bilateral pulmonary AVMs were identified. The patient was diagnosed with HHT, based on positive family history and multiple cerebral AVMs recognized on subsequent catheter angiogram, in addition to the presence of bilateral pulmonary AVMs. Craniotomy with drainage of the brain abscess and endovascular embolization of the pulmonary AVMs was offered to the patient. As a preembolization work-up, the patient underwent nuclear lung perfusion scan with technetium-99m macroaggregated albumin (Tc-99m MAA) to assess the right-to-left shunt secondary to the pulmonary AVMs. Postembolization follow-up perfusion scan was also obtained to estimate the hemodynamic response. The case is presented to describe the role of Tc-99m MAA perfusion lung scan in preoperatively evaluating patients with pulmonary AVMs and to emphasize on the scan's utility in posttreatment follow-up. Various present day usages of the Tc-99m MAA lung perfusion scan, other than diagnosing pulmonary thromboembolism, are discussed. Providing background knowledge on the physiological and hemodynamic aspects of the Tc-99m MAA lung perfusion scan is also attempted. Various imaging pitfalls and necessary precautions while performing Tc-99m MAA lung perfusion scan are highlighted.

An Approach to Various Gastric Pathologies Using an "Image Appearance-Based Classification" on Computed Tomography.

Although pathologies affecting stomach are commonly encountered in computed tomography imaging of the abdomen, they are frequently overlooked. Their etiologies are often diverse; however, most of them have certain well-documented imaging characteristics. Conventionally the stomach abnormalities were classified according to their etiopathogenesis. This article aims at providing the readers with an easy approach by categorizing abnormalities of stomach using a novel image appearance-based classification. An attempt to illustrate various gastric pathologies using this new classification by means of pictorial examples is made. Basic computed tomography imaging anatomy of the stomach and imaging techniques that need to be adapted are also emphasized in the outset of the discussion.

Imaging Features of Sinonasal Inverted Papilloma: A Pictorial Review.

Computed tomography and magnetic resonance imaging are widely used for evaluation of patients with nasal masses, playing an integral role in their diagnosis and treatment. Inverted papilloma is a rare tumor of the sinonasal region that demonstrates characteristic imaging appearances. Preoperative diagnosis and precise tumor extent are essential for surgical planning as this tumor grows centrifugally and has high potential to recur following incomplete surgery. This pictorial review aims to illustrate the spectrum of imaging features of inverted papilloma and highlight the key features that are useful for making an accurate diagnosis of this condition. Common differential diagnoses are also discussed.

Os Trigonum - Sheer Incidental or Quite Significant? Single Photon Emission Computed Tomography/Computed Tomography's Role in a Case of Ankle Impingement.

Accessory ossicles are widely prevalent in the ankle and foot. Although they are often asymptomatic, they can present clinically with symptoms at times. When they occur bilaterally in a patient who presents with unilateral complaints, it is clinically difficult to attribute the symptoms to the presence of these common anatomic variants. One needs specific imaging to assess the clinical relevance of the accessory ossicles, in order to tailor the treatment plan. The case presented in this article is one such example, where the patient presented with chronic unilateral ankle pain and initial radiographs revealed bilateral os trigonum and os subtibiale. He underwent a technetium-99m methyl diphosphonate (Tc-99m MDP) bone scan and single photon emission computed tomography/computed tomography (SPECT/CT). The Tc-99m MDP scan showed a focal uptake in the ankle of concern. SPECT/CT complemented the finding by exactly localizing the uptake to the posterior subtalar joint and around the os trigonum, thereby pointing to the diagnosis of os trigonum syndrome.

Unusual Cause of Swelling in the Upper Limb: Kimura Disease.

Kimura disease is a rare chronic inflammatory disease of unknown etiology. The disease typically presents in young Asian males with single or multiple slowly progressing painless subcutaneous lumps in the head and neck region; regional lymphadenopathy is commonly accompanied. The disease is associated with peripheral blood eosinophilia and elevated serum immunoglobulin E levels. This gives an important clinical clue to the diagnosis and implies a possible immune-mediated pathophysiology. Although the disease commonly affects the head and neck region, it may also affect the extremities, axilla, groin, and abdomen. Upper limb involvement in Kimura's disease is rare and few cases have been reported in the literature. We describe the case of a man who presented with a history of progressive upper limb swelling. He was diagnosed with Kimura's disease based on concordant clinical, laboratory, radiological, and histopathological grounds. Although rare in the upper limb, the possibility of Kimura's disease has to be considered in young males presenting with painless swelling in the medial epitrochlear region with compatible imaging appearance, particularly if associated with lymph node enlargement and increased blood eosinophils. Characteristic imaging findings of Kimura's disease of the upper limb include specific location along the neuro-lymphovascular structures, the absence of necrosis or calcification, mutliple flow voids representing vascular structures, a varying amount of edema of subcutaneous fat plane overlying the lesion; displacement of adjacent muscles; and neurovascular structures without signs of direct invasion. Clinicians should be aware of this distinct entity in order to avoid misdiagnosis and to tailor appropriate management.

Diverticulitis of the appendix, a distinctive entity: preoperative diagnosis by computed tomography.

Diverticular disease of the appendix is rare and is usually diagnosed during surgery. We report a case of a 50-year-old man who presented to the emergency department with right lower quadrant pain of 1-day duration. A preoperative diagnosis of appendiceal diverticulitis was made by computed tomography of the abdomen. The patient underwent emergency laparoscopic appendectomy, which confirmed the diagnosis.

Rare case of urinary bladder agenesis--multislice CT abdomen imaging.

Complete agenesis of urinary bladder is an extremely rare anomaly with only a few live cases reported so far. In most of the instances death occurs early as it may be incompatible with life. Here we report a case of adolescent female with urinary bladder and unilateral renal agenesis, who presented with a rather unusual presentation of incontinence, for a computed tomography (CT) examination. Other congenital abnormalities visualised in the CT abdomen are also discussed.

Technical note: CT-guided biopsy of lung masses using an automated guiding apparatus.

Automated guiding apparatuses for CT-guided biopsies are now available. We report our experience with an indigenous system to guide lung biopsies. This system gave results similar to those with the manual technique. Automated planning also appears to be technically easier, it requires fewer number of needle passes, consumes less time, and requires fewer number of check scans.