RESUMO
Bone marrow necrosis (BMN) is a rare malignancy-associated hematologic disorder characterized by necrosis of myeloid and stromal marrow elements with preservation of cortical bone. Overlap between the imaging appearances of BMN and avascular necrosis (AVN) raises the potential for diagnostic confusion. We report a case of BMN presenting with a traumatic multi-level vertebral body collapse, and finding that may potentially confound distinction between the two entities. We discuss important pathophysiologic, clinical, and radiologic differences between BMN and AVN with emphasis on features important in the differential diagnosis.
Assuntos
Doenças da Medula Óssea/diagnóstico , Fraturas por Compressão/diagnóstico , Vértebras Lombares/lesões , Osteonecrose/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Doenças da Medula Óssea/complicações , Diagnóstico Diferencial , Fraturas por Compressão/complicações , Humanos , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Necrose/complicações , Necrose/patologia , Osteonecrose/complicações , Fraturas da Coluna Vertebral/complicaçõesRESUMO
A 49-year-old patient with primary, recurrent melanoma on the lower extremity developed metastatic leptomeningeal melanoma that did not respond to treatment with radiation therapy or intrathecal interleukin 2 (IL-2). Disease was characterized by neurological symptoms, including loss of hearing, loss of short-term memory, and gait disturbance. CD8+ CTLs were generated in vitro using autologous dendritic cells pulsed with peptides from the melanoma-associated antigens tyrosinase (145-156), Melan-A/MART-1 (26-35), and gp100/Pmel 17 (209-217). The CTLs exhibited up to 74% specific lysis against peptide-pulsed autologous EBV-transformed B cells, with Melan-A-specific CTLs yielding the greatest lytic activity. CD8+ CTLs possessed a type 1 cytokine profile, expressing tumor necrosis factor alpha and IFNgamma but not IL-4. Infusions of CTLs were supported with systemic low-dose IL-2 administration. 111In labeling and computerized gamma imaging were used to monitor the distribution of CTLs up to 48 h after infusion. Intra-arterial delivery via the right carotid artery was followed by redistribution of the CTLs to the lungs, liver, and spleen within 16 h. In contrast, delivery via an indwelling Ommaya reservoir resulted in prolonged retention of CTLs within the brain for at least 48 h after infusion. Marked but transient elevations in tumor necrosis factor alpha, IFN-gamma, and IL-6 in the cerebrospinal fluid were observed within 4 h of CTL infusion. There was no evidence of tumor progression throughout the treatment period, and clinically the patient showed some resolution of neurological symptoms.
Assuntos
Imunoterapia , Melanoma/terapia , Neoplasias Meníngeas/terapia , Linfócitos T Citotóxicos/metabolismo , Antígenos de Neoplasias , Linfócitos B/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Citocinas/biossíntese , Células Dendríticas/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Humanos , Imunoterapia Adotiva , Índio/metabolismo , Interferon gama/biossíntese , Interferon gama/metabolismo , Interleucina-2/metabolismo , Interleucina-4/metabolismo , Interleucina-6/biossíntese , Antígeno MART-1 , Glicoproteínas de Membrana , Pessoa de Meia-Idade , Monofenol Mono-Oxigenase/química , Proteínas de Neoplasias/química , Proteínas , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Tempo , Distribuição Tecidual , Células Tumorais Cultivadas , Fator de Necrose Tumoral alfa/biossíntese , Antígeno gp100 de MelanomaRESUMO
We examined two patients with unilateral ophthalmologic findings secondary to pansinusitis caused by Bipolaris. Both patients were healthy young men. One patient had a gradual visual loss, whereas the other showed proptosis. Surgical debridement was the primary treatment in both patients. One patient received antifungal therapy, whereas the other was cured with surgery alone.
Assuntos
Micoses , Sinusite/etiologia , Adolescente , Humanos , Itraconazol , Cetoconazol/análogos & derivados , Cetoconazol/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Sinusite/diagnóstico , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND PURPOSE: Cytogenetic abnormalities, especially chromosome 13 deletion, are high-risk factors for multiple myeloma. Attaining the highest detection rates of cytogenetic abnormalities is important to provide accurate prognostic information to the referring oncologist. The purpose of this study was to use CT-guided percutaneous fine-needle aspiration bone biopsy (CT-guided FNA) of MR-detected focal lesions in patients with multiple myeloma to increase identification of abnormal cytogenetics. METHODS: Patients enrolled in two clinical trials for myeloma therapy underwent MR imaging of the entire spine and pelvis. CT-guided FNA biopsy samples obtained from MR-detected focal lesions in these patients were sent for cytogenetic analysis. FNA results were then compared with random bone marrow sampling of the iliac crest done at or near the same time as the FNA to provide the data revealed in this study. RESULTS: Forty-one patients (47 lesions) in one of the trials and 37 patients (38 lesions) in the other trial had biopsies performed. CT-guided FNA revealed cytogenetic abnormalities in 21% of the total patient population and new information in nearly 10% of the patients in one trial and in 20% of those in the other trial. CONCLUSION: CT-guided biopsy of MR-detected focal lesions is a safe technique that can provide important cytogenetic information in a significant number of patients with multiple myeloma not identified during random marrow sampling.
Assuntos
Biópsia por Agulha/instrumentação , Aberrações Cromossômicas , Mieloma Múltiplo/patologia , Tomografia Computadorizada por Raios X/instrumentação , Osso e Ossos/patologia , Deleção Cromossômica , Cromossomos Humanos Par 13 , Humanos , Mieloma Múltiplo/genéticaRESUMO
Computed tomographic myelography (CTM) is the procedure of choice in patients exhibiting spinal manifestations of neurofibromatosis. Due to the lack of specificity of several of the more important plain spine radiographic findings in this disease, CTM may be necessary to distinguish between surgical and nonsurgical entities. CTM will determine the size, shape, and intraspinal extension of posterior mediastinal neural tumors and separate them from the more common thoracic meningoceles. CTM will likewise elucidate the causes of posterior vertebral body scalloping, distinguishing between dural ectasia and neural tumor. CTM will also frequently demonstrate additional asymptomatic lesions at other levels.
Assuntos
Neurofibromatose 1/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Criança , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Meningocele/diagnóstico por imagem , Metrizamida , Mielografia , Neurilemoma/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagemRESUMO
Thin section, high resolution computed tomographic (CT) scans of the lumbar spine produce images that can show herniated intervertebral discs without intravenous or intrathecal contrast enhancement. With this technique, the diagnosis of posterolateral and midline herniation has been greatly facilitated. This communication reports the use of CT discography in the preoperative evaluation of two patients who were shown at discography and proven at operation to have extreme lateral disc herniations.
Assuntos
Deslocamento do Disco Intervertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The finding of mature neuroglial tissue in a mass from the head and neck region of a child raises four differential diagnostic possibilities: teratoma, encephalocele, glioma, and heterotopic brain tissue. We present a review of the literature and discuss the clinical, radiographical, and pathological features of a rare nasopharyngeal brain heterotopia in an infant causing upper airway obstruction.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Encéfalo , Coristoma/diagnóstico por imagem , Neoplasias Nasofaríngeas/diagnóstico por imagem , Coristoma/complicações , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Neoplasias Nasofaríngeas/complicações , Tomografia Computadorizada por Raios XRESUMO
Fetal anomalies have been the subject of innumerable publications both in the prenatal and neonatal literature. This has significantly increased in the last 10 years, mainly because of the advent of high-resolution ultrasound equipment and improvement of scanning techniques. In addition, guidelines issued by professional organizations involved in prenatal diagnosis have encouraged a more universal approach to the imaging and documentation of prenatal findings. The fetal central nervous system is the most frequently investigated organ system, mainly because of its easy accessibility and prominence even in the early stages of embryologic development. The biparietal diameter was the first fetal measurement to be widely used in determining gestational age. As investigators gained more experience, the appearance of ultrasound images achieved the resolution that allows direct comparisons with gross specimens and more recent sophisticated techniques of computed tomography and magnetic resonance imaging. Now endovaginal ultrasound can document early first trimester development and compare it to known embryologic landmarks. Interest in demonstrating the ultrasound counterpart of central nervous system structures in the early stages of development has resulted in a plethora of articles proving the unique ability of ultrasound in imaging the developing fetus. In view of all these developments, the beginning ultrasound specialist is faced with the challenge and responsibility not only of being familiar with the literature but also of the mastery of scanning techniques that allow accurate prenatal diagnosis. It is therefore helpful to review key developmental milestones in embryologic life and correlate them with the corresponding prenatal ultrasound appearance. In addition, the changing appearance of the developing fetus has created a need for a systematic approach in the evaluation of structures so routine protocols can be established. This has been the subject of other publications that allow the novice to draw from the cumulative experience of different centers around the world. It is important to pay attention to the specifics described in the literature when duplicating results in one's laboratory. The frustration of not being able to reproduce results is common, especially when technical limitations prevent imaging under ideal conditions. This is especially true in patients who are first seen in the later third trimester with no prior prenatal care.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Dano Encefálico Crônico/embriologia , Encéfalo/anormalidades , Sistema Nervoso Central/anormalidades , Anormalidades Congênitas/diagnóstico , Diagnóstico Pré-Natal/métodos , Medula Espinal/embriologia , Encéfalo/embriologia , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/diagnóstico por imagem , Sistema Nervoso Central/diagnóstico por imagem , Sistema Nervoso Central/embriologia , Diagnóstico Diferencial , Ecoencefalografia , Feminino , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/diagnóstico por imagem , Defeitos do Tubo Neural/embriologia , Gravidez , Medula Espinal/anormalidades , Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Infarto Cerebral/complicações , Transtornos de Deglutição/etiologia , Mutismo/etiologia , Infarto Cerebral/diagnóstico , Infarto Cerebral/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mutismo/fisiopatologia , SíndromeAssuntos
Blastomicose/diagnóstico , Imageamento por Ressonância Magnética , Doenças Nasofaríngeas/diagnóstico , Osso Temporal , Tomografia Computadorizada por Raios X , Adulto , Blastomicose/diagnóstico por imagem , Doenças Ósseas/diagnóstico , Doenças Ósseas/diagnóstico por imagem , Feminino , Humanos , Doenças Nasofaríngeas/diagnóstico por imagemRESUMO
High-resolution computed tomography in intracranial aneurysms is a highly valuable procedure. Its indications are as follows: to determine the presence of subarachnoid hemorrhage and to predict the location of aneurysms; to identify and characterize saccular and giant aneurysms; to assess the complications of aneurysm rupture; to evaluate operative maneuvers and postoperative complications. The technique of high resolution computed tomography consists of unenhanced and enhanced 10-mm-thick sections followed by 1.5mm thin sections through suspicious areas. A bolus of 100cc of 60% meglumine diatrizoate is given for the enhanced study. A repeat bolus of 60cc of contrast agent is administered prior to the thin sections. Direct coronal scanning and sagittal/coronal reformatting is frequently used. This review will detail the technique used in this procedure as well as present examples of the major indications listed above. This is the procedure of choice for patients suspected of having had a subarachnoid hemorrhage or harboring an intracranial aneurysm.
Assuntos
Aneurisma Intracraniano/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Angiografia Cerebral , Meios de Contraste , Seguimentos , Hematoma Subdural/diagnóstico por imagem , Humanos , Hemorragia Subaracnóidea/diagnóstico por imagemRESUMO
High-resolution computed tomography (CT) is superior to other imaging modalities in assessing the extent and degree of spinal fractures. The determination of bone fragments within the spinal canal and the detection of posterior neural arch damage are major advantages offered by computed tomography. The addition of intrathecal contrast allows proper assessment of the oftentimes confusing neurologic picture. Plain roentgenograms of the spine are only the initial diagnostic examinations of spinal fractures. Roentgenograms in conjunction with high-resolution CT, performed with or without intrathecal contrast, provide the best evaluation of thoracolumbar spinal fractures.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Torácicas/lesões , Humanos , Luxações Articulares/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Metrizamida , Mielografia , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Craniopharyngiomas usually arise in the suprasellar or parasellar region. The occurrence of the tumors in other locations is rare and they have to be distinguished from lesions in the suprasellar or sellar region with unusual extension. Thus far, few craniopharyngiomas of infrasellar origin have been described. We report a case in which the tumor presented as a nasopharyngeal mass and CT and magnetic resonance were used for evaluation. Review of the pertinent embryology and literature is also included.
Assuntos
Craniofaringioma/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias Nasofaríngeas/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Craniofaringioma/embriologia , Humanos , Masculino , Neoplasias Nasofaríngeas/embriologiaRESUMO
The present report demonstrates a complication not previously reported secondary to thyroid surgery as a treatment of hyperthyroidism. This complication of a sinus tract extending 6 cm from the thyroid to the skin appeared to be due to a foreign body reaction to the sutures utilized in the operation. This sinus tract which extruded some sutures became infected with Staphylococcus aureus which prevented spontaneous closure. The formation of a sinus tract in the neck after a subtotal thyroidectomy for hyperthyroidism appears to be a much less common complication than the previously reported complications of bilateral abductor vocal fold paralysis, unilateral recurrent nerve paralysis, permanent post-operative hypoparathyroidism and thyroid storm secondary to this surgery, but the true incidence of sinus tract formation after thyroid surgery is unknown at present.
Assuntos
Fístula/etiologia , Doença de Graves/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Tireoidectomia/efeitos adversos , Feminino , Reação a Corpo Estranho/complicações , Humanos , Pessoa de Meia-Idade , Pescoço , Suturas/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
Gangliogliomas are uncommon primary brain tumors composed of atypical glial and neuronal cells. These tumors usually occur in children and young adults. They are slow-growing tumors that present with seizures. We have reviewed four cases from our institution and have correlated the magnetic resonance (MR) findings with CT and histology. Two distinct patterns were observed with MR. In three of four patients, ranging in age from 7 to 14 years, MR showed a mass with decreased signal on T1-weighted images (WI) and increased signal on T2WI. The most common CT finding was a hypodense enhancing mass with focal calcifications. The histologic features of these tumors comprised microcysts and hypervascularity. In one of four patients, an infant. MR showed increased signal on T1WI and decreased signal on T2WI. Computed tomography showed a hyperdense nonenhancing mass. Histology demonstrated an increase of hypercellularity with both atypical glial and neuronal components.
Assuntos
Neoplasias Encefálicas/diagnóstico , Imageamento por Ressonância Magnética , Neuroblastoma/diagnóstico , Adolescente , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Neuroblastoma/diagnóstico por imagem , Neuroblastoma/patologia , Tomografia Computadorizada por Raios XRESUMO
A device was constructed to allow rapid adjustment of the position of a surface coil in magnetic resonance (MR) imaging of the spine. The device consists of two sheets of acrylic plastic and a movable sled. The surface coil is placed on the sled and can be precisely moved superiorly or inferiorly with a cord attached to the sled. The device can save approximately 30 minutes during MR imaging of the entire spine and increases patient comfort and cooperation.
Assuntos
Imageamento por Ressonância Magnética/instrumentação , Coluna Vertebral/anatomia & histologia , HumanosRESUMO
Four patients with spinal epidural sepsis were evaluated with MR imaging. The lesions were best visualized with spin-echo techniques with long repetition (2000 msec) and long echo (80-100 msec) times. Sagittal and axial images were equally important in defining the extent of the lesions. Comparison with available contrast-enhanced CT scans showed that MR was more definitive in the early demonstration of the abscesses. This early recognition influenced the management greatly and improved the clinical outcome significantly. The findings in our four cases support previous reports that MR is superior to other imaging methods for early recognition and anatomic localization of infectious diseases in patients suspected of having either spinal osteomyelitis or spinal epidural sepsis.
Assuntos
Espaço Epidural , Imageamento por Ressonância Magnética , Canal Medular , Infecções Estafilocócicas/diagnóstico , Tuberculose da Coluna Vertebral/diagnóstico , Adulto , Criança , Feminino , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/diagnóstico , Vértebras Torácicas/patologiaRESUMO
A 62-year-old man presented with papilledema, a cranial bruit, and a partial left oculomotor nerve palsy. Arteriography revealed a large mixed pial-dural arteriovenous malformation involving the superior sagittal and both transverse sinuses. After the superior part of the malformation was embolized, the patient's papilledema and ocular motility disturbance resolved. The oculomotor disturbance may have been a nonspecific sign of increased intracranial pressure. Cranial auscultation should be performed in all cases of papilledema and cranial nerve palsy.