Valsalva sinus aneurysms: findings at CT and MR imaging.

Aneurysms of the Valsalva sinus (aortic sinus) can be congenital or acquired and are rare. They are more common among men than women and among Asians than other ethnic groups. Nonruptured aneurysms may be asymptomatic and incidentally discovered, or they may be symptomatic and manifest acutely with mass effect on adjacent cardiac structures. Ruptured Valsalva sinus aneurysms result in an aortocardiac shunt and may manifest as insidiously progressive congestive heart failure, severe acute chest pain with dyspnea, or, in extreme cases, cardiac arrest. Although both ruptured and nonruptured Valsalva sinus aneurysms may have potentially fatal complications, after treatment the prognosis is excellent. Thus, prompt and accurate diagnosis is critical. Most Valsalva sinus aneurysms are diagnosed on the basis of echocardiography, with or without angiography. However, both electrocardiographically gated computed tomography and magnetic resonance (MR) imaging can provide excellent anatomic depiction, and MR imaging can provide valuable functional information.

Pseudallescheria boydii (Scedosporium species) in 3 lung transplant recipients: computed tomography findings and literature review.

OBJECTIVE: The objective of our study was to evaluate chest computed tomography (CT) findings in 3 lung transplant recipients infected with Pseudallescheria boydii complex or its asexual anamorph, Scedosporium apiospermum, 2 after double-lung transplant and 1 after single-lung transplantation. Awareness and early diagnosis of this rare but potentially lethal infection are important, as it is largely refractory to treatment with the antifungal agents of choice used for the more common Aspergillus species. Computed tomography investigation focused on the location, quality, and appearance of the various pulmonary lesions as well as the presence of cavitation, mediastinal lymphadenopathy, and pleural effusions. A literature review of previous lung and other solid organ transplant recipients infected with pulmonary Pseudallescheria boydii was also conducted and compared with our findings. CONCLUSION: While the high-resolution CT findings of pulmonary P. boydii infection are nonspecific and markedly similar to the manifestations of the more common Aspergillus species, awareness of this rare opportunist is important, given the high mortality associated with disseminated infection and the relative success possible with timely and appropriate treatment. The most common CT abnormalities present in our 3 patients included hilar and paratracheal adenopathy, noncavitary tree-in-bud nodules surrounded by ground-glass opacities, and airway thickening.

Carotid blowout in a patient with nasopharyngeal carcinoma treated with SBRT re-irradiation for local recurrence using twice weekly treatment.

We present the case of a patient undergoing reirradiation for a T4 nasopharyngeal tumor 1 year after his initial radiation, treated with SBRT to a moderate dose with twice weekly fractionation. Despite the measures of caution employed, the patient had a fatal carotid blowout at 7 months following SBRT. This suggests that spacing apart fractions of SBRT alone may not be sufficient to obviate the risk of carotid blowout syndrome and other risk factors and interventions should be considered.

Stereotactic body radiotherapy for a large arteriovenous malformation of the head and neck.

Large arteriovenous malformations (AVMs) of the head and neck present a treatment challenge. A 38-year-old woman presented with a large intraoral bleed from longstanding AVMs of the left infratemporal fossa and the right tongue, despite 10 prior surgeries and embolizations. She was treated with stereotactic body radiotherapy with a dose of 24 Gy in three weekly fractions. Four years later, she has had dramatic shrinkage of her AVM, no recurrent bleeding episodes, no further treatment required, and no significant late effects. Level of evidence: NA.

Imaging for headache: what the neuroradiologist looks for.

In this article, computed tomography and magnetic resonance imaging anatomy and pathology of sinus disease is discussed, specifically relating to facial pain, rhinogenic headache, and sinus outflow obstruction. Findings commonly seen in acute, chronic, infectious, and inflammatory sinusitis are illustrated, with additional examples of secondary intracranial and orbital involvement, and more aggressive infectious and neoplastic processes.

Impact of surgical resection on survival in patients with advanced head and neck cancer involving the carotid artery.

IMPORTANCE: The present study addresses the survival benefit of aggressive surgical treatment of head and neck cancer involving the carotid artery. OBJECTIVE: To assess survival outcomes in patients treated for advanced squamous cell carcinoma involving the carotid artery using different treatment strategies. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study at a tertiary care center of 44 consecutive patients with squamous cell carcinoma involving the carotid artery from 2005 to 2012 with a median follow-up of 12 months. The radiologist was blinded to the outcome of surgical procedures. INTERVENTIONS: Surgery with or without radiotherapy, and definitive chemoradiation. MAIN OUTCOMES AND MEASURES: Overall survival and rates of locoregional and distant failures. The hypothesis was formulated before data collection. RESULTS: Of 44 patients, 35 (80%) were treated with curative intent with surgery with or without adjuvant therapy (n = 27 [61%]) or definitive chemoradiation therapy (n = 8 [18%]), while 9 patients (21%) were treated in a palliative fashion. Patients treated with curative intent had improved overall survival (median survival, 13.5 months) compared with the palliative group (median survival, 3.6 months) (P = .001). Of patients treated with curative intent, those with previously untreated disease (n = 14 [40%]) had an improved outcome relative to patients with recurrent or persistent disease (n = 21 [60%]), with median survival of 38.7 and 9.6 months, respectively (P = .008). Patients were treated with curative intent using 3 different treatment strategies (ie, carotid artery resection with or without reanastamosis) (n = 6 [17%]), curative peeling with or without adjuvant therapy (n = 21 [ 60%]), and definitive chemoradiation therapy (n = 8 [23%]). Survival outcome was not significantly different between subgroups treated with curative intention (P = .47). When reviewed by a head and neck radiologist in a blinded fashion (n = 30), preintervention imaging had a positive predictive value of 72.7% for resectability of cancer involving the carotid artery. In cases with almost circumferential involvement (>270°) and narrowing of the carotid artery, the disease was unresectable (n = 3). CONCLUSIONS AND RELEVANCE: Advanced head and neck cancer involving the carotid artery can be treated with curative intent with favorable results in most patients. If disease burden merits, an aggressive approach involving resection with or without reanastamosis of the carotid artery can be used without significant added morbidity.