Congenital vascular malformations in scintigraphic evaluation.

BACKGROUND: Congenital vascular malformations are tumour-like, non-neoplastic lesions caused by disorders of vascular tissue morphogenesis. They are characterised by a normal cell replacement cycle throughout all growth phases and do not undergo spontaneous involution. Here we present a scintigraphic image of familial congenital vascular malformations in two sisters. MATERIAL/METHODS: A 17-years-old young woman with a history of multiple hospitalisations for foci of vascular anomalies appearing progressively in the upper and lower right limbs, chest wall and spleen. A Parkes Weber syndrome was diagnosed based on the clinical picture. Due to the occurrence of new foci of malformations, a whole-body scintigraphic examination was performed. A 12-years-old girl reported a lump in the right lower limb present for approximately 2 years, which was clinically identified as a vascular lesion in the area of calcaneus and talus. Phleboscintigraphy visualized normal radiomarker outflow from the feet via the deep venous system, also observed in the superficial venous system once the tourniquets were released. In static and whole-body examinations vascular malformations were visualised in the area of the medial cuneiform, navicular and talus bones of the left foot, as well as in the projection of right calcaneus and above the right talocrural joint. CONCLUSIONS: People with undiagnosed disorders related to the presence of vascular malformations should undergo periodic follow-up to identify lesions that may be the cause of potentially serious complications and to assess the results of treatment. Presented scintigraphic methods may be used for both diagnosing and monitoring of disease progression.

Pneumatosis cystoides interstitialis: A complication of graft-versus-host disease. A report of two cases.

BACKGROUND: Pneumatosis cystoides intestinalis (PCI) is a rare disorder characterized by the presence of multiple gas collections in the subserosal or submucosal intestinal wall of the large or small intestine. We report two cases of PCI in the course of chronic graft-versus-host disease. CASE REPORT: A 5-year-old girl was treated for acute lymphoblastic leukemia. Twenty-four months after the hematopoietic stem cell transplantation, in the course of graft-versus-host disease, she developed subcutaneous emphysema of the right inguinal and pudendal region. PCI was diagnosed based on a CT examination. A 3-year-old boy was treated for juvenile myelomonocytic leukemia. Fourteen months after the hematopoietic stem cell transplantation he presented with an increased severity of intestinal symptoms, including intermittent bleeding from large intestine. PCI was diagnosed based on a CT exam and was confirmed by a colonoscopy. CONCLUSIONS: Pneumatosis cystoides interstitialis in the course of chronic graft-versus-host disease has a heterogeneous clinical presentation that does not correlate with results of imaging. CT is a method of choice to diagnose PCI. In patients with PCI, the presence of free air in the peritoneal cavity does not confirm an intestinal perforation.

Comparison of calcium scoring with 4-multidetector computed tomography (4-MDCT) and 64-MDCT: a phantom study.

OBJECTIVE: To determine differences in coronary artery calcium (CAC) measurement performed with the use of 2 generations of multidetector computed tomography (CT) scanners of the same manufacturer. METHODS: Agatston Score (AS) and calcium mass (CM) were measured with a 4-row scanner (AS4 and CM4) and a 64-row scanner (AS64 and CM64) using a cardiac phantom with calcium inserts. RESULTS: The results of the AS measurements (mean ± SD) varied significantly between the equipment: 880.6 ± 30.1 (AS4) vs 586.5 ± 24.0 (AS64; P < 0.0001). The AS interscanner variability was 31.6% for the phantom and from 25.5% to 110.1% for particular inserts. Mean ± SD CM values were different as well: 192.8 ± 5.0 mg (CM4) vs 152.4 ± 2.6 mg (CM64; P < 0.0001). Determination of CM with 64-row CT was more accurate than that with an older scanner; the mean relative error was -9.1% and 15.0%, respectively (P < 0.0001). The CM interscanner variability was 23.3% for the phantom and from 19.0% to 122.8% for particular inserts. The interexamination variability ranged from 1.7% (CM64) to 5.6% (AS4). CONCLUSIONS: Coronary artery calcium scoring with the 64-row CT scanner is more accurate than with the 4-row device The difference between the results of AS and CM measurements carried out with both scanners is statistically significant.

High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media.

BACKGROUND: Percutaneous endovascular examinations and interventions require significant amounts of iodinated contrast media (CM) and have been reported to be complicated by an increased incidence of post-contrast nephropathy. PURPOSE: To evaluate renal function, the incidence of post-contrast nephropathy, and risk factors after interventional procedures in neurosurgical patients after intra-arterial administration of a low-osmolar contrast medium (LOCM) versus an iso-osmolar contrast medium (IOCM). MATERIAL AND METHODS: This single-center, prospective, randomized, double-blinded study included 92 patients in its final analysis (mean age 49.6 ± 12.6 years, 29.3% men, mean eGFR 97.8 ± 26.3 mL/min/1.73 m(2)). LOCM was used in 48 patients (52.2%) and IOCM in 44 patients (47.8%). The patients were given an average of 151.2 ± 52.1 mL of contrast medium intra-arterially. Serum creatinine (SCr), urinary N-acetyl-ß-glucosaminidase (NAG) excretion, and creatinine clearance (CCr) were measured at baseline, and on days 1 and 3 after the procedure. RESULTS: Baseline risk factors, renal functional parameters, and average CM doses were not statistically different between the two groups. SCr, NAG, and CCr values did not differ significantly between the LOCM and IOCM groups on days 1 and 3 after CM administration. Nephropathy developed in 21 cases (22.8%): 13 (27.1%) after LOCM use and 8 (18.2%) after IOCM; (P = NS). The only significant risk factors of CIN were the diabetes (P = 0.0466) and atherosclerosis (P = 0.0498). CONCLUSION: We found a high incidence of nephropathy in neurosurgical patients after intra-arterial CM administration. The renal function values and incidence of nephropathy following LOCM administration were not statistically different from those following IOCM administration.

Pancreaticopleural fistulas of different origin: Report of two cases and a review of literature.

BACKGROUND: Pancreaticopleural fistula (PPF), a form of internal pancreatic fistula, is a rare complication of acute or chronic pancreatitis or pancreatic trauma. CASE REPORT: We report two cases of PPF resulting in formation of pleural pancreatic pseudocysts. A 35-year-old male alcoholic patient with a history of recurrent episodes of acute pancreatitis was admitted due to a severe dyspnea. A CT scan showed a significant left pleural effusion with a total left lung atelectasis, compression of the mediastinum, and dislocation of the left diaphragm. A follow-up CT showed a fistula between the abdominal pancreatic pseudocyst and the left pleural cavity. The second case was a 13-year-old male patient, who was admitted for a splenic stump excision. Two weeks after the surgery the patient presented a massive pleural amylase-rich effusion. CT exam suggested a PPF, which was indirectly confirmed by a thoracoscopy. CONCLUSIONS: PPF should be considered in cases of massive pleural effusion and encapsulated pleural fluid collections in patients with a history of acute pancreatitis and surgery involving pancreas.

A single photon emission computed tomography of the chest with the use of receptor radiotracer (Tc-99m-Depreotide) in sarcoidosis.

BACKGROUND: Sarcoidosis is a systemic and multiorgan disease with unknown etiopathogenesis. Granulomas that do not undergo necrosis and caseous degeneration are distinctive for this disease. Mostly it is connected with young adults, more frequently females than males, and changes are mainly situated in the lymph nodes of the pulmonary hilus and pulmonary parenchyma. Somatotropin release inhibiting hormone receptors could be located in epithelioid and giant cells that create sarcoidal tubercles and lymph nodes. Aim of the study was to determine the usefulness of a single photon emission tomography (SPECT) for an evaluation of the range of sarcoidal changes in the chest after using a receptor tracer. An assumption was made that scintigraphy with the use of Tc-99m-Depreotide could help with location of extrapulmonary sarcoidosis focuses. MATERIAL/METHODS: Authors present five patients with clinically recognized and histopathologically confirmed sarcoidosis. Patients were given Tc-99m-Depreotide and underwent SPECT of chest. The results were compared with X-rays of these patients chests and with the accumulation of radiotracer in 2 other patients with carcinoid syndrome without visible pathological changes in examination. Patients got an intravenous injection of 500 MBq (14mCi) Tc-99m-Depreotide. SPECT of chest together with a "whole body" examination, was performed after 2 hours and 24 hours. RESULTS: Higher radiotracer accumulation was observed in all patients in the area of some chest lymph nodes, in pulmonary tissue in 3 patients and in other groups of lymph nodes in 2 patients. CONCLUSIONS: Emission Tomography of the chest with the use of receptor radiotracer (Tc-99m-Depreotide) can be a crucial complement of sarcoidosis diagnostics in an evaluation of the extent of lung changes together with an estimation of chest lymph nodes abnormalities.

Coronary artery calcifications in renal graft recipients at the time of transplantation.

BACKGROUND: Coronary artery calcifications (CACs) represent an important risk factor of coronary artery disease in the general population. The purpose of the study was to determine the amount of CAC, including calcium mass, in renal graft recipients early after transplantation. MATERIAL/METHODS: Forty-nine patients aged 43.7+/-9.8 years underwent CAC determination with multi-detector row computed tomography within two weeks after transplantation. The calcium scores were compared with the clinical and laboratory data of the subjects. RESULTS: CACs were detected in 73% of the subjects. The mean calcium score (CS) was 500.8+/-1100.4 and the mean calcium mass (CM) 127.0+/-228.6 mg. Presence of diabetes, duration of hypertension, and diastolic blood pressure (DBP) were significantly associated with the presence of CAC in univariate analysis. CS and CM positively correlated with duration of hypertension, time on dialysis, and pulse pressure (PP) and negatively with DBP. In multiple regression analysis the duration of hypertension, DBP, and PP were identified as independent predictors of CAC presence (p<0.01), while the time on dialysis and DBP were independent predictors of CAC severity (p<0.02). CONCLUSIONS: The results suggest that hypertension may play a crucial role in the development of coronary artery calcifications in end-stage renal disease patients, but the nature of the relation between CAC and blood pressure needs further investigation.

Palliative percutaneous kidney embolization with enbucrilate in patients with renal cell carcinoma: safety and symptom control.

BACKGROUND: Primarily palliative renal embolization is a relatively rare procedure which is indicated in patients with unresectable kidney malignancies and in patients in poor general condition. The aim of this paper was to evaluate the role of primarily palliative transarterial renal embolization for the treatment of inoperable patients with renal cell carcinoma, assessing the indications, safety, and efficacy of this procedure. MATERIAL/METHODS: Seventy-three patients scheduled for palliative embolization between 1998 and 2005 were retrospectively analyzed regarding their medical history, the procedure report, and data from the early postoperative period. RESULTS: Sixty-six of the 73 patients presented with renal cell carcinoma stage IV. The most common indication for embolization was hematuria (34%), followed by flank pain (32%), prophylaxis in stage IV (25%), lack of consent for surgery (7%), and poor general condition (3%). Embolizations were performed under local anesthesia with a mixture of enbucrilate and iodinated oil, with the use of additional embolizing materials in two cases. The procedure eliminated hematuria in 100% of cases and removed the loin pain completely in 72%. Migration of the embolizing material was observed in 10% of cases, and in 4% it resulted in symptomatic occlusion of the lower extremity distal arteries. Postembolic syndrome was noted in 92% of the patients CONCLUSIONS: Percutaneous palliative embolization with enbucrilate is a safe and effective method of treating patients with unresectable renal cell carcinoma. The potential effect of the embolization on cancer progression and improvement of survival in these patients still requires prospective investigation.

Calcified fibromatosis of the neck in 4-year old girl: rapid growth, rapid therapy.

Fibromatosis is a rare soft tissue disease typical for infants and characterized by fibroblastic proliferation, which may appear similar to fibrosarcoma. An unusual case of 4-year old girl presenting large tumor of the neck with massive calcification is described. The growth of the tumor was rapid and mediastinal involvement was observed. The final diagnosis showed benign nature of tumor with microscopic features of fibromatosis calcificans. After surgical resection of neck tumor, residual mass persisted both in the neck and in the mediastinum in 6 years of follow-up without signs of progression.

[The role of preoperative hooked-wire localization of occult lesions for early detection of breast cancer]. / Rola przedoperacyjnego znakowania zmian niepalpacyjnych dla wczesnego wykrywania raka sutka.

OBJECTIVES: Nonpalpable small lesions, usually few millimeters in diameter, consist an important problem in the early diagnostics of breast cancer. DESIGN: An aim of this paper was an evaluation of usefulness of preoperative hooked-wire localization of such lesions for the detection of breast cancer. MATERIALS AND METHODS: Material consisted of 131 patients aged 37-77 in whom 132 procedures of preoperative hooked-wire localization were performed. The correlation between the mammographic findings and the cytologic or histologic results were then evaluated, with the histologic results being treated as standard. RESULTS: Histologic examination of the localized lesions revealed benign changes in 71.2%, atypical ductal hyperplasia in 4.6% and cancer in 24.2%. Positive predictive value for mammography was 24%. Significant correlation was seen between the suspicion of cancer in mammography and the histologic results. CONCLUSIONS: Preoperative localization should be used as a method of choice in radial lesions, suspected clustered microcalcifications and after the positive result from SFAB.

Ultrasound examination in arthropathia humeroscapularis.

This article discusses the diagnostic potential of ultrasonography in a common clinical condition: periarthropathia humeroscapularis. The authors describe pathologies of the rotatory cuff, the tendon of the long head of humeral biceps, the bursa subacromialis, and the articular capsule. The advantages of ultrasonography are emphasized, such as its noninvasiveness, the possibility of performing dynamic examination, and general accessibility. The authors describe pathological changes, such as tendinitis, tenosynovitis, bursitis, tendinitis calcarea, tendinosis, degenerative changes, and partial and complete tear of the tendon. Impingement syndrome and dialysis- related amyloidosis of the shoulder are separately discussed.

[Transvaginal ultrasonography and sonohysterography in the diagnosis of benign uterine lesions in women at peri- and postmenopausal age]. / Przydatnosc endosonografii dopochwowej i sonohisterografii w diagnostyce lagodnych zmian macicy u kobiet w wieku okolo- i pomenopauzalnym.

Abnormal uterine bleeding is important clinical problem in women at peri- and postmenopausal age. It may be caused by the lesions located in endometrium or in deeper uterine wall layers. An aim of this paper was a comparison of transvaginal sonography (TVS) vs. sonohysterography (SIS) in the diagnostics of endometrial polyps, endometrial hyperplasia as well as uterine myomas. Also the results of the sonographic imaging were compared to those of pathologic examination of the specimens taken from the uterine cavity. The material consisted of 100 women aged 40-80 with an irregular menstruation. All of the patients were examined gynecologically, and then the transvaginal sonography, sonohysterography and the curettage of the uterine cavity were performed. Sensitivity of TVS was 43% in endometrial polyps, 77% in endometrial hyperplasia and 69% in uterine myomas imaging. Introduction of SIS increased the sensitivity to 94%, 82%, and 95%, respectively. Specificity was similar in both techniques except endometrial hyperplasia (TVS--68%, SIS--91%). Diagnostic accuracy also improved with the SIS use reaching 93% for polyps, 89% for hyperplasia and 98% for myomas imaging. Our results show higher sensitivity and accuracy of SIS in the diagnostic of benign uterine lesions.

Langerhans' cell histiocytosis of the mandible in bone scintigraphy and CT.

UNLABELLED: The authors present a case of a 4-year old boy with a quickly growing tumor of the jaw. The CT examination revealed a destructive tumor in the body of the mandible involving soft tissues. A diagnosis of eosinophilic granuloma of the mandible was confirmed by a biopsy of the tumor. Skeletal scintigraphy showed areas of increased and decreased radiotracer uptake. The fusion of CT and scintigraphy images showed that the "cold" focus corresponds with the osteolytic area and the "hot" focuses are larger than the areas of osseous reconstruction shown in CT. CONCLUSION: In cases of histiocytosis skeletal scintigraphy and CT are complementary methods that enable one to make an assessment of the extent of the disease.

[Metastasis of renal carcinoma to the diaphragm]. / Przerzut raka nerki do przepony.

The most common sites of metastases originating from primary renal clear cell carcinoma are bones and lungs. The authors present a rare case of the tumor that metastasized to the diaphragm. Both lesions, the primary in the kidney and the secondary in the diaphragm, were detected occasionally during the ultrasound examination of the right pleural cavity and abdominal cavity.

[Cauda equina syndrome caused by Tarlov's cysts--case report]. / Zespól ogona konskiego na podlozu mnogich torbieli Tarlova--opis przypadku.

UNLABELLED: Perineural Tarlov cysts located on lumbo-sacral roots can be a cause of cauda equina syndrome. OBJECTIVES: 1) To draw attention to the fact that multiple Tarlov lumbo-sacral perineural cysts can produce serious movement disturbances. 2) To document the usefulness of the magnetic resonance imaging in noninvasive diagnosis of perineural cysts. CASE DESCRIPTION: A male patient, 80 years of age, suffered from progressive weakness of lower limbs, which caused an increasing drop of the feet. The disease began in August 2000, following a long journey by train. The patient additionally complained of urinary incontinence as result of sneezing, coughing or fast walking. The urologist did not find prostatic gland hypertrophy. An examination by the internist revealed atheromatous myocardiopathy in circulation failure stage. Magnetic resonance imaging showed multiple perineural cysts up to 15 mm in diameter on lumbo-sacral roots. This clinical picture, supported by the magnetic resonance imaging allowed to recognize cauda equina syndrome caused by Tarlov lumbo-sacral perineural cysts. DISCUSSION: This case is a reminder, that part of perineural cysts, particularly multiple, can be a cause of nerve roots injury, and their lumbo-sacral location can produce cauda equina syndrome. As reported by Zarski and Leo, Tarlov cysts were cause of 7.3% of pain syndrome cases 2 patients in the study group showed lower limb claudication. Magnetic resonance imaging of patients with back pain, performed by Paulsen, Call and Murtagh, revealed that Tarlov cysts occurred in 4.6% of patients, but only 1% had the symptoms connected with the presence of those cysts. In available Polish literature no report has been found referring to fixed cauda equina syndrome which was caused by multiple cysts revealed through the magnetic resonance imaging of spinal canal. Only Zarski and Leo, discussing the correlation between the clinical and radicographic picture, described transient cauda equina syndrome in two patients who, beside Tarlov cysts, were also found to have intervertebral lumbosacral disc herniation. Tarlov was the first to describe well documented cauda equina syndromes caused by cysts on the lumbo-sacral roots. It is necessary to emphasize the established role of magnetic resonance of spinal canal in the diagnosis of perineural cysts on the lumbo-sacral roots as well as other anatomical anomalies of cerebrospinal fluid spaces. Despite the fact that cauda equina syndrome in the case reported here was a serious complication of multiple Tarlov cysts in the lumbo-sacral region, a surgical treatment was not undertaken; in such cases this treatment should be the chosen procedure. CONCLUSION: Multiple perineural Tarlov cysts in lumbo-sacral region, without disc herniation or other cause of vertebral canal stenosis, can produce cauda equina syndrome.

[Scintimammography in breast cancer imaging]. / Miejsce scyntymammografii w diagnostyce raka sutka.

Scintimammography is a rarely used method of breast cancer imaging. The aim of the study was to find its place among other radiological methods. Routine methods of breast cancer detection were compared considering their advantages and disadvantages. Scintimammography seems to be a promising complementary method. Indications for scintimammography are considered and suggestion of a diagnostic algorithm in breast cancer, including of this method is proposed.