Borne identity: CT imaging of vascular infections.

Vascular infections present in a multitude of ways with computed tomography (CT) aiding in the diagnosis of many of the uncommon vascular infections, which are equally dangerous and carry severe life-threatening consequences if untreated from a delay in diagnosis. This pictorial review aims to discuss and illustrate the CT findings of the following vascular infections including aortitis, mycotic aneurysms, infective endocarditis, septic thrombophlebitis in the chest and abdomen, and Kawasaki disease. Recognition and prompt diagnosis of these uncommon vascular infections are critical to the initiation of the appropriate management and therapy.

Long-term outcome after chemoembolization and embolization of hepatic metastatic lesions from neuroendocrine tumors.

OBJECTIVE: Hepatic artery chemoembolization and hepatic artery embolization (HAE) are accepted treatments of patients with hepatic metastasis from neuroendocrine tumors. Long-term outcome data are limited. We present our experience in the use of hepatic artery chemoembolization in the treatment of patients with hepatic metastasis from neuroendocrine tumors. MATERIALS AND METHODS: Forty-six patients with carcinoid (n = 31) or islet cell (n = 15) tumors were treated. Overall and progression-free survival times starting with the first treatment were calculated. Potential factors affecting survival, including presence of extrahepatic disease and resection of the primary lesion, were analyzed. Relief of symptoms was subjectively determined for tumors with hormonal secretion. RESULTS: The 46 patients underwent 93 hepatic artery chemoembolization or HAE sessions. The mean overall survival time for the entire group was 1,273 +/- 185 days. The mean overall survival times for the carcinoid (1,255 +/- 163 days) and islet cell tumor (1,311 +/- 403 days) subgroups were similar (p = 0.66). The progression-free survival times for the carcinoid (602 +/- 144 days) and islet cell (501 +/- 107 days) tumor subgroups also were similar (p = 0.72). The survival time of patients without known extrahepatic metastasis (n = 18; 1,571 +/- 291 days) trended toward significance compared with that of patients with known extrahepatic disease (n = 26; 770 +/- 112 days; p = 0.08). Resection of the primary tumor in 19 of 46 patients did not affect survival (resection survival, 1,558 +/- 400 days; nonresection survival, 1,000 +/- 179 days; p = 0.44). Twenty of 25 patients with hormonally active tumors had relief of symptoms after one cycle of treatment. The 30-day mortality was 4.3%. CONCLUSION: The overall survival time after hepatic artery chemoembolization or HAE among patients with neuroendocrine tumors is approximately 3.5 years. The progression-free survival time approaches 1.5 years. The presence of extrahepatic metastasis or an unresected primary tumor should not limit the use of hepatic artery chemoembolization or HAE.

Multidetector computed tomography of spontaneous versus secondary pneumomediastinum in 89 patients: can multidetector computed tomography be used to reliably distinguish between the 2 entities?

PURPOSE: To analyze the multidetector computed tomography (MDCT) findings of spontaneous pneumomediastinum (PM) to determine whether MDCT can reliably differentiate spontaneous from secondary PM. MATERIALS AND METHODS: A retrospective clinical and chest MDCT analysis of all patients diagnosed with spontaneous PM over an 8-year period was performed. Radiologic comparison was undertaken with patients diagnosed with secondary PM from a central airways defect, esophageal rupture, or recent intervention in the airway or esophagus. The Fisher exact test for independence was used to compare the different MDCT findings between the groups. RESULTS: A total of 89 patients were analyzed, with 1 secondary PM patient being included in both esophageal and central airways subsets, as the patient had an esophageal balloon-assisted intubation. Thirty-four patients were diagnosed with spontaneous PM. Compared with 28 patients with secondary PM from esophageal pathology, spontaneous PM patients were more likely to have air in the anterior mediastinum (97% vs 61%, P<0.001) and pulmonary interstitial emphysema (57% vs 4%, P<0.001), and less likely to show subdiaphragmatic air (0% vs 32%, P<0.001), pleural effusions (9% vs 61%, P<0.001), and acute pulmonary airspace opacities (14% vs 50%, P=0.003). Similarly, compared with 28 patients with secondary PM from trachea and bronchi pathology, patients with spontaneous PM were more likely to have pulmonary interstitial emphysema (57% vs 25%, P=0.01), and were less likely to show subdiaphragmatic air (0% vs 25%, P=0.002), pleural effusions (9% vs 39%, P=0.005), and acute pulmonary airspace opacities (14% vs 43%, P=0.02). CONCLUSION: Spontaneous PM is associated with a favorable clinical course, and it is possible to suggest this clinical diagnosis based on typical MDCT findings and clinical presentation.