Arteriographically confirmed focal defect in colloid spleen scan with no gross pathologic lession: case report.

A focal avascular defect in an enlarged spleen, clearly shown both by 99mTc-sulfur colloid scanning and by celiac angiography, could not be associated with any gross pathologic abnormality at splenectomy. Vascular lesions can probably produce focal defects on the scan in the absence of infarction.

Sulcal prominence in young chronic schizophrenic patients: CT scan findings associated with impairment on neuropsychological tests.

Four of 17 chronic schizophrenic (or chronic schizoaffective) patients between the ages of 20 and 35, in partial remission, and living in the community were found to have mildly or moderately prominent sulci, as disclosed by computerized tomography (CT scan). These four patients were matched for sex and age with four chronic schizophrenic (or schizoaffective) patients without sulcal prominence. The Halstead-Reitan battery (HRB) of neuropsychological tests, including the Wechsler Adult Intelligence Scale (WAIS), was administered to these eight patients with the examiner blind to results of the CT scan. Each of the four patients with sulcal prominence considerably exceeded an established cutoff score for brain impairment on the HRB, whereas only one of the control schizophrenics performed in the impaired range, and that just beyond the cutoff. The WAIS Verbal IQ, mneasured concurrently, was in the normal range for all subjects and similar for the two groups. These findings suggest that mild or moderate sulcal prominence on CT scans among young chronic schizophrenics is associated with impaired neuropsychological functioning.

Radiation osteitis: a problem of recognition.

Localized changes of radiation necrosis in 6 patients treated for Ewing sarcoma are described. Well-circumscribed lytic areas in the cortex of a previously irradiated long bone may be mistaken for tumor recurrence, especially if they are few in number and surrounded by relatively normal bone. The clarity of demarcation of these lesions, their progression, and the lack of a periosteal reaction are stressed.

Radiolucent "zones" in parietal bones seen on computed tomography: a normal anatomic variant.

Computed tomographic images of the head, photographed at wide window settings to better demonstrate bone details, show radiolucencies in the parietal bones especially on sections taken at the vertex of the skull. These represent a normal finding and should not be mistaken for pathology.

Failure to detect a 1.5 centimeter lung nodule by chest computed tomography.

Although computed tomography (CT) of the chest is the most sensitive modality for the detection of pulmonary nodules, false negatives occur. A case is presented in which a 1.5 cm nodule in the lung confirmed by surgery and linear tomography was not detected by using a state-of-the-art CT scanner. The reason for this failure is movement of the nodule between scans due to variations in respiratory excursion. This effect can be somewhat reduced by scanning at end tidal volumes with thick overlapping or contiguous scans.

Cerebral mass lesions in torulosis demonstrated by computed tomography.

Cryptococcus neoformans is an ubiquitous yeast. As a budding type of fungus, it is also known as Torula histolytica and is a common cause of infection of the central nervous system (CNS), particularly in debilitated and immunodeficient patients. We have examined 12 patients with computed tomography who had well documented cryptococcal CNS infection and will review our findings in this paper. Three of these patients had mass lesions, while nine others had a variety of changes such as ventricular dilatation, cortical atrophy, and focal ischemic changes.

Intravenous hepatosplenography. Experiment evaluation of a new contrast material.

A new, lipoid-based experimental contrast material (AG 60-99) was intravenously infused into 29 rhesus monkeys. The injections resulted in dense hepatosplenograms, preserving diagnostic quality for over 24 hours, and enabling routine utilization of tomography. This technique is capable of demonstrating simulated hepatic masses as small as 5 mm in diameter in vivo. Limited histopathologic and toxicity studies showed no serious or lasting toxic manifestations from AG 60-99 and none of the animals died from it. AG 60-99 is felt to be potentially useful in the radiographic detection of early metastic or lymphomatous involvement of the liver and spleen.

Positional shift of intraventricular blood clots demonstrated by computed tomography.

Computed tomography with the patient in the prone position was employed to obtain information in a case of intraventricular hematoma secondary to arteriovenous maliformation. A gravitational shift in the position of the intraventricular blood clots was demonstrated by a scan obtained with the patient in the brow-down position. Consideration is given to the possible use of the "prone EMI scan" for other intracranial problems of differential diagnosis.

Hypoplasia of the nose and eyes, hyposmia, hypogeusia, and hypogonadotrophic hypogonadism in two males.

Two males, 9-11 and 29-31 years of age, with severe hypoplasia of the nose, hypoplasia of the eyes, sensory abnormalities of taste and smell, and hypogonadism were studied. The nasal septum, cribriform plates and foramina of the vomeronasal (vn) nerves were demonstrated in both; the capsule of the vn organ was shown in one. Their nasal skeleton, demonstrated by tomoradiography, had grown in early embryological form. The nose was not patent in either patient. In both, the cranial vaults, orbits, epipharynges, and oral cavities were indented toward the hypoplastic nasal composite and the peripheral dimensions of their faces were normal for their respective ages. Each patient had impaired visual function with cataracts and colobomata. Each was unable to recognize the smell of any vapor (Type I hyposmia), and had severe impairment of recognition of any tastant (recognition hypogeusia); detection of vapors and of tastants were in appropriate anatomical areas. Each was unable orally to recognize standard plastic forms (astereognosis) though each could recognize the forms manually. Each patient had bilateral inguinal hernias, one or two undescended testes, and hypogonadotrophic hypogonadism. These patients do not fall within the spectrum of arrhinencephaly because of the presence of medial structure of attachment of the falx cerebri and because of their normal intelligence. Distinction of patients with this pattern of abnormalities from arrhinencephaly is important by reason of their potentiality of normal mental development. We hypothesize that their abnormalities resulted from an embryological disruption that occurred in the first trimester of pregnancy. The embryogenesis of the nasal composite is presumed to have been adequate for reciprocal induction of the anlagen of the forebrain. Development of their faces to normal peripheral dimensions indicates that the nasal composite is not essential for gross facial enlargement.

Saline lavage: a rapid, effective, and acceptable method for cleansing the gastrointestinal tract.

The standard preparation for cleansing the gastrointestinal tract for diagnostic studies such as barium enema usually involves dietary restrictions, purgatives, and cleansing enemas. This preparation is time consuming, often uncomfortable for the patient, and frequently unsuccessful. In this study, we examined the efficacy of saline lavage (without dietary restrictions or cleansing enemas) as a gentle, alternative method for cleansing the bowel, and compared lavage to the standard castor oil method of bowel preparation. Lavage cleansing was preferred by 75% of patients who had previously experienced a castor oil preparation. Although 11% of patients could not consume an adequate (4-liter) lavage volume, there was no significant difference in preparation success rate between the remaining lavage patients and the castor oil patients. Total preparation time for lavage (3 +/- 1 hr) was 60% less than for castor oil. The anticipated dehydration produced by castor oil and the hydration produced by lavage were confirmed. No significant changes were noted, however, in serum electrolytes with either method of preparation. Additional early studies are promising for the lavage method when used in inflammatory bowel disease patients and as a cleansing preparation for colonoscopy.

Computer assisted tomography in methotrexate encephalopathy.

Five children with acute lymphocytic leukemia (ALL) developed encephalopathy following treatment with intrathecal or intraventricular methotrexate (MTX). In these patients computer assisted tomography was informative by revealing areas of decreased attenuation coefficient located periventricularly and in each centrum semiovale (three cases) and calcifications, mostly in the deep and cortical gray matter (two cases), as well as ventricular dilatation (four cases). Contrast injection used in one of these five patients, as well as in another child (not affected by ALL) with MTX encephalopathy, failed to reveal enhancement.

Tissue signatures with dual-energy computed tomography.

By providing information on two parameters, dual-energy computed tomography can offer clinically useful tissue signatures for metallic deposits (Ca) or injected iodine, as well as for different normal and abnormal types of brain parenchymal tissues and CSF. Cerebral CT was performed on 36 patients and tissue differences analyzed using Hounsfield notation.