Isolated tuberculous liver abscess invading the abdominal wall: report of a case.

Isolated tuberculous liver parenchymal and subcapsular abscesses are unusual,^but an abdominal wall abscess secondary to a tubercular liver abscess is extremely rare. To our knowledge, there is only one reported case of an abdominal wall abscess occurring secondary to a subcapsular liver abscess. We report the first documented case of direct invasion of the abdominal wall from an isolated tuberculous liver parenchymal abscess, diagnosed by imaging, surgical, and pathological findings. Although ultrasonography and computed tomography showed nonspecific hypoechoic and hypodense findings with peripheral contrast enhancement, T2-weighted magnetic resonance imaging (MRI) revealed a heterogeneous mass with characteristic hypointensity, suggesting the presence of free radicals produced by macrophages during active phagocytosis in tuberculosis. Although our case is extremely unusual, when hypointensity on T2-weighted MRI is seen, the possibility of tuberculosis should be considered and the results of polymerase chain reaction, culture, and histopathological diagnosis must be taken into account to avoid needless invasive surgery.

Data management solution for large-volume computed tomography in an existing picture archiving and communication system (PACS).

Multidetector row computed tomography (MDCT) creates massive amounts of data, which can overload a picture archiving and communication system (PACS). To solve this problem, we designed a new data storage and image interpretation system in an existing PACS. Two MDCT image datasets, a thick- and a thin-section dataset, and a single-detector CT thick-section dataset were reconstructed. The thin-section dataset was archived in existing PACS disk space reserved for temporary storage, and the system overwrote the source data to preserve available disk space. The thick-section datasets were archived permanently. Multiplanar reformation (MPR) images were reconstructed from the stored thin-section datasets on the PACS workstation. In regular interpretations by eight radiologists during the same week, the volume of images and the times taken for interpretation of thick-section images with (246 CT examinations) or without (170 CT examinations) thin-section images were recorded, and the diagnostic usefulness of the thin-section images was evaluated. Thin-section datasets and MPR images were used in 79% and 18% of cases, respectively. The radiologists' assessments of this system were useful, though the volume of images and times taken to archive, retrieve, and interpret thick-section images together with thin-section images were significantly greater than the times taken without thin-section images. The limitations were compensated for by the usefulness of thin-section images. This data storage and image interpretation system improves the storage and availability of the thin-section datasets of MDCT and can prevent overloading problems in an existing PACS for the moment.

A case of lipiduria after arterial embolization for renal angiomyolipomas.

We report the case of a 31-year-old woman who suffered lipiduria after selective transcatheter arterial embolization for renal angiomyolipoma (AML). Computed tomography confirmed cystic liquefactive necrosis with fat-fluid level in AML. Although the process by which AML fat tissue excretion occurs is not clear, we speculated that the infarcted AML was connected to the urinary collection duct system and subsequently its adipose component was excreted into the urine.

Radiological assessment following thermoradiation therapy for primary pleural synovial sarcoma: case report.

Primary pleural synovial sarcoma is a rare disease with poor outcomes. Although hyperthermia therapy as part of a combined treatment regimen can offer improved local tumor control, only two reports of hyperthermia therapy for synovial sarcoma have appeared in the literature, and these sarcomas were not of pleuropulmonary origin. This report of an advanced inoperable primary pleural synovial sarcoma is the first to address the use of hyperthermia therapy in combination with chemoradiotherapy for this disease, together with radiological assessment following that therapy. Computed tomography performed after thermoradiation showed a decrease in tumor size and a characteristic unenhanced low-density area in the tumor suggesting that tumor necrosis resulted from the therapy. These image findings were helpful in assessing the tumor response to thermoradiation. We believe that hyperthermia therapy combined with chemoradiotherapy should be regarded as an option for advanced primary pleural synovial sarcoma. This would give computed tomography important role in evaluating this approach.

Primary leiomyosarcoma of the inferior vena cava: case report.

The patient was a 63-year-old woman with a chief complaint of blood-stained sputum. A tumor of the inferior vena cava was found on chest computed tomography (CT) and identified as a primary tumor based on multidetector CT and contrast-enhanced MR angiography. An intrapelvic tumor was also discovered. On autopsy, the two tumors were diagnosed as leiomyosarcoma and ovarian fibroma, respectively.

Characteristics of ectopic pancreas in dynamic gadolinium-enhanced MRI.

The characteristics of jejunal ectopic pancreas in dynamic gadolinium-enhanced magnetic resonance imaging are described in a 40-year-old man with bowel obstruction. The pre-contrast signal intensity and post-contrast enhancement pattern of ectopic pancreas are the same as those of the pancreas.

Adverse allergic reaction to 131I MIBG.

No adverse allergic reactions to iodine-131-metaiodobenzylguanidine ((131)I MIBG) at a diagnostic dose have been reported in the English literature. This report of a skin eruption in a 35-year-old man after an intravenous injection of (131)I MIBG strongly suggests an adverse allergic reaction, and is the first to address such a side effect of (131)I MIBG at a diagnostic dose. Erythematous maculopapular eruptions, some of which were contiguous, were seen in a symmetric disposition on the patient's chest walls, elbows, neck and face 18 h after the (131)I MIBG injection. Antiallergic treatment resolved the lesions completely. There were no possible causes of the exanthema other than the (131)I MIBG injection. Urticaria related to the (131)I MIBG injection and caused by type I allergic reaction was suspected, and these findings point to the possible risk of a hitherto unreported allergic skin reaction to (131)I MIBG. We would like to draw the attention of nuclear physicians to this possible drawback of (131)I MIBG.

Subendomyocardial perfusion abnormality and necrosis detected by magnetic resonance imaging in a patient with isolated noncompaction of the ventricular myocardium associated with ventricular tachycardia.

A 74-year-old man presented with left ventricular failure and nonsustained ventricular tachycardia. Coronary angiography revealed normal coronary arteries; left ventriculography showed hypokinesis of the lateral wall segment. The ejection fraction was 54%. Cine-magnetic resonance imaging showed a double-layered appearance on four-chamber view and marked trabeculations as well as intratrabecular recesses in the inferolateral segments on short-axis view, findings consistent with isolated noncompaction of the ventricular myocardium (INVM). Contrast-enhanced imaging revealed hypoperfusion and delayed enhancement of the endomyocardium in the inferolateral segments. Subendomyocardial perfusion abnormality and necrosis may constitute the diagnostic criteria of INVM.

A filmless radiology teaching conference system for pertinent displaying and image searching.

To solve the problems of image displays in filmless radiology conferences for the purpose of teaching, we made an experimental design of a conference system with dual 50-in. plasma monitors for displaying larger images and a shared folder containing shortcuts to images for quick display during conferences on the desktop of each client computer in a picture archival and communication system. The image quality of the monitors was evaluated using the TG18-QC test pattern. The display time of images was measured in 20 cases when the shared folder was used and when it was not. Monitor screen size and image quality, operability, display time of images, and overall impression given by the system were evaluated subjectively by five radiologists. Although the image quality of the monitor was not as high as that of the high-resolution monitors used for diagnostic radiology, its performance was good enough for teaching. The average display time using the shared folder (2.6 +/- 0.39 s) was significantly shorter than without it (16.9 +/- 5.04 s; p = 2.85 x 10(-6)). Despite the need for certain improvements in monitor size and in the operability of the system, the radiologists considered the system suitable for radiology teaching conferences. We believe that this system is useful for institutions that intend to introduce a filmless system for filmless radiology teaching conferences.

A computer-assisted system for diagnostic workstations: automated bone labeling for CT images.

Although accurate information on thoracolumbar bone structure is essential when computed tomography (CT) images are examined, there is no automated method of labeling all the vertebrae and ribs on a CT scan. We are developing a computer-aided diagnosis system that labels ribs and thoracolumbar vertebrae automatically and have evaluated its accuracy. A candidate bone was extracted from the CT image volume data by pixel thresholding and connectivity analysis. All non-bony anatomical structures were removed using a linear discriminate of distribution of CT values and anatomical characteristics. The vertebrae were separated from the ribs on the basis of their distances from the centers of the vertebral bodies. Finally, the thoracic cage and lumbar vertebrae were extracted, and each vertebra was labeled with its own anatomical number by histogram analysis along the craniocaudal midline. The ribs were labeled in a similar manner, based on location data. Twenty-three cases were used for accuracy comparison between our method and the radiologist's. The automated labeling of the thoracolumbar vertebrae was concordant with the judgments of the radiologist in all cases, and all but the first and second ribs were labeled correctly. These two ribs were frequently misidentified, presumably because of pericostal anatomical clutter or high densities of contrast material in the injected veins. We are confident that this system can contribute usefully as part of a picture archiving and communication system workstation, though further technical improvement is required for identification of the upper ribs.

A case of dual ectopic thyroid accompanied by positive antithyroid antibodies.

Ectopic thyroid tissue is an uncommon congenital aberration that is seldom present at two different sites simultaneously. The patient was a 32-year-old woman with dual ectopic thyroid accompanied by positive antithyroid antibodies. The simultaneous occurrence of dual ectopic thyroid and positive antithyroid antibodies has been documented in only two cases: the case discussed here and one previous case. The cervical ectopic thyroid was followed up by ultrasound, which showed an increase in the size of the lesion and an internal echo texture that became slightly heterogeneous after the patient had her second child. We speculated that these changes resulted from the changes in hormone demand brought on by pregnancy and parturition.

Right ventricular involvement in a patient with isolated noncompaction of the ventricular myocardium.

Isolated noncompaction of the ventricular myocardium (INVM) is an unclassified cardiomyopathy and is thought to be due to arrest of myocardial morphogenesis. Although right ventricular involvement is not uncommon, the correct diagnosis is often difficult by echocardiography. In this report, we describe a patient with INVM in whom magnetic resonance imaging was useful to detect right ventricular morphological and functional abnormalities.

Whole heart coronary magnetic resonance angiography for the detection of coronary artery stenosis and atherosclerotic coronary artery plaque in a patient with unstable angina.

Whole heart coronary magnetic resonance angiography (MRA) has been established as a totally noninvasive diagnostic modality for the assessment of coronary artery disease. We report a case with unstable angina, in whom coronary artery stenosis with an atherosclerotic plaque was detected by whole heart coronary MRA. Intravascular ultrasound in the stenotic lesion revealed a soft plaque containing focal calcification, corresponding to a low-signal mass containing a no-signal mass on MRA. Whole heart coronary MRA can become a useful diagnostic tool for the diagnosis of acute coronary syndrome.

Coronary artery dissection after blunt chest trauma: depiction at multidetector-row computed tomography.

Coronary artery dissection after blunt chest trauma has rarely been reported in traumatic cardiac injuries, but it may cause fatal or nonfatal myocardial infarction. We report a case of dissection of the left main coronary artery, which resulted in acute myocardial infarction 5 weeks after blunt chest trauma. Multidetector-row computed tomography performed prior to the onset of infarction depicted intimal flap and dissected cavities.