Terminology, Definitions, and Classification in the Imaging of Laryngoceles.

OBJECTIVE: We aim to better define the anatomy, criteria, and classification of laryngoceles, and to raise the awareness to potential mimickers and anatomical variants leading to misdiagnosis. METHODS: A retrospective review of all computed tomography studies, performed over a decade, with the diagnosis of "laryngocele" in the radiological report in a tertiary medical center. All relevant studies were reviewed by two independent readers for the presence of true laryngoceles. RESULTS: One hundred and twelve patients were included; average age was 54 (±18). Re-read of scans with 3D reconstructions resulted in detecting 58 (52%) true laryngoceles, with 19.5% bilateral laryngoceles. Anatomical variants and laryngocele mimickers formerly misdiagnosed as laryngoceles included 26/54 (48%) prominent ventricles, 19/54 (35%) saccules not meeting criteria for laryngocele, 8/54 (15%) prominent pyriform sinuses and one tracheal diverticulum. CONCLUSIONS: Intimate knowledge of the laryngeal anatomy, the criteria for a laryngocele and anatomical variants as well mimickers, is the key to avoid radiological misdiagnosis.

Attributable costs of differentiated thyroid cancer in the elderly Medicare population.

BACKGROUND: Little is known about costs associated with differentiated thyroid cancer (DTC) and follow-up care. This study used data from the Surveillance Epidemiology and End Results (SEER) database to examine cumulative costs attributable to disease stage and treatment options of DTC in elderly patients over 5 years. METHODS: We identified 2,823 patients aged >65 years with DTC and 5,646 noncancer comparison cases from SEER Medicare data between 1995 and 2005. Cumulative costs were obtained by estimating average costs/patient in each month up to 60 months after diagnosis. We performed multivariate analyses of costs by fitting each monthly cost to linear models, controlling for demographics and comorbidities. Marginal effects of covariates were obtained by summing coefficients over 60 months. RESULTS: Cumulative costs were $17,669/patient the first year and $48,989/patient 5 years after diagnosis. Regional disease was associated with higher costs at 1 year ($9,578) and 5 years ($8,902). Distant disease was associated with 1-year costs of $28,447 and 5-year costs of $20,103. Patients undergoing surgery and radiation had a decrease in cost of $722 at 5 years. CONCLUSION: DTC in the elderly is associated with significant economic burden largely attributable to patient demographics, stage of disease, and treatment modalities.

Idiopathic inflammatory pseudotumor of the carotid sheath

We present a biopsy proven case of 47 years-old man with a carotid pseudotumor, clinically presented as carotidynia. CT showed a mass encasing and narrowing the common carotid artery and MRI showed hypointense signal in T2 and intense enhancement after contrast media administration. The patient was suspected to have an inflammatory process and steroids were prescribed. Eight days after the steroid treatment significant radiological and clinical improvement was observed. The patient remains free of symptoms.

Apresentamos um caso comprovado por biópsia de pseudotumor carotídeo em um homem de 47 anos, com apresentação clínica de carotidinia. A TC mostrou massa envolvendo e estenosando a artéria carótida comum direita e a RM apresentava lesão com hipossinal em T2 e importante realce com o uso de meio de contraste paramagnético. O paciente recebeu a hipótese de lesão inflamatória e um tratamento com corticosteróides foi iniciado. Após oito dias de tratamento uma melhora clínica e radiológica significativas foram observadas. O paciente permanece assintomático.

Idiopathic inflammatory pseudotumor of the carotid sheath.

We present a biopsy proven case of 47 years-old man with a carotid pseudotumor, clinically presented as carotidynia. CT showed a mass encasing and narrowing the common carotid artery and MRI showed hypointense signal in T2 and intense enhancement after contrast media administration. The patient was suspected to have an inflammatory process and steroids were prescribed. Eight days after the steroid treatment significant radiological and clinical improvement was observed. The patient remains free of symptoms.