CT and MRI of aggressive osteoblastoma of thyroid cartilage.

We present a unique case of aggressive osteoblastoma arising from thyroid cartilage. A 52-year-old man presented with a 10 month history of neck discomfort but without frank pain. CT and MR examinations disclosed a well defined mass arising from the thyroid cartilage. This lesion had areas of coarse calcifications and a central area of lucency. The appearance suggested chondrosarcoma. Hemilaryngectomy was performed to remove the mass en bloc. Surgical pathology diagnosed aggressive osteoblastoma arising from thyroid cartilage.

Passive hepatic congestion: cross-sectional imaging features.

Passive hepatic congestion is caused by stasis of blood within the liver parenchyma due to compromise of hepatic venous drainage. It is a common complication of congestive heart failure and constrictive pericarditis, wherein elevated central venous pressure is directly transmitted from the right atrium to the hepatic veins because of their close anatomic relationship (Fig. 1). The liver becomes tensely swollen as the hepatic sinusoids dilate and engorge to accommodate the backflow of blood. A variety of structural and functional hepatic derangements develop that have distinctive appearances on sonograms, CT scans, and MR images.

Renal failure due to bronchogenic adenocarcinoma metastatic to kidneys.

A case is presented of a fifty-eight-year-old woman with bronchogenic adenocarcinoma in whom renal failure developed manifested by hypertension and azotemia. Subsequent percutaneous needle aspiration biopsy confirmed metastatic renal involvement. No etiology other than renal infiltration due to metastatic bronchogenic adenocarcinoma was found to explain the renal failure. Literature review revealed no previous reported case of metastatic bronchogenic adenocarcinoma to the kidney presenting antemortem with renal failure.

Bilateral adrenal hemorrhage as a complication of intravenous ACTH infusion in two patients with inflammatory bowel disease.

We report two patients with inflammatory bowel disease in whom intravenous corticotropin therapy was complicated by bilateral adrenal hemorrhage. In one, the initial presentation was acute and unilateral, simulating colonic perforation and/or abscess. The diagnosis was made only at exploratory laparotomy. In the second patient, the presentation was subacute; multiple episodes of adrenal hemorrhage occurred subsequent to the course of corticotropin, and ultimately, hypoadrenalinism developed. Pertinent clinical and computed tomographic findings are reviewed.

Non-Hodgkin lymphoma of ureteral wall: CT findings.

We report a case of focal ureteral wall non-Hodgkin lymphoma without contiguous or other associated abdominal abnormalities. The CT findings and the differential diagnosis are discussed.

Ectopic pregnancy: surgical-pathologic correlation with US.

The ultrasound (US) examinations of 53 patients with proved ectopic pregnancy were reviewed and compared with surgical and pathologic findings. The most common finding with US and surgery was free fluid. Hematosalpinx tended to have sharply defined margins, whereas free pelvic hematomas were poorly defined or filled the pelvis. The echogenicity of the clots was variable but generally in the same range of echogenicity as the uterus. A prominent decidual reaction occurred in 26% of the patients and had a variety of appearances.

Appendicitis as the initial manifestation of Crohn's disease: radiologic features and prognosis.

Twenty-five patients 15-47 years old presented with appendicitis as the initial manifestation of Crohn's disease. This entity accounted for 1.8% of all appendicitis patients undergoing surgery at our institution during a recent 9-year period. Preoperative radiologic studies in 18 (72%) of 25 cases showed abnormalities indicating the presence of appendicitis or periappendiceal abscess, but not the specific diagnosis of Crohn's disease as the underlying cause. Histopathologic evidence for an isolated, transmural, or granulomatous appendicitis was found in 20 patients; in two of these there was a local recurrence within 3 years after surgery, while 18 others have remained asymptomatic during follow-ups of up to 8 years. In the other five patients Crohn's disease caused appendicitis with concurrent inflammation of the cecum or terminal ileum; three of these cases were complicated by progressive granulomatous ileocolitis within 2 years. The data presented herein indicate that Crohn's disease can originate in and be confined to the appendix, yet manifest clinical symptoms leading to emergency laparotomy; preoperative radiologic findings are similar to those of suppurative appendicitis, but visualization of a markedly thickened appendiceal wall with patent or irregularly narrowed lumen supports the diagnosis of Crohn's appendicitis; and primary Crohn's disease of the appendix has a favorable long-term prognosis after simple appendectomy, despite a 10% incidence of recurrence as granulomatous ileocolitis.

Sonographic demonstration of renal arterial calcification simulating multiple renal calculi.

A case of arterial calcification simulating renal calculi during ultrasound examination is described. The differential diagnosis of echogenic foci with acoustic shadowing is discussed.

Ultrasonographic evaluation of uterine perforation by an intrauterine device.

PIP: A case is reported of a 31-year-old woman who had a copper-7 IUD inserted two years prior to admission but became pregnant and had a normal delivery a year prior to admission. The IUD had not exited her body during delivery, and she was asymptomatic. Ultrasonography was used to locate the IUD, which was extending through the wall of the uterus. Upon mini-laparotomy, the IUD was found to be completely outside of the uterus, embedded in the omentum. This represents the first reported case which documents the use of ultrasonographic technology to locate an IUD extending through a uterine wall.^ieng

Angiosarcoma of the heart. Diagnosis by echocardiography.

Angiosarcoma of the heart is a rare tumor infrequently diagnosed ante mortem. The clinical presentation is usually that of pericarditis or congestive heart failure. This case report illustrates the contribution of echocardiography in suggesting the diagnosis.