RESUMEN
OBJECTIVE: The objective of this study was to assess the prevalence of pathologically proven intrapulmonary lymph nodes and to evaluate their appearance on CT. MATERIALS AND METHODS: Over a 15-year period (1980-1994), 184 patients underwent minithoracotomies for evaluation of CT-detected peripheral pulmonary abnormalities. Of these 184 patients, 96 had well-circumscribed peripheral pulmonary nodules. The size, position, and radiographic features of all pathologically proven intrapulmonary lymph nodes were independently assessed by two experienced radiologists. RESULTS: The nodules in 17 (18%) of the 96 patients with well-circumscribed peripheral pulmonary nodules were pathologically proven to be intrapulmonary lymph nodes. Two of the 17 patients had two nodules; the remaining patients had solitary nodules. The maximum diameter of the nodules varied from 7 to 12 mm. All the nodes were located within 20 mm of a visceral pleural surface. Twelve of the nodules were located in the lower lobes, and the remaining nodules were located in the right middle lobe. CONCLUSION: Although intrapulmonary lymph nodes are not a well-known entity, our results indicate that they are discovered in a significant number of patients who undergo minithoracotomies for the evaluation of CT-detected pulmonary nodules. Although these lymph nodes do not possess any specific CT appearance, they should be considered in the differential diagnosis of single (or multiple) parenchymal nodules, particularly those found in the lower lobes.
Asunto(s)
Pulmón/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Nódulo Pulmonar Solitario/diagnóstico por imagen , Femenino , Humanos , Pulmón/patología , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Prevalencia , Nódulo Pulmonar Solitario/epidemiología , Nódulo Pulmonar Solitario/patología , Tomografía Computarizada por Rayos XAsunto(s)
Enfermedades de la Aorta/microbiología , Aspergilosis/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Adolescente , Aorta Torácica/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico por imagen , Aspergilosis/complicaciones , Aspergilosis/inmunología , Femenino , Humanos , Huésped Inmunocomprometido , Leucemia-Linfoma de Células T del Adulto/complicaciones , Leucemia-Linfoma de Células T del Adulto/inmunología , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/inmunología , Tomografía Computarizada por Rayos XRESUMEN
Over the past 13 years 681 consecutive patients have undergone computed tomographic staging and surgical staging of the mediastinum. Five hundred one tested negative for mediastinal lymph node enlargement by computed tomographic staging, and 37 of these patients had cancerous mediastinal lymph nodes at thoracotomy (n = 36) or mediastinoscopy (n = 1). The survival in this group of patients was analyzed according to T status, central or peripheral location of tumor, cell type, areas of mediastinum that are involved, and extent of nodal involvement with tumor. Twelve patients had central tumors, and 25 had peripheral tumors. Two of the patients in the central tumor group died postoperatively and only 2 others survived, whereas 12 of the 25 patients in the peripheral tumor group survived. Four of the 37 patients, 2 in each group, did not undergo resection, and all died. All but 2 of the 31 survivors who underwent resection received postoperative adjuvant x-ray therapy (23 patients), chemotherapy (1 patient), or x-ray therapy and chemotherapy (5 patients). The projected 2-year and 5-year survivals (Kaplan-Meier) were 40% and 28% for patients overall, 46% and 31% for those whose tumors were resected, 40% and 20% for those with resected central tumors, and 52% and 45% for those with resected peripheral tumors. None of these differences was significant. Cell type, location or number of locations of involved nodes, and the average percentage or maximum percentage of mediastinal node that was involved with tumor did not influence survival. The high negative predictive index for computed tomographic staging of the mediastinal lymph nodes and the observed 2-year and 5-year survivals in patients with false-negative computed tomographic scans of the chest justifies definitive thoracotomy without mediastinoscopy in most patients with a normal mediastinum on computed tomographic scan.
Asunto(s)
Neoplasias Pulmonares/mortalidad , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/mortalidad , Adenocarcinoma/secundario , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/secundario , Reacciones Falso Negativas , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Análisis de SupervivenciaRESUMEN
Twenty-five patients had Russe anterior corticocancellous bone-grafting between 1973 and 1984 for twenty-six symptomatic established non-unions of the scaphoid. The mean duration of follow-up was eleven years (range, seven to eighteen years). Twenty-one (81 per cent) of the twenty-six scaphoid bones united. We developed two rating scales to evaluate the results of the operation. One scale, based on objective findings, included the radiographic appearance of the wrist, the range of motion, and strength; the other scale, based on subjective findings, comprised function, pain, perception of a decrease in performance because of limitation of motion or strength, and satisfaction. These scales were used to compare the objective and subjective results in patients who had a malunion of the scaphoid in which the lateral intrascaphoid angle was more than 45 degrees convex dorsally between the proximal and distal poles (a so-called flexion or humpback deformity, which results in extension of the proximal fragment of the scaphoid at the radiocarpal joint) with the results in patients who had no such deformity. The lateral intrascaphoid angle was more than 45 degrees in thirteen (50 per cent) of the twenty-six wrists. Although the difference in the objective results between the wrists that had a malunion and those that did not have a malunion was highly significant (p = 0.001), there was no significant difference in the subjective results between the two groups, including satisfaction of the patient (p = 0.39). Twenty-three patients (92 per cent) returned to full-time employment and twenty-two (88 per cent), to sports activities. Twenty-three patients (92 per cent) reported that they had pronounced relief of pain and that the procedure had improved their quality of life. The presence of this deformity of the scaphoid after bone-grafting for a symptomatic non-union was not predictive of a poor long-term subjective outcome.
Asunto(s)
Trasplante Óseo , Huesos del Carpo/lesiones , Fracturas no Consolidadas/cirugía , Traumatismos de la Muñeca/rehabilitación , Adolescente , Adulto , Huesos del Carpo/diagnóstico por imagen , Huesos del Carpo/cirugía , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Masculino , Osteoartritis/etiología , Dimensión del Dolor , Satisfacción del Paciente , Rango del Movimiento Articular , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Traumatismos de la Muñeca/complicaciones , Traumatismos de la Muñeca/cirugíaRESUMEN
We retrospectively reviewed abdominal computed tomographic (CT) studies from 20 patients with sclerosing cholangitis and found evidence of abdominal lymphadenopathy in 13 patients. Enlargement occurred primarily in areas draining the liver, such as the gastrohepatic ligament or celiac axis (N = 8), the porta hepatis (N = 7), and the pancreaticoduodenal region (N = 2). One patient had reactive adenopathy and retroperitoneal fibrosis. The presence of benign reactive lymphadenopathy in at least one intraabdominal location was confirmed by pathological examination of excised lymph nodes in seven patients. Malignancy was excluded by surgical exploration or clinical follow-up. We conclude that enlarged lymph nodes are a common finding by CT in patients with sclerosing cholangitis. Enlarged reactive lymph nodes in this condition should not be mistaken for evidence of periportal metastasis or cholangiocarcinoma.
Asunto(s)
Colangitis Esclerosante/complicaciones , Enfermedades Linfáticas/etiología , Adenoma de los Conductos Biliares/diagnóstico por imagen , Adulto , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Colangitis Esclerosante/diagnóstico por imagen , Colestasis/diagnóstico por imagen , Diagnóstico Diferencial , Reacciones Falso Positivas , Femenino , Humanos , Enfermedades Linfáticas/diagnóstico por imagen , Enfermedades Linfáticas/epidemiología , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Small peripheral pulmonary nodules ranging in size from 1 mm to 20 mm were excised in 58 patients. Computed tomography was used to mark the skin overlying the nodules to minimize the surgical exposure needed for operative identification. The nodules were 1 cm or less in maximum diameter in 76% of the patients. Twenty-six patients had single nodules and 32 patients had multiple nodules. The preoperative diagnosis was inaccurate in 67% of the patients. In 61% of the patients in whom malignancy was suspected, no tumor was demonstrated. Conversely, of the 20 patients in whom a malignant nodule was excised, the preoperative diagnosis was correct in only 50%. Thirty-one patients required no further treatment apart from their biopsy and 27 required additional intervention. Small peripheral pulmonary nodules require biopsy for diagnosis. When percutaneous needle aspiration biopsy is unsuccessful, or technically difficult, a computed tomography-guided thoracotomy is an effective and minimally invasive surgical alternative.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Toracotomía/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Biopsia con Aguja , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
Exclusive reliance on radiographic techniques for the diagnosis of renal angiomyolipoma can lead to misdiagnosis when the histological status is atypical, computerized tomographic findings are equivocal or renal cell carcinoma coexists. We report our experience and those of others in combining fine needle aspiration biopsy and radiological imaging to identify renal angiomyolipoma. Fine needle aspiration biopsy is safe and provides accurate histological diagnosis of renal angiomyolipoma.
Asunto(s)
Hemangioma/diagnóstico , Neoplasias Renales/diagnóstico , Riñón/patología , Lipoma/diagnóstico , Anciano , Biopsia con Aguja , Hemangioma/patología , Humanos , Riñón/diagnóstico por imagen , Neoplasias Renales/patología , Lipoma/patología , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Clinically significant adrenal hemorrhage due to adrenal metastases has rarely been reported. We describe three cases of this unusual entity, two from lung carcinoma and one from sarcoma. Adrenal hemorrhage was bilateral in two patients, and was the presenting manifestation of malignancy in two. A computed tomography diagnosis of hemorrhage within bilateral adrenal metastases was made when adrenal masses rapidly enlarged in one case, and when previously resolving hematomas showed enlargement in a second case. The third case was believed to represent a pheochromocytoma preoperatively. We conclude that significant adrenal hemorrhage can result from adrenal metastases and can be the presenting manifestation of metastatic tumor. In the patient without discernible risk factors for adrenal hemorrhage, underlying malignancy should be considered as a possible cause, even if the hemorrhage is bilateral.
Asunto(s)
Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/secundario , Hemorragia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedades de las Glándulas Suprarrenales/etiología , Neoplasias de las Glándulas Suprarrenales/complicaciones , Adulto , Femenino , Hemorragia/etiología , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana EdadRESUMEN
The authors retrospectively evaluated computed tomographic (CT) scans obtained in 21 patients with primary biliary cirrhosis, 13 of whom subsequently underwent liver transplantation. Evidence of enlarged lymph nodes, primarily in the gastrohepatic ligament and porta hepatis, was seen on CT scans in 17 patients (81%). Lymphadenopathy also occurred in unusual sites for benign adenopathy, including the paracardiac (24%) and mesenteric (19%) lymph nodes. Surgical or autopsy confirmation of enlarged lymph nodes was made in 13 patients, and histologic analysis of the specimens revealed reactive hyperplasia, sinus hyperplasia, sinus histiocytosis, fibrosis, or normal architecture in these enlarged nodes. The authors conclude that lymphadenopathy is a frequent CT finding in primary biliary cirrhosis and that recognition can help prevent misdiagnosis of lymphoma or metastatic disease.
Asunto(s)
Cirrosis Hepática Biliar/complicaciones , Enfermedades Linfáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Linfáticas/diagnóstico , Enfermedades Linfáticas/etiología , Metástasis Linfática , Linfoma/diagnóstico , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Correlative imaging by dual-isotope thallium/technetium subtraction scintigraphy, computed tomography, and magnetic resonance imaging demonstrated a pathologically proven parathyroid adenoma in a 62-year-old man with known neurofibromatosis, who presented with hypercalcemia and an elevated parathormone level. The association between neurofibromatosis and primary hyperparathyroidism is discussed.
Asunto(s)
Adenoma/complicaciones , Imagen por Resonancia Magnética , Neurofibromatosis 1/complicaciones , Neoplasias de las Paratiroides/complicaciones , Tecnecio , Radioisótopos de Talio , Adenoma/diagnóstico , Adenoma/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Neurofibromatosis 1/diagnóstico , Neurofibromatosis 1/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/diagnóstico por imagen , CintigrafíaRESUMEN
A modified coaxial technique for the biopsy of small or deeply situated lesions using computed tomographic (CT) guidance is described. A 22-gauge needle was passed coaxially through an outer 18-gauge introducing needle and aspiration biopsy was performed. This modified coaxial technique allows for multiple biopsies to be obtained safely, expeditiously, and repeatedly.
Asunto(s)
Biopsia con Aguja/métodos , Tomografía Computarizada por Rayos X , HumanosRESUMEN
The relative value of magnetic resonance imaging (MRI) versus computed tomography (CT) for imaging benign and malignant lesions of the maxilla and mandible was studied in a group of 16 patients. The imaging methods were evaluated for their ability to detect the lesion and define lesion margins, soft tissue extension, and bone involvement. The abnormality was identifiable with both imaging methods. For benign cystic lesions of either the maxilla or mandible (50%), MRI was overall equal to or better than CT. Magnetic resonance imaging was superior to CT in the evaluation of lesion margins and soft tissue extent of disease, whereas it was equal or slightly inferior to CT in lesion detection and in the evaluation of bone involvement. In the imaging of malignant neoplasms (50%), MRI was overall superior to CT in all four categories reviewed. Magnetic resonance imaging also had the highest rate of correlation with clinical findings, either from physical examination or at the time of surgery.
Asunto(s)
Imagen por Resonancia Magnética , Neoplasias Mandibulares/diagnóstico , Neoplasias Maxilares/diagnóstico , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Maxilares/anatomía & histología , Maxilares/diagnóstico por imagen , Masculino , Enfermedades Mandibulares/diagnóstico , Enfermedades Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/diagnóstico por imagen , Enfermedades Maxilares/diagnóstico , Enfermedades Maxilares/diagnóstico por imagen , Neoplasias Maxilares/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
A case of global renal infarction resulting from blunt renal trauma is presented. The cortical 'rim sign' on computed tomographic (CT) scanning is suggestive of major renal arterial occlusion. Clinicians who use CT scanning as the initial imaging modality for the evaluation of blunt kidney trauma should be aware of this sign and its implications for management.
Asunto(s)
Riñón/lesiones , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagen , Adulto , Femenino , Humanos , Infarto/diagnóstico por imagen , Riñón/irrigación sanguíneaRESUMEN
To more clearly characterize the role of computed tomography in staging the mediastinal lymph nodes of patients with lung cancer, we analyzed computed tomographic and surgical findings in the chest in 345 consecutive patients with lung cancer who underwent operative staging. Patients were grouped according to the TNM staging system of the American Joint Commission, central or peripheral location of the primary tumor, lobar location of the tumor, and maximum tumor diameter as determined by computed tomography or gross pathology. One third of patients with abnormal findings on the computed tomographic scan did not have mediastinal lymph node metastases. Mediastinal metastases occurred frequently in patients with central cancers (38%). The predictive value of a negative scan in all patients was high (greater than or equal to 90%) except for patients with central T3 lesions (72%), left upper lobe lesions (83%), and central adenocarcinomas (75%). However, only the differences between central T3 and central T2 or T1 lesions, and between central adenocarcinomas and central squamous cell carcinomas, were unlikely to be due to chance alone (p less than 0.05). None of the lobar differences were statistically significant. The frequency of mediastinal metastases in patients with peripheral lesions was 15% (28 of 192 patients); computed tomography correctly identified enlarged mediastinal lymph nodes in all but seven patients. However, there were no true-positive computed tomographic scans in 59 patients with peripheral lesions 2 cm in diameter or smaller; accordingly, we suggest that computed tomography is not indicated for the sole purpose of mediastinal staging in this group. Ninety-four percent of patients in this series undergoing thoracotomy with a curative intent had a curative resection. Only 4% had unresectable lesions; palliative resections were done in 2%.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Ganglios Linfáticos/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Mediastino/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios ProspectivosAsunto(s)
Carcinoma/diagnóstico por imagen , Carcinoma/secundario , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Neoplasias de la Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Femenino , Humanos , Neoplasia Endocrina Múltiple/diagnóstico por imagenRESUMEN
Computed tomography (CT) is a sensitive, noninvasive radiographic technique which can produce detailed cross-sectional images of any anatomic region. The amount and accuracy of the information it provides far exceeds that produced by conventional radiographic techniques. The chemosurgeon can find CT scanning invaluable in his preoperative evaluation of patients with large, invasive head and neck tumors of cutaneous origin.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Cuidados Preoperatorios , Tomografía Computarizada por Rayos X , Anciano , Biopsia , Carcinoma Basocelular/diagnóstico por imagen , Carcinoma Basocelular/patología , Carcinoma Basocelular/radioterapia , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Masculino , Cuidados Paliativos , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/radioterapiaRESUMEN
A review of 23 consecutive patients with tumors of the nasopharynx and maxillary sinus seen over a two-year period was carried out. The purpose was to assess the value of computerized tomography (CT) in the definition of tumor extension to contiguous structures and its effect on treatment selection and management.CT was found to be very useful in detailing bone and soft-tissue invasion. In 11 of 15 patients with nasopharyngeal cancer and in the eight patients with maxillary sinus tumors, the selection of treatment and the techniques of irradiation were influenced by the CT findings.There is a high degree of accuracy in the evaluation to the nasopharynx and maxillary sinus by CT. This improvement in pretreatment assessment of the tumors enables adequate treatment to be offered. Since most of the failures of treatment are a result of local recurrence, improvement in local control is likely to result in improved survival.
Asunto(s)
Neoplasias del Seno Maxilar/diagnóstico por imagen , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Humanos , Invasividad NeoplásicaRESUMEN
The CT appearance of bronchogenic cysts is well known. In addition, CT is useful in evaluating cases of suspected superior vena cava (SVC) syndrome. Although most cases of SVC syndrome are caused by malignant diseases, certain benign disorders such as granulomatous infections may be the underlying cause. A case of a bronchogenic cyst causing SVC occlusion is presented here.
Asunto(s)
Quistes/complicaciones , Enfermedades Pulmonares/complicaciones , Tomografía Computarizada por Rayos X , Vena Cava Superior/diagnóstico por imagen , Adulto , Constricción Patológica/etiología , Femenino , HumanosAsunto(s)
Ascitis/complicaciones , Punciones , Choque/etiología , Ascitis/cirugía , Gasto Cardíaco , Femenino , Hemodinámica , Humanos , Persona de Mediana Edad , Choque/fisiopatologíaRESUMEN
Necrotising enterocolitis may occur as a complication of granulocytopenia of any aetiology. The clinical presentation may be non-specific and the diagnosis therefore depends heavily on radiographic findings, particularly changes seen by CT. In immune-compromised patients being investigated for possible abdominal sources of fever, CT may be particularly helpful in elucidating bowel sources of infection. Two cases of necrotising enterocolitis demonstrated by CT are presented. The two cases were in immune-compromised patients with malignant disorders who presented with fever. The CT findings of this disorder are presented.