Case report: Spontaneous regression of a supraclavicular thoracic duct cyst: case report with a follow-up of 25 years.

This article is a follow-up of a previously reported case of a thoracic duct cyst. In 1982, a left supraclavicular swelling appeared spontaneously in a 55-year-old man. The mass was located near the lower part of the sternocleidomastoid muscle. Fine-needle puncture yielded chylous fluid. Radiography of the thoracic duct following direct puncture and injection of contrast medium revealed cystic dilatation of the upper part in close proximity to the jugular and subclavicular veins, with widening of the adjacent intrathoracic duct. Surgery was considered but was not performed as the patient had no symptoms. Radiological re-examination in 1991 showed progression in the size of the cystic expansion but, as the patient was still without complaints, no treatment was given. In 1995 (after 13 years), the patient noted that the cyst had diminished spontaneously. Follow-up MR and clinical examination in 2007, 25 years after the first appearance, showed complete regression of both the cervical cystic dilatation and the widened intrathoracic duct. Thus, spontaneous regression of a cystic dilatation of the thoracic duct can occur.

Chest abnormalities in juvenile-onset mixed connective tissue disease: assessment with high-resolution computed tomography and pulmonary function tests.

BACKGROUND: Mixed connective tissue disease (MCTD) is associated with several chest manifestations. Only a few studies have focused on chest manifestations in juvenile-onset MCTD (jMCTD), and the true prevalence of pulmonary abnormalities on high-resolution computed tomography (HRCT) in these patients is unknown. PURPOSE: To investigate the occurrence of pulmonary abnormalities in jMCTD with particular reference to interstitial lung disease (ILD), and to evaluate a possible association between pulmonary findings and disease-related variables. MATERIAL AND METHODS: Twenty-four childhood-onset MCTD patients with median disease duration of 10.5 years (range 1-21 years) were investigated in a cross-sectional study by means of HRCT, pulmonary function tests (PFT), and clinical assessment. RESULTS: Discrete ILD was identified in six patients (25%). Median extent of ILD was 2.0%, and all except one of the patients had very mild disease in which 5% or less of the parenchyma was affected. The CT features of fibrosis were mainly microcystic and fine intralobular. The most frequently abnormal PFT was carbon monoxide uptake from the lung, which was abnormal in 33% of the patients. PFT and disease duration were not significantly associated with HRCT findings of ILD. CONCLUSION: The prevalence of ILD in childhood-onset MCTD patients was lower than previously believed. In most of the patients with ILD, the findings were subtle and without clinical correlation. The results suggest a low extent of ILD in childhood-onset MCTD, even after long-term disease duration.

Computed tomography enhancement characteristics of lymphomatous lymph nodes of the neck.

OBJECTIVES: The objective of this study was to investigate prospectively CT contrast medium enhancement curves of lymphomatous lymph nodes of the neck. MATERIALS AND METHODS: Eleven patients with biopsy-proven lymphoma had their enlarged cervical lymph nodes examined with dynamic CT and compared with a control group. RESULTS: The mean contrast medium enhancement of the lymphomatous nodes was significantly lower than that of the control group in the time interval from 40 s to 180 s after injection. DISCUSSION: The enhancement pattern previously suggested from studies of retroperitoneal lymph nodes was confirmed in this prospective study of cervical nodes.

Mylohyoid herniation of the sublingual gland diagnosed by magnetic resonance imaging.

Mylohyoid herniation of the sublingual gland has been a frequent finding at dissection of adult human cadavers and at retrospective studies of computed tomography (CT) and magnetic resonance imaging (MRI) of the floor of the mouth. Even so, very few clinical reports exist. The present report describes an adolescent boy with a suspected submental tumour, which at MRI was shown to be caused by a mylohyoid hernia of part of an enlarged, but otherwise normal sublingual gland.

Complications following ultrasound-guided thoracocentesis.

PURPOSE: To retrospectively register the number and type of complications following ultrasound-guided thoracocentesis, and to evaluate the need for routine chest X-ray after the procedure. MATERIAL AND METHODS: Complications were retrospectively registered from the radiological and clinical reports of 371 consecutive patients who had undergone thoracocentesis with a total of 711 procedures. RESULTS: The mean volume evacuated was 823ml (range 0-3600ml). Twenty (2.8%) pneumothoraces were found after 711 thoracocenteses, but in no case was chest tube drainage necessary. Hemoptysis occurred in one patient. CONCLUSION: Ultrasound-guided thoracocentesis was found to be a safe procedure. Based on these results, no reason was found to introduce an upper limit of the amount of fluid drained in one session. Routine follow-up chest X-ray is not justified in the absence of clinical symptoms.

Priapism of the glans and corpus spongiosum. Report of two cases with angiography.

Priapism, whether of the arterial or veno-occlusive type, mainly affects the cavernous bodies, leaving the low-pressure system in glans and corpus spongiosum soft without urethral compression. In the present 2 case reports, the pathologically increased pressure primarily affected the corpus spongiosum. One had arterial priapism following penile revascularization and the other veno-occlusive priapism due to thrombosis of the internal pelvic veins. Both had ulcerations of the glans and urinary retention requiring suprapubic catheterization. Arteriography revealed the disease mechanism in both, and led to embolization in 1.

Conventional sinus radiography compared with CT in the diagnosis of acute sinusitis.

OBJECTIVES: To evaluate the value of plain film radiography in a prospective investigation of patients with clinical suspicion of acute sinusitis, using standard CT as a gold standard. METHODS: 47 consecutive patients were examined. Each patient underwent conventional X-ray and standard dose CT examinations on the same day. The sensitivity and specificity of the plain film examination were calculated. RESULTS: The specificity of the plain film examination was high, but the sensitivity was low except for the maxillary sinus (sensitivity 80%). Thus, for maxillary sinusitis, plain film examination was reasonably accurate. A negative finding in the other sinuses could not be relied upon. CONCLUSIONS: The sensitivity of plain film radiography for detecting sinus opacifications was unacceptably low for the ethmoid, frontal and sphenoid sinuses. The specificity was high.

A new low-dose CT examination compared with standard-dose CT in the diagnosis of acute sinusitis.

A low-dose CT of the paranasal sinuses was designed with few, thin sections, non-uniform intersection gaps, low milliampere settings and avoidance of direct radiation to the eye lens. The low-dose CT was prospectively compared with standard-dose CT in patients with suspicion of acute sinusitis. Forty-seven patients were examined with low-dose CT immediately after standard-dose CT. The effective dose and the lens dose were calculated and compared. Using standard-dose CT as a gold standard the sensitivity and specificity of low-dose CT was calculated for each sinus group. The effective dose and the lens dose of the low-dose CT were reduced to, respectively, 3 and 2% of the standard-dose CT. The diagnostic yield of the low-dose CT with regard to acute sinusitis was good with a high specificity (> or =96%) for all sinus groups. The sensitivity was also high (> or =95%) except for the frontal sinus where the sensitivity was 83%. Low-dose CT offers considerable dose reduction and should be the standard for imaging patients with suspected acute inflammatory paranasal disease.

CT appearances of unilateral cleft palate 20 years after bone graft surgery.

PURPOSE: To describe CT appearances in patients with unilateral cleft lip and palate (CLP) 20 years after bone graft surgery. MATERIAL AND METHODS: Eighteen consecutive patients with unilateral CLP were examined. All patients had been treated with primary closure, both in infancy and early childhood, supplemented with bone grafting at the age of around 10 years. The CT examination of the upper jaw included a dental CT program. The CT appearances of the cleft side were compared with those of the untreated non-cleft side. RESULTS: Abnormal CT appearances included skew nasal aperture (n=17), nasal septal deviation (n=17), low floor of nasal aperture (n=15) at or towards the cleft side, and deviation of anterior nasal spine towards the non-cleft side (n=18). The posterior part of the bone cleft was visible in all patients, and the dental arch was V-shaped in 8. CONCLUSION: Although adherence to the present treatment protocol is considered to give satisfactory functional and cosmetic results, certain abnormalities persist. A knowledge of these is a prerequisite for a complete and final evaluation of the surgical and orthodontic regimen.

[Lymphadenography--pioneering work of Sven Bruun and Arnfinn Engeset]. / Lymfadenografi--pionerarbeid av Sven Bruun og Arnfinn Engeset.

Lymphadenography is a method for direct radiologic visualization of lymph nodes following injection of fat soluble contrast medium. Sven Bruun and Arnfinn Engeset at Rogaland Hospital developed this method in 1952 and published preliminary results in 1956. They have been somewhat overshadowed by the English surgeon John B. Kinmonth who published his method on lymphangiography in 1954. Kinmonth succeeded in visualizing the peripheral lymph vessels by direct injection of water soluble contrast medium. By this technique it was not feasible to depict lymph nodes above the knee because of diffusion of medium to surrounding tissues. Lymphography is a technique that visualizes both lymph vessels and lymph nodes. This method is based on a combination of the two above-mentioned methods with injection of fat soluble contrast medium into peripheral lymph vessels. Lymphography was a very important examination which was used all over the world in the 1960s and 1970s. It has now been replaced by other examinations.

[Salivary gland drainage into the thyroglossal duct]. / Spyttkjerteldrenasje til ductus thyreoglossus.

BACKGROUND: Failure in regression of the thyroglossal duct is one of the most common reasons for midline swellings in the neck. Several authors have described recurrent thyroglossal duct remnants with persisting draining sinuses. However, few have described accessory salivary glands that drain into the thyroglossal duct. MATERIAL AND METHODS: In this article we report two such cases with midline salivary glands in the floor of the mouth. RESULTS: These two patients were subsequently successfully treated with radical tissue resection in the area between the hyoid bone and foramen cecum. INTERPRETATION: Preoperative fistulography or sinography was useful to demonstrate the ductal ramification of the salivary glands, and use of methylene blue during surgery proved of significant value for the result.

CT of the oral vestibule with distended cheeks.

PURPOSE: To evaluate patient compliance in CT examination of the oral vestibule with distended, blown-up cheeks and to determine how often such images provided additional information when disease processes in this area were suspected. MATERIAL AND METHODS: Fifty-four patients were examined with CT of the oral vestibule with distended cheeks and 16 of them had diseases where oral vestibule affection was considered possible. RESULTS: Fifty-three of 54 patients were able to perform cheek distension. Of 16 patients with possible disease involvement of the oral vestibule, additional information was thus obtained in 11 patients. CONCLUSION: When lesions involving the oral vestibule or adjacent regions are suspected, CT examination with distended cheeks is recommended as a routine procedure. The oral vestibule separates the teeth and gingiva from the buccal mucosa of the lips and cheek. On CT images of the oral region, the buccal and gingival mucosa are not separated and thus difficult to define. Problems may arise in deciding whether or not a limited tumorous or infectious lesion of the gingiva also involves the buccal region and vice-versa. We observed that images with distended, blown-up cheeks could be useful in this respect, as the air separated the gingival from the buccomasseteric region and allowed a determination of buccal distensibility. The purpose of the present report was to establish how well the patients could co-operate in performing the CT examination with distended cheeks, and how often such images provided additional information in patients with disease processes which might affect the oral vestibule.

[High-resolution computer tomography of the lungs]. / Høyoppløsningscomputertomografi av lungene.

High-resolution CT (HRCT) is a technique developed over the last decade. It optimises spatial resolution and provides details similar to those obtainable from gross pathologic specimens. HRCT of the lungs provides an accurate assessment of the pattern and distribution of many disease processes that in the conventional chest radiograph are occult or non-specific. HRCT is an established technique and the method of choice for evaluating a variety of pulmonary diseases. In this review we describe the modifications in CT technique that are instrumental in obtaining HRCT, and we also give examples of normal and pathologic findings in general.

[CT combined with arterial portography. A sensitive method for evaluation of liver tumors]. / CT kombinert med arteriell portografi. En sensitiv metode for evaluering av leversvulster.

During the period 1994-95, 22 patients were examined with CT during arterial portography for evaluation of hepatic tumours. The majority, 20 patients, had metastases from colon cancer. All patients were candidates for liver resection. In the series of patients described here, this process detected additional lesions in four more of the patients than found with any other imaging techniques. This supports that CT during arterial portography is the most sensitive method for detecting small malignant hepatic tumours, and for localizing them in relation to liver segments and major vascular structures. Optimal results are obtained in the absence of diffuse parenchymal disease and portal hypertension. Non-tumourous perfusion defects limit the accuracy of this technique, but such defects have characteristic locations and appearance. In difficult cases the technique should be correlated with ultrasonography and MR.

When to suspect and how to diagnose pulmonary lymphangioleiomyomatosis.

The objective of this study was to present clinical and radiological data of eight women with histologically proven lymphangioleiomyomatosis (LAM) diagnosed between 1984 and 1994, and to suggest a diagnostic strategy when LAM is suspected. A review of case reports, including results of biopsies, lung function and radiological procedures was undertaken. The mean age of the women at start of symptoms was 36 years, and the mean age at time of diagnosis 42 years. The most frequent presenting complaint was dyspnea, either in conjunction with pneumothorax (3), chylothorax (2) or on exertion (2). All patients had airflow limitation and markedly reduced gas transfer. Five patients had 16 episodes of pneumothorax. In seven patients multiple cysts were observed on the surface of the lung during thoracotomy while computerized tomography (CT) scans revealed numerous cysts evenly distributed throughout the lung parenchyma. The procedures that confirmed the diagnosis included transbronchial lung biopsy (4), open lung biopsy (2), thoracoscopy (1), thoracotomy (3) and autopsy (1). Three specimens had to be revised before the histological diagnosis was confirmed. It was concluded that the important clues to a diagnosis of LAM are recurrent episodes of pneumothoraces in fertile women, progressive air-flow limitation, markedly reduced gas transfer and characteristic findings on thoracic CT scans. A specific request to the pathologist to stain lung tissue specimens for smooth muscle cells is mandatory.

[Embolization of congenital pulmonary arteriovenous malformations]. / Embolisering av medfødte arteriovenøse malformasjoner i lungene.

Patients with arteriovenous pulmonary malformations are at risk of developing secondary brain disease such as transient ischemic attacks, strokes or abscesses. Lethal haemothorax and haemoptysis also occur. 12 of 14 malformations in five patients were treated using a total of eight procedures. One patient experienced a transient unilateral hemiparesis, otherwise no complications occurred. None of the 43 deployed occlusion coils was lost through the fistulas. Complete occlusion was achieved in all lesions where coils could be placed in a stable position. One patient suffered a minor recurrence. The use of interlocking detachable coils (IDC) which can be retracted or repositioned prior to full deployment is recommended.

Arterial high flow priapism role of radiology in diagnosis and treatment.

Radiological methods for diagnosis and treatment of arterial high flow priapism are described based on experience with 7 patients, 6 with lesions of the cavernous and 1 with a lesion of the spongious body and glans. Arteriography (7 patients) and cavernosography (6 patients) indicated the site of the lesion in all cases. Color Doppler was useful in the two patients examined. Embolisation was successfully performed in 4 patients and resulted in complete or partial detumescence in all Two patients had a 10 year history without complete loss of erectile function. They had markedly dilated veins at cavernosography, and one responded favorably to venoablative surgery.

Mechanical coupling between the hemithoraces in humans.

Unilateral airway occlusion permits measurement of single lung function. Since the results suggest that the occluded lung influences the mobility of the contralateral hemithorax, we wanted to test this hypothesis. In eight healthy subjects, we measured, using computed tomography, lung parenchymal area and inner rib cage parasagittal and transverse diameters at three different levels and at maximal inspiration and expiration. These measurements were made without and during balloon occlusion of one mainstem bronchus at residual volume (RV) and at total lung capacity (TLC). Unilateral occlusion at RV reduced the ipsilateral diameters in maximal inspiration, but the increase during inspiration was still 39-50% of that without occlusion. The inspiratory increase in contralateral diameters was reduced to 64-80% of the increase without occlusion. Occlusion at TLC reduced the expiratory decrease in ipsilateral diameters to 37-57% of that without occlusion. The expiratory decrease on the contralateral side was reduced to 56-70% of that without occlusion. Due to accompanying mediastinal shifts the parenchymal areas of the occluded lung barely changed. In contrast, the contralateral area was 86-97% of that without occlusion. We conclude that the movement of the two hemithoraces are, at least partially, interdependent. The occluded hemithorax prevents full expansion/compression of the nonoccluded contralateral side, whilst its own mobility appears to be increased by the presence of this nonoccluded side. Potential negative effects are outweighed by the physiological benefit of the coupling, as this mechanism could secure ventilation to a chest half without own movement.