A pictorial review of scrotal and penile pathology on computed tomography.

Computed tomography (CT) may show a variety of scrotal and penile pathologic finding, but is usually not used as a first-line imaging due to its limited soft tissue contrast. Nonetheless, there are three main scenarios for imaging of the scrotum and penis with CT. Pathologies may be found incidentally in patients undergoing abdominal and pelvic CT scanning for different reasons. In emergency settings, CT is frequently performed, and the recognition of scrotal and penile pathologies by the reporting radiologist is crucial to ensure optimal patient treatment and outcome. If MRI scanning cannot be performed due to contraindications or is unavailable in resource, limited CT may be used for the further characterization of scrotal and penile pathology found on ultrasound. This pictorial review wants to familiarize general and emergency radiologists with the anatomy and possible pathological findings of the scrotum and penis on CT.

[Congenital malformations of the brain misinterpreted as sequelae of poliomyelitis]. / Angeborene Fehlbildungen des Gehirns als Folgezustände der Poliomyelitis verkannt.

BACKGROUND: Poliomyelitis is an infectious disease of the peripheral motor neurons, which predominantly affects children and causes residual palsies. Because of the oral poliomyelitis vaccination started in Germany in 1960 and 1962 and the following rapid decline of the incidence of this infection, the postpolio syndrome in Germany is a disease of older people. METHODS: Since 2008, we have offered a poliomyelitis outpatient consultation at the Center of Geriatrics, Protestant Hospital Göttingen-Weende and have treated 33 patients. RESULTS: The spectrum of persistent deficits after poliomyelitis ranges from palsy of single extremities to severe disability with (temporary) ventilator dependence. Many patients suffer from scoliosis or shortening of limbs of different degrees, which promotes degenerative diseases of the spinal cord and joints with secondary myelopathy, injury of spinal nerve roots or peripheral nerves or respiratory failure. The postpolio syndrome is characterized by an increase of the functional deficits after decades of compensation. The palsies of 2 of the 33 patients were not caused by poliomyelitis but by myelomeningocele and schizencephaly, respectively. CONCLUSION: The motor deficits acquired in childhood enable the majority of the patients to successfully master their lives. Because of the limited compensatory capacities of postpolio patients, even small increases in the severity of the palsy can cause a severe decline of the functional status and an impairment of the ability to live an independent life. In a substantial proportion of patients with the diagnosis poliomyelitis the symptoms are caused by other diseases.

Ceftriaxone-induced neutropenia successfully overcome by a switch to penicillin G in Cardiobacterium hominis endocarditis.

Leukopenia, including agranulocytosis, is a severe complication of treatment with all ß-lactam antibiotics. Its incidence increases with age. Cardiobacterium hominis endocarditis after implantation of an aortic valve bio-prosthesis in a 77-year-old woman was treated with ceftriaxone 2 g/day plus gentamicin 160 mg/day intravenously. On Day 25 of treatment, blood leukocytes had decreased to 1800/µl (neutrophils 370/µl). Antibiotic therapy was switched to penicillin G 20 million international units (IU)/day. Thereafter, blood leukocytes including neutrophils normalized suggesting that penicillin G was less bone marrow-toxic than ceftriaxone. High-dose ciprofloxacin, the alternative to penicillin G, was avoided because of the risk of cognitive and behavioral side effects. The present case suggests that with close laboratory monitoring a ß-lactam with differing side chains should not be considered contraindicated after ß-lactam antibiotic-induced neutropenia.

Calcific Discitis Seems to be a Common Incidental Finding in Adults.

Calcific discitis seems to be a rare cause of back pain in adults. Imaging shows a calcification of the nucleus pulposus with extension through the endplates on computed tomography. This can be accompanied by bone marrow edema on magnetic resonance imaging. In a retrospective review of 150 patients, 4 cases of calcific discitis were found (2.8%). None of the patients reported about back pain. Therefore, it seems that symptomatic cases of calcific discitis are a rare occurrence in contrast to the quite frequent incidental finding of asymptomatic cases on imaging. Knowledge of the various imaging appearances of calcific discitis is necessary for radiologists, because especially in acute cases with substantial bone marrow edema, this benign entity may be confused with infectious spondylodiscitis or malignancy.

A case of coexisting hyperostosis frontalis interna and biparietal bone thinning.

Incidental pathology of the skull is frequently detected on cross sectional imaging of the brain. In contrast to the common finding of hyperostosis frontalis interna, biparietal bone thinning is less common. A case of an 87-year-old woman showing coexistence of hyperostosis frontalis interna and biparietal bone thinning is presented. This coexistence has not been reported previously.

Breast Implants on Computed Tomography-A Pictorial Review of Normal and Pathologic Findings.

Breast augmentation with implants is frequently performed. Therefore breast implants can be seen quite frequently on computed tomography (CT) of the body. This offers the possibility to detect incidental pathology and help to improve patient outcome. Basic knowledge about imaging findings of breast implants on CT is therefore needed for radiologists reporting body CT. CT may also be used for further workup of breast implants if magnetic resonance imaging (MRI) is contraindicated or not available. The purpose of this pictorial review is to give a brief overview of normal and pathologic findings of breast implants on CT.

Sepsis-associated encephalopathy and septic encephalitis: an update.

INTRODUCTION: Sepsis-associated encephalopathy (SAE) and septic encephalitis (SE) are associated with increased mortality, long-term cognitive impairment, and focal neurological deficits. AREAS COVERED: The PUBMED database was searched 2016-2020. The clinical manifestation of SAE is delirium, SE additionally is characterized by focal neurological symptoms. SAE is caused by inflammation with endothelial/microglial activation, increase of permeability of the blood-brain-barrier, hypoxia, imbalance of neurotransmitters, glial activation, axonal, and neuronal loss. Septic-embolic (SEE) and septic-metastatic encephalitis (SME) are characterized by focal ischemia (SEE) and small abscesses (SME). The continuum between SAE, SME, and SEE is documented by imaging techniques and autopsies. The backbone of treatment is rapid optimum antibiotic therapy. Experimental approaches focus on modulation of inflammation, stabilization of the blood-brain barrier, and restoration of membrane/mitochondrial function. EXPERT OPINION: The most promising diagnostic approaches are new imaging techniques. The most important measure to fight delirium remains establishment of daily structure and adequate sensory stimuli. Dexmedetomidine and melatonin appear to reduce the frequency of delirium, their efficacy in SAE and SE remains to be established. Drugs already licensed for other indications or available as food supplements which may be effective in SAE are statins, L-DOPA/benserazide, ß-hydroxybutyrate, palmitoylethanolamide, and tetracyclines or other bactericidal non-lytic antibiotics.

Safety of CT-guided cervical nerve root infiltrations using a dorsal approach.

Cervical nerve root infiltrations are frequently performed in patients with radiculopathy, and computed tomography (CT) is commonly used for image guidance. With the traditional anterolateral approach, catastrophic side events due to spinal ischemia have been reported. To minimize risk, a dorsal approach has been advised, but the safety of this dorsal approach has not been studied systematically. In a 5-year period, 137 cervical nerve root infiltrations using a dorsal approach were performed on 109 patients and retrospectively reviewed. In our series, no major complications like spinal ischemia, spondylodiscitis, large hematomas with the need for surgery or severe allergic reactions occurred. In conclusion, using a dorsal approach, CT-guided cervical nerve root infiltrations with an extraforaminal needle position seem to be a safe intervention.

Cisterno-lumbar gradient of complement fractions in geriatric patients with suspected normal pressure hydrocephalus.

BACKGROUND: The complement system is a functional link between the innate and adaptive immune system and present in all compartments of the body. The composition of the cerebrospinal fluid (CSF) differs between the ventricular, cisternal and lumbar space. Usually, concentrations of blood-derived CSF proteins increase from ventricular to lumbar fractions. METHODS: In 20 geriatric patients with suspected normal pressure hydrocephalus (NPH) [13 women, 7 men, age 80.5 (75/85) years; median (25th/75th percentile)] a lumbar spinal tap of 40 ml was performed, and 10 ml of serum was drawn. CSF, sequentially collected in 8 fractions of 5 ml (1st fraction: lumbar CSF; 8th fraction: cisterna magna-near CSF), was analyzed for complement protein C3, and the activation products C3a and sC5b-9 by enzyme immunoassay. RESULTS: The concentrations of the complement factors measured in fractions 1 and 8 of each individual patient were strongly correlated: C3 (Spearman's rank correlation coefficient rS = 0.75, p = 0.0002); C3a (rS = 0.93, p < 0.0001); sC5b-9 (rS = 0.64, p = 0.002). CSF complement concentrations were lower in the cistern-near fraction 8 than in the lumbar fraction 1 (C3: p = 0.005; C3a: p = 0.0009; sC5b-9: p = 0.0003, Wilcoxon signed rank test). The concentrations of complement factors in CSF were two orders of magnitude lower than those in serum. C3 levels in the lumbar CSF strongly correlated with the lumbar CSF/serum albumin concentration quotient (QAlb) as a measure of the functionability of the blood-CSF barrier and the velocity of CSF flow (rS = 0.84, p < 0.0001) suggesting diffusion of C3 from blood to CSF. The lumbar and cistern-near concentrations of C3a did not significantly correlate with QAlb (rS = 0.26) pointing to a local conversion of C3 to C3a. The lumbar concentrations of sC5b-9 moderately correlated with QAlb (rS = 0.62, p = 0.004). Plotting the CSF/serum quotient of C3 and sC5b-9 versus the QAlb revealed an approx. 50% local synthesis of C3, but a strong production of sC5b-9 in the CNS. CONCLUSIONS: The increase of the complement concentrations from cisternal to lumbar CSF and the strong correlation of C3 with QAlb suggest that (1) a substantial portion of complement C3 in CSF originates from blood and (2) the complement system is mildly activated in the CSF of NPH patients.

Sonography in capsular contracture after breast augmentation: value of established criteria, new techniques and directions for research.

Capsular contracture or capsular fibrosis is the most common complication following breast augmentation with implants. Sonography is usually the initial imaging test performed to examine a suspicious implant. In contrast to the large number of patients developing capsular fibrosis there is only sparse literature reporting about sonographic findings. In this letter after a brief review of normal sonographic findings after breast augmentation, established ultrasound findings suggestive of capsular fibrosis (deformity, increased number of radial folds and thickening of the fibrous capsule) are discussed. The possible value of new techniques and possible directions for further research are addressed.

Tuberculosis in newly arrived asylum seekers: A prospective 12 month surveillance study at Friedland, Germany.

PURPOSE: In the European Union tuberculosis prevalence-rates are among the lowest in the world. The prevalence of active tuberculosis in migrant populations has to be analyzed to get valid data on the risk of tuberculosis and for the decision of screening activities. METHODS: Therefore, we prospectively quantified the risk of active tuberculosis among asylum seekers at time of arrival. Investigation was performed as regular part of the admission screenings for people arriving at Friedland, Germany, a primary major receiving center during one year. RESULTS: In 11.773 newly arrived asylum seekers 16 X-ray investigations gave the suspicion of active tuberculosis, thereof 11 cases could be verified by culture, thereof 9 cases were classified as microscopically positive. These data translate into rates of 136 per 100.000 suspected cases, 93 per 100.000 verified cases, and finally 76 per 100.000 infectious cases, respectively. Prevalence was higher in asylum seekers coming from Eritrea and Russia compared to the main origins of current migration Syria, Afghanistan, Iraq, Iran, and Lebanon. One case of MDR-tuberculosis could be detected in a migrant from Russia. CONCLUSIONS: Prevalence rates of tuberculosis in newly arrived asylum seekers are higher than in native European populations. Rates seem to reflect the prevalence in the home countries. X-ray investigation during first examination may help identifying people needing further tests for detecting infectious tuberculosis and therefore may prevent transmission. However due to the low prevalence rates screening procedures have to be reviewed.

Digital Mammography in Young Women: Is a Single View Sufficient?

INTRODUCTION: Single view mammography may be a less time consuming, more comfortable and radiation reduced alternative for young women, but there are no studies examining this approach after the implementation of digital mammography into clinical practice. MATERIALS AND METHODS: Retrospective analysis of all mammographies performed in women younger than 40 years during a 24 month period. The sample consisted of 109 women with 212 examined breasts. All patients initially received standard two- view mammography. In the study setting the MLO- views were read by a single viewer and compared to a composite reference standard. RESULTS: In this sample 7 malignant findings were present and the review of the MLO-view detected 6 of them (85%). In patients with dense breasts 4 out of 5 malignant findings were found on the single-view (sensitivity 80%) and all 2 malignant findings were detected in patients with low breast density (sensitivity 100%). There were 7 false positive findings (3.3%). i.e. in total 8 out of 212 examined breasts were therefore misinterpreted (3.8%). CONCLUSION: Single view digital mammography detects the vast majority of malignant findings, especially in low density breast tissue and the rate of false-positive findings is within acceptable limits. Therefore this approach may be used in different scenarios (for example in increasing patient throughout in resource poor settings, reducing radiation burden in the young or in combination with ultrasound to use the strengths of both methods). More research on this topic is needed to establish its potential role in breast imaging.

Intramammary Findings on CT of the Chest - a Review of Normal Anatomy and Possible Findings.

Computed tomography (CT) is a frequently performed examination in women of all ages. In all thoracic CT examinations of the chest at least parts of the breasts are included. Therefore incidental breast pathology may be observed. It has been suggested that one out of 250 women undergoing chest CT will show a malignant incidental breast lesion. Given the high number of performed chest CT examinations, this contributes to a significant number of malignancies. In this review, after a brief discussion of the value of computed tomography in breast imaging, normal and pathologic findings are discussed to create awareness of this potential "black box" on chest CT.