Non-squamous cell neoplasms of the larynx: radiologic-pathologic correlation.

A variety of benign and malignant non-squamous cell neoplasms may affect the larynx. Most of these uncommon laryngeal neoplasms are located beneath an intact mucosa, making diagnosis difficult with endoscopy alone, and sampling errors may occur if only traditional superficial biopsies are performed. In some laryngeal neoplasms, radiologic evaluation allows the correct diagnosis. Hemangiomas have very high signal intensity at T2-weighted magnetic resonance (MR) imaging and strong enhancement at both computed tomography (CT) and MR imaging after administration of contrast material. Phleboliths, which are pathognomonic for hemangiomas, are easily identified at CT. Chondrogenic tumors typically manifest with coarse or stippled calcifications at CT. Because of their high water content, chondrogenic tumors have very high signal intensity on T2-weighted MR images, whereas only moderate enhancement is observed after administration of contrast material. Lipomas typically manifest at both CT and MR imaging as homogeneous nonenhancing lesions. They are isoattenuating to subcutaneous fat at CT and isointense relative to subcutaneous fat with all MR pulse sequences. Metastases from renal adenocarcinoma typically demonstrate strong contrast enhancement and flow voids at MR imaging, and metastases from melanotic melanoma usually have high signal intensity on T1-weighted MR images and low signal intensity on T2-weighted images owing to the paramagnetic properties of melanin. Although radiologic findings are nonspecific in most other non-squamous cell neoplasms of the larynx (eg, Kaposi sarcoma, hematopoietic tumors, tumors of the minor salivary glands, metastases from amelanotic melanoma), cross-sectional imaging can play an important role in the diagnostic work-up of these unusual tumors by delineating the extent of submucosal tumor spread and directing the endoscopist to the appropriate site for the deep, transmucosal biopsies needed to establish the diagnosis. In addition, CT and MR imaging are crucial for posttherapeutic monitoring and early detection of local recurrence.

Myonecrosis induced by drug overdose: pathogenesis, clinical aspects and radiological manifestations.

The authors report five cases of myonecrosis varying in degree of severity and extent of the lesions, following drug overdose in young patients. The pathogenesis of this condition is discussed with reference both to the literature and the radiological findings of the present study. The clinical and radiological manifestations are described and a possible differential diagnosis is suggested, based on these data. Semeiologic data obtained by ultrasound and computerized tomography was found to give the most accurate information concerning the morphological characteristics of myonecrosis while ultrasound can reveal the extent of the involvement in the limbs.

Diagnosis of deep vein thrombosis by combination of Doppler ultrasound flow examination and strain gauge plethysmography. An alternative to venography only in particular conditions despite improved accuracy of the Doppler method.

Doppler ultrasound flow examination, strain gauge plethysmography and contrast venography were performed in 160 lower limbs of 80 in-patients. Deep vein thrombosis (DVT) was suspected in 87 limbs. Using measurement of venous stop-flow pressure, the Doppler method hae an overall sensitivity of 83%. By combined use of Doppler and Plethysmography, sensitivity was increased to 96%. Specificity was 62% and 51%, respectively. With a positive and a negative predictive value of 80% and 73%, respectively, the combination of both non-invasive method cannot reliably replace venography in the diagnosis of DTV, although all (40/40) thromboses proximal to or involving the popliteal segment were detected by either Doppler and Plethysmography or both. After exclusion of 14 patients (18%) suffering from conditions known to alter the results of these non-invasive methods, the positive predictive value of abnormal findings in both Doppler and Plethysmography was increased to 94% for suspected limbs, whilst negative predictive value of both negative Doppler and Plethysmography was 90%, allowing the avoidance of venography in these patients.

Tracheal and subglottic lesions following long-standing intubation. A radiological and clinical study.

A 3-year systematic study was made for subglottic and tracheal lesions of patients who had been intubated for more than 10 h (87 patients intubated for time periods ranging from 10 to 1,960 h). The radiological aspect of the lesions was studied and classified as tracheal stenosis, cartilage lesions and granulomas. The radiological analyses were performed by tracheography (14 cases), xerography, xerotomography (87 cases) and CT (2 cases). The incidence of lesions was 34% with 3.4% (3 cases) of severe stenosis; only 1 patient was symptomatic. The cuff, the tip of the endotracheal tube and the suction cannula were found to be responsible for the tracheal sequelae. A statistically significant correlation was found between the duration of the intubation and the severity of the tracheal lesions. The lesions, examined radiologically about a year after the intubation, were found to be stable.