Evaluation of pericardial sinuses and recesses with 2-, 4-, 16-, and 64-row multidetector CT.

PURPOSE: The aim of this study was to describe visualisation rate and appearance of all pericardial sinuses and recesses and to evaluate whether there is a significant difference between visualisation of these sinuses and recesses on 2-, 4-, 16- and 64-slice multidetector computed tomography (MDCT). MATERIALS AND METHODS: We retrospectively analysed 588 MDCT scans of the chest obtained with a protocol for pulmonary embolism. RESULTS: The visualisation rate of any pericardial recess was 85.2%. The rates on 2-, 4-, 16- and 64-slice MDCT were 74.7%, 90.6%, 90.3% and 88.7%, respectively. There was a statistically significant difference in visualisation rates of pericardial recesses between 2-slice MDCT and other MDCT systems (p<0.01). Age, and 4-, 16- and 64-slice MDCT versus 2-slice MDCT and the presence of pleural effusion appeared as significant predictors of the presence of any recess. CONCLUSIONS: Visualisation rates of pericardial recesses are higher with 4-, 16- and 64-slice MDCT than with 2-slice MDCT. Therefore, radiologists need to be familiar with the different appearances of pericardial recesses on MDCT to avoid misdiagnosis.

Incidental localized (solitary) mediastinal malignant mesothelioma.

Primary mediastinal mesotheliomas are rare tumours. The mesothelial lining cells of the the pericardium are suggested as the most probable cells of origin. Most of these tumours appear either as a diffuse or nodular thickening of the pericardium that encase and even invade the heart. Localized mediastinal mesotheliomas are distinctly uncommon. We report the imaging findings of a solitary malignant mediastinal mesothelioma that presented mainly as a cystic anterior mediastinal mass. On chest radiography, the tumour appeared as a right paramediastinal soft tissue mass located adjacent to the right middle and lower lobes. On CT, a large, well-circumscribed, right anterior mediastinal mass with a central zone of fluid attenuation was observed. This mass had a thin, smooth wall of uniform thickness as well as a small component that demonstrated soft tissue attenuation. There was no plane of separation between the tumour and aorta/superior vena cava. At surgery the tumour could be dissected easily free from the pericardium and great vessels and it was removed totally. Histopathological examination of the tumour revealed a malignant epitheloid mesothelioma.

Shortcomings of lateral sinus radiograph in the preoperative determination of the extent of endonasal endoscopic sinus surgery.

Lateral sinus radiograph is helpful in determining the distances between certain anatomic landmarks in preparation for endonasal endoscopic sinus surgery. However, some misleading factors limit the usefulness of this radiograph. In this study these distances were measured in 49 patients and compared with measurements obtained from another imaging modality, magnetic resonance imaging, which provides more accurate measurements. Results show a discrepancy in the measurements of distances between some of these landmarks that cannot be explained by the factor of magnification alone on the sinus radiographs. Statistical analysis of the results for women revealed a significant discrepancy between the distances from the nasal spine to the midfovea ethmoidalis, the sphenoethmoid junction, and the posterior sphenoid wall as measured on MR images and those as measured on lateral sinus radiographs (P < .05). For men the same was true for the distances from the nasal spine to the midfovea ethmoidalis and the posterior sphenoid wall (P < .05). It is concluded that there should be reservations in the surgical application of data provided by the lateral sinus radiograph before endoscopic sinus surgery.

Obliteration of maxillary and sphenoid sinuses in Gaucher's disease.

Paranasal sinus obliteration is described in a patient with adult type Gaucher's disease. Plain radiographs and computed tomography showed obliteration of paranasal sinuses due to medullary expansion of surrounding bone. The mandible and maxilla are rarely affected in Gaucher's disease and obliteration of paranasal sinuses due to bony expansion has not previously been reported.

Calcium within a bronchogenic cyst with a fluid level.

A 38-year-old man presented with a bronchogenic cyst which showed a high calcium content. The calcium precipitate layered in the dependent part of the cyst to form a fluid level. The CT and MRI findings of this rare case are discussed.

Quantitative CT of the orbit in Graves' disease.

In order to determine the value of quantitative CT of the orbit in patients with Graves' disease, we clinically examined 174 orbits of 87 patients with Graves' disease and evaluated them by CT in respect to the density and size of the extraocular muscles, the globe position and the width of the optic nerve-sheath complex. We also determined the normal ranges for density of extraocular muscles in 200 normal orbits of 100 patients for comparison. Normal ranges for the density of extraocular muscles were (mean +/- 2 SD) medial rectus, 28-63 HU; lateral rectus, 24-78 HU; inferior rectus, 20-64 HU; superior muscle group, 28-62 HU. 51 of 77 (66%) patients with Graves' disease had extraocular muscle density changes. Some extraocular muscles showed fatty infiltration on CT. 50 of 87 (57%) patients had at least one enlarged extraocular muscle, 47 (54%) patients had exophthalmos and 59 (68%) patients had either exophthalmos and/or extraocular muscle enlargement. A diagnosis of Graves' ophthalmopathy was made in 69 of 87 (79%) patients using CT and in 50 (57%) patients by clinical examination. We conclude that quantitative CT imaging of the orbit with evaluation of the size and density values of extraocular muscles and the globe position may be very helpful in detecting ophthalmopathy in patients with Graves' disease.

CT presentation of Wegener's granulomatosis in a child: rapidly progressive changes of pulmonary nodules to cavities.

We present a child with Wegener's granulomatosis who showed lung lesions progressing from nodules to cavities within a 1-month period on CT.

Bone mineral density in children with juvenile chronic arthritis.

The aim of this study was to evaluate bone mineral density changes in patients with juvenile chronic arthritis (JCA) and to determine the most likely causes of osteoporosis in these patients. Eighteen (11 male, 7 female) patients suffering from JCA and 14 healthy controls (10 male, four female) were included in this study. The mean age of the patients and control groups were 11.0 +/- 3.2 and 10.9 +/- 2.9 years respectively. Disease activity was determined by clinical and laboratory evaluation and 'Articular Disease Severity Score' (ADSS). Bone mineral density (BMD) of the femoral neck and lumbar spine was measured by dual photon absorptiometry. BMD of the patients at the lumbar spine was significantly lower than the control group (p < 0.05). This difference was more marked in patients treated with steroids. Femoral neck BMD was also lower in the patient group but this difference was not statistically significant. There was a negative correlation between ADSS and BMD at the spine. In conclusion, trabecular bone loss is characteristic for osteoporosis in JCA. Our results indicate that steroid treatment and disease severity are important factors in the development of osteoporosis in JCA.

Bone mineral density in ankylosing spondylitis.

Vertebral osteoporosis is a well-recognized feature of ankylosing spondylitis (AS) and also the vertebral compression fractures due to osteoporosis are a common but frequently unrecognized complication of AS. Both may contribute to the pathogenesis of spinal deformity and back pain. The aim of this study was to measure vertebral and femoral neck bone mass in patients with AS by dual photon absorptiometry, to determine the prevalence of compression fractures and to examine the relationship between bone density and disease severity. We found that the bone mass was diminished in the lumbar spine in moderate AS versus mild forms but the patients with advanced disease had the highest BMD values. Examination of spinal radiographs revealed compression and biconcave fractures in 9 (40.9%) cases. Neither the duration of the disease and the degree of sacroiliitis, nor the disease activity assessed by laboratory and clinical parameters was found to significantly affect the results.

Osteoporosis in rheumatoid arthritis: effect of disease activity.

In addition to juxtaarticular osteoporosis, which appears to reflect predominantly local disease mechanisms, more generalized bone loss can occur in rheumatoid arthritis (RA). The aim of this study was to compare bone mineral density (BMD) of the lumbar spine and proximal femur in RA patients versus controls and evaluate the influence of disease related determinants. Twenty-seven patients with RA and twenty healthy subjects were included in this study. BMD was significantly reduced in RA patients compared with the control group. BMD was correlated with duration of disease, health assessment questionnaire scores, hand grip strength and erythrocyte sedimentation rate. These results support the hypothesis that BMD may be affected by RA related determinants.

Aneurysmatic arteriovenous fistula complicating splenic injury.

A child with a posttraumatic aneurysmatic arteriovenous (AV) fistula located in the spleen is presented. The fact that the increased use of more conservative diagnostic and therapeutic approaches in splenic injuries might lead to underestimation of some uncommon complications is discussed.

Congenital tracheoesophageal fistula without atresia: an incidental finding.

A four-year-old boy who had a long history of upper respiratory tract infections and growth retardation was admitted because of recurrent abdominal pain. During upper gastrointestinal series to search for a gastric or duodenal ulcer, the examiner noticed a minute amount of contrast medium within the trachea. Repeat esophagography on an angiographic table led to the correct diagnosis of a congenital H-type fistula. The patient did not have the classical symptoms of a history of choking and cyanosis after feeding during infancy or recurrent lower respiratory tract infections. The only finding consistent with a fistula was growth retardation, and the diagnosis was established incidentally during a work-up for abdominal pain.

Non-invasive imaging of aberrant right subclavian artery pathologies and aberrant right vertebral artery.

Here, we review the CT and MR angiography findings of aberrant right subclavian and right vertebral arteries, with emphasis on the differences between these structures. In addition, non-invasive imaging findings of aberrant right subclavian artery pathologies, including arteritis, aneurysm and dissection, are discussed.

Effects of claritromycin on inflammatory parameters and clinical conditions in children with bronchiectasis.

BACKGROUND: The effects of the macrolides cannot be ascribed to their antibacterial action alone. Their immunoregulatory and anti-inflammatory functions are significant too. They are frequently used in the treatment of diffuse panbronchiolitis and cystic fibrosis (CF). AIM: To evaluate the effects of a macrolide antibiotic [clarithromycin (CAM)] on the process of inflammation [by measuring IL-8, TNF-alpha, IL-10 levels and cell profiles in bronchoalveolar lavage (BAL) fluid], pulmonary function and sputum production in children with steady-state bronchiectasis, secondary to causes other than CF or primary immunodeficiencies. METHODS: Seventeen patients randomized to the treatment group received CAM and supportive therapies for 3 months and 17 patients in the control group were given supportive therapies only. RESULTS: Compared with the control group, the treatment group showed a significant decrease in IL-8 levels, total cell count, neutrophil ratios in BAL fluid and daily sputum production at the end of the third month. There was also a significant increase in the treatment group's BAL fluid macrophage ratios. The differences in pulmonary function test parameters were not significant. CONCLUSION: Use of CAM in children with steady-state bronchiectasis results in laboratory improvement by reducing the inflammatory processes in the lungs. No corresponding clinical improvement could be shown but although this is possible with long-term use, trial validation is necessary.

Normative measurements of orbital structures using CT.

OBJECTIVE: The purposes of this study were to establish criteria for the diameters of normal extraocular muscles, to determine the normal position of the globe as revealed by CT, and to investigate the effects of age and sex on these structures. SUBJECTS AND METHODS: Diameters of extraocular muscles, distance from the interzygomatic line to the posterior margin of the globe, width of the optic nerve-sheath complex, and length of the interzygomatic line were calculated for 200 normal orbits of 100 patients on axial and direct coronal CT images. Effects of age and sex on muscle diameters and globe position were analyzed. RESULTS: Normal ranges for the diameters (mean +/- 2SDs) of extraocular muscles were medial rectus, 3.3-5.0 mm; lateral rectus, 1.7-4.8 mm; inferior rectus, 3.2-6.5 mm; and superior group, 3.2-6.1 mm. The normal position of the globe was 9.4 mm behind the interzygomatic line (range, 5.9-12.8 mm). The mean diameters of the extraocular muscles and the length of the interzygomatic line in male patients were significantly larger than in female patients (p < .001). Statistically significant correlation was found between age and the diameters of the inferior and lateral rectus muscles (r = .32, p = .013; and r = .23, p = .048, respectively). CONCLUSION: Our results may be important in interpreting CT scans of the orbit because, to our knowledge, no reliable normative data exist regarding these orbital structures.

Inappropriate reference range for peak bone mineral density in dual-energy X-ray absorptiometry: implications for the interpretation of T-scores.

An inappropriate reference range for peak bone mineral density (BMD) may result in identification of an incorrect proportion of subjects with osteopenia and osteoporosis at dual-energy X-ray absorptiometry (DXA). In this study, we assessed the prevalence of low BMD in Turkish young adults with respect to local population reference range T-scores and the US reference range T-scores. The BMD values of lumbar spine (L1-L4) and proximal femur (femoral neck, intertrochanter, trochanter, Ward's triangle and total) were measured by DXA in 323 healthy young adults (171 women, 152 men) aged 19-25 years. The World Health Organization criteria for the diagnosis of osteopenia (-2.5 < T-score < -1) and osteoporosis (T-score < or = -2.5) were applied. In women, the means of the US reference range T-scores were significantly lower than zero at the spine and proximal femoral sites (p < 0.0001). In men, the means of the US reference range T-scores were significantly lower than zero at the spine, femoral neck, intertrochanter, total femur (p < 0.0001) and trochanter (p < 0.05), but not at Ward's triangle (p = 0.92). When the diagnoses were based on local population reference range T-scores instead of the US reference range T-scores, the prevalence of low BMD (T-score < -1) in women fell from 50.3% to 14.0% at the lumbar spine and from 60.8% to 14.6% at the femoral neck, and in men from 42.8% to 15.8% at the lumbar spine and from 30.9% to 17.1% at the femoral neck. Our data suggest that individual populations should use their own reference range T-scores to avoid misdiagnoses of osteopenia and osteoporosis by DXA.

The effect of onlay Medpor implants on mandibular growth in young rabbits: an experimental study.

Medpor implants were placed on the periosteum of the mandible in infant rabbits to study their effects on growth. Three months later radiological and histopathological studies were performed in situ and after removal of the mandible. The authors demonstrate that implants did not affect normal development of the mandible; however, there was a decrease in bone thickness and a mononuclear cell reaction was caused where the implant came in contact with the bone.

Traumatic aneurysm and arteriovenous fistula of the splenic artery.

Aneurysmal arteriovenous fistulas are rare and mostly seen in adults. A 13-year-old girl developed a subcapsular hematoma of the spleen following blunt abdominal trauma. Follow-up ultrasonography 4 months after the trauma revealed an aneurysm at the splenic hilum. Selective splenic angiography demonstrated the lesion to be an aneurysmal arteriovenous fistula. Repeat ultrasonography enabled us to be certain of the traumatic origin of the aneurysm and arteriovenous fistula which are very unusual in the pediatric age group.

CT and MR imaging of splenic leiomyoma in a child with ataxia telangiectasia.

Computed tomographic and magnetic resonance imaging findings of a splenic leiomyoma in an 8-year-old boy with ataxia telangiectasia are presented. This is the first reported case of a splenic leiomyoma in the literature.

Choledochal cysts: ultrasonographic findings and correlation with other imaging modalities.

In the past, choledochal cysts had been infrequently diagnosed prior to surgical exploration for obstructive jaundice. However, with the advance of imaging modalities, preoperative diagnosis is usually apparent. We evaluated the radiological findings of choledochal cysts in 14 patients in whom ultrasonography (US) or computed tomography (CT) were mainly used for diagnosis. In addition, oral cholecystography, intravenous (i.v.) cholangiography, scintigraphy, and percutaneous transhepatic cholangiography were performed in some of them. The diagnosis was confirmed surgically in all patients. Ultrasonographic examinations were diagnostic in 13 of 14 patients. Preoperative specific diagnosis of choledochal cyst was possible with the demonstration of direct entrance of the extrahepatic bile ducts into the cyst in most cases. When US fails to show relation of cystic mass with biliary system, other imaging modalities can be used to clarify the findings.