Biomedical subjects
Publications and source records attributed to C F Lanzieri.
Fat within meningiomas is histologically not uncommon. Focal areas of low density on computed tomography scans within meningiomas have been demonstrated and are most often intratumoral cysts. The case presented demonstrates a focal area of low density within a meningioma that is proved histologically to be fat.
A rare case of a carotid body tumor that completely occluded the internal carotid artery is presented. To our knowledge this is only the second such case documented by angiography. In the present computed tomography era, the role of vascular imaging in these tumors is discussed and the varied clinical presentations of these neoplasms are reviewed. The confusion between the locally malignant behavior of some of these lesions and the accepted definition of a malignant carotid body tumor is discussed.
Twenty-eight patients had combined conventional drip infusion CT scans. The information about the anatomic location of the lesion, its configuration, its cross-sectional appearance, its vascularity (as determined by dynamic signature curves), and its clinical presentation were considered as a single overall unit. This diagnostic approach allowed a diagnosis to be made on virtually all of these enhancing lesions without resorting to either a digital venous imaging study or angiographic procedure. In 17 of these cases, such an invasive second procedure was performed either to confirm the CT impression as part of this study or as part of a therapeutic embolization procedure.
Combined conventional drip infusion-dynamic CT scanning was performed on 28 patients with clinically discovered neck or parapharyngeal space masses. Seventeen of these also had digital venous study or angiographic studies either to confirm the CT diagnosis or as part of an embolization procedure. The studies indicate that the initial portion of the dynamic scan curve can be characteristically classified as either an arterial, venous, or hypovascular signature curve. The current ideas of how these curves are generated, the specific appearance of these signature curves, and the types of pathologic conditions that correlate with each curve are discussed.
We report on the appearance of parathyroid, thyroid, and cervical thymic cysts on computed tomography (CT) scans. The differential diagnostic considerations include thyroglossal and branchial cleft cysts, cystic hygromas, primary and metastatic tumors, dermoids, teratomas, choristomas, tracheoesophageal and cervical bronchogenic cysts, as well as cystic neuromas, abscesses, and lipomas. Most cannot be differentiated using CT alone and require clinical observations, laboratory testing, and surgical and histologic findings for definitive diagnosis. Our experience with these rare lesions is reported, and the differential diagnoses are discussed.
Cholangiocarcinoma is an uncommon tumor that presents with hepatobiliary dysfunction. We report a patient with a chronic progressive organic mental syndrome, diffuse weakness, and gait disturbance who was discovered to have obstructive hydrocephalus due to a neoplasm. Pathologic examination revealed primary cholangiocarcinoma metastatic to the cerebellum. This tumor has not been previously reported to present with neurologic involvement.
Apparent intrathird ventricular masses were the only CT manifestations in four patients with central nervous system lymphoma. Involvement of the third ventricular region by lymphoma may not be as unusual as previously described in the literature. When lymphoma involves the third ventricle, its CT appearance may mimic other more common third ventricular masses.
Orbital decompression is an excellent surgical procedure to relieve acute increased intraorbital pressure. The most commonly used approach is via a Caldwell-Luc incision. Far less often a lateral orbitotomy is used. The postoperative CT findings of these procedures are described. It is important to recognize these changes so that they are not mistaken for primary sinus and orbital lesions.
Two patients with rare isolated posterior antral compartments are presented. In both cases, the radiologist directed the surgeon to these clinically hidden recesses. The radiographic appearance included a walled-off compartment filled with material of soft-tissue density; clinical importance is discussed.
Surgical and CT examinations of 104 patients, each of whom presented with a parapharyngeal space mass, has resulted in the development of an updated CT protocol designed to provide a preoperative diagnosis. When dynamic scanning is used, diagnostic angiography or digital venous imaging (DVI) can be avoided in almost all of these cases. A specific preoperative diagnosis can be made in 88% of the patients and a limited differential diagnosis, which includes the final diagnosis, can be made in virtually all cases. The protocol and the problems encountered in differential diagnosis are presented. Evidence to suggest that minor salivary gland benign mixed tumors may arise in salivary rest tissue, rather than pharyngeal mucosal glands, is also presented.
The sacral plexus forms the sciatic nerve, which leaves the pelvis through the greater sciatic foramen. The anatomic boundaries of the greater sciatic foramen and the relation of the sacral plexus and sciatic nerve to the structures within are identified and described on axial computed tomography (CT). The piriform muscle, which passes through the center of the greater sciatic foramen, is a recognizable landmark that is extremely helpful in locating the sacral plexus and sciatic nerve on CT. The pelvic CT images of 25 patients studied for unrelated reasons and two patients studied for complaints related to the greater sciatic foramen were reviewed. CT was very useful in demonstrating the anatomy of this region and for the investigation of sciatic pain due to lesions outside the neural canal.
The computed tomographic (CT) features of two cases of bilateral lacrimal gland sarcoidosis are presented. The incidence of this type of bilateral orbital involvement may be greater than the previously reported statistics, which were based purely on clinical examination. The CT findings and the differential diagnosis are discussed.
The magnetic resonance images of seven patients with biopsy-proven epidermoids were evaluated. The epidermoids were hypointense on T1-weighted images. Intermediate density images revealed the tumors to be heterogeneous in signal intensity consisting of areas of hypo- and isointensity. Signal intensity on T2-weighted images was hyperintense and inhomogeneous in all but one case. CT performed in five patients demonstrated the tumors to be well-defined hypodense lesions without contrast enhancement.
Two cases of thyroid-related papillary adenocarcinoma are presented. Both patients had clinically benign neck masses that were clearly separated from the thyroid gland. In both cases the thyroid gland was normal to clinical evaluation, CT, and 99mTc scanning. One patient had an occult thyroid carcinoma with a solitary metastatic node in the lateral neck, and the other patient had a rare carcinoma in a suprahyoid thyroglossal duct cyst that had been previously misdiagnosed as a cystic hygroma.
Phlebectasia of the internal jugular vein (IJV) is a rare entity with only 25 cases having been reported. Clinically this condition presents with enlargement with a Valsalva maneuver and decrease at rest. Venography, anteriography, and ultrasound have previously been used to diagnose this unusual cause of neck mass. We present a case in which CT confirmed the clinical diagnosis and in which there was an incomplete ipsilateral duplication of the IJV. This is only the second case reported of IJV phlebectasia and duplication.
A case of so-called spontaneous epidural hematoma is presented. A new constellation of myelographic and CT myelographic signs are described that may assist in localizing a mass within the spinal epidural space.
Although intraventricular craniopharyngiomas are usually located within the suprasellar cistern, they may arise from the floor of the third ventricle or lamina terminalis. Four cases of intraventricular craniopharyngioma are presented in which the CT findings included thickening or separation of the leaves of the septum pellucidum. The importance of this CT finding and its possible etiologies are discussed.
Mucoepidermoid carcinomas of minor salivary gland origin rarely arise in the nasal cavity. A patient with such a tumor in association with bilateral sphenoid sinus mucoceles is presented. This diagnosis was established preoperatively by CT and allowed an attempt at curative surgery to be made. The CT and pathological findings are discussed.