Biomedical subjects
Publications and source records attributed to I Yaghmai.
We report the case of a 23-year-old man with a giant-cell tumor of the sphenoid bone. The radiologic manifestations consisted of an expansile mass arising from the sphenoid bone with extension into the cranial cavity and the nasopharynx. The findings with computed tomography and magnetic resonance imaging best reflected respectively the osseous and soft-tissue extent of the disease.
In this report, the clinical and unusual sonographic manifestations of a perforated appendiceal abscess is described.
Imaging with Ga-67 and Tc-99m sulfur colloid was performed in ten patients with amebic liver abscesses. The most common imaging pattern appeared to be with the sharp identification of a "rim" sign on delayed Ga-67 imaging, from 48-72 hours.
Wilms tumor (nephroblastoma), a primary renal neoplasm containing primitive blastema and embryonic glomerulotubular structures, is seen rarely in adults. To identify clinical and radiologic criteria for preoperative diagnosis of adult Wilms tumor, we studied 29 cases reported in the literature from 1975 to 1987 (all patients were 15 years old or older) and four newly diagnosed cases. The mean age of patients was 30 years; 80% were less than 35 years old. Each patient presented with a large, rapidly growing, abdominal mass (average duration of symptoms, less than 2 months), had no constitutional symptoms (e.g., weight loss, fever), and otherwise were healthy (80%). Twenty-six patients had IV or retrograde pyelograms. Twenty-three showed a nonspecific mass effect. In seven (78%) of nine patients, abdominal CT scans showed a large, inhomogeneous mass with large areas of low density and increased enhancement of the compressed remaining normal renal parenchyma, which resembled a pseudocapsule. In five (63%) of eight patients, sonograms showed a complex mass with large cystic components. In 18 (82%) of 22 patients, arteriograms showed a hypovascular mass with fine wavy or zigzag (creeping-vine) neovascularity. We conclude that a rapidly growing renal mass in a young patient (less than 35 years old) that is shown to be complex and cystic by CT or sonography and that is hypovascular with fine, wavy neovascularity on arteriography is suggestive of adult Wilms tumor (75-80%). An awareness of this constellation of findings may be helpful in diagnosing this unusual tumor before surgery.
Arterial occlusion or stenosis due to blunt trauma is rare. Only isolated examples have been reported. The majority result from sport-related trauma or are iatrogenic in nature. The clinical importance of blunt trauma is that it can create delayed vascular stenosis but few symptoms at the time of the incident. This is even more important in children and adolescents as any delay in diagnosis can lead to severe sequelae such as limb shortening and other growth disturbances. We here report a patient with common femoral artery stenosis after a bicycle injury in whom, apparently uniquely, delayed symptoms developed after eight months.
Immersion hand radiographs were performed on 25 patients with various clinical presentations and compared to plain radiographic studies of the hands. The immersion technique is superior in outlining the skin, subcutaneous fat layers, and fat layers between muscle planes. More important, this technique highlights the tendons and soft tissue components of the joint, which are hardly seen on standard hand radiographs. Immersion studies are therefore useful, both in the early diagnosis of erosive arthritis and in the follow-up of the course of the disease. They are recommended as an adjunct to conventional hand radiography in musculoskeletal disorders with soft tissue involvement.
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The author illustrates the spinal changes of neurofibromatosis, distinguishing those that are primary and due to mesodermal dysplasia from those that are secondary to the effects of nerve sheath tumors.
Congenital coalition between the lunate and triquetrum is a common anomaly that may have several different radiographic appearances. We report seven patients with partial coalition and rounded radiolucencies in the subarticular region of both bones. The most likely cause of this combination of findings is abnormal differentiation of the joint space and remnants of misplaced synovial tissue that formed during the disorganized process of joint development.
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Large bowel involvement is a rare manifestation of plasma cell tumors, especially in association with multiple myeloma. A review of the world literature reveals only 21 reported cases, the majority of which are classified as the solitary form of the disease. A case of multiple myeloma with rectosigmoid involvement is herein presented, and the radiological findings of reported cases are summarized.
Hemangiopericytomas are rare vascular tumors and may originate wherever there are capillaries. So far, the author has found 341 cases of soft-tissue and 10 cases of osseous hemangiopericytomas. Only a few of these vascular tumors have been investigated angiographically. A review of 20 previously reported cases and 5 cases of his own, including a case of periosteal hemangiopericytoma, reveals that these are the only vascular tumors which present some characteristic angiographic features, regardless of their location or site of origin. Typically, a few feeder arteries enter the mass with radially arranged branching around and inside the tumor and a longstanding, well-demarcated tumor stain is seen.
Three cases of xanthomata associated with Type II and III hyperlipidemia are presented. A review of the radiologic manifestations of these and previously reported cases revealed that tendon xanthomata are more frequent than osseous ones. Osseous involvement is reported only in Type III hyperlipidemia and should be considered in the differential diagnosis of soft-tissue masses and bone marrow replacement disorders.
Neurofibromatosis is seen in association with elephantiasis neuromatosa and overgrowth of abnormal bones, but rarely with subperiosteal hemorrhage. This is a secondary finding after severe or minor trauma to the periosteum, which is abnormally loose from mesodermal dysplasia. The clinical, plain radiographic, and angiographic findings of 2 cases of massive subperiosteal hemorrhage are presented, and the literature reviewed.
Angiography was done in 38 cases of pathologically-confirmed fibrous-tissue tumor. All benign fibromatous tumors and one case of desmoid fibroma were angiographically normal. A great spectrum of angioarchitecture exists in fibrosarcomas, whether they are of bone or soft-tissue origin. Heterogeneous vascularity was seen in 55% of these cases, and was related to the cell composition of the tumor. There exists a close relationship between the number of vessels in a tumor and its degree of clinical and histopathological malignancy. The most vascular part of a tumor is the least differentiated and should be used for biopsies. Angiography can be used for the grading of fibrosarcomas, and probably for assessing clinical prognosis.
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Myositis ossificans circumscripta is the heterotopic formation of nonneoplastic bone and cartilage in soft tissue. These benign lesions can mimic more serious lesions, both radiographically and histopathologically. Recognition of the benign character of myositis ossificans is imperative in order to avoid mutilating surgical procedures. Five cases are presented with emphasis on angiographic signs which differentiate this lesion from histopathologically similar lesions. Three of these are illustrated, along with an example of an osteosarcoma for comparison. The angiographic manifestations of myositis ossificans differ in the various phases of the disease. In the active stage, the lesions have numerous fine vessels causing a diffus stain. Malignant tumors such as osteosarcoma, extraosseous osteosarcoma, and fibrosarcoma, which are included in the differential diagnosis, often present clearly defined pathologic vessels as well as arteriovenous shunts, venous lakes, amputated vessels, invasion of large arteries and veins, and large abnormal draining veins. In the healing stage, the lesions are usually avascular, and there is no difficulty in differentiating this condition from malignant bone lesions with the sole exception of well differentiated parosteal osteosarcomas. In these cases, the plain radiographic features are most important in arriving at the correct diagnosis.