[Tumor hemorrhage with fluid accumulation in a pituitary adenoma].
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Biomedical subjects
Publications and source records attributed to M Galanski.
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In 72 patients with primary aldosteronism who were classified on the basis of adrenal pathology after adrenalectomy, analysis of routine clinical and laboratory data, of supine and upright plasma aldosterone, and of plasma renin activity were of limited value in differentiating patients with aldosterone-producing adenoma(s) (APA, n = 59) from those with idiopathic adrenal hyperplasia (IAH, n = 13). Normokalemic aldosteronism occurred in 6 patients (3 APA, 3 IAH). A correct classification of the adrenal lesion(s) was obtained in 80% of the patients by computed tomography and only in 69% by adrenal scintiscan. In addition, adrenal scintiscan was hampered by a relatively high rate of incorrect results independent of whether dexamethasone was used or not. Small adenomas (less than 1 cm) and more often adrenal hyperplasia may escape visualization by computed tomography.
Localization procedures are required in catecholamine-producing tumors after clinical and biochemical confirmation. Computed tomography, ultrasound and/or 131I-metaiodobenzylguanidine (131I-MIBG) scintigraphy was performed in patients with pheochromocytoma, neuroblastoma and metastases of carcinoid tumors. Whereas computed tomography and ultrasound reflect morphological abnormalities, adrenomedullary scintigraphy depends on hormonal activity and other factors. 131I-MIBG scintigraphy has the advantage of detecting extraadrenal, multilocular and malignant pheochromocytomas. Especially small lesions and tumor tissue in bone marrow in children with neuroblastoma can be visualized more easily.
Approximately 10% of patients with malignant lymphoma will show neurological symptoms at some time during the course of their illness. In non-Hodgkin lymphoma, CNS involvement is more frequent than in Hodgkin's disease. Diffuse histiocytic and poorly differentiated lymphomas, bone marrow involvement, advanced tumor stage and hematogenous spread are particular risk factors. Invasion of the spinal canal is the most common type of CNS involvement. Intracranial lesions, which are comparatively rare, may present as intracerebral metastases, epi- or subdural masses or focal or diffuse leptomeningeal disease. Lymphomatous leptomeningitis usually cannot be demonstrated by CT. On the other hand, dural and cerebral parenchymal lesions are sometimes highly characteristic of lymphoma as a result of their features and location.
Cochleomeatal scintigraphy (CMS) and CT or air CT cisternography are today the methods of choice for the detection or exclusion of a neuro-otologically suspect acoustic neuroma. Whereas CT as a morphological method of investigation provides better preoperative information, CMS is likely to be superior to CT as a functional investigation technique in relapse diagnosis.
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The median section of the base of the skull offers many diagnostic problems in radiology. Findings of the plain radiographs and tomographs, of computed tomography and angiography are demonstrated in cases of space-occupying growths of the sella region, lesions of the fossa temporalis and of the region of the pyramid of the medulla oblongata, from a differential diagnostic viewpoint. Sequelae of traumas are discussed separately.
Since the cranial nerves and the base of the skull are spatially close to each other, certain complexes of symptoms and signs give a very accurate indication of the possible location of the lesion. Basing on such neurologic-topical structuralisation, lesions of the cerebrellopontine angle, the foramen jugulare, the clivus and of the foramen magnum are discussed systematically. The various techniques of radiological imaging or examination are assessed in accordance with their diagnostic ranking, and characteristic constellations of findings are described.
31 patients with craniocerebral gunshot wounds were examined in the acute phase and 14 out of 22 survivors followed up for a period of up to 3 years. The clinical and CT findings as well as treatment measures are explained. The value of CT is convincingly demonstrated with this type of injury, as with others, but its prognostic value including prediction of follow-up results remains limited.
The basic abnormality of neurofibromatosis consists not only of a maldevelopment of the neuroectoderm but also of the mesoderm. Therefore any organ or system of the body may be involved. Following a short clinical review of the central (acoustic) and peripheral type the well known and the more unusual radiographic findings are summarized. They include cranial and intracranial manifestations (orbitosphenoid dysplasia, bone defects of the skull, acoustic neuroma, glioma of the optic nerve and chiasm, meningioma), spinal lesions (scoliosis, vertebral scalloping, meningocele, neuroma, ependymoma), skeletal abnormalities (pseudarthrosis), cardiovascular manifestations, pulmonary fibrosis, tumors of the gastrointestinal and urinary tract and different endocrinopathies. Some of the roentgenologic symptoms are very characteristic and allow definitive diagnosis.
Glomus-jugulare tumours (chemodectomas, non-chromaffin paragangliomas) are semi-malignant tumours arising from the glomus structures of the jugular bulb. They are soft tissue tumours which usually expand the jugular foramen and destroy its bony margins. Conventional methods of examination are therefore very effective. However, they only demonstrate the bone destruction and are therefore an indirect method for showing the tumour. The actual size and extent of the tumour, which are important for the surgeon or radiotherapist, cannot be demonstrated by simple x-rays. Computer tomography is very effective in the diagnosis of soft tissue lesions in the skull. CT is therefore of great importance in the diagnosis of glomus-jugulare tumours.
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Lumbar spinal stenosis is a condition of polyetiologic origin. It is defined as narrowing of the spinal canal, the nerve root canals or the intervertebral canals. For clinical, diagnostic and therapeutic reasons it may be divided into two main types: central and lateral stenosis with obstruction of the lateral recesses. Plain radiographs may be suggestive in central or generalized narrowing only. Diagnosis is confirmed by additional investigations, i.e. myelography and CT. Lumbar myelography allows definitive diagnosis of central spinal stenosis. However, validity regarding visualization of the lateral recesses is limited and a decision on the nature of the obstruction, bony or soft tissue, cannot be made. In contrast, CT does support information on the bony outline of the lateral recess as related to the facet and soft tissue structures in particular. Treatment of choice should be conservative-supportive if clinical symptoms permit. Surgery is indicated when there is intolerable pain, progressive muscle weakness or sphincter dysfunction. Surgery seeks to attain complete decompression of neural elements, if instability is present or imminent spinal fusion has to be considered. Shape, size and configuration of the spinal canal have to be determined prior to any surgical approach. CT fulfills these requirements most admirably.
In 41 patients with adrenal diseases and hormonal excess (pheochromocytoma n = 9, Cushing's syndrome n = 6, primary aldosteronism n = 26) computer tomography was performed for localization and classification of the adrenal lesion(s). In all patients diagnosis was confirmed by surgery. In all patients with pheochromocytoma a tumor was detected. 8 patients had unilateral adrenal pheochromocytoma, whereas in one female patient the pheochromocytoma was multilocular. 4 of the 6 patients with hypothalamic-pituitary Cushing's syndrome had enlargement of the adrenals. In the 26 patients with primary aldosteronism, computed tomography showed normal adrenal glands in 2 of the 17 patients with unilateral adenoma (with a diameter of 8 mm in both of the 2 patients) and in 6 of the 9 patients with bilateral hyperplasia. In the remaining patients adenoma or hyperplasia was detected. The results document that in patients with pheochromocytoma, with Cushing's syndrome, and in those with primary aldosteronism, computed tomography is a simple and valid method for localization and classification of the adrenal lesion(s). In primary aldosteronism with a normal adrenal computed tomography, however, differentiation between a small unilateral adrenal adenoma and bilateral adrenal hyperplasia remains problematic.
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The radiograph is usually the first step in diagnosis of tumorous bone lesions. Although definitive diagnosis depends on biopsy in many instances the radiograph allows the most essential decision on malignancy or benignity. This radiological grading of neoplastic bone disease is based on various criteria in particular the pattern of bone destruction and behaviour of the cortex. 3 main types of bone destruction predicting tumour behaviour can be differentiated: 1. the geographic well-defined destruction which is characteristic of static or slowly growing lesions; 2. moth-eaten pattern with scattered and confluent holes reflecting a highly aggressive lesion; 3. most aggressive permeative pattern characterized by multiple tiny holes. The cortex also reflects the response of normal bone against destruction. Depending on the activity of the process, the cortex will either remain intact, or will be expanded, or is even penetrated. The characteristic features of the different destruction patterns are illustrated by radiographs and corresponding pathologico-anatomical slices.
For diagnosis of adenomas in primary aldosteronism CT proved to be helpful. Although microadenomas have to be ruled out by selective venous sampling from both adrenal glands adenomas down to 8 mm in diameter can be visualized. Scintigraphy does not always permit reliable differentiation of unilateral adenoma from bilateral hyperplasia. -- in endogenous Cushing's syndrome adrenal carcinomas are underlying etiologically in about 10% of the cases. Since carcinomas are detected easily by CT it should be performed in the first place. Whereas adenomas and hyperplasia are easily diagnosed by scintigraphy carcinomas may escape scintigraphy. -- Pheochromocytomas, if situated in the vicinity of the kidneys, can be localized safely by CT. Contrary to adenomas, carcinoma and pheochromocytomas may be detected by CT without difficulty because of their size.