Biomedical subjects
Publications and source records attributed to M Korobkin.
CT can accurately distinguish between ascites and pleural fluid if the four signs described here are all considered in each case. Used individually these signs may be indeterminate or misleading.
Myoclonic encephalopathy is a unique clinical syndrome of infants and children that is associated with a neurogenic tumor of ganglion-cell origin in approximately half of cases. A review of the literature as well as our personal experience with two recent infants suggests an imaging approach that includes chest radiography and abdominal computed tomography (CT). Ultrasonography, neck CT, and chest CT myelography may be required in selected patients. An expedient clinical and imaging evaluation of infants and children with opsomyoclonus is important to detect those patients with neurogenic tumors.
Little is known about the significance of one or more septations within a renal cyst. The records of 26 patients whose sonographic and/or CT studies showed evidence of internal septations were reviewed to assess their significance. Thirteen patients underwent surgical exploration; in 10, the final diagnoses were benign lesions, while in three there were elements of renal cell carcinoma. Criteria are suggested to distinguish benign from malignant lesions. One or more thin septations alone is probably of no clinical significance, but if there are solid elements demonstrated, further evaluation is mandatory.
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Four cases of pneumatosis intestinalis detected by computed tomography (CT) are described. Plain abdominal films obtained on the same day as CT failed to show pneumatosis in three of the four cases. The CT appearances characteristic of pneumatosis intestinalis are cystic, linear, or curvilinear gas collections in the periphery of distended, partly fluid-filled loops of bowel. Two of the four cases had underlying bowel infarction. Evidence of pneumatosis should be carefully looked for in patients with acute abdominal pain referred for CT examination. Computed tomography may be a useful modality for the early diagnosis of bowel ischemia when plain abdominal films are noncontributory.
Paramediastinal masses adjacent to the aorta require a diagnostic evaluation to differentiate between tumor and aneurysm. It has been suggested that neoplasm may enhance sufficiently to be confused with a vascular structure or that a clot filled aneurysm may simulate a neoplasm by not filling with contrast medium. Five patients, two with thoracic aneurysms, two with malignancy, and one with a malignancy and an aortic dissection, are presented in whom bolus injection computed tomography (CT) was able to distinguish between aneurysm and mass. The CT examination also accurately visualized the point of communication of the aneurysm with the aorta, defined the relationship of the aneurysm to vital mediastinal structures for planning surgical resection, and helped plan the approach for percutaneous transthoracic needle aspiration when tumor was suspected. Bolus injection CT represents a rational alternative to aortography for mediastinal paraaortic masses.
Eleven patients are described whose computed tomography (CT) examinations showed homogeneous, high density (62-76 Hounsfield units) renal masses. In two patients a hemorrhagic benign cyst was found at surgery. In the remaining nine patients the constellation of CT and clinical findings supported the benign nature of this lesion.
Actinomycosis is an unusual bacterial infection that most often affects the head and neck region. Abscesses occasionally associated with a draining sinus may result secondary to extensive tissue destruction. We report the CT appearance in a case of actinomycosis of the neck. A thick walled enhancing mass with a low attenuation center was identified between the sternocleidomastoid muscle and the strap muscles of the neck. Enhancement of the adjacent muscles was present. Surgery confirmed an abscess with inflammation of the adjacent muscle. Histologic examination of the specimen showed the presence of multiple yellow (sulfur) granules containing Actinomyces. Computed tomography correctly determined the extent of the mass and lack of involvement of the deep structures of the neck.
Sharply demarcated homogeneously hyperdense renal lesions have been found to be benign renal cysts, with hemorrhage or a high protein content the most common etiology of the high density. A similar hyperdense renal lesion is presented that was found to be a renal adenocarcinoma. This lesion showed mild contrast enhancement on CT and was found by ultrasound to be a solid mass. The malignant nature of this lesion suggests that further evaluation, such as ultrasound, fine needle aspiration biopsy, or surgery may be needed.
Thirteen patients with benign angiomatous lesions of the extremities were evaluated by CT. The relationship of the lesion to specific muscle groups and fascial planes was defined better by CT than on plain radiography or angiography. Computed tomography without contrast enhancement demonstrated well circumscribed masses of lower attenuation value than the surrounding muscle. Eight of the 11 patients who received intravenous injection of contrast material showed characteristic punctate or curvilinear structures within the mass, which had attenuation values similar to normal blood vessels. The characteristic CT features of benign angiomatous lesions of the extremities are presented.
Twenty consecutive patients underwent computed tomography (CT) prior to total laryngectomy in order to assess the accuracy of CT scanning in the evaluation of carcinoma of the larynx and hypopharynx. CT scans were prospectively interpreted and the extent of tumor was recorded graphically at five major levels of the larynx. The extent of tumor was similarly evaluated on whole-mount histologic sections of the laryngeal specimens prepared in the horizontal plane similar to the CT scans. The results were compared to assess the ability of CT to identify tumor extent accurately. Despite good correlation of gross tumor extent between histologic specimens and CT scanning, specific pitfalls in CT diagnosis were identified. Overestimation of tumor extent was caused by edematous changes in six patients and tumor-associated inflammatory changes in three patients. In seven patients, mass effect from adjacent bulky tumor significantly distorted normal structures, mimicking tumor involvement. Small foci of mucosal tumor in three patients and microscopic cartilage involvement in two patients were not identified on CT scanning, causing underestimation of tumor extent.
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Traditionally, thyroid imaging has been performed primarily using radionuclide scanning. High-resolution computed tomography (CT) was performed in 18 patients to evaluate the CT appearance of various thyroid abnormalities including diffuse toxic goiter, multinodular goiter, Hashimoto thyroiditis, thyroid adenoma, and malignant thyroid tumors. CT images of the thyroid were correlated with radionuclide scanning, surgical findings, and clinical and laboratory results. CT provided a complementary method for evaluation of the thyroid by defining the morphology of the thyroid gland and more precisely defining the anatomic extent of thyroid abnormalities in relation to the normal structures of the neck and mediastinum.
Fifty computed tomographic (CT) scans in 33 patients with 37 separate episodes of hepatic abscess were reviewed retrospectively. Abnormalities were detected in all but one case (97% sensitivity). However, a characteristic CT appearance of hepatic abscess was not evident. Most intrahepatic foci were solitary, but multiple abscesses were present in 34% of cases. The CT appearance of the lesions varied from well defined, rounded cavities with contents near water density, resembling poorly defined hepatic cysts, to higher-density foci indistinguishable from hepatic neoplasms. In only 19% was gas present within the abscess. Rim enhancement was seen in only 6%. This study suggests that CT is a sensitive test for detecting hepatic abscess but is often nonspecific.
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Superior mesenteric vein thrombosis was identified on computed tomographic scans in six patients. In each case, contrast-enhanced scans showed a high-density superior mesenteric vein wall surrounding a central filing defect. Four of the six patients had isolated superior mesenteric vein thrombosis. A fifth patient had associated portal vein and splenic vein thrombosis, and the sixth patient had associated portal vein and inferior vena cava thrombosis. The diagnosis of superior mesenteric vein thrombosis was confirmed by angiography in two patients and by surgery in a third. One of the six patients had acute ischemic bowel disease. The other five patients did not have acute ischemic bowel symptoms associated with their venous occlusion. This study defines the computed tomographic appearance of mesenteric vein thrombosis. A dense venous wall surrounding a central lucency representing blood clot was present in all six cases.
Abdominal computed tomography was performed in six patients with suspected ruptured abdominal aortic aneurysm but in whom an alternate clinical diagnosis was seriously considered. In each patient, a large aortic aneurysm was demonstrated in association with a retroperitoneal accumulation of high-density blood. The retroperitoneal blood was primarily confined to the extracapsular perinephric space. In four of the six patients, a focal area of the aortic wall was indistinct on the side of the retroperitoneal hemorrhage at the presumed site of rupture. Five of the six patients underwent emergency surgery, which confirmed the site of aneurysm, presence of rupture, and the location of fresh retroperitoneal blood.
Thirty patients were studied to evaluate the CT appearance of the normal mesentery and its vasculature. Mesenteric vessels were identified by determining their relations to segments of the small bowel and colon in the 30 patients. Jejunal and ileal branches supplying small bowel were identified in all patients. The ileocolic and right colic branches of the ascending colon were identified in 27 and 26 patients, respectively; middle colic vessels were identified in 29 patients. Left colic branches were identified in only 14 patients; sigmoid branches were identified in 23 patients. The vessels showed a characteristic wavy appearance as they coursed through mesenteric fat. The average attenuation of the mesenteric fat was -117.4 +/- 7.9 H. Normal lymph nodes were not routinely identified within the mesentery. Various pathologic processes altered the normal appearance of the components of the mesentery.