Biomedical subjects

P M Som

Publications and source records attributed to P M Som.

At least 19 recordsLinked to original sources

PubMed2006

Bisphosphonate-associated mandibular osteonecrosis.

A 66-year-old man with multiple myeloma treated with zoledronic acid, melphalan, and prednisone after a tooth extraction developed severe osteonecrosis of the mandible that was nonresponsive to antibiotic therapy. A CT scan showed innumerable fragmented sequestra in the mandible and some adjacent soft tissue fullness around the mandible. The association between the use of bisphosphonates and osteonecrosis of the jaw has been described only recently.

Aged↗

PubMed2006

Palatal enlargement in chronic lymphocytic leukemia.

Palatal involvement in chronic lymphocytic leukemia (CLL) is rare and has only been reported 3 previous times in the non-radiology literature. To our knowledge this is the first imaging description of this entity. Based on our experience, when smoothly lobulated, homogeneous masses are identified on the oral surface of the hard palate, the diagnosis of CLL should be considered.

Diagnosis, Differential↗

PubMed2003

Distension technique to improve computed tomographic evaluation of oral cavity lesions.

BACKGROUND: The apposing mucosa of the oral cavity makes the computed tomographic identification of a clinically obvious mass difficult. Contrast distension techniques have been used in radiology to evaluate for presence of a "hidden" mass. OBJECTIVE: To illustrate the utility of distending the oral cavity with air, water, or contrast to display otherwise obscure oral cavity lesions. PATIENTS AND METHODS: In 3 normal subjects and 5 patients with biopsy-proved oral cavity lesions, serial contiguous 3-mm axial and coronal computed tomographic scans were obtained before and after distension of the oral cavity using intraoral air or water. Air distension was achieved by having the subjects perform a modified Valsalva maneuver during the scan acquisitions. Fluid distension was obtained using approximately 40 mL of water. RESULTS: In each case, the contrast successfully distended the oral cavity, separating the mucosal surfaces. Gingivobuccal lesions that were obscured by apposition of the lips and cheeks to the gums and teeth, or by apposition of the tongue to the inner margins of the gums and teeth, were clearly demonstrated. Lesions involving or extending into the retromolar trigone were also well demonstrated using this distension technique. CONCLUSIONS: Computed tomographic display of the anatomy and pathology of the oral cavity can be improved simply by distending the oral cavity using air or water as a contrast medium. This technique successfully shows lesions that are obscured by the apposing surfaces of the vestibule and the oral cavity proper, improving computed tomographic diagnosis.

Air↗

PubMed2001

Intraosseous hemangioma of the zygoma: CT and MR findings.

Intraosseous hemangiomas are uncommon, constituting less than 1% of all osseous tumors. The most frequent sites are the calvaria and the vertebral column. Involvement of the facial bones is rare, and occurs most commonly in the maxilla, mandible, and nasal bones. Only 20 cases of zygomatic involvement have been reported in the English-language literature. We report a case of an intraosseous hemangioma of the zygoma documented by CT and MR studies.

Adult↗

PubMed2000

The difficulties of diagnosing myositis ossificans circumscripta in the paraspinal muscles of a human immunodeficiency virus-positive man: magnetic resonance imaging and temporal computed tomographic findings.

Myositis ossificans circumscripta (MOC) is an uncommon disease that has been reported to develop after trauma, burns, and infections, as well as in cases in which the pathogenesis is unknown. Although most cases of MOC develop below the clavicles, it has been reported in the head and neck area, where it primarily involves the muscles of mastication. To our knowledge, there have been only 4 previous reports of MOC affecting the paraspinal muscles. We report the fifth such case, which developed in a human immunodeficiency virus-positive patient, and describe the longitudinal imaging changes of MOC.

Adult↗

PubMed2000

Lymph node pathology. Benign proliferative, lymphoma, and metastatic disease.

The evaluation of cervical lymph nodes is one of the main indications for performing CT and MR imaging of the neck. Imaging may be done for evaluation of an unknown neck mass, but more commonly the neck is imaged to evaluate potential metastasis from a known mucosal malignancy. CT and MR imaging characteristics of both malignant and nonmalignant nodal diseases are reviewed and the differential diagnosis of nodal pathologies for specific imaging findings are discussed. A recently proposed imaging-based nodal classification for metastatic nodal diseases from head and neck cancer is also described.

Calcinosis↗

PubMed2000

Imaging-based nodal classification for evaluation of neck metastatic adenopathy.

OBJECTIVE: This study was undertaken to create an imaging-based classification for the lymph nodes of the neck that will be readily accepted by clinicians, result in consistent nodal classification, and be easily used by radiologists. SUBJECTS AND METHODS: Over an 18-month period, the necks of 50 patients with cervical lymphadenopathy were scanned with CT, MR imaging, or both. Imaging anatomic landmarks were sought that would create a nodal classification of these necks similar to the clinically based nodal classifications of the American Joint Committee on Cancer and the American Academy of Otolaryngology-Head and Neck Surgery. Each nodal level was defined to ensure consistent nodal classification and eliminate areas of confusion existing in the clinically based classifications. RESULTS: Necks were classified using the imaging-based classification and then compared with the classification of the same necks using the most common clinically based classifications. The imaging-based nodal classifications of the superficial nodes were the same as the clinically based classifications; however, the deep nodes of eight patients were found only by imaging. The anatomic precision and the level definition afforded by sectional imaging allowed the radiologists to use the imaging-based classification in a consistent manner. CONCLUSION: This imaging-based classification has been endorsed by clinicians who specialize in head and neck cancer. The boundaries of the nodal levels were easily discerned by radiologists and yielded consistent nodal classifications. The reproducibility of this classification will allow it to become an essential component of future classifications of metastatic neck disease.

Adult↗

PubMed2000

Imaging of the osseous, membranous, and perilymphatic labyrinths.

The inner ear is located within the petrous portion of the temporal bone and consists of the membranous, perilymphatic, and the outer osseous labyrinths. Together, these structures form the end organs for mediating hearing and balance. This article provides a detailed review of the neonatal anatomy and development of these structures, knowledge of which derives in great part from advances in CT and sophisticated MR imaging. Current research should soon enable clinicians to identify a wide variety of subtle lesions of the inner ear that heretofore have been inaccessible to imaging diagnosis.

Cochlea↗

PubMed1999

Isolated primary unilateral stenosis of the internal auditory canal.

Congenital primary stenosis of the internal auditory canal (IAC) may exist in isolation or along with a number of other osseous anomalies of the temporal bone. Most of the literature on IAC stenosis is concerned with its effect on the outcome of cochlear implantation (i.e. patients with profound bilateral hearing loss). In addition, some degree of canal asymmetry has been noted in patients with normal hearing, questioning the causal relationship of this finding to deafness. We describe two children with computed tomography (CT) documented severe primary unilateral narrowing of the IAC and an associated ipsilateral sensorineural hearing loss. Typical radiographic findings are described, and the relevant developmental pathology is discussed. The ipsilateral association of stenosis and hearing loss strengthens the link between narrowing of the IAC and deafness.

Adolescent↗

PubMed1999

Recurrence of a deep neck infection: a clinical indication of an underlying congenital lesion.

OBJECTIVE: To discuss the computed tomographic (CT) and clinical findings of those entities that may present as recurrent deep neck infections. PATIENTS AND METHODS: Twelve patients with recurrent deep neck infections and CT scans were retrospectively identified since 1990. Their CT scans and medical histories were reviewed. The diagnosis was pathologically confirmed in all cases. RESULTS: The CT scans revealed an abscess or a localized infected cyst in the deep soft tissues of the neck, with varying degrees of associated inflammatory change in the adjacent soft tissues. The diagnoses in these cases included 1 first branchial cleft cyst, 3 second branchial cleft cysts, 1 third branchial cleft cyst, 2 fourth branchial cleft cysts, 2 infected lymphangiomas, 2 thyroglossal duct cysts, and 1 cervical thymic cyst. CONCLUSIONS: Most deep neck infections are the result of suppurative adenitis. The location of the primary focus is usually from the mucosa of the upper aerodigestive tract or from an odontogenic source. Less common causes are perforations due to a foreign body, thrombophlebitis of the internal jugular vein, or osteomyelitis of the spine. Recurrences in these situations are unusual. Less commonly, congenital lesions can present as deep neck infections, and recurrences are common. Our cases suggest that the recurrence of a deep neck infection should alert the physician to the possibility of an underlying congenital lesion and that CT is helpful in the early recognition of these lesions.

Adolescent↗

PubMed1999

An imaging-based classification for the cervical nodes designed as an adjunct to recent clinically based nodal classifications.

Over the past 18 years, numerous classifications have been proposed to distinguish among the diverse nodal levels. Some classifications have used surgical landmarks, others physical assessment criteria. These classifications do not agree precisely and exhibit sufficient variation that competent physicians could arrive at slightly different staging of the patient's nodal disease. In the past 2 decades, computed tomography and magnetic resonance imaging have offered progressively more refined anatomical precision, reproducibility, and visualization of deep, clinically inaccessible structures. Because the majority of patients with head and neck malignancies presently undergo sectional imaging prior to treatment planning, we felt a need to integrate anatomical imaging criteria with the 2 most commonly used nodal classifications: those of the American Joint Committee on Cancer and those of the American Academy of Otolaryngology-Head and Neck Surgery. The imaging-based nodal classification proposed herein has been developed in consultation with surgeons interested in such classifications in the hope that the resultant classification would find ready acceptance by both clinicians and imagers. It is our desire that the best attributes of imaging, combined with those of the physical assessment, can result in a better and more consistently reproducible nodal staging than is possible by either

Head and Neck Neoplasms↗

PubMed1999

Imaging central skull base neural tumor spread from paranasal sinus malignancies: a critical factor in treatment planning.

Eight cases of paranasal sinus tumors with central skull base disease are presented. Each patient had coned down noncontrast and contrast-enhanced magnetic resonance imaging (MRI) studies to evaluate the tumor margins and any potential tumor spread into the cavernous sinuses, V2 and the Vidian nerve. Two patients had tumors that extended up to the face of the sphenoid bone and one had a tumor in the ventral cavernous sinus. These three patients had a complete tumor resection with postoperative irradiation. Two more patients had extensive tumor invasion of the central skull base, one was treated with only irradiation, one refused treatment. Three more patients had tumors that involved the ventral portion of the sphenoid bone with limited neural tumor extension. Two of these patients had surgery with cavernous sinus dissections followed by irradiation. One patient delayed treatment for 2 months and when he returned he had a more extensive tumor and was considered incurable by surgery. He refused further treatment. The technique of the focused MR examination and its impact on treatment planning is discussed.

Journal Article↗

PubMed1999

Upper aerodigestive tract liposarcoma: report on four cases and literature review.

OBJECTIVE: To report on the clinical behavior, histopathology, treatment, and prognosis of laryngeal, hypopharyngeal, and cervical esophageal liposarcomas. STUDY DESIGN: Retrospective reviews of pathology files and hospital records at a tertiary care hospital and a retrospective search of the English-language literature. METHODS: Cases of upper aerodigestive tract (UADT) liposarcoma with adequate histopathologic documentation and clinical information were included for review. RESULTS: Four cases of UADT liposarcomas were identified. The literature review revealed 26 cases of laryngeal liposarcomas, 7 cases of hypopharyngeal liposarcomas, and 6 cases of esophageal liposarcomas: the mean age at presentation was 55.8 years, the male:female ratio was 5:1, and 60% of the patients presented with dysphagia. Eighty-six percent of tumors had low-grade histologic findings. The recurrence rate after primary resection was 50%. Recurrence correlated with surgical procedure rather than with histologic subtype; 94.7% of recurrences happened after simple excision. Distant metastases occurred in three patients; two of them died of the disease. CONCLUSIONS: The literature supports that UADT liposarcomas are rare and usually of low-grade histologic type. The rate of metastatic disease and tumor-related mortality is low. However, high recurrence rates have been noted, particularly when less radical surgery is employed.

Adult↗

PubMed1999

The spectrum of benign and malignant etiologies of cervical node calcification.

OBJECTIVE: The purpose of this study was to determine if the presence and pattern of lymph node calcification can be used to make a limited differential diagnosis and differentiate benign from malignant disease. MATERIALS AND METHODS: Two radiologists reviewed each of 2300 neck CT scans obtained at our institution between January 1996 and July 1998 for the presence of nodal calcifications. The scans were obtained as 3-mm contiguous axial sections, and most were obtained with IV contrast material. Twenty-six scans revealed nodal calcification, which was classified as being within the node itself or along the periphery of the node. The diagnosis was established from surgical specimens for 20 patients and from CT-guided thin-needle biopsy for four patients. For two patients, the diagnosis was inferred from a previously well-documented case of the disease. RESULTS: Of the 2300 scans, 26 (1%) showed nodal calcification. Of these 26, eight (31%) were from patients with benign disease; six (23%) from patients with treated diseases, including four lymphomas and one infection; and 12 (46%) from patients with malignancies, including nine cases of head and neck primary tumors and three cases of metastatic adenocarcinoma from breast and lung primary tumors. CONCLUSION: Cervical node calcification is rare. On the basis of our limited number of cases, nodal calcification, regardless of its location within the node, is not a reliable predictor of either benign or malignant disease. However, nodal calcification does suggest a limited differential diagnosis that most commonly includes tuberculosis, treated lymphoma, and metastatic thyroid carcinoma, adenocarcinoma, or squamous carcinoma.

Adult↗

PubMed1999

Surveillance CT and the prompt use of CT-guided fine-needle aspiration in patients with head and neck cancer who have undergone surgery.

OBJECTIVE: The purpose of this study was to assess the usefulness of prompt CT-guided fine-needle aspiration in the evaluation of suspected tumor recurrence seen on surveillance images of patients who had undergone surgery for head and neck cancer. SUBJECTS AND METHODS: We reviewed 32 patients who had undergone CT-guided fine-needle aspiration after surgery for head and neck cancer. CT-guided fine-needle aspiration was performed with a 22-gauge spinal needle and a cytopathologist was present to assess the adequacy of the biopsy sample. As many as five needle passes were made. RESULTS: Of the 32 cases, pathologic findings revealed squamous cell carcinoma (n = 27), mucoepidermoid carcinoma (n = 2), neuroendocrine carcinoma (n = 1), papillary thyroid carcinoma (n = 1), and adenocarcinoma (n = 1). In 20 cases (62.5%) the results of CT-guided fine-needle aspiration were positive for tumor recurrence, whereas in 11 cases (34.4%) the results were negative. In one case (3.1%) the results were nondiagnostic. Of the 11 patients with negative findings on CT-guided fine-needle aspiration, two patients had a subsequent recurrence that was not at the biopsy site. There were no complications from the procedure. CONCLUSION: When a radiologist who is trained in head and neck imaging identifies with CT a possible early recurrence of tumor, the prompt use of CT-guided fine-needle aspiration is an effective way to diagnose these tumors so that appropriate treatment can be initiated.

Adult↗

PubMed1998

Clinical and molecular pathology of aggressive Schneiderian papilloma involving the temporal bone.

BACKGROUND: Inverting papilloma is a benign but locally aggressive sinonasal tumor that rarely involves the middle ear or temporal bone. METHODS: A report of a case and the molecular pathology of the tumor is presented. RESULTS: A 35-year-old woman with a history of recurrent inverting papilloma of the left paranasal sinuses was found to have evidence of extension through the eustachian tube and extensive involvement of the temporal bone. Surgical management resulted in the patient being disease-free at 14 months. Molecular pathology studies of the resected tumor suggest an association with human papillomavirus. CONCLUSIONS: Direct extension of the sinonasal tumor through the eustachian tube may represent the pathologic mechanism involved in the development of inverting papilloma involving the middle ear and temporal bone.

Adult↗

PubMed1998

Salivary glands.

This article discusses the anatomy, physiology, and pathology of the parotid, submandibular, and sublingual glands, which often are referred to as the major salivary glands. Overall, diseases of the salivary glands are relatively uncommon; however, as an organ system, they have the greatest diversity of pathology. Acute viral and bacterial inflammatory diseases are the most common salivary gland abnormalities; tumors are uncommon. The imaging approach to these lesions is discussed.

Adenoma, Pleomorphic↗

PubMed1998

CT of pilomatrixoma in the cheek.

Pilomatrixoma is an uncommon benign tumor arising from hair follicles. They occur most commonly in the head and neck region, and are usually found in girls during the first two decades of life. These tumors may contain calcification, which, when present, is helpful in suggesting the diagnosis. We present a classic case of pilomatrixoma in the cheek of a young woman. The tumor was documented on CT studies, which showed a subcutaneous, noninvasive mass with calcifications.

Adult↗