Quiz case of the month. Partial agenesis of the internal carotid artery with collateral circulation through an enlarged inferior tympanic artery.
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Adult↗
Biomedical subjects
R Hermans
Publications and source records attributed to R Hermans.
CT findings in osteoradionecrosis of the mandible.
CT scans of ten patients in whom the diagnosis of mandibular osteoradionecrosis was proven pathologically or by clinical follow-up were reviewed. All ten patients had bony abnormalities (cortical interruptions and loss of spongiosa trabeculation) on the symptomatic side. These were predominantly seen in the body of the mandible (premolar and molar region, eight patients), in some of these cases extending into the retromolar triangle (two patients) or mandibular angle (two patients). In the remaining two patients the abnormalities were in the ramus and angle. The two patients treated with iridium implantation showed localized lingual-sided cortical destruction. Three patients had a pathological fracture. The cortical destruction was buccal-sided in two and both buccal- and lingual-sided in three of the other five patients. Contralateral bony abnormalities were present in four patients. Soft tissue thickening on the symptomatic side was seen in nine patients. As the bony abnormalities in mandibular osteoradionecrosis are often associated with a soft tissue mass, CT differentiation from tumor recurrence can be difficult. The association with cortical defects distant from the position of the original tumor (buccal surface or opposite side of mandible) should evoke the possibility of mandibular osteoradionecrosis.
Adult↗
Magnetic resonance imaging of experimental tracheal transplantation.
RATIONALE AND OBJECTIVES: We evaluated the feasibility of using contrast-enhanced magnetic resonance (MR) imaging for in vivo monitoring of tracheal transplants in rabbits. METHODS: Plain and gadolinium-enhanced, high-resolution MR images were obtained from six rabbits 4 weeks to 6 months after an orthotopic tracheal transplantation (after heterotopic revascularization). The animals were sacrificed after the MR examination, and comparisons were made among the MR images, macroscopic observations, and histologic sections. RESULTS: All transplants were clearly identifiable on the MR images; they produced slight-to-moderate narrowing of the airway diameter. Enhancement of the transplant tissues was clearly present. There was close correspondence between the MR morphology and the macroscopic and histologic sections. CONCLUSION: MR imaging can be used to monitor in vivo tracheal transplantation after heterotopic revascularization.
Anastomosis, Surgical↗
Tongue necrosis as a complication of temporal arteritis: CT and angiographic findings.
We report the case of an 82-year-old woman with probable temporal arteritis complicated by extensive tongue necrosis. This severe complication was diagnosed on CT; angiography suggested the diagnosis of arteritis.
Aged↗
Spiral CT of the temporal bone: value of image reconstruction at submillimetric table increments.
Axial spiral CT of the temporal bones with a nominal slice thickness of 1 mm and 180 degrees linear interpolation was performed in 13 patients. In 18 temporal bones, the spiral data set was used to reconstruct overlapping axial images with a table increment of 0.1 mm. These images gave additional information in four cases: in two by examining the heavily overlapping axial images themselves, and in two by obtaining supplementary information from secondary image reconstructions. In two cases less information was obtained than by using the conventional incremental images. This study shows that reconstructing overlapping slices can be useful, even if the temporal bone is scanned at 1 mm nominal slice thickness.
Humans↗
Submandibular gland mucocele of the extravasation type. Report of two cases.
The clinical and radiological differential diagnosis of cystic lesions of the head and neck region can be difficult. We report two cases of submandibular gland mucoceles presenting as cystic masses in the submandibular region. The imaging characteristics and differential diagnosis are discussed.
Adolescent↗
Experimental tracheal allograft revascularization and transplantation.
The feasibility of tracheal allotransplantation with a fascial vascular carrier was examined in three groups with varied dose sequences of immunosuppression. A control group (group 1) received no medication. The three experimental groups were given daily cyclosporine intramuscular doses of 5 mg/kg (group 2), 5 mg/kg plus 3 mg/kg methylprednisolone (Solu-Medrol) (group 3), and 10 mg/kg (group 4) for 6 weeks or until death. Grafts were assessed by silicone dye infusion of the artery of the fascial flap to examine their microcirculation and by quantitative histologic study. Group 1 evidenced complete rejection after a heterotopic revascularization period of 14 days. The allografts of the experimental groups remained viable after 14 days of revascularization and could be transplanted orthotopically after this period. After transplantation, the viability of group 2 tracheas was unpredictable with changes ranging from mild to complete rejection. Group 3 evidenced well-preserved transplant viability with infection-induced necrosis at the anastomoses caused by the corticosteroid component. All group 4 animals survived the follow-up period with normal allograft viability. Cyclosporine in a dosage of 10 mg/kg per day can effectively suppress the immune response after transplantation of vascularized tracheal allografts. This experimental model will allow future studies to examine airway wall immunogenicity.
Acute Disease↗
Three-dimensional CT-imaging of the ossicular chain.
In eight patients, with a known air-conduction hearing loss, three-dimensional images of the ossicular chain were constructed based on heavily overlapping high resolution CT-slices, obtained from a spiral CT data set. High quality three-dimensional images could be obtained in all eight patients. Supplementary information was derived from these three-dimensional images in three patients; in one, this supplementary information had therapeutic importance. The slight image quality loss in spiral-CT of the temporal bone, compared with conventional CT, is in some cases largely compensated by the possibility of rendering high quality secondary reconstructions.
Adult↗
Revascularization of a salvage supraglottic laryngectomy. Preliminary report.
After supraglottic laryngectomy, particularly if there has been a large preoperative dose of radiotherapy, significant ischemia at the suspension anastomosis site may ensue. Neovascularization may play a major role in the healing of this salvage horizontal laryngectomy anastomosis. We have analyzed the process of angiogenesis and neovascularization from a fascial flap in a case of salvage supraglottic laryngectomy.
Adult↗
[Application of spiral CT in the head and neck region].
In comparison with other regions of the body, spiral CT has only been recently applied in the radiological evaluation of the head and neck region. Some interesting applications seem to emerge. The fast data acquisition allows to examine children (e.g. temporal bone examinations) without sedation, to reduce patient moving artefacts in adults, and to limit the dose of injected contrast material in enhanced studies. Furthermore, without additional irradiation, images with a very small table increment can be calculated out of the volumetric data set, allowing generation of high quality secondary reconstructions.
Ear Ossicles↗
Imaging of laryngeal and tracheal stenosis.
Most laryngeal and tracheal disorders will sooner or later narrow the airway lumen to some degree. Often a presumptive diagnosis may be considered from an evaluation of the history and symptoms. A final diagnosis is often possible by visual inspection through laryngoscopy and tracheo-bronchoscopy, but in the case of submucosal or extrinsic pathology only narrowing of the airway is detected; radiography can be of great value in coming to a definitive diagnosis. After a brief discussion of the normal anatomy of the larynx and cervical trachea, this manuscript reviews the imaging features of several pathological entities causing stenosis of these structures, without being exhaustive. Many radiological procedures of varying complexity have been devised to study these organs; emphasis will be placed on computer tomography (CT) and to a lesser extent on magnetic resonance imaging (MRI), as these imaging modalities usually provide most information.
Adolescent↗
[The contribution of proton spin resonance tomography in the diagnosis of petrous bone anomalies].
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Adult↗
Eosinophilic granuloma of the head and neck: CT and MRI features in three cases.
We report the radiological findings and more specifically the MRI features in three typical cases of Langerhans' cell histiocytosis of the head and neck. All three cases were of solitary eosinophilic granuloma of bone: two mandibular and one temporal bone lesion. Reports on the MRI features of head and neck eosinophilic granulomas are rare.
Adolescent↗
Callus originating in the laryngeal skeleton, presenting as a neck lump: a case report.
We report on the case of a young woman, presenting with a left lateral neck lump, which turned out to be a bony callus originating from the thyroid cartilage; similar but smaller lesions were found on the same side in the hyoid and cricoid cartilages. The CT, MRI and pathological findings are described.
Adult↗
Benign symmetric lipomatosis of the neck or Madelung-Launois-Bensaude syndrome, also known as Madelung's neck: CT findings in two cases.
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Adult↗
Preoperatively diagnosed utricular neuroma treated by selective partial labyrinthectomy.
Unlike the acoustic neuroma that occupies the internal acoustic meatus and extends into the cerebellopontine angle, the true intralabyrinthine neuroma is an extremely uncommon finding. The majority of the published cases were found at autopsy or during destructive labyrinthectomy for uncontrollable Meniere's syndrome. To the best of our knowledge, we present the smallest exclusively intrautricular neuroma that has ever been diagnosed preoperatively. Detailed magnetic resonance imaging studies allowed the detection of this tumor, measuring only 3.5 mm in diameter. The tumor was removed via atticomastoidectomy and partial labyrinthectomy. The diagnostic workup, radiographic characteristics, and surgical treatment are discussed, together with a review of the literature.
Ear, Inner↗
Extranodal non-Hodgkin lymphoma of the head and neck.
Non-Hodgkin lymphoma (NHL) is the second most frequent malignant tumor in the head and neck, squamous cell carcinoma being the most frequent. NHL often appears in extranodal localisations. In the head and neck, two distinct extranodal sites are recognised: extranodal lymphatic localisations or involvement of the ring of Waldeyer, and extranodal extralymphatic localisations. In this study we reviewed the imaging features of 55 patients who showed extranodal NHL-localisations to investigate whether we could find specific imaging characteristics. There are no pathognomonic signs. However, if more than one extranodal mass is detected, if the mass appears huge without necrosis or ulceration, if the mass is associated with large, non-necrotic nodes, the diagnosis of non-Hodgkin lymphoma can be suggested; however, it is usually not possible to exclude other pathological processes with absolute certainty.
Adult↗