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Biomedical subjects

R Rymer

Publications and source records attributed to R Rymer.

71 records · Page 4Linked to original sources
PubMedDate not supplied

Leiomyoma of the adrenal gland in a patient with AIDS.

Leiomyoma of the adrenal gland is an exceptional localization. We report a case occurring in a young patient with AIDS. Diagnosis was a surprise on pathologic examination. On enhanced computed tomographic (CT) scan, the adrenal mass had a low central attenuation area and a thin enhancing peripheral ring. On magnetic resonance (MR) imaging the left adrenal mass was isointense with the liver on T1-(TR/TE = 500/300 ms) and T2-(TR/TE = 2030/60, 120 ms) weighted spin-echo images, except a central area with a lower signal on T1-weighted images and a higher signal on T2-weighted images. The mass was slightly enhanced after Gd-DOTA injection, but the central area remained unchanged.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Fluid-fluid levels within focal hepatic lesions: imaging appearance and etiology.

PURPOSE: To report our experience with fluid-fluid levels within focal hepatic lesions and determine if this finding indicates a specific diagnosis. MATERIALS AND METHODS: We reviewed our experience with eight patients with focal hepatic lesions that showed fluid-fluid level on cross-sectional imaging. Seven CT scans, four MR examinations, and four sonograms were reviewed. The hepatic lesions included metastases (four patients), biliary cystadenoma (two patients), cavernous hemangioma (one patient), and hematoma (one patient). A histologic diagnosis was made in all cases. RESULTS: Fluid-fluid levels were found in both malignant and benign focal hepatic lesions. Fluid-fluid levels were seen on six CT scans, four MR examinations and on none of the four sonograms. Radiologic-pathologic correlation showed that fluid-fluid levels corresponded to internal hemorrhage in all but one case. In the case of cavernous hemangioma, a fluid-fluid level was found to correspond to a sedimentation effect within a large vascular space. CONCLUSION: Fluid-fluid levels in focal hepatic lesions do not indicate a specific diagnosis but can be seen in both malignant and benign conditions affecting the liver.

Adult↗
PubMedDate not supplied

Macrocystic serous cystadenoma of the pancreas: CT and endosonographic features.

Recently, the term "serous cystadenoma" has been adopted in the pathological community to qualify the so-called microcystic adenoma of the pancreas. This change in terminology was based on the emergence of a new type of serous cystadenoma of the pancreas, i.e., the macrocystic variant. We report one case of pathologically proven macrocystic serous cystadenoma of the pancreas for which the diagnosis of mucinous cystadenoma was suggested preoperatively. This rare but benign macrocystic variant exhibits radiological features similar to those of mucinous cystadenoma. In addition, inflammatory changes and foci of hemorrhage within the tumor may simulate mucinous cystadenocarcinoma.

Adenoma↗
PubMedDate not supplied

Carcinoid tumors of the abdomen: CT features.

Carcinoid tumors are rare neuroendocrine neoplasms that belong to a more general category of tumor called the APUDomas. Ninety percent of carcinoid tumors are located in the gastrointestinal tract. Abdominal carcinoid tumors are categorized according to the division of the primitive gut from which they arise. Carcinoid tumors originating from the foregut develop in the gastric wall, duodenum, and pancreas; those originating from the midgut develop from the small bowel, appendix, and right colon; and those originating from the hindgut develop from the transverse or left colon or from the rectum. This report illustrates the computed tomographic appearance of primary and metastatic carcinoid tumors of the abdomen. Among the different organs that may be involved by metastases from carcinoid tumor, special emphasis is placed on the liver.

Abdominal Neoplasms↗
PubMedDate not supplied

Imaging features of nodular regenerative hyperplasia of the liver mimicking hepatic metastases.

We described the sonographic, computed tomographic (CT), and magnetic resonance (MR) imaging features of one atypical case of nodular regenerative hyperplasia of the liver. The presence of multiple hepatic nodules suggested the diagnosis of metastatic disease to the liver because of a peripheral rim of enhancement on CT obtained after intravenous administration of contrast material and a halo sign on T2-weighted spin-echo MR imaging. Examination of the pathologic specimen obtained after surgical biopsy showed that the nodules were made of hepatocytes, with a nodular arrangement surrounded by peliosis, without fibrosis or cirrhosis. These findings suggested that peliosis may cause peripheral rim of enhancement on CT and halo sign on MR imaging. In light of this case, nodular regenerative hyperplasia of the liver should be considered in the differential diagnosis of hepatic metastases.

Adult↗
PubMedDate not supplied

Ovarian artery: angiographic appearance, embolization and relevance to uterine fibroid embolization.

PURPOSE: To describe the angiographic appearance of the ovarian artery and its main variations that may be relevant to uterine fibroid embolization. METHODS: The flush aortograms of 294 women who had been treated by uterine artery embolization for fibroids were reviewed. Significant arterial supply to the fibroid, and the origin and diameter of identified ovarian arteries were recorded. In patients with additional embolization of the ovarian artery, the follow-up evaluation also included hormonal levels and Doppler imaging of the ovaries. RESULTS: A total of 75 ovarian arteries were identified in 59 women (bilaterally in 16 women and unilaterally in 43 women). All ovarian arteries originated from the aorta below the level of the renal arteries with a characteristic tortuous course. Fifteen women had at least one enlarged ovarian artery supplying the fibroids. Fourteen women (14/15, 93%) presented at least one of the following factors: prior pelvic surgery, tubo-ovarian pathology or large fundal fibroids. CONCLUSION: We advocate the use of flush aortography in women with prior tubo-ovarian pathology or surgery or in cases of large fundal fibroids. In the case of an ovarian artery supply to the fibroids, superselective catheterization and embolization of the ovarian artery should be considered.

Adult↗
PubMedDate not supplied

[Percutaneous drainage of abdomino-pelvic collections. Indications, techniques, and results].

Extra-parenchymal collections in the abdomen and pelvis are a not infrequent occurrence in gastrointestinal pathologies. Twenty years of experience have proved percutaneous drainage to be a safe and effective therapeutic modality. Several studies have demonstrated the efficacy of radio-guided percutaneous drainage which can serve as a substitute for open surgical drainage in 70% of cases. This therapeutic modality should be considered for every case of abdomino-pelvic collection.

Abdominal Abscess↗
PubMedDate not supplied

Differentiation between hepatic cavernous hemangioma and malignant tumor with T2-weighted MRI: comparison of fast spin-echo and breathhold fast spin-echo pulse sequences.

PURPOSE: The goal of our study was to compare a T2-weighted breathhold fast spin-echo (BHFSE) technique with T2-weighted nonbreathhold fast spin-echo (FSE) technique for characterizing cavernous hemangioma of the liver and differentiating this entity from malignant tumor. MATERIALS AND METHODS: Eighteen patients with cavernous hemangiomas and 18 patients with malignant hepatic tumors were studied with T2-weighted MRI with a nonbreathhold FSE technique with and without fat suppression and with a BHFSE technique without fat suppression. Hepatic lesions were analyzed quantitatively using signal intensity (SI) and contrast-to-noise (C/N) ratio. In addition, images were qualitatively compared for accuracy in characterizing hepatic lesion. RESULTS: Quantitatively, hemangioma had significantly higher SI and C/N ratios than did the malignant tumor on every pulse sequence (P < 0.01). Qualitatively, all malignant tumors were correctly categorized; differentiation between cavernous hemangioma and malignant tumor was impossible in three cases of cavernous hemangioma with the three pulse sequences (92% accuracy, 100% sensitivity, and 83% specificity). CONCLUSION: T2-weighted FSE and BHFSE MRI shows comparable levels of accuracy for differentiating between hepatic cavernous hemangioma and malignant tumor. Because overlap may exist using quantitative measurement, morphologic patterns must be carefully analyzed, supporting that quantitative analysis and morphologic evaluation are complementary.

Adult↗
PubMedDate not supplied

CT of abdominal wall implantation metastases after abdominal percutaneous procedures.

PURPOSE: Our goal was to report the CT manifestations of abdominal wall implantation metastases occurring after abdominal percutaneous procedure. METHOD: CT scans and clinical data of six patients with abdominal wall implantation metastases at the puncture site following abdominal percutaneous procedure were reviewed. The abdominal percutaneous procedures included drainage of intraperitoneal abscess in patients with colon or gastric cancer (n = 2), transhepatic biliary drainage in a patient with hilar cholangiocarcinoma (n = 1), biopsy of intrahepatic hepatocellular carcinoma (n = 1), biopsy of a metastatic left adrenal gland (n = 1), and laparoscopic cholecystectomy in a patient with unsuspected gallbladder cancer (n = 1). RESULTS: CT enabled the diagnosis of abdominal wall implantation metastasis in all six patients and showed coexisting intraabdominal tumor sites in five patients. All abdominal wall implantation metastases were homogeneous before intravenous administration of iodinated contrast material and became moderately heterogeneous on contrast-enhanced CT scan with marked enhancement relative to adjacent tissues. CONCLUSION: Abdominal wall implantation metastases are moderately heterogeneous on contrast-enhanced CT scan with marked enhancement relative to adjacent tissues. In most cases of abdominal wall implantation metastasis following abdominal percutaneous procedure, CT shows additional intraabdominal tumor sites. This complication may occur following a variety of abdominal percutaneous procedures (either radiological or surgical).

Abdominal Muscles↗
PubMedDate not supplied

Ct evaluation of small bowel obstruction.

Although small bowel obstruction is a common occurrence, it is essential that this clinical condition be treated properly, that the site, level, and cause of obstruction be determined accurately, and that a tentative prognosis be formulated prior to surgery. The diagnosis of small bowel obstruction is based on a comprehensive approach that includes clinical background, patient history, and results of physical examination and laboratory tests. A variety of radiologic procedures are available to aid in the diagnosis of small bowel obstruction. Recent studies have demonstrated the superiority of CT in revealing the site, level, and cause of obstruction and in demonstrating threatening signs of bowel inviability. CT has proved useful in characterizing small bowel obstruction from extrinsic causes (adhesions, closed loop, strangulation, hernia, extrinsic masses), intrinsic causes (adenocarcinoma, Crohn disease, tuberculosis, radiation enteropathy, intramural hemorrhage, intussusception), intraluminal causes (eg, bezoars), or intestinal malrotation. Conventional radiography was the modality of choice for many years and should remain the initial imaging method in patients with suspected small bowel obstruction. However, the unique capabilities of CT in this setting make this modality an important additional diagnostic tool when specific disease management issues must be addressed.

Diagnosis, Differential↗