Clinical imaging
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Comparative Study
Diagnostic imaging of idiopathic adult respiratory distress syndrome (ARDS)/diffuse alveolar damage (DAD) histopathological correlation with radiological imaging.
In ten patients with idiopathic adult respiratory distress syndrome (ARDS) who had histopathologically diffuse alveolar damage (DAD), and who did not have specific underlying diseases, we compared the histopathological findings with their radiographic images in order to study the detail analysis of radiographic images and the clinical courses. These patients were roughly classified as having the interstitial pneumonia dominant type (type IP) of idiopathic ARDS, in which alveolar septal thickening, alveolitis, or both were the predominant histological findings and images showed increasing attenuation of lung fields with small honeycomb lung, or the organizing pneumonia dominant type (type OP), in which organizing exudate predominantly filled the alveoli histologically and images showed consolidation shadows with some air. Hyaline membrane was seen very frequently in patients with a short clinical course, and in accordance with a longer clinical course, widespread fibrosis and honeycomb lung covered by organizing hyaline membrane was seen with both types. Patients with type OP in whom collapse of the normal pulmonary structure was less and for whom changes on radiographic images were larger seemed to respond relatively favorably to steroid treatment, as judged from pulmonary function and radiographic images.
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The purpose of this study was to review the computed tomography (CT) appearance of mycotic aneurysm of the aorta caused by Salmonella infection. Eight patients were suggested to have mycotic aneurysm of the aorta by clinical presentation of fever, abdominal or back pain, leukocytosis, and pulsatile abdominal mass in addition to positive blood or tissue culture of salmonella. ⋯ CT features of mycotic aneurysm of aorta included (a) hazy aortic wall with rupture; (b) gas-forming inflammation around the aneurysm; (c) retroperitoneal paraaortic fluid collection and vertebral erosion; and (d) thrombus formation within a false lumen after aneurysmal rupture. Because of its availability and noninvasiveness, CT is the major diagnostic modality to use for Salmonella-related mycotic aneurysm.
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Clinical and radiological features of 22 Chinese patients with sacral insufficiency fractures were reviewed. Twenty-one were postmenopausal women. Other risk factors were external pelvic radiotherapy (eight) and total hip replacement (two). ⋯ Concomitant parasymphyseal and pubic rami fractures were detected in 17 and 10 patients, respectively. Follow-up assessment by CT and bone scintigraphy in five patients showed various stages of fracture healing. Recognition of the radiological patterns of this entity is emphasized.
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Primary thymic carcinoma is a rare neoplasm that in contradistinction to thymoma, is not supposed to be associated with a paraneoplastic syndrome. A 73-year-old man, with new onset of disorientation, was found to have an elevated serum calcium level as the cause. ⋯ Examination of a biopsy specimen revealed thymic squamous cell carcinoma. Thus, a paraneoplastic syndrome, in this case hypercalcemia, does not exclude primary carcinoma of the thymus.
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This is a retrospective study of the computed tomography (CT) examinations and medical records of 243 consecutive pediatric patients sent for CT studies after blunt abdominal trauma. The purpose of the study was to determine the frequency and significance of periportal tracking identified by CT, and correlate this finding with liver enzyme levels and liver injury. Periportal tracking (PPT) was divided into four grades (0-3) depending upon the distribution of decreased attenuation adjacent to the portal vessels. ⋯ Sixteen children with grade 3 PPT and no liver injury had significantly elevated liver enzymes as compared to children with combined 0-2 grade PPT. Eleven of the 20 children with grade 3 PPT had no other CT evidence of intraabdominal injury and none of these patients developed intraabdominal hemorrhage. Thus, grade 3 periportal tracking as an isolated abnormality did not indicate a clinically significant liver injury in any patient.