胰腺实性假乳头状瘤的CT征象分析

Objective: The aim of our study was to demonstrate the CT features of solid pseudopapillary tumor of the pancreas (SPTP) so as to improve the imaging diagnostic abilities. Methods: The CT materials of 10 cases with surgery andpathology proved SPTP were retrospectively analyzed, including 8 females and 2 males, their age ranged from 12 to 54years (average being 27.2 years). All of the 10 cases underwent spiral CT scan and also with contrast enhancement before surgery. Results: All of the 10 cases were isolated mass. They were located at the head (n = 5), tail (n = 4), and body (n =1) of the pancreas. Their shapes were round (n = 3), oval (n = 4), and irregular (n = 3). The long-axis diameter ranged from 2.1-8.6 cm (mean 6.5 cm). All of neoplasms consisted of solid and cystic components. Mostly solid components in 5 cases,nearly the same proportion of solid and cystic part in 3 cases, and mostly cystic components in 2 cases. After dynamic contrast-enhanced, the solid parts of the lesion showed progressive enhancement and the cystic parts of the lesion showed no enhancement. Calcification was noted in 5 cases, such as the spot, line-like, small nodules or patchy calcification. Fluiddebris level and "floating cloud" sign were noted in one case. In one case of mostly cystic components, patchy area of high attenuation were shown on CT imaging which then was proved as old hemorrhage by pathologic evaluation. Seven cases were completely encapsulated and made more remarkable on post-contrast images. Three cases had incomplete capsules,and adhesion to the surrounding tissues could be seen during operation, including one case in which invasion to the adjacent adipose tissues near the inferior vena cava and walls of the duodenum could be seen under the microscope. Pancreatic duct broadening or hepatic duct dilatation was caused by tumor each in 1 case. All of the 10 cases had no enlargement of the intra-abdominal lymph nodes or distant organ metastasis. Conclusion: SPTP occurs mainly in young women and has comparatively characteristic CT imaging features: a large solid and cystic tumor of pancreas, sharp edges, the solid parts of the lesion showed progressive enhancement, a few with hemorrhage and calcification.     

Bilateral hypothalamic dopamine infusion in male Zucker rat suppresses feeding due to reduced meal size

PURPOSE: To determine whether vascular, ischemic, and inflammatory causes of bowel wall thickening in children can be differentiated at gray-scale and color Doppler ultrasonography (US). MATERIALS AND METHODS: Thirty-seven children with acute bowel disease underwent graded compression US. Findings of bowel wall thickness, wall echotexture, location of bowel involvement, and presence of color Doppler flow were evaluated. Diagnoses were classified as inflammation (n = 25), vasculitis (n = 7), or ischemia (n = 5) and were confirmed with findings from colonoscopy and biopsy, stool culture analysis, surgery, and cutaneous biopsy, and with a combination of clinical and laboratory data. RESULTS: Patient age (P = .0022), bowel wall thickness (P = .0001), and color Doppler flow (P = .0013) were statistically significantly related to disease type. Wall thickening and absence of visible color Doppler flow suggested ischemia. Older patient age and visible color Doppler flow suggested inflammation, whereas younger patient age and visible color flow suggested vasculitis. Difference in location of bowel disease in patients with ischemic versus those with vascular wall thickening was statistically significant (P = .0185). No difference was found between disease type and wall stratification. CONCLUSION: Gray-scale and color Doppler flow US can aid in differentiating ischemic, vascular, and inflammatory bowel wall thickening.     

Hepatic peribiliary cysts: multiple tiny cysts within the larger portal tract, hepatic hilum, or both

PURPOSE: To describe characteristic imaging features of hepatic peribiliary cysts. MATERIALS AND METHODS: Four patients with hepatic cysts in which the radiologic (n = 3) or histologic (n = 1) findings were consistent with peribiliary cysts of the liver (multiple small cysts seen exclusively in the larger portal tract, hepatic hilum, or both at gross examination and dilatations of extramural peribiliary gland at histologic examination) underwent computed tomography (CT) and ultrasound (US). In three patients, CT was performed after drip infusion of cholangiographic contrast material. RESULTS: Contrast material-enhanced CT clearly depicted many tiny cysts along the larger portal veins up to the third- or fourth-order branch (n = 3). US depicted multiple cysts in the echogenic portal tract definitely (n = 2) or equivocally (n = 2). On cholangiographic contrast-enhanced CT scans, cystic areas were located adjacent to or surrounding the bile ducts, and the possibility of biliary dilatation, communication, or both was disproved. CONCLUSION: Hepatic peribiliary cysts can be diagnosed with US and enhanced CT, especially with CT performed after administration of cholangiographic contrast material.     

Endothelial cell compatibility of glycopeptide antibiotics for intravenous use

OBJECTIVE: The aim of this study was to evaluate the pulmonary CT findings in patients with Churg-Strauss syndrome to determine the frequency and nature of parenchymal abnormalities. MATERIALS AND METHODS: CT examinations performed at the time of diagnosis in 17 patients with Churg-Strauss syndrome were retrospectively evaluated by two observers who reached a decision by consensus about the presence and nature of parenchymal abnormalities. High-resolution CT (1- to 3-mm collimation) was performed in 14 patients and conventional CT (6- to 10-mm collimation) was performed in three cases. RESULTS: Predominant CT findings consisted of parenchymal opacification (consolidation or ground-glass attenuation) (n = 10), pulmonary nodules (n = 2), bronchial wall thickening or dilatation (n = 2), interlobular septal thickening (n = 1), and normal anatomy (n = 2). Parenchymal opacification was predominantly peripheral (n = 6) or random in distribution (n = 4). CONCLUSION: The most common CT finding in patients with Churg-Strauss syndrome consists of areas of parenchymal opacification that may be random or peripheral in distribution. These findings are nonspecific.     

Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings

PURPOSE: To determine the two-phase (hepatic arterial phase [HAP] and portal venous phase [PVP]) spiral computed tomographic (CT) findings of a nontumorous arterioportal shunt in the cirrhotic liver that can mimic a hypervascular tumor. MATERIALS AND METHODS: For 14 months, 803 patients with known or suspected hepatocellular carcinoma were referred for initial or repeated transcatheter arterial chemoembolization (TACE). Twenty-nine hyperattenuating lesions on HAP CT images obtained in 25 patients (23 men, two women; age range, 39-70 years) were regarded as nontumorous arterioportal shunts and were included in this study. The diagnosis of nontumorous arterioportal shunt was established by four radiologists who reviewed the two-phase spiral CT images and hepatic angiograms. RESULTS: The longest dimension of the lesion was 1.0-7.9 cm (mean dimension, 2.9 cm). The morphology at HAP CT was wedge-shaped in 25 (86%), geographic (ie, focal area with irregular outline) in two (7%), and nodular in two (7%) lesions. All lesions were homogeneous in attenuation. Hyperattenuating linear branching structures that represented early opacification of portal veins were demonstrated during the HAP in nine (31%) lesions. PVP CT images showed these lesions as isoattenuating (n = 20 [69%]) or slightly hyperattenuating (n = 9 [31%]). Iodized oil CT images showed faint or no accumulation of iodized oil in all lesions. CONCLUSION: In cirrhotic liver, nontumorous arterioportal shunts can be a cause of pseudolesions that mimic hypervascular tumors at two-phase spiral CT. Lesions that have the typical wedge-shaped and homogeneous appearance with or without internal linear branching structures during the HAP and that are isoattenuating or slightly hyperattenuating during the PVP can suggest this unusual condition.     

The current aspects of seroepidemiological research in combined foci of leishmaniasis

The accuracies of ultrasonography (US) and computed tomography (CT) for determining tumor invasion of the chest wall in lung cancer were compared in a retrospective study of 120 patients. US findings were evaluated preoperatively according to the following criteria: disruption of pleura, extension through the chest wall, and fixation of tumor during breathing. CT findings were evaluated with the following criteria: obtuse angle of the mass to the pleural surface, more than 3 cm contact with the pleural surface, and visible pleural thickening associated with the mass. Chest wall invasion was judged as positive when at least two of the three findings were present with either technique. Nineteen of the 120 patients had chest wall invasion by tumor. The sensitivity of US was 100% and the specificity was 98%. The sensitivity of CT was 68% and the specificity was 66%. The accuracy of US and CT were 98% and 67%, respectively.     

Intrathoracic lymphadenopathy in patients with empyema

PURPOSE: Our goal was to determine the prevalence of intrathoracic lymphadenopathy on chest CT in patients with empyema. METHOD: We retrospectively identified 27 patients (14 men, 13 women, mean age 43 years) with nontuberculous empyema examined with chest CT. All scans were reviewed by two of three board-certified radiologists for the presence of intrathoracic lymphadenopathy (> or = 1 cm, short axis) in an American Thoracic Society (ATS) nodal station or the internal mammary region. Differences were resolved by consensus. RESULTS: Thirteen (48%) patients with empyema had lymphadenopathy on chest CT. The mean number of enlarged lymph nodes for the patients with lymphadenopathy was 3.2 (SD +/-2.3, range 1-8). The mean size of the largest lymph node was 1.4 cm (range 1.0-2.5 cm). The lymphadenopathy was unilateral and ipsilateral to the empyema in seven (54%), bilateral in five (38%), and unilateral contralateral to the empyema in one. The distribution of lymphadenopathy according to ATS nodal stations was 4R (n = 8), 7 (n = 6), 10R (n = 5); n = 2 each 2R, 10L, 11L; and n = 1 each 11R, 2L, 4L, and 6. Four patients had internal mammary lymphadenopathy. Pleural fluid and smooth pleural thickening were present in each case. Four patients had follow-up CT after treatment. There was a decrease or resolution of the lymphadenopathy in each case. CONCLUSION: Intrathoracic lymphadenopathy is a common CT finding in patients with empyema and occurred in 48% of this series. In patients with smooth pleural thickening and pleural effusion, intrathoracic lymphadenopathy should not be used as a criterion to differentiate empyema from malignant or tuberculous pleural effusion.     

Thoracic actinomycosis: CT findings

PURPOSE: To characterize computed tomographic (CT) findings of thoracic actinomycosis. MATERIALS AND METHODS: Chest CT scans and radiographs obtained in 22 patients with histopathologically proved thoracic actinomycosis were retrospectively reviewed. All patients were immunocompetent; they were aged 12-73 years (mean, 42.6 years; 14 male, eight female). CT findings were correlated with histopathologic findings in nine patients who underwent surgery (lobectomy [n = 8] or segmental resection [n = 1]). RESULTS: All of the lesions were unilateral, with an average diameter of 6.5 cm (range, 2-12 cm). Patchy air-space consolidation (n = 20) or a mass (n = 2) was seen on CT scans. Fifteen (75%) of the 20 patients with air-space consolidation had central areas of low attenuation (5-30 mm in diameter) within the consolidation. Thirteen of the 15 patients underwent contrast medium-enhanced CT. Ten (77%) of the 13 patients showed ring-like rim enhancement. Adjacent pleural thickening was seen in 16 patients (73%). At histopathologic examination, central low-attenuation areas at CT were seen as microabscesses with sulfur granules or a dilated bronchus that contained inflammatory cells and Actinomyces colonies. Peripheral enhancement of the low-attenuation areas was wall of the microabscess or surrounding parenchyma composed of granulation tissue rich in vascularity. CONCLUSION: Findings of chronic segmental air-space consolidation that contained low-attenuation areas with peripheral enhancement or adjacent pleural thickening at CT were suggestive of thoracic actinomycosis.     

Incremental doses of dobutamine induce a biphasic response in dysfunctional left ventricular regions subtending coronary stenoses

BACKGROUND: Dobutamine stress echocardiography has been proposed as a diagnostic tool to identify viable myocardium. How regional wall thickening responds to dobutamine in the ischemic or short-term hibernating myocardium has not been adequately defined. We hypothesized that regional wall thickening would improve initially and subsequently deteriorate with incremental doses of dobutamine in viable myocardial regions supplied by a stenotic coronary artery. This study was undertaken to determine whether this biphasic pattern of regional function characterizes the response of ischemic or hibernating myocardium to dobutamine and to explore the factors and mechanisms that determine this response. METHODS AND RESULTS: Twenty-six pigs in four groups were studied: a control group (n = 5) to assess the response of myocardium perfused by nonstenotic coronary artery to incremental doses of dobutamine, and three experimental groups with a left anterior descending coronary artery stenosis producing acute myocardial ischemia (n = 7), short-term myocardial hibernation for 90 minutes (n = 7), and short-term hibernation for 24 hours (n = 7) to determine the functional and metabolic response to dobutamine under these conditions. Regional coronary flow was reduced to 40% to 60% of baseline, with significant reductions of regional wall thickening as measured by two-dimensional echocardiography and sonomicrometers. An incremental dobutamine infusion from 2.5 to 25 micrograms.kg-1.min-1 increased wall thickening and coronary flow without lactate production in the control group. In the other three groups, during the incremental dobutamine infusion, regional wall thickening improved initially, from 11.4 +/- 7.5% to 19.8 +/- 11.4%, P < .01, at dobutamine doses of 2.5 to 10 (4.5 +/- 2.2) micrograms.min-1.kg-1 but deteriorated subsequently to 5.0 +/- 5.8% at the maximal dose of dobutamine of 12.6 +/- 4.1 micrograms.min-1.kg-1. The initial improvement of regional wall thickening was associated with a small increase in regional coronary flow (from 0.53 +/- 0.18 to 0.68 +/- 0.25 mL.min-1.g-1 myocardium, P < .05) and with regional lactate production. High doses of dobutamine did not further increase regional coronary flow but markedly increased lactate production and induced regional myocardial acidosis (pH 7.26 +/- 0.07). The biphasic pattern of response to dobutamine was observed in each of the three experimental groups. Both peak improvement and peak deterioration occurred earlier and at lower dobutamine dose levels in the group with acute ischemia compared with the group with short-term hibernation for 24 hours (P < .05). CONCLUSIONS: A biphasic response of wall thickening to incremental dobutamine with initial improvement and subsequent deterioration is characteristic of ischemic or short-term hibernating myocardium. The initial low-dose dobutamine infusion improved wall thickening in the ischemic or hibernating myocardial region to a modest level. This initial modest improvement was transient and at the expense of metabolic deterioration of myocardial ischemia, so that at higher doses during prolonged dobutamine infusion, wall thickening deteriorated, lactate accumulated, and myocardial acidosis developed.     

Thoracic CT in the intensive care unit: assessment of clinical usefulness

PURPOSE: To enlarge the prostatic urethra with thermal coagulation with transrectal radio-frequency (RF) application in dogs. MATERIALS AND METHODS: Eight aged dogs underwent RF ablation of periurethral prostatic tissue for 6 minutes. Eighteen-gauge electrodes were placed into the periurethral tissues with a transrectal approach and ultrasound (US) guidance. Prostatic and rectal temperatures were measured during RF application. US, conventional and computed tomographic (CT) retrograde urethrography (RUG), and CT were performed immediately (n = 8) and at 3-96 days (n = 6) after ablation. Histopathologic analysis was performed at sacrifice immediately (n = 2), at 28 days (n = 2), or at 3 months (n = 4) after treatment. RESULTS: All procedures were successful with no complications and were performed in less than 30 minutes. Rectal mucosal temperature did not exceed 38 degrees C. Immediately after treatment, CT and US demonstrated 1.2-cm foci of altered periurethral tissue that corresponded to solid coagulated tissue at histopathologic analysis. By day 3, CT, RUG, and US demonstrated that these foci had begun to cavitate, resulting in enlargement of the urethra. Complete cavitation was demonstrated by day 28. Minimal reduction in the degree of urethral enlargement was noted by day 60, but narrowing, urethral strictures, or fistulas were not observed at 3 months. At histopathologic analysis, focal cavitary enlargement with at least doubling of the urethral diameter and with normal urothelium was noted in all dogs surviving at least 28 days. CONCLUSION: Transrectal RF urethral enlargement is feasible and safe in animals and merits investigation for alleviating urethral obstruction due to benign prostatic hyperplasia.     

Differentiation of achalasia from pseudoachalasia by computed tomography

OBJECTIVES: The purpose of this study was to determine the computed tomography (CT) findings in idiopathic achalasia and in the pseudoachalasia of malignancy. METHODS: We identified 12 patients with the manometric diagnosis of achalasia who also had CT scans available for review: eight had idiopathic achalasia, and four had pseudoachalasia. As controls, we selected nine patients with endoscopically obvious esophageal cancer who also had CT scans. The CT scans were blindly reviewed to determine esophageal wall thickness, symmetry of the esophageal wall, presence of esophageal dilation or mass, and a radiological diagnosis. RESULTS: Six of the eight patients with achalasia had a dilated esophagus. Five had symmetric wall thickening >5 mm (range 7-10 mm) at the gastroesophageal junction. One patient with a 10-mm wall thickening was incorrectly diagnosed with a mass. All others were correctly diagnosed with achalasia. Three of the four patients with pseudoachalasia had esophageal dilation. Two had an obvious esophageal mass. The other two were given an indefinite diagnosis: one had asymmetric wall thickening (11 mm) at the gastroesophageal junction, and the other had symmetric thickening of 18 mm. Eight of the nine patients with obvious esophageal cancer had a mass on CT; the other patient had asymmetric wall thickening of 6 mm at the gastroesophageal junction and was given an indefinite diagnosis. CONCLUSIONS: Most achalasia patients have CT findings of esophageal dilation and mild, symmetric wall thickening. Therefore, symmetric esophageal wall thickening (<10 mm) should not dissuade one from the diagnosis of achalasia. Most pseudoachalasia patients have CT findings of esophageal dilation, more marked and/or asymmetric wall thickening, or mass. In this group, asymmetric or marked thickening (>10 mm) indicated pseudoachalasia. Therefore, CT can be helpful in differentiating between achalasia and the pseudoachalasia of malignancy.     

Usefulness of CT in patients with intestinal obstruction who have undergone abdominal surgery for malignancy

OBJECTIVE: The purpose of this study was to evaluate the usefulness of CT in determining the causes of intestinal obstruction in patients who have undergone abdominal surgery for malignancy. MATERIALS AND METHODS: We analyzed the CT scans of 55 patients with benign (n = 26) or malignant (n = 29) intestinal obstruction that developed after abdominal surgery for malignancy. After calculating the diagnostic accuracy of interpretations by three radiologists, we compared CT findings for benign and malignant intestinal obstructions with respect to peritoneal involvement patterns and other ancillary findings. Multivariate logistic regression analysis was used to determine the diagnostic performance of CT in revealing causes of obstruction. RESULTS: Diagnostic accuracies of the three radiologists were 67%, 75%, and 78%. CT findings indicating malignant obstruction were a mass at the site of obstruction or prior surgery, lymphadenopathy, or an abrupt transition zone and irregular bowel wall thickening at obstructed sites (p < .05). Conversely, the chance for benign obstruction increased when CT revealed mesenteric vascular changes, a large amount of ascites, or a smooth transition zone and smooth bowel wall thickening at the obstructed site (p < .05). With multivariate logistic regression analysis using two variables (a mass at the site of obstruction or prior surgery and lymphadenopathy), we calculated the overall accuracy of CT as 84% (46/55 patients). CONCLUSION: CT is useful in differentiating benign from malignant intestinal obstructions in patients who have undergone abdominal surgery for malignancy. However, CT has limitations in patients not having a demonstrable peritoneal mass.     

US and CT findings in the diagnosis of tuberculous peritonitis

PURPOSE: To evaluate the ultrasonographic and CT findings of tuberculous peritonitis. MATERIAL AND METHODS: Ultrasonographic and CT findings of 11 patients with the ascitic type of tuberculous peritonitis were reviewed. RESULTS: All patients had ascites, and ultrasonography (US) demonstrated fine complete and incomplete mobile septations in 10 patients. In 5 of them, the ascites had a lattice-like appearance. Diffuse regular peritoneal thickening was detected in all patients by CT and in 10 patients by US. CT demonstrated infiltration of the greater omentum in 9 patients, whereas US showed omental thickening in only 5 patients. CONCLUSION: Peritoneal and omental thickening detected by CT and ascites with fine, mobile septations shown by US strongly suggest the ascitic type of tuberculous peritonitis. The 2 imaging modalities should be used together for accurate diagnosis of tuberculous peritonitis.     

Gastrointestinal submucosal tumors: evaluation with endoscopic US

PURPOSE: To describe the endoscopic ultrasound (US) features of benign versus malignant submucosal tumors throughout the gastrointestinal tract. MATERIALS AND METHODS: One hundred nine patients aged 24-81 years suspected to have submucosal tumors (11 esophageal, 41 stomach, 24 duodenal, and 33 colorectal tumors) at barium studies or endoscopy underwent endoscopic US. The layer of origin, internal echo pattern, and lesion margin were analyzed by means of consensus and independent interpretation by three radiologists. RESULTS: Endoscopic US findings revealed several distinct patterns among various submucosal tumors. Sixteen (94%) of the 17 homogeneous lesions with histopathologic findings of malignancy were hypoechoic, although 29 (43%) of the 68 homogeneous lesions with histopathologic findings of benignity were similarly hypoechoic. Homogeneous lesions that were anechoic, of intermediate echogenicity, or hyperechoic were almost exclusively benign (39 [98%] of 40). In contrast, 23 (96%) of the 24 malignant lesions were heterogeneous (n = 7) or homogeneously hypoechoic (n = 16). The sizes of benign and malignant lesions were significantly different (P < .05). There was no significant difference in the echo pattern (i.e., homogeneous versus heterogeneous), but there was a significant difference in the proportion of hypoechoic versus nonhypoechoic lesions (anechoic, hyperechoic, or of intermediate echogenicity; P < .001). CONCLUSION: The differential diagnosis of gastrointestinal submucosal tumors is assisted with endoscopic US.     

Abdominopelvic CT scan findings after surgery for ovarian cancer

AIMS: To evaluate abdomino-pelvic changes in patients who had total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) for stage I ovarian cancer. METHOD: The postoperative computed tomographic (CT) scans of 23 patients who had undergone TAH and BSO for stage I ovarian tumours between 3 and 14 weeks previously were assessed, providing there had been no treatment with chemotherapy or radiotherapy and that each patient had normal tumour marker (CA125) levels after surgery. After the CT scan patients were followed up and had no clinical or biochemical (CA125) evidence of relapse for a median of 27 months (range 11 to 78 months). The following sites were assessed by two observers: the vaginal vault, round ligaments, bladder, rectum, perirectal fat, pelvic sidewalls, omentum, surgical scar and abdominal wall. Any abnormality was recorded, with re-evaluation on follow-up CT scans in ten patients (between three and 17 months). RESULTS: The following abnormalities were seen: (1) Thickened round ligaments (n=12) with bulbous masses at the surgically transected ends (n=7). This was bilateral in eight patients. (2) Vaginal vault thickening (n=11) either uniform (n=6) or bulbous bilaterally (n=2) or unilaterally (n=3). (3) Subtle omental bed stranding or nodularity (n=11). (4) Peritoneal thickening underlying the scar (n=4). (5) Asymmetrical rectus abdominis muscles (n=3) adjacent to the surgical scar or thickened scar tissue in the anterior abdominal wall (n=4). No significant bladder, rectal, perirectal or nodal abnormalities were found. CONCLUSION: Pseudotumours at the transected ends of the round ligaments, or uniformly swollen round ligaments, may be identified in patients who have had TAH and BSO, as may vaginal vault thickening. Other changes which may be observed in the abdomen and pelvis are peritoneal thickening adjacent to the scar and omental bed stranding.     

Mediastinal hemangioma: radiographic and CT features in 14 patients

PURPOSE: To characterize the imaging features of mediastinal hemangioma. MATERIALS AND METHODS: The authors retrospectively reviewed chest radiographs and computed tomographic (CT) scans from 14 patients with mediastinal hemangioma. RESULTS: Most mediastinal hemangiomas manifested as well-marginated masses at CT. Three masses had punctate calcifications, and one had phleboliths. Five masses were of heterogeneous attenuation at unenhanced CT. Ten of 11 (91%) hemangiomas were of heterogeneous attenuation at contrast material-enhanced CT, and the following four patterns were observed: central (n = 6, 60%), mixed central and peripheral (n = 2, 20%), peripheral (n = 1, 10%), and nonspecific (n = 1, 10%) increased attenuation. Central increased attenuation was observed more frequently after administration of a bolus of contrast material than after slow infusion. CONCLUSION: Hemangiomas should be considered in the differential diagnosis of well-marginated mediastinal masses that have heterogeneous attenuation on CT scans, show central enhancement after administration of contrast material or contain punctate calcification.     

Systematic analysis of hMSH2 and hMLH1 in young colon cancer patients and controls

PURPOSE: To assess the computed tomographic (CT) and histologic findings of intrathoracic lymphoproliferative disease (LPD) associated with the Epstein-Barr virus (EBV). MATERIALS AND METHODS: The authors retrospectively reviewed the CT scans of the chest and the pathologic specimens obtained in 24 patients with histologically proved intrathoracic LPD and with positive serologic findings or immunohistochemical staining for EBV. Five patients had acquired immunodeficiency syndrome (AIDS); one had common variable immune deficiency; and 18 were receiving immunosuppressive therapy for heart, lung, or heart-lung (n =15) or bone marrow (n = 2) transplantation and vasculitis (n = 1). RESULTS: Final diagnoses included malignant lymphoma (n = 15), polyclonal LPD (n = 8), and hyperplasia of bronchus-associated lymphoid tissue (n = 1). CT findings included multiple nodules (n = 21), lymphadenopathy (n = 9), areas of groundglass opacification (n = 8), septal thickening (n = 7), consolidation (n = 5), pleural effusion (n = 4), and solitary endobronchial lesion (n = 2). The nodules were 2-4 cm in diameter, involved mainly the middle and lower lung zones, and frequently had a predominantly peribronchovascular (n = 15) or subpleural (n = 14) distribution. CONCLUSION: EBV-associated LPD may range from benign lymphoid hyperplasia to high-grade lymphoma. The most common CT manifestation consists of multiple nodules, frequently in a predominantly peribronchovascular or subpleural distribution.     

Solitary cystic tumor of the pancreas: EUS-pathologic correlation

BACKGROUND: It is clinically important to distinguish neoplastic from non-neoplastic pancreatic cysts. METHODS: Retrospective correlations were made between pathologic and EUS data from 52 pancreatic solitary cystic tumors: mucinous cystadenoma (10), mucinous cystadenocarcinoma (7), serous cystadenoma (5), ductectatic mucinous cystic tumor (10), solid and papillary epithelial neoplasm (5), and non-neoplastic cyst (15). The mean tumor size was 3.5 cm (range, 1.2 cm to 6.0 cm). RESULTS: Six classifications of the internal structures of these cysts were developed: thick wall type, tumor protruding type, thick septal type, microcystic type, thin septal type, and simple type. Although all neoplastic cysts belonged to the first four types, all non-neoplastic cysts belonged to the last two types. The accuracy of EUS for differentiating tumors was estimated at 96% and 92%, respectively, by two observers. CONCLUSIONS: EUS may become a mandatory modality for differentiating pancreatic solitary cystic tumors and choosing an optimal treatment.     

Effects of a high NaCl diet on eating and drinking patterns in pygmy goats

PURPOSE: Our goal was to determine the spectrum of 2-[18F]fluoro-2-deoxy-D-glucose (FDG) PET findings in patients with round atelectasis (RA). METHOD: All patients from 1992 to 1997 with radiologic features of RA and FDG-PET scans were evaluated. There were nine men ranging in age from 52 to 75 years (mean 65 years). All had chest radiographs and CT scans that were correlated with FDG-PET. FDG-PET was considered positive if lesion activity was greater than mediastinal activity and negative if lesion activity was the same as or less than mediastinal activity. RESULTS: Nine patients had 10 lesions, ranging in size from 1.2 to 5.0 cm (mean 3.1 cm). Lesion locations were right lower lobe (n = 5), left lower lobe (n = 4), and lingula (n = 1). All lesions were homogeneous and of soft tissue attenuation on CT. None contained air bronchograms or calcification. All had in-curving vessels and bronchi (comet tail sign), adjacent pleural thickening, and volume loss on CT. All lesions were negative on FDG-PET. Four lesions were percutaneously biopsied and showed chronic inflammation consistent with RA. Two lesions were unchanged on 2 and 3 year follow-up CT and were presumed to be RA as were four other lesions with characteristic CT features and negative FDG-PET. CONCLUSION: Our experience suggest that RA in not metabolically active on FDG-PET imaging. Thus, FDG-PET scans can play a role in differentiating RA from malignancy when there are few or atypical features of RA on chest radiographs and CT.     

Prospective study of the detection of anomalous connections of pancreatobiliary ducts during routine medical examinations

BACKGROUND/AIMS: It is important to achieve detection of of anomalous connections of the pancreatobiliary ducts (ACPBD), because this condition often leads to pancreatobiliary disease. The present prospective investigation focused on revealing the incidence of ACPBD in asymptomatic individuals undergoing medical checkups. MATERIAL AND METHODS: Extracorporeal ultrasonography (US) was performed on all asymptomatic individuals undergoing medical checkups. Identification by abdominal ultrasonography of 3 mm or more gallbladder wall thickening, or 10 mm or more dilatation of the bile duct were considered indicative of ACPBD and endoscopic ultrasonography (EUS) was carried out in selected cases. Endoscopic retrograde cholangiopancreatography (ERCP) was then performed to confirm the existence of ACPBD. RESULTS: The overall incidence of ACPBD was 0.03% (9/27,076 subjects). ACPBD was found in 23% of cases with bile duct dilatation, and in 2.9% with gallbladder wall thickening. CONCLUSION: ACPBD was not as rare a disease as expected. For early detection of ACPBD, identification by abdominal ultrasonography of gallbladder wall thickening or dilatation of the bile duct are indicative. Patients who are suspected of having this abnormality should then undergo EUS. The final diagnosis should then be made by ERCP.