[Show abstract][Hide abstract] ABSTRACT: Aortic thrombus is a rare condition unless there is an underlying wall pathology such as atherosclerosis, aneurysm, dissection, or thrombus within the left heart chambers. It causes visceral or peripheral embolisms, and is fatal, if not treated. These characteristics make early diagnosis and therapy essential. We report here the computed tomography findings of a floating thrombus that hanged on to the normal aortic wall with a thin peduncle and caused peripheral embolism in a 58-year-old lymphoma patient who had no evident source of emboli.
[Show abstract][Hide abstract] ABSTRACT: To evaluate computed tomography (CT) findings of pulmonary infections in immunocompromised patients with hematologic malignancies, and to detect the accuracy of first-choice diagnoses.
CT chest scans of 57 immunocompromised patients who had pulmonary infections were evaluated retrospectively, and a first and second interpretation of etiology (first- and second-choice diagnosis) was proposed. The etiology of pulmonary infection was verified by microbiological tests such as blood, sputum, bronchoalveolar lavage (BAL) cultures, sputum, and BAL smears, or diagnosed on the basis of response to treatment and clinical follow-up.
Nineteen patients had a bacterial infection, 20 patients had a fungal infection, 8 patients had a cytomegalovirus (CMV) infection, 8 patients had Pneumocystis jiroveci pneumonia (PCP) and 2 patients had a Mycobacterium tuberculosis infection. There were consolidations in 13 patients (68.4%) and areas of ground-glass attenuation and ground-glass nodules in 6 patients (31.6%) with bacterial infection. Six of 8 eight patients (75%) with CMV infection had centrilobular nodules associated with bronchial wall thickening and ground-glass areas and nodules. There were parenchymal nodules in 18 of 20 patients (90%) who had a fungal infection. All 8 patients who had PCP had bilateral areas of ground-glass densities on CT scans. The first-choice diagnosis was accurate in most of the fungal infections (95.0%) and PCP (87.5%), but was less accurate for bacterial and viral infections (73.7% and 75.0%, respectively). Neither of the 2 tuberculous infections was identified on the basis of CT findings.
In the evaluation of febrile immunocompromised patients, pulmonary fungal infection and PCP may be identified with high accuracy on the basis of CT findings.
[Show abstract][Hide abstract] ABSTRACT: We report a case of organizing pneumonia (OP) that developed after radiation therapy (RT) for breast cancer. A 54-year-old woman presented with malaise and fever within a month after the completion of RT for breast cancer. Chest radiographs and computed tomography (CT) demonstrated consolidation in the left upper lobe consistent with radiation pneumonia. The patient was given 60 mg/day IV cortisone for 15 days after which her complaints and consolidation in the left upper lobe disappeared. The daily dose of her corticosteroid was tapered down to 20 mg/day. Two weeks later, the patient again had fever and malaise. Chest X-ray and CT revealed bilateral pulmonary opacities located outside the irradiated fields, predominantly in the middle and lower lung zones. The patient's laboratory tests were normal except for her erythrocyte sedimentation rate, which was elevated. Bronchial lavage revealed moderate elevation of the total cell number with lymphocyte predominance. Open lung biopsy was performed and histopathological examination demonstrated findings consistent with OP. High dose (60 mg/day) prednisolone treatment resulted in rapid clinical and radiological improvement. When the prednisolone dose was gradually tapered down to 20 mg/day during follow-up, new pulmonary opacities developed in both lungs, as well as the recurrence of the patient's symptoms. Increased dose of prednisolone resulted in the rapid improvement of the clinical symptoms and radiological abnormalities. OP rarely presents after RT for breast and lung cancer. One should always consider OP in the clinical setting of a patient who has a history of RT completed 3-6 months prior to fever, multiple areas of consolidation, and ground glass opacities outside the RT field.
[Show abstract][Hide abstract] ABSTRACT: We report a breast mass associated with a foreign body mimicking malignancy on mammography. Although retained penrose drains have been reported in other parts of the body, our case is the first report of a retained penrose drain in breast diagnosed by mammography. Mammography can be used if there is suspicion of a retained penrose drain during the course of breast abscess treatment.
[Show abstract][Hide abstract] ABSTRACT: Our aim was to evaluate the positive predictive value (PPV) of the analysis of breast microcalcifications according to Breast Imaging Reporting and Data System (BI-RADS) and Le Gal's classification in identification of malignancy, and to assess the interobserver agreement using these criteria.
Eighty-two patients with breast microcalcifications on their screening mammograms underwent surgical excision after a needle localization at our institution between July 1993 and June 2000. The mammograms were examined by two experienced mammographers retrospectively and independently. Each observer noted the morphology, distribution, associated findings, final assessment categories of microcalcifications according to BI-RADS criteria and the morphologic type of microcalcifications according to Le Gal's classification. The PPVs for each radiologist and the interobserver agreement were determined by using these data and histologic findings.
Histopathologic results yielded malignancy in 25 (30%) cases. The evaluation of microcalcifications according to BI-RADS criteria revealed PPVs of 17% and 25% for category 4 lesions, and 68% and 44% for category 5 lesions. In the assessment of microcalcifications according to Le Gal's classification, the PPV of type 4 lesions was 45% (for both observers), whereas the PPVs of type 5 lesions were 70% and 50%. The interobserver agreement was fair in evaluation of morphology of microcalcifications (kappa:0.31), distribution of microcalcifications (kappa:0.29), final assessment categories (kappa:0.27), and moderate in evaluation of associated findings (kappa:0.48) by using BI-RADS lexicon. It was higher for the assessment of milk of calcium and round microcalcifications than other typically benign microcalcifications, and for fine linear or fine linear branching microcalifications than other probably malignant calcifications. There was a fair interobserver agreement (kappa:0.30) in the description of the morphologic type of microcalcifications according to Le Gal's classification.
In our study, both BI-RADS lexicon and Le Gal's classification did not succeed expectedly in reducing the ambiguity in assessment of breast microcalcifications. Further studies and perhaps development of new methods are required to improve accuracy and standardization in mammographic interpretation.
European Journal of Radiology 10/2003; 47(3):227-31. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A case of anomalous (subaortic) position of the left brachiocephalic vein was incidentally detected on computed tomography images. Magnetic resonance angiography was performed to demonstrate the relationship of this vessel with other vascular structures. The anomalous vein was formed by the union of the left internal jugular and left subclavian veins. This vein passed downward along the left lateral side of the aortic arch, entered the aorticopulmonary window, descended in the mediastinum between the ascending aorta and the trachea and joined with the right brachiocephalic vein to form the superior vena cava. No cardiac anomalies accompanied the subaortic left brachiocephalic vein in the present case. We present the computed tomography and magnetic resonance angiography findings of this rare anomalous vein.
Surgical and Radiologic Anatomy 07/2003; 25(3-4):335-8. · 1.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the mammographic features of nonpalpable spiculated lesions in order to find differentiating findings between malignant and benign pathologies.
Standard mammograms of 27 patients with 28 nonpalpable spiculated lesions were evaluated retrospectively. Two dimensions of dense centre of the spiculated lesions were measured and the mean dimensions were compared in analysing the malignant and benign features. Fine radiolucent lines between dense spicules were noted.
Thirteen spiculated lesions (46.4%) were malignant and 15 were benign. Eleven malignant lesions (84.6%) have dense centre larger than 5 mm, whereas only four benign lesions (26.7%) had a dense core larger than 5 mm. There were fine radiolucent lines parallel to dense spicules in 5 malignant lesions (38.5%) and in 13 benign lesions (86.7%). Only one invasive carcinoma and one radial scar with florid ductal epithelial hyperplasia and papillomatosis had punctate calcifications. The sensitivity and specificity of the dense core larger than 5 mm for malignancy were 84.6% and 73.3%, respectively. The sensitivity of radiolucent lines for benign lesions was 86.7% and the specificity was 61.5%.
When the dense centre of a nonpalpable spiculated lesion is larger than 5 mm, the probability of malignant pathology increases. The fine radiolucent lines between dense spicules may indicate benign etiology. However, there is no reliable mammographic feature differentiating benign spiculated lesions from carcinomas. Therefore, all of them should be diagnosed pathologically unless they are postsurgical.
[Show abstract][Hide abstract] ABSTRACT: We present CT findings of a young woman who has bilateral pulmonary nodules mimicking metastases. Clinical presentation with active multiple pulmonary macronodules without cavitation responsive to treatment is an atypical manifestation of pulmonary tuberculosis. We reviewed the causes of multiple pulmonary nodules, role of radiological findings in differential diagnosis and parenchymal manifestations of pulmonary tuberculosis in this report.
European Journal of Radiology 11/2002; 44(1):33-6. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mammographic, ultrasonographic and MR imaging features in a patient with non-Hodgkin's lymphoma are reported in this paper. Mammography and ultrasonography revealed ill-defined, round masses with skin thickening. Precontrast T1W images demonstrated multiple well-defined, hypointense masses, which showed rapid rim enhancement in dynamic postcontrast sequence. The enhancement rate indicated malignant pathology. MR imaging demonstrated the extent of involvement more apparently than conventional imaging. Although, not pathognomonic for lymphoma, MR imaging may be helpful in evaluation and follow-up of breast masses in patients with previous lymphoma.
European Journal of Radiology 05/2002; 42(1):62-4. · 2.51 Impact Factor