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Prognosis in aplastic anemia is usually linked to the degree of hypoplasia in the bone marrow and pancytopenia in the blood. The authors were, therefore, intrigued when a patient with methimazole-associated aplastic anemia who satisfied criteria for severe disease recovered rapidly and completely once her drug was withdrawn. Review of the English language literature revealed ten fully documented cases of aplastic anemia associated with use of the antithyroid drugs methimazole, carbimazole, and propylthiouracil. Analysis of the ten and of an eleventh case presented here indicated that the disorder is typically characterized by severe pancytopenia and profound marrow hypoplasia, yet surprisingly good prognosis, ie, minimum survival of more than 70% with partial or complete recovery from symptoms and cytopenias in survivors within 2–5 weeks. The only deaths, both in the 1950s, were from brain hemorrhage in patients who were not transfused with platelets. The discrepancy between the clinical and laboratory severity of antithyroid drug-associated aplasia, on the one hand, and its relatively good prognosis and short term course, on the other, should be kept in mind when considering these patients for bone marrow transplantation or for therapy with antithymocyte globulin.

Midline cysts in the male pelvis are a confusing entity due to their relatively infrequent presentation and the uncertainty as to their origin and classification. We report on CT appearance of four cases of midline prostatic cysts. Ultrasound correlation was available in one case. Two patients presented with lower urinary tract symptoms (hematospermia and/or hematuria), and two were asymptomatic, with one case detected on physical examination and one found incidentally on CT. Computed tomography demonstrated a characteristic sharply marginated, low density, homogeneous midline cyst within the prostate. On ultrasound a well defined midline anechoic cystic mass was seen. These cases are illustrated and a discussion of cystic masses in the male pelvis is included.

The computed tomographic (CT) appearance of 5 cases of primary malignancy of the renal pelvis causing ureteropelvic junction (UPJ) obstruction is presented. The tumors appeared as enhancing thickened, nodular, and crescentic masses at the UPJ. Comparison is made to the thin, regular wall of the hydronephrotic pelvis caused by congenital UPJ obstruction. Differentiation from other causes of UPJ obstruction by CT is discussed. A CT scan is particularly valuable when the cause of UPJ obstruction remains elusive after urography and pyelography.

A 35-year-old man presented with a bullous eruption similar to erythema multiforme following the administration of high doses of busulfan therapy for chronic granulocytic leukemia. There was pancytopenia, hypoplasia of the bone marrow, elevation of serum vitamin B12 and B12 binding capacity and a paradoxical elevation of the leukocyte alkaline phosphatase level. Discontinuation of the busulfan and the administration of prednisone were followed by gradual healing of the skin lesions, reversal of the pancytopenia and reduction of the leukocyte alkaline phosphatase activity to zero. This case illustrates an unusual and previously unreported untoward response to busulfan and is another example of the capacity of the leukocytes in some patients with chronic granulocytic leukemia to develop high alkaline phosphatase activity in response to inflammation.

Appendectomy was safely performed in a 9-year-old boy with classic hemophilia, and hemostasis was achieved by the use of cryoprecipitated human antihemophilic globulin therapy begun preoperatively and continued for 17 days. Except for urticaria, the use of cryoprecipitated factor VIII was entirely free of side effects. Cryoprecipitated factor VIII is unique among all factor VIII concentrates prepared heretofore in that it is a by-product of plasma fractionation. It may be simply and economically prepared in any blood bank geared to plasma fractionation procedures and may be stored for months without loss of potency. As such cryoprecipitated factor VIII is soon expected to become generally available. The broad clinical use of a potent human factor VIII concentrate holds promise of further reducing the risk and morbidity of bleeding in hemophilia and of permitting safe elective as well as life-saving surgery.

Presents a letter to the editor concerning Eric Trefelner's "Perturbations" column in March 2005 issue of "Diagnostic Imaging" concerning overuse of emergency room imaging.

Computed tomography is currently used as an adjunct to oral contrast studies in the diagnosis and management of esophageal and posterior pharyngeal perforation. We present the CT findings of a surgically proven iatrogenic pyriform sinus perforation. Although extravasation of contrast material was depicted by pharyngography, the site of perforation could not be demonstrated. Knowledge of the pattern of spread of pharyngeal neoplasms was essential for correct interpretation of CT. In our patient the perforation was caused by traumatic passage of an Ewald tube, an unusual and previously unreported complication.

Multiple adrenal pseudotumors have been previously described on CT and routine radiography. In the following case report we demonstrate interposition of normal colon between the liver, kidney, and adrenal in the hepatorenal recess that produced the CT appearance of a pseudotumor of the right adrenal gland.

A letter to the editor about medical error and negligence lawsuits is presented.

Presents a letter to the editor in response to the article "Expert witness review helps protect patients," by Richard Chesbrough in the November 2003 issue of "Diagnostic Imaging".