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Background Lung ultrasound (LUS) has been successfully used in the diagnosis of different pulmonary diseases. Present study design to determine the diagnostic value of LUS in the evaluation of children with COVID-19. Method and objectives Prospective multi-center study, 40 children with confirmed COVID-19 were included. LUS was performed to all patients at admission. The chest X-ray and CT were performed according to the decision of the primary physicians. LUS results were compared with chest X-ray and CT findings and diagnostic performance was determined. Results Of the 40 children median (range) was 10.5 (0.4-17.8) years. Chest X-ray and LUS were performed on all and chest CT was performed on 28 (70%) patients at the time of diagnosis. Sixteen (40%) patients had no apparent chest CT abnormalities suggestive of COVID-19, whereas 12 (30%) had abnormalities. LUS confirmed the diagnosis of pulmonary involvement in 10 out of 12 patients with positive CT findings. LUS demonstrated normal lung patterns among 15 patients out of 16 who had normal CT features. The sensitivity and the area under the ROC curve (AUC) identified by the chest X-ray and LUS tests were compared and statistically significantly different (McNemar's test: p-value 0.016 and 0.001 respectively) detected. Chest X-ray displayed false-negative results for pulmonary involvement in 75% whereas for LUS it was 16.7%. Conclusions LUS might be a useful tool in the diagnostic steps of children with COVID-19. A reduction in chest CT assessments may be possible when LUS is used in the initial diagnostic steps for these children. This article is protected by copyright. All rights reserved.

Background Invasive mucinous adenocarcinoma (IMA) of the lung is a rare and distinct subtype of adenocarcinoma that can appear as airspace opacities on computed tomography (CT). In daily practice, we have occasionally encountered spontaneous regression of airspace opacities (SRAs) without treatment on serial CTs in patients with IMAs, which has not previously been described in the literature. Here, we describe serial CT findings with emphasis on SRAs in relation to clinicopathological features and treatment outcomes in patients with IMAs. Methods A total of 46 patients with pathologically‐confirmed IMAs of the lung from January 2013 to June 2018 were included. Serial CT scans were reviewed and the patients were classified into SRA and no‐SRA groups according to the presence of SRA. Radiological features, clinicopathological characteristics, and treatment outcomes were compared between the SRA and no‐SRA groups. Results A total of 32 patients were included in the no‐SRA group and 14 patients in the SRA group. IMAs in the SRA group were mostly pneumonic (P, Invasive mucinous adenocarcinomas (IMAs) of the lung can show spontaneous regression of airspace opacities (SRAs) on serial CTs, not correlated with the administration of anticancer drugs. IMAs that show SRAs demonstrated reduced overall survival in patients. When airspace opacity shows regression on CT, IMA should still be included in the differential diagnosis and a more careful application of RECIST 1.1 is needed in the assessment of tumor response of IMAs.

Orleans Parish in Louisiana is in the midst of an exponentially increasing number of patient admissions with COVID‐19 and respiratory symptoms. Patients have been described having CT findings most consistent with an early‐stage (

In rare cases, foreign body aspiration may present with similar clinical features and CT findings to subglottic stenosis. A high index of suspicion and additional diagnostic techniques may be required to distinguish them.

The diagnosis and treatment of nasal foreign bodies usually includes a combination of rhinoscopy and imaging techniques, such as CT. The purpose of this retrospective, multicenter study was to describe the CT characteristics of nasal foreign bodies in dogs and cats and to determine if different nasal CT features exist between acute and chronic cases. Twenty dogs and six cats met the inclusion criteria. Eleven nasal foreign bodies (42%) were detected confidently with CT. The foreign body had a linear shape in 81% of cases and displayed a "tubular-like appearance" in 54% of cases. In five cases (19%), a foreign body was suspected but not clearly visible. Additional CT changes were present in the nasal passages in 96% of the cases. The presence of turbinate destruction (P = .021) and mucosal thickening (P = .014) on CT were associated with the presence of a chronic nasal foreign body. In this sample, the nature of the foreign body did not influence its visibility and was not associated with specific CT characteristics. Computed tomography may be useful in the investigation of nasal foreign bodies, however, a negative CT examination does not exclude their presence.

Extramedullary hematopoiesis (EMH) is the formation and development of blood cells outside the bone marrow, and in dogs it frequently occurs in the spleen. Although splenic EMH is a relatively common condition, data regarding its appearance in veterinary medicine are lacking. Our aim was to describe different multidetector computed tomographic (MDCT) features of splenic EMH in dogs. In this descriptive retrospective study, dogs with cytological diagnosis of splenic EMH and three-phase MDCT study of the abdomen were included. Multi-detector CT findings recorded were splenomegaly, appearance of the parenchyma, and mean attenuation of the spleen and lesions. Out of 89 dogs included, 55 (62%) presented multifocal nodular aspect, 14 (16%) mass, 12 (13%) diffuse heterogeneous parenchyma, and eight (9%) normal spleen. Most lesions were hyperattenuating to the parenchyma in the arterial (57/89, 64%) and portal (59/89, 66%) phases; whereas in the interstitial phase only 40 of 89 (45%) were hyperattenuating. The mean attenuations of the lesions were higher compared to the values of the adjacent spleen, and the difference of the mean attenuation between the hyperattenuating lesions and the parenchyma was significantly higher in arterial and portal phases than in interstitial phase (P < .0001). The most frequent MDCT aspect of splenic extramedullary hematopoiesis consists of multiple nodules hyperattenuating to the normal spleen, best visualized in the arterial and portal phases.

Objectives Detection of B-line in dyspneic patients is often accompanied by abnormal changes of pleural line on transthoracic ultrasonography (TUS). The aim of the study was to evaluate the relevance and diagnostic performance of pleural line abnormalities and B-lines detected on high-resolution TUS against the computed tomography (CT) findings. Methods Transthoracic ultrasonography was performed in patients admitted to the emergency department with dyspnea. The pleural line and accompanying B-line were assessed using a linear transducer. The TUS findings were assessed against the corresponding high-resolution CT findings in the same location, which were considered to be the gold standard. Results Out of a total of 116 patients, 68.1% had changes of the pleural line on TUS. The characteristic changes of the pleural line were classified into four types: slightly rough pleural line with confluent B-lines on TUS corresponded with CT findings of ground-glass opacity; irregular and interrupted pleural line with confluent B-lines corresponded with parenchymal infiltration; fringed pleural line with confluent B-lines corresponded with superimposed ground-glass and irregular reticular opacities; and fringed pleural line with scattered B-lines corresponded with irregularly thickened interlobular septa. Wavy pleural line indicated subpleural emphysema. The coexistence of more than one abnormal pleural line was also found in 31 cases (26.7%). Conclusions High-resolution TUS may help in the initial assessment of lung pathology by its ability to identify pleural line abnormalities and B-lines that are shown to be associated with CT, which could add diagnostic value in the emergency evaluation of dyspneic patients.

This is the first report of a case of COVID‐19 after allogeneic stem cell transplantation. Our case suggests that COVID‐19 may exist without characteristic CT images, especially in immunocompromised hosts, such as patients after transplantation.

The CT "sentinel clot sign" has been defined as the highest attenuation hematoma adjacent to a bleeding organ in humans with hemoabdomen. The aims of this retrospective descriptive multicenter study were to describe CT findings in a sample of dogs with surgically or necropsy confirmed intra-abdominal bleeding and determine prevalence of the "sentinel clot sign" adjacent to the location of bleeding. Medical records between 2012 and 2014 were searched for dogs with hemoabdomen and in which the origin of the bleeding was confirmed either with surgery or necropsy. Retrieved CT images were reviewed for the presence and localization of the "sentinel clot sign," HU measurements of the "sentinel clot sign" and hemoabdomen, and presence of extravasation of contrast media within the abdominal cavity. Nineteen dogs were included. Three dogs were excluded due to the low amount of blood that did not allow the identification of a "sentinel clot sign." A "sentinel clot sign" was detected in the proximity of the confirmed bleeding organ in 14/16 (88%) of the patients. The mean HU of the "sentinel clot sign" was 56 (range: 43-70) while that of the hemoabdomen was 34 (range: 20-45). Active hemorrhage was identified as extravasation of contrast medium within the peritoneal cavity from the bleeding organ in three dogs. In conclusion, the CT "sentinel clot sign" may be helpful for identifying the source of bleeding in dogs with hemoabdomen.

Computed tomography (CT) is increasingly applied as an aid to clinical decision making in congenital heart disease (CHD) with regard to surgery, interventional catheterizations, and follow-up. It is particularly useful for the assessment of vascular and airway abnormalities. Updated knowledge of CT imaging techniques is mandatory not only for the optimization of image acquisition protocols, but also for the postprocessing reconstruction and interpretation of CT findings. The purpose of this article was to review the clinical indications, techniques, and dose reduction methods for CT imaging in children and adults with CHD. Relevant discussion and illustrations of common forms of CHD evaluated by CT are presented.

Background Our study investigated the diagnostic value of the mineralization findings and high-density secretion features of sinus computed tomography (CT) images in cases of chronic rhinosinusitis (CRS) compared to histopathology and operative findings. Methods This was a prospective cohort study of 193 patients consecutively enrolled for endoscopic sinus surgery (ESS). Group 1 had mineralization in the sinus; group 2 had high-density secretions in the sinus but no mineralization; group 3 lacked both high-density secretions and evidence of mineralization. Intergroup comparisons were performed for histopathology (especially presence of fungus ball), CT scores, and gross operative appearance. Results Histopathologic evidence of fungus ball (FB) compared to presence of CT findings was significantly different between the groups, with the following percentages of patients demonstrating FB presence: 33% of group 1 (CT mineralization) (n = 48); 4% of group 2 (CT hyperdensity) patients (n = 25); and 2% of group 3 (no mineralization, no hyperdensity) patients (n = 120) (p < 0.05). Operative findings did not necessarily correlate with CT findings and all groups demonstrated varying amounts of dry cheesy (DCM) or wet clay-like (WCLM) material, though this was slightly higher in groups 1 and 2. Conclusion A preoperative survey of sinus mineralization and high-density secretion features observed with CT was predictive of operative findings and histopathological results indicating a sinus FB.

Summary 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT is commonly used to assess tumour recurrence in high-risk patients with malignant melanoma (MM). However, results can be ambiguous either because of the CT's insufficient soft-tissue contrast or non-specific FDG accumulation caused by inflammation. Ultrasound (US) can provide additional morphologic information that is superior to CT. For precisely combining PET and US findings, we used a real-time fusion technique based on navigated US (PET/US fusion). Here, we describe our results from patients where PET/US fusion proved helpful in differentiating unclear PET/CT findings. This fusion technique is likely to be helpful for decision making in MM patients and biopsy guidance.

Objective. To study the computed tomography(CT) images of royal Ancient Egyptian mummies dated to the 18th to early 20th Dynasties for the claimed diagnoses of ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) and to correlate the findings with the archaeology literature.Methods. We studied the CT images of 13 royal Ancient Egyptian mummies (1492–1153 BC) for evidence of AS and DISH and correlated our findings with the archaeology literature.Results. The findings of the CT scans excluded the diagnosis of AS, based on the absence of sacroiliac joint erosions or fusion of the facet joints. Four mummies fulfilled the diagnostic criteria for DISH:Amenhotep III (18th Dynasty), Ramesses II, his son Merenptah, and Ramesses III (19th to early 20th Dynasties).The diagnosis of DISH, a commonly a symptomatic disease of old age, in the 4 pharaohs is in concordance with their longevity and active lifestyles.Conclusion. CT findings excluded the diagnosis of AS in the studied royal Ancient Egyptian mummies and brought into question the antiquity of the disease. The CT features of DISH during this ancient period were similar to those commonly seen in modern populations,and it is likely that they will also be similar in the future.The affection of Ramesses II and his son Merenptah supports familial clustering of DISH. The process of mummification may induce changes in the spine that should be considered during investigations of disease in ancient mummies.

Emergency department (ED) management of mild traumatic brain injury (TBI) patients with any form of traumatic intracranial hemorrhage (ICH) is variable. Since 2000, our center's standard practice has been to obtain a repeat head computed tomography (CT) at least 6 hours after initial imaging. Patients are eligible for discharge if clinical and CT findings are stable. Whether this practice is safe is unknown. This study characterized clinical outcomes in mild TBI patients with acute traumatic ICH seen on initial ED neuroimaging.This retrospective cohort study included patients presenting to the ED with blunt mild TBI with Glasgow Coma Scale (GCS) scores of 14 or 15 and stable vital signs, during the period from January 2001 to January 2010. Patients with any ICH on initial head CT and repeat head CT within 24 hours were eligible. Cases were excluded for initial GCS14, injury24 hours old, pregnancy, concomitant nonminor injuries, and coagulopathy. A single investigator abstracted data from records using a standardized case report form and data dictionary. Primary endpoints included death, neurosurgical procedures, and for discharged patients, return to the ED within 7 days. Differences in proportions were computed with 95% confidence intervals (CIs).Of 1,011 patients who presented to the ED and had two head CTs within 24 hours, 323 (32%) met inclusion criteria. The median time between CT scans was 6 hours (interquartile range = 5 to 7 hours). A total of 153 (47%) patients had subarachnoid hemorrhage, 132 (41%) patients had subdural hemorrhage, 11 (3%) patients had epidural hemorrhage, 78 (24%) patients had cerebral contusions, and 59 (18%) patients had intraparenchymal hemorrhage. Four of 323 (1.2%, 95% CI = 0.3% to 3.2%) patients died within 2 weeks of injury. Three of the patients who died had been admitted from the ED on their initial visits, and one had been discharged home. There were 206 patients (64%) discharged from the ED, 28 (13.6%) of whom returned to the ED within 1 week. Of the 92 who were hospitalized, three (0.9%, 95% CI = 0.2% to 2.7%) required neurosurgical intervention.Discharge after a repeat head CT and brief period of observation in the ED allowed early discharge of a cohort of mild TBI patients with traumatic ICH without delayed adverse outcomes. Whether this justifies the cost and radiation exposure involved with this pattern of practice requires further study.

Intussusception of the appendix is an uncommon condition that is difficult to diagnose with radiology. Endometriosis causing appendiceal intussusception is a rare condition that has only been reported a few times in the literature. Here, we report a case of appendiceal intussusception caused by endometriosis in a 33-year-old woman who presented with intermittent right lower abdominal pain. Sonography revealed a hypoechoic mass invaginating into the cecum, which was covered by echogenic cecal wall with central dimpling indicating the appendiceal orifice. On CT, the mass was identified as an enhancing mass invaginating into the cecum at the level the appendiceal orifice.

A three-year-old Border collie was diagnosed with a bipartite atlas and bilateral forelimb hypodactyly. The dog showed signs of acute, non-progressive neck pain, general stiffness and right thoracic limb non-weight-bearing lameness. Computed tomography imaging revealed a bipartite atlas with abaxial vertical bone proliferation, which was the cause of the clinical signs. In addition, bilateral hypodactyly of the second and fifth digits was incidentally found. This report suggests that hypodactyly may be associated with atlas malformations.

Congenital agenesis of the submandibular gland is uncommon. We report dynamic sonography and CT findings of the unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland tissue through the mylohyoid gap. The dynamic sonography examination applied at rest and during the modified Valsalva maneuver demonstrated hypertrophied sublingual gland prolapsing to the anterior part through the mylohyoid gap. This may be the first reported case describing dynamic sonography findings of this entity. CT confirmed the agenesis of the left submandibular gland and compensatory hypertrophy of the ipsilateral sublingual gland.

Background and objective: The development of computed tomography (CT) findings usually precedes the diagnosis of pulmonary nontuberculous mycobacterial infection. The utility of specific CT scan features, although often available long before respiratory sample cultures, is not fully understood. We sought to assess associations among CT features, symptoms and microbiological disease criteria in pulmonary Mycobacterium xenopi isolation. Methods: We reviewed 70 consecutive immunocompetent patients with pulmonary M. xenopi isolation and classified them according to the American Thoracic Society (ATS) diagnostic criteria for disease. ‘Definite disease’ patients (n = 16) met modified ATS criteria. ‘Possible disease’ patients (n = 10) met microbiological criteria, had abnormal CT scans, but data regarding symptoms were unavailable. ‘No disease’ patients (n = 44) had only one positive sputum culture, or were asymptomatic or had no relevant CT findings. Two radiologists, without knowledge of the clinical or microbiological information, independently reviewed the scans. Results: The mean (standard deviation) age of all patients was 63 (16) years, and 39% were women. Patients with ‘definite disease’ usually had nodules (88%) and cavities (63%), but less often bronchiectasis (50%) and tree-in-bud (50%). Patients with ‘possible’ or ‘no disease’, respectively, had nodules (100% or 80%), bronchiectasis (40% or 18%) or tree-in-bud (40% or 11%). Cavitation (P ≤ 0.0001) and nodules ≥5 mm (P = 0.0002) were associated with fulfilled microbiological criteria for disease. Bronchiectasis (P = 0.02) and nodules

A seven-month-old Cocker Spaniel had a cough, acute lethargy, decreased responsiveness, and episodes of hyperexcitability. There were bilateral generalized increased lung sounds, bilateral episcleral hemorrhage, and systemic hypertension. Prolonged buccal mucosal bleeding time and elevated D-dimer concentrations were detected. Radiographically, there was a generalized moderate unstructured interstitial pattern. In thoracic CT images, there was a diffuse moderate hyperattenuating appearance of the bronchial walls and interstitium and diffuse areas of moderate bronchiectasis. The brain CT images were characterized by marked hyperattenuating well-defined masses. In addition, there were smaller hyperattenuating and hypoattenuating masses scattered throughout the cerebral and cerebellar parenchyma. A zinc sulphate flotation test confirmed large numbers of Angiostrongylus vasorum L1 larvae. Despite therapy the dog continued to deteriorate and underwent euthanasia. Postmortem examination confirmed the presence of multiple intracranial and extracranial hemorrhages. Angiostrongylosis should be considered as one of the differential diagnoses in dogs presenting with neurologic signs consistent with acute intracranial haemorrhage.

Background: Pituitary pars intermedia dysfunction (PPID) is the most common endocrinologic disorder of aged horses. Hypothesis/Objectives: Pituitary glands of PPID-affected horses are larger than those of aged horses without signs of PPID, and the size difference can be detected using computed tomography (CT) imaging. Animals: Eight horses with clinical signs of PPID and supportive endocrinologic test results and 3 aged control (PPID-negative) horses. Methods: Computed tomography examination of the brain and pituitary gland was performed twice in 10 of the 11 horses, approximately 6 months apart. Six PPID-affected horses were treated with pergolide for 6 months between CT scans. The second CT scan was followed by euthanasia and pathologic examination of 6 PPID-affected horses (4 treated horses). Results: On initial examination, pituitary glands of PPID-affected horses were larger in height (P

Purpose of the study: To evaluate the usefulness of C-arm computed tomography (CT) during superselective intra-arterial infusion chemotherapy for advanced head and neck carcinoma. Methods: C-arm CT was performed during superselective intra-arterial infusion chemotherapy for 11 patients with advanced head and neck carcinoma located in the hypopharynx (n = 3), maxillary sinus (n = 3), oropharynx (n = 1), larynx (n = 1), extra-auditory canal (n = 1), tonsil (n = 1) and tongue (n = 1). The usefulness of C-arm CT during superselective catheterisation was evaluated. Results: On arteriography, nine tumours showed tumour stains and two in the oropharynx or tonsil showed no obvious tumour stains. C-arm CT was performed one to four times (mean ± standard deviation, 2.5 ± 0.8) in each patient during a single procedure. C-arm CT clearly showed not only the vascular territory of the selected branch but also the tumour itself in all patients. Intra-arterial infusion chemotherapy was performed through one to three branches (mean, 1.7 ± 0.9) according to C-arm CT findings without any complications. Conclusion: C-arm CT during superselective intra-arterial infusion chemotherapy was useful to determine the arterial supply of head and neck carcinoma. C-arm CT may replace conventional CT during superselective arteriography in this procedure.

Objective: We performed transesophageal echocardiography (TEE) and computed tomography (CT) on patients with aortic pathology to describe a more anatomically coherent marker on TEE studies by using the celiac artery as a reference. Background: As there are no anatomic markers for the eight-vertebrae long descending thoracic aorta, aortic disease (AD) is routinely reported as a distance from the dental incisors in TEE studies. This method does not provide an anatomically accurate location of AD relative to recognizable anatomy. Methods: Ten patients referred for contrast CT and TEE for evaluation of embolic events were studied. Twenty-seven focal aortic lesions found on TEE were measured relative to their distance from the celiac artery. The agreement among the two methods of quantification of aortic lesions from the celiac artery was assessed by univariate regression analysis and by the Bland–Altman method. Difference in the mean values between the two groups was analyzed by paired t-test. Results: The P value for the two-tailed t-test for the difference between the two modalities was 0.122. The Pearson coefficient for comparison of CT and TEE data was 0.98. The coefficient of determination for TEE versus CT data was 0.96. Conclusions: The TEE CA reference marker proves to be an accurate method for localizing disease in the descending thoracic aorta relative to CT findings. Reporting of aortic disease relative to this marker is more clinically applicable than the current method of measurement. The CA reference marker should be routinely reported in TEE studies to enhance the diagnosis of aortic disease. (Echocardiography 2010;27:1093-1097)

We describe the findings on computed tomography (CT) in a prenatally diagnosed case of bladder exstrophy, and compare them with the findings on two- and three-dimensional sonography. The CT data of the affected fetus were compared with the CT findings of 14 fetuses with normal bony pelvises. The CT images showed differences in the structure of the bony pelvis in the case of bladder exstrophy, with a wide gap between the iliopubic and ischiopubic rami and a widening of the iliac bones. CT scanning was useful in confirming the sonographic diagnosis of bladder exstrophy, and it may also be helpful for planning early surgery following delivery. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

SUMMARY Computed tomography scan findings are described in cerebral arterial gas embolism in two patients with right to left intracardiac shunts by accidental injection of air during intravenous therapy. Although imaging may not be necessary to diagnose the condition, the patient may be referred to CT scan as a case of stroke. Cerebral arterial gas embolism should be considered in the differential diagnosis of stroke, particularly in case of right-to-left shunts. CT findings described are classical and diagnostic of the condition.

To propose a CT-based method for early identification of severe cases of malignant external otitis (MEO) by correlating between initial CT findings and clinical course.Eighteen MEO patients who underwent CT on admission were included in this retrospective study conducted at a tertiary center. The number and extent of anatomical areas involved according to CT were compared to clinical course severity.The patients were categorized into two groups according to clinical course. There were 13 patients in the "nonsevere" group and 5 in the "severe." In six out of eight CT anatomical areas the "severe" group had significantly higher scores (P0.05 to P0.0005). The average number of areas involved in the "nonsevere" group was 2.9 and in the "severe" 5.4 (P0.0005).We found a clear correlation between clinical course and initial CT findings in MEO patients. Based on these findings it may be possible to predict clinical course severity according to initial CT.

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with the nasopharynx. The aim of this study was to investigate and analyse the CT findings in such cases. Seven patients with CCA were included in our study over a 3-year period (2001-2004). All had a CT scan of the nasal cavity and nasopharynx to establish the diagnosis and to define the extent and type of atresia. The choanal atresia was found to be more commonly bilateral and more of the mixed (membranous-osseous) type. Bilateral CCA in the neonate is a medical emergency that should be treated as early as possible. Computed tomography is a valuable and easily accessible diagnostic tool.

Purpose. To evaluate the sonographic findings of mesenteric panniculitis (MP) and correlate them with CT findings. Methods. We retrospectively evaluated the clinical, CT, and sonographic findings in 26 cases of MP in our hospital between January 1997 and July 2003. We also reviewed the sonographic features of MP previously described in the literature. Results. The sonographic findings were well correlated to CT in 24 of 26 patients (92%). In these 24 cases, abdominal sonographic examination revealed a hyperechogenic, well-defined fatty mass (corresponding to the pseudocapsule CT sign) in the root of the mesentery, displacing the bowel loops. We found a clear interface between MP and normal intra abdominal fat. Examination with color Doppler sonography revealed the nondeviated mesenteric vessels within the mass. The persence of MP improved sonographic transmission in 9 obese patients and enabled the retroperitoneal vessels to be clearly visualized. Sonography was unable to demonstrate the preservation of the fat nearest the mesenteric vessels corresponding to the “fatty halo” sign on CT. Conclusions. Sonography is useful in the diagnostic workup for MP. The characteristic sonographic features of MP (well-defined mass, homogeneous hyperechogenicity of the mass, nondeviated vessels within the mass, and displaced bowel loops) correlate well with CT findings. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:169–176, 2006

Computed tomography (CT) of the thorax was performed in 28 dogs and five cats and findings were compared with previous thoracic radiographs. The sample population included all animals that had thoracic radiographs and a CT study within 5 days of each other, where the complete imaging studies were available for review. Thoracic radiographs were considered indeterminate in 31 patients and CT examinations were done to acquire additional information. The presence of additional information from CT relating to presence of pathology, location of pathology, extent of pathology, and involvement of mediastinal structures was recorded. Whether there was a change in diagnosis based on the CT findings was also recorded. In only 4/33 animals (all dogs) did CT fail to provide any new information for the parameters evaluated when compared with survey thoracic radiographs. Additional information about the pathology that was present was gained by CT in 5/5 cats and 21/ 28 dogs. New information on compartmental location of pathology was seen in 4/5 cats and 19/28 dogs. New information on pathology extent was noted in 5/5 cats and 20/28 dogs. Additional information regarding involvement of mediastinal structures was obtained in 2/5 cats and 10/28 dogs. A change in diagnosis was made in 3/5 cats and 13/28 dogs. In conclusion, CT is a valuable tool for evaluating intrathoracic disease. CT provides additional cross-sectional anatomic information that can aid in anatomic localization and evaluation of the extent of the pathology in question.

We report a case of a ruptured aneurysm difficult to diagram preoperatively. A 35-year-old man admitted for “thunderclap headache” (TH) had the possibility of subarachnoid hemorrhage (SAH) ruled out because of CT findings and the color of the cerebrospinal fluid (CSF). During examinations, we found an IC-PC aneurysm. An arachnoid adhesion with localized SAH around the aneurysm was found intraoperatively. SAH thus cannot be ruled out even when CT and CSF studies show no abnormalities after TH onset. MRA and 3D-CT angiography are thus recommended in such patients.

Computed tomography (CT) findings in a dog with intracranial blastomycosis were marked periventricular contrast enhancement of the lateral ventricles, the 3rd ventricle, and the mesencephalic aqueduct. The CT appearance correlated with the histopathologic findings, where severe ependymitis was present throughout the ventricular system and there was stenosis of the mesencephalic aqueduct due to an inflammatory infiltrate. CT is therefore recommended as a screening test for intracranial blastomycosis in dogs and also as an imaging modality for follow-up evaluation after treatment. This is particularly true in dogs with systemic or ocular blastomycosis, which appear to be at higher risk of developing CNS involvement.

Mucocele of the appendix is a rare but well-known entity. Accurate preoperative diagnosis of this surgically curable entity is very important to prevent intraoperative rupture. With multimodality approach using ultrasound and CT, it has been possible to preoperatively diagnose mucocele of the appendix. We describe the ultrasound and CT findings of a giant appendicular mucocele that led us to the correct preoperative diagnosis.

Objectives:(1) Determine the diagnostic yield of contrast-enhanced computed tomography (CT) in the evaluation of patients with idiopathic unilateral vocal fold paresis. (2) Determine the proportion of CTs yielding nondiagnostic incidental findings requiring further patient management.Methods:Retrospective cohort. Precision-based power calculations were performed. All patients of the 2 senior authors who underwent contrast-enhanced CT for a clinical diagnosis of vocal fold paresis from January 2004 to January 2014 were included. Demographic, history, examination, and investigation data were extracted from outpatient records and CT reports were reviewed. Patients were excluded if there was insufficient history or examination information, if there was a known neurological diagnosis, or if there was vocal fold immobility or bilateral involvement. A diagnostic CT was defined as depicting a pathological lesion along the course of the ipsilateral recurrent or superior laryngeal nerves. Incidental CT findings wer...

Computed tomography (CT) images of nine dogs with a multilobular tumor of bone of the head were reviewed. The CT characteristics of the neoplasms involving the calvarium (n = 7) were rounded, well defined with a fine granular, nonhomogeneous bone opacity usually in the occipital region. Cranial vault invasion (5 of 7) was commonly found with a significant portion of the mass within the vault. The neoplasms involving the zygomatic arch (n = 2) were also generally rounded and well defined but with a more coarse granular appearance. The common CT findings were best seen when the images were viewed in a bone window.

突然に心肺停止状態(全脳虚血)に陥った症例の脳の蘇生直後の変化を頭部CTにて検討した。対象は一次性脳疾患を除く非外傷性院外心肺停止症例88例で,推定心停止時間から4群に分類した。A群(心停止時間15分未満);2例,B群(心停止時間15～30分未満);11例,C群(心停止時間30分以上);40例,D群(心拍再開せず);35例。心拍再開した症例は心拍再開後4時間以内に,再開しなかった症例は蘇生断念後1時間以内に頭部CTを施行した。転帰はA群全例意識清明となり,B群C群と心停止時間が延長することで機能的予後のみならず生命的予後も悪く,15分以上の心停止では死亡率は85%以上であった。頭部CTにて蘇生後の脳浮腫所見を大脳基底核・視床さらに大脳皮髄境界について検討した。基底核・視床あるいは皮髄境界が明瞭に認められる症例,やや不明瞭な症例そして不明瞭(著明な浮腫)症例の3種類が認められた。心停止15分未満のA群では境界不明瞭症例はみられなかった。心停止時間が延長するにつれて境界不明瞭例が多く認められ,とくに皮髄境界については心停止時間の長い群で不明瞭例が多く認められた。脳浮腫は低酸素状態の遷延によって出現増強するが,胸骨圧迫心臓マッサージによる胸腔内圧上昇が頭蓋内圧を上昇させることも報告され,これも脳浮腫を増強させるひとつの原因と考えられた。これは基底核・視床よりも皮髄境界で脳浮腫所見が強く認められたことからも示唆された。これら脳浮腫の所見は,心肺蘇生後4時間以内に頭部CT上出現していることが認められ,さらに血管閉塞を疑わせる所見も認められた。

We report a case of metastasis to the colon from a primary angiosarcoma of the scalp in a 61-year-old Japanese man and describe the sonographic features and CT findings, with a brief discussion of the clinical and histopathologic findings. Although this entity is extremely rare, it should be considered when a patient with prior diagnosis of angiosarcoma in another organ has focal thickening with preserved compressibility of the wall of the colon.

Summary Torsion of the free end of the falciform ligament is an extremely rare cause of localized peritonitis. A surgically proven case is presented here, with ultrasound and CT findings and a review of the published work.

The purpose of the study was to characterize the renal lesions of hereditary renal cystadenocarcinomas in the German shepherd dog using computed tomography (CT). Fourteen dogs with renal cystadenocarcinomas and nodular dermatofibrosis, and two unaffected dogs were studied. There were nine dogs with spontaneous disease and seven dogs from a test mating. The characteristic renal CT findings of renal cystadenocarcinomas were bilateral multiple cysts and tumor masses of various sizes. The earliest changes were detected between 4 and 5 years of age and the smallest cysts measured 2-3 mm in diameter. Abdominal CT examination gives a wide field view and excellent anatomic images of the kidneys. It is easy to differentiate between cysts and solid tumors. CT examination is useful for the early detection of renal cystadenocarcinomas and for screening suspected carrier dogs before breeding.

One hundred computerized tomography (CT) scans from patients with rhinosinusitis were compared with 100 CT scans from patients with intraorbital disease. There were no significant bony anatomical differences between the rhinosinusitis group and the control group and there remained no difference when 17% of the control group, who were incidentally found to have mucosal changes, were excluded from the control data. None of the anatomical bony variations compared between the two groups showed any significant difference, including any associated with narrowing of the ostiomeatal complex (P = 0.41). Eight per cent of all subjects (n = 200) had Onodi cells and 7% had an asymmetrical anterior skull base. In conclusion, bony anatomical variations appear not to influence the prevalence of rhinosinusitis. Intrinsic mucosal disease is probably of much more importance than the bony anatomy.

Objectives:Identify clinical features associated with unsuccessful medical therapy in children with deep space neck infections (DSNI). Propose a clinical decision-making algorithm, which may avoid radiation exposure from computed tomography (CT) imaging, based on clinical features found to be associated with surgical intervention for DSNI and those at highest risk for complicated clinical courses.Methods:Consecutive case series with chart review at a tertiary-care, academic children’s hospital. One hundred and seventy-eight pediatric patients treated for retropharyngeal or parapharyngeal infections between July 1, 2007, and May 23, 2012.Results:Median age was 34.5 months (2.9 years, range 2 to 142 months); two-thirds were male. Increased surgical drainage was found in children age ≤ 15 months (P = 0.002) and for abscesses greater than 2.2 cm (P = 0.0001). Risk factors associated with increased likelihood of medical therapy failure included ≤ 51 months, ICU admission, and CT findings consistent with absces...

Objectives:Assess the headache outcomes for patients treated with targeted endoscopic sinus surgery. Study Design: Prospective, non-randomized.Methods:Consecutive patients (n=50) presenting to our clinic with headache as a feature of their presenting symptoms were recruited. Pre-operative SNOT 20, HIT-6 (Headache Impact Test) scores, and computed tomography (CT) analysis of multiple radiological parameters was calculated and compared to post-operative measures.Results:Preliminary results for our cohort revealed an average pre-operative HIT-6 score of 61 and SNOT-22 score of 49. Average post-operative HIT-6 score was 44 and SNOT-22 score 19 (p

Objectives:Evaluate round window niche (RWN) visibility during cochlear implant (CI) surgery and to predict RWN visibility using high resolution computed tomography (HRCT).Methods:Sixty-five ears from 19 adults and 46 children who received CI were enrolled. All patients were examined with HRCT and their surgical video was recorded. In the axial slice showing RWN, a line was drawn along the posterior wall of the external auditory canal (line A). Another line (line B) parallel to line A was drawn to get contact with the vertical segment of the facial nerve. Relationship between the band between lines A and B and the position of the RWN was classified into 3 types: RWN was 1) fully, 2) partially, or 3) not included in the band. The visibility of the RWN during CI was classified as A) fully, B) partially, or C) not visible.Results:From the surgical video review, 27 cases were classified as A), 21 as B), and 17 as C). All the 15 cases classified as 3) based upon CT findings were classified as C). Out of 19 cas...

Background Although useful in evaluation of suspected appendicitis, not all patients require computed tomography (CT) evaluation. Clinical stratification of patients who benefit from CT evaluation is essential. We utilize the Alvarado score (AS) to stratify patients with suspected appendicitis into subgroups who benefit from CT evaluation and propose an objective algorithm with AS guiding CT utilization. Methods This study is a retrospective review of medical records of all patients admitted for suspected appendicitis over a 6-month duration. Relevant data were recorded. The AS for each patient was determined retrospectively and correlated with histological and CT findings. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined for various ASs and for CT. Results Three hundred fifty-eight patients were studied, with 167 males (46.6%) and 191 females (53.4%). Prevalence of appendicitis was 50% (179 patients). Two hundred fourteen patients (59.8%) had CT performed. Surgery was performed for 206 patients (57.5%). Overall negative appendicectomy rate was 13.1%. Patients who underwent CT evaluation had a negative appendicectomy rate of 5.7% compared to 17.9% in those without CT evaluation (P = 0.009). CT scan had a sensitivity and specificity of 92.6% and 96.9%, respectively. An AS greater than 3 had a sensitivity superior to CT (95.5%), while an AS of 9 or greater had a specificity superior to CT (100%). Conclusions In suspected appendicitis, patients who benefit from CT evaluation are those with the AS ranging from 4 to 8. We propose a management algorithm with the AS guiding the necessity for CT evaluation.

On CT, a thickened intestinal wall configured with a middle layer of low attenuation surrounded on each side by layers of higher attenuation has been termed the target sign. The presence of fat within the submucosal layer of the small intestine is a well-known manifestation of Crohn's disease, but has not been reported in other chronic intestinal diseases. We describe CT findings of fat density target sign in a patient with prior radiation.

Objective: 1) Ascertain whether CT findings correlate with surgical need for access septoplasty during endoscopic sinus surgery. Evaluated due to risk of litigation from patients not consented for septoplasty who require it, despite having a “straight septum” on CT. 2) Establish whether site of septal deviation affects the requirement for septoplasty.Method: We retrospectively studied 129 endoscopic sinus surgery procedures. The preoperative CT report was recorded. Blinded to the report, 2 independent observers commented on evidence and site of septal deviation and predicted the need for access septoplasty. The operative notes were used to record the surgical outcome.Results: Septal deviation was reported by radiologists in 57 of the 129 patients (44%). Both observers agreed on septal deviation being present in 85 patients (66%). Thirteen of 87 patients who were predicted not to need access septoplasty underwent the procedure (15%). A confidence interval (CI) of 95% gives a range of 9%-24% for patients un...

Clinical symptoms and findings in cranial computed tomography (CT) were evaluated in 326 patients with intracerebral hemorrhage (ICH). Localizations of ICH were the lobes (n = 254), the basal ganglia (n = 46), the pons and brain stem (n = 13) and the cerebellum (n = 8). Multiple hematomas were present in nine patients. An initial coma (n = 225) was most frequent in ICH of the pons (n = 7), cerebellum (n = 6), and the frontal (n = 71) and temporal (n = 66) lobes. Epileptic seizures (n = 70) were most common in hematomas of the frontal (n = 24), temporal (n = 19) and parietal (n = 12) lobes and the basal ganglia (n = 6). A history of hypertension was given in 140 patients; 119 of these had an ICH with a size of ≥3 cm. Mortality (n = 162) was high with ICH in the pons and brain stem (10 out of 13), in the frontal (54 out of 98) and parietal (32 out of 58) lobes and the basal ganglia (n = 23). A size of the ICH of 3 cm or more in cranial CT and an associated ventricular hemorrhage were associated with a bad outcome. An initial disturbance of consciousness was the only reliable clinical predictor of outcome (chi-square, p < 0.001). Katamnestic evaluation of 66 of the 164 survivors after 5.2 years revealed seizures in 20 patients and mild neurological deficits in 41. Another 14 patients were partially, and nine totally dependent Nineteen patients had died in between; there was only one death attributable to another ICH.