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Objective. The purpose of this study was to clarify the sonographic features of thyroglossal duct cysts (TDCs) in children. We also investigated how the presence of inflammation influences the sonographic appearance. Methods. We reviewed the sonograms from 36 children (0.5–14 years old) with pathologically proven TDCs. The lesions were evaluated for location, shape, internal echo pattern, internal septa, wall thickness, posterior enhancement, solid components, margins, and fistulas. The sonographic features of 7 lesions that pathologically showed inflammation were also investigated. Results. Most TDCs were midline (77.8%), were located at the hyoid bone (44.4%) or were infrahyoid (38.9%), showed posterior enhancement (77.8%), were unilocular (86.1%), lacked internal septa (91.7%), and had a thin wall (75%). None had a solid component. The internal echo patterns were classified into 4 types: anechoic (25%), homogeneously hypoechoic (16.7%), pseudosolid (16.7%), and heterogeneous (41.6%). Inflammation was confirmed in 78% of the lesions with wall thickening and 100% of the lesions with internal septa. Conclusions. Most TDCs in children had echogenicity ranging from hypoechoic to heterogeneous. A thick wall and internal septa were considered to correlate with the presence of inflammation but not with the internal echo patterns of TDCs. Key words: child; sonography; thyroglossal duct cyst.

Two women presented with sore throat and fever. Their symptoms were not alleviated by antibiotics. Cervical computed tomography (CT) with contrast enhancement demonstrated enlargement of predominant posterior cervical lymph nodes and streaky heterogeneous tonsils with interspersed low attenuation. They were diagnosed as having infectious mononucleosis by their laboratory data. Thus, when radiologists encounter these CT findings of pharyngitis that is not alleviated by antibiotic therapy, infectious mononucleosis should be considered in the differential diagnosis.

The objective of this study is to analyze the outcome of surgery for high/intermediate-type imperforate anus using anal endosonography (AES), magnetic resonance imaging (MRI), and a continence evaluation questionnaire (CEQ).In this study, 24 cases of high/intermediate-type imperforate anus were studied. Fifteen of 24 had Georgeson's laparoscopy-assisted anorectoplasty (GLA), and 9 of 24 had Pena's posterior sagittal anorectoplasty (PPA). All subjects had AES and MRI postoperatively. On AES, differences in thickness of the external sphincter (ES) and puborectalis (PR) at 3 and 9 o'clock were compared, and if pull-through colon was central, AES was 0. On MRI, differences in thickness were analyzed semiquantitatively and scored; if muscles were of even thickness, the score was 0; slight difference was 1, and marked difference was 2. A 5-parameter CEQ questionnaire (maximum score, 10) was administered to 16 of 24 subjects followed up for more than 3 years (9 GLA, 7 PPA). Surgical stress was assessed using mean febrile period, duration of raised white blood cell count, and peak C-reactive protein level.Mean age at surgery and mean postoperative period for both groups were not statistically different. There were no differences in mean muscle thickness for ES or PR on AES according to procedure (ES: GLA = 0.19 +/- 0.15 mm, PPA = 0.16 +/- 0.09 mm, P = .59; PR: GLA = 0.19 +/- 0.19 mm, PPA = 0.22 +/- 0.15 mm, P = .69). Magnetic resonance imaging scores were also not significantly different according to procedure (GLA: 0.77 +/- 0.83; PPA: 0.75 +/- 0.50, P = .97). When CEQ were compared annually, scores for GLA were generally higher throughout the study but only statistically significant at 3 and 4 years (P.05). Differences in parameters of surgical stress were not significant.Although there were no differences in muscle thickness and parameters of surgical stress observed according to technique, GLA would appear to provide better outcome based on CEQ scores.

We report a case of adrenal schwannoma, an extremely rare retroperitoneal neoplasm. The patient was a 33-year-old man who presented with an abdominal mass that was discovered at abdominal sonography. Computed tomography showed an 8-cm well-circumscribed homogeneous mass that enhanced slightly after intravenous administration of contrast material. Magnetic resonance imaging showed low signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images. Although these imaging findings are nonspecific, adrenal schwannomas should be included in the differential diagnosis of solid nonfunctioning adrenal tumors.

The purpose of this study is to evaluate the capability of breast MRI (magnetic resonance imaging) and mammography in determining tumor extent and the detectability of ductal carcinoma in situ (DCIS) in association with histopathological features. Thirty women with breast cancer underwent 3D dynamic MRI. Twelve women had pure DCIS and 18 women had DCIS with microinvasion. We analyzed the results of preoperative MRI and mammography with histopathologic results, retrospectively. The mean lesion size was 55.1 mm from the histopathologic results. Twenty-six lesions were detected through the MRI (a sensitivity of 86.7%). MRI depicted eight lesions without mammographically detected microcalcification. In seven cases, MRI showed tumor extent accurately compared with mammography, and the combined diagnosis improved the accuracy of evaluating tumor extent. MRI can complement mammography in guiding surgical treatment of DCIS by providing better assessment of the extent of the lesion.

Carmofur (1-hexylcarbamyl-5-fluorouracil), a derivative of 5-fluorouracil (5-FU), has been widely used in Japan as a postoperative adjuvant chemotherapy agent for colorectal and breast cancer. Periventricular hyperintensity on T2-weighted MR images in carmofur-induced leukoencephalopathy confront the physician with a broad range of differential diagnoses. We describe two cases of carmofur-induced leukoencephalopathy in which diffusion-weighted MR imaging revealed periventricular hyperintensity. We compared their findings with those of age-related periventricular hyperintensity in five patients and found discrepancies in signal intensity of periventricular areas. Our results suggest that diffusion-weighted MR imaging may be useful to differentiate carmofur-induced leukoencephalopathy from age-related periventricular hyperintensity.

Exostosis occurs in the ribs either sporadically or as a manifestation of a genetic disorder known as hereditary multiple exostoses. Costal exostosis may cause chest pain and, on rare occasions, result in hemothorax. We report a case of hemothorax owing to costal exostosis in a 4-year-old boy.

PURPOSE Our purpose was to present imaging findings of six cases proven or supposed to be von Meyenburg complexes (VMCs) with a basis of reviewing the pathologic literature and to describe imaging points for the diagnosis of typical VMC along with its differential diagnosis. METHOD Six cases were diagnosed as VMC of the liver with imaging modalities (one had histopathologic proof). Both ultrasound (US) and CT were available for all cases, and MRI was used for three cases. Follow-up with US, CT and/or MRI was performed in five cases. RESULTS US detected varying abnormalities of the livers in four cases. CT and MRI revealed multiple or numerous intrahepatic tiny (usually < 5 mm) cystoid lesions in all of the cases. The lesions were scattered throughout the livers, and some of them were located more frequently adjacent to the medium-sized portal veins than to the hepatic veins of similar size on CT. Moreover, some lesions were apparently located in the subcapsular areas (up to the hepatic capsules). They were usually irregular in shape and showed no enhancement but increased in number by approximately 80-150% after administration of intravenous contrast medium. The T2-weighted MR images and MR cholangiopancreatography showed the lesions to be much more apparent and to be more numerous than T1-weighted images did. Follow-up of five cases with imaging modalities did not show remarkable change of the lesions. CONCLUSION Despite our limited experience, VMC lesions seem to show some CT and MR features different from those of other multiple small hepatic lesions. They presented as multiple or numerous intrahepatic tiny cystoid lesions usually with irregular contour, scattered throughout the liver up to the subcapsular areas, and were detected in far greater number by enhanced CT or T2-weighted MR images than by unenhanced CT or T1-weighted images. They showed no remarkable change on long term follow-up imaging. We propose that a diagnosis of typical VMC could be made after analyzing CT or MR images carefully with good understanding of its pathologic basis, but imaging follow-up is necessary in oncology patients.

The case of an aneurysm of a systemic artery supplying otherwise normal basal segments of the left lower lobe is presented. The diagnosis was correctly made postprocessed with three-dimensional reformatting using a multidetector row CT (MDCT) scanner. Conventional angiography was obviated.

Objective : Our goal was to describe attenuation differences bordered by a straight line in the right hepatic lobe on enhanced CT in patients with right adrenal tumors and to discuss the cause of this appearance. Materials and Methods : Three patients showing attenuation differences bordered by a straight line were discovered in the CT files of 26 cases of right adrenal tumor over 3 cm in diameter. All CT scans were examined by incremental dynamic study. Results : Two patients had large zone of hyperattenuation in the right lobe bordered with a straight line intersecting both anterior branches of the right portal vein and the inferior vena cava (IVC). A third patient and one of the two patients mentioned already had zones of relative hyper- and hypoattenuation in the medial portion of the posterior hepatic segment, respectively. All three patients had large right adrenal tumors, which severely compressed the right hepatic vein near its confluence with the IVC and/or the IVC in or below its intrahepatic portion. The distribution of attenuation differences was similar to the hyperattenuation at CT arteriography or perfusion defect at CT arterial portography under temporary balloon occlusion of the right hepatic vein and inferior right hepatic vein, respectively. Conclusion : Straight-bordered attenuation differences within the right hepatic lobe at dynamic CT can be caused by compression of the right hepatic vein by large right adrenal tumors.

The purpose of this prospective study was to perform quantitative multidetector computed tomography (MDCT) analysis of pulmonary solid nodules using three parameters (long-short ratio, compactness, and intranodular CT number) and to evaluate the usefulness of each parameter in the differentiation of the nodules. Seventy solitary pulmonary nodules with a long axis length of 5–30 mm were examined using one multidetector CT (MDCT) system and one three-dimensional (3D) system, and the findings regarding the three parameters were statistically analyzed among five diseases (hamartoma, organizing pneumonia, adenocarcinoma, squamous cell carcinoma, and metastasis). The long-short ratio of the pulmonary nodule showed no significant differences among five diseases. The compactness showed significant differences (P < 0.05) in five pairs of diseases. Intranodular CT number showed significant differences (P < 0.05) in three pairs of diseases. Our results are insufficient for the complete differentiation of pulmonary solid nodules. However, among the three parameters, compactness and intranodular CT number contribute somewhat to the differentiation of pulmonary nodules.

We report a case of giant hepatic cavernous hemangioma associated with spontaneous subacute intratumoral hemorrhage. Magnetic resonance imaging showed an oval, homogeneous, high-intensity lesion with a low-intensity rim in the original high-intensity tumor on T2-weighted images. On T1-weighted images, this oval lesion showed heterogeneous high intensity with peripheral higher intensity. The histologic specimen confirmed hepatic hemangioma with intratumoral hemorrhage.

Purpose: The authors used ultrasonographic endoprobes during laparoscopy-assisted colon pull-through (LACPT) for the repair of high imperforate anus to confirm the pull-through canal was surrounded symmetrically by pelvic floor muscles. Methods: Six patients with high imperforate anus were treated by LACPT (mean age at LACPT, 8.2 months). An endoscopic (12-MHz, 2.5-mm in diameter) and proctoscopic (7.5-MHz, 12-mm in diameter) probe were inserted into the proposed route of dissection intraoperatively to measure the thickness of the surrounding muscle tissue at at least 3 levels: the external anal sphincter, the levator ani muscle sling, and the intervening muscle complex. Results: The average thickness of the external anal sphincter was 2.3 ± 0.4 mm anteriorly, 2.4 ± 0.4 mm on the left, 2.4 ± 0.5 mm posteriorly, and 2.6 ± 0.6 mm on the right. The average thickness of the muscle complex was 2.3 ± 0.6 mm anteriorly, 2.2 ± 0.5 mm on the left, 2.1 ± 0.4 mm posteriorly, and 2.2 ± 0.5 mm on the right. The average thickness of the left crus of the levator ani muscle was 1.8 ± 0.3 mm, the right crus was 1.9 ± 0.4 mm, and the rim located posterior to the rectum was 2.0 ± 0.3 mm. No statistically significant difference was found between the measurements taken at each level. Conclusion: Intraoperative endosonography during LACPT can greatly enhance the precision of positioning the pull-through canal. J Pediatr Surg 37:1657-1660. Copyright 2002, Elsevier Science (USA). All rights Reserved.

A case of uterine tumors resembling ovarian sex-cord tumors (UTROSCT) producing parathyroid hormone-related protein (PTH-rP) of the uterine cervix is reported. A 66-year-old woman underwent total hysterectomy with bilateral salpingo -oophorectomy due to the possibility of a malignant uterine tumor. A fairly well-circumscribed tumor, measuring 8 x 5 x 7 cm, was present in the myometrium of the cervix and extended into the endocervical mucosa. Histologically, the tumor showed predominantly sex-cord-like differentiation and the features of conventional endometrial low-grade stromal sarcoma were observed in part. Immunohistochemically, the tumor cells were negative for CD10. From these findings, we diagnosed the present case as Clement and Scully's group II UTROSCT arising from the uterine cervix. To our knowledge, this is the first report of the cervical occurrence of UTROSCT. Furthermore, in this tumor, production of PTH-rP was demonstrated by normalization of serum PTH-rP after the tumorectomy and immunoreactivity for PTH-rP in the tumor cells.

The cisterna chyli is the dilated origin of the thoracic duct, which receives the right and left lumbar lymphatic trunks and the intestinal lymphatic trunk. In 1996, Gollub and Castellino [1] first described its appearance on CT: the cisterna chyli appears as a retrocrural tubular structure of near-water attenuation and is located to the right of the aorta and anterior to the vertebral bodies between T11 and L1. The cisterna chyli may be located to the left of the aorta. A 49-year-old asymptomatic man was admitted for surgical treatment of gastric carcinoma that had been detected on upper gastrointestinal endoscopy during an annual checkup. CT of the upper abdomen showed neither liver metastasis nor lymph node enlargement. Incidentally found was an 8-mm round structure of low attenuation at the retrocrural space to the left of the abdominal aorta; the average attenuation was 1.5 H on unenhanced CT and 5.6 H on enhanced CT (Fig. 1). At surgery, no regional lymph nodes were grossly enlarged, and distal gastrectomy was performed. Histologic examination revealed moderately differentiated tubular adenocarcinoma confined to the submucosa and no lymph node metastasis. Follow-up CT performed 1 year later showed no change in the appearance of a leftsided retrocrural structure of low attenuation. Although the upper and lower portions of the thoracic duct usually originate from the left and right members of a pair of the ducts, respectively, variations are not rare [2]. In a study of 104 cadavers by Kutsuna [3], the duct was found to take a typical course in 92 cadavers (88.4%); two ducts paralleling each other drained into the left subclavian vein in 11 (10.6%); and the duct was located on the left side along the entire course in one (1.0%). Therefore, the left-sided cisterna chyli appeared the least common. The left-sided cisterna chyli would be expected to be an exact mirror image of that described by Gollub and Castellino on CT scans [1]. In our patient, it appeared as a rounded structure of near-water attenuation and was smaller than 2 cm in diameter at the retrocrural space to the left of the aorta. The left-sided cisterna chyli may mimic the structures that the retrocrural space to the left of the aorta contains: the hemiazygos vein, lymph nodes, and sympathetic chain. An enlarged lymph node with central necrosis or cystic degeneration may mimic the cisterna chyli. A history of malignant tumor and substantial change in size suggests the diagnosis of metastatic lymphadenopathy. Radiologists should be aware that the cisterna chyli may be depicted on CT at the retrocrural space not only to the right but also to the left of the aorta. Bilateral cisterna chyli could be encountered more frequently than a left-sided one. Yoshihisa Kurosaki Akira Fujikawa Self Defense Forces Central Hospital Tokyo 154-8532, Japan References

Familial conductive deafness is rare. This report confirms the existence of a lineage with congenital conductive hearing loss in 3 generations. The results of otologic evaluations, including pure-tone audiometry, tympanometry, acoustic reflex test, and liquid test, in 14 patients in this family were consistent with the findings of ossicular fixation in 10 patients. Tympanotomies performed in both ears of 4 patients indicated stapes ankylosis caused by ossification of the stapedius tendon. The patients gained normal hearing levels using a simple surgical procedure.

症例は57才男性で, 健康診断にて右下肺野の孤立性輪状影を指摘された. この陰影が同じ形態を保ったまま次第に増大するため手術を施行し, 気管支腺由来の腺癌と診断した. 肺原発の腺癌で孤立性薄壁空洞を呈することは極めて稀であり, 薄壁空洞の形成機序を考える上でも興味深い症例である. 本症例では, 交通気管支のvalvularobstructionにcheckvalvemechanismが加わって孤立性薄壁空洞が形成されたものと推測した.

Changes in tumor area and the attenuation value determined from computed tomography (CT) slice section of the tumor at its maximum size were investigated in 18 patients with hepatocellular carcinoma who were studied by CT after arterial embolization therapy. The tumor area was reduced in all cases after embolization therapy. Greater than 50% reduction of the tumor area occurred during the follow-up period in 13 cases (87%). In cases evaluated by follow-up CT, the relative attenuation value of tumor to nontumor regions decreased during the initial stage after embolization therapy, but showed a tendency towards greater elevation than in the initial stage, despite tumor reduction. This change in the attenuation value was considered to reflect necrosis and shrinkage of the tumor after embolization therapy. The absence of such changes in nontumor regions supports the use of arterial embolization therapy as an effective, conservative treatment for hepatocellular carcinoma. Follow-up examination by CT of hepatocellular carcinoma after embolization therapy contributes to the post-therapeutic evaluation of tumors and to the determination of the appropriate time for reembolization therapy.

From March 1978 to May 1987, 22 cases of primary adrenal tumors were examined by ultrasonography. The patients ranged in age from 21 to 79 years with an average of 42.6 year, including 11 cases of pheochromocytoma, 6 cases of primary aldosteronism, 4 cases of Cushing's syndrome and 1 case of ganglioneuroma. Visualization of tumors was successful in 19 of the 22 patients (86.4%). The detecting rate of right adrenal tumors was 100% (12/12), while the rate of the left was 80% (8/10). The sizes of detected adrenal tumors were larger than 10 mm on the right and larger than 20 mm on the left. Obesity and bowel gas degraded the image of left adrenal tumors, resulting in a lower detective rate of the tumors. The suprarenal area and small lesions were best demonstrated by a lateral intercostal approach using longitudinal scanning plane and by a right subcostal approach using transverse scanning plane. In pheochromocytoma, cystic lesions (echo free space) existed, and the fact that no cystic lesion in other adrenal tumors was helpful for diagnosis of pheochromocytoma. It is concluded that ultrasonography is a very useful method for diagnosis of adrenal tumors as an initial imaging procedure, because it is totally non-invasive, rapid and less expensive than all of the other techniques.

Twelve cases of hepatocellular carcinoma treated by arterial embolization were followed with ultrasonography. Shrinkage of the tumor after the therapy was confirmed in all cases. Echo level reduction in the tumor occurred in 10 cases. High-level reverberation echoes with acoustic shadows emerged in seven cases; however, these echoes were not detected in any cases 3 weeks after the procedure. Echoes were considered either as the consequence of gas produced in the tumor or air trapped in the embolic substance. Ultrasonography, therefore, is an effective technique for the posttherapeutic evaluation of arterial embolization therapy for hepatocellular carcinoma.