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Objective: To describe the spectrum and frequency of computed tomographic (CT) features in tuboovarian abscess (TOA) in order to increase the utility of computed tomography in diagnosing this condition., Study Design: Search of our hospital registry found 22 patients diagnosed with TOA who underwent pelvic tomography between the years 1998 and 2001. A retrospective review of their CT scans was performed, and the CT features of TOA were recorded. Clinical signs and symptoms were also summarized., Results: All 22 patients presented with lower abdominal pain. Additional clinical signs of TOA, such as a palpable abdominal mass (23%), vaginal discharge (27%) and fever (36%), were less common. On tomography the majority of TOAs were unilateral (73%) and multilocular (89%) and had fluid density (95%) and a thick, uniform, enhancing wall (95%). Other common CT findings were thickening of the mesosalpinx (91%) and infiltration into pelvic fat (91%). Less common CT findings included bowel thickening (59%), thickening of the uterosacral ligaments (64%) and pyosalpinx (50%). Ascites, lymphadenopathy, peritoneal involvement and hydronephrosis were uncommon findings on tomography., Conclusion: Computed tomography is a useful imaging modality in the diagnosis of TOA, especially in cases that are clinically indeterminate. Recognition of the spectrum of CT findings and their frequency can result in improved CT diagnosis of this disease.

Purpose: The purpose of this work was to examine the accuracy and safety of CT-guided core biopsy of gastrointestinal wall lesions., Method: We reviewed over 1,200 CT-guided abdominal core biopsy results from 1989 through 1998. Forty-five were from gastrointestinal wall lesions (16 gastric, 3 duodenal, 7 small intestine, and 19 colon)., Results: A definitive histologic diagnosis was obtained from the core biopsy in 41 patients (91%) without complication. The gastric lesion diagnoses were mesenchymal tumor of smooth muscle origin (eight), lymphoma (one), adenocarcinoma (three), and normal (one). Duodenal core biopsy diagnoses were inflammation (one) and normal (one). Small intestinal core biopsy diagnoses were non-Hodgkin lymphoma (four), metastatic leiomyosarcoma (one), carcinoma (one), and tuberculosis (one). Colon core biopsy diagnoses were carcinoma (11), lymphoma (2), actinomycosis (2), granulomatous inflammation (1), metastatic squamous cell carcinoma (1), chronic abscess (1), and mesenchymal tumor of smooth muscle origin (1)., Conclusion: Percutaneous CT-guided core needle biopsy from gastrointestinal wall lesions is safe and accurate, especially in submucosal lesions, and should be considered in selected cases with negative endoscopic biopsy or in which endoscopic biopsy is not possible.

Purpose: To retrospectively determine the computed tomographic (CT) signs associated with diverticulitis or colon cancer, and to prospectively apply these signs in the differentiation of these diseases., Materials and Methods: Fifty-eight CT scans in cases of proved diverticulitis (n = 27) or colon cancer (n = 31) were evaluated retrospectively by radiologists (blinded to the proved diagnosis) for the presence or absence of previously reported CT findings. These findings were correlated with the pathologic or final clinical diagnosis. The retrospective findings were applied in a prospective evaluation with a new set of 72 CT scans. The same five radiologists rendered a diagnosis according to a five-point confidence scale from definitely benign to definitely malignant. Individual and consensus readings were correlated with the final diagnosis., Results: Retrospectively, pericolonic inflammation (P < .01) and segment involvement greater than 10 cm (P < .012) were the most significant findings for diverticulitis; pericolonic lymph nodes (P < .0001) and luminal mass (P < .003) were the most significant findings for colon cancer. Prospectively, an unequivocal diagnosis was made correctly in 16 (40%) of 40 cases of diverticulitis and 21 (66%) of 32 cases of colon cancer., Conclusion: When there are no pericolonic lymph nodes adjacent to a segment of colonic wall thickening, with pericolonic inflammatory changes, the most likely diagnosis is diverticulitis. When pericolonic lymph nodes are present, with or without pericolonic edema, the most likely diagnosis is colon cancer.

Retrocrural splanchnic nerve alcohol neurolysis with a CT-guided anterior transortic approach, a new method for splanchnic block alleviation of chronic abdominal pain, is described. Ten patients with chronic abdominal pain requiring narcotic treatment, six with pancreatic carcinoma, one with gastric carcinoma, two with chronic pancreatitis, and one with pain of unknown etiology, were referred for splanchnic nerve neurolysis. With CT guidance, a 20 gauge needle was placed through the aorta into the retrocrural space at T11-T12, and 5-15 ml 96% alcohol was injected into the retrocrural space. Following the procedure, 6 of 10 patients were pain free, 2 patients had temporary pain relief, and 2 patients were without response. There were no significant complications. CT-guided anterior transaortic retrocrural splanchnic nerve alcohol neurolysis is technically feasible, easier to perform than the classic posterolateral approach, and may have less risk of complications. The success rate in this initial trial was reasonable and, therefore, this technique provides an additional method for the treatment of abdominal pain.

The methodology of determining an invisible target by CT-stereotaxy, such as the ventrolateral nucleus of the thalamus, is described. This approach obviates the need for traditional ventriculographic determination of the third ventricle commissures and allows accurate measurement of third ventricular width. Morbidity and length of hospitalization are thereby reduced.

Although soft tissue lipomata are common tumours, a large lipoma arising from the deep layers of the abdominal wall would appear to be excessively rare and the site of origin may be difficult to determine. The CT and MRI appearances of such a tumour are described.

Synovial chondromatosis of the temporomandibular joint was diagnosed and location of dens particles was assessed by means of computed tomography. Based upon the data collected, the joint was operated conservatively and most of the calcifications were removed leaving the patient symptom free. The importance of an accurate preoperative diagnosis of synovial chondromatosis by use of CT scan is stressed in view of numerous unnecessary condylectomies and parotidectomies reported in the literature.

Percutaneous chemical lumbar sympathectomy with alcohol (PCLSA) using computed tomography (CT) control was performed in 8 patients suffering from advanced peripheral arterial occlusive disease. PCLSA under CT guidance was found to be a simple and safe procedure. The use of CT control added precision in the guidance of needle placement. Positive results were obtained in all patients, without significant morbidity. PCLSA may be an alternative to surgical sympathectomy.

A case of visceral leishmaniasis (Kala-Azar) is presented which clinically and on CT examination mimicked lymphoma. The value of the recognition of the previously unreported CT findings of visceral leishmaniasis is discussed.

The plain film, barium enema, and CT findings in a case of giant colonic diverticulum with the atypical feature of marginal calcifications are presented. The value of CT in the diagnosis and evaluation of giant colonic diverticulum is discussed.

We report a 54-year-old postmenopausal woman with a leiomyoma which on an ultrasound scan and on computed tomography (CT) had cystic areas and extensive necrosis suggesting sarcomatous change.

The value of investigation of patients with ovarian carcinoma by preoperative computed tomography scan was evaluated in all the patients operated on during the last 2 years; 22 patients were included in this study and evaluated. In 11 patients the scan was performed prior to the primary surgery and in the other 11 patients before second look following chemotherapy. CT scan was found to be highly sensitive in detecting ascites, pelvic wall extension and spread or involvement of the uterus. Peritoneal and omental spread was detected in only half of the patients before primary surgery. Prior to second look operation CT scan was effective in excluding liver metastasis, ascites, paraaortic lymph node enlargement, pelvic wall extension and pelvic residual tumour. Generally, CT scan failed to detect peritoneal and omental spread. It is an important tool for preoperative evaluation of the extension of the disease and planning of surgery, but still, the final staging deserves explorative laparotomy.

The authors report the case of a 15-year-old female who presented with a history of vague but constant pain about the medial aspect of her right knee. X-ray established the presence of an expanding lesion in the medial tibial plateau. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) were used in the evaluation of the lesion. The authors compare the preoperative CT and MRI findings with the microscopic histopathology of the amputation specimen and note that the CT scan underestimated the extent of the microscopic tumor boundaries, whereas MRI showed altered activity beyond these boundaries.

A bony bridge was created in the growth plates of young rabbits. Weekly computed tomography (CT) scanning was done in the axial (transverse) plane for 3 weeks. Transverse histological sections from the plate area were examined after 3 weeks. The CT image showed the exact location and extent of the sclerotic bony bridge. The area of the bony bridge as a percentage of the plate was measured from the CT image. Good correlation was found between the CT image and the histological section. This technique has been applied to children, and three such examples show accurate assessment of the growth plate.

CT guided diagnostic aspiration was performed on a patient suspected of aortic graft infection. The positive aspiration prompted aggressive successful surgical intervention.

We report a case of primary pleural lymphoma. The CT appearance was of hemorrhagic pleural effusion with thickened membranes. The CT evaluation of pleural disease is discussed.