bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Psoas Syndrome: Recognition of an Oncologic Entity
Authors: STEVENS MARK J. , GONET YVONNE M.
Published: March 2008

From January 1985 to January 1989 four patients with advanced cancer developed a syndrome characterized by proximal lumbosacral plexopathy and painful flexion of the ipsilateral hip with positive psoas muscle stretch test. Malignant involvement of the psoas major muscle was confirmed radiologically in all cases. Pain was intractable in 3 patients until time of death.

We have termed this presentation the malignant psoas syndrome (MPS) and retrospective review of 427 oncology patients with “high risk” solid cancer culled no additional cases during the same 4–year period. We believe MPS to be a hitherto unreported complication of systemic cancer in which malignant involvement of the psoas muscle, in addition to producing severe nociceptive pain, contributes to the process of lumbosacral deafferentation. The clinical presentation, diagnosis and strategies of management of MPS are discussed.
Use of Mouse Tail in the Study of Irradiated Microvasculature
Authors: NARAYAN KAILASH
Published: March 2008

The use of the mouse tail in the study of microvasculature following fractionated radiotherapy is described. Mice are restrained in a perspex housing and mounted on a perspex tray containing slots for individual mice. The mouse restrainer, irradiation set up, and dosimetry are described in detail. Irradiation was carried out using a 4MV Linear accelerator. The technique described here is reproducible. It can be used to study the volume effects in fractionated radiotherapy.
Mesentenic Giant Lymph Node Hyperplasia — Report of a Case and Review of the Literature
Authors: LEE JIMMY P.K. , NGAI RUDOLPH L.C.
Published: March 2008

A case of hyaline vascular type of mesenteric giant lymph node hyperplasia (MGLNH) is presented. 15 previously reported cases were found in the literature with 14 belonging to the plasma cell type and one belonging to the hyaline vascular type. This is contrary to thoracic giant lymph node hyperplasia (TGLNH) where hyaline vascular type predominates. Like TGLNH, the hyaline vascular type of MGLNH produces no systemic symptoms but the plasma cell type is associated With various systemic symptoms and abnormal laboratory findings.
CT Demonstration of Traumatic Ventral Hernia and Diaphragmatic Rupture A Case Report
Authors: LOW VINCENT , KELSEY PETER
Published: March 2008

Traumatic ventral hernias occur rarely. A case is presented where bowel has herniated through a traumatic defect of the anterior abdominal musculature, demonstrated by CT. This has not been previously reported in the literature. These loops of bowel showed mural thickening and high density indicating severe injury and were found at laparotomy to be ischaemic.

The patient simultaneously suffered rupture of the right hemidiaphragm, also demonstrated by CT and also an uncommon injury.
Paget's Disease of the Thoracic Spine A Case Report
Authors: CICUTTINI FLAVIA , BARO GFUEME , LITTLEJOHN GEOFFREY
Published: March 2008

A case of cord compression, secondary to Paget's disease, and responding to medical therapy is presented. The role of current imaging techniques in this condition is discussed.
Analysis of 308 Localisation Breast Biopsies in a New Zealand Hospital
Authors: JOHNSTON J.A. , CLEE C.Z.
Published: March 2008

The authors have reviewed 308 localisation biopsies performed on nonpalpable breast lesions between 1986 and 1990. The initiating mammogram, specimen radiograph, radiologists' reports and histology reports have been analysed with respect to the nature of the mammographic lesion, patient age, breast parenchymal pattern and histologic diagnosis.

The overall malignant biopsy rate was 28%. Malignancy was found in 67% of biopsies for architectural distortion, 27% for calcification and 25% for a mass lesion. Masses if malignant proved to have an invasive component in the majority of cases (29/33). Calcification if malignant was more often in situ carcinoma (25/44).

29% of malignant biopsies were in women under the age of 50 and approximately half of these had an invasive component. The histologic nature of benign lesions is presented with identification of those with proliferative breast disease.

The results are compared with those of other recently published series. Implications are discussed for the management of minimally suspicious lesions and for screening mammography.
Carotid and Vertebral Artery Trauma: Clinical and Angiographic Features
Authors: O'SULLIVAN RICHARD M. , GRAEB DOUGLAS A. , NUGENT ROBERT A. , ROBERTSON WILLIAM D. , LAPOINTE JOCELYNE S.
Published: March 2008

Injury to the carotid or vertebral artery is an important clinical entity that requires angiography for definitive diagnosis and evaluation. The common carotid artery may be injured by penetrating trauma while the internal carotid artery is usually damaged by either trivial or blunt trauma.

With trivial trauma extracranial internal carotid artery dissection should be considered if there is unilateral headache, Honer's syndrome or delayed transient ischaemic attack, and intracranial dissection if a profound neurological defect occurs immediately following trauma. Injury to the internal carotid artery following blunt trauma includes dissection of the extracranial internal carotid artery, carotid‐cavernous fistula and pseudoaneurysm formation. These should be considered in a patient with delayed neurological deficit, mandibular or skull fracture, a constellation of orbital signs or diffuse subarachnoid haemorrhage, respectively.

Vertebral artery injury is less frequent. Dissection typically follows abrupt cervical rotation and occurs at C1‐2, whereas penetrating trauma may involve either the proximal or distal vertebral artery and occlusion, arteriovenous fistula or pseudoaneurysm may be found.

Endovascular techniques may be used in either the carotid or vertebral artery to close fistulae or occlude an extensively damaged vessel.
Concurrent Radiotherapy and Carboplatin in Non Small‐Cell Lung Cancer: A Pilot Study Using Conventional and Accelerated Fractionation
Authors: BALL DAVID , BISHOP JAMES , CRENNAN ELIZABETH , OLVER IAN
Published: March 2008

Thirteen patients with unresectable non small cell lung cancer were treated with radical radiotherapy and carboplatin administered concurrently. The first 6 patients were treated to a total dose of 60 Gy in 30 fractions in 6 weeks, with carboplatin 70 mg/m2/day on days 1 to 5 during weeks 1 and 5 of radiotherapy. The remaining 7 patients were given 60 Gy in 30 fractions in 3 weeks, treating twice a day (accelerated fractionation). Carboplatin was given as above but only during week 1 of radiotherapy. Twelve patients completed radiotherapy without interruption but 2 patients developed WHO grade 3 neutropenia. Major toxicity was oesophagitis, one patient requiring nasogastric feeding. Average duration of dysphagia (any grade) in the accelerated fractionation group was 21 weeks. Four patients achieved good partial responses even though intial tumour volume was large. We conclude that this treatment is associated with increased but acceptable early mucosal toxicity.
The Role of Radiotherapy in the Control of Midbrain Tumours
Authors: FRANKLIN C. I. V.
Published: March 2008

This study examined 37 patients who were referred to the Queensland Radium Institute between 1980 and 1989 with tumours of the midbrain to determine if there were any factors which were associated with an improved prognosis. In those patients in whom histology was available, the grade of the tumour was of importance. High grade tumours had a shorter survival than low grade tumours. There was a dose response effect with increasing survival as the dose increased from less than 45Gy up to 50Gy. There were no deaths beyond two years, implying that two year survival is an indicator of long term survival.
Case Report ‐ CT Findings in Adenomyomatosis of the Gallbladder
Authors: CLOUSTON J. E. , THORPE R. J.
Published: March 2008

A case report of the CT findings in adenomyomatosis of the gallbladder is presented. Significant CT findings of this entity are variation in wall density, marked differential enhancement of wall layers during dynamic liver scanning and detection of Rokitanksy‐Aschoff sinuses within the wall. CT apparently depicts both mucosal and muscularis thickening.
Duplication of the Vertebro‐Basilar System
Authors: TRAN‐DINH H.D. , SOO Y.S. , JAYASINGHE L.S.
Published: March 2008

During the examination of 75 fixed brains and 2086 vertebral angiograms we encountered two cases of fenestration of the vertebral artery and two cases of partial duplication of the basilar artery.

In the first case, an 81 year old male, there was fenestration, of the basilar artery at the union of the two vertebral arteries. The fenestration was 9mm long with no associated vascular disease. The other partial duplication of the basilar artery was observed in the upper portion of the artery in a 54 year old male patient investigated angiographically for subarachniod haemorrhage. The fenestration of the third case was demonstrated in the intracranial part of the right vertebral artery of a 50 year old female patient during digital substraction angiography for subarachnoid haemorrhage. In the fourth case, the fenestration was found angiographically at the atlanto‐axial level in the extracranial portion of the left vertebral artery in a 37 year old female patient with subarachnoid haemorrhage from an arteriovenous malformation in the left cerebral hemisphere.

The embryonic, histological and radiological implications of the duplication are discussed.
Radiological‐Pathological Correlation of Mass Lesions in the Liver
Authors: KREEL LOUIS , ARNOLD MUOI M. , FAILO YUET‐
Published: March 2008

Thirty two human livers were removed at autopsy. These included 7 with space‐occupying or tumour‐like lesions, namely one with multiple cysts, three with haemangiomas, a lobated liver with multiple nodules of focal nodular hyperplasia, one with a metastasis which also had a small haemangioma and one with a hepato‐cellular carcinoma. Fine particle barium diluted 2:l with water was injected by hand to fill the arterial system. In the lobated liver, the portal system was also filled. High definition radiographs of liver slices showed arteriographic detail not visible on angiography. The arteriographic appearances were correlated with the macroscopic and microscopic pathology.

Liver cysts compress the arteries and arterioles but an apparent halo on the whole liver radiograph was shown to be spurious on a 1 cm thick high definition film. The small vessel pattern of haemangiomas is well demonstrated accounting for the hyperechoic sonograms but hypoechoic areas may also occur due to involution of or haemorrhage into tumours. The small lesions of focal nodular hyperplasia had a poor arterial supply but filled from a portal venous injection. Metastases had a peripheral network of small vessels, central necrosis and normal sized peripheral arteries with no large artery entering the tumour. In hepatocellular carcinoma, a large artery was demonstrated entering the tumour which was considerably more vascular than the metastases. These features should aid in distinguishing these lesions on sonography.
Carbon Localisation of Impalpable Mammographic Abnormalities
Authors: LANGLOIS S. Le P. , CARTER M.L.
Published: March 2008

A prospective study was undertaken to assess the usefulness, safety and cost‐effectiveness of stereotacti‐cally guided carbon localisation of impalpable breast lesions. Fifty six lesions in 53 patients were iocalised by this method, some in combination with fine‐needle aspiration and hookwire localisation. Some modification of the study was required due to ready acceptance of the technique by surgeons, who preferred carbon to hookwire localisation. The technique was proven to be safe and accurate, and highly acceptable to patients, referring clinicians and radiology staff. It is now the preferred procedure for localising impalpable breast lesions prior to excision biopsy.
Rhizomelic Bone Dysplasia with Club‐like Femora (Case report and confirmation of a syndrome)
Authors: KISS P. , KOZLOWSKI K. , ZAVODI E.
Published: March 2008

A newborn with rhizomelic bone dysplasia with club‐like femora is reported. This is the fourth case Of this easily recognizable, recently reported, congenital bone disease.

Maroteaux et al recently reported two patients with rhizomelic bone dysplasia and club‐like femora as a distinctive new bone dysplasia. Their observation was confirmed by Gugliantini et al (2) who reported another case.

This paper reports a fourth patient with this easily recognisable disorder.
The Accessory Soleus Muscle: A Case Report and Review of the Literature
Authors: MANSBERG V.J. , NIEKEKK A.L. VAN
Published: March 2008

A case of histologically proven accessory soleus muscle simulating a soft tissue turnour in a young male is reported. The radiological features are demonstrated and reviewed.
Primary Renal Carcinoid ‐ Case Report
Authors: MALTHOUSE S.R. , WAUGH R.C. , GRACE J.
Published: March 2008

Carcinoid tumour is a rare cause of a renal mass. Only fourteen cases have been reported since it was first described in 1966. This case illustrates most of the commoner features.
The Recalcitrant Subclavian Pseudoaneurysm: A Case Report
Authors: BUCKENHAM T. M. , WATKINS G.
Published: March 2008

A case of pseudoaneurysm of the left subclavian artery is presented. It demonstrates not only the difficulties facing the surgeon and radiologist in the management of this rare condition, but also how interventional radiology and surgery can be used in tandem to approach such a complex vascular problem.
Water‐Soluble Contrast CT Cisternography in CSF Fistulas
Authors: SHARMA PRADEEP , SEHGAL A.D.
Published: March 2008

High resolution C.T. cisternography with water‐soluble contrast media was performed in eight patients with C.S.F. rhinorrhea and suspected C.S.F. fistula.

This technique, aided by video fluoroscopy, proved successful in documenting the precise anatomical localisation of the fistulous track in all eight patients.

Surgical exploration and correction was done in every case with confirmation of the radiological findings.
Investigation of a Family with Von Hippel‐Lindau Syndrome
Authors: ANDERSEN JOHN
Published: March 2008

A family with Von Hippel‐Lindau syndrome has been investigated with Ultrasound, CT and MRI. The major lesions found were posterior fossa haema‐gioblastomas, retinal haemangioblastomas and renal cell carcinoma. Screening of family members has been undertaken due to the known autosomal dominant inheritance of this condition.
Childhood Hepatocellular Carcinoma and Hepatoblastoma: Integrated Sonography and Dynamic CT
Authors: FOULNER DERYCK , CREMIN BRYAN
Published: March 2008

13 cases of hepatoblastoma and hepatocellular carcinoma are reviewed with respect to the visibility of the tumour margin, hepatic veins, and portal veins on non‐contrast, non‐dynamic and dynamic computerised scans. In large tumours the accurate interpretation of venous anatomy can be difficult. We found that dynamic scanning followed by a repeat scan of selected slices after a few minutes was the most useful method. If facilities for dynamic scanning are not available then it is suggested that conventional scanning be performed immediately after the intravenous injection so as to avoid the isodense phase of hepatic enhancement.
A Review of Imaging Practice in Bone and Soft Tissue Lesions
Authors: SLAVOTINEK J.P. , ALBERTYN L.E. , OAKESHOTT R.
Published: March 2008

Thirty six consectutive bone and soft tissue lesions which were referred to the Bone Transplantation Service between January 1987 and June 1989 were reviewed with respect to the information provided by pre‐operative CT, MR and plain X‐ray and the final histopathologic diagnosis. The ability of CT and MR to demonstrate cortical destruction, periosteal reaction, a soft tissue mass and soft tissue calcification was scored on a scale of one (low suspicion of abnormality) to four (definite abnormality) in each case.

Of the thirty six cases reviewed there were twenty‐two histologically confirmed tumours with all of the above three imaging modalities available for comparison. In each of these tumours MR was found to provide an equal or more accurate assessment of soft tissue extent. On a scale of 1 to 4 the average point scores were 3.6 and 2.6 for MR and CT respectively. Little difference was shown between CT and MR with respect to medullary involvement (4.0 points vs. 3.9) and cortical destruction (2.5 points vs. 2.7). CT (3.7 points) was more sensitive than MR (1.2 points) in detecting fine soft tissue calcification.

In only five cases did the radiology report correctly nominate the histologic diagnosis and thus the role of imaging was more valuable in staging than diagnosis. For this reason a management oriented report should include comment regarding cortical destruction, the intramedullary extent of tumour and the extent of soft tissue involvement. MR is recommended in the investigation of all suspected malignant soft tissue or bone tumours.
Does the Extent of Surgery Make a Difference in High Grade Malignant Astrocytoma?
Authors: FRANKLIN C.I.V.
Published: March 2008

This paper examines the effect of patient age, tumour grade and extent of surgery on the outcome of treatment of 278 patients with high grade malignant gliomas referred to the Queensland Radium Institute between 1980 and 1987. The aim was to determine whether the extent of surgical resection alters survival rates.

The extent of surgery had no effect on survival except for those patients with grade 3 tumours in whom a total excision was possible. Those in whom only a biopsy was done did not have a worse prognosis. Grading was found to be of importance, as patients with grade 3 tumours had a better survival than those with grade 4 tumours. In grade 4 tumours, those under 30 years of age had a better survival than those over 30 years, whereas with grade 3 tumours there was a gradation of age effect (under 40 years best, then 40–49 years, and those 50 years and over doing worst).
Acute Osteomyelitis: Early Diagnosis by Ultrasonography
Authors: TANETA K. , MITTAL S.K. , MARYA S.K. , MEHROTRA G. , SHIV V.K. , BHARGAVA S.K.
Published: March 2008

A prospective study was carried out to evaluate the role of ultrasound in early detection of infections of bone. Presence of a hypoechoic collection adjacent to bone was considered highly suggestive of osteomyelitis whereas a hypoechoic collection away from the bone implied a soft tissue abscess. Cellulitis presented as increased subcutaneous thickness. Of the 31 patients clinically suspected to have osteomyelitis, and subjected to ultrasound, 25 were proven to be osteomyelitis at surgery or by subsequent radiological changes, 4 had soft tissue abscesses and the remaining 2 had cellulitis. Co‐existent hip joint effusion was seen in 2 patients. It is felt that ultrasound is simple and non‐invasive investigation, capable of detecting bone and soft tissue infections.
Duplex Doppler Ultrasound Signs of Portal Hypertension: Relative Diagnostic Value of Examination of Paraumbilical Vein, Portal Vein and Spleen
Authors: DITCHFIELD M.R. , GIBSON R.N. , DONLAN J.D. , GIBSON P.R.
Published: March 2008

The sonographic parameters in portal hypertension (PHT) were examined in a consecutive population of 118 patients who had PHT diagnosed using specific endoscopic, sonographic and Doppler signs. A patent or enlarged paraumbilical vein was found in 85.6% of patients overall and 82.5% of patients with varices indicating a relatively high sensitivity. A portal vein diameter ≤ 13mm was found in only 41.1% and ≤ 15mm in only 20% of patients. A thrombosed portal vein and reversed portal vein flow were present in 3.4% and 5.3% of patients respectively. These signs have only been reported in the context of PHT and are felt to be specific for PHT, but both have a very low sensitivity.

Portal vein velocities were highly variable suggesting that this is not a useful predictor of PHT. Splenomegaly was found in only 53.5% of patients demonstrating its poor sensitivity as a sign of PHT. Varices were found in 73.3% of patients overall, and in 100% of patients with a patent or enlarged paraumbilical vein combined with ascites. No other statistically significant correlation between varices and sonographic findings was demonstrated.

We conclude that the presence of a patent or enlarged paraumbilical vein is a practical, useful and sensitive ultrasound sign to look for in the diagnosis of PHT.
Breast Pain Associated with Mammographic Compression
Authors: LEANEY BARRY J. , MARTIN MICHAEL
Published: March 2008

Firm breast compression during film‐screen mammography is necessary to achieve optimum image quality while minimizing radiation time. Of 374 women who fully completed a questionnaire following mammography, 225 (60%) reported no pain, 115 (31%) moderate pain and only 3 (1%) reported severe pain. Only one patient stated that the pain from the procedure would prevent her from having a further mammogram. Underlying breast disease (usually fibmystic disease) is associated with a greater incidence and severity of breast pain, but, no relationship has been demonstrated with regards to the patient's age, hormonal status, menstruation or caffeine intake. The high level of acceptance of firm compression by women in our study indicates that undue concern regarding patient discomfort should not deter people from referral for mammography or from the application of firm compression.
CT Evaluation of Orbital Osseous Hemangioma
Authors: SOOD SAMEER , VASHISHT S. , BETHARIA S.M. , BERRY M.
Published: March 2008

Two patients with osseous hemangioma of the orbit, and with typical features on plain radiography and computed tomography, are reported. The typical features of osseous hemangioma of the orbit on computerised tomography (CT) are: expansile bony lesion limited by a thin sclerotic rim, bony trabeculae radiating from the centre to the periphery of the lesion, and absence of an associated extra‐tumoral soft tissue mass. To the best of our knowledge this is the first report of osseous hemangioma of the orbit evaluated by CT.
Cerebro‐Costo‐Mandibular Syndrome
Authors: LIM C.T. , KOH M.T.
Published: March 2008

Cerebro‐costo‐mandibular syndrome (CCM) is a very rare entity with oro‐facial features closely resembling Pierre‐Robin anomaly (1,2). We describe a patient with typical features: severe micro‐gnathia, glossoptosis, central cleft soft palate and multiple posterior rib‐gap defects Seen on chest radiograph. Respiratory distress which was evident soon after birth was relieved by an oro‐pharyngeal airway. He suffered from a cardio‐respiratory arrest and succumbed, presumably secondary to aspiration of milk feeds, before a tracheostomy cwld be performed.
A Comparison Between M.R.I. and C.T. in Acute Spinal Trauma
Authors: SILBERSTEIN MORRY , TRESS BRIAN M. , HENNESSY OLIVER
Published: March 2008

Magnetic Resonance Imaging (MRI) at 0.3T and Computed Tomography (CT) were compared in the retrospective evaluation of 34 patients with acute spinal cord injury. MRI was highly accurate in the imaging of vertebral body fracture, and spondylitk changes, and is the method of choice for imaging ligament injury, traumatic disc protrusion and spinal cord compression. It was also useful for the identification of subtle subluxations in the sagittal plane. CT remains the method of choice for imaging neural arch fractures. MRI at 0.3T is a valid technique for assessing patients with acute spinal trauma.
Pulmonary Arteriovenous Malformations: Pathology, Clinical Features and Treatment with Balloon and Coil Occlusion
Authors: GOERGEN STACY K. , SACHARIAS NINA R.
Published: March 2008

This paper discusses the cases of 5 patients who have had therapeutic occlusion of their pulmonary arteriovenous malformations (PAVM) performed radiologically at Alfred Hospital in the past 4 years. The salient pathological, clinical and radiological features of PAVM are also presented.
Accelerated Thrombolysis Facilitated by Direct Puncture of Occluded Prosthetic Femoral Grafts
Authors: PAGE J.E. , BUCKENHAM T.M. , TAYLOR R.S.
Published: March 2008

Inability to access occluded grafts is a major limitation to successful thrombolysis and may even preclude it. This paper addresses the problem and offers a new technique of direct puncture of prosthetic grafts through which thrombolysis and angioplasty can be performed. These techniques resulted in accelerated thrombolysis in all 15 patients studied with no failures due to inability to attain graft access.
Non Small Cell Carcinoma of the Lung A Retrospective Study Presented at the 41st Annual Meeting of the Royal Australasian College of Radiologists, September 1990, Perth
Authors: STEVENS GRAHAM , FIRTH IAN
Published: March 2008

A retrospective study was undertaken in 1990 of 188 patients with the diagnosis of non small cell carcinoma of the lung referred to the Department of Radiation Oncology in 1984. Most patients (178/188) received a course of radiotherapy. This was definitive in 23, palliative in 148 (primary site in 113, metastases in 16, primary plus metastases in 19) and postoperative in 7. This report is a 5 year followup of the 171 patients treated by radiation alone, to assess factors that influence survival.

Tumour histology was 50% squamous, 23% adenocarcinoma, 16% large cell and 4% unspecified, non small cell carcinoma. In 8% no histological diagnosis was obtained. The most common symptoms were cough (44%), dyspnoea (43%), chest pain (37%), haemoptysis (33%) and systemic symptoms (36%). Tumour stage (TNM) was assessed retrospectively as I(5%), II(8%), IIIA(18%), IIIB(22%) and IV(28%). A subgroup of 31 cases (18%) of uncertain staging (I‐III) was analysed separately and in 2 cases (1%) no staging information was available.

Palliative intent of treatment and poorer performance status were related significantly to increasing stage of disease. The effects of palliative treatment were recorded in 79 cases; in 71 there was a reduction in symptoms.

The median survival from diagnosis was 8 months (range <1–72). Using univariate and multivariate analyses, significant and independent prognostic factors for improved survival were good performance status, absence of systemic symptoms, lower tumour stage and curative intent of treatment (higher radiation dose). However the 5–year survival was only 2%. Long‐term survival was associated predominantly with early stage disease but not with the type or intent of treatment. Age, sex, histology and apical site did not influence survival.

These results are comparable to those found in the literature and emphasise the need to select patients carefully for either palliative or aggressive treatment.
Bilateral Spondylolysis and Associated Dysplasia of C6
Authors: JONES D.N. , SAGE M.R.
Published: March 2008

Cervical spondylolysis is a rare condition, characterised by the presence of a corticated cleft between the superior and inferior articular facets of the articular mass (1). This defect involves the cervical equivalent of the pars interarticularis of the lumbar spine. Associated dysplastic changes are present, suggesting that the lesion is congenital (1 and 2). This case report describes bilateral spondylolysis and associated dysplasia of C6 in an 18 year old female. The importance of this lesion lies in its differentiation from the more serious articular mass fracture or dislocation (1).
Post‐Laminectomy Pseudomeningocele: An Unusual Cause of Bone Erosion
Authors: LAU KENNETH K. , STEBNYCKYJ MARK , McKENZIE ALLAN
Published: March 2008

Pseudomeningocele is a rare complication of laminectomy, which can cause recurrent back pain with or without radicular signs. A case of bone erosion of the posterior vertebral elements by a pseudomeningocele is discussed.
Sonographic Appearance of Plasmacytoma of the Testis
Authors: CROFT G.V. , ALBERTYN L.E.
Published: March 2008

A case of solitary extramedullary plasmacytoma of the testis is presented demonstrating the appearances on ultrasound. The clinical implications of this diagnosis are discussed.
Scintigraphic Diagnosis and Computed Tomographic Localization of an Accessory Spleen Following Relapse of Chronic Immune Thrombocytopaenia
Authors: CARDACI G.T. , BLAKE M.P.
Published: March 2008

Chronic immune thrombocytopaenia is an immunologically mediated disorder resulting in disordered platelet kinetics and potentially life‐threatening thrombocytopaenia. Failure of medical therapy is an indication for splenectomy, and responses are seen in 80% of patients following this procedure. An important cause of relapse following splenectomy is the presence of an accessory spleen.

We describe a patient with Hodgkin's Disease who developed chronic immune thrombocytopaenia despite previous splenectomy. A remission was induced with immunosuppressive therapy, but he later relapsed.

An accessory spleen was detected using 99mTc denatured red blood cells and localized using computed tomography (CT). Resection of the accessory spleen resulted in clinical remission.

Accessory spleens are often small in size. Combined modality imaging is recommended in the evaluation of patients with a possible accessory spleen.
Lung dose rate and interstitial pneumonitis in total body irradiation for bone marrow transplantation
Authors: GOGNA N. KUMAR , MORGAN GRAEME , DOWNS KATE , ATKINSON KERRY , BIGGS JAMES
Published: March 2008

The effect of dose rate to the lungs and development of interstitial pneumonitis (IP) was evaluated in 114 bone marrow transplant patients receiving fractionated total body irradiation (TBI) (1200 rads TD in 6 fractions twice daily over 3 days) as part of their pre‐conditioning regimen. The tumour dose (TD) was calculated as the mean lung dose as previously described (1). A 6MV linear accelerator at a mid‐line dose rate of 7.5 rads/minute was used between March 1981 and June 1985 and a Co‐60 source at 5 rads/minute thereafter. This resulted in a range of dose rates to the lung of between 6.9 and 8.9 rads/minute and 2.9 and 6.5 rads/minute respectively. In the majority of patients the aetiology of IP was investigated by lung biopsy with histology and culture. There was no statistically significant difference in the incidence of IP over the two sets of dose rates. Our study suggests tat the incidence of IP using fractionated TBI is not influenced by dose rates below 8.9 rads per minute.
Gadolinium‐enhanced MRI of soft tissue masses
Authors: HARKENS KAREN L. , MOORE TIMOTHY E. , YUH WILLIAM T.C. , KATHOL MARY H. , HAWES DONALD R. , EL‐KHOURY GEORGES Y. , BERBAUM KEVIN S.
Published: March 2008

The efficacy of gadopentetate dimeglumine (Gd‐DTPA) enhanced magnetic resonance (MR) imaging in the diagnosis and differentiation of soft‐tissue, neoplastic and non‐neoplastic lesion has not been well established. Thirty patients with soft tissue masses (18 neoplastic and 12 non‐neoplastic) were studied, using MR imaging with and without administration of Gd‐DTPA. Gd‐DTPA proved helpful in characterisation of several entities, including differentiation of solid mass from proteinaceous cyst, demonstration of tumour nodules within haemor‐rhagic or necrotic masses, and delineation of tumour adjacent to oedema. The use of Gd‐DTPA may provide additional information for tissue specificity and, in complicated cases, Gd‐DTPA may also provide essential information that cannot be obtained using other methods. We recommend the use of contrast enhanced MR as an adjunct to conventional MR imaging in the initial assessment of musculoskeletal soft tissue masses. However, T2‐weighted images show better tissue contrast of the lesions, and are equal to contrast enhanced images in delineation of tumour margins. Non‐contrast enhanced images are, therefore, probably adequate for the delineation of lesions for surgical planning when a diagnosis has already been made.
The use of MRI in the diagnosis of benign and malignant bone and soft tissue tumours
Authors: GRIFFITHS HARRY J. , GALLOWAY HOWARD R. , THOMPSON ROBY C. , SUH JIN‐SUCK , NELSON THOMAS E. , EVERSON LENORE , EDLIN JAMES P. , LYNN BRYAN J. , LANG DAVID
Published: March 2008

Two hundred and thirty four suspected primary bone and soft tissue tumours were investigated using plain films and MRI. The MR appearance of 200 of these tumours was assessed with respect to the intensity of the lesion, the homogeneity of the tumour, the presence or absence of a capsule or lobulation, whether the tumour was whorled or not and whether it contained either fluid or blood. Apart from benign lipomas and some malignant myxoid liposarcomas, however, it seemed virtually impossible to tell one tumour from another and in many cases to differentiate a benign lesion from a malignant tumour using MRI alone. We recommend that the workup of a suspected soft tissue tumour should be initially by MR scanning and that the workup of a suspected malignant bone tumour should be plain films followed by an MRI scan.
Amiodarone pulmonary toxicity: its radiological features
Authors: DELANY STEPHEN G. , TAYLOR D. ROBIN , RESTIEAUX NORMA , DOYLE TERENCE C.
Published: March 2008

Two cases of pulmonary toxicity associated with chronic ingestion of amiodarone are presented. Special emphasis is given to the radiological features which may aid in the clinical diagnosis of this disorder.
Hereditary tyrosinaemia (HT) type 1A
Authors: LAM ALBERT H. , VILLANUEVA ANGELA C. , ONG JULIE
Published: March 2008

Two infants, aged 5 and 6 months, with the chronic form of HT Type 1 A were studied with sonography and CT. The imaging findings mirrored the pathological process. The sonographic findings included marked hepatomegaly, the parenchyma being of increased echogenicity due to fibrosis and fatty infiltration, and containing multiple hypoechoic regenerating nodules of varying sizes. There was marked nephromegaly, with uniform thickening of the renal cortices. Apart from the density measurement of the hepatic nodules and the perfusion status of the liver and kidney, no additional information was added by CT imaging. The diagnosis of HT Type 1 A should be excluded in an infant presented with the described typical sonographic features.
Bone involvement in Hodgkin's disease
Authors: BORG M.F. , CHOWDHURY A.D. , BHOOPAL S. , BENJAMIN C.S.
Published: March 2008

Bone involvement in Hodgkin's disease is uncommon and seldom encountered at initial diagnosis. Seven cases with osseous involvement were identified from a series of 147 patients with Hodgkin's disease treated at Auckland Hospital from 1980 to 1988. Only one patient was found to have bone lesions at the time of initial presentation.

Two patients had multiple lesions and 5 had a solitary lesion. Sites of involvement included the spine, pelvis, femur, humerus, ribs, sternum, scapula and base of skull. Six patients had nodular sclerosing histology and one had mixed cellularity disease.

All 7 patients were treated with systemic chemotherapy for their advanced disease, and 5 patients needed local radiotherapy to sites of bone involvement. The radiation dosage schedules were individualized, ranging from 30 Gy to 40 Gy, using either a 6 MeV linear accelerator or cobalt machine. At the time of analysis of this study, 4 patients were in complete remission, 2 patients completed chemotherapy with good response and only 1 patient died of disseminated disease. The current review has demonstrated an encouraging response to treatment and good long term control. We believe that combined‐modality therapy is effective in the treatment of osseous involvement in Hodgkin's disease.
Superselective catheterisation with the “Explorer” catheter
Authors: THOMSON K.R.
Published: March 2008

An Australian‐manufactured, superselective catheter is available for deep catheterisation of target vessels using a coaxial technique. The catheter is compatible with standard micro coils and is able to deliver embolic particles of appropriate size.
Interventional sialography using digital imaging
Authors: BUCKENHAM T. , GUEST P.
Published: March 2008

We review our results in treating 5 patients with parotid duct pathology (3 stenoses, 2 calculi), using digital subtraction imaging for sialography, and standard interventional techniques using balloon catheters. Good technical results were achieved in all 5 patients. We describe our techniques and how they were modified to overcome various difficulties.
Skeletal abnormalities in primary oxalosis
Authors: DESMOND PATRICIA , HENNESSY OLIVER
Published: March 2008

A case of primary oxalosis and hyperoxaluria in a 16 year old boy is presented. The skeletal appearances in this disorder result from the deposition of oxalate crystals in the bone marrow. Prior to the advent of renal dialysis and transplantation these patients invariably died at a young age.
A thrombosed saccular posterior cerebral artery aneurysm in an infant
Authors: CHEUNG H. , LEE F.C.
Published: March 2008

A case of recurrent hemiplegia due to saccular aneurysm of the left posterior cerebral artery in a female infant is described. The diagnosis was made at angiography, prompted by CT detection of a hyperdense, intra‐aneurysmal thrombus, and was confirmed at subsequent surgery.
A very unusual breast lump
Authors: COSTELLO SHAUN A. , MUNN ELIZABETH , MACDONALD JOHN , WYNNE CHRISTOPHER J.
Published: March 2008

A 77 year old woman presenting with a malignant phyllodes tumour of the right breast with exclusively stromal metastases to axillary lymph nodes refractory to both radiotherapy and chemotherapy.
Hemangioma of spleen with spontaneous, extra‐peritoneal rupture, with associated splenic tuberculosis — an unusual presentation
Authors: RAO R.C. KESAVA , GHOSE RITA , SAWHNEY SUKHPAL , BERRY MANORAMA
Published: March 2008

We report a case of unusual presentation of a patient with hemangioma of the spleen. The patient had presented with recurrent gastric hemorrhage and significant weight loss, due to ruptured hemangioma of the spleen and associated splenic tuberculosis. The true nature of the lesions remained a diagnostic dilemma despite complete radiological workup and review of literature.
Pacemaker function during irradiation: in vivo and in vitro effect
Authors: NGU S. L. CHARLES , O'MELEY PATRICK , JOHNSON NEVA , COLLINS CATHRYN
Published: March 2008

With an ageing population in Australia, one would expect the probability of treating cancer patients who have a cardiac pacemaker to increase. In this paper the effect of ionizing radiation and electromagnetic interference on pacemaker function is discussed. A case of a cancer patient, with pacemaker, treated with radiotherapy without III effect, is described. Concurrently, four pacemakers were tested in vitro with gamma radiation from a 60 Cobalt machine and no adverse effect was found. A list of precautions is recommended.
Budd‐Chiari syndrome: successful treatment by percutaneous transluminal angioplasty
Authors: FOCK K.M. , CHAN C.C. , KHOO T.K.
Published: March 2008

Budd Chiari syndrome is a rare disorder. It is caused by obstruction of the hepatic veins. The prognosis is usually dismal, except in the rare case where the obstruction is due to either webs in the hepatic veins or membranous obstruction of the inferior vena cava. Such cases, more common in the Orient, can be treated by percutaneous transluminal angioplasty. We report a case of Budd Chiari syndrome, due to a membranous obstruction in the right hepatic vein, successfully treated by percutaneous transluminal angioplasty.
Cavernous haemangiomas (angiomas) of the brain: Clinically significant lesions
Authors: SAGE M R , BROPHY B P , SWEENEY C , PHIPPS S , PERRETT L V , SANDHU A , ALBERTYN L E
Published: March 2008

A review of 2000 consecutive magnetic resonance imaging (MRI) brain studies identified 18 (0.9%) patients with lesions that satisfied MRI criteria for cavernous haemangiomas. The clinical, computed tomography (CT) and MRI findings in 23 patients with probable cavernous haemangiomas were compared. Thirty‐three lesions were identified with multiple lesions in five (22%) patients. In 19 (82%) patients the neurological presentation corresponded to a cavernous haemangioma. The presenting symptoms were: seizures in 11 patients (48%); progressive neurological symptoms and signs in four (17%); and acute symptoms and signs due to haemorrhage in four (17%). T2 weighted images suggested the diagnosis in all cases, with 24 (73%) lesions showing the typical appearance of an area of mixed signal intensity with a rim of low signal intensity.

In the absence of acute haemorrhage, CT demonstrated well circumscribed, round or oval hyperdense lesions without significant mass effect and with normal surrounding brain tissue in the majority of cases. Although not diagnostic, these CT features are strongly suggestive of cavernous haemangiomas.
Perimesencephalic subarachnoid haemorrhage: Negative angiography and favourable prognosis
Authors: GOERGEN STACY K , BARRIE DONALD , SACHARIAS NINA , WAUGH JOHN R
Published: March 2008

The computed tomography (CT) scans of 110 consecutive patients who presented, over a 4.5‐year period, following spontaneous subarachnoid haemorrhage (SAH), were reviewed. All 110 patients also had one or more 4‐vessel digital subtraction cerebral angiograms. The CT scans were reviewed in each case without knowledge of the angiographic result. In nine patients (8%), SAH was confined to the perimesencephalic area, interpeduncular cistern and/or prepontine region at CT. All nine patients had at least two, and some as many as four, negative cerebral angiograms. Eighteen of the 110 patients (16%) ultimately had negative angiography. Hence, the patients with isolated perimesencephalic haemorrhage (PMH) accounted for 50% of the negative angiograms. There was a significant association between isolated PMH and negative angiography (X2= 50.1, P < 0.005). The specificity of PMH for negative angiography was 100% (95% confidence interval (CI) = 97–100%) and the sensitivity of PMH for a negative study was 50% (95% CI = 16–84%). Six of the 110 patients had basilar artery aneurysms demonstrated angiographically as the cause of their SAH but none of these six had isolated PMH at CT.

All patients with isolated PMH were alive and well at follow up and none had suffered repeat SAH or vasospasm‐related ischaemic cerebral injury. Perimesencephalic haemorrhage should be distinguished from SAH in general, because of the good prognosis associated with it and the doubtful need for repeat cerebral angiography after an intitial negative study.
Sonographic detection of pneumoperitoneum: An experimental and clinical study
Authors: CHADHA DEEPA , KEDAR RAJENDRA P , MALDE HITEN M
Published: March 2008

The sonographic appearance of intra‐peritoneal air collection has been studied in 46 patients. In 30 patients (group I), a pneumoperitoneum had been iatrogenically induced either during aspiration of ascitic fluid or during laparoscopy. Three normal volunteers (group II) had been subjected to graded intraperitoneal air injection to quantify the smallest amount of air detectable by ultrasound (US). In eight patients (group III) the sonographic demonstration of free intraperitoneal air led to a diagnosis of hollow visceral perforation; whereas in another five patients (group IV) the sonographic findings reinforced the clinical suspicion of a ‘sealed off’perforation in the presence of negative roentgenograms. In all patients intraperitoneal air was seen as an echogenic line with a posterior reverberation or ring down arte‐fact. In patients with free air, this was best seen in the perihepatic spaces with the patient in the supine, left lateral decubitus or prone position. As little as 5 mL of air could be consistently detected in all three volunteers (group II). Artefacts leading to a pseudopneumoperitoneum on US included; (i) the artefacts distal to an overlying rib; (ii) ring‐down artefact from air in the adjacent lungs; and (iii) hepatodia‐phragmatic interposition of colon. With proper sonographic technique and principles of interpretation these can be distinguished from true intraperitoneal air.

Although sonography may be more informative than conventional radiology in patients with hollow visceral perforation, we did not find it more sensitive than conventional roentgenograms in detecting free intraperitoneal air. Sonography, however, is distinctly superior in patients with a sealed off perforation in whom conventional roentgenograms are frequently negative.
Post‐orchiectomy management in stage I testicular seminoma: Elective irradiation or surveillance?
Authors: SINGHAL S , DIXIT S , VYAS R K , NEEMA J P , MURTHY R RAMANA , BABOO H A
Published: March 2008

Fifty‐six patients with stage I testicular seminoma were treated at this institute between January 1982 and December 1988. Post‐orchiectomy elective radiotherapy to ipsilateral iliac‐inguinal and para‐aortic lymph nodes was delivered in 54 cases. An overall 3 year survival rate of 96% was observed in this series. Four patients (7%) relapsed (one junctional recurrence in iliac node region, two mediastinal/hilar nodes and one skeletal metastasis). Salvage chemotherapy proved successful in two out of three cases with nodal relapse. No dose limiting acute or late radiation related complications were noticed. No definite correlation was found between the patients who relapsed and various known adverse prognostic factors. We recommend elective irradiation of the draining lymph nodes in stage I seminoma, particularly at centres where surveillance is not feasible.
Direct communication between the right pulmonary artery and the left atrium: Magnetic resonance findings
Authors: STUCKEY STEPHEN
Published: March 2008

A case of direct communication between the right pulmonary artery and the left atrium is presented with the imaging findings that confirmed the diagnosis including magnetic resonance imaging.
Treatment of fibromuscular hyperplasia of the external iliac artery by percutaneous transluminal angioplasty
Authors: WING RICHARD J , WAUGH RICHARD C , HARRIS JOHN P
Published: March 2008

A case of fibromuscular hyperplasia of the external iliac artery successfully treated by percutaneous transluminal angioplasty is described.
Cerebral hydatid disease
Authors: PATRIKAR D M , MITRA K R , BHUTADA V R
Published: March 2008

Although hydatid disease of the liver and lungs is common in South Asia, involvement of the brain is relatively rare. Two cases of cerebral echinococcosis are presented. One case involved the brain, kidney, heart and spleen. The case is unusual because of the multiplicity of intracranial lesions and sparing of the liver and lungs. The other case is a classical cerebral hydatid cyst. Both cases were confirmed histologically.
Magnetic resonance angiography. II. Applications
Authors: DESMOND PATRICIA M , TRESS BRIAN M , GILFORD ERIC J
Published: March 2008

The objective of this paper is to describe clinical applications of magnetic resonance angiography. The data used were obtained from recent articles on vascular and flow magnetic resonance imaging retrieved from Index Medicus 1988–91. Other contributions were from the 29th Annual Meeting of the American Society of Neuroradiology held in Washington DC in June 1991 and the 10th Annual Conference of the Society of Magnetic Resonance in Medicine in August 1991. The data are presented in such a way as to give the reader unfamiliar with magnetic resonance a basic insight into some of the new imaging techniques.

Magnetic resonance imaging is advancing at a rapid rate. Magnetic resonance angiography is already finding many areas of clinical use with concomitant reduction in conventional angiographic and duplex Doppler ultrasound procedures.