摘要:

Isotope lung scanning is the only non-invasive test capable of making the diagnosis of pulmonary embolism reliably. While defects of perfusion have many causes (Wagner&Strauss, 1975) combining a perfusion lung scan with images of regional ventilation increases specificity, such that segmental or larger defects of perfusion unmatched in ventilation are taken as strong evidence in favour of the diagnosis of pulmonary embolus (“high probability”) (Biello et al, 1979).In the present paper we report three cases in which bullous areas showed normal ventilation with Krypton 81m and absent perfusion, resulting in large areas of ventilation/perfusion mis-match.A 65-year-old female Irish betting clerk was admitted with a Staphylococcal septicaemia following a boil on her elbow. She had no respiratory symptoms but she was known to have basal lung fibrosis and a chest radiograph showed apical bullae with bilateral basal fibrosis. During her admission she developed acute left sided pleuritic chest pain and a chest radiograph showed a small left pleural effusion. The diagnosis of pulmonary embolism (PE) seemed likely and a ventilation/ perfusion lung scan was performed using Technetium-99m macro aggregates and Krypton 81m gas.As expected the bullae in the left apex showed matched defects of ventilation and perfusion. In the right mid-zone, however, there was a large area of ventilation/perfusion mismatch, corresponding to a region of bullous formation on radiography (Fig. 1). A moderate sized mis-matched defect in the left mid-zone probably corresponded to a bullous area also, but PE could not be excluded.

DOI:10.1259/0007-1285-64-757-56

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

Melorheostosis is a rare condition principally affecting the bones of the appendicular skeleton, producing characteristic radiographic features of flowing “candle wax” subperiosteal bone and streaky endosteal bone formation in the diaphysis and epiphysis, which may affect only one side of long bones within a limb. Radiographic appearances form the basis of the diagnosis, as clinical and histological findings are non-specific.Our patient, an elderly woman, was admitted from the Casualty Department following a fall. Radiographs of her pelvis and left elbow were obtained (Figs 1 and 2) showing the typical longitudinal distribution of flowing subperiosteal and endosteal new bone. The left wrist and right elbow were similarly affected, but to a lesser extent. Skull radiographs showed (Fig. 3) bony obliteration of the left maxillary antrum without expansion of its outline, thought to be due to melorheostosis and similar in appearance to a previously described case. Thickening of the vault may be partially due to hyperostosis frontalis interna, but is asymmetrical, and melorheostosis was suspected in addition.Examination revealed no skin changes, vascular abnormalities or joint deformity and the patient had experienced no pain in the affected areas.Over 200 cases have now been reported. The classic pattern of subperiosteal bone deposition may be monostotic, polyostotic, monomelic or affect multiple limbs and the trunk (Morris et al, 1963). Extra-osseous bone deposition can occur.

DOI:10.1259/0007-1285-64-757-60

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

Lymphangiohaemangiomas are rare congenital malformations, which on histological examination show both vascular and lymphatic elements. Clinically they tend to behave as lymphangiomas. Conservative management is usually recommended, with intervention only if vital structures are affected or if required for cosmetic reasons (Bruce Williams, 1981). Mediastinal lymphangiohaemangiomas are exceedingly rare and may require treatment because of their position.A case of benign lymphangiohaemangioma of the mediastinum is presented. Unlike the only previously reported case of computed tomography (CT) in this condition (Angtuacoet al, 1983), our case showed neither near-water density nor contrast enhancement following intravenous contrast medium administration.A girl of 2 years and 8 months was admitted to Queen Elizabeth Hospital, Hackney, with a discharging cervical tuberculous fistula. She was incidentally found to have a superior mediastinal mass. After treatment of her tuberculosis, at the age of 2 years and 10 months, an exploratory thoracotomy was performed at Great Ormond Street Hospital. The operative findings were of an irresectible tumour densely adherent to the pericardium and to the great vessels in both thoracic cavities. Histological specimens showed a complex vascular malformation predominantly of lymphangiomatous tissue but containing abnormal blood vessels, appearances consistent with a diagnosis of benign lymphangiohaemangioma. A subtotal resection was performed at the age of 3 years 4 months. The left phrenic nerve was noted to pass through part of the tumour and had to be resected.At 4 years and 7 months the patient presented with a persistent cough.

DOI:10.1259/0007-1285-64-757-62

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

Focal nodular hyperplasia (FNH) is a benign hamartomatous liver mass (Robbinset al, 1984). It is usually identified incidentally during ultrasonographic examination, other diagnostic procedures or autopsy. The patients are often asymptomatic (Drum, 1982). Physical examination is found to be normal in most of the cases. Jaundice, hepatomegaly, palpable mass, and chronic intermittent vague abdominal pain, especially in the right upper quadrant, may be present in some patients. Eighty-eight per cent of the cases are female, of whom 80% give a history of oral contraceptive or supplemental oestrogen use (Kerlinet al, 1983). The lesion may be solitary (55%) or multiple, and it is usually located in the right lobe of the liver (Rogerset al, 1981), varying in size between 1 and 20 cm, and containing hepatocytes, bile ducts and Kuppfer cells (Rogerset al, 1981; Robbinset al, 1984). Colloid scintigraphic appearance may be hyperactive (40%), hypoactive (30–60%) or normoactive (30–55%) (Diament et al, 1982; Kerlin et al, 1983; Rogers et al, 1981; Welch et al, 1985). A central, stellate-shaped collageneous scar with peripherally radiating septa is the typical histopathologic feature of FNH (Kerlin et al, 1983; Rogers et al, 1981).We present a case of FNH with planar colloid scintigraphy demonstrating slightly increased uptake in the ultrasonographically detected lesion. Single photon emission computed tomography (SPECT) showed a hyperactive region at the lesion site.

DOI:10.1259/0007-1285-64-757-64

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

A 35-year-old sales executive presented with a history of abdominal discomfort and distention of 2 months duration. Systematic enquiry revealed an increased frequency of bowel action and vague dyspepsia over the same period. Examination revealed a poorly denned mass extending from the periumbilical region to the right iliac fossa. An ultrasound scan of the abdomen demonstrated ascites but was unhelpful in further characterizing the mass. A computed tomographic (CT) scan of the abdomen was then performed (Figs 1 and 2). What does this show and what diagnosis would account for these appearances?The upper cut of the CT scan, at the level of the lower border of T12, shows a soft tissue mass of low attenuation adjacent to the left lobe of the liver. Indenting or “scalloping” of the liver margin by the mass is seen. On the lower cut, at the level of L4, a rim of soft tissue of similar density to the extrahepatic mass is seen anterior to the small bowel which contains oral contrast material. Posterior to the mass, and continuous with it, is a calcified cystic structure 5 cm in diameter. A large volume of ascites is present.The patient underwent laparotomy 5 days later. At operation the peritoneal cavity was filled with mucoid ascites. Multiple nodules of tumour extended over the entire visceral and parietal peritoneum. The anterior mass shown on CT proved to be a multiloculated semicystic tumour involving the omentum and ascending and transverse colon.

DOI:10.1259/0007-1285-64-757-67

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

The growth of interventional techniques in radiology and the consequent close proximity of staff to patients during screening emphasizes the need for provision of proper protective clothing and for appropriate personnel monitoring for radiological staff. In order to comply fully with the Ionising Radiation Regulations (HMSO, 1985a) and the associated Approved Code of Practice and Guidance Notes (HMSO, 1985b; HMSO, 1988), an employer must demonstrate not only that staff doses are below any relevant limits but also that they are as low as is reasonably practicable. Since heavy protective aprons may be unduly inconvenient to wear and since routine personnel monitoring makes use of just one or two dosemeters, it is important for both the optimization of protective clothing and the estimation of whole body effective dose equivalent (IPSM, 1977) that the broad beam shielding properties of lead under relevant working conditions are known (Faulkner&Harrison, 1988).Although there are several sources which tabulate the broad beam shielding characteristics of lead and other materials at diagnostic X-ray energies (BSI, 1971; HMSO, 1971; O'Riordan&Brotherton, 1968; Binks, 1943; NCRP, 1976), a number of limitations exist when these data are applied in practice to lead apron shielding:(1) the data represent primary beam attenuation whereas personnel need to be protected against scatter;(2) data for only a limited number of tube voltages are represented possibly leading to difficult interpolation;(3) a very large range of thicknesses is covered by the data and accuracy may be compromised at the low lead equivalent thicknesses of aprons.

DOI:10.1259/0007-1285-64-757-69

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

We read with interest the papers by Pageet al(1990) and Russellet al(1990) on the importance of differentiating retroperitoneal haematoma following transinguinal orchidectomy from metastatic lymph node involvement. We have recently seen a 24-year-old man who underwent a right inguinal orchidectomy for testicular swelling of 3 months duration. Histological examination of the resected testis showed malignant teratoma undifferentiated (MTU), with no evidence of vascular invasion and absence of yolk sac elements. Tumour markers were negative pre-operatively and have remained so.

DOI:10.1259/0007-1285-64-757-72-b

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

The success of the National Breast Screening Program relies on accurate dose measurements, essential for any risk–benefit analysis and radiation protection considerations (Forrest, 1986). This need to measure absorbed doses within and around the irradiated breast necessitates the use of carefully selected materials from which phantoms and radiation detectors can be constructed.

DOI:10.1259/0007-1285-64-757-73

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

In both 1986 and 1989, multidisciplinary meetings were held under the auspices of the British Institute of Radiology for those actively engaged in magnetic resonance as applied to medicine. These one-day meetings were extremely successful, providing an environment for a valuable scientific interchange between participants, and it was decided that a similar meeting should be held in 1990.

DOI:10.1259/0007-1285-64-757-75

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY

摘要:

This small book serves to remind us that tuberculosis has not been eradicated in the Third World, and indeed is increasing even in nations with better than average health care, particularly as a consequence of AIDS. The material illustrated is based on a study of 370 patients seen in The Netherlands over the period 1955–1987.The text is brief but adequate, and in many respects this could be regarded as an atlas.

DOI:10.1259/0007-1285-64-757-81-c

出版商:The British Institute of Radiology    

年代:1991

数据来源: WILEY