Imaging of the pelvis via computed tomography (CT), ultrasound, or magnetic resonance (MR) provides excellent anatomical detail and superb resolution. Despite this, radiologists often have difficulty ...reaching a specific diagnosis in evaluating adnexal masses. A wide spectrum of benign extraovarian pathology may closely resemble ovarian cancer. Fallopian tube disease such as hydrosalpinx, tuboovarian abscess, and chronic ectopic pregnancy may mimic cystic or solid ovarian neoplasm. Pedunculated uterine leiomyomas may imitate ovarian lesions. Gastrointestinal causes of adnexal masses include mucocele, abscess, and hematoma. These entities may appear similar to ovarian lesions, thus requiring close attention to specific anatomical detail in order to help differentiate them. Similarly, peritoneal disease including tuberculous peritonitis and peritoneal pseudocyst may simulate ovarian tumor. While ultrasound represents the initial imaging modality in the evaluation of most pelvic disease, MR's multiplanar capability and improved tissue characterization make it a valuable modality in many circumstances.
We report the ultrasound, computed tomographic, and magnetic resonance imaging findings in a case of extramedullary hematopoiesis presenting as a focal splenic mass in a patient with myelodysplastic ...syndrome. Ultrasound demonstrated a well-circumscribed hyperechoic mass, whereas computed tomography showed a heterogeneous mass better visualized after administration of intravenous contrast. On magnetic resonance imaging, the lesion was hypointense to the spleen on T1-weighted images, with increased signal on T2-weighted images, and demonstrated enhancement after intravenous contrast administration. Extramedullary hematopoiesis should be considered in the differential diagnosis for a splenic mass in any patient with a hematologic disorder.
To determine the prevalence and appearance of cardiophrenic angle (CPA) varices at computed tomography (CT) in patients with portal hypertension (PHT).
A retrospective review was performed of 148 ...consecutive contrast material--enhanced abdominal CT scans of patients with PHT. The paracardiac region was assessed for tubular structures suggestive of varices. Variceal diameter and CT attenuation relative to adjacent liver were noted.
Tubular structures consistent with CPA varices were noted in 29 cases and were more common on the right side than on the left. Mean CPA variceal diameter was 2.6 mm. In three cases, right CPA varices measured 10-13 mm in diameter, but no variceal enhancement was noted on initial dynamic CT images. Delayed CT demonstrated contrast enhancement that reflected delayed enhancement of the portal venous system.
CPA varices, particularly on the right side, are not uncommon in patients with PHT. Varices should be considered and excluded as a cause of CPA masses, particularly before percutaneous biopsy. Delayed CT may be necessary to correctly delineate CPA varices.
To assess the prevalence and significance of arteriovenous fistulae after prostate biopsy, we performed color Doppler ultrasonography immediately after 136 consecutive transrectal prostate needle ...biopsies. Pathologic results were correlated with color Doppler ultrasonographic findings. Arteriovenous fistulae developed after 17 biopsies (13%), all closed spontaneously within 18 minutes, and none were associated with unusual bleeding. Carcinoma was noted in 25 biopsy specimens (18%), 10 (40%) of which were followed by arteriovenous fistula. The correlation between malignancy and postbiopsy arteriovenous fistula was statistically significant (P < 0.0004), consistent with hypervascularity known to be present in many prostate cancers.
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with no known cure. Maintaining quality of life (QOL) as the disease progresses is an important treatment goal.
the purpose ...of this study is to identify factors that support QOL as ALS progresses.
Changes in QOL were monitored in 162 individuals with ALS at 3- to 4-month intervals. Forty-nine of the participants survived in the study for over 1 year and were included in a longitudinal comparison. The 49 long-term participants were younger and stronger at Time 1 than were the participants who died before reaching the 1-year point. The McGill Quality of Life Scale demonstrated a high and stable QOL despite physical deterioration.
Patients maintained a positive self-perception of their health despite the physical deterioration. Over time, self-perception of health and religiosity were shown to be significantly correlated with QOL.
Results support the need for better instrumentation to enable future studies to more precisely measure multiple dimensions of ALS-related QOL, to identify reference points for self-ratings of both health and QOL, and to capture the religious and spiritual mechanisms related to QOL as individuals face the end of life.
PDF
