We reviewed 17 cases of pulmonary lymphangioleiomyomatosis diagnosed by open lung biopsy. All patients were women with a mean age of 39.6 years. Tuberous sclerosis was diagnosed in two cases. The patients were submitted to high-resolution computed tomography that showed diffuse thin walled cystic lesions of less than 60 mm in diameter. Associated pneumothorax was seen in two cases. The main high-resolution computed tomography findings were diffuse, rounded, cystic lesions, generally of less than 20 mm in diameter.

Keywords: Lymphangioleiomyomatosis, Cystic lung diseases, High-resolution computed tomography

PURPOSE: To determine the frequency and etiology of intrahepatic calcifications diagnosed on abdominal computed tomography (CT) studies. MATERIALS AND METHODS: A retrospective study of 1,362 consecutive CT scans of the abdomen was carried out to determine the presence of intrahepatic calcifications. The clinical and laboratorial data of all patients with liver calcifications were reviewed in order to establish the etiology of the lesions. RESULTS: Intrahepatic calcifications were found in 3.6% (49/1,362) of the patients, and were predominantly seen in women (57.2%) than in men (42.8%). The population age ranged from 18 to 92 years (mean 59.4 years; median 63.5 years). Calcifications were considered residual and without clinical repercussion in most cases (39/49; 79.5%) whereas in 14.4% (7/49) of the patients calcifications were associated with metastatic disease and in 6.1% (3/49) with cystic lesions. The primary tumors in the seven patients with calcified liver metastases were colon carcinoma (five patients), sarcoma (one patient) and malignant ovarian teratoma (one patient). Two of these patients presented calcifications only after chemotherapy. CONCLUSION: Intrahepatic calcifications are infrequent findings on routine abdominal CT scans (< 5%) and are mostly related to previous inflammatory and/or infectious diseases.

Keywords: Liver, Calcification, Neoplasm, Computed tomography

The authors report the clinical, gross pathology and ultrasonography findings of 11 prospectively studied patients with solid and papillary epithelial neoplasm of the pancreas (SPEN). The patients were one male and ten females aged 15 to 75 years (mean age at diagnosis: 27 years). All patients had pathology proven SPEN and were submitted to preoperative ultrasonography. The size, location and ultrasonographic features of the tumors were evaluated and correlated with the gross pathology findings. The mean transverse diameter of these tumors was 8.7 cm (range: 4.2 cm to 16.0 cm). Tumors were located in the head (three cases), body (three cases) and tail (five cases) of the pancreas. All lesions were well encapsulated and presented some degree of internal hemorrhage. There was full correlation between ultrasonography and gross pathology findings. In three cases (27.3%) the tumors were predominantly solid, cystic in one case (9.1%), and had equal degrees of solid and cystic components in seven cases (63.6%). Calcifications, predominantly peripheral, were seen in four (36.4%) of the 11 patients. All tumors were in contact with the portal, mesenteric and splenic venous axis. In all cases except one there was no venous invasion. Lymph nodes or distant metastases were not observed in any of the patients. The authors concluded that in all cases there was a correlation between the ultrasonography and gross pathology findings, and although ultrasonography findings are not specific they may be highly suggestive of SPEN in the appropriate clinical context.

Keywords: Neoplasm of the pancreas, Solid and papillary epithelial neoplasm of the pancreas, Ultrasonography

BACKGROUND: The diversity of existing techniques for the measurement of the spleen using Doppler ultrasound (Doppler-US) as well as the lack of biometrical and Doppler velocimetry reference values make the evaluation of this organ and its hemodynamics quite difficult. OBJECTIVES: To establish biometrical and hemodynamics Doppler-US standard values for healthy adult individuals. MATERIALS AND METHODS: This is a prospective study involving 44 healthy individuals (19 males and 25 females) with mean age of 37.4 ± 9.6 years (23-60 years). Morphometry (US-B mode): spleen: longitudinal (L), transversal (T) and anteroposterior (AP) axes; splenic artery diameter (AD) and splenic vein diameter (VD). Morphometrical spleen indexes: uniplanar (UI), biplanar (BI) and the splenic volume (SV). Doppler velocimetry (US-Doppler): a) splenic artery: systolic peak velocity (SPV), mean of the highest flow speeds (TAMax); pulsability index (PI) and vascular impedance resistivity index(RI); b) splenic vein: mean of the highest flow speeds (TAMax). RESULTS: Morphometry: L = 9.3 ± 1.3 cm; T= 3.9 ± 0.7 cm; AP = 8.4 ± 1.2 cm; AD = 0.3 ± 0.07 cm; VD: 0.5 ± 0.12 cm. Morphometrical spleen indexes: UI = 33.5 ± 9.9; BI = 36.7 ± 10.3; SV = 164.3 ± 62.9 cm³. Doppler velocimetry: a) splenic artery: SPV = 59.8 ± 23.6 cm/s; TAMax = 40.2 ± 15.9 cm/s; PI = 0.86 ± 0.30; RI = 0.55 ± 0.09; b) splenic vein: TAMax = 16.8 ± 8.3 cm/s. CONCLUSION: Report of biometrical and Doppler velocimetry standard values of the spleen in healthy individuals.

Keywords: Spleen, Splenic biometry, Ultrasound, Doppler

OBJECTIVE: We developed a protocol to compare the measurements of the anorectal angle in nulliparous and multiparous asymptomatic volunteers in three different situations. SUBJECTS AND METHODS: Defecograms were carried out in 30 women (15 nulliparous and 15 multiparous) from May, 1997 to December, 1998. After rectal administration of texturized barium contrast media, lateral radiographic views of the rectum were obtained at rest, during contraction of the puborectal muscle and during defecation. A repeated measures model was used for the statistical analysis. RESULTS: There were no significant differences between the mean anorectal angles of nulliparous and multiparous volunteers. Measurements were as follows: 92.9° at rest, 78.8° during the contraction of the puborectal muscle and 117.9° during defecation for the nulliparous volunteers; 94.3° at rest, 79.7° during the contraction of the puborectal muscle and 121.4° during defecation for the multiparous volunteers. A significant difference was observed between the anorectal angle measurements at rest, during contraction of the puborectal muscle and during defecation. CONCLUSION: There were no significant differences between the anorectal angle measurements of the two groups of volunteers examined.

Keywords: Defecography, Anus, Rectum, Defecation, Pelvis, Female

The authors studied seven patients with gingival carcinoma attended at the Head and Neck Surgery and Otorrhinolaryngology Service and the Diagnostic Imaging Service of "Complexo Hospitalar Heliópolis", São Paulo, SP, Brazil, between 1985 and 1996. Squamous cell type carcinomas were identified in all cases. All patients were male (100%) aged 48-72 years. Computed tomography was performed in six patients (85.6%). Four patients (57.1%) had not received any treatment before imaging examination whereas three patients (42.8%) had already been submitted to surgery or radiotherapy. The authors analyzed the primary site of the tumor and its extension to the mandible (5/7 cases; 71.4%), the floor of the mouth (3/7 cases; 42.8%), the floor of the maxillary sinus (1/7 cases; 14.2%) and the retromolar trigonum (1/7 cases; 14.2%). Metastatic lymph nodes were observed in five patients (71.4%). Diagnosis was confirmed by biopsy and histopathological examination in all cases. Comparison with surgical findings was possible in five cases (71.4%).

Keywords: Gingiva, Malignant tumors, Gingiva

Helical computed tomography has been widely used in the evaluation of the liver parenchyma for clinical and surgical management. The liver is probably the organ for which helical computed tomography examination is best indicated due to hepatic dual blood perfusion and the difference in blood supply between liver tumors and normal parenchyma. However, there are pitfalls in the interpretation of the images that may impair differentiation of true lesions from pseudolesions, particularly for the inexperienced radiologist. These pseudolesions present different shapes, location and characteristics that may mimic parenchymal lesions and their recognition and understanding are essential to avoid misdiagnoses. The aim of this study is to propose a systematic classification of the pseudolesions of the liver using illustrative cases and thus offer alternative means to differentiate these lesions from true parenchymal lesions.

Keywords: Liver, Helical computed tomography, Pitfalls

The purpose of this study is to review the anatomical structures, ultrasonography examination technique and imaging findings in patients with musculotendinous lesions of the shoulder with the aim of helping the radiologist in the differential diagnosis of these lesions. We performed ultrasonography examinations of the shoulder using high-resolution probes (7.5-10 MHz) in 34 patients from January to December, 2001. The examination was normal in eight patients (23%) whereas 26 patients presented abnormalities: eight patients had total rotator cuff tears (30%), five had partial rotator cuff (19%), ten had tendinopathy (38%), one had calcified tendinopathy (3%), one had biceps tendinitis, one had biceps tendon luxation (3%) and one had tendinopathy associated to crystal arthropathy (3%). The lack of experience and the insufficient knowledge about the main diseases of the shoulder are limiting factors for the diagnosis of these lesions. Therefore, a comprehensive study of the abnormalities of the shoulder should be carried out.

Keywords: Shoulder, Ultrasonography, Rotator cuff

Sarcomatoid renal carcinoma is an aggressive neoplasm with clinical and radiological features similar to those of clear cell renal sarcomas. The tumor is formed by layers of malignant spindle cells that show immunohistochemical and ultrastructural characteristics of both stromal and epithelial cells, and may also contain mixoid areas of osteoclast-like giant cells, rhabdomyoblast-like pleomorphic cells as well as other rare sarcomatoid components. The authors report a case of sarcomatoid renal carcinoma in a 54-year-old male patient presenting with the classic clinical triad seen on patients with renal cell carcinomas. The typical macroscopic and microscopic features, imaging findings and differential diagnosis with true renal sarcomas are discussed.

Keywords: Renal cell carcinoma, Sarcomatoid renal carcinoma, Tumor metaplasia, Computed tomography, Ultrasonography

We report a case of a patient with primary cutaneous actinomycosis of the foot mimicking a soft tissue neoplasm. A literature review on the incidence, clinical features, pathology and imaging findings is also presented. The plain films and magnetic resonance imaging findings and the pathology results are presented. This paper reports a rare disease occurring in an atypical location, simulating a soft tissue neoplasm.

Keywords: Actinomycosis, Skin, Foot

The authors report a rare case of intramedullary spinal cord cysticercosis in a 36-year-old male patient. Computed tomography and magnetic resonance imaging examinations of the brain showed multiple ring enhanced lesions. Magnetic resonance imaging of the cervical spine showed a cystic intramedullary formation at C5-C6 level containing a scolex.

Keywords: Intramedullary spinal cysticercosis, Computed tomography, Magnetic resonance imaging