Image Interpretation Session: 1998
The Radiological Society of North America 84th Scientific Assembly and Annual Meeting
James G. Smirniotopoulos, MD1,2,
Gael J. Lonergan, Lt Col, USAF, MC1,2,
Robert M. Abbott, Maj, USAF, MC1,3,
Peter L. Choyke, MD1,4,
Julianna M. Czum, MD1,
Neal C. Dalrymple, Maj, USAF, MC3,
Daniel DoDai, MD2,1,6,
David S. Feigin, COL, MC, USA1,
Vincent B. Ho, MD1,
John R. Leyendecker, Maj, USAF, MC3,5 and
Miguel J. Rovira, LTC, USA, MC1,7
1 Departments of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (J.G.S., G.L., R.M.A., P.L.C., J.M.C., D.D., D.S.F., V.B.H., M.J.R.)
2 Armed Forces Institute of Pathology, Washington, DC (J.G.S., G.L.)
3 Wilford Hall Air Force Medical Center, San Antonio, Tex (R.M.A., N.D., J.R.L.)
4 National Institutes of Health, Bethesda, Md (P.L.C.)
5 Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Md (J.R.C.)
6 Tripler Army Medical Center, Honolulu, Hawaii (D.D.)
7 Madigan Army Medical Center, Tacoma, Wash (M.J.R.).
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Figure 1a. Case 1. US images demonstrate complex, heterogeneous, extratesticular masses on the left (a, b) and right (c) sides. The masses are both solid and cystic.
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Figure 1b. Case 1. US images demonstrate complex, heterogeneous, extratesticular masses on the left (a, b) and right (c) sides. The masses are both solid and cystic.
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Figure 1c. Case 1. US images demonstrate complex, heterogeneous, extratesticular masses on the left (a, b) and right (c) sides. The masses are both solid and cystic.
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Figure 2a. Case 1. Axial contrast-enhanced CT scans through the pancreas (a at a higher level than b) demonstrate multiple abnormalities, including heterogeneous cystic renal masses, extensive replacement of the pancreas by largely cystic heterogeneous masses, and surgical clips in the region of both adrenal glands.
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Figure 2b. Case 1. Axial contrast-enhanced CT scans through the pancreas (a at a higher level than b) demonstrate multiple abnormalities, including heterogeneous cystic renal masses, extensive replacement of the pancreas by largely cystic heterogeneous masses, and surgical clips in the region of both adrenal glands.
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Figure 3. Case 1. Contrast-enhanced T1-weighted MR image of the head shows a "cyst with nodule" mass in the left cerebellar hemisphere that proved to be an hemangioma.
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Figure 4. Case 1. Intraoperative photograph obtained after the scrotum was opened shows a lobulated mass in the right scrotal sac.
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Figure 5. Case 1. High-power photomicrograph (original magnification, x40; hematoxylin-eosin [H-E] stain) of a section of epididymis shows papillary structures, characteristic of cystadenoma.
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Figure 6. Case 2. Contrast-enhanced CT scan of the abdomen obtained shortly after skin biopsy reveals a slight mass effect on the falciform ligament from the left hepatic lobe; however, no discrete masses are seen.
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Figure 7a. Case 2. (a) Unenhanced T1-weighted image demonstrates an ill-defined, heterogeneous 7 x 4 cm mass in the left hepatic lobe with high signal intensity relative to that of liver parenchyma. (b, c) On proton-density–weighted (b) and T2-weighted (c) fast spin-echo images, the lesion remains high in signal intensity, with slight diminution in intensity with the more heavily T2-weighted pulse sequence (c).
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Figure 7b. Case 2. (a) Unenhanced T1-weighted image demonstrates an ill-defined, heterogeneous 7 x 4 cm mass in the left hepatic lobe with high signal intensity relative to that of liver parenchyma. (b, c) On proton-density–weighted (b) and T2-weighted (c) fast spin-echo images, the lesion remains high in signal intensity, with slight diminution in intensity with the more heavily T2-weighted pulse sequence (c).
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Figure 7c. Case 2. (a) Unenhanced T1-weighted image demonstrates an ill-defined, heterogeneous 7 x 4 cm mass in the left hepatic lobe with high signal intensity relative to that of liver parenchyma. (b, c) On proton-density–weighted (b) and T2-weighted (c) fast spin-echo images, the lesion remains high in signal intensity, with slight diminution in intensity with the more heavily T2-weighted pulse sequence (c).
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Figure 8a. Case 2. Follow-up unenhanced fat-suppressed T1-weighted MR images show many small (<1-cm), diffuse lesions throughout the liver. On the image obtained at a slightly lower level (b), these lesions are more conspicuous, and a lesion is visible in the vertebral body.
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Figure 8b. Case 2. Follow-up unenhanced fat-suppressed T1-weighted MR images show many small (<1-cm), diffuse lesions throughout the liver. On the image obtained at a slightly lower level (b), these lesions are more conspicuous, and a lesion is visible in the vertebral body.
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Figure 9a. Case 3. Frontal (a) and lateral (b) chest radiographs of a 3-month-old boy obtained on the day of admission show ill-defined nodular opacities in both lungs and early cyst formation in the right lung. Two expansile, lytic lesions of the left clavicle are also seen on the frontal radiograph (arrows).
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Figure 9b. Case 3. Frontal (a) and lateral (b) chest radiographs of a 3-month-old boy obtained on the day of admission show ill-defined nodular opacities in both lungs and early cyst formation in the right lung. Two expansile, lytic lesions of the left clavicle are also seen on the frontal radiograph (arrows).
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Figure 10. Figures 10, 11. Case 3. (10) Lateral chest radiograph of the same infant obtained on day 19 shows substantial cystic disease throughout both lungs. (11) Frontal chest radiograph of the same infant obtained on day 23 shows a large right pneumothorax. Expansile, lytic lesions in the middle and distal third of the left clavicle are well seen.
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Figure 11. Figures 10, 11. Case 3. (10) Lateral chest radiograph of the same infant obtained on day 19 shows substantial cystic disease throughout both lungs. (11) Frontal chest radiograph of the same infant obtained on day 23 shows a large right pneumothorax. Expansile, lytic lesions in the middle and distal third of the left clavicle are well seen.
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Figure 12a. Case 3. (a) Axial CT scan of a 16-year-old patient with LCH shows multiple cysts, some small and thick walled and others much larger and thin walled. (b) Low-power photomicrograph (original magnification, x30; H-E stain) of the patient's lung biopsy specimen shows two cysts (*), the walls of which are lined with histiocytic cellular infiltrate.
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Figure 12b. Case 3. (a) Axial CT scan of a 16-year-old patient with LCH shows multiple cysts, some small and thick walled and others much larger and thin walled. (b) Low-power photomicrograph (original magnification, x30; H-E stain) of the patient's lung biopsy specimen shows two cysts (*), the walls of which are lined with histiocytic cellular infiltrate.
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Figure 13a. Case 4. Contrast-enhanced CT scans obtained at several levels through the neck demonstrate a largely cystic mass anterior to the hyoid bone, extending toward the right. A small focus of calcification (arrow in b) is seen in a soft-tissue mass attached to the wall of the cyst. Enlarged and calcified lymph nodes posterior to the right sternocleidomastoid muscle are also seen.
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Figure 13b. Case 4. Contrast-enhanced CT scans obtained at several levels through the neck demonstrate a largely cystic mass anterior to the hyoid bone, extending toward the right. A small focus of calcification (arrow in b) is seen in a soft-tissue mass attached to the wall of the cyst. Enlarged and calcified lymph nodes posterior to the right sternocleidomastoid muscle are also seen.
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Figure 13c. Case 4. Contrast-enhanced CT scans obtained at several levels through the neck demonstrate a largely cystic mass anterior to the hyoid bone, extending toward the right. A small focus of calcification (arrow in b) is seen in a soft-tissue mass attached to the wall of the cyst. Enlarged and calcified lymph nodes posterior to the right sternocleidomastoid muscle are also seen.
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Figure 14a. Case 4. (a) Photomicrograph (original magnification, x60; H-E stain) of a specimen taken from the wall of a cystic mass from a different patient reveals thyroid tissue. Small histologic rests of thyroid tissue embedded in the cystic wall are a normal finding in a thyroglossal duct cyst, which arises from persistent anlage of the thyroid gland. (b) Photomicrograph (original magnification, x150; H-E stain) of another specimen from the wall of the thyroglossal duct cyst shows the typical papillary appearance of papillary thyroid adenocarcinoma.
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Figure 14b. Case 4. (a) Photomicrograph (original magnification, x60; H-E stain) of a specimen taken from the wall of a cystic mass from a different patient reveals thyroid tissue. Small histologic rests of thyroid tissue embedded in the cystic wall are a normal finding in a thyroglossal duct cyst, which arises from persistent anlage of the thyroid gland. (b) Photomicrograph (original magnification, x150; H-E stain) of another specimen from the wall of the thyroglossal duct cyst shows the typical papillary appearance of papillary thyroid adenocarcinoma.
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Figure 15. Case 4. Sagittal T2-weighted MR image of a different patient illustrates the more typical midline infrahyoid appearance of a thyroglossal duct cyst. The cyst fluid is homogeneously hyperintense.
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Figure 16a. Case 5. Frontal (a) and lateral (b) plain radiographs of the chest demonstrate a subtle opacity overlying the pedicle of the thoracic vertebra, just above the diaphragm on the lateral view (b). On the frontal view (a), the mass is barely visible just to the right of the heart border at the level of the right hemidiaphragm.
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Figure 16b. Case 5. Frontal (a) and lateral (b) plain radiographs of the chest demonstrate a subtle opacity overlying the pedicle of the thoracic vertebra, just above the diaphragm on the lateral view (b). On the frontal view (a), the mass is barely visible just to the right of the heart border at the level of the right hemidiaphragm.
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Figure 17a. Case 5. Contrast-enhanced CT scans of the chest (a obtained at a higher level than b) show a bilobed mass with a serpentine connection, located in the medial base of the anterior right lower lobe. The lobed portions of the mass clearly have greater attenuation than any of the soft tissues, including the liver.
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Figure 17b. Case 5. Contrast-enhanced CT scans of the chest (a obtained at a higher level than b) show a bilobed mass with a serpentine connection, located in the medial base of the anterior right lower lobe. The lobed portions of the mass clearly have greater attenuation than any of the soft tissues, including the liver.
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Figure 18. Case 5. Selective angiogram of the right main pulmonary artery demonstrates that the mass is entirely vascular, with a dilated feeding artery and dilated draining vein.
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Figure 19a. Case 6. Axial contrast-enhanced CT scans of the pelvis (obtained at successively higher levels) show a large soft-tissue mass isoattenuated relative to the adjacent skeletal muscle. The mass invades the posterior wall of the bladder (c) and completely surrounds the uterus, vagina, and sigmoid colon (a, b).
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Figure 19b. Case 6. Axial contrast-enhanced CT scans of the pelvis (obtained at successively higher levels) show a large soft-tissue mass isoattenuated relative to the adjacent skeletal muscle. The mass invades the posterior wall of the bladder (c) and completely surrounds the uterus, vagina, and sigmoid colon (a, b).
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Figure 19c. Case 6. Axial contrast-enhanced CT scans of the pelvis (obtained at successively higher levels) show a large soft-tissue mass isoattenuated relative to the adjacent skeletal muscle. The mass invades the posterior wall of the bladder (c) and completely surrounds the uterus, vagina, and sigmoid colon (a, b).
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Figure 20a. Case 6. Sagittal fat-suppressed T1-weighted (a) and fast-spin-echo T2-weighted (b, c) MR images demonstrate the infiltrating mass invading the posterior wall of the bladder, completely surrounding the adjacent uterus and vagina and involving the presacral space. With T2 weighting (c), the mass appears heterogeneously hyperintense relative to muscle.
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Figure 20b. Case 6. Sagittal fat-suppressed T1-weighted (a) and fast-spin-echo T2-weighted (b, c) MR images demonstrate the infiltrating mass invading the posterior wall of the bladder, completely surrounding the adjacent uterus and vagina and involving the presacral space. With T2 weighting (c), the mass appears heterogeneously hyperintense relative to muscle.
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Figure 20c. Case 6. Sagittal fat-suppressed T1-weighted (a) and fast-spin-echo T2-weighted (b, c) MR images demonstrate the infiltrating mass invading the posterior wall of the bladder, completely surrounding the adjacent uterus and vagina and involving the presacral space. With T2 weighting (c), the mass appears heterogeneously hyperintense relative to muscle.
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Figure 21a. Case 7. (a) CT scan of the abdomen shows marked thickening of the cecal wall, a narrowed lumen, vague regions of low attenuation within the wall, poorly defined margins of the wall of the cecum, and stranding in the pericecal fat. (b, c) CT scans obtained at lower levels show thickening of the inferior tip of the cecum and nodular stranding of the pericecal fat extending to the right lateral conal fascia, which is thickened. Note the thickened mesentery in c.
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Figure 21b. Case 7. (a) CT scan of the abdomen shows marked thickening of the cecal wall, a narrowed lumen, vague regions of low attenuation within the wall, poorly defined margins of the wall of the cecum, and stranding in the pericecal fat. (b, c) CT scans obtained at lower levels show thickening of the inferior tip of the cecum and nodular stranding of the pericecal fat extending to the right lateral conal fascia, which is thickened. Note the thickened mesentery in c.
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Figure 21c. Case 7. (a) CT scan of the abdomen shows marked thickening of the cecal wall, a narrowed lumen, vague regions of low attenuation within the wall, poorly defined margins of the wall of the cecum, and stranding in the pericecal fat. (b, c) CT scans obtained at lower levels show thickening of the inferior tip of the cecum and nodular stranding of the pericecal fat extending to the right lateral conal fascia, which is thickened. Note the thickened mesentery in c.
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Figure 22a. Case 7. CT scans of the chest (a obtained at a higher level than b) show parenchymal nodules along the bronchovascular bundles, nodular thickening of the interlobular septa, and small subpleural nodules.
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Figure 22b. Case 7. CT scans of the chest (a obtained at a higher level than b) show parenchymal nodules along the bronchovascular bundles, nodular thickening of the interlobular septa, and small subpleural nodules.
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Figure 23. Case 7. Compression spot image from a barium enema study shows irregular narrowing of the cecal lumen.
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Figure 24a. Case 7. (a) Low-power photomicrograph (original magnification, x10; H-E stain) of a specimen from the cecum shows noncaseating, submucosal granulomas (arrowheads) and chronic inflammatory changes in the mucosa. (b) High-power photomicrograph of another cecal specimen (original magnification, x100; H-E stain) shows a noncaseating granuloma, characterized by central epithelioid histiocytes and Langerhans giant cells rimmed by scattered lymphocytes and fibroblasts, with associated hyalinization.
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Figure 24b. Case 7. (a) Low-power photomicrograph (original magnification, x10; H-E stain) of a specimen from the cecum shows noncaseating, submucosal granulomas (arrowheads) and chronic inflammatory changes in the mucosa. (b) High-power photomicrograph of another cecal specimen (original magnification, x100; H-E stain) shows a noncaseating granuloma, characterized by central epithelioid histiocytes and Langerhans giant cells rimmed by scattered lymphocytes and fibroblasts, with associated hyalinization.
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Figure 25a. Case 8. US images of the right (a) and left (b) kidneys show multiple, bilateral small renal cysts.
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Figure 25b. Case 8. US images of the right (a) and left (b) kidneys show multiple, bilateral small renal cysts.
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Figure 26a. Case 8. Axial (a) and coronal (b) enhanced T1-weighted images of the brain show a 1-cm high-signal-intensity nodule in the wall of the right lateral ventricle. Several smaller enhancing periventricular nodules are present along both lateral ventricles.
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Figure 26b. Case 8. Axial (a) and coronal (b) enhanced T1-weighted images of the brain show a 1-cm high-signal-intensity nodule in the wall of the right lateral ventricle. Several smaller enhancing periventricular nodules are present along both lateral ventricles.
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Figure 27. Case 8. Photograph of the brain from a different patient with tuberous sclerosis demonstrates the subependymal nodules that protrude in-to the ventricular lumen from the caudothalamic (striothalamic) groove along the lateral border of the lateral ventricles.
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Figure 28. Case 8. CT scan of the head of the 16-year-old boy demonstrates several calcified periventricular subependymal nodules.
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Figure 29a. Case 9. Axial CT scans demonstrate a destructive process involving the posteromedial petrous portion of the temporal bone (near the vestibular aqueduct), with extension into the middle ear. Erosion includes the right sigmoid sinus area.
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Figure 29b. Case 9. Axial CT scans demonstrate a destructive process involving the posteromedial petrous portion of the temporal bone (near the vestibular aqueduct), with extension into the middle ear. Erosion includes the right sigmoid sinus area.
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Figure 30a. Case 9. Axial T1-weighted MR (a, b) and coronal T2-weighted MR (c, d) images demonstrate an irregular, multilobulated, and heterogeneous (partially cystic and partially solid) mass involving the petrous portion of the temporal bone. On the T1-weighted images (a, b), the mass has high signal intensity. On the T2-weighted images (c, d), there are curvilinear, serpentine areas of hypointensity, suggestive of vessels, hemosiderin deposition, or calcifications.
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Figure 30b. Case 9. Axial T1-weighted MR (a, b) and coronal T2-weighted MR (c, d) images demonstrate an irregular, multilobulated, and heterogeneous (partially cystic and partially solid) mass involving the petrous portion of the temporal bone. On the T1-weighted images (a, b), the mass has high signal intensity. On the T2-weighted images (c, d), there are curvilinear, serpentine areas of hypointensity, suggestive of vessels, hemosiderin deposition, or calcifications.
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Figure 30c. Case 9. Axial T1-weighted MR (a, b) and coronal T2-weighted MR (c, d) images demonstrate an irregular, multilobulated, and heterogeneous (partially cystic and partially solid) mass involving the petrous portion of the temporal bone. On the T1-weighted images (a, b), the mass has high signal intensity. On the T2-weighted images (c, d), there are curvilinear, serpentine areas of hypointensity, suggestive of vessels, hemosiderin deposition, or calcifications.
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Figure 30d. Case 9. Axial T1-weighted MR (a, b) and coronal T2-weighted MR (c, d) images demonstrate an irregular, multilobulated, and heterogeneous (partially cystic and partially solid) mass involving the petrous portion of the temporal bone. On the T1-weighted images (a, b), the mass has high signal intensity. On the T2-weighted images (c, d), there are curvilinear, serpentine areas of hypointensity, suggestive of vessels, hemosiderin deposition, or calcifications.
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Figure 31. Figures 31, 32. Case 9. (31) Photograph of the medial (internal) view of the temporal bone illustrates the location of the endolymphatic canal and sac (circle). (32) Photomicrograph (original magnification, x100; H-E stain) of a section of endolymphatic sac tumor illustrates the pink proteinaceous fluid (cystic component) and the solid papillary tissue component. (These tumors are almost invariably removed piecemeal, and photographs of gross specimens are not available.)
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Figure 32. Figures 31, 32. Case 9. (31) Photograph of the medial (internal) view of the temporal bone illustrates the location of the endolymphatic canal and sac (circle). (32) Photomicrograph (original magnification, x100; H-E stain) of a section of endolymphatic sac tumor illustrates the pink proteinaceous fluid (cystic component) and the solid papillary tissue component. (These tumors are almost invariably removed piecemeal, and photographs of gross specimens are not available.)
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Figure 33a. Case 10. (a, b) Frontal (a) and lateral (b) plain radiographs of the chest show hyperexpansion of the lungs without flattening of the hemidiaphragms. The frontal view shows unequal aeration, increased lucency of the left lower lung, and asymmetry of vascularity, with pulmonary vessels of the left lung diminished in caliber compared with those in the right lower lung. No evidence of air trapping is seen in the left lung base. (c) Close-up view of the right upper lung shows air trapping with diminished vessel caliber as well as extra linear areas of opacity adjacent to the right upper hilum.
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Figure 33b. Case 10. (a, b) Frontal (a) and lateral (b) plain radiographs of the chest show hyperexpansion of the lungs without flattening of the hemidiaphragms. The frontal view shows unequal aeration, increased lucency of the left lower lung, and asymmetry of vascularity, with pulmonary vessels of the left lung diminished in caliber compared with those in the right lower lung. No evidence of air trapping is seen in the left lung base. (c) Close-up view of the right upper lung shows air trapping with diminished vessel caliber as well as extra linear areas of opacity adjacent to the right upper hilum.
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Figure 33c. Case 10. (a, b) Frontal (a) and lateral (b) plain radiographs of the chest show hyperexpansion of the lungs without flattening of the hemidiaphragms. The frontal view shows unequal aeration, increased lucency of the left lower lung, and asymmetry of vascularity, with pulmonary vessels of the left lung diminished in caliber compared with those in the right lower lung. No evidence of air trapping is seen in the left lung base. (c) Close-up view of the right upper lung shows air trapping with diminished vessel caliber as well as extra linear areas of opacity adjacent to the right upper hilum.
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Figure 34. Case 10. High-resolution CT scan of the lungs shows vessels of diminished caliber and number in regions of the right upper and right middle lobes. However, vessels were seen in all sections. A dilated bronchus is visible near the middle of the right lung, as well as abnormal linear markings in the center of the right middle lobe; these may represent dilated bronchi filled with secretions.
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Copyright © 1999 by the Radiological Society of North America.
