Cystic Lucencies Research Articles

Hypercalciemia in severe kidney failure, differential diagnosis

Hypercalcemia is a metabolic condition characterized by an increase in total serum calcium concentration above normal. The prevalence of hypercalcemia in the population is about 1–3% according to pilot screening trials, and hypercalcemia is most oſten parathyroid-dependent. In the majority cases hypercalcemia remains asymptomatic, and clinical features are appeared only when the level of total calcium rises to 3,0–3,5 mmol/l. Detection of hypercalcemia in a patient allows the doctor to suspect first the pathology of parathyroid glands - primary hyperparathyroidism or malignant neoplasms, when under the influence of metastases of solid tumors there is destruction of bone tissue. This paper presents a clinical case of hypercalcemia in a patient with severe kidney failure, arterial hypertension and multiple cystic lucencies on radiographs of the leſt shoulder joint. Determination of intact parathyroid hormone concentration within the reference range allows us to reject the hyperparathyroidism and do extend differential diagnostic search. The result of nephrobiopsy was the diagnosis of multiple myeloma, myeloma nephropathy. Unusual for terminal stage of chronic kidney disease hypercalcemia and searching of its cause allows to verify the diagnosis of multiple myeloma in a short period of time.

Perinephric and psoas abscesses leading to empyema: An unusual tuberculosis presentation

Tuberculous psoas abscess usually results from tuberculous spondylitis but may also develop from direct spread or via hematogenous route [1]. Our case involves direct spread from an adjacent perinephric abscess with associated thoracic extension from suspected direct erosion or a diaphragmatic defect. We present a case of pleural empyema arising from abdominal tuberculous abscesses. This is an 11-year-old male who initially presented with a three-week history of cough, intermittent fever, and dyspnea. Congenital diaphragmatic hernia was first suspected at the emergency department when an opacified left hemithorax with cystic lucencies was noted. Further imaging of the chest and upper abdomen was done in our institution revealing large left perinephric and psoas abscesses with intra-thoracic extension resulting in empyema thoracis and necessitans. Culture of the abscess fluid yielded no growth but GenExpert tested positive for M. tuberculosis. Tuberculosis remains a major illness in developing countries and has a multitude of infection sites and clinical presentation. Our case presented as an ascending thoracic extension of a perinephric and psoas abscess, likely from a diaphragmatic defect. The absence of spinal involvement proves its renal origin. The importance of CT scan is highlighted in medically-confounding cases such as this one.

The Most Valuable Predictive Factors for Bronchopulmonary Dysplasia in Very Preterm Infants.

It is urgent to make a rapid screening of infants at the highest risk for bronchopulmonary dysplasia (BPD) via some succinct postnatal biomarkers, such as Ureaplasma Urealyticum (UU) infection and chest radiograph images. A retrospective study was performed. Moderate to severe BPD or death was set as the main outcome. The association between putative variables and the main outcome were assessed by bivariate analyses and logistic regression. A total of 134 infants were enrolled. Bivariate analyses showed the gestational age, birth weight, appearances of diffuse opacities or grid shadows/interstitial opacities or mass opacities or cystic lucencies on chest radiographic images, a ductal diameter ≥1.5 mm and whether UU infection was associated with BPD. After adjustment by logistic regression, the risk of BPD with gestational age, sex and specific chest-radiographic manifestations remained significant. Chest radiograph images (appearance of diffuse opacities or grid shadows/interstitial opacities or mass opacities or cystic lucencies) could provide a quick prediction of developing BPD in clinical practice, in addition to gestational age and sex. UU infection was not an independent risk factor for BPD.

Single dose intralesional doxycycline foam infusion promotes bone growth and resolution of an odontoid aneurysmal bone cyst

Aneurysmal bone cysts (ABCs) are locally invasive bone tumors that most commonly arise in long bone metaphyses, the vertebral column, and pelvis, often presenting in the second decade of life. ABCs can be treated with resection, radiation, arterial embolization, and intralesional curettage. More recently intralesional doxycycline foam injections, which appear to act through the inhibition of matrix metalloproteinases and angiogenesis, have been used successfully, although multiple treatments are often required with this approach.A 13-year-old male with an incidentally discovered ABC filling much of the odontoid process but not violating the native odontoid cortex was treated with a single intralesional doxycycline foam injection delivered through a transoral approach with an excellent radiographic result. After placing a Crowe-Davis retractor, a transoral exposure of the odontoid process was performed with neuronavigation guidance. A fluoroscopy-guided Jamshidi needle biopsy was performed and via the needle doxycycline foam (2 mL 50 mg/mL doxycycline, 2 mL 25% albumin, and 1 mL Isovue 370 mixed with 5 mL of air) was infused, filling the cystic cavities of the odontoid process. The patient tolerated the operation well. Two months postoperatively, a computed tomography (CT) scan demonstrated a decrease in the size of the lesion with substantial new bone formation. Repeat CT at 6 months showed no residual cystic lucency, formation of dense new bone, and only minimal irregularity of the cortex at the prior needle biopsy site.This case illustrates that the use of doxycycline foam can be an excellent option when managing ABCs that cannot be resected without incurring significant morbidity.

Proximal interruption of the pulmonary artery: A review of radiological findings.

Proximal interruption of the pulmonary artery (PIPA) has various clinical manifestations. This review focused on and summarized the clinical and radiological features of PIPA, based on relevant literature studies. The study included a total of 25 PIPA cases in the Guangzhou Women and Children's Medical Center between January 2015 and December 2021. Conventional chest photographs and chest computed tomography angiography (CCTA) of patients with PIPA were analyzed and summarized. The radiological results showed that 17 cases were right-sided and 8 cases were left-sided PIPA. Additionally, the percentage of pulmonary hypoplasia on the affected side was 44%, 36% for pulmonary hypertension, 28% for the mosaic sign, 20% for subpleural cystic lucency shadow, 20% for subpleural serrated shadow, 20% for collateral vessel thickening, 16% for subpleural band-like parenchyma, 12% for pneumonia, and 56% for patent ductus arteriosus. The clinical manifestations of PIPA are non-specific. Awareness of this anomaly, based on radiological manifestations, particularly those observed on CCTA images, is important for ruling out alternative diagnoses and implementing appropriate management.

GIANT PULMONARY BULLA IN A 2-YEAR-OLD CHILD

SESSION TITLE: Critical Care and Pediatrics SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM INTRODUCTION: Cystic anomalies of the lung in the pediatric population represent entities with several differentials mainly divided into congenital and acquired lesions. It can be caused by a diverse array of pathologic processes. CASE PRESENTATION: A 2yr-old female child was admitted due to recurrent cough. Her condition started 5 weeks prior to admission when patient had non-productive cough but without fever. Chest radiograph revealed Koch's pneumonia, massive pneumothorax with minimal hydrothorax on the left lung (fig1). Chest tomography showed a large pulmonary bulla with deviation of the mediastinal structures to the right (fig 2). Mantoux test was 0mm. Pertinent chest and lung findings include chest asymmetry, positive chest lag on left hemithorax, no retractions, hyperresonant and decrease tactile fremitus as well as decrease breath sounds on the left. CBC, electrolytes, protime and APTT were normal. Patient underwent thoracotomy and bullectomy on the left lung. Post-operative chest xray revealed interval resolution of previously noted cystic lucency and rightward mediastinal shift (fig 3). Lung biopsy showed fragments of lung tissue with focal intra-alveolar hemorrhages and mild emphysematous changes and thin fibrous cyst wall favors Pulmonary Bulla. No complications noted and patient was discharged. DISCUSSION: The morphologies of pulmonary cystic and cavitary lesions exhibit a broad spectrum. On chest xray and computed tomography, a cyst appears as a round parenchymal lucency with a well-defined interface of normal lung . Bulla is an air space in the lung measuring more than 1cm in diameter. A Giant bulla occupy at least 30% of the hemithorax .A single bulla is rare and occupy portions of upper anterior and mediastinal aspect of the lung. Bulla formation begins when there is confluence of two or more of the terminal elements of the bronchial tree.Patients with giant bullae may be asymptomatic or in distress.Complications include repeated infections, hemorrhage or spontaneous pneumothorax. Management depends on the degree of symptoms. For asymptomatic patients medical and surgical therapy is usually deferred. Bullectomy involves the surgical removal of one or more giant bullae by thoracotomy or VATS. Indications for bullectomy aside from a symptomatic patient includes a bulla that occupies greater than 30% of the hemithorax and a radiographic evidence that the bulla is compressing adjacent structures which were the indications for doing bullectomy in this patient. Following bullectomy, expansion of surrounding healthy lung tissue and improvement in chest mechanics by remodeling of the thorax and diaphragm occurs. CONCLUSIONS: This is a rare case of a 2-yr old child presented with recurrent cough who was asymptomatic but had a large (>30%) pulmonary cystic lesion in the left lung. CT scan revealed a giant pulmonary bulla and the patient underwent bullectomy with no post-op complications. Reference #1: Na Rae Kim and Joungho Han; Pathologic Review of Cystic and Cavitary Lung Diseases; Korean JPathol. 2012 Oct;46(5):407-414 Published online 2012 Oct25.https://doi.org/10.4132/KoreanJPathol.2012.46.5.407 Reference #2: Jay H. Ryu, MD and Stephen J. Swensen; Cystic and Cavitary Lung Diseases: focal and diffuse; MayoClinic Proceedings, 2003 Jun; 78(6); 744-52 Reference #3: Suhail Raoof et al; Cystic Lung Diseases algorithmic approach ; CHEST JOURNAL October 2016 , Vol150, No.4 DISCLOSURES: No relevant relationships by Brenda Lou Lovely Abanilla, source=Web Response

High-resolution CT findings of pulmonary interstitial glycogenosis.

Pulmonary interstitial glycogenosis is a form of childhood interstitial lung disease characterized by the histological finding of abundant glycogen-laden mesenchymal cells within the pulmonary interstitium. Patients present in the neonatal period with disproportionate respiratory distress. Often, pulmonary interstitial glycogenosis is accompanied by alveolar simplification complicating recognition and diagnosis. Despite the recognition of pulmonary interstitial glycogenosis as a distinct entity, only a few case reports describing imaging findings are found in the literature, with no published systematic review available. The purpose of this review is to provide a review of CT findings of pulmonary interstitial glycogenosis with histological correlation to aid in early diagnosis and management. A 10-year retrospective review was performed to identify pediatric patients <18years who underwent biopsy and CT within the last 10years at our institution. The inclusion criteria include patients who had a CT within 3months of biopsy and pathology-proven pulmonary interstitial glycogenosis CTs that were evaluated by three radiologists using a standardized scoring system. Fifteen patients met inclusion criteria (9 male, 6 female). At the time of initial pre-biopsy CT, ages ranged from 2weeks to 5months. Pulmonary symptoms presented at birth in the majority of patients (n=13). Two patients presented in early infancy at 3months (n=1) and 5months (n=1). Ground glass opacities were the most common CT finding (n=14), which varied from diffuse to scattered. Cystic lucencies (n=11) were noted in the majority of patients as well. Interlobular septal thickening (n=10) and architectural distortion (n=8) were less common findings. The most common CT findings of pulmonary interstitial glycogenosis are ground glass opacities with cystic lucencies. While the imaging findings are distinct from the typical presentation of neuroendocrine hyperplasia of infancy, there is significant overlap of these findings with surfactant dysfunction mutations, entities that also present with respiratory distress in the neonatal period. Therefore, imaging findings in pulmonary interstitial glycogenosis are helpful in guiding the need for genetic testing and/or biopsy.

An Intriguing Case of Bright Red Blood per Rectum

Question: A 36-year-old man with a history of seizure disorder, mental retardation, and recurrent aspiration requiring percutaneous endoscopic gastrojejunostomy tube for feedings, presented to the emergency room with bright red blood per rectum. He was also complaining of generalized abdominal pain. The patient was hemodynamically stable on presentation but the initial hemoglobin measurement was low at 6.5 g/dL and he was transfused 2 units of packed red blood cells. An abdominal radiograph showed moderate colonic gaseous distension with numerous cystic lucencies of various sizes throughout the colon (Figure A).

Iodopovidone Pleurodesis for Isolated Pulmonary Langerhan’s Cell Histiocytosis in a Two Year Old Child

Isolated pulmonary involvement in Langerhans Cell Histiocytosis (LCH) is rare in childhood. The authors report a 2-y-old boy who presented with acute history of fever, cough and respiratory distress; later developed pneumothorax; whose CT thorax showed diffuse pulmonary cystic lucencies bilaterally. Lung biopsy confirmed pulmonary LCH with CD1a positivity. Recurrent spontaneous pneumothoraces are common in patients of pulmonary LCH; which necessitates rapid intervention. The authors share their experience of successfully using iodopovidone in pleurodesis for repeated pneumothorax episodes in this child with rare diagnosis of isolated pulmonary LCH.

Isolated Pulmonary Langerhans Cell Histiocytosis

Isolated pulmonary involvement in Langerhans Cell Histiocytosis (LCH) is rare in childhood. The authors report a 6-y- old boy presenting with recurrent pneumothorax, whose CT thorax showed diffuse pulmonary cystic lucencies bilaterally. Biopsy of the lesions confirmed pulmonary LCH with Cd1a and S 100 positivity.

Development of an Increased Signal Intensity in Fat-Suppressed Images into a Navicular Cyst of an 11-Year-Old Warmblood Horse Evidenced by Six Follow-Up Standing Low-Field Magnetic Resonance Imaging Examinations Over 2 Years

Abstract This case report demonstrates the development and management of an osseous cyst-like lesion in the spongiosa of the navicular bone in a high-level show jumper with chronic intermittent forelimb lameness. The first evidence of navicular bone pathology was increased signal intensity on fat-suppressed images in the medulla of the right navicular bone, which progressed to a cystic lucency identified on radiographs at 24 months. The horse's progress was documented over a period of 2 years and 2 months, including lameness investigation, treatment, radiographs, and six follow-up standing low-field magnetic resonance imagings. At the last clinical recheck, the horse showed no signs of lameness and continued to compete in show jumping at an international level event.

The Many Faces of Ameloblastoma

About 80% of ameloblastomas are found in the mandible. Radiographically, they are most commonly seen in the posterior mandible but can occur anywhere in the mandible. Twenty percent are found in other parts of the body, mostly in the face. They may, rarely, occur in the maxilla and skullbase (for which CT scans are recommended). Panoramic x-rays, also called panorex films, orthopantomograms or pantomograms, are adequate for assessing ameloblastomas of the mandible. The procedure is simple, with the patient’s chin placed in an immobilizer while the xray beam moves in an arc in front of the patient, taking a full view of the mandible in 1-2 minutes. Because the beam converges at a midpoint in the oral cavity, the resulting image “spreads out” the mandible from angle to angle (but overlaps and is hazier at the mentum).&#x0D; In early stages, ameloblastomas start out as a unilocular cystic lucency, similar in appearance to any other odontogenic cyst. They are usually well-defined with scalloped borders and tend to displace, rather than destroy teeth. Typically expansile &amp; multilocular, they have been described by such terms as “honeycomb” &amp; “soap bubble”.

Lung Disease in Premature Neonates: Radiologic-Pathologic Correlation

Pulmonary disease is the most important cause of morbidity in preterm neonates, whose lungs are often physiologically and morphologically immature. Surfactant deficiency in immature lungs triggers a cascade of alveolar instability and collapse, capillary leak edema, and hyaline membrane formation. The term respiratory distress syndrome (RDS) has come to represent the clinical expression of surfactant deficiency and its nonspecific histologic counterpart, hyaline membrane disease. Historically, chest radiographs of infants with RDS predictably demonstrated decreased pulmonary expansion, symmetric generalized reticulogranular lung opacities, and air bronchograms. Refinements in perinatal medicine, including antenatal glucocorticoid administration, surfactant replacement therapy, and increasingly sophisticated ventilatory strategies have decreased the prevalence of RDS and air leak, altered familiar radiographic features, and lowered the threshold of potential viability to a gestational age of approximately 23 weeks. Alveolar paucity and pulmonary interstitial thickness in these profoundly premature neonates impair normal gas exchange and may necessitate prolonged mechanical ventilation, increasing the risk of lung injury. Bronchopulmonary dysplasia (BPD), alternatively termed chronic lung disease of infancy, is a disorder of lung injury and repair originally ascribed to positive-pressure mechanical ventilation and oxygen toxicity. Before the advent of surfactant replacement therapy, chest radiographs of infants with classic BPD demonstrated coarse reticular lung opacities, cystic lucencies, and markedly disordered lung aeration that reflected alternating regions of alveolar septal fibrosis and hyperinflated normal lung parenchyma. In the current era of surfactant replacement, BPD is increasingly a disorder of very low-birth-weight neonates with arrested alveolar and pulmonary vascular development, minimal alveolar septal fibrosis and inflammation, and more subtle radiographic abnormalities.

A small and painful puzzle

This case of osteoid osteoma is reported for two reasons. First, for its rarity and unusual location (it was diagnosed very late) and second because it demonstrates that the history of a painful condition leads to the correct diagnosis, and although clinical investigations may provide corroboratory evidence, they are certainly no substitute. A 23-year-old student experienced spontaneous nightly pain in the distal phalanx of his right hallux. The pain increased over 2 years but with a good response to non-steroidal anti-inflammatory medication. After 9 months X-rays showed a cystic lucency. The patient was seen by a number of consultants, but the diagnosis of osteoid osteoma was delayed. After surgery the diagnosis was confirmed histologically and the pain has not recurred.

Iangerhans' cell histiocytosis of the lung in association with mediastjnal lymphadenopathy

A 17 year old female was seen because of a non-productive cough and one episode of blood-tinged sputum. A computerized tomography (CT) scan of the chest showed multiple small cystic lucencies in the upper lobes. The mediastinal CT window revealed concurrent mediastinal lymphadenopathy. An open lung biopsy showed Langerhans' cell histiocytosis (LCH). The significance of nodal involvement in LCH of the lung is not known, but raises the possibility of regional LCH and warrants a further search for bone or visceral involvement as well as closer follow-up and monitoring of patients.

Large-bowel obstruction resulting from traumatic diaphragmatic hernia: imaging findings in four cases.

Large-bowel obstruction is most often due to primary carcinoma, diverticulitis, or volvulus. In populations of patients in which trauma is prevalent, however, an additional important consideration is traumatic diaphragmatic hernia. We describe the findings on plain radiographs and single-contrast enema in four adults who had vague complaints of abdominal pain days to months after an abdominal stab injury and large-bowel obstruction resulting from herniation of colon or omentum through the left hemidiaphragm. We retrospectively analyzed plain radiographs of the chest and abdomen that were obtained before confirmation of colonic obstruction by single-contrast enema, surgery, or both in four men. Herniation of colon or omentum through the left hemidiaphragm was confirmed at surgery in all four cases. Posteroanterior and lateral radiographs of the chest obtained as part of the initial evaluation showed, in all four cases, abnormalities of the left hemidiaphragmatic contour. These included elevation of the hemidiaphragm in one case, loss of definition of a portion of the hemidiaphragm due to adjacent confluent opacity in two cases, pleural effusion in two cases, and small cystic lucencies above the diaphragmatic contour in one case. Abdominal radiographs obtained at the same time as the initial chest radiograph showed normal findings in two cases and mild dilatation of gas-filled colon in the upper part of the abdomen in two cases. In three of the four patients, progressive dilatation of the colon to the level of the splenic flexure was seen on serial abdominal radiographs. Large-bowel obstruction was confirmed by single-contrast enema in three cases and surgery in four cases. Minimal dilatation of the large bowel in the fourth patient resolved the day after admission; however, progression to complete obstruction was shown by single-contrast enema the following day. Delayed herniation through a trauma-induced defect in the left hemidiaphragm can be an unsuspected cause of large-bowel obstruction. Abnormalities of the left hemidiaphragmatic contour on plain radiographs of the chest should suggest the diagnosis in patients who have abdominal pain, colonic dilatation, and a history of abdominal injury.