Sixteen cases of anaplasic thyroid carcinoma have been reviewed. In 13 cases out of 16, a diffuse invasion of one or both thyroid lobes and of the isthm associated with calcifications (50%) and necrosis (62%) was present. In 6 cases out of 8, CT Scan with contrast media injection has detected an extension into surrounding tissues. Twelve of the 16 patients presented cervical lymph nodes on the ultrasound examination and 4 of 8 patients presented mediastinal lymph nodes on the CT Scan. In 3 cases out of 16, the anaplasic carcinoma of the thyroid presented as a localized, hypoechoic nodule associated with a cervical lymph node in 1 case.
The authors report three cases of extrahepatic lipiodol enhancement: two fortuitous discoveries of gastric and duodenal leiomyomas during the management of malignant hepatic lesion and a pancreatic surgical detection of an insulinoma which had not been detected with conventional techniques. The principles of the technique are described. The basis of its application to the pancreatic region is purposed and the future developments of pancreatic studies are discussed.
The splenic cysts are rare diseases and the diagnosis is now easier with modern imaging modalities. The authors report two cases of asymptomatic splenic cysts. The spontaneous involution in less than 3 years has been followed by CT Scan. This possible evolution which has never been described, the improvements of the splenic surgery and the risk of serious infectious complications after splenectomy, must modify the indications of the treatment. A US or CT follow up can be purposed for non symptomatic cyst and a partial splenectomy when these lesions are clinically symptomatic.
The non functional extraperitoneal paragangliomas are rare tumors (less than 50 cases reported). We report a case with ultrasound and CT scan imaging. The tumor is usually large with important necrotic areas leading to a cystic aspect. The malignant tumors more frequent than the benign tumors present with a regional extension and delayed metastasis.
Delayed hepatic CT (DH-CT) was studied in 250 patients without any major bile duct pathology. One hundred thirty-five of these patients had liver metastases. All patients were administrated 76 grams of iodine. Tolerance of the examination was good. Six hours after injection, average contrast enhancement in the normal liver was 24 HU (greater than 1.3 g/kg iodine), 22 HU (1 to 1.3 g/kg) and 14 HU (1 g/kg). Comparison of scans taken before, immediately after, and 6 hours post-injection revealed the frequent superiority of postinjection scans for diagnosis of liver metastases. Focal steatosis is the only benign pathology to benefit from DH-CT, because of the parallelism in the difference in density between the normal and steatotic tissue regardless of the time of scanning. Aside from isolated tumors requiring exploration by conventional CT (pre- and post-contrast studies), the workup of liver metastases can be optimized by postcontrast and DH-CT scans.
Seventeen cases of muscular lymphoma are reported (5 primary non-Hodgkin lymphoma, 11 secondary NHL, 1 secondary Hodgkin's disease). The psoas or gluteus muscle was involved in 10 cases, and the lower limb was affected in the remaining 7 cases. Nine cases of muscular extension of bone NHL are also reported. On sonograms these lesions were always large and less echogenic than adjacent structures, with no signs of necrosis before treatment. US and CT patterns were comparable for both primary and secondary lesions, regardless of the type of lymphoma or whether or not there was any previous bone lesion. Associated lymphomatous lesions were observed in 14 cases. On angiograms, muscular lymphomatous involvement presented a hypovascular pattern. While ultrasonography is an excellent monitoring technique for soft tissue lymphomas (specially for the lower limbs), a major contribution of CT is the detection and the follow-up of deep or thoracic wall lesions.