Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS 2003]

DECEMBER 20, 2002

Hungarian Radiology - 2002;76(06)

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Hungarian Radiology

[Foreign body in the urinary bladder causing diagnostic problem]

LADÁNYI Erzsébet, FEKETE Márta

Hungarian Radiology

[Significance of ultrasound examination in acute abdominal attack of hereditary angioneurotic oedema]

FARKAS Henriette, HARMAT György, KAPOSI N. Pál, KARÁDI István, FEKETE Béla, FÜST György, FÁY Kálmán, VAS Anikó, VARGA Lilian

[INTRODUCTION - Hereditary angioneurotic oedema (HANO) is a rare cause of ascites. As acute abdominal attacks of the disease can mimic surgical emergencies, the prompt and accurate diagnosis is essential. This study was undertaken to evaluate the usefulness of abdominal ultrasound examinations in the differential diagnosis. PATIENTS AND METHODS - Seventy patients with HANO were followed up for almost a decade. All patients presenting with an acute oedematous attack underwent abdominal ultrasound, which was then repeated 24 and 48 hours after appropriate therapy. RESULTS - 22 patients with acute oedematous attacks with abdominal complaints severe enough to justify hospital admission occurred in the study population. Abdominal ultrasound performed during the attack showed oedematous thickening of the intestinal wall in 80 per cent of cases and invariably demonstrated the presence of free peritoneal fluid in all patients. Rapid symptomatic relief achieved by treatment was accompanied by the significant regression of ultrasound abnormalities. CONCLUSIONS - Demonstration of transitory ascites by abdominal ultrasound is a clue to the diagnosis of an acute abdominal attack of HANO. The possibility of HANO should always be considered whenever unexplained abdominal pain returns with or without ascites.]

Hungarian Radiology

[Craniometry using conventional radiographs]

FEHÉRVÁRI Szabolcs

[I measured the length, width and height of the skull’s hole on standard two-direction radiographs. From these data the volume of the skull's hole can be calculated with high accuracy. I used for calculation the modified formula of sonographic determination of prostate size. Using this measurement method in 1.000 adults (500 male and 500 female) the average skull's hole volume was 1.492 cubic centimetres. In 100 children of 6-7 years (50 boys and 50 girls) average skull's hole volume was 1.423 cubic centimetres.]

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[Facts and questions about EU admission]

HORVÁTH István, TANÁCS Edit

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NÉMETH Éva

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[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

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Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

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Association of anterior thoracic meningocele and azygos lobe of the lung

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Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

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[The quality control of radiological equipments in Hungary]

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