Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS, 2005]

AUGUST 10, 2005

Hungarian Radiology - 2005;79(04)

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Hungarian Radiology

[Errare humanum est]

LOMBAY Béla

Hungarian Radiology

[Development of Coronary Disease After Irradiation of Gastric Ulcer]

GYENES György

Hungarian Radiology

[Results of non-operative pathological breast diagnostics - One year experience at the Bács-Kiskun County Teaching Hospital]

CSERNI Gábor, AMBRÓZAY Éva, SERÉNYI Péter, BORI Rita, LŐRINCZ Margit, LÓRÁND Katalin

[INTRODUCTION - Non-operative cytological and histopathological assessment of breast lesions are part of the triple (physical, imaging and pathologic) diagnostic approach and allow a more precise planning of surgical procedures. Both methods have advantages and disadvantages; currently, core biopsy is believed to be more efficient in reaching the diagnostic target. PATIENTS AND METHODS - Breast specimens with a histological diagnosis at the Department of Pathology of the Bács-Kiskun County Teaching Hospital were analysed for their preoperative pathology, using the conventional C1-5 and B1-5 diagnostic categories. RESULTS - 295 cytology and 130 core needle biopsy cases were analysed. The rate of non diagnostic (C1 and B1) material was higher for cytology (0.18 versus 0.08 in general; 0.09 versus 0.01 for malignant cases). The rate of cases with an uncertain diagnostic category (C3 and C4 or B3 and B4) was also higher for the cytology specimens (0.24 versus 0.07). False-negative and false-positive cases were rare, but still more frequent among cytology specimens. CONCLUSION - Core needle biopsy performs better than fine needle aspiration cytology in the establishment of a nonoperative diagnosis at our institution. Despite these results, cytology continues to be the first diagnostic choice, because of its relatively low costs.]

Hungarian Radiology

[Thoughts relating to PET and CT]

LOMBAY Béla

Hungarian Radiology

[The glove-finger phenomenon on postero-anterior chest radiograph]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - The glove-finger phenomenon observed on chest plain film is characterized by branching tubular or fingerlike opacities that originate from the hilum and are peripherally directed. This change brings about impaction and inspissation of the mucus and inflammatory debris besides the obstruction of bronchi and of its prestenotic dilatation about. CASE REPORT - A 51 year old male patient presented with coexisting bronchial asthma and microcellular carcinoma of left 2nd pulmonary segment, leading to a tubular type glovefinger phenomenon. The diagnosis was proved by decrease of Tiffeneau’s index, bronchoscopy, bronchocytology and bronchogenic biopsy. CONCLUSION - The glove-finger phenomenon is correctly visible on postero-anterior chest plain film. The dilated and mucus-filled bronchi are not visible on radiography if the sorrounding lung is atelectasic. Because obstructive and nonobstructive bronchogenic diseases can appear with similar presentation, therefore, definitive diagnosis is only possible on the basis of pneumodynamic examinations, bronchoscopy, bronchocytology and biopsy.]

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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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[The quality control of radiological equipments in Hungary]

PELLET Sándor, PORUBSZKY Tamás, BALLAY László, GICZI Ferenc, MOTOC Anna Mária, VÁRADI Csaba, TURÁK Olivér, GÁSPÁRDY Géza

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Association of anterior thoracic meningocele and azygos lobe of the lung

DENIZ Ersay Fatih, SENAYLI Atilla, BICAKCI Ünal

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 ANALYSIS OF LIFE EVENTS IN HUNGARY]

NAGY Judit

[INTRODUCTION - In the social vulnerability model the concept of Life Events is the measure of forces and life events presenting in the social field that makes someone susceptible to mental illnesses. The stress value of these events add up. The Life Events Scale by Paykel is a questionnaire used in international practice. The objective of this study is the Hungarian adaptation and introduction of the Life Events Scale in the national practice, the international comparison of our results, the comparison of healthy people with the patient population and the analysis by social data. PATIENTS AND METHOD - The questionnaires were filled in by both healthy people and different patient populations. The participants rated the life events between 0-7 points according to their degree of causing stress, then they indicated whether it had happened with them. This was followed by a questionnaire about social data. We separated question groups by factor analysis: losses, changes, failures, difficulties, joyful events. RESULTS - When making the international comparison we only found differences in two areas: becoming unemployed and infidelity/divorce. Young people scored losses higher, while older ones scored changes higher. Those who declared themselves as religious scored suicide attempts higher. The mean scores of patient populations were higher compared to healthy subjects. The number of life events occurred was the highest in the depression-suicide attempt group. CONCLUSION - Our results can be used in everyday clinical practice and may be extremely important in suicide prevention.]

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[Percutaneous-transpedicular acrylat vertebroplasty for treatment of lumbar vertebral hemangioma - case report]

KASÓ Gábor, STEFANITS János, KÖVÉR Ferenc, DÓCZI Tamás, HORVÁTH Gábor

[The authors present the management of a patient suffering from lumbar vertebral hemangioma. Percutaneous transpedicular acrylate vertebroplasty was performed. This method has widely been used for the treatment of pathological vertebral bodies of different aetiology. A brief rewiev of the literature of previous and current methods is presented. A detailed discussion is given why vertebroplasty was used in contrast to the radiological investigation where the patient's hemangioma proved to be a non-agressive type. According to the authors' knowledge this is the first Hungarian publication of acrylate vertebroplasty for the treatment of vertebral hemangioma.]