Iranian Journal of Radiology
Volume:4 Issue: 3, Spring2007

Duodenal diverticula are frequently encountered in daily practice of radiology centers. Dissimilar figures with different dimensions and unlikely positions of duodenal diverticula-sometimes unusual-may be found. In this pictorial essay, we present various atypical shapes, dimensions and locations of duodenal diverticula which are found during many years of experience in the field of gastrointestinal fluoroscopic contrast assessments.

Background/ Endoscopy is the gold-standard technique for the assessment of acutely hemorrhagic esophageal varices in patients with hepatic cirrhosis. The objective of this study is to determine the value of different hepatic vasculature Doppler ultrasonography and their flow characteristics for non-invasive assessment of esophageal varices.Patients and Fifty-five (31 male, 24 female) consecutive patients with a mean±SD age of 55±16 (range: 20-88) years, with biopsy-proven hepatic cirrhosis were prospectively studied using Doppler ultrasonography. All of these patients were also examined endoscopically and by echocardiography. None of patients had clinical or echocardiographic signs of right heart failure, tricuspid valve regurgitation or previous history of therapeutic interventions on varices. An ordinal logistic regression (OLR) model was used for determining the adjusted associations between sizes of esophageal varices and hepatic hemodynamic determinants. There was a significant correlation between the size of esophageal varices and maximum portal vein velocity, which was lower in patients with varices (p = 0.04). Other parameters though not statistically significant, were of clinical importance. Those included portal vein mean velocity (p = 0.08), hepatic artery volume flow (p = 0.06) and hepatic venous waveform pattern (p = 0.15). OLR model did not show any significant adjusted associations between these parameters and the size of esophageal varices. The maximum portal vein velocity and to a lesser extent, hepatic artery volume flow were superior to Doppler ultrasonographic spectral waveform pattern of hepatic vein in differentiating patients with esophageal varices from those with no varices. None of hepatic vasculature Doppler measurements had a significant role in predicting the size of esophageal varices, nonetheless.

Cystic hydatid disease is caused by the parasite Echinococcus granulosus. The breast is a rare primary site of hydatid disease that accounts for only 0.27% of all cases. The cyst is usually asymptomatic and should be included under differential diagnosis of a breast lump, especially in endemic areas of this disease. Herein, we described the biopsy-proven case of a 46-year-old woman with primary hydatid disease of left breast.

Background/ Eosinophilic pneumonia is a rare cause of lung disease in adulthood. The relatively non-specific clinical presentations of this disease process make the diagnosis a unique challenge. Herein, we reported on clinical and radiological manifestations of this rare clinical entity in 18 patients. Patients and We retrospectively reviewed the medical records of 18 patients with acute eosinophilic pneumonia in Masih Daneshvari Medical Center. Diagnostic criteria were based on clinical, laboratory and imaging findings. The most clinical manifestations were cough and weight loss 15 (0.83) followed by dyspnea 13 (0.72). The most frequent imaging findings were diffuse opacities (reticulo-nodular or alveolar infiltration) in 11 (0.65), consolidation in six (0.33) and ground-glass opacities in four (0.28) patients. Diffuse rather than peripheral air-space opacities in imaging of a patient presented with dyspnea, cough, sputum, constitu-tional symptoms and eosinophilia should make us to think about eosinophilic pneumonia as one of differential diagnoses.

Background/ The gray scale sonography (GSS) in initial studies and color Doppler sonography in more recent studies have been used for evaluation of parotid tumors. The objective of this study is to evaluate the validity of triplex sonography, i.e., GSS, color Doppler mapping (CDM) and spectral Doppler sonography (SDS) to differentiate the malignant from benign parotid tumors. Patients and Fifty parotid tumors were evaluated. On GSS the tumor margin was evaluated and divided into "well-defined" and "ill-defined." On CDM, tumors vascularity was divided into two groups of "hypovascular" (≤2 arteries) and "hypervascular" (2 arteries). On SDS, the peak systolic velocity (PSV) of tumor arterial blood flow was measured. The diagnostic indices (sensitivity, specificity, positive predictive value and negative predictive value) of GSS, CDM and SDS findings alone and in combination were calculated, considering the histopathology results as the gold standard. For PSV, we used the receiver operating characteristic (ROC) curve analysis and calculated the area under the ROC curve. After excisional biopsy and histopathologic examination, 18 out of 50 tumors were malignant and 32 were benign. The sensitivity and specificity of the GSS was 77.8% and 90.6%, respectively. These diagnostic indices for CDM were 83.3% and 87.5%, respectively. The mean±SD PSV was significantly higher in malignant tumors than in benign ones (40.1±9.9 vs 19.1±4.9 cm/s) (p<0.0001). For PSV, the area under the ROC curve was 0.98; with a cut-off point of ≥24 cm/s; the sensitivity was 100% and the specificity was 81.2%. With a cut-off point of ≥29 cm/s for PSV, the sensitivity was 83.3% and the specificity was 100%. Using a cut-off value of 27.5 cm/s for PSV, the sensitivity and specificity of this modality for differentiation of malignant tumors were 88.9% and 96.9%, respectively. Combining the results of triplex sonography in a scoring system showed a little improvement in the diagnostic indi-ces. The PSV alone and combination of the GSS, CDM and SDS findings are sensitive and specific methods in differentiation of malignant parotid tumors from benign diseases.

Background/ We assessed the validity of computed tomography (CT) in the diagnosis of complicated chronic otitis media (COM). Patients and The findings obtained from a pre-operative high resolution CT of temporal bone including coronal and axial views of 20 patients with complicated COM were compared to their intraoperative findings. In our study, CT was helpful in determining the anatomy of the mastoid and could accurately predict the mastoid air cell aeration, size and status of ossicles, presence of lateral semicirculal canal (SCC) fistula and post-auricular fistula (All sensitivities equal to 100%). But it overdiagnosed the erosion of tegmen (positive predictive value of 50%). CT was unable to distinguish between cholesteatoma and fluid (abscess or effusion) and granulation tissue or polyps and was also unable to correctly reveal the facial nerve dehiscence and had a low sensitivity for showing erosion of facial canal (50%) and sigmoid sinus (60%). Because most complications resulting from cholesteatoma are caused by bony erosions, CT is helpful in determining the complications of COM. CT can accurately predict the extent of disease and is helpful in detection of some complications such as fistula of Lateral Semicircular Canal (LSC), erosions of dural plate and ossicular erosions. However, it is unable to distinguish between cholesteatoma, mucosal disease and fluid, and little it did contribute to detecting the facial nerve course and dehiscence. It cannot also be used for the diagnosis of the sigmoid sinus problems which could be related to no contrast administration in our study.

Intracranial rhabdomyosarcoma is a very rare disorder. Subdural rhabdomyosarcoma has not been reported yet. It can be misdiagnosed with chronic subdural hematoma in CT images. Herein, we presented a 2.5-year-old boy with intractable chronic subdural hematoma who were treated with burr hole insertion, needle aspiration and shunting for about 2 years with partial resolution of his symptoms after each procedure. The final pathologic evaluation after extensive bilateral craniotomy revealed rhabdomyosarcoma. The role of CT and MRI in early diagnosis and management of this rare situation is discussed.

The diagnosis of intrauterine conditions that may cause infertility is generally made by hysterosalpingography (HSG). Herein, we are presenting seven hysterosalpingo graphically-proven patients of Developmental Uterine Cavity Defects. We believed that some of developmental defects of these uterine cavity have not been addressed in preceding medical texts. Accurate diagnosis and reports of such cases are important not only for the benefit of treatment, but also to reflect the true incidence of these anomalies and to consolidate embryologic concept.The presented anomalies included "flying bird" uterus, "wine-glass-shaped" uterus, "buffalo head" uterus, "heart-shaped" uterus, "phantom-shaped" uterus, "candle light" uterus, and "jackal-shaped" uterus.The presented cases belonged to many years before, thus they were not evaluated by recently-developed advanced diagnostic modalities.