Six patients, aged 14-83 years, were shown by computed tomography (CT) to have thromboses of the internal jugular vein. In all cases, medical attention was sought only after a delay (4-21 days). In no case was the provisional clinical diagnosis correct, with working diagnoses ranging from abscess to neoplasm. A wide variety of likely causes was discovered, including venous catheters, local malignancy, infective cervical adenopathy, and polycythemia. CT showed distended veins with enhancing walls, low-attenuation intraluminal filling defects, and swelling of the adjacent soft tissues. Four of the six patients also underwent ultrasound examinations, which showed the veins to be distended and nonpulsatile, with internal echoes. Both modalities proved reliable and accurate. Because of the subtle and often non-specific clinical findings, it is likely that more clinically unsuspected cases will be encountered by the radiologist.
A review of 2000 consecutive magnetic resonance imaging (MRI) brain studies identified 18 (0.9%) patients with lesions that satisfied MRI criteria for cavernous haemangiomas. The clinical, computed tomography (CT) and MRI findings in 23 patients with probable cavernous haemangiomas were compared. Thirty-three lesions were identified with multiple lesions in five (22%) patients. In 19 (82%) patients the neurological presentation corresponded to a cavernous haemangioma. The presenting symptoms were: seizures in 11 patients (48%); progressive neurological symptoms and signs in four (17%); and acute symptoms and signs due to haemorrhage in four (17%). T2 weighted images suggested the diagnosis in all cases, with 24 (73%) lesions showing the typical appearance of an area of mixed signal intensity with a rim of low signal intensity. In the absence of acute haemorrhage, CT demonstrated well circumscribed, round or oval hyperdense lesions without significant mass effect and with normal surrounding brain tissue in the majority of cases. Although not diagnostic, these CT features are strongly suggestive of cavernous haemangiomas.
A case of solitary extramedullary plasmacytoma of the testis is presented demonstrating the appearances on ultrasound. The clinical implications of this diagnosis are discussed.
Of 254 primary malignant tumors of the thyroid gland diagnosed in the pathology department of the University of Cape Town, 212 (83.5%) were differentiated carcinomas. In this differentiated group, tumors composed exclusively of papillary structures exhibited the most favorable prognosis; local recurrences and/or spread were noted in tumors with a mixed papillary and follicular pattern and, more commonly association with 21 tumors (8.3%) but an associated multinodular goitre was found in only nine patients (3.5%). In addition to the well-known preponderance of thyroid carcinoma in women, a majority of lesions occurred in white patients in this series despite a higher hospital admission rate for coloreds (mulattos).
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