Search

Septic cavernous sinus thrombosis (CST) is a rare and fatal disease. Clinical presentations in the early stage are nonspecific, and the sensitivity of cranial axial computed tomography (CT) with thick section is low. This study analyzed the clinical manifestation and neuroimaging findings in patients with septic CST in a medical center in Taiwan. Methods: This retrospective case series included nine patients with septic CST who had typical symptoms and clinical course, evidence of infection, and imaging studies which demonstrated cavernous sinus lesion, and who were treated between 1995 and 2003 at National Taiwan University Hospital. Results: Seven (77.8 %) patients were more than 50 years old. Five (55.6%) had diabetes, and three (33.3%) had hematologic diseases. All cases were associated with paranasal sinusitis. The most frequent initial symptom was headache (66.7%), followed by ophthalmic complaints (diplopia or ophthalmoplegia, 55.6%; blurred vision or blindness, 55.6%), and ptosis (44.4%). Initial cranial images failed to identify CTS in all patients. Subsequent magnetic resonance imaging (MRI) or coronal contrast-enhanced CT (CECT) with thin section confirmed the diagnosis. Fungi were the most common pathogens (55.6%). The inhospital case-fatality rate was high (44.4%). Conclusion: Due to the high case-fatality rate and low yield rate of blood cultures, fungal CST should be suspected in an immunocompromised patient with ophthalmic complaints that progress from one eye to the other. Coronal thin-section CECT may be a useful alternative to MRI as a diagnostic modality for this condition.

Seminal vesicle cysts rarely cause symptoms. Data on long-term follow-up from childhood to adulthood are lacking. The study analyzed the magnetic resonance imaging (MRI) and follow-up results of this condition. Methods: From 1991 to 1996, seminal vesicle cyst was diagnosed in 13 boys (mean age, 12 years; range, 7-15 years), six of whom had long-term follow-up data. The clinical symptoms and MRI findings at diagnosis and at follow-up were analyzed. Results: The seminal vesicle cyst was on the right side in six patients and on the left in seven. The size varied, ranging from 1.0 × 1.3 × 1.4 to 4.4 × 3.1 × 3.6 cm. All showed high signal intensity on T2-weighted images but variable signal intensity on T1-weighted images. Associated urinary tract anomalies included renal anomalies (dysplasia in 2 patients, agenesis in 11), ectopic ureteral orifice (11), hydroureter (6), and vertebral anomalies (2). One of the six patients with follow-up had repeated urinary tract infection and underwent surgical resection of the cyst 8 years after the diagnosis. The other five had no symptoms during the follow-up period. Three of the six patients had repeat MRI after a median of 11 years, which showed slight cyst enlargement and increased T1-weighted signal intensity. Conclusion: Most seminal vesicle cysts were asymptomatic and did not change during long-term follow-up. MRI is a powerful tool for detecting seminal vesicle cysts and in delineating associated congenital anomalies of the urogenital tract.

Primary liver lymphoma is a very rare disease and is frequently overlooked as a possible diagnosis. We report the case of an asymptomatic middle-aged man with chronic hepatitis C who developed primary liver lymphoma (PLL). A large solitary tumor in the left lobe of the liver was incidentally detected on routine ultrasound examination. Imaging studies showed mixed iso- and hypoechogenicity with hypoechoic rim, hypodense in the pre-contrast phase and thick wall enhancement in the post-contrast phase on computed tomographic study, hypointensity on T1WI, and hyperintensity of the central portion and slightly higher intensity in the peripheral wall on T2WI. These pictures were different from focal nodular hyperplasia, hepatocellular carcinoma, cholangiocarcinoma or metastases. Atypical hepatectomy was performed and the pathology of the hepatic tumor revealed non-Hodgkin's lymphoma. Systemic staging revealed no evidence of nodal or bone marrow involvement, so PLL was diagnosed. There was no tumor recurrence more than 4 years after operation and chemotherapy. PLL should be included in the differential diagnosis of solitary hepatic tumor in patients who are hepatitis C virus-positive, and who have atypical imaging and no known malignancy or elevated tumor marker levels.