Graves orbitopathy: correlation of CT and clinical findings

Article Abstract:

Graves orbitopathy is a disease that affects the cavity in the skull that contains the eyeball and the muscles, nerves and other associated tissues. Computed tomography (CT) can be used to gather data from orbits, such as to help characterize and diagnose Graves orbitopathy. This study compared CT data from orbits of patients with Graves with data from normal orbits, as well as with clinical findings. CT and clinical findings were reviewed from 71 patients with Graves orbitopathy and from 20 healthy individuals. The patients with Graves were subdivided into two groups, 9 who had optic neuropathy (disease of optic nerve) and 62 who did not have it. CT measurements were made of the sizes of muscles, veins, and optic nerve sheath. Muscle measurements showed that most extraocular muscle groups were significantly larger in those with Graves than in those who did not have Graves. There was a correlation between increased muscle size and clinical eye problems. Crowding of the optic nerve was seen in 47 percent of the diseased orbits. The lacrimal gland was found to be displaced in 37 percent of the diseased orbits. In comparing the orbits of Graves patients with optic neuropathy to those without, significantly larger muscle diameters were found in the former. They also were found to have a much higher percentage of apical crowding. The diameter of the optic nerve sheath was larger in the neuropathy group and that group had a much larger percentage of lacrimal gland displacement. These results show that CT can distinguish between normal and Graves-afflicted orbits on the basis of increased size in a number of the ocular muscle groups. Apical crowding was found to be a major CT determinant of optic neuropathy. CT imaging of the orbit can be a useful tool in indicating the presence of Graves orbitopathy and as an early indicator of patients at risk for developing optic neuropathy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, CT imaging, CAT scans, Eye diseases, Graves' disease, Eye-sockets, Eye sockets

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Dieulafoy disease: arteriographic findings and treatment

Article Abstract:

Dieulafoy disease is a rare abnormality of the arteries beneath the mucous membranes that line the gastrointestinal (GI) tract. It causes erosion in these arteries that leads to ruptures in the arteries and resultant bleeding in the upper (GI) tract. Bleeding arteries can be detected using an endoscope, an instrument that can be inserted in the GI tract to visualize the interior of the tract, but if the bleeding is not continuous or if clotted blood has covered the rupture, endoscopy may not be useful. Treatment to stop the bleeding can be greatly enhanced if the locations of the ruptures are found prior to surgery. No reports have characterized the clinical and radiologic findings associated with this disease. This study examined the clinical and radiologic findings associated with Dieulafoy disease. The cases of nine patients with the disease are reviewed. All nine patients underwent endoscopic examination and three underwent arteriographic examination (X-rays of arteries.) In eight cases, the disease was not diagnosed until surgery was performed. In the other case, arteriography was used to diagnose the disease. Arteriography was helpful in locating the rupture, but was not diagnostic in two other cases where it was performed. The arteries appeared eroded, but otherwise normal on the X-rays. Endoscopy was not useful in diagnosing Dieulafoy in any of the cases. Eight of the nine rupture sites were found in the stomach. Bleeding was stopped in all patients, but five patients died from other causes. These results indicate that in patients with upper GI tract bleeding where endoscopic examination cannot find the cause of the bleeding, Dieulafoy should be considered. Arteriography results should help locate the rupture site. Embolization or blocking blood flow in the artery branch where the bleeding is suspected should be considered so that surgery can be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Arteries

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CT findings in Swyer-James syndrome

Article Abstract:

Swyer-James syndrome (SJS) or Macleod syndrome, as it is also known, is a variant of postinfectious bronchiolitis obliterans, a degenerative disease of the bronchiole. This disease is defined by the presence of granulation tissue plugs within the lumen of small airways and destruction of these small airways. Although usually asymptomatic in adults, the patient may have a cough, chronic and repeated lung infections, decreased exercise tolerance, and spitting up of blood. SJS is usually diagnosed with the aid of chest x-rays. This study was undertaken to assess the effectiveness of computed tomography (CT) in demonstrating the severity and extent of bronchial and lung involvement in SJS. Nine patients with a diagnosis of SJS were examined. All nine patients underwent chest x-ray and a definitive diagnosis of SJS was obtained in all patients. These same patients then underwent prospective CT examinations of the chest. On x-rays, SJS must be differentiated from an endobronchial lesion incompletely obstructing the lumen of a lobar or main bronchial passage, unilateral bullous disease, and pulmonary artery abnormalities. CT can be used in the differential diagnosis of SJS, as it may demonstrate the patency of the bronchial tree and therefore help rule out other diagnoses including such problems as foreign bodies in children and endobronchial tumors in adults. Moreover, CT can demonstrate the presence, location, and type of bronchiectasis the chronic dilation of a bronchus or bronchi, with a secondary infection that usually involves the lower portion of the lung. Radiologists should be aware of the CT findings in SJS which enable the diagnosis of this disease in patients referred for a chest CT examination who have bronchiectasis or infected lung cavities. In the experience of the researchers, CT was more reliable than x-ray imaging in demonstrating the extent of SJS and identifying some of the underlying causes of the disease.

Evaluation, Complications and side effects, Lungs, Lung, Bronchiolitis, Bronchiectasis

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