Peripheral enhancement in computerized cranial tomography: a non-specific finding

Background: Fat can be identified in numerous liver lesions, and usually is not a specific finding. Distinguishing between different kinds of fatty deposits is an important part of differential diagnosis. Magnetic Resonance Imaging (MRI) is superior to other imaging techniques because it allows distinguishing intracellular from macroscopic fat. Discussion: Intracellular lipid may be found in focal hepatic steatosis, hepatic adenoma, hepatocellular carcinoma and, less commonly, in focal nodular hyperplasia as well as regenerative and dysplastic nodules. Macroscopic fat is seen in angiomyolipoma, lipoma, metastases from fatcontaining neoplasms, primary or metastatic liposarcoma, hydatid cyst, pseudolipoma of the Glisson capsule, pericaval fat collection, lipopeliosis, hepatic teratoma, focal hepatic extramedullary haematopoiesis and adrenal rest tumour. Conclusion: Liver nodules should be characterised with regard to underlying liver condition, MRI characteristics and contrast enhancement pattern, including hepatobiliary phase. In many cases, identification of fatty content may help narrowing the differential diagnosis.

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Secondary haemophagocytic lymphohistiocytosis in COVID-19: correlation of the autopsy findings of bone marrow haemophagocytosis with HScore

Journal of Clinical Pathology ◽

10.1136/jclinpath-2020-207337 ◽

2021 ◽

pp. jclinpath-2020-207337

Author(s):

Claudia Núñez-Torrón ◽

Ana Ferrer-Gómez ◽

Esther Moreno Moreno ◽

Belen Pérez-Mies ◽

Jesús Villarrubia ◽

...

Keyword(s):

Bone Marrow ◽

Immune Response ◽

Immune System ◽

Multiorgan Failure ◽

Histological Findings ◽

Haemophagocytic Lymphohistiocytosis ◽

Bone Marrow Tissue ◽

Autopsy Findings ◽

Specific Finding ◽

Clinical Records

BackgroundSecondary haemophagocytic lymphohistiocytosis (sHLH) is characterised by a hyper activation of immune system that leads to multiorgan failure. It is suggested that excessive immune response in patients with COVID-19 could mimic this syndrome. Some COVID-19 autopsy studies have revealed the presence of haemophagocytosis images in bone marrow, raising the possibility, along with HScore parameters, of sHLH.AimOur objective is to ascertain the existence of sHLH in some patients with severe COVID-19.MethodsWe report the autopsy histological findings of 16 patients with COVID-19, focusing on the presence of haemophagocytosis in bone marrow, obtained from rib squeeze and integrating these findings with HScore parameters. CD68 immunohistochemical stains were used to highlight histiocytes and haemophagocytic cells. Clinical evolution and laboratory parameters of patients were collected from electronic clinical records.ResultsEleven patients (68.7%) displayed moderate histiocytic hyperplasia with haemophagocytosis (HHH) in bone marrow, three patients (18.7%) displayed severe HHH and the remainder were mild. All HScore parameters were collected in 10 patients (62.5%). Among the patients in which all parameters were evaluable, eight patients (80%) had an HScore >169. sHLH was not clinically suspected in any case.ConclusionsOur results support the recommendation of some authors to use the HScore in patients with severe COVID-19 in order to identify those who could benefit from immunosuppressive therapies. The presence of haemophagocytosis in bone marrow tissue, despite not being a specific finding, has proved to be a very useful tool in our study to identify these patients.

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What demographics matter for organisational culture, commitment and identification?

International Journal of Organizational Analysis ◽

10.1108/ijoa-05-2019-1762 ◽

2020 ◽

Vol 28 (1) ◽

pp. 274-290

Author(s):

Natalia Volkova ◽

Vera Chiker

Keyword(s):

Design Methodology ◽

Organisational Culture ◽

Employee Perceptions ◽

International Studies ◽

Content Type ◽

Specific Finding ◽

Public Organisations ◽

A Company ◽

Practical Implications ◽

Demographic Effects

Purpose The purpose of this study to establish what demographic characteristics (gender, generations and organisational tenure) play a role in employee perceptions of organisational culture, commitment and identification in Russian public organisations. Design/methodology/approach The data were collected electronically from 248 employees of two public organisations. Three questionnaires were used. Findings Organisational tenure plays a central role in the way how employees perceive organisational culture; tenure also shapes the levels of both commitment and identification. The specific finding of Russian settings is that the longer employees work for a company, the lower the levels of psychological attachments they demonstrate, while it is not the case for some existing international results. The other findings correspond with those in international studies, in which women were more psychologically attached to the organisation and showed a higher level of identification and lower rates of negative forms of this concept than men did. The older the employees are, the higher the level of identification they express. Practical implications Managers working in Russian settings can struggle with engaging and retaining employees. Understanding the demographic effects can help alleviate these challenges. Originality/value Based on empirical findings, this paper contributes to the literature on organisational socialisation by providing evidence of the damaging effects of the length of organisational tenure on psychological attachment to the company (in the form of commitment and identification). Additionally, tenure is the shaping factor of employee perception of organisational culture.

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Metatarsal periosteal reactions: a common non-specific finding in radiographs of the diabetic foot.

BMJ ◽

10.1136/bmj.297.6658.1243 ◽

1988 ◽

Vol 297 (6658) ◽

pp. 1243-1244 ◽

Cited By ~ 4

Author(s):

C. E. Williams ◽

B. M. Carey ◽

A. J. Birtwell ◽

J. K. Wales ◽

P. G. Wiles

Keyword(s):

Diabetic Foot ◽

Specific Finding

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Computerized Cranial Tomography-Reply

JAMA ◽

10.1001/jama.1977.03280230031013 ◽

1977 ◽

Vol 238 (22) ◽

pp. 2368

Author(s):

Harvey V. Fineberg

Keyword(s):

Computerized Cranial Tomography

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Abdomen System

Clinical Medicine for the MRCP PACES ◽

10.1093/oso/9780199542550.003.0008 ◽

2010 ◽

Author(s):

Gautam Mehta ◽

Bilal Iqbal

Keyword(s):

Liver Disease ◽

Vascular Lesions ◽

Skin Fold Thickness ◽

System P ◽

Skin Fold ◽

Normal Individuals ◽

Palmar Erythema ◽

Triceps Skin Fold ◽

Specific Finding ◽

Fat Stores

1. Jaundice is a marker of severity of liver disease, as well as a consequence of decompensation. Yellow discolouration is not usually seen until the serum bilirubin is >40μmol/L (twice the upper limit of normal), although the earliest signs of jaundice can be detected in the periphery of the conjunctivae, or in the buccal mucosa. Remember, there are other causes of jaundice in liver disease, such as Zieve’s syndrome (haemolysis and hyperlipidaemia in alcohol misuse), or biliary obstruction. 2. Cachexia can be established by demonstrating muscle and fat loss. Wasting of the temporalis muscle is an early sign of generalized muscle atrophy. A reduced triceps skin-fold thickness is a marker of loss of fat stores. This can be demonstrated by palpating for redundant skin over the triceps area between your thumb and forefingers. 3. Anaemia is most reliably demonstrated by looking for conjunctival pallor. This is thought to be more sensitive than looking for pallor of skin creases, nails, or other mucosal membranes. If there is no evidence of anaemia, it is an important negative to mention to the examiner. The principal causes of anaemia in chronic liver disease are blood loss from portal hypertensive gastropathy, alcohol excess causing bone marrow suppression and poor nutrition. 4. Other gastrointestinal (GI) causes of clubbing include inflammatory bowel disease (IBD), coeliac disease, GI lymphoma and rare causes of malabsorption such as tropical sprue and Whipple’s disease. 5. Leuconychia is a non-specific finding which is associated with hypoalbuminaemia as well as other conditions such as heart failure, renal disease, Hodgkin’s lymphoma (HL) and diabetes mellitus (see Case 8—Nephrotic Syndrome). 6. Palmar erythema reflects the vasodilated state of cirrhosis. Other causes of palmar erythema include hypercapnoea, rheumatoid arthritis, thyrotoxicosis, pregnancy, fever, and exercise. 7. Spider naevi are vascular lesions, with a central arteriole that supplies smaller surrounding vessels. Generally, the number and size correlate with the severity of liver disease, although they may occur in normal individuals and pregnancy. Spider naevi, palmar erythema, gynaecomastia, and loss of body hair are thought to be the consequence of altered sex hormone metabolism, and an increase in the oestradiol:free testosterone ratio.

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Intrahepatic sarcomatoid cholangiocarcinoma

BMJ Case Reports ◽

10.1136/bcr-2018-225017 ◽

2018 ◽

pp. bcr-2018-225017 ◽

Cited By ~ 1

Author(s):

Sara Sintra ◽

Rui Costa ◽

Carlos Filipe ◽

Adélia Simão

Keyword(s):

Primary Tumour ◽

Sarcomatoid Carcinoma ◽

Malignant Neoplasm ◽

Liver Mass ◽

Immunohistochemical Examination ◽

Abdominal Ct ◽

Rare Tumour ◽

Positive Expression ◽

Proper Diagnosis ◽

Peripheral Enhancement

Sarcomatoid carcinoma is a rare tumour composed of intermingled malignant epithelial and mesenchymal cells, and it has been reported in various organs including the liver. Sarcomatoid cholangiocarcinoma (CCC) is an extremely rare liver primary tumour. Here, we report a case of an elderly man who was admitted to our hospital after head trauma. He performed a head CT that diagnosed cerebral metastasis. On abdominal CT, he presented a 10×8×9 cm-sized hypodense liver mass in the VII and VIII segments, with peripheral enhancement. Histological and immunohistochemical examination of the tumour showed a malignant neoplasm with both carcinomatous and sarcomatous components and positive expression of cytokeratin and vimentin antibodies. The patient was diagnosed with intrahepatic sarcomatoid CCC at an advanced stage and died 45 days after the diagnosis. We emphasise the importance of immunohistochemistry which may provide a clue to proper diagnosis.

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Computerized Cranial Tomography

Journal of Computer Assisted Tomography ◽

10.1097/00004728-197904000-00009 ◽

1979 ◽

Vol 3 (2) ◽

pp. 196

Author(s):

George du Boulay

Keyword(s):

Computerized Cranial Tomography

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Reporting Discrepancy Resolved by Findings and Time in 2947 Emergency Department Ankle X-rays

Skeletal Radiology ◽

10.1007/s00256-019-03317-7 ◽

2019 ◽

Vol 49 (4) ◽

pp. 601-611 ◽

Cited By ~ 2

Author(s):

Thomas James York ◽

P. J. Jenkins ◽

A. J. Ireland

Keyword(s):

Emergency Department ◽

Working Hours ◽

High Standard ◽

Causative Factor ◽

X Rays ◽

Type B ◽

Complete Dataset ◽

Specific Finding ◽

Weber Type ◽

Major Discrepancy

Abstract Aims To identify common errors in ankle X-ray reporting between initial interpretation and final assessment at the virtual fracture clinic. Also, to assess time of initial reporting as a causative factor for discrepancy. Methods Two thousand nine hundred forty-seven final reports were reviewed by standard of agreement to the initial interpretation. Where discrepancy was found, it was classified and collated by specific finding. Comparison was made between reports with discrepancy and the complete dataset, allowing rates of error by finding to be established. The reports containing discrepancy were further classified by time period, this was compared against an expected value to establish if initial reporting outside of routine working hours was as accurate as that conducted within routine working hours. Results 94.4% of reports were in agreement with the initial interpretation, 2.9% contained minor discrepancy, and 2.7% major discrepancy. In 45.6% of reports there was no radiologically observable injury. 16.4% of reports contained a lateral malleolar fracture, most commonly Weber type B. 40.0% of all navicular fractures, and 33.3% of all cuboidal fractures were not commented upon in the initial reporting. Lower rates of more frequently observed findings were missed with 2.5% of Weber type B fractures not commented upon. An increased proportion of major discrepancy reports were generated from 00:00 to 07:59 (expected = 15.0%, observed = 22.2%; p = 0.07908). Similarly, a greater than expected number of minor discrepancy reports were found between 20:00 and 23:59 (expected = 18.0%, observed = 34.1%, p = 0.00025). Conclusions The initial reporting of ankle X-rays in the emergency department is performed to a high standard, however serious missed findings emphasise the need for timely senior review. Reporters should increase their awareness of navicular, cuboid, talar, and Weber A fractures which were missed at disproportionate rates. This study also finds evidence to support increased rates of error in initial reporting of ankle X-rays outside of normal working hours (17:00–07:59), particularly with a significantly increased rate of minor discrepancy seen from 20:00 to 23:59.

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The Trapped Temporal Horn

Neurosurgery ◽

10.1227/00006123-197908000-00008 ◽

1979 ◽

Vol 5 (2) ◽

pp. 245-249 ◽

Cited By ~ 8

Author(s):

Harold Smith ◽

Dixon Moody ◽

Marshall Ball ◽

Wayne Laster ◽

David L. Kelly ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Right Ventricle ◽

Brain Stem ◽

Lateral Ventricle ◽

Ventricular Wall ◽

X Ray ◽

Temporal Horn ◽

Grade Ii ◽

Computerized Cranial Tomography ◽

The Right

Abstract Although the advent of computerized cranial tomography (CT) has decreased the number of pneumoencephalograms performed for the diagnosis of hydrocephalus and lesions of the posterior fossa, brain stem, and ventricles, there are some patients in whom pneumoencephalography should still be done because it adds valuable information to that obtained with CT. When the temporal horn becomes obstructed, the choroid plexus and ependymal surface “upstream” from the obstructing mass continue to produce cerebrospinal fluid (CSF). The temporal horn can thus enlarge enough to appear as a mass on CT because of its reduced x-ray attenuation coefficient. Pneumoencephalography is effective in this situation because air will flow past a mass that obstructs CSF and because the ventricular system dilates during pneumoencephalography. When pneumoencephalography is used in a patient with a trapped temporal horn, the partially trapped horn may enlarge approximately 24 hours later. With that precaution in mind, the neurosurgeon should find pneumoencephalography to be a useful adjunct to CT in delineating the cause of a trapped temporal horn. In the three patients reported here CT had indicated a unilateral trapped temporal horn; pneumoencephalography confirmed that finding and demonstrated both the location and the nature of the lesion. One patient had a Grade II astrocytoma fungating into the atrium of the right lateral ventricle, one had a mass extending into the right ventricle from the medial and superior ventricular wall with nodular encroachment on the ventricle, and one had a meningioma in the atrium of the right lateral ventricle.

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