Endoscopic Management of Inverted Papilloma Using CT Scan as the Predictor of Tumour Origin

Introduction Inverted papillomas are notorious for recurrence. The surgical cause attributed to recurrence is failure to achieve good surgical exposure and inadequate clearance of disease. Pre-operative prediction about the site of origin by CT Scan may contribute to a better surgical outcome. This study was undertaken to assess if focal hyperostosis on pre-operative CT scan can be considered to be a predictor of the site of tumour origin and correlate with endoscopic finding of the site of origin. Materials and Method A prospective descriptive study was carried out between Jan 2014 and May 2016. Fifteen patients of histopathologically proven inverted papilloma that reported during this time period were evaluated using contrast enhanced CT Scan and subsequently underwent endoscopic excision of tumour identifying the tumour origin. Assessment of age, gender, symptoms, pre-operative staging, location of the tumour origin on CT Scan and surgical correlation of origin was done. Post-operative follow-up was done at 1 month, 3 months and 6 monthly thereafter. Results Six (40%) were classified as Krouse II and nine (60%) were classified as Krouse III. 12 (80%) arising from maxillary sinus, 02 (13.3%) arising from maxillary sinus and anterior ethmoids and 01 (6.7%) from sphenoid. Thirteen (86.7%) cases CT scan could predict the tumour origin which was confirmed during surgery. All cases managed by endoscopic technique with no recurrence or co-existence of malignancy. Discussion Focal hyperostosis in the walls of paranasal sinus is seen to be associated with IP tumour origin, the cause of which is not fully understood. It is hypothesized that tumour induced inflammation at the site of origin leads to bone remodeling and increased bone deposition with vascularity at the site of attachment. Conclusion CT scan is a good predictor of tumour origin and a conservative endoscopic approach can be planned accordingly for complete clearance of disease.

Download Full-text

Unilateral maxillary swelling: a varied spectrum

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185298 ◽

2018 ◽

Vol 5 (1) ◽

pp. 120

Author(s):

Deepthi Satish ◽

C. B. Pratibha ◽

A. M. Balasubramanya ◽

Sumy Philip

Keyword(s):

Ct Scan ◽

Maxillary Sinus ◽

B Cell Lymphoma ◽

Sinus Surgery ◽

Preoperative Imaging ◽

Low Grade ◽

Care Hospital ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

Background: Diverse disease entities may present with mass in the maxilla and include benign conditions and malignant tumours. A detailed evaluation including preoperative imaging is essential to plan approach to management of isolated maxillary sinus lesions optimally.Methods: We did a retrospective chart review of 14 patients with isolated maxillary swelling and involvement of maxillary sinus who presented to the Department of ENT in a tertiary care hospital over a period of 4 years. A detailed history and examination were done and investigations including contrast enhanced CT scan of the nose and paranasal sinuses was done in all patients. Results: A total of 14 patients were included in this study. 7 were male and 7 were female. The mean age of the patients was 52.6, the age group of patients varied from 6 to 77 years. In our series we had patients with benign lesions like dentigerous cyst, fibro-osseous lesions, mucocele, radicular cyst, aspergilloma, and mucormycosis. Malignant cases included Adenoid cystic carcinoma, Low grade myofibroblastic sarcoma, Diffuse B cell lymphoma and undifferentiated carcinoma. All patients were treated surgically, they underwent a combined endoscopic and Caldwell Luc approach.Conclusions: In patients with unilateral maxillary swelling, a systematic approach to diagnosis with preoperative contrast enhanced CT scan is essential with a high index of suspicion. Trans nasal endoscopic approach with sinus surgery is the preferred approach for these lesions, however, in cases of jaw cysts and odontogenic cysts extending laterally it can be combined with a Caldwel-Luc approach.

Download Full-text

The contrast-enhanced CT scan in the diagnosis of isodense subdural hematoma

Journal of Neurosurgery ◽

10.3171/jns.1979.50.1.0064 ◽

1979 ◽

Vol 50 (1) ◽

pp. 64-69 ◽

Cited By ~ 22

Author(s):

Fong Y. Tsai ◽

James E. Huprich ◽

Hervey D. Segall ◽

James S. Teal

Keyword(s):

Cerebral Cortex ◽

Ct Scan ◽

Subdural Hematoma ◽

Correct Diagnosis ◽

Content Type ◽

Subdural Hematomas ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Fine Print

✓ The authors review 29 cases of surgically-proven isodense subdural hematomas examined by non-contrast and contrast-enhanced computerized tomography scans. Three types of isodense collections were noted: homogeneous isodense collections, mixed-density collections, and gravitational layering within subdural collections. Contrast enhancement within the cerebral cortex, cortical vessels, and subdural membranes led to the correct diagnosis in each case. Contrast-enhanced scans are essential for the evaluation of isodense subdural hematomas.

Download Full-text

Abdominal case of the day. Focal liver enhancement on contrast-enhanced CT scan caused by obstruction of the superior vena cava (SVC).

American Journal of Roentgenology ◽

10.2214/ajr.169.1.9207535 ◽

1997 ◽

Vol 169 (1) ◽

pp. 250-250 ◽

Cited By ~ 2

Author(s):

T E Herbener ◽

V Basile ◽

D Nakamoto ◽

H E Butler ◽

S P Pickering

Keyword(s):

Ct Scan ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

Download Full-text

Is CT Angiogram of the Abdominal Vessels Needed following the Diagnosis of Ischemic Colitis? A Multicenter Community Study

ISRN Gastroenterology ◽

10.1155/2014/756926 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Muhammed Sherid ◽

Salih Samo ◽

Samian Sulaiman ◽

Husein Husein ◽

Sankara N. Sethuraman ◽

...

Keyword(s):

Ct Scan ◽

Ischemic Colitis ◽

Celiac Trunk ◽

Ct Angiogram ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Group 3 ◽

Group 5 ◽

Atherosclerotic Changes

Background. CT angiogram is frequently obtained after diagnosis of ischemic colitis (IC). Aims. To investigate the vascular findings of CT angiogram as compared to contrast-enhanced CT scan and whether this modality changes the management or prognosis of IC. Methods. We conducted a retrospective analysis of patients with IC from 2007 to 2013. Results. CT angiogram was performed in 34 patients (28.81%), whereas contrast-enhanced CT scan was performed in 54 patients (45.76%). In CT angiogram group, 8 patients (23.5%) had atherosclerotic changes. Stenosis was found in 12 patients (35.3%) (9: celiac trunk, 3: SMA). Among this group, one patient underwent colectomy and another underwent angioplasty of the celiac trunk who died within 30 days. Among contrast-enhanced CT scan group, 5 patients (9.3%) had atherosclerotic changes. Stenosis was found in 5 patients (9.3%) (3: celiac trunk, 1: SMA, and 1: IMA). Among this group, 3 patients had colectomy and one died within 30 days. There was no statistical difference between both groups in all vascular findings except the stenosis which was higher in CT angiogram group (P=0.0025). Neither the need for surgery nor all-cause mortality was different between both groups. Conclusion. CT angiogram did not provide any useful findings that altered the management or the prognosis of IC.

Download Full-text

Contrast enhanced CT scan 1-year after admission. The bifurcated surgical graft of the abdominal aorta with visceral sidegrafts is seen

ASVIDE ◽

10.21037/asvide.2018.292 ◽

2018 ◽

Vol 5 ◽

pp. 292-292

Author(s):

Paul Schoenhagen

Keyword(s):

Ct Scan ◽

Abdominal Aorta ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

Download Full-text

Delayed response to proton beam treatment of hepatocellular carcinoma

BJR|case reports ◽

10.1259/bjrcr.20180125 ◽

2020 ◽

Vol 6 (1) ◽

pp. 20180125

Author(s):

Chee-Wai Cheng ◽

Mitchell Machtay ◽

Jennifer Dorth ◽

Olga Sergeeva ◽

Hangsheng Xia ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Ct Scan ◽

Proton Beam ◽

Arterial Phase ◽

Delayed Response ◽

Data Set ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Imaging Response

Hepatocellular carcinoma (HCC) has become one of the leading causes of cancer death worldwide. There has been anecdotal report regarding the effectiveness of proton beam treatment for HCC. In this pre-clinical investigation, the woodchuck model of viral hepatitis infection-induced HCC was used for proton beam treatment experiment. The radiopaque fiducial markers that are biodegradable were injected around the tumor under ultrasound guidance to facilitate positioning in sequential treatments. An α cradle mode was used to ensure reproducibility of animal positioning on the treatment couch. A CT scan was performed first for contouring by a radiation oncologist. The CT data set with contours was then exported for dose planning. Three fractionations, each 750 CcGyE, were applied every other day with a Mevion S250 passive scattering proton therapy system. Multiphase contrast-enhanced CT scans were performed after the treatment and at later times for follow-ups. 3 weeks post-treatment, shrinking of the HCC nodule was detected and constituted to a partial response (30% reduction along the long axis). By week nine after treatment, the nodule disappeared during the arterial phase of multiphase contrast-enhanced CT scan. Pathological evaluation corroborated with this imaging response. A delayed, but complete imaging response to proton beam treatment applied to HCC was achieved with this unique and clinically relevant animal model of HCC.

Download Full-text