August 21, 2011

Ileal Diverticulitis

Axial CT image shows an ileal diverticulum (arrow) with surrounding inflammation (arrowheads). Thin arrow = normal appendix.
Sagittal CT image again confirms the presence of an inflamed ileal diverticulum. Note a normal cecum.

  • Two percents of population have small-bowel diverticula
  • These can be congenital or acquired.
  • Acquired diverticula are common in jejunum and terminal ileum. They are mucosal herniation along the mesenteric border.
  • About 6-10% of patients with small-bowel diverticula develop complications (-itis, hemorrhage, obstruction, intussusception)
  • CT can show inflammatory change around the diverticulum with mural thickening of the adjacent bowel loops. The appendix and cecum are normal.

Gourtsoyiannis NC. Radiologic Imaging of the Small Intestine, 2002.

August 11, 2011

Kaposi's Sarcoma

Axial CT image shows perihilar peribronchovascular thickening (arrows) and several small ill-defined nodules in the peribronchovascular distribution.
Axial CT image shows patchy groundglass opacities and consolidation in the right middle and lower lobes.

  • Multicentric neoplasm occuring in three distinct clinical settings: classic (middle-aged adults or elderly men with indolent course), endemic (native populations of equatorial Africans) and disseminated forms (AIDS and immunosuppressed recipients of organ transplants)
  • Associated with human herpesvirus type 8
  • Cutaneous manifestations usually precede visceral disease
  • Respiratory disease is a late manifestation of the disease, it can involve trachea, bronchial tree, pleura and lung parenchyma
  • Diagnosis of respiratory disease is often made presumptively based on clinical/imaging appearance and exclusion of other entities. Biopsy is most definitive.
  • Treatment of pulmonary disease almost always involves chemotherapy
Thoracic Imaging Findings
  • Two patterns: interstitial and nodular
  • Interstitial pattern -- septal lines, localized/focal consolidations, perihilar distribution, "flame-shaped" opacities
  • Nodular pattern -- ill-defined nodules of various sizes that may coalesce into areas of patchy consolidation
  • Up to 60% has pleural effusion
  • Up to 16% has hilar/mediastinal lymphadenopathy
Our case: Kaposi's sarcoma, biopsy-proven

Humes HD. Kelley's Essentials of Internal Medicine, 2001.
Parsons PE, Heffner JE. Pulmonary/reespiratory Therapy Secrets, 2002.