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Theodorou DJ, Theodorou SJ, Kakitsubata Y. Pneumatosis: Appearances on CT Imaging. Cureus 2023; 15:e41927. [PMID: 37583727 PMCID: PMC10424766 DOI: 10.7759/cureus.41927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pneumatosis is a general term used to designate the presence of spontaneous air or gas leaks into the body's compartments. PURPOSE In this paper, we provide an overview of gas originating from different sites and present the most common routes by which air may escape free to surrounding or distant tissues. METHODS On the basis of 45 interesting clinical cases, we discuss the CT imaging characteristics of thoracic and spinal pneumatosis, better known as pneumomediastinum and pneumorrhachis. In addition, we present craniocervical pneumatosis manifesting as subcutaneous emphysema. RESULTS Isolated pneumatosis was diagnosed in 12 (27%) of the 45 patients, manifesting as craniocervical free air or pneumoperitoneum. In 28 (62%) patients with pneumomediastinum, 12 (43%) had concomitant pneumothorax. Soft tissue emphysema was seen in 24 (52%) patients. One of the patients with generalized pneumatosis had craniocervical and extensive soft tissue emphysema, in conjunction with pneumomediastinum, pneumothorax, and pneumoperitoneum. Intraspinal pneumatosis was always coupled with pneumomediastinum. CONCLUSION Pneumatosis may not be as uncommon as it seems, and indeed, this condition may need to be recognized early as it can be an alarming sign of serious pathology.
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Hoegger MJ, Strnad BS, Ballard DH, Siegel CL, Shetty AS, Weimholt RC, Yano M, Stanton ML, Mellnick VM, Kawashima A, Zulfiqar M. Urinary Bladder Masses, Rare Subtypes, and Masslike Lesions: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e220034. [PMID: 36490210 DOI: 10.1148/rg.220034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Urinary bladder masses are commonly encountered in clinical practice, with 95% arising from the epithelial layer and rarer tumors arising from the lamina propria, muscularis propria, serosa, and adventitia. The extent of neoplastic invasion into these bladder layers is assessed with multimodality imaging, and the MRI-based Vesical Imaging Reporting and Data System is increasingly used to aid tumor staging. Given the multiple layers and cell lineages, a diverse array of pathologic entities can arise from the urinary bladder, and distinguishing among benign, malignant, and nonneoplastic entities is not reliably feasible in most cases. Pathologic assessment remains the standard of care for classification of bladder masses. Although urothelial carcinoma accounts for most urinary bladder malignancies in the United States, several histopathologic entities exist, including squamous cell carcinoma, adenocarcinoma, melanoma, and neuroendocrine tumors. Furthermore, there are variant histopathologic subtypes of urothelial carcinoma (eg, the plasmacytoid variant), which are often aggressive. Atypical benign bladder masses are diverse and can have inflammatory or iatrogenic causes and mimic malignancy. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Mark J Hoegger
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Benjamin S Strnad
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Cary L Siegel
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - R Cody Weimholt
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Motoyo Yano
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Melissa L Stanton
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Akira Kawashima
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
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