Mediastinal Teratoma

The above images are a PA Chest X-Ray and a CT Scan of the of the Chest revealing a Mediastinal Teratoma.

A teratoma is tumor consisting of different types of tissue, as of skin, hair, and muscle, caused by the development of independent germ or reproductive cells.

Mediastinal teratomas account for 7% of all teratomas. The mature type of these are benign and do not have potential to metastasize. These can be found in all age groups however they are most common in adults 20-40 years of age.

They are often asymptomatic. If symptoms due occur, they can include chest pain, cough, difficulty breathing, or symptoms similar to pneumonitis.

The treatment for mediastinal teratomas is typically just surgical removal of the cyst. The surgical procedure is the most often cause of complications.

Carotid Body Tumor

This image is a contrast-enhanced T1-weighted MRI of a right carotid body tumor overlying the right carotid bifucation.

The tumor is considered a glomus tumor which are part of the extra-adrenal neuroendocrine system. Glomus tumors most oftenly occur in the inner ear or the temporal bone. They are slow growing and not usually fatal.

Patients with the carotid body type of glomus tumor usually have symptoms such as hoarseness, dysphagia, vertigo, or paresis. They may present with a mobile, non tender lateral neck mass. They are believed to be caused by an overresponse to a change in the body's homeostasis.

CT with contrast, MRI with contrast, and angiography are best for diagnosing. Surgery is the preferred treatment. Patients that are not able to tolarate surgery may undergo radiation therapy or embolization. Embolization can be done prior to surgery because of the vascular nature of the tumors.

Pleomorphic Adenoma

This image is a coronal fat saturated T2-weighted MR image of a patient with a Pleomorphic adenoma. The mass seen involves the deep lobe of the parietal gland.

Pleomorphic adenoma is the most common type of benign salivary gland tumor. These are not typically life threatening however, surgical removal is recommended. Patients do not usually complain of symptoms. They are usually found during routine physical exams or palpated by the patient. CT or MRI studies are done to determine the proximity of the mass to the patient's facial nerve.

Hydrocephalus in Achondroplasia Patients

Achondroplasia is the cause of the most common type of dwarfism and is characterized by abnormally short stature with short arms and legs as well as an enlarged head. It is suggested that hydrocephalus in patients is related to stenosis of the sigmoid sinus. This results in a rise in intracranial venous pressure. The increased venous pressure impairs the absorption of cerebrospinal fluid. The build up of CSF in the brain results in hydrocephalus. This can be seen on MR venography.

Chronic Sinusitis

Chronic Sinusitis is defined as a sinus infection lasting longer than six to eight weeks. An infection lasting less than six to eight weeks is considered acute.

The factors involved in Chronic Sinusitis are:
Structural Obstructions
Allergies
Fungal Infections
Deviated Septum
Nasal Polyposis

The common symptoms of Chronic Sinusitis are:
Sinus Pressure
Pain with Nasal Drainage
Nasal Obstruction
Congestion
Headaches

Patients are clinically evaluated for their symptoms for diagnosis. Along with a clinical evaluation a CT of the sinuses, nasal endoscopic and rhinoscopic evaluations are used to diagnose Chronic Sinusitis. When diagnosing Chronic Sinusitis with a CT exam, the clinician is looking at the osteomeatal complex, which is the area where all of the sinuses drain into the nasal cavity. An obstruction in this area is a souce of recurrent and chronic sinus issues. Abnormal scans will show sinuses filled with fluid or thickened mucous membranes.

Treatments of Chronic Sinusitis include:
Nasal Rinses with Antibiotics
Nasal Steroid Sprays
Oral Steroids
Endoscopic Sinus Surgery

With the endoscopic sinus surgery the abnormal obstructive tissues are removed. Sometimes a sinus shaver is used which precisely removes redundant mucosa and thin bones causing obstructions.

Patients outlook after surgery most patients experience easier nasal breathing, a reduced number and frequency of sinus issues, and sinus related headaches improves.

These images came from facialbeauty.com and demonstrate coronal CT images before and after sinus surgery.

Orbital Cellulitis

Orbital cellulitis is an infection of the soft tissues of the orbit. The most common cause is the spread of an infection of the ethmoid sinuses. However, it can also occur as a result of direct infection cause by orbital trauma or surgery. Bacteria in the blood can also spread and cause optical cellulitis. The first picture above is of a patient with optical cellulitis of the left eye. (emedicine.com) The second image is an axial slice CT image of a patient with optical cellulitis. (Also from emedicine.com) This infection is most common in winter due to the increase in sinusitis. Children are more likely than adults to be affected. Some symptoms include lid edema, orbital pain, fever, headache, decreased vision, increased intra-ocular pressure and inability to open the eye.

To diagnose orbital cellulitis lab test are done as well as imaging studies. Lab tests include CBC, blood cultures and smear for Gram stain and culture of nasal discharge. A high resolution CT scan with pre and post contrast images are used with axial and coronal slices.

Treatment for orbital cellulitis is antibiotics for the infection, diuretics for increased intra-ocular pressure, nasal decongestant if cellulitis is secondary to sinusitis, and an antifungal if the cellulitis is attributed to a fungus.

Craniopharyngioma

Craniopharyngiomas are tumors in the brain located at the base of the skull near the pituitary gland. Most craniopharyngiomas are benign tumors. They account for between 2%-4% of adult and between 5%-13% of childhood primary brain tumors. Patients with these tumors don't usually have symptoms until the tumor grows and pushes against the optic nerve, pituitary gland or the brain. Symptoms can include headache, nausea, vomiting, vision problems, balance issues, difficulty speaking, confusion, seizures, hearing difficulties, and hormonal disorders. To diagnose craniopharyngioma doctors can evaluate the patient clinically by testing their hearing, vision, balance, coordination, reflexes and hormone levels. Imaging studies can be used to confirm clinical evaluation. MRI would show good soft tissue contrast and is the imaging modality of choice. Other imaging could include CT, Angiogram, MRS, SPECT, and PET. Treatments for craniopharyngioma, given separate or together, can give patients a high rate of long term survival. Surgery, external radiation, stereotactic radiosurgery, and intracavity irradiation, are included in the therapies along with the occasional use of chemotherapy.

The images above are a sagittal T1 weighted MRI image on the left and an axial CT scan on the right, both showing a craniopharyngioma.