Yannick De Brucker

Teaching point: Peripheral giant cell granuloma (PGCG) is a common benign hyperplastic reactive lesion that originates from the soft tissues of the oral cavity and should be considered following a tooth extraction.

Proliferative myositis (PM) is a rare type of inflammatory myositis. It is a benign and self-limiting pathology, but its clinical presentation can simulate malignancy. This pictorial essay illustrates the typical imaging findings of PM on ultrasound (US) and magnetic resonance imaging (MRI) in three patients. Clinical history in all three patients revealed recent vaccination procedures.

The purpose of this study is to report and take into account a rare and potentially dangerous disease, often considered as a historical complication of skin infections in the nasal area. This case report describes the story of a 7-year-old girl who was hospitalized with a high fever and furunculosis of the nasal dorsum and tip. On admission, she presented with an increasing swelling of both eyes. Computed tomography and magnetic resonance imaging scans showed periorbital cellulitis with limited post-septal expansion and right-sided cavernous sinus thrombosis. This young, immune-competent girl recovered fully after appropriate antibiotic and anticoagulation therapy. We conclude that cavernous sinus thrombosis of nasal origin is a rare but serious complication of skin infections in the nasal area. Early diagnosis and aggressive treatment are mandatory to prevent the development of a cavernous sinus syndrome and thereby ensure a good outcome Cite this article as: De Raedemaeker K, Verstappen G, Halewyck S, De Brucker Y, Gordts F. Seven-year-old girl with cavernous sinus thrombosis due to nasal furunculosis. B-ENT 2022;18(3):201-203.

A multiphase 4DCT technique can be useful for the detection of parathyroid adenomas. Up to 16 different phases can be obtained without significant increase of exposure dose using wide beam axial scanning. This technique also allows for the calculation of perfusion parameters in suspected lesions. We present data on 19 patients with histologically proven parathyroid adenomas. We find a strong correlation between 2 perfusion parameters when comparing parathyroid adenomas and thyroid tissue: parathyroid adenomas show a 55% increase in blood flow (BF) ( p < 0.001 ) and a 50% increase in blood volume (BV) ( p < 0.001 ) as compared to normal thyroid tissue. The analysis of the ROC curve for the different perfusion parameters demonstrates a significantly high area under the curve for BF and BV, confirming these two perfusion parameters to be a possible discriminating tool to discern between parathyroid adenomas and thyroid tissue. These findings can help to discern parathyroid from thyroid tissue and may aid in the detection of parathyroid adenomas.

4-Dimensional computed tomography (4DCT) for the detection of (an) enlarged parathyroid(s) is a commonly performed examination in the management of primary hyperparathyroidism. In our center, we introduced a high-frequency multiphase 4DCT protocol obtaining 16 phases, including 11 different arterial phases. Exposure to this multiphase 4DCT technique is similar to that for classic helical 4DCT. In this pictorial essay we reconstructed our multiphase 4DCT series in the manner of a classic helical 4DCT and compare both techniques. We illustrate how multiphase 4DCT may aid in the detection of parathyroid adenomas. We found 17 out of 19 lesions demonstrating a type A pattern of enhancement, therefore suggesting this pattern could be more prevalent than previously thought. Some parathyroid adenomas may be mistaken for enlarged lymph nodes using classic 4DCT whereas high-frequency multiphase 4DCT can detect a temporary rise in enhancement, thus suggesting the lesions in question to be of parathyroid origin. Smaller lesions may prove more obvious as the difference in enhancement between parathyroid and thyroid can become more prominent. Key Point: Using high-frequency multiphase 4DCT an arterial phase with maximum enhancement of parathyroid tissue can be defined. This phase may aid in the detection of parathyroid adenomas.

Background: Four-dimensional computed tomography (4DCT) is a commonly performed examination in the management of primary hyperparathyroidism, combining three-dimensional imaging with enhancement over time as the fourth dimension. We propose a novel technique consisting of 16 different contrast phases instead of three or four different phases. The main aim of this study was to ascertain whether this protocol allows the detection of parathyroid adenomas within dose limits. Our secondary aim was to examine the enhancement of parathyroid lesions over time. Methods: For this prospective study, we included 15 patients with primary hyperparathyroidism and a positive ultrasound prior to surgery. We performed 4DCT with 16 different phases: an unenhanced phase followed by 11 consecutive arterial phases and 4 venous phases. Continuous axial scanning centered on the thyroid was performed over a fixed 8 cm or 16 cm coverage volume after the start of contrast administration. Results: In all patients, an enlarged parathyroid lesion was demonstrated, and the mean lesion size was 13.6 mm. The mean peak arterial enhancement for parathyroid lesions was 384 Hounsfield units (HU) compared to 333 HU for the normal thyroid. No significant difference could be found. The time to peak (TTP) was significantly earlier for parathyroid adenomas than for normal thyroid tissue: 30.8 s versus 32.3 s (p value 0.008). The mean slope of increase (MSI) of the enhancement curve was significantly steeper than that of normal thyroid tissue: 29.8% versus 22.2% (p value 0.012). The mean dose length product was 890.7 mGy cm with a calculated effective dose of 6.7 mSv. Conclusion: Our 4DCT protocol may allow better visualization of the pattern of enhancement of parathyroid lesions, as enhancement over time curves can be drawn. In this way, wash-in and wash-out of contrast in suspected lesions can be readily demonstrated. Motion artifacts are less problematic as multiple phases are available. Exposure to our proposed 4DCT technique is comparable to that for classic helical 4DCT. Careful selection of parameters (lowering kV and SNR) can help to further reduce the dose.