1977, British Journal of Radiology, 50, 522-523 Case reports and decreased echo amplitude. Investigative staging procedures are important in the management of Hodgkin's disease (Glatstein et ah, 1969). In the patient described here, the site and size of splenic tumour deposits was accurately located preoperatively. Ultrasound can be a useful noninvasive technique for the diagnosis of Hodgkin's disease of the spleen.

REFERENCES

HOLM, H. H., 1975. In Abdominal Ultrasound, edited by H. H. Holm, J. K. Kristensen, and S. N. Rasmussen et al., p. 95 (University Park Press, London). TAYLOR, K. J. W. and MILAN, J., 1976. Differential diag-

nosis of chronic splenomegaly by grey-scale ultrasonography. British Journal of Radiology, 49, 519—525. GLATSTEIN, E., GUERNSEY, J. M., ROSENBERG, S. A. and

KAPLAN, H. S., 1969. The value of laporotomy and splenectomy in the staging of Hodgkin's disease. Cancer, 24, 709-718.

A foreign body granuloma simulating a pericardial cyst: an unusual case report By R. P. Uflacker, M.D.,* and D. L Duarte, M.D. Roentgen Department of Lazzarotto's Hospital, Porto Alegre, Brazil {Received October, 1976) This report presents an unusual case of paracardiac mass which was revealed ten years after heart surgery. The mass could not be distinguished radiologically from a pericardial cyst. At surgery it was found to be a foreign body granuloma containing a piece of surgical sponge. CASE REPORT

A 31-year-old white man was admitted to this centre on September 19, 1974, complaining of palpitations and dull precordial pain. * Present address: Department of Radiology, Rikshospitalet, Oslo, Norway.

Ten years previously the patient had had a Starr-Edwards aortic prosthesis and mitral commissurotomy for aortic and mitral rheumatic valve disease. On admission, his temperature was 36°C, pulse 88 per minute, sinus rhythm and the blood pressure was 120/80 mm Hg. He was a well nourished white male. Systemic review was unremarkable. ECG showed S-T and T waves alterations consistent with left ventricular hypertrophy. Laboratory examination showed anaemia with a haemoglobin of 10.7 g but was otherwise normal. Chest X ray revealed a large mass in the right cardiophrenic angle apparently fused with the cardiac border, measuring about 10 cm in diameter. This was interpreted as probably a pericardial cyst, secondary to the cardiac surgery. Surgery, through a sternotomy, disclosed a rounded mass attached to the right side of the heart. It measured about 10 cm in diameter.

A FIG. 1. The "Pericardial Cyst". A P.A. roentgenogram (A) reveals a large paracardiac mass in the right cardiophrenic angle. The lateral projection (B) shows the cyst and the aortic prothesis (arrow).

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1977, British Journal of Radiology, 50, 523-525

JULY 1977

Case reports The mass was incised and found to be a cyst containing a surgical sponge. The cyst was removed and dissected out from the auricular border with the local pericardium, preserving the phrenic nerve. Following surgery his symptoms disappeared completely and he has been free of symptoms for the last year. Pathology examination showed a piece of surgical sponge about 5 x 5 cm surrounded by greyish caseous material. Microscopic examination revealed a typical foreign body granuloma with giant cells, lymphocytes and monocytes surrounding homogeneous acellular material.

tiation between this kind of cyst and congenital or post-surgical cysts (Deenadayalu and Tuuri, 1974; Pokorny and Idriss, 1974). However, a percutaneous transthoracic needle biopsy might have given the correct diagnosis (Klatte and Yune, 1972). REFERENCES DEENADAYALU, R. P., and TUURI, D., 1974. Intrapericardial

teratoma and bronchogenic cyst, journal of Thoracic and Cardiovascular Surgery, 67, 954-958. KLATTE, E. C , and YUNE, H. Y., 1972. Diagnosis and treat-

ment of pericardial cysts. Radiology, 104, 541-544.

DISCUSSION

We did not find any similar case described in the literature. It is difficult to make a radiologic differen-

POKORNY, W. J., and IDRISS, F. S., 1974. Mediastinal masses

in infants and children. Journal of Thoracic and Cardiovascular Surgery, 68, 869-875.

Unusual, isolated seminoma metastases to the lung By A. Y. Rostom, M.B., Ch.B., D.M.R.T., F.R.C.R., and R. L Morgan, M.A., B.Sc, M.B., B.Ch., D.M.R.T., F.R.C.R. Division of Radiotherapy and Oncology, The Royal Marsden Hospital, Institute of Cancer Research, London and Surrey {Received October, 1976 and in revised form January, 1977) Metastases following adequate treatment of stage I seminoma of the testicle are rare, and they usually appear within the first 24-30 months following diagnosis. The lung is the commonest site, frequently bilateral, rounded, well defined opacities growing rapidly if untreated. We report a case of solitary lung metastasis with unusual appearance and behaviour. No similar case has been traced in the literature.

irregular opacity with multiple areas of translucency within it and a central more solid lesion, with the remainder of both lung fields clear.

CASE HISTORY

A 41 -year-old male presented with a three month history of painless right scrotal heaviness and swelling. On examination he was found to have a painless irregular swollen right testicle 10 cm in diameter. Exploration of the right scrotal contents was carried out through a right inguinal incision, and orchidectomy was performed. Histology revealed seminoma of the classical type with invasion of the tunica vaginalis, rete testis, epididymis as well as vascular invasion. Chest X-ray, bipedal lymphography and IVP were all within normal limits. Accordingly he was staged as stage I seminoma of the testicle, and a post-operative radiotherapy course to the para-aortic and right pelvic nodes was given using a 6 MeV linear accelerator and 3484 rad midplane dose in 22 fractions over four-and-a-half weeks, which was well tolerated. He was well for the following 40 months, and on a routine check-up a small confluent left upper zone lung shadow was found. This suggested an inflammatory rather than metastatic lesion, possibly tuberculosis or aspergillosis. At this time the patient was in excellent health with no evidence of recurrence, and it was decided to watch this carefully. In the following 14 months this shadow increased only very slightly in size, and radiologically still appeared very unlike metastasis (Fig. 1). It was decided to investigate this further. Total body 67 Gallium scan showed no evidence of metastasis. Whole lung tomography (Fig. 2) showed an

FIG. 1. Chest X-ray showing left upper zone irregular lung lesion suggesting inflammatory rather than metastasis from seminoma of the testicle.

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A foreign body granuloma simulating a pericardial cyst: an unusual case report.

1977, British Journal of Radiology, 50, 522-523 Case reports and decreased echo amplitude. Investigative staging procedures are important in the manag...
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