Computed
Tomography
of Localized as Tumor
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WILLIAM
Computed from other
tomography soft tissues.
pose deposits
N. COHEN,’
presenting
as tumors
Computed tomography (CT) providing digital information tion coefficients of tissues format [1, 2]. For example, study (scan time 2 mm 43 adipose
tissues
+30
to +80,
Therefore,
be
distinguished
to
more
in which
and
soft
predominately
cellular
tissue
[3,
4].
Case
was
discharged
with
planned
follow-up.
Her
symptoms
spontaneously
papillary
as
adenocarcinoma
ileocecal
of the
ileocecal
valve
which
was
mis-
valve
may.
on
occasion,
necessitate
extirpation
of
the
ileocecal region or hemicolectomy [5-7]. The administration of a water enema has been proposed to diagnose colonic lipomas radiographically [8]. The lower density of the fat would then become apparent when contrasted with the water. Although this should apply to lipolyperplasia as well, the technique is difficult to apply since water is not visible during fluoroscopy. and proper filling of the lumen cannot be ascertamed. This is particularly true when the area of interest is located in the proximal colon.
This
Reports
1
A 65-year-old female was obese and diabetic with vascular disease. She had a 3 week history of mild upper abdominal fullness and cramping. Because of her obesity she was difficult to examine, but a poorly defined right upper quadrant fullness was suggested. The only positive finding on radiographic examination
was an enlarged
ileocecal
valve detected
on the barium
Case 2 A 53-year-old moderately obese female was seen in the emergency room because of lower abdominal pain and fever, which was assessed as probable diverticulitis. A course of antibiotics was administered and the symptoms subsided. A thorough radio-
enema
graphic
examination (fig. 1A) CT examination was proposed for further characterization as well as to image the area in question at the physical examination (the right upper quadrant). After standard cleansing for bowel colon examination, the patient
reported
scheduled intramuscularly temporarily her ability solution of concentration ficiently,
to
the
fluoroscopic
area
time
for CT. Glucagon (2 mg) 5 mm before fluoroscopy. arrest peristaltic activity during to retain the contrast medium iodinated water-soluble contrast of 3% iodine was used. This
visible
under
fluoroscopy
to assure
30
mm
before
the
was administered This was done to CT and to facilitate during scanning. A medium diluted to a was faintly, but sufthat
the
cecum
Received December 22. All authors: Department J Roentgenol
1976; accepted of Radiology.
128:1007-1011,
June
after State
was
1977
revision March 1. 1977. University of New York
evaluation
was
obtained
including
intravenous
urog-
raphy. oral cholecystography, upper gastrointestinal examination. and barium enema examination. The positive findings were diverticular disease of the sigmoid colon and an apparent mass in the left lower quadrant which displaced the bowel. Although the mass could not be palpated, the patient was referred for CT examination to determine if this finding could be further elucidated. Prior to CT, dilute (2.5% iodine) water-soluble contrast material was administered orally. The scan sections of the lower abdomen demonstrated only a coalescence of mesenteric fat with an absorption value of - 1 1 5 (fig. 2). The ingested contrast medium
evenly filled. Flow was terminated prior to ileal reflux. The ileocecal region was then localized precisely and the overlying skin marked. The patient was immediately transferred to the CT unit and scanning was begun over this point. After two scan sequences (about 51/2 mm), the area was fully imaged and the patient could have evacuated her colon and returned for additional sections. However, she remained comfortable, so scanning was continued through the upper abdomen to encompass the right upper quadrant. There was copious mesenteric fat throughout without evidence of abnormal masses. A CT image of the enlarged ileocecal valve is illustrated in figure lB. The absorption value of -87 clearly indicated its
Am
J. BRYAN
takenly followed for 6 months as lipohyperplasia. No treatment is required for lipohyperplasia in an asymptomatic patient [6]. However, bleeding from mucosal ulceration or obstruction of the
information, obtained in a noninvasive manner, can justify a decision to withhold surgical intervention when a mass of fat density is found, particularly in patients who are at higher risk because of medical problems and obesity. Case
PATRICK
resolved. Comment. Prior to the advent of CT scanning. histologic confirmation of ileocecal valve masses was usually necessary. Elliot et al. [5] reported a case of an infiltrating, mucin-secreting
of fat can
neoplasms
AND
patient
have
1 20,
-
masses
Presenting
fatty composition and resulted in a diagnosis of lipohyperplasia (or lipomatosis). Since other conditions such as carcinoma, lymphoma, carcinoid, and Ieiomyoma could be excluded, the
has the unique advantage of corresponding to the absorpdisplayed in a cross-sectional the Delta scanner used in this sec) records water density as
as -40
from
fat adi-
can be discriminated presented
Deposits
Masses
E. SEIDELMANN,
can reliably differentiate As a result of this property.
from neoplasms. Five examples are surgery was obviated by CT findings.
zero,
FRANK
Adipose
opacified
conclusively
and
excluded
identified
the
a solid
neoplasm
bowel
loops
in the
area.
CT
or abscess.
Case 3 A 46-year-old obese female had an 8 year history of periodic lower urinary tract infections. Intravenous urography was performed in 1 968 and interpreted as negative. She also had difficulty
controlling
her
weight
and
past year. When the latest episode summer of 1976. another intravenous Although the urinary tract remained examination,
Upstate
1007
Medical
the
Center,
axis
750
of
East
the
Adams
had
gained
9
of cystitis urogram intrinsically
right
Street,
kidney
kg
during
the
occurred in the was performed. negative on this had
Syracuse.
changed
New
York
with
13210.
COHEN
Downloaded from www.ajronline.org by 104.235.185.38 on 10/19/15 from IP address 104.235.185.38. Copyright ARRS. For personal use only; all rights reserved
1008
Fig
El
AL.
1 -Case
1 A, Focal spot film from barium enema examination showing considerable enlargement of area of ileocecal valve B. CT scan at level valve showing enlarged valve surrounded by contrast medium in lumen (arrows) Absorption value of -- 87 is well within range of fat visual of this density can be made with subcutaneous and mesenteric fat in area and contrasted to muscle density adjacent to ilium
of ileocecal comparison
definite
lateral
of the
deviation
lower
pole
(fig.
3A).
The
patient
was then referred for CT examination to determine if a neoplastic mass were responsible for the displacement of the kidney. CT
(fig.
tissue,
3B)
with
pole
of the
her
increasing
further
demonstrated
a value
right
a localized
deposition
of
-
obesity.
diagnostic
The
studies
or
patient
is
surgical
being
value
possibly
in
followed
without
What
is the
their
they
A 38-year-old white female had a routine chest radiograph on a mass was found in the right cardiophrenic angle. (fig. 4A). Although this is a common site for a pericardial fat pad, the mass in this case was well circumscribed, suggesting the possibility of a penicardial cyst, foramen of Morgagni hernia, or soft which
was
tumor. entirely
confirming Case
CT
the
of
white
male
with
4B)
showed
an absorption
pericardial
fat
that
the
value
of
lesion
1 20.
-
pad.
right
Linear
could
for
diverticular
paraspinal
mass
tomography not
showed
disease
determine
the mass
was
the
differential
includes
1975.
consistency
of
to be of fat density.
myeloma. tuberculosis,
diagnosis
lymphoma.
dorsolumbar
vertebral the
with
of
a paraspinal
metastatic
tumor,
(ipoma.
hematoma,
and
diagphragmatic
per
examination
in the
region.
bodies
mass.
CT
but
(fig.
SB)
an absorption mass
hernia.
in this
value
In
view
region
month
most
lipoma
(or
was
made.
often
primary
with
fatty
lesions
being
malignant
encountered
in
retropenitoneum,
where
malignant
However,
tumor
[9]
liposancomas
considerable
toward same
922
are
variation
is quite
a
in clinical
described
only
here
more
cases,
negative from
Furthermore,
one
were
a
areas many
Therefore,
was
encountered higher
of
and
in a 4 statistical
values
fat
and
benign
were
close
to
fat
in the
well
differentiated
may
be difficult lipomas even
to diswhen
the
of
28 than
in 1974
absorption
range
a Mayo
liposarcoma
much
contain mature fat and from poorly circumscribed surgically.
In
period, less
reported
the
known
low.
a 36 year diagnosed
cancers
representing
obtained patient.
disease
institution
the
In all five the
readings
this
At our
period,
frequency.
approached
absorp-
are
common
of
The cases
hematopoesis. the
a
considered
[1 1 1 encompassing liposancomas were among
of
tumor,
of these
on in the
group
year.
sarcomas tinguish
neurogenic
extramedullary
most
incidence
On
-108. The
types. The
(fig.
intact
of
omentum)
behavior and histology. Enzinger and Winslow [101 studied 103 cases and found the best prognosis (uncornected 5 year survival rate, 85%) in the well differentiated
diagnosed
noticed
the
heterogeneous
examination
this
diagnosis
are
They
tissues
lymphomas.
enema
demonstrated
soft
are
a barium 5A).
the
containing
of any
inception.
excluding
one had
fat,
Liposarcomas
Clinic report retropenitoneal
5
performed
of
(fig.
of fat,
diagnosis
A 58-year-old a
examination
composed
of
hernia
probability
a liposarcoma? from
intervention.
4
tissue
range
Discussion
superficial Case
the
a diaphragmatic
adipose
98. medial to the laterally deviated lower kidney. This was probably a manifestation of of
tion
probability
lipo-
of
lipo-
Downloaded from www.ajronline.org by 104.235.185.38 on 10/19/15 from IP address 104.235.185.38. Copyright ARRS. For personal use only; all rights reserved
CT OF ADIPOSE
Fig.
2. CT scan at level of suspected
2.-Case
showing that loops opacified this
region in question by orally ingested
lower
is composed of contrast medium
abdominal
fat (arrows). are displaced
1009
MASSES
mass Bowel from
region.
sarcoma is low and, if present, would be a well differentiated and minimally aggressive form. Follow-up observation for excessive growth nate could then be justified as a lesser risk than surgical intervention, particularly in patients
with
other
medical
problems.
Very preliminary experience tends to support the supposition that liposarcomas aggressive enough or large enough to produce symptoms and require removal may have higher absorption values than benign fat. In a patient with recurrence from a proved lesion who was examined by CT at our obtained.
two
institution,
Stanley
examples.
experience
will
An additional genic tumors. which in the to
contained range of
an absorption
and
Sagel
Eventually,
cells.
duced
interspersed 25 to 4O.
negative being
a larger
of -57
higher
and
consideration may Recently we examined
Presumably the
currently
value
related
was
values
more
in
conclusive
be available.
be a neunofibroma
fat
[12]
zones with The excised
containing myelin values.
relate to some a paravertebral absorption specimen
myxoid or
This
other and
material lipid similar
neunomass values proved but
elements lesions
no proare
studied. REFERENCES
1 . New PFJ, Scott WA, Schnur Computerized axial tomography Radiology
110:109-123,
JA,
Davis KR, Taveras JM: with the EMI scanner.
1974
2. Alfidi RJ, Haaga J, Meaney TF, Maclntyre WJ, Gonzalez L, Tarar A, Zelch MG, BoIler M, Cooks S. Jelden G: Computed tomography of the thorax and abdomen: a preliminary report. Radiology 117:257-264, 1975 3. Stanley AJ, Sagel 55, Levitt AG: Computed tomography of the body: early trends in application and accuracy of the method. Am J Roentgenol 1 27 :53-67, 1976 4. Carter BL, Kahn PC, Wolpert SM, Hammerschlag SB,
Fig. 3.-Case 3. A. Normal intravenous urogram (top) obtained in 1968. Intravenous urogram 8 years later (bottom) shows lateral displacement of lower pole of right kidney. B. CT scan at level of lower poles of kidney showing kidney and superior
excessive portion
fat interposed of psoas muscle
between (arrows)
lower (cf.
pole of left side).
right
Downloaded from www.ajronline.org by 104.235.185.38 on 10/19/15 from IP address 104.235.185.38. Copyright ARRS. For personal use only; all rights reserved
1010
Fig. 4.-Case its fatty composition.
COHEN
4
A.
Posteroanterior
.J. 5.-Case 5. adiograph mass showing well encapsulated
fn
mass
chest
irium (arrow)
radiograph
showing
discrete
enema examinationshowing of fat density. Aorta (a)
is left
El
right
AL.
cardiophrenic
angle
right paraspinal mass in of mass, and gas-containing
mass.
low
B. CT scan through
dorsal esophagus
mass
(arrows)
showing
region (arrows). B. CT scan at level is anterior to both structures.
of
CT OF ADIPOSE
Schwartz
Downloaded from www.ajronline.org by 104.235.185.38 on 10/19/15 from IP address 104.235.185.38. Copyright ARRS. For personal use only; all rights reserved
parison
AM, of
Scott
computed Radiology
AM:
Unusual
pelvic
tomographic 1 21 :383-390,
masses:
scanning 1976
a cam-
and
ultra-
sonography. 5. Elliott GB, Sandy JTM, Elliott KA, Sherkat A: Lipohyperplasia of the ileocecal valve. Can J Surg 1 1 :179-187, 1968 6. Axelsson C, Andersen A: Lipohyperplasia of the ileocecal region. Acta Chir Scand 140:649-654, 1974 7. Boquist
L. Bergdahl L, Andersson valve. Cancer 29:136-140, 8. Margulis AR, Jovanovich A: The subcutaneous lipoma of the colon.
ileocecal
A:
Lipomatosis
of the
1972 roentgen diagnosis Am J Roentgenol
of
84:
1011
MASSES
1114-1120,
9. Ackerman 10. Enzinger
cases. 1 1 Deweerd .
1960
LV, delRegato FM, Winslow Virchows Arch
JH,
JA:
Cancer.
St. Louis, Mosby,
DJ: Liposarcoma: a study [Pathol Anat] 335:367-388,
Dockerty
MB:
Lipomatous
1970 of
103 1962
retroperitoneal
tumors. Am J Surg 84:397-407, 1952 1 2. Stanley RJ. Sagel SS: Whole body computed tomography: anatomical correlations. Course no. 403 presented at the annual meeting of the Radiological Society of North America, Chicago.
November
1976
Tomography
of Localized as Tumor
Downloaded from www.ajronline.org by 104.235.185.38 on 10/19/15 from IP address 104.235.185.38. Copyright ARRS. For personal use only; all rights reserved
WILLIAM
Computed from other
tomography soft tissues.
pose deposits
N. COHEN,’
presenting
as tumors
Computed tomography (CT) providing digital information tion coefficients of tissues format [1, 2]. For example, study (scan time 2 mm 43 adipose
tissues
+30
to +80,
Therefore,
be
distinguished
to
more
in which
and
soft
predominately
cellular
tissue
[3,
4].
Case
was
discharged
with
planned
follow-up.
Her
symptoms
spontaneously
papillary
as
adenocarcinoma
ileocecal
of the
ileocecal
valve
which
was
mis-
valve
may.
on
occasion,
necessitate
extirpation
of
the
ileocecal region or hemicolectomy [5-7]. The administration of a water enema has been proposed to diagnose colonic lipomas radiographically [8]. The lower density of the fat would then become apparent when contrasted with the water. Although this should apply to lipolyperplasia as well, the technique is difficult to apply since water is not visible during fluoroscopy. and proper filling of the lumen cannot be ascertamed. This is particularly true when the area of interest is located in the proximal colon.
This
Reports
1
A 65-year-old female was obese and diabetic with vascular disease. She had a 3 week history of mild upper abdominal fullness and cramping. Because of her obesity she was difficult to examine, but a poorly defined right upper quadrant fullness was suggested. The only positive finding on radiographic examination
was an enlarged
ileocecal
valve detected
on the barium
Case 2 A 53-year-old moderately obese female was seen in the emergency room because of lower abdominal pain and fever, which was assessed as probable diverticulitis. A course of antibiotics was administered and the symptoms subsided. A thorough radio-
enema
graphic
examination (fig. 1A) CT examination was proposed for further characterization as well as to image the area in question at the physical examination (the right upper quadrant). After standard cleansing for bowel colon examination, the patient
reported
scheduled intramuscularly temporarily her ability solution of concentration ficiently,
to
the
fluoroscopic
area
time
for CT. Glucagon (2 mg) 5 mm before fluoroscopy. arrest peristaltic activity during to retain the contrast medium iodinated water-soluble contrast of 3% iodine was used. This
visible
under
fluoroscopy
to assure
30
mm
before
the
was administered This was done to CT and to facilitate during scanning. A medium diluted to a was faintly, but sufthat
the
cecum
Received December 22. All authors: Department J Roentgenol
1976; accepted of Radiology.
128:1007-1011,
June
after State
was
1977
revision March 1. 1977. University of New York
evaluation
was
obtained
including
intravenous
urog-
raphy. oral cholecystography, upper gastrointestinal examination. and barium enema examination. The positive findings were diverticular disease of the sigmoid colon and an apparent mass in the left lower quadrant which displaced the bowel. Although the mass could not be palpated, the patient was referred for CT examination to determine if this finding could be further elucidated. Prior to CT, dilute (2.5% iodine) water-soluble contrast material was administered orally. The scan sections of the lower abdomen demonstrated only a coalescence of mesenteric fat with an absorption value of - 1 1 5 (fig. 2). The ingested contrast medium
evenly filled. Flow was terminated prior to ileal reflux. The ileocecal region was then localized precisely and the overlying skin marked. The patient was immediately transferred to the CT unit and scanning was begun over this point. After two scan sequences (about 51/2 mm), the area was fully imaged and the patient could have evacuated her colon and returned for additional sections. However, she remained comfortable, so scanning was continued through the upper abdomen to encompass the right upper quadrant. There was copious mesenteric fat throughout without evidence of abnormal masses. A CT image of the enlarged ileocecal valve is illustrated in figure lB. The absorption value of -87 clearly indicated its
Am
J. BRYAN
takenly followed for 6 months as lipohyperplasia. No treatment is required for lipohyperplasia in an asymptomatic patient [6]. However, bleeding from mucosal ulceration or obstruction of the
information, obtained in a noninvasive manner, can justify a decision to withhold surgical intervention when a mass of fat density is found, particularly in patients who are at higher risk because of medical problems and obesity. Case
PATRICK
resolved. Comment. Prior to the advent of CT scanning. histologic confirmation of ileocecal valve masses was usually necessary. Elliot et al. [5] reported a case of an infiltrating, mucin-secreting
of fat can
neoplasms
AND
patient
have
1 20,
-
masses
Presenting
fatty composition and resulted in a diagnosis of lipohyperplasia (or lipomatosis). Since other conditions such as carcinoma, lymphoma, carcinoid, and Ieiomyoma could be excluded, the
has the unique advantage of corresponding to the absorpdisplayed in a cross-sectional the Delta scanner used in this sec) records water density as
as -40
from
fat adi-
can be discriminated presented
Deposits
Masses
E. SEIDELMANN,
can reliably differentiate As a result of this property.
from neoplasms. Five examples are surgery was obviated by CT findings.
zero,
FRANK
Adipose
opacified
conclusively
and
excluded
identified
the
a solid
neoplasm
bowel
loops
in the
area.
CT
or abscess.
Case 3 A 46-year-old obese female had an 8 year history of periodic lower urinary tract infections. Intravenous urography was performed in 1 968 and interpreted as negative. She also had difficulty
controlling
her
weight
and
past year. When the latest episode summer of 1976. another intravenous Although the urinary tract remained examination,
Upstate
1007
Medical
the
Center,
axis
750
of
East
the
Adams
had
gained
9
of cystitis urogram intrinsically
right
Street,
kidney
kg
during
the
occurred in the was performed. negative on this had
Syracuse.
changed
New
York
with
13210.
COHEN
Downloaded from www.ajronline.org by 104.235.185.38 on 10/19/15 from IP address 104.235.185.38. Copyright ARRS. For personal use only; all rights reserved
1008
Fig
El
AL.
1 -Case
1 A, Focal spot film from barium enema examination showing considerable enlargement of area of ileocecal valve B. CT scan at level valve showing enlarged valve surrounded by contrast medium in lumen (arrows) Absorption value of -- 87 is well within range of fat visual of this density can be made with subcutaneous and mesenteric fat in area and contrasted to muscle density adjacent to ilium
of ileocecal comparison
definite
lateral
of the
deviation
lower
pole
(fig.
3A).
The
patient
was then referred for CT examination to determine if a neoplastic mass were responsible for the displacement of the kidney. CT
(fig.
tissue,
3B)
with
pole
of the
her
increasing
further
demonstrated
a value
right
a localized
deposition
of
-
obesity.
diagnostic
The
studies
or
patient
is
surgical
being
value
possibly
in
followed
without
What
is the
their
they
A 38-year-old white female had a routine chest radiograph on a mass was found in the right cardiophrenic angle. (fig. 4A). Although this is a common site for a pericardial fat pad, the mass in this case was well circumscribed, suggesting the possibility of a penicardial cyst, foramen of Morgagni hernia, or soft which
was
tumor. entirely
confirming Case
CT
the
of
white
male
with
4B)
showed
an absorption
pericardial
fat
that
the
value
of
lesion
1 20.
-
pad.
right
Linear
could
for
diverticular
paraspinal
mass
tomography not
showed
disease
determine
the mass
was
the
differential
includes
1975.
consistency
of
to be of fat density.
myeloma. tuberculosis,
diagnosis
lymphoma.
dorsolumbar
vertebral the
with
of
a paraspinal
metastatic
tumor,
(ipoma.
hematoma,
and
diagphragmatic
per
examination
in the
region.
bodies
mass.
CT
but
(fig.
SB)
an absorption mass
hernia.
in this
value
In
view
region
month
most
lipoma
(or
was
made.
often
primary
with
fatty
lesions
being
malignant
encountered
in
retropenitoneum,
where
malignant
However,
tumor
[9]
liposancomas
considerable
toward same
922
are
variation
is quite
a
in clinical
described
only
here
more
cases,
negative from
Furthermore,
one
were
a
areas many
Therefore,
was
encountered higher
of
and
in a 4 statistical
values
fat
and
benign
were
close
to
fat
in the
well
differentiated
may
be difficult lipomas even
to diswhen
the
of
28 than
in 1974
absorption
range
a Mayo
liposarcoma
much
contain mature fat and from poorly circumscribed surgically.
In
period, less
reported
the
known
low.
a 36 year diagnosed
cancers
representing
obtained patient.
disease
institution
the
In all five the
readings
this
At our
period,
frequency.
approached
absorp-
are
common
of
The cases
hematopoesis. the
a
considered
[1 1 1 encompassing liposancomas were among
of
tumor,
of these
on in the
group
year.
sarcomas tinguish
neurogenic
extramedullary
most
incidence
On
-108. The
types. The
(fig.
intact
of
omentum)
behavior and histology. Enzinger and Winslow [101 studied 103 cases and found the best prognosis (uncornected 5 year survival rate, 85%) in the well differentiated
diagnosed
noticed
the
heterogeneous
examination
this
diagnosis
are
They
tissues
lymphomas.
enema
demonstrated
soft
are
a barium 5A).
the
containing
of any
inception.
excluding
one had
fat,
Liposarcomas
Clinic report retropenitoneal
5
performed
of
(fig.
of fat,
diagnosis
A 58-year-old a
examination
composed
of
hernia
probability
a liposarcoma? from
intervention.
4
tissue
range
Discussion
superficial Case
the
a diaphragmatic
adipose
98. medial to the laterally deviated lower kidney. This was probably a manifestation of of
tion
probability
lipo-
of
lipo-
Downloaded from www.ajronline.org by 104.235.185.38 on 10/19/15 from IP address 104.235.185.38. Copyright ARRS. For personal use only; all rights reserved
CT OF ADIPOSE
Fig.
2. CT scan at level of suspected
2.-Case
showing that loops opacified this
region in question by orally ingested
lower
is composed of contrast medium
abdominal
fat (arrows). are displaced
1009
MASSES
mass Bowel from
region.
sarcoma is low and, if present, would be a well differentiated and minimally aggressive form. Follow-up observation for excessive growth nate could then be justified as a lesser risk than surgical intervention, particularly in patients
with
other
medical
problems.
Very preliminary experience tends to support the supposition that liposarcomas aggressive enough or large enough to produce symptoms and require removal may have higher absorption values than benign fat. In a patient with recurrence from a proved lesion who was examined by CT at our obtained.
two
institution,
Stanley
examples.
experience
will
An additional genic tumors. which in the to
contained range of
an absorption
and
Sagel
Eventually,
cells.
duced
interspersed 25 to 4O.
negative being
a larger
of -57
higher
and
consideration may Recently we examined
Presumably the
currently
value
related
was
values
more
in
conclusive
be available.
be a neunofibroma
fat
[12]
zones with The excised
containing myelin values.
relate to some a paravertebral absorption specimen
myxoid or
This
other and
material lipid similar
neunomass values proved but
elements lesions
no proare
studied. REFERENCES
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Fig. 3.-Case 3. A. Normal intravenous urogram (top) obtained in 1968. Intravenous urogram 8 years later (bottom) shows lateral displacement of lower pole of right kidney. B. CT scan at level of lower poles of kidney showing kidney and superior
excessive portion
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between (arrows)
lower (cf.
pole of left side).
right
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1010
Fig. 4.-Case its fatty composition.
COHEN
4
A.
Posteroanterior
.J. 5.-Case 5. adiograph mass showing well encapsulated
fn
mass
chest
irium (arrow)
radiograph
showing
discrete
enema examinationshowing of fat density. Aorta (a)
is left
El
right
AL.
cardiophrenic
angle
right paraspinal mass in of mass, and gas-containing
mass.
low
B. CT scan through
dorsal esophagus
mass
(arrows)
showing
region (arrows). B. CT scan at level is anterior to both structures.
of
CT OF ADIPOSE
Schwartz
Downloaded from www.ajronline.org by 104.235.185.38 on 10/19/15 from IP address 104.235.185.38. Copyright ARRS. For personal use only; all rights reserved
parison
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