Cases and figures Gross anatomy The trachea divides at the carina forming the left and right main stem bronchi which enter the lung substance to divide further. This initial division is into secondary or lobar bronchi , but subsequent divisions give rise to smaller and smaller bronchi and bronchioles until the smallest bronchioles connect to the innumerable alveoli. Each segment has its own pulmonary arterial branch and thus, the bronchopulmonary segment is a portion of lung supplied by its own bronchus and artery. Each segment is functionally and anatomically discrete allowing a single segment to be surgically resected without affecting its neighboring segments. There is some form of segmental symmetry between the right and left lungs, even though the left lung is smaller and only contains two lobes.
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Tel: E-mail: moc. This article has been cited by other articles in PMC. Abstract Objective: Intracranial calcifications underlie certain brain diseases which may be de novo or systemic.
But calclfications un-connected to pathologies are classified physiological. Aim: To evaluate physiological intracranial calcifications in Douala with establishment of earliest age range of detection. Axial, reconstructed and bone window images as well Hounsfield unit measurements were used for final evaluations. Results were analysed with SSPS 3.
Results: patients with 75 males and 57 females were studied and separate calcifications were identified due to co-existent calcifications. The highest calcification was in choroid plexi, constituiting This was followed by pineal gland. Both were commonly co-existent with advancing age. These calcifications were first seen at years. No type of physiological intracranial calcification was seen below age The least calcification of 0.
Conclusion: No intra-cranial physiological calcifications started earlier than 9years in Douala, a city in Cameroon, Central Africa. Introduction Intracranial physiological calcifications are unaccompanied by any evidence of disease and have no demonstrable pathological cause Daghighi et al, , pp They are due to calcium and sometimes iron depositions in the blood vessels of the different structures of the brain Daghighi et al, , pp Computed tomography is a veritable imaging modality for best identification and characterizations of any intracranial calcifications Sarmiento de La Iglesia et al, , pp, Rozylo-Kalinowaska et al, , pp It is also the most sensitive means of detections of these calcifications Daghighi et al, , pp It is superior to conventional radiography in this respect as the specific regional localisation of the calcification can be ascribed.
Besides, most calcifications are not visualized on plain radiographs especially if the CT attenuation values are less than Hounsfield units HU Patel, , pp CT is superior to MRI in the detection of calcifications as. The most frequent appearance of intracranial calcifications on T1W sequence is an area isointense with the cerebral cortex while most frequent appearance on T2W sequence is focus of hypointensit Sarmiento de La Iglesia et al, , pp Depositions of calcium salts in intracranial structures forms calcifications Rozylo-Kalinowaska, et al.
Physiological intracranial calcifications are seen in sites like pineal gland, choroid plexus, basal ganglia, lens, cerebellum, ligaments, dura, vessels, arachnoid granulations and habenula. Daghighi et al. Physiological intracranial calcifications are asymptomatic and detected by neuro-imaging Basak, , pp They may have no clinical importance but may be critical findings in diagnosing underlying pathology The Intracranial calcifications, The Free-online Librarary ,.
Most importantly, these statistics can be used in comparing physiological and pathological intracranical calcifications Daghighi et al, , pp To the best of our knowledge, the publications on this topic is scant in this African region, encouraging us in pursuit of this study.
To evaluate the pattern of physiological intracranial calcifications in Douala and observation of earliest age range of each calcification 2. This was done using Schumadzu CT scan machine with continuous rotational system. Axial sections were done using slice tissue thickness of 2mm from the base of the skull to the sella turcica, thence 5mm from the sella to the vertex.
Images were reconstructed to achieve sagital and coronal images. Hounsfield unit HU measurement and bone window were employed in some cases of doubt so as to differentiate calcifications from acute haemorrhage. The HU of calcifications is above HU while HU of acute haemorrhage is in the range of HU taking into account the effect of partial volume averaging. The structures evaluated consisted of a the pineal gland, b the choroid plexus, c the habenula, d the basal ganglia, e the tentorium cerebelli, sagittal sinus and falx cerebri, f vessels and g lens and other structures which could be calcified.
Patients consent was obtained. All patients with any pathology linked or associated with intra-cranial calcifications and those with improper data documentation were excluded. Results were analysed using SSPS 3. Results of brain computed tomograms were considered optimal for our study and analysed.
There were 75 males Largest population studied was 38 in year age range with 24 males and 14 females. This age range also had the highest number of intra-cranial calcifications of 58 In this years, 40 This is followed by 26 calcifications 14 in males, 12 in females with ratio of male to female 1.
No calcification was seen below 10 years of age in both sexes. In older age of 70 years and above, females had more calcifications whereas from 69years and below, males had more calcifications.
The highest number of calcifications of 75, constituting Pineal gland calcifications were 61 It was the second highest with 36 cases in males and 25 in females male: female 1. Peak age is also years followed by years. Least calcifications of 1 case were in the dentate nucleus in a female. Anterior falx calcifications 21 is more than posterior falx calcification 3 anterior to posterior Both show male predominance anterior falx male: female ratio 1.
Earliest calcification of anterior falx started at year age range. Highest incidence is also at years, with 6 cases in males and 3 cases in females male to female ratio Posterior falx calcifications started at years.
Discussion Intra-cranial calcifications can be physiological or pathological. When physiological, it is asymptomatic and detected incidentally in neuro-imaging Verulashirili et al, , pp Intracranial calcifications seen on computed tomography CT are the most common finding in the everyday practice of neuroradiology, because noncontrast-enhanced CT of the head is the preferred imaging modality worldwide for the initial evaluation of patients with acute or chronic neurological problems The Intracranial calcifications, The Free-online Librarary.
Possible sites of physiological calcifications are pineal gland, choroid plexi, habenula, dura falx cerebri, tentorium, vault , ligaments petro-clinoid, interclinoid , dura, pacchonian bodies, basal ganglia, cerebellum, pituitary gland, and lens The Intracranial calcifications, The Free-online Librarary, Sutton, , p, Medical definitions-online.
This physiological calcifications is thought to be an adaptive metabolic processes which depend on many factors, among which include the individual constitutional ground and aging Guja et al, , pp In this study, understandably no intracranial calcifications of any type was seen in the young age range of years as in other studies Guja et al, , pp Presence of pineal calcifications in a child less than 6 years suggests neoplasm Dahnert, , p, Medical definition, online.
Males started choroid plexus calcification earlier than females in this study, years and years respectively. Evidence of choroid plexus calcifications has been recorded in 9. The Intracranial calcifications, The Free-online Librarary. Individual calcifications were from patients. This is because a single patient can have multiple calcifications.
Such co-existence was commonly between pineal gland and choroid plexus and between anterior and posterior falx cerebri. Choroid plexus calcification is known to be associated with pineal gland calcification Doyle and Anderson, , pp In this study, the commonest calcifications noted were choroid plexi and pineal glands Both choroid and pineal calcifications in this study peaked at years with male predominance. The physiologic calcifications of the choroid plexus are very common after the age of 40 years The Intracranial calcifications, The Free-online Librarary.
Choroid plexi calcifications are known to occur in all ventricles, most commonly in the glomus within the atrium of lateral ventricles near foramen of Monro. Other sites are tela choroidea of third ventricles, roof of fourth ventricle along foramen of Luschaka Dahnert, , p In this study, all the calcifications were in the atria of lateral ventricles. Physiologic pineal calcification is more common in children than previously reported, mostly because of improving computed tomography technology.
Vigh et al, , pp Predominantly composed of calcium and magnesium salts, corpora arenacea are numerous in old patients. In smaller number they can be present in children as well. Vigh et al, , pp Corpora arenacea occur not only in the actual pineal tissue but also in the leptomeninges, habenular commissure and in the choroid plexus Vigh et al, , pp The size of physiological pineal calcification is usually mm, if greater than 1 cm, raise concerns for underlying tumor, like pinealoma, teratoma, AV malformation Medical definition, online.
Usually, pineal gland calcifications are in the form of cluster of amorphous, irregular densities or it may be solitary Medical definition, online. But the incidence of pineal calcification noted in this study across all ages was The pattern of pineal calcification across ages in this study is that females showed more calcifications in older age group of 70 years and above whereas males had more calcifications below 69 years.
The plausible explanation is the complete removal of the effect of the female sex hormonal control. The incidence of pineal gland and choroid plexus calcifications show male bias in this study as in other studies. The incidence of normal pineal gland and choroid plexus calclfications were higher in males than females by The only dura calcifications in this study were in the falx cerebri.
The anterior to posterior falx calcification ratio is Males show predominance in the above mentioned two dural calcifications. Displacement of falx calcifications has been a good indicator of raised intra-cranial pressure or intracranial mass lesion in adults in earlier days of only conventional radiography.
This is because physiologic calcifications of the dura are very common in older age groups and are usually located in the falx or the tentorium The intracranial calcifications, The Free-onlineLibrary..
Presence of dural calcifications in children should raise the suspicion of underlying pathology, mainly basal-cell nevus syndrome. The intracranial calcifications, The Free-onlineLibrary Brain calcinosis syndrome BCS is usually defined as bilateral calcium accumulation in the brain parenchyma, most often within the basal ganglia. Various terms have been used to describe basal ganglia calcification including calcification s of the basal ganglia, basal ganglia calcification s , Fahr syndrome, intracranial calcification, pallidal calcification, and striopallidodentate calcinosis Basak, , pp More than 50 reported clinical conditions have been associated with BCS, including sporadic entities and the heredofamilial conditions Basak, , pp Basal ganglia are supplied by perforating arteries which are prone to small vessel ischaemia with increasing age Rossi et al, ,
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Radiology Review Manual (Dahnert, Radiology Review Manual)
Find articles by Darshana A. Sanghvi Dahnert Wolgang. E-mail: moc. The manual essentially provides extensive lists of imaging findings that are associated with a specific pathology as well as lists of differential diagnoses for a given imaging finding. A word of caution: the manual is not meant for the novice or for in-depth reading as there are no detailed conceptual discussions. The manual is comprehensive. The organization of the text is similar to that of prior editions.
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Tel: E-mail: moc. This article has been cited by other articles in PMC. Abstract Objective: Intracranial calcifications underlie certain brain diseases which may be de novo or systemic. But calclfications un-connected to pathologies are classified physiological. Aim: To evaluate physiological intracranial calcifications in Douala with establishment of earliest age range of detection. Axial, reconstructed and bone window images as well Hounsfield unit measurements were used for final evaluations. Results were analysed with SSPS 3.