Diffusion thickening

A 54-year-old woman and a 62-year-old man with catheter blockages both developed aseptic peritonitis (166). In both cases clots had earlier been removed by laparoscopy, which also showed diffuse thickening around the tip and in the peritoneal fat, with fluid accumulation or inflammation and whitish urticarialike plaques. The tissue was granulomatous, with histiocytes, fibrosis, and pseudo-amyloid material that could not be labeled by anti-insulin antibodies. The peritoneal fluid contained a lot of fibrin, monocytes, lymphocytes, and macrophages, but no bacteria or cancer cells. 

The level of oxidative protein modifications may indicate oxidative stress in normal and pathological conditions. Increased content of carbonyl groups was found in diffusely thickened intima (neointima) of arterial walls in arteriosclerotic tissues (M19). Comparison of oxidatively modified amino acids content in normal intima and in human carotid plaque samples revealed an increased content of 3-chlorotyrosine, DOPA, o-tyrosine, m-tyrosine, hydroxyleucine, hydroxyva-line, and especially, dityrosine (F17, H13). These plaques are indicative of the role of protein oxidative damage in the formation of atherosclerotic plaques. Postmortem studies revealed that the content of dityrosine is increased in the stage of advanced lesions. However, the o-tyrosine and m-tyrosine are not elevated in plaque proteins (H13, LI 1). The question of 3-nitrotyrosine level in atherosclerotic plaques remains unresolved, the reported data being contradictory (E6, L10, M24). 

Another tissue that may be affected in humans exposed to asbestos in air is the pleura. The most common effect is the formation of thickened fibrous areas called plaques, but diffuse thickening and fibrosis may also occur, as may areas of pleural effusions. An increased incidence of pleural plaques has been noted at relatively low cumulative exposures (approximately 0.12 f-5T/mL). Localized pleural plaques are not thought to be of significant health concern, although diffuse pleural thickening and circumscribed pleural plaques are associated with impairment of respiratory function. This may also be due to subclinical alveolitis or interstitial fibrosis not detected by routine chest radiograms. These plaques are normally very mild, but may be severe in a few cases probably associated with high exposures. 

Miller A, Miller JA. 1993. Diffuse thickening superimposed on circumscribed pleural thickening related to asbestos exposure. Am J Ind Med 23(6) 859-871. 

T221F. This is another gain-of-function SCCMS mutation that has been found in two unrelated families and that causes myasthenic symptoms (102). Ultrastructural studies revealed degenerated junctional folds and diffusely thickened end-plate basal lamina, as in other forms of SCCMS. 

IV. Diagnosis is based on a history of exposure to asbestos (usually at least 15-20 years before onset of symptoms) and clinical presentation of one or more of the syndromes described above. Chest x-ray typically shows small, irregular, round opacities distributed primarily in the lower lung fields. Pleural plaques, diffuse thickening, or calcification may be present. Pulmonary function tests reveal decreased vital capacity and total lung capacity and impairment of carbon monoxide diffusion. 

Fig. 6.2a,b. Ischemic colitis in an 82-year-old patient, a Transverse view of the sigmoid colon shows thickening of the colon, with wall stratification and discrete mural flow detected with color Doppler sonography. The pericolic fat tissue is slightly infiltrated, b A CT scan of the pelvis of the same patient shows diffuse thickening of the sigmoid colon (SC)... 

Fig. 12.1. Ileocecal tuberculosis.Transverse sonogram of the right lower abdomen shows diffuse thickening of the terminal ileum (TI) and cecum (Q...

Fig. 13.1a,b. Sagittal views of the left colon in a severe form of pseudomembranous colitis, a B-mode sonogram shows hyp-oechoic, nodular, and diffuse thickening of the haustral relief of the colonic wall, b Discrete mural flow of the thickened colonic wall is observed in the same patient when colour Doppler evaluation is performed. On both images, there is a mild hyperechogenicity of the pericolic fat tissue... 

Fig. 17.1. a Disruption of the normal layer pattern by diffuse thickening of the layers (arrow) and an increased echogenicity in a patient with low grade gastric MALT-NHL stage 12. b Endoscopic loss of gastric folds and an ulceration was detected (arrow), harbouring the NHL... 

Fig. 24.3. Power Doppler of a diffuse thickened gastric wall shows clear vascular signals (to be avoided during fine needle biopsy)...

Fig. 8.2. Patient with Peyronie s disease presenting with severe penile shortening and erectile dysfunction. No significant penile bending was appreciable. Grey-scale ultrasonography shows diffuse thickening of the entire tunica albuginea (arrowheads)...

Posterior scleritis is a special, locally confined type of idiopathic inflammation of the orbit, which presents clinically with slowly progressive, painful proptosis. Cross-sectional imaging shows diffuse thickening of the sclera and inflammation of adjacent tissue, with marked contrast uptake. As differential diagnoses, nodular scleritis does not show with contrast uptake, while uveal melanoma does take up contrast media, but usually delineates well (Mueller-Forell and Pitz 2004). 

On gross examination the leptomeninges show moderate patchy or diffuse thickening. Pacchionian granulations may be more prominent than usual (Reese... 

One of the first signs of scleroderma is tight, firm skin, and eventually a diffuse thickening and rigidity of the skin and subcutaneous tissue. These changes in the skin are reflected in the name of this diseeise, which means hard skin. Sometimes the disease is called hidebound skin. As the disease progresses, it involves the internal organs, specifically the intestinal tract, the heart, and the kidneys. 

Fig. 24.6. Diffuse nephroblastomatosis. Coronal T2-W MR image showing diffuse enlargement of both kidneys and diffuse thickening of renal cortex (courtesy Dr. A. Smets, AMC, Amsterdam, The Netherlands)...

Fig. 14.58a,b. Spectrum of patellar tendinopathies. Two different patients, a Longitudinal extended field-of-view 12-5 MHz US image reveals a diffusely thickened and heterogeneous hypoechoic patellar tendon (arrows) reflecting diffuse tendinopathy. b Longitudinal extended field-of-view 12-5 MHz US image demonstrates selective thickening (arrows) of the distal third of the patellar tendon as an expression of distal tendinopathy. The proximal portion of the tendon (arrowheads) retains a normal appearance... 

Contrast-enhanced CT sometimes shows an unspecific diffuse thickening of the intestinal wall and mucosal folds early after transplantation presumably due to edema related to organ procurement and interruption of draining lymphatic vessels combined with an unspecific enlargement of the donor s mesenteric lymph nodes (Fig. 7.47b). CT can also detect an unspecific focal wall thickening of the small bowel but cannot delineate the... 

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