Inflammatory myofibroblastic tumor ofabdomen: computerized tomographic (CT) and pathological findings.

Inflammatory Myofibroblastic Tumor (IMT) is the recent name of Inflammatory pseudotumor which was in intermediate group of fibrous-origin tumor. The authors retrospectively reviewed such cases in Ramathibodi Hospital from January 2001 to December 2005. There were 115 cases of fibrous-origin tumor which was IMT in 17 cases. Nine cases occurred in the abdomen and only 3 of these had complete computerized tomographic (CT) imaging. One was hypodense liver mass with thick rim enhancement. Another one in the liver presented as a liver abscess which appeared as multiloculated hypodense mass with enhanced septum. The third case was a large malignant-looking retroperitoneal mass and having a small accompanying hepatic lesion which rapidly grew in the follow up study at nine months. IMT in the abdomen was scanty. The diagnosis was done with difficulty because of different signs and symptoms such as fever and palpable abdominal mass. The laboratory findings were nonspecific or within normal limits. Tissue biopsy was the way of definite diagnosis. We reported 3 cases of abdominal IMT with variable imaging findings that may lead to inappropriate treatment. Recognization of such findings will help achieve correct diagnosis.

Asymptomatic avascular osteonecrosis of the hip in new patients diagnosed as systemic lupus erythematosus in Ramathibodi Hospital.

OBJECTIVE: To determine asymptomatic avascular osteonecrosis (AVN) of the hip in new patients diagnosed as Systemic Lupus Erythematosus (SLE) in Ramathibodi Hospital. MATERIAL AND METHOD: A prospective descriptive study of new SLE patients with asymptomatic hip at the Rheumatology clinic of Ramathobodi Hospital was conducted from February 2005 to November 2005. The information of steroid and immunosuppressive drug treatment was recorded Plain film (AP and frog leg views) and MR study of both hips were analyzed. RESULTS: Twenty-two hips (II patients) were enrolled in the present study (women 100%; mean age 27.8 years; range 16-50). Four hips (2 patients, 18%) had A VN, without other abnormal imaging findigs of the hips and pelvis. Seventeen hips of nine patients hadjoint effusion; none of them had AVN. No marrow edema, secondary osteoarthritis, collapsed femoral head or pelvic insufficiency fracture in allpatients is detected. In the present study, the 2 AVN patients had longest duration of steroid treatment before MR study (105 & 99 days) and rather high cumulative dose of prednisolone or its equivalent dose (4920 & 4540 mg), compared to non-AVN patients. CONCLUSION: SLE patients without hip pain may have AVN of the hips. Joint effusion and marrow edema do not necessarily associate with early AVN, and the authors found early AVN without joint effusion. Cumulative dose and duration of steroid treatment seem to relate to AVN in the present study. However a larger number of cases, prospective clinical data, and long-term follow up will help better evaluate the prevalence of asymptomatic AVN of the hips, as well as to evaluate the benefit of MRI as a screening tool for patients at risk of AVN.

An intramuscular cysticercosis, a case report with correlation of magnetic resonance imaging and histopathology.

The authors report a case of a solitary intramuscular cysticercosis in a 47-year-old female who presented with a mass in the right elbow for five years. The magnetic resonance imaging (MRI) findings revealed a cystic mass of 1.5 cm. in size located at the periphery of the pronator teres muscle; the T1-weighted MRI showed hypointensity mass with internal content that was more obviously seen on T2-weighted image and T1-weighted with fat suppression after gadolinium administration. The authors could not recognize perilesional edema in the MRI that corresponded with the histological findings of chronic inflammatory process in combination with foreign body giant cell reaction. The scolex could not be seen in the imaging but could be identified in the histopathological sections.

Apical derotation in the treatment of idiopathic scoliosis.

STUDY DESIGN: A prospective study of the pedicular screw plate system in the treatment of idiopathic scoliosis. OBJECTIVES: To study the efficacy of apical derotation of pedicular screw plate system in idiopathic scoliosis correction and evaluate the feasibility of the technique. SUMMARY OF BACKGROUND DATA: In the surgical treatment of idiopathic scoliosis, the standard technique of fixation currently utilized the linkage of the pedicle screws via rods. Alternatively the technique of apical correction of the deformity by sagittally contoured plates found to be a convenient and effective mean of deformity correction and rigid fixation. MATERIAL AND METHOD: Twenty-five patients who were diagnosed as idiopathic scoliosis and underwent posterior spinal fusion and fixation with pedicle screws and plates were prospectively analysed. The parameters were compared between preoperative and postoperative by paired t-test. These parameters included Cobb angles, body height, shoulder height difference, coronal trunk balance, hump difference and vertebral rotation. RESULTS: There was statistically significant difference between the pre-op and post-op parameters studied. CONCLUSION: The instrument can effectively correct the scoliosis of moderately severed deformity in 3 dimensions especially regarding the vertebral derotation and restoration of thoracic kyphosis.

Determination of the thecal sac ending using magnetic resonance imaging: clinical applications in craniospinal irradiation.

PURPOSE: To determine level of the thecal sac ending in unaffected individuals of young age-group and in patients with cerebrospinal fluid (CSF) seeding tumor using Magnetic Resonance Imaging (MRI). MATERIAL AND METHOD: MRI of the lumbosacral spine of 253 cases (age range 1-40 years) had been reviewed. Of these, 20 cases were known having CSF seeding tumors. Two hundred and thirty-three cases of unaffected individuals were used as control group. Sagittal MR images were used to determine the level of thecal sac ending by referencing on the corresponding vertebral body and intervertebral disc. RESULTS: The range of the thecal sac ending level in unaffected population varied from the lower one-third of L5 to the middle one-third of S3. About 97% of cases, the distal end of thecal sac terminated at the S2-3 intervertebral disc space or higher. In patients with CSF seeding tumor, the range of thecal sac ending was from the middle one-third of L5 to the S2-3 intervertebral disc space. There was no statistically significant difference of thecal ending level between unaffected group and patients with CSF seeding tumors (p=0.19). CONCLUSION: Placing inferior border of radiation field at the middle one-third of S3 vertebra would help to cover the entire subarachnoid space in all cases. Without MR machine, this study may be used as a general guideline for placing the inferior border for spinal irradiation.

Bilateral extraordinary huge, multi-compartmental tuberculous abscesses: a case report.

OBJECTIVE: To illustrate computerized tomography (CT) and magnetic resonance imaging (MRI) findings of tuberculous spondylitis with extensive abscess collections. METHOD: A review of one patient with tuberculous spondylitis and extensive paraspinal, subligamentous, retroperitoneal, and subcutaneous abscesses including pertinent history, important physical examination, CT and MR imaging findings was performed. RESULT AND CONCLUSION: This case demonstrates multiple patterns of tuberculous abscess formation secondary to spinal tuberculosis; included are paraspinal, subligamentous, retroperitoneal, and subcutaneous locations. The extension of the abscess should be kept in mind when treating a patient with tuberculous spondylitis. MR imaging is a modality of choice to illustrate full extension of the disease process, which is necessary for therapeutic decision making and planning.

The incidence of deep vein thrombosis and pulmonary embolism after total knee arthroplasty: the screening study by radionuclide venography.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are considered uncommon in Asian populations and thrombo-prophylaxis is rarely indicated. The objective of this study was to investigate the incidence of DVT and PE after total knee replacement in an Asian population. MATERIAL AND METHOD: There were 100 patients who underwent total knee replacement enrolled in this study. No thrombo-prophylaxis was given to these patients. The possible risk factors such as age, sex, body mass index (BMI), operative time and the post-operative blood loss were recorded. RESULTS: The duplex ultrasonography (controlled) showed no evidence of DVT in all cases. There were 67 patients who completed radionuclide venography in this study. The incidence of DVT from positive radionuclide venography was 24% (16/67 patients) and PE was 12% (8/67 patients). All patients with positive imaging studies were asymptomatic. The risk factors were similar in both groups. CONCLUSION: The incidence of DVT and PE in post-operative total knee replacement surgery, although lower than the incidence in Western populations, is higher than previously assumed. The radionuclide venography is less invasive and a useful diagnostic method for both DVT and PE. Because all patients with DVT and PE are asymptomatic, the use of thrombo-prophylaxis should be considered for risk and benefit.