Humeral chondral defect and labral tear associated with paraglenoid labral cyst: a case report

Objective: To report an unusual combination of paraglenoid labral cyst and labral tear with chondral defect of the humeral head

Clinical Presentation and Intervention: A 34-year-old man presented with right shoulder pain. Conventional MR imaging showed paraglenoid labral cyst. MR arthrography revealed a humeral chondral defect and labral tear associated with paraglenoid labral cyst, and a defect of the posterior inferior labrum extending to the superior labrum and humeral chondral defect. The patient underwent arthroscopic surgery

Conclusion: This case showed the importance of MR arthrography in a case that involved an unusual combination of paraglenoid labral cyst and labral tear with chondral defect

Anatomy, Variants, and Pathologies of the Superior Glenohumeral Ligament: Magnetic Resonance Imaging with Three-Dimensional Volumetric Interpolated Breath-Hold Examination Sequence and Conventional Magnetic Resonance Arthrography

The purpose of this review was to demonstrate magnetic resonance (MR) arthrography findings of anatomy, variants, and pathologic conditions of the superior glenohumeral ligament (SGHL). This review also demonstrates the applicability of a new MR arthrography sequence in the anterosuperior portion of the glenohumeral joint. The SGHL is a very important anatomical structure in the rotator interval that is responsible for stabilizing the long head of the biceps tendon. Therefore, a torn SGHL can result in pain and instability. Observation of the SGHL is difficult when using conventional MR imaging, because the ligament may be poorly visualized. Shoulder MR arthrography is the most accurately established imaging technique for identifying pathologies of the SGHL and associated structures. The use of three dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences produces thinner image slices and enables a higher in-plane resolution than conventional MR arthrography sequences. Therefore, shoulder MR arthrography using 3D VIBE sequences may contribute to evaluating of the smaller intraarticular structures such as the SGHL.

Intraoperative flexible choledochoscopy: outcomes of 216 cases over 23 years

Intraoperative flexible choledochoscopy can help in the diagnosis and treatment of various biliary tract diseases by providing direct visualization of the bile ducts. This study discusses the role of choledochoscopy in diagnosing and treating most diseases of the hepato-biliary-pancreatic system particularly in patients in whom laparotomy with or without choledochotomy is planned or performed and in whom ERCP, MRCP, or other advanced techniques are not applied, deficient or unsuccessful. Choledochoscopy was performed via a vertical choledochotomy using a flexible choledochoscope during the surgical procedures on the patients, who were operated on because of hepato-biliary-pancreatic system diseases, and the choledochotomy line was closed by primary closure, t-tube application or choledochoduodenal anastomosis. The clinical records of 216 patients over the course of 23 years were retrospectively evaluated. The age range was 19-92 years [mean: 63.1 years], and 139 patients [64.4%] were female. The most common indication included the presence of suspected choledochal stones in 77 patients [35.6%]. Additional diagnostic or therapeutic endoscopic procedures [stone or hydatid vesicula removal, biopsy or cytology, balloon dilation, and stent removal or placement] were performed on 106 patients [49.1%]. The average choledochoscopy duration was 8.5 minutes [range: 5-25 minutes]. Choledochoscopy confirmed the anticipated diagnosis in 98 patients [45.4%], whereas it provided additional unanticipated diagnostic information in 68 [31.5%] patients; the results were normal in 50 patients [23.1%]. In the present series, complications occurred in four patients [1.9%], whereas no choledochoscopy-related mortality was observed. Intraoperative flexible choledochoscopy is a safe and useful procedure that can aid in the diagnosis and treatment of various biliary tract diseases

Multiple renal arteries: variations demonstrated by multidetector computed tomography angiography

To present a case of a rare variation of the renal artery and multiple [7] renal arteries by multidetector computed tomography [MDCT] angiography. A 36-year-old male patient was admitted to our hospital as a potential living donor for renal transplantation. An MDCT angiography was performed using a 16-detector row CT scanner to obtain a detailed image of vascular structures and associated pathologies. The MDCT clearly revealed the presence of 3 right and 2 left renal arteries arising from the abdominal aorta. Additionally, the accessory renal artery arose from the inferior mesenteric artery on the left side and from the common iliac artery on the right side. This case highlights the importance of awareness of renal artery variations if surgical procedures are indicated in this region

Absence of a Sphenoid Wing in Neurofibromatosis Type 1 Disease: Imaging with Multidetector Computed Tomography

Neurofibromatosis type 1 disease is characterized by pigmented cutaneous lesions and generalized tumors of a neural crest origin and it may affect all the systems of the human body. Sphenoid dysplasia is one of the characteristics of this syndrome and it occurs in 5-10% of the cases; further, abnormalities of the sphenoid wings are often considered pathognomonic. However, complete agenesis of a sphenoid wing is very rare. We report here on an unusual case of neurofibromatosis type 1 disease with the associated absence of a sphenoid wing that was diagnosed by using multidetector computed tomography.