Tracheoesophageal Fistula Resulting from Invasive Aspergillosis in Acute Lymphoblastic Leukemia: A Case Report

Tracheoesophageal fistula (TEF) in adult patients is an uncommon complication in leukemia. We present here on a case of TEF in a 46-year-old woman with ALL. The patient was asymptomatic and TEF is resulted from aspergillus bronchitis during the chemotherapy for acute lymphoblastic leukemia (ALL).

Intracapsular and Paraarticular Chondroma of the Knee: Case Report

We report here on a case of intracapsular and paraarticular chondroma of the left knee in a patient with a 6-month history of knee pain and swelling. Magnetic resonance image (MRI) revealed a well-defined solid mass with central hemorrhagic necrosis in the infrapatellar area of the knee.

Aortocaval Fistula Complicating Abdominal Aortic Aneurysm: A Case Report

Aortocaval fistula is a rare complication arising from an abdominal aortic aneurysm. A typical feature observed during the arterial phase of contrast-enhanced CT scanning in such patients is simultaneous enhancement of the dilated inferior vena cava and aorta. Awareness of the specific radiologic features of aortocaval fistula may facilitate diagnosis when the condition is unsuspected clinically. We report a case of aortocaval fistula secondary to abdominal aortic aneurysm, and review the previous literature.

The Relationship between Cerebral Infarction on MR and Angiographic Findings in Moyamoya Disease: Significance of the Posterior Circulation

PURPOSE: To investigate the relationship between changes in the posterior and anterior circulation, as seen at angiography, and the frequency and extent of cerebral infarction revealed by MR imaging in moyamoya disease. MATERIALS AND METHODS: This study involved 34 patients (22 females and 12 males, aged 2-52years) in whom cerebral angiography revealed the presence of moyamoya disease (bilateral: unilateral=24:10; total hemispheres=58) and who also underwent brain MR imaging. To evaluate the angiographic findings, we applied each angiographic staging system to the anterior and posterior circulation. Leptomeningeal collateral circulation from the cortical branches of the posterior cerebral artery (PCA) was also assigned one of four grades. At MR imaging, areas of cerebral cortical or subcortical infarction in the hemisphere were divided into six zones. White matter and basal ganglionic infarction, ventricular dilatation, cortical atrophy, and hemorrhagic lesions were also evaluated. To demonstrate the statistical significance of the relationship between the angiographic and the MR findings, both the Mantel-Haenszel chi-square test for trend and the chi-square test were used. RESULTS: The degree of steno-occlusive PCA change correlated significantly with the internal carotid artery (ICA) stage (p0.05). The prevalence of infarction showed significant correlation with the degree of steno-occlusive change in both the ICA and PCA. The degree of cerebral ischemia in moyamoya patients increased proportionally with the severity of PCA stenosis rather than with that of steno-occlusive lesions of the anterior circulation. Infarctions tended to be distributed in the anterior part of the hemisphere at PCA stage I or II , while in more advanced PCA lesions, they were also found posteriorly, especially in the territories of the posterior middle cerebral artery (MCA), the posterior border zone, and the PCA (p0.05). CONCLUSION: The degree of steno-occlusive lesions of the PCA correlated with the ICA stage. Progressive changes in steno-occlusive lesions of the ICA and PCA are associated with the extent and distribution of cerebral infarction. The degree of cerebral ischemia in moyamoya patients increased proportionally with the severity of PCA stenosis rather than with that of steno-occlusive lesions of the anterior circulation. In these patients, the presence of stenotic or occlusive PCA lesions appears to be significantly related to the occurrence of cerebral infarction.

Intraventricular Hemorrhage Caused by Lateral Ventricular Meningioma: A Case Report

Meningiomas causing intracranial hemorrhage are rare, and hemorrhage from a lateral ventricular meningioma seems to be even rarer. We report a case of trigonal meningioma in a 43-year-old woman who presented with intraventricular hemorrhage, and describe the CT, MRI and angiographic findings.

Clinical Significance of Nerve Root Enhancement in Contrast-Enhanced MR Imaging of the Postoperative Lumbar Spine

PURPOSE: To determine the significance of nerve root contrast enhancement in patients with residual or recurrent symptomatic postoperative lumbar spine. MATERIALS AND METHODS: Eighty-eight patients with 116 postoperative lumbar disc lesions causing radiating back pain underwent enhanced MR imaging. Intradural nerve root enhancement was quantified by pixel measurement, and affected nerve roots were compared before and after contrast administration. Extradural nerve root enhancement was assessed visually, and nerve root enhancement and clinical symptoms were correlated. Associated lesions such as recurrent disc herniation, scar tissue, nerve root thickening and nerve root displacement were also evaluated. RESULTS: Of 26 cases(22.4%) involving intradural nerve root enhancement, 22 (84.6%) showed significant clinical symptoms (p=0.002). and of 59 (50.9%) demonstrating extradural enhancement, clinical symptoms showed significant correlation in 47 (79.7%) (p=0.001). Nerve root enhancement, including eleven cases where this was both intra-and extradural, showed highly significant association with clinical symptoms in 74 of the 116 cases (63.8%) (p=0.000). Among 33 cases (28.4%) of recurrent disc herniation, nerve root enhancement was observed in 28 (84.8%) and in 24 of these 28 (85.7%), significant correlation with clinical symptoms was observed (p=0.000). Where epidural fibrosis was present, correlation between nerve root enhancement and clinical symptoms was not significant (p>0.05). Nerve root thickening and displaced nerve root were, however, significantly associated with symptoms(87.2% and 88.6%, respectively). CONCLUSION: In patients with postoperative lumbar spine, the association between nerve root enhancement revealed by MRI and clinical symptoms was highly significant.

Reversible Posterior Leukoencephalopathy Syndrome

PURPOSE: To review reversible posterior leukoencephalopathy syndrome. MATERIALS AND METHODS: We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. RESULTS: Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement; in one, enhancement was mild, and in two, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions; in two, small infarctions remained but the extent of the lesions had decreased. CONCLUSION: Reversible posterior leukoencephalopathy syndrome develops in patients with toxemia of pregnancy, renal insufficiency or complicated migraine, and those who undergo immonosuppresive therapy. The characteristic MR finding is edema in cortical or subcortical areas of the parietal and occipital lobes, without enhancement after Gd-DTPA injection. Early recognition of this readily treatable condition may obviate the need for extensive, invasive investigations, and prompt treatment can lead to a favorable prognosis.

Bilateral Simultaneous Quadriceps Tendon Rupture in a Patient with Secondary Hyperparathyroidism: A Case Report

Simultaneous bilateral rupture of the quadriceps tendon without a significant history of trauma may occur in association with chronic metabolic disorders such as chronic renal failure and secondary hyperparathyroidism, though has rarely been reported. We describe a case of spontaneous bilateral quadriceps tendon rupture in a 36-year-old female patient with secondary hyperparathyroidism.

CT Findings of Right Paraduodenal Hernia Presenting as Acute Small Bowel Obstruction

Because it is rare, acute small bowel obstruction due to right paraduodenal hernia is an entity with which radiologists are not entirely familiar. Its clinical importance, however, lies in the fat that delayed diagnosis leads to significantly increased morbidity and mortality rates. We report a case of small bowel obstruction due to right paraduodenal hernia in which all the known characteristic findings were demonstrated.

Warthin's Tumor of Extraparotid Location in Neck: A Case Report

Warthin's tumor is a benign lesion of the salivary and principally-parotid gland. An extraparotid location is rare. We report a case of Warthin 's tumor which was located in the neck, far from the parotid gland.

Pubic Insufficiency Fracture: MRI Findings

PURPOSE: To evaluate the characteristic MRI findings of pubic insufficiency fracture. MATERIALS AND METHODS: In nine cases of pubic insufficiency fracture, the findings of plain radiography (n=9), MRI (n=9), and bone scintigraphy (n=8) were reviewed. We retrospectively analyzed, with regard to fracture site, the destructive pattern revealed by plain radiography, and uptake by other pelvic bones, as demonstrated by RI bone scanning. The MR findings evaluated were the fracture gap and its signal intensity, the site and signal intensity of the soft tissue mass, and other pelvic bone fractures. RESULTS: Plain radiography revealed osteolysis and sclerosis of pubic bone in eight of nine cases (89%), and parasymphyseal fractures in seven (78%). RI indicated uptake by the sacrum in six cases (66%), and by the ilium in three (33%). MR findings of fracture gap (seven cases, 78%) were hypo to isointensity on T1WI, hyper-intensity on T2WI and the absence of contrast enhancement. Soft tissue masses were found in seven cases (78%); in four of these the location was parasymphyseal, and in three, surrounding muscle was involved. Hypo to isointensity was revealed by T1WI, hyperintensity by T2WI, and there was peripheral enhancement. Other associated pelvic bone fractures involved the sacrum in seven cases and the ilium in four. CONCLUSION: The characteristic MR findings of pubic insufficiency fracture were parasymphyseal location, fracture gap, peripherally enhanced soft tissue mass formation, and fractures of other pelvic bones, namely the sacrum and ilium.

Clinical Significance of the Corpus Callosum in Cerebral Palsy

PURPOSE: To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. MATERIALS AND METHODS: Fifty-two children [30 boys and 22 girls aged between six and 96 (median, 19) months in whom cerebal palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebal palsy were classified as hemiplegia(n =14), spastic diplegia(n=22), or spastic quadriplegia(n=16), and according to the severity of motor palsy, the condition was also classified as mild(n=26), moderate(n=13), or severe(n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. RESULTS: Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p < 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p< 0.05). CONCLUSION: There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury.

Ultrasonographic Findings of Carpal Tunnel Syndrome

PURPOSE: To describe the ultrasonographic (US) findings of carpal tunnel syndrome (CTS) and to evaluate the diagnostic value of US in CTS. MATERIALS AND METHODS: Forty-four wrists of 26 patients aged 35 to 67 (mean, 52) years with CTS who were electrophysiologically diagnosed, and 30 wrists of 15 normal control subjects aged 33-62(mean, 48 years) were studied using US with a 7.5MHz linear transducer. Axial images of these wrists in the neutral position were obtained at the level of the distal radius, pisiform, and hook of hamate. The following measurements were taken: at each level, cross sectional area (CSA) and flattening ratio (FR) of the median nerve; at the hamate level, bowing of the flexor retinaculum (palmar displacement: PD); during passive flexion and extension of the index finger, transverse sliding of the median nerve. RESULTS: CSA at each level was significantly higher in patients than in controls (p=0.0001): 9.29 +/-2. 63 mm 2(mean +/-S.D.) vs 5.45 +/-1.98 mm 2 at the distal raidus; 10.68 +/-3.38 mm 2 vs 6.55 +/-2.01 mm 2 at the pisiform; 1 0 . 8 8 +/-2.78 mm2, vs 6.34 +/-2.00 mm2 at the hamate. FR was significantly higher in patients(2.37+/-0.56) than in controls (2.06 +/-0.36) only at the level of the hamate (p=0.0064). In additi on, PD of the flexor retinaculum was also significantly higher in patients (3.44 +/-0.90 mm) than in controls (2.20 +/-0.55mm) (p=0.0001). The sliding distance of median nerve during passive flexion and extension of the index finger was, however, significantly lower in patients (0.98 +/-1.03 mm) than in controls (1.65 +/-1.22 mm) (p=0.0180). CONCLUSION: For the diagnosis of CTS, US proved useful. Significant ultrasonographic findings in CTS were swelling of the median nerve, increased flattening ratio of the median nerve at the distal carpal tunnel, increased bowing of the flexor retinaculum, and decreased mobility of the median nerve during motion of the index finger.

Prenatally Diagnosed Cystic Neuroblastoma: A Case Report

Cystic masses of the adrenal gland are unusual in the fetus and most are secondary to hemorrhage. Cysticneuroblastoma is extremely rare, and in contrast to solid neuroblastoma, follows a benign course, is diagnosedearlier, and rarely presents with metastatic lesions(1-4). We report one case of cystic neuroblastoma diagnosedprenatally by ultrasound(US) and magnetic resonance(MR) imaging, and include a review of the literature.

Metastatic Thy roid Carcinoma of Jugular Foramen Simulating Glomus Jugulare Tumor: A Case Report

We report a case of hyper vascular metastatic thyroid carcinoma of the jugular fora-men simulating a glomus jugulare tumor. Computed tomography(CT) revealed areas of irregular lytic bony destruction of the left jugular foramen, as well as characteristic in vasion routes of a glomus jugulare tumor. Magnetic resonance(MR) imaging and angiography demonstrated a hypervascular mass similar to a glomus tumor.

CT Diagnosis of Tracheobronchial Rupture Following Blunt Trauma with Demonstration of the Injury Site: A Case Report1

Tracheobronchial disruption is a rare injury associated with blunt trauma, and for proper management, accurate diagnosis is essential. We describe a case of isolated tracheal rupture following blunt trauma, and the related CT findings, including details of the injury site. Preoperative bronchoscopy was not performed, but the patient immediately underwent surgery, which was successful. This case demonstrates that CT scanning is very helpful both for diagnosis of tracheobronchial injury and for delineation of the exact injury site.

Deep Cerebral Venous Thrombosis Associated with Oral Contraceptives: A Case Report

Deep cerebral venous thrombosis(DCVT) is a rare category of stroke that can be caused by various conditions.We report a case of spontaneous DCVT in a 34-year-old female using oral contraceptives; clinical and radiologicmanifestations were characteristic.

CT and MRI Findings of Metastatic Uterine Carcinoma from Gastric Cancer: A Case Report

Uterine metastasis from stomach carcinoma occurred in a patient who five years previously had undergonegastrectomy for gastric adenocarcinoma. CT scans showed an ill-defined lobulated low density mass in the center ofthe uterus. T1-weighted MRI imaging showed that the lesion was indistinct from the myometrium; on T2-weightedimaging it showed increased signal intensity and had infiltrated the myometrium. After Gd-DTPA administration, thelesion showed very little enhancement.

Mesenchymal Chondrosarcoma Arising from the Periosteum of the Rib: A Case Report

We describe a case of mesenchymal chondrosarcoma arising from the periosteum of the rib. On chest radiographthe mass showed well-defined radiopacity, and there was rib erosion. On CT, there was marked enhancement withirregular ossification and rib erosion, while a 99mTc-MDP scan revealed dense radionuclide uptake.

Diagnostic Value of Dipyridamole Tc-99m Tetrofosmin SPECT for Detection of Coronary Artery Disease

Background and Objects: Tc-99m tetrofomsin is a recently developed myocardial perfusion agent. We examined the diagnostic accuracy of dipyridamole Tc-99m tetrofosmin SPECT. MATERIALS AND METHOD: 61 patients underwent one-day rest/dipyridamole Tc-99m tetrofosmin SPECT. 26 patients had history of myocardial infarction. Coronary angiography, performed within 1 week after SPECT study, revealed normal coronary arteries or insignificant coronary artery stenosis in 19 and 22 patients (when considering > or = 50% or > or = 70% reduction of luminal diameter as significant stenosis). RESULTS: Number of male was 39 (63.9%) and mean age was 59 (range 32 - 84). The diagnostic accuracy of dipyridamole Tc-99m tetrofosmin SPECT for detection of coronary artery disease (> or = 50% and > or = 70% coronary artery stenosis, respectively) was as follows: sensitivity 90.5%, 90.0%, specificity 73.7%, 66.7%, positive predictive value 88.4%, 83.7%, negative predictive value 77.8%, 77.8% and predictive accuracy was 85.2%, 81.9% respectively. The overall sensitivity and specificity of dipyridamole Tc-99m tetrofosmin SPECT for detection of individual coronary stenosis (> or = 50% and > or = 70% coronary stenosis by coronary angiography) were 64.6%, 64.1% and 86.4%, 85.7% respectively. In patients without myocardial infarction, sensitivity 76.5%, specificity 76.5%, positive predictive value 83.3%, negative predictive value 76.5% and predictive accuracy was 80.0%. CONCLUSION: One-day rest/stress dipyridamole Tc-99m tetrofosmin myocardial SPECT is a useful noninvasive method for detection of coronary artery disease.