Pregnancy complicated by Gorham disease.

BACKGROUND: A pregnancy with Gorham disease (massive osteolysis syndrome) is described. To our knowledge, this is the first reported case of a pregnancy associated with this disease. CASE: A 25-year-old woman was seen for pre-conception counseling with the diagnosis of Gorham disease. Before pregnancy, magnetic resonance imaging confirmed a stable disease process. The woman and fetus were followed during pregnancy with ultrasound and consultations. Severe preeclampsia developed at delivery, with a significant thrombocytopenia. We delivered the infant by low forceps, with a good outcome. Subsequently, the mother and child were doing well at 18 months postpartum. CONCLUSION: We briefly review this rare bone disease as it relates to pregnancy and provide information for preconception counseling.

Postprandial augmentation of portal hepatic inflow after prosthetic H-graft portacaval shunt.

Encephalopathy after portasystemic shunting generally occurs after eating. After partial portal decompression, encephalopathy is uncommon, presumably because of associated portal hemodynamics. However, after partial shunting, the changes in portal venous hemodynamics that occur with eating are unknown. With this in mind, 11 nonencephalopathic adults were studied more than 1 year after 8-mm H-graft portacaval shunt (PCS). The studies utilized color flow duplex ultrasound to determine the changes in portal vein (PV) and inferior vena cava blood flow that occur with eating a standardized meal. Following H-graft PCS, there is increased blood flow in the inferior vena cava after eating, particularly cephalad to the H-graft PCS, implying increased flow through the prosthetic shunt. Eating also increases hepatopedal blood flow in the PV distal to the H-graft PCS. Postprandial increases in hepatopedal portal blood flow may play an important role in avoiding encephalopathy after H-graft PCS.

CT evaluation of parathyroid adenomas: diagnostic criteria and pitfalls.

Sixty-three patients with biochemically proven primary hyperparathyroidism underwent CT of the neck and upper chest prior to surgery. All examinations were prospectively evaluated. Parathyroid adenomas were correctly identified on CT in 81% of patients. Thyroid adenomas, tortuous vessels, the esophagus, and atypical parathyroid adenomas may be potential sources of error in the diagnosis of parathyroid adenomas.

Contrast optimization for the detection of focal hepatic lesions by MR imaging at 1.5 T.

The relative efficacies of different spin-echo pulse sequences at 1.5 T were evaluated in the detection of focal hepatic disease. Pulse sequences compared were spin-echo with a repetition time (TR) of 200 msec and echo time (TE) of 20 msec, with six excitations; TR = 300 msec, TE = 20 msec, with 16 excitations (T1-weighted sequences); and a double spin-echo with TR = 2500 and TE = 25 and 70, with two excitations (proton-density-weighted and T2-weighted pulse sequences, respectively). Respiratory-motion compensation, which involved a recording of the phase-encoding gradients (Exorcist), was used for the last two sequences. Spin-echo with TR = 2500 msec and TE = 70 msec was superior in lesion detection and contrast-to-noise ratio. The proton-density-weighted and T2-weighted sequences with respiratory compensation produced better artifact suppression than did the short TR, short TE T1-weighted sequence with temporal averaging. In contradistinction to prior results at 0.6 T, T2-weighted pulse sequences appear superior to T1-weighted pulse sequences with multiple excitations for both lesion detection and artifact suppression at 1.5 T.

Treatment of blunt hepatic injuries: role of CT.

Serial dynamic upper abdominal computed tomography (CT) studies were performed on 20 patients as part of the conservative treatment of blunt hepatic injuries (hematoma, laceration, or fracture). Fourteen of these patients had either major or minor associated hemoperitoneum. In 13 patients, hemoperitoneum was either significantly reduced or absent by 1 week. A severe delayed hemorrhage occurred in one patient 7 1/2 days after admission; a large and unchanged volume of intraperitoneal fluid had been seen on a preceding abdominal CT scan. One other patient who had a satisfactory response underwent surgery for a pancreatic laceration. Serial abdominal CT studies are an integral part of the conservative treatment of blunt hepatic injuries and seem to be useful in monitoring resorption of hemoperitoneum and the pattern of healing of intrahepatic hematomas, lacerations, and fractures.

High resolution surface coil magnetic resonance imaging of the joints: anatomic correlation.

Magnetic resonance imaging appears to be a particularly promising approach to the evaluation of articular and periarticular abnormalities. Its ability to produce images in multiple planes directly (without reconstruction) provides a unique advantage over CT for the radiologist when he attempts to interpret the complex three dimensional anatomy of most joints. The inherent contrast resolution of MR is excellent, and with the use of surface coils, spatial resolution is sufficient to permit the identification of the small soft tissue structures in and around joints. Artifacts generated by respiratory and cardiac motion are not a problem in MRI of the joints as they are in MR scanning of the body. Based on all these qualities, we believe that MRI will play an important role in the diagnosis of joint abnormalities.

High-resolution MR imaging of the normal rotator cuff.

The shoulders of six normal volunteers were imaged with high-resolution MR in the axial, sagittal, and coronal planes. An angled pair of counter-rotating current loop-gap resonators designed specifically for the shoulder was used as a local coil. All images were compared with corresponding cryomicrotome sections from cadaver shoulders. The rotator cuff was analyzed in detail. It appeared as a complex, heterogeneous band to tissue superficial to the humeral head. The areas of low signal intensity corresponded to the central tendons of the four rotator cuff muscles. These tendons could be distinguished from each other as well as from the intervening components of the cuff, which have a moderate intensity. We concluded that MR is capable of imaging the normal rotator cuff and of separating the various components. This may allow for improved precision in the diagnosis of rotator cuff disorders.

MR imaging of the carpal tunnel: normal anatomy and preliminary findings in the carpal tunnel syndrome.

MR imaging was performed through the carpal tunnel in 18 wrists of nine normal volunteers and compared with cryomicrotome sections from cadaver wrists. MR reliably imaged the flexor retinaculum and carpal bones and thus defined the borders of the carpal tunnel. In all cases the median nerve was seen as an ovoid structure of moderate signal intensity and was easily distinguished from the flexor tendons of the hands running in the carpal tunnel. The tendons were separated from each other by their tendon sheaths, and this allowed for identification of the various tendons. Anatomic variations encountered in the normal volunteers included anomalous positioning of the origin of the lumbrical muscles within the carpal tunnel in two, persistent median arteries in two, and interposition of the median nerve between the flexor pollicis longus and the superficial flexor tendon to the index finger in one. Preliminary observations in 10 wrists of patients with carpal tunnel syndrome include segmental and diffuse swelling of the median nerve in six, distortion of the nerve in one, and thickening of the tendon sheaths in one. We conclude that MR imaging accurately and reliably displays the normal anatomy of the carpal tunnel and can detect morphologic changes in patients with carpal tunnel syndrome.

CT diagnosis of massive hemorrhage from hepatocellular carcinoma.

Massive hemorrhage from rupture of hepatocellular carcinoma is uncommon. We report our experience in two cases diagnosed by CT.

Retrograde opacification of the renal vein: a CT sign of renal artery avulsion.

Retrograde opacification of the renal vein occurred during dynamic computed tomographic scanning of a patient with renal artery avulsion. This is a potentially confusing finding in the patient with renal trauma.