Massive pneumorrhachis, pneumocephalus and pneumoopticus following thoracic trauma and avulsion of the brachial plexus: case report and review of the literature.

A 41-year-old man with injury of right half of the thorax, fractures of the left crural bones and paralysis of the right upper limb was admitted to our hospital. A CT examination at admission revealed bilateral pulmonary contusion and bilateral fluid- and pneumothorax. In addition pneumomediastinum, pneumopericardium, subcutaneous emphysema and pneumorrhachis at the cervicothoracic transition was demonstrated. Abnormal findings in the skull and brain were not revealed. The fifth day after admission repeated CT examination demonstrated extensive frontal pneumocephalus on the right, presence of air in several cisterns and in the right optic nerve sheaths (pneumoopticus). Right frontal craniotomy was performed, dura mater was incised and air was evacuated. Rapid regression of pneomocephalus was evident postoperatively. The tenth day after admission MRI of the cervical spine and brachial plexus was performed. At the level of the C7 and C8, nerve roots pneumomenigocele and a nerve retracting ball indicating the presence of a nerve root injury were discernible. This case demonstrated that severe thoracic blunt trauma leads to acute increase of intrathoracic pressure with concomitant fluid- and pneumothorax, pneumomediastinum and pneumopericard. From the mediastinum air propagated subcutaneously. Disrupted cervical dural sheaths resulted in leakage of cerebrospinal fluid and entry of air from mediastinum to subdural and subarachnoid spinal and cranial space and to the subarachnoid space of the optic nerve.

[Postpartal atraumatic sacral fracture. A case report and biomechanical comments]. / Poporodní netraumatická zlomenina krízové kosti: kazuistika a biomechanické poznámky.

OBJECTIVE: A case report describing postpartal nontraumatic sacral fracture. DESIGN: A case report and biomechanical commment. SETTING: Institute of anatomy, 2nd Medical faculty, Charles University at Prague. SUMMARY: Nontrauma--related stress fractures of the sacrum are rare complications of the pregnancy and postpartal period. We report a new case of nontrauma-related postpartal sacral fracture. A 36-year-old woman after second delivery presented symptoms of left L 5 radiculopathy. MRI of the lumbar spine and pelvis demonstrated a vertical fracture through the left sacral wing, paralel to the left sacroiliac joint (type Denis I). Fracture was surrounded by prominent bone marrow oedema. Biomechanical factors contributing to the stress fractures of the pelvic girdle in pregnancy and post partum are discussed.

[An occult acetabular fracture revealed by magnetic resonance imaging]. / Skrytá zlomenina acetabula prokázaná pri vysetrení MR.

The authors describe the case of a 35-year-old man with an injury to the left hip joint. When examined at the surgical ward, the patient complained of pain and restricted motion of the left hip. No traumatic changes in the left hip joint were revealed on X-ray and CT examination. When checked-up 13 days later, the patients still complained of persistent pain and restricted movement. Because of the discrepancy between the results of X-ray and clinical examinations, magnetic resonance imaging was recommended. This revealed an infraction of the roof of the acetabulum without trauma to the soft joint tissues and adjacent muscles. A retrospective analysis of the X-ray and CT examination data showed an infraction of the acetabular roof on CT scans. The authors emphasize the role of non-invasive magnetic resonance imaging in the diagnosis of occult fractures.

[Initial experience with magnetic resonance cholangiopancreatography]. / Nase první zkusenosti s magneticko-rezonancní cholangiopankreatikografií.

BACKGROUND: Magnetic resonance cholangiopancreaticography (MRCP) is based on heavily weighted T2 sequences (ETSE--echo-train spin echo) with suppression of fat, giving visualisation of slowly flowing or stagnating fluid. MRCP are short sequences in coronary plane with thickness of 8 cm or 4 mm. Retrospective analysis of all MRCP examinations performed during last 12 months is presented. METHODS AND RESULTS: Eighty-eight examinations were done, of which 67 ones with both adequate technical quality and clinical indication were included into the study (20 males aged 25-83 years, 47 women aged 19-82 years). Patients were divided into 4 groups regarding to the indications (group I.--temporary cholestasis, normal abdominal ultrasound, II.--definite cholestasis, III.--pathologic findings on pancreas, IV.--other). Vast majority of patients were included into group I (35 subjects). In 7 (20%) of them choledocholithiasis and/or stenoses (including multiple stenoses in primary sclerotizing cholangoitis) were found. MRCP brought diagnostic information in subjects with cholestasis (group II.) and answered questions given by clinicians. However, in 1 of 4 subjects with primary sclerotizing cholangoitis, MRCP did not reveal intra-hepatic stenoses, which were later visualised by classical ERCP. Only the extrahepatic stenoses were diagnosed by MRCP in the latter subject. CONCLUSIONS: MRCP should become a standard examination in the diagnostic algorithm in patients with cholangiopathies. MRCP has its value not only in subjects with unsuccessful or contraindicated ERCP, but also in subjects with temporary cholestasis with negative ultrasound finding.

[Occult bone trauma detected by magnetic resonance imaging]. / Skryté kostní trauma prokázané pri vysetrení magnetickou rezonancí.

Authors deal with a case of a 23-year old women presented with a sport-related injury of the left knee joint. Initially seen in the surgical department, patient presented with pain, swelling, and decreased range of motion of the left knee. Conventional radiographs of the left knee showed no evidence of fracture or osseous abnormality, while the puncture of the joint proved haemarthros. One day later surgical examination demonstrated repeatedly pain and swelling of the left knee expanding to the proximal third of the leg. Repeated puncture exhibited haemorrhagic synovial fluid containing fat tissue, lipohaermarthos. With regard to the contradiction between the surgical examination and negative radiographs, the MRI examination was recommended. MR images revealed linear area of abnormal signal intensity in the medial condyle of the tibia indicating subchondral fracture of the posterior margin of the medial tibial condyle. This finding was associated with increased volume of the haemorrhagic intraarticular fluid. The menisci, intraarticular and capsular ligamentous apparatus was noted to be intact. The control MR examination performed six weeks later demonstrated healed fracture with surrounding bone marrow edema. The importance of non-invasive MR examination for revealing of the occult bone fractures is stressed.

[Magnetic resonance imaging of growth plates nailing of the forearm and leg bones.]. / Zobrazení rustových chrupavek po osteosyntéze predloketních a bércových kostí pomocí magnetické rezonance.

Results of the presented study indicate that MR imaging is a suitable method for demonstration of the abnormalities of the growth cartilage associated with the intramedullary fixation of the long bones of the forearm and leg. MR imaging permits noninvasive evaluation of the cartilage of the growth plate and the demonstration of the osseous bridges and the residual fibrous channels. Key words: osteosynthesis, growth plate, osseous bridge, MR imaging.

[Early differential diagnosis of tumors of the lesser pelvis using an appropriate combination of noninvasive and invasive methods]. / Vcasná diferenciální diagnostika tumoru malé pánve vhodnou kombinací neinvazívních a invazívních metod.

One hundred and twenty-three female patients were subjected to ultrasound and CT examinations on account of suspected tumours in the area of the lesser pelvis, or to evaluate the postoperative situation. Twenty-five patients were subjected in addition to the mentioned examinations also to angiography of the pelvic arteries. From comparison of the results of the radiodiagnostic examination and the surgical (histological) diagnosis ensues that in patients with a malignant tumour of the ovaries and uterus and with a benign tumour of the uterus the CT examination gives-more satisfactory results than the ultrasound examination. In patients with a benign tumour of the ovaries ultrasonic and CT examinations were approximately equally satisfactory.

[The place of postoperative angiography after vascular reconstruction]. / Stellenwert der postoperativen Angiographie nach Gefässrekonstruktion.

In 284 patients after angioplasty of the aortoiliac vessels postoperative angiography discovered complications in 63 cases (22%), most frequently in case of prostheses at the bifurcation. Late thrombosis was the prime complication. In 221 patients with reconstructions in the femoropopliteal region complications were found in 24.5% of the cases, most frequently in case of venous bypass (29%). As in the first group, late thrombosis prevailed.