ABSTRACT
PURPOSE: To analyze the magnetic resonance (MR) imaging, clinical, and pathologic features of radiation-induced telangiectasia of the brain. MATERIALS AND METHODS: The clinical and radiation therapy records were reviewed of 20 patients who developed focal hypointense lesions on T2-weighted MR images obtained after radiation therapy of the central nervous system. Pathologic material was reviewed in six patients. RESULTS: Eleven patients had solitary lesions, and nine had multiple foci on MR images. Fourteen of the 20 patients were less than 20 years old. The appearance ranged from small hypointense foci to larger regions of acute hemorrhage. Hematomas occurred at the site of a previously identified focus of T2 shortening in five patients. Pathologic findings included ectatic thin-walled vessels surrounded by hemosiderin and gliosis, with minimal evidence of necrosis. CONCLUSION: Radiation-induced telangiectasia in the brain results in varying amounts of hemorrhage and, occasionally, parenchymal hematomas, and may appear similar to cryptic vascular malformations on T2-weighted MR images.
Subject(s)
Brain Diseases/diagnosis , Brain/pathology , Cerebral Hemorrhage/diagnosis , Intracranial Arteriovenous Malformations/diagnosis , Radiation Injuries/diagnosis , Telangiectasis/diagnosis , Adolescent , Adult , Brain/radiation effects , Brain Diseases/etiology , Brain Neoplasms/radiotherapy , Cerebral Hemorrhage/etiology , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Male , Radiation Injuries/complications , Telangiectasis/etiologyABSTRACT
PURPOSE: To correlate the MR findings in transverse myelitis secondary to systemic lupus erythematosus with clinical findings during disease exacerbation and remission. METHODS: Four patients (ages 33 to 47 years) with episodes of transverse myelitis secondary to systemic lupus erythematosus were identified. Three patients had recurrent transverse myelitis episodes (one patient with two recurrences), for a total of eight episodes. MR examinations (six after contrast administration) were performed during each transverse myelitis episode, as well as during four periods of remission (in three patients) after therapy with steroids and/or immunosuppressive agents. MR examinations were reviewed for the presence of spinal cord enlargement, intramedullary signal abnormality, and contrast enhancement. RESULTS: Prolongation of T1 or T2 signal (or both) was seen in eight episodes (100%). Spinal cord enlargement was seen in six (75%) of eight transverse myelitis episodes, although it was mild during two episodes. Contrast enhancement was seen in three of six transverse myelitis episodes (dense, inhomogeneous enhancement during two episodes in one patient, and a small focus of enhancement in one patient). During periods of remission, spinal cord diameter returned to normal, and no contrast enhancement was seen, although abnormal signal was present in three examinations performed within 2 months of a transverse myelitis episode. CONCLUSION: Spinal cord widening and signal abnormalities are common MR findings during episodes of transverse myelitis related to systemic lupus erythematosus, and contrast enhancement is less frequently seen. Improvement or resolution of these findings correlates with clinical improvement.
Subject(s)
Lupus Erythematosus, Systemic/diagnosis , Magnetic Resonance Imaging/methods , Myelitis, Transverse/diagnosis , Adrenal Cortex Hormones/therapeutic use , Adult , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Middle Aged , Myelitis, Transverse/drug therapy , Neurologic Examination/drug effects , Retrospective Studies , Spinal Cord/drug effects , Spinal Cord/pathologyABSTRACT
We reviewed the clinical and sonographic findings in 297 patients who had graded compression sonography for suspected acute appendicitis. The purpose of the study was to determine the accuracy of sonography in detecting other diseases in the 174 patients in this group who proved not to have acute appendicitis. Of the 174 patients without acute appendicitis, 93 patients (53%) were ultimately discharged with a diagnosis of abdominal pain of unknown origin. Of the 81 patients in whom specific diagnoses were established, sonography suggested the correct diagnosis in 57 patients (70%). A broad spectrum of diseases was detected, including: gynecologic diseases (35); visceral diseases, including hollow viscera and diseases of liver, pancreas, or spleen (18); and urinary tract abnormalities (four). This study suggests that sonography is useful in establishing alternative diagnoses in patients undergoing sonography for suspected acute appendicitis.
Subject(s)
Appendicitis/diagnosis , Ultrasonography , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Diagnosis, Differential , Evaluation Studies as Topic , Female , Humans , Male , Middle AgedABSTRACT
Gastrobronchial fistula is a rare complication of antireflux surgery. Presentation can be subacute, with only productive cough. Endoscopy often fails to visualize these fistulae. Barium in the bronchial tree during postoperative upper gastrointestinal series is diagnostic, but can be confused with that appearing due to aspiration. Every case reported after antireflux surgery has followed intrathoracic Nissen fundoplication.