Fluid signal in the mastoid is a common incidental finding on MRI of the brain.

Incidental findings are common on patients undergoing magnetic resonance imaging (MRI) of the brain. Fluid signal in the mastoid can be such an incidental finding on MRI of the brain. In only a small number of patients, this relates to inflammatory disease of the middle ear or mastoid. In a small retrospective study, the prevalence of this finding has been studied. Fluid signal in the mastoid was found in 21 out of 84 patients (25%). Only in two patients MRI revealed a cause for the mastoid fluid (mastoid osteolysis in a patient with metastatic breast cancer and presumed recurrent cholesteatoma in another patient). Two patients reported about longstanding presbyacusis. At the initial examination, none of the patients reported symptoms of an inflammatory otological disease, and clinical examination was unremarkable in all patients. In conclusion, fluid signal in the mastoid seems to be a frequent incidental finding in asymptomatic patients. A diagnosis of mastoiditis should only be made if there are distinct clinical findings.

Pseudarthrosis of the cartilaginous part of the first rib is a common incidental finding on chest CT.

PURPOSE: The cartilaginous parts of the first rib are usually articulating with sternal manubrium via a synchondrosis. With advancing age, there is progressive calcification of the rib cartilage. Pseudarthrosis of this calcified cartilage have been described in a study on anatomic specimen, but there are no systematically studies examining the anatomy of the cartilaginous parts of the first rib in vivo or using computed tomography (CT). MATERIAL AND METHODS: A retrospective study of 60 chest CT scans of patients without history of trauma was performed and 120 first ribs were examined. In all patients, the grade of calcifications of the first rib was determined (no calcifications/some calcifications/severe and at least on one side contiguous calcification of the cartilage) and the presence of pseudarthrosis was noted. RESULTS: Pseudarthrosis was found in 39/120 ribs (32.5%). The occurrence of pseudarthrosis was significantly more common in patients with severe calcifications (54%) in contrast to patients with no or minor calcifications (6.1%). CONCLUSIONS: Pseudarthrosis of the first rib is a common finding in patients with severe calcifications. Radiologists should be aware of this frequent incidental finding, that should not be mistaken for pathology in CT imaging after trauma.

Relationship of sternal foramina to vital structures of the chest: a computed tomographic study.

Sternal foramina are a well-known variant anatomy of the sternum and carry the risk of life-threatening complications like pneumothorax or even pericardial/cardial punction during sternal biopsy or acupuncture. There have been numerous studies numerous studies examinimg prevalence of sternal foramina, but the study of the exact anatomical relationship to intrathoracic structures has received little attention. In a retrospective study of 15 patients with sternal foramina, the topographical anatomy in respect to vital chest organs was examined. In most patients, the directly adjacent structure was the lung (53.3%) or mediastinal fat (33.3%). Only in three patients, the heart was located directly adjacent to a sternal foramen (20%). Theoretically, if the needle is inserted deep enough it will at some point perforate the pericardium in all examined patients. There was no correlation between the patient habitus (i.e., thickness of the subcutaneous fat) and the distance to a vital organ. In this sample, pericardial punction would have not occured if the needle is not inserted deeper than 2.5 cm. Given the preliminary nature of the data, general conclusions of a safe threshold for needle depth should be made with caution. To minimize the risk of hazardous complications, especially with sternal biopsy, preprocedural screening or image guidance is advocated.

Geriatric chest imaging: when and how to image the elderly lung, age-related changes, and common pathologies.

Even in a global perspective, societies are getting older. We think that diagnostic lung imaging of older patients requires special knowledge. Imaging strategies have to be adjusted to the needs of frail patients, for example, immobility, impossibility for long breath holds, renal insufficiency, or poor peripheral venous access. Beside conventional radiography, modern multislice computed tomography is the method of choice in lung imaging. It is especially important to separate the process of ageing from the disease itself. Pathologies with a special relevance for the elderly patient are discussed in detail: pneumonia, aspiration pneumonia, congestive heart failure, chronic obstructive pulmonary disease, the problem of overlapping heart failure and chronic obstructive pulmonary disease, pulmonary drug toxicity, incidental pulmonary embolism pulmonary nodules, and thoracic trauma.

Small intracranial lipomas may be a frequent finding on computed tomography of the brain. A case series.

Intracranial lipomas are described as a rare finding. In this small retrospective analysis of 50 cases undergoing brain CT for various reasons small intracranial lipomas where found in nine patients. In contrast to previous reports lipomas may be a frequent finding on CT imaging of the brain. In particular, these small lipomas seem to be incidental findings lacking clinical relevance. Radiologists should be aware of intracranial lipomas to establish proper differential diagnosis.

Marked Subchondral Bandlike Osteopenia on Radiography after Trauma and Inactivity: A Report of four Cases.

We report about four cases of marked subchondral osteopenia on followup radiography after trauma and prolonged disuse. This localized form of disuse osteopenia has not been reported in details beside the followup imaging of talar neck fractures, where it is known as the "Hawkins sign." Due to its unique morphology, it can be easily recognized as a benign finding in posttraumatic followup imaging and can be morphologically distinguished from severe complications like complex regional pain syndrome type 1 (Sudeck's disease) or periarticular osteopenia in infectious arthritis. It is important for the radiologist and orthopaedic surgeon to be aware of this form of disuse osteopenia in the proper clinical context.

Usefulness of the bolus-tracking baseline scan for the diagnosis of hepatic steatosis in abdominal computed tomography: a feasibility study.

Nonalcoholic fatty liver disease (NAFLD) is a common pathology in western societies. Unenhanced computed tomography (CT) of the liver is a valuable tool in determining the presence of steatosis hepatis, but in most departments standard CT protocols of abdomen often do not include unenhanced scans anymore. In a small series of 22 patients the liver density was measured in the acquired low-dose baseline scan for bolus tracking and was compared to the measurement in a regular unenhanced CT scan of the upper abdomen. The mean difference between the unenhanced CT scan and the low-dose baseline scan was 3.4 HU (range 0.2-8.6 HU); the difference between these two scans was 5 HU or smaller in 82% of the patients. There was a significant difference between the two used CT scanners; this has to be kept in mind before implementing this approach into daily practice. All but one patient with fatty liver disease on unenhanced CT were diagnosed using the baseline scan. The baseline scan for bolus tracking may be useful for the diagnosis or in the followup of fatty liver disease.

Feasibility of computed tomography pulmonary angiography with low flow rates.

Computed tomography pulmonary angiography (CTPA) is the imaging test of choice in suspected pulmonary embolism. High flow rates for the administration of contrast medium are recommended, but these cannot be achieved in a number of patients due to poor peripheral venous access or when using certain central venous catheters. This small feasibility study has examined the CTPA data in a set of 22 patients in whom contrast medium was given at low flow rates (2.0 or 2.5 mL/s). Subjectively, all but one of the patients was judged to be diagnostic. Objectively, enhancement values ≥200 HU were reached in 92% of the examined central vessels (pulmonary trunk, main pulmonary arteries, and lobar arteries). In conclusion, even with a low injection rate CTPA is of diagnostic value in most patients.

[Clinical and radiological mid-term results after autologous osteochondral transplantation under consideration of quality of life]. / Mittelfristige klinische und radiologische Ergebnisse nach autologer osteochondraler Transplantation unter Berücksichtigung der Lebensqualität.

BACKGROUND: Treatment of full-thickness cartilage defects remains a challenge in musculoskeletal surgery. Autologous osteochondral transplantation represents a possible solution for the repair of affected areas. However, some problems like degenerative changes of the transplanted cylinders and the surrounding cartilage or lack of cylinder integration to the surrounding cartilage arise with this method. Thus mid-term results respecting the quality of life are useful for assessment of the method. PATIENTS/MATERIAL AND METHODS: We investigated 22 patients with a mean follow-up of 88 ± 14.5 months after autologous osteochondral transplantation due to a full-thickness cartilage defect of the medial femoral condyle. Beside clinical scores we assessed at follow-up the quality of life using the SF-36 health survey and the EQ-5D. Furthermore, radiological changes were detected and MRI was performed in 21 patients. A control group of 19 patients, treated with microfracture, was matched in terms of BMI, gender and age. Exclusion criteria for this group were tibial kissing lesion, ligament instability, arthrosis and malalignment. RESULTS: In a longitudinal comparison with results 13.5 months after operation, no difference in Lysholm score was found. In plain radiographs higher degrees of arthritic changes in the medial compartment compared to the unaffected knee were observed. MRI revealed a mean modified MOCART score of 41.2 ± 7.7 for the OAT group and of 39.4 ± 16.1 for the microfracture group, without being significant. For OAT patients all cylinders showed an osseous integration. However, cylinder oedema was found in 9 patients. Those patients had a higher intensity of pain on a visual analogue scale. Quality of life was better for OAT patients in the physical scale of SF-36, but not in the mental scale. CONCLUSION: Autologous osteochondral transplantation has an unaltered significance in treating full-thickness cartilage defects and leads to satisfying mid-term results. The development of early arthritic changes might not be preventable by this method. Oedema of the transplanted cylinders is attended by higher pain intensity and might be an indirect sign of cartilage degeneration.

Tandem aneurysms of an internal mammary-aortocoronary bypass graft.

Graft aneurysms following aortocoronary surgery are a rare occurrence in clinical practice. Reported cases have mostly involved saphenous vein grafts. Here we report the rare finding of a tandem aneurysm of an internal mammary artery graft which was incidentally detected 17 years following bypass surgery. (Neth Heart J 2009;17:300-2.).