ABSTRACT
INTRODUCTION: Diagnosis of choroidal hematoma, either spontaneous or associated with age-related macular degeneration, is clinical. In some cases of expansive or posterior lesion, hematoma may be misdiagnosed as a tumor. MRI and color Doppler imaging (CDI) are important in ruling out uveal melanoma in these cases. PATIENTS AND METHODS: We reviewed the clinical, MRI, and ultrasonographic characteristics of 95 patients sent to the Curie Institute for suspected uveal melanoma between 1998 and 2006, whose final diagnosis was a choroidal hematoma. Imaging differences with melanomas are discussed. RESULTS: A total of 95 patients with a diagnosis of hematoma were seen; the age varied from 54 to 92 years with a median age of 77 years; there was a history of macular degeneration in 27 cases and 11 patients were taking an anticoagulant. Intravitreous hemorrhage was noted in 18 cases and the lesion was located in the posterior pole in 28 cases. The thickness of the lesions measured by B scan ultrasonography varied between 1 and 7.8mm, with a mean thickness of 2.86mm. MRI was performed in 27 cases and CDI in ten cases. On CDI, hematomas appeared as linear or regular bulging lesions with no intralesional blood flow. On MRI, hematomas appeared as a high-intensity signal on T1-weighted images, heterogeneous on T2-weigted images in relation to the progression of the clot, but no contrast enhancement was noted inside the lesion. Follow-up examinations showed the progressive involvement of the clot and delayed decreasing size of the lesion. CONCLUSION: The diagnosis of choroidal hematoma is usually made by fundus examination. In some posterior locations with pseudo-tumoral appearance, CDI and MRI are useful to rule out a uveal tumor.
Subject(s)
Choroid Hemorrhage/epidemiology , Hematoma/epidemiology , Macular Degeneration/complications , Vitreous Hemorrhage/epidemiology , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Choroid Hemorrhage/chemically induced , Choroid Hemorrhage/diagnosis , Choroid Hemorrhage/diagnostic imaging , Choroid Hemorrhage/etiology , Choroid Neoplasms/diagnosis , Cohort Studies , Diagnosis, Differential , Female , Hematoma/chemically induced , Hematoma/diagnosis , Hematoma/diagnostic imaging , Hematoma/etiology , Humans , Magnetic Resonance Imaging , Male , Melanoma/diagnosis , Middle Aged , Retrospective Studies , Ultrasonography, Doppler, Color , Vitreous Hemorrhage/chemically induced , Vitreous Hemorrhage/diagnosis , Vitreous Hemorrhage/diagnostic imaging , Vitreous Hemorrhage/etiologyABSTRACT
Magnetic resonance imaging (MRI) of two pig brains was realized. The animals were placed in the stereotaxic conditions currently used in experiments. To allow the positioning of the animal in the MRI instrument, landmarks were previously traced on the snout of the pig. To avoid movements, animals were deeply anesthetized. MRI were taken in frontal, horizontal and sagittal directions. Afterwards, the brains of the pigs were frozen and cut into sections, frontal for one animal and sagittal for the other. Histologic and MR images were compared. The usefulness of this technique is discussed.
Subject(s)
Brain/anatomy & histology , Swine/anatomy & histology , Animals , Magnetic Resonance Imaging/methods , Stereotaxic TechniquesABSTRACT
The authors present the case of a patient who suffered a violent maxillo-facial trauma. She suffered four mandibular fractures. During the postoperative course there was the development of very marked exophthalmos of of the right eye which was due to a carotido-cavernous fistula. The case has a double interest:--stomatological, osteosynthesis of the angular fractures being achieved by miniaturised screw-plates which ensured a solid mandible and facilitated postoperative intensive care;--neuro-ophthalmological, since the carotido-cavernous fistula closed spontaneously after arteriography during which intermittent compression was applied to the internal carotid.
