ABSTRACT
OBJECTIVE: Faecal incontinence often persists after surgery for rectal prolapse. Multiple mechanisms have been proposed as responsible, however, anal sphincter integrity has only been studied in a handful of cases. This study assesses the incidence of ultrasound detected anal sphincter tears in patients with rectal prolapse and faecal incontinence. METHODS: Retrospective search of medical records at Flinders Medical Centre over a 7-year period to identify patients with full thickness rectal prolapse and faecal incontinence who had undergone endosonographical imaging of the anal sphincter complex. Anal manometry and pudendal nerve terminal motor latency studies were also included. RESULTS: Twenty-one patients were identified (1 male, 20 female) of median age 67.5 years. Fifteen (71%) subjects had an abnormality in the anal sphincter complex on endoanal ultrasound. Of these, the defects in 4 (19%) patients were isolated to the internal sphincter, 3 (14%) to the external sphincter and in the remaining 8 (38%) subjects, defects were found in both internal and external sphincters. The degree of sphincteric defect was variable but at least 6 (29%) of the study group had full-length external sphincter tears. In the 19 patients studied, anal manometry revealed reduced basal and squeeze pressures in the majority. Delayed pudendal nerve terminal motor latency was evident in 9 of 18 patients studied. CONCLUSION: Anal sphincter tears are common in patients presenting with rectal prolapse and faecal incontinence. The faecal incontinence associated with prolapse appears to be multifactorial in aetiology. Anal sphincter defects are likely to contribute to persistent faecal incontinence or recurrence following rectal prolapse. Endoanal ultrasound derived knowledge of anal sphincter injury may guide surgical management in problematic cases.
Subject(s)
Anal Canal/injuries , Fecal Incontinence/etiology , Rectal Prolapse/etiology , Adult , Aged , Aged, 80 and over , Anal Canal/diagnostic imaging , Endosonography , Female , Humans , Male , Middle Aged , RuptureABSTRACT
This paper highlights the importance of cavernous haemangiomas as clinically significant lesions and the role of imaging, particularly MRI, in suggesting the diagnosis. An understanding of the pathology of these lesions helps to explain the features demonstrated by imaging techniques.
Subject(s)
Brain Neoplasms/diagnosis , Hemangioma, Cavernous, Central Nervous System/diagnosis , Adult , Brain Neoplasms/pathology , Hemangioma, Cavernous, Central Nervous System/pathology , Humans , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
This review summarizes important pathological lesions of the lung that typically present radiographically with an 'alveolar pattern'. For each entity, the latest findings as to its pathogenesis, aetiology and pathology are reviewed in the introductory remarks. We then present the typical radiological appearances alongside macroscopic and microscopic pathological photographs. It is hoped that the parallel presentation of radiological image with the pathology will enhance the understanding of the diverse range of diseases the aevolar pattern comprises.
Subject(s)
Lung Diseases/pathology , Pulmonary Alveoli/pathology , Diagnosis, Differential , Humans , Lung Diseases/diagnostic imaging , Pulmonary Alveoli/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
We describe a 4-year-old girl with an inflammatory pseudotumour of the pancreas, which was preceded by varicella-zoster infection. Inflammatory pseudotumour may involve a variety of tissues, the lungs and liver being typical sites of predilection. Imaging and laboratory tests are nonspecific, and for this reason the diagnosis of inflammatory pseudotumour is rarely made prior to surgery. These benign but locally aggressive masses simulate malignancy in the majority of cases. Inflammatory pseudotumour should, therefore, be considered when a mass arises in an unusual location in the paediatric age group.
Subject(s)
Chickenpox/complications , Granuloma, Plasma Cell/virology , Herpesvirus 3, Human/isolation & purification , Pancreatic Diseases/virology , Child, Preschool , Female , Granuloma, Plasma Cell/pathology , Granuloma, Plasma Cell/surgery , Humans , Pancreatic Diseases/pathology , Pancreatic Diseases/surgery , Tomography, X-Ray ComputedABSTRACT
The imaging findings of a case of meningioangiomatosis with pathologic correlation are presented.
Subject(s)
Angiomatosis/diagnosis , Meninges/pathology , Adolescent , Angiomatosis/pathology , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Meninges/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To examine shoulder appearances at magnetic resonance (MR) imaging in long-term dialysis recipients. MATERIALS AND METHODS: Twenty-two chronic dialysis recipients underwent 1.0-T MR imaging with a combination of T1-, T2-, and T2*-weighted sequences. Rotator cuff tendon thickening was graded as present or absent by a musculoskeletal radiologist, who also measured the supraspinatus and subscapularis tendon thicknesses with electronic calipers. The long-axis dimension and location of focal osseous lesions, in addition to their T1, T2, and T2* signal intensities, were noted. RESULTS: Supraspinatus (n = 9) and subscapularis (n = 10) tendon thickening was frequently observed. Six (27%) of the 22 patients had combined thickening of the supraspinatus and subscapularis tendons without substantial involvement of the infraspinatus or teres minor tendons. These patients had undergone dialysis longer (median, 19.2 years; range, 16.3-22.8 years) than had the other patients (median, 11.7 years; range, 5.8-19.3 years; P: =.004). The 29 intraosseous lesions had high, intermediate, and low T2 signal intensity in six (21%), nine (31%), and 14 (48%) instances, respectively. CONCLUSION: Supraspinatus and/or subscapularis tendon thickening is common in chronic dialysis recipients. Bone lesions in such patients are of variable T2 signal intensity and usually subchondral or adjacent to the greater tuberosity.
Subject(s)
Magnetic Resonance Imaging , Renal Dialysis , Shoulder Joint/pathology , Adult , Aged , Aged, 80 and over , Female , Humans , Joint Diseases/diagnosis , Male , Middle Aged , Prospective Studies , Rotator Cuff/pathology , Tendons/pathology , Time FactorsABSTRACT
The anatomical basis of the primary empty sella turcica is illustrated to emphasize that it represents a normal variant and not pathology.
Subject(s)
Empty Sella Syndrome/diagnostic imaging , Empty Sella Syndrome/pathology , Humans , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To determine the prevalence of neurological and magnetic resonance imaging (MRI) abnormalities in a well defined population of unselected patients with primary Sjögren's syndrome (SS) and age and sex matched healthy patients. METHODS: Thirty patients with SS and 29 age and sex matched controls were examined by a neurologist and subsequently underwent MRI scanning with a 1.0 Tesla Siemens Impact MR scanner. Scans were graded by a neuroradiologist blinded to the clinical status of each subject. The number and location of white matter lesions > 3 mm in long axis (to exclude non-specific perivascular changes) were recorded for each subject. RESULTS: There was a significant increase in lesions detected by MRI in SS patients versus controls (p = 0.02) including deep white matter lesions (p = 0.03) and subcortical white matter lesions (p = 0.02). The presence of white matter lesions did not correlate with serum IgG or rheumatoid factor levels, or with presence of anticardiolipin antibodies. No subjects had symptoms or signs of serious neurological disease including multiple sclerosis, and corpus callosal lesions commonly seen in multiple sclerosis were notably absent in this study. CONCLUSION: Cerebral white matter lesions detected by MRI are more frequent in patients with primary SS than control subjects, yet do not appear to be associated with significant clinical manifestations. Although the pathological nature of these lesions is yet to be defined, their presence should not be over-interpreted.
Subject(s)
Brain/pathology , Nerve Fibers, Myelinated/pathology , Sjogren's Syndrome/pathology , Adult , Age Factors , Aged , Female , Humans , Immunoglobulin G/blood , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Rheumatoid Factor/blood , Sex Factors , Sjogren's Syndrome/bloodABSTRACT
Cavernous haemangiomas confined to the epidural space are rare and are therefore infrequently considered in the differential diagnosis of spinal epidural masses. In order to draw attention to this diagnosis, a case in which an epidural cavernous haemangioma simulates a lateral/foraminal disc protrusion is presented.
Subject(s)
Hemangioma, Cavernous/diagnosis , Adult , Diagnosis, Differential , Epidural Space , Female , Hemangioma, Cavernous/surgery , Humans , Intervertebral Disc Displacement/diagnosis , Lumbar Vertebrae , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
Blood, cerebrospinal fluid, and extracellular fluid of the parenchyma form the fluid compartments of the brain with three interfaces between--the blood-brain interface, the CSF-brain interface, and the blood-CSF interface. These and other issues are discussed in this article.
Subject(s)
Contrast Media , Image Enhancement , Magnetic Resonance Imaging , Radiographic Image Enhancement , Tomography, X-Ray Computed , Blood , Blood-Brain Barrier , Brain/anatomy & histology , Brain/diagnostic imaging , Cerebrospinal Fluid , Choroid Plexus/anatomy & histology , Choroid Plexus/diagnostic imaging , Extracellular Space , Humans , IodineSubject(s)
Blood-Brain Barrier/drug effects , Contrast Media/toxicity , Toxicity Tests , Animals , Arabinose/toxicity , Dose-Response Relationship, Drug , Extravasation of Diagnostic and Therapeutic Materials , Iohexol/analogs & derivatives , Iohexol/toxicity , Osmolar Concentration , Rabbits , Triiodobenzoic Acids/toxicitySubject(s)
Blood-Brain Barrier/drug effects , Brain/drug effects , Contrast Media/toxicity , Heterocyclic Compounds/toxicity , Magnetic Resonance Imaging , Organometallic Compounds/toxicity , Pentetic Acid/analogs & derivatives , Animals , Arabinose/pharmacology , Contrast Media/pharmacokinetics , Electroencephalography/drug effects , Gadolinium , Gadolinium DTPA , Heterocyclic Compounds/pharmacokinetics , Organometallic Compounds/pharmacokinetics , Pentetic Acid/pharmacokinetics , Pentetic Acid/toxicity , Rabbits , Seizures/chemically inducedABSTRACT
Spinal intradural arachnoid cysts are seen most frequently in the thoracic region, particularly near the midline posteriorly. A thoracic intradural arachnoid cyst in this typical location is reported, with the additional unusual finding of herniation of the spinal cord through an anterior defect in the dura matter. The MRI findings are described.
Subject(s)
Arachnoid Cysts/diagnosis , Dura Mater , Magnetic Resonance Imaging , Myelography , Spinal Cord Compression/diagnosis , Adult , Arachnoid Cysts/pathology , Arachnoid Cysts/surgery , Diagnosis, Differential , Dura Mater/pathology , Dura Mater/surgery , Female , Follow-Up Studies , Humans , Neurologic Examination , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Reoperation , Spina Bifida Occulta/diagnosis , Spina Bifida Occulta/surgery , Spinal Cord Compression/pathology , Spinal Cord Compression/surgeryABSTRACT
In a patient with celiac disease, folate and iron deficiency, and epilepsy, CT over a 4-month period showed parietoocipital calcifications in the corticomedullary junctions. The calcification was progressive, but it and the seizures stabilized after institution of a gluten-free diet and iron and folic acid supplements.