MRI of recurrent isolated cerebral Whipple's disease.

Whipple's disease is a rare systemic bacterial infection, characterized predominantly by gastrointestinal symptoms. Neurological symptoms are frequent in the course of the disease; however, a purely neurological presentation is uncommon. Diagnosis is confirmed with biopsy and polymerase chain reaction studies. Magnetic resonance imaging (MRI) findings vary, most commonly showing increased signal intensity on T2-weighted images. Contrast-enhanced images and diffusion- weighted imaging are useful to demonstrate meningeal enhancement and any accompanying infarcts. Brain biopsy is often performed, and MRI is crucial to guide the biopsy. Cerebral Whipple's disease is a long-lasting infection requiring long-term follow-up of these patients. MRI should be performed to detect any potential recurrence. We present a case of recurrent isolated cerebral Whipple's disease in a 68-year-old man with atypical presentation and MRI findings.

Multidetector CT findings of spontaneous rupture of hepatic adenoma in a patient with hepatic adenomatosis.

Hepatic adenomatosis (HA) is characterized by more than 10 adenomas in the liver, frequently scattered within both lobes. The potential for spontaneous bleeding, rupture, and malignant transformation is known. In HA, tumors show hypervascularization on arterial angiography, computed tomography (CT), and magnetic resonance imaging. We report the case of a 32-year-old woman who presented with a large intraparenchymal and subcapsular hematoma in the liver, and an underlying large adenoma with atypical radiologic characteristics detected with multidetector CT imaging. On follow-up CT examination, a large adenoma was clearly visualized at the site of the previous hematoma.

MRI findings in renal transplant recipients with hip and knee pain.

PURPOSE: To evaluate and demonstrate the MRI findings of renal transplant recipients with hip and knee pain and to investigate the most common etiology of pain. MATERIALS AND METHODS: 69 hip MRIs of 57 patients with hip pain and 30 knee MRIs of 24 patients with knee pain with no history of trauma were retrospectively evaluated by two radiologists. RESULTS: In the evaluation of hip MRIs, 24 patients had avascular necrosis and effusion, 2 patients had bone marrow edema consistent with early stage of avascular necrosis. 18 patients had only intraarticular effusion, 6 patients had tendinitis, 6 patients had bursitis and 1 patient had soft tissue abscess. Five patients had muscle edema and five patients had muscle atrophy as additional findings to the primary pathologies. Among patients with knee pain, nine patients had degenerative joint disease. Seven patients had chondromalacia, five had bone marrow edema, six had meniscal tear, six had ligament rupture and two had bone infarct. Three of the patients had muscle edema accompanying to other pathologies. CONCLUSION: The most common etiology of hip pain in renal transplant recipients is avascular necrosis as expected, intraarticular effusion is found to be the second reason for pain. However, knee pain is explained by ligament pathology, meniscal tear, chondromalacia or degenerative joint disease rather than osteonecrosis.

Noninvasive imaging findings of idiopathic renal arteriovenous fistula.

Renal arteriovenous fistula (AVF) is an uncommon clinical entity, which can be congenital, acquired, or idiopathic. Diagnosis is aided by radiological studies, with digital subtraction angiography as a gold standard. However, Doppler ultrasound with color Doppler interrogation and computed tomography (CT) angiography are alternative imaging techniques that are noninvasive and can be used for patients to whom no intervention is planned. In this report, we present a case of idiopathic renal AVF diagnosed by Doppler ultrasound and CT angiography. Grayscale ultrasound showed a cyst-like lesion which was confirmed to be a focal aneurysmatic dilatation with heterogeneous fill-in and turbulent blood flow on color Doppler and spectral analysis. CT angiography demonstrated multiple aneurysmatic dilatations of the segmental branch and early opacification of right renal vein on the arterial phase, consistent with renal AVF.