Lhermitte-Duclos disease associated with neurofibromatosis type-1 and non-ossifying fibroma.

Lhermitte-Duclos disease (LDD) is a rare cerebellar disorder of uncertain pathogenesis characterized by enlargement of cerebellar folia. Magnetic resonance imaging is the diagnostic modality of choice and usually distinguishes the LDD by its characteristic "striated or laminated pattern" appearance. Various additional abnormalities have been reported in association with LDD. We report a case of LDD coexisting with neurofibromatosis type 1 (NF-1) and non-ossifying fibroma.

Magnetic resonance imaging and diffusion-weighted imaging in methylmalonic acidemia.

Methylmalonic acidemia (MMA) is an inborn disorder of amino acid metabolism, often presenting with neurological symptoms. We present the results of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) of the brain in a 16-month-old male patient with classic neurological and laboratory findings for MMA. MRI demonstrated the hyperintensity within globi pallidi both on T2-weighted image and DWI during the acute episode of metabolic acidosis.

The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome.

AIM: The aim of study was to assess the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. MATERIALS AND METHODS: Eighty-six patients with carpal tunnel syndrome confirmed by electromyography and 45 asymptomatic controls were included in the study and underwent high-resolution ultrasonography of the wrists. The cross-sectional area and flattening ratio at the level of the pisiform bone of the proximal carpal tunnel were measured. Data from the patient group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) analysis. RESULTS: One hundred and forty-eight wrists of 86 patients with carpal tunnel syndrome and 76 wrists of 45 control patients were examined. All measurements showed significant differences between patients and controls. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a cut-off value of >10.5 mm2 at the level of pisiform bone provided a diagnostic sensitivity of 89% and specificity of 94.7% CONCLUSION: The ultrasonographic measurement of the median nerve cross-sectional area is a sensitive, specific and useful non-invasive method for the diagnosis of carpal tunnel syndrome.

Splenodiaphragmatic interposition of the descending colon.

We present a variation named splenodiaphragmatic or retrosplenic interposition of the colon in three patients aged 6, 70, and 71 years who suffered from different symptoms. The cases were found in 1,000 thoracoabdominal CT scans examined at the radiology clinic between 1999 and 2001. The upper part of descending colon was seen to be between the spleen and the left kidney on abdominal CT scans with contrast enema in the patient aged 71 years. In a 6 year-old child, part of the left colic flexure in the intestinal gas patterns was located between the left kidney and spleen, extending up to the diaphragm in the left hypochondrium on radiological examinations. The left colic flexure and the beginning of the descending colon were imaged on CT behind the spleen at the level of the 11th thoracic vertebra in the third patient aged 70 years. Hepatodiaphragmatic interposition of the colon has been reported previously in many patients; however, no detailed reports are available dealing with the interposition of the descending colon between the diaphragm and spleen. Three cases with retrosplenic colon variation were investigated in detail in the present study. The significance of retrosplenic colon is discussed. It is concluded that the identification of this anatomical variation could avoid unnecessary colon perforation during percutaneous nephrostomy, splenostomy, biopsy, or splenectomy.

Detection of vesico-ureteric reflux in children by colour-flow Doppler ultrasonography.

OBJECTIVES: To assess the findings of colour-flow Doppler ultrasonography (DUS) in the diagnosis of vesico-ureteric reflux (VUR), as an alternative to the primary diagnostic tool, voiding cysto-urethrography (VCUG). PATIENTS AND METHODS: Thirty-five children (aged 2-15 years) were examined for VUR by DUS and standard VCUG. All patients underwent DUS and VCUG within 48 h but the findings of the latter were not reported to the ultrasonographer. The DUS was undertaken using a colour Doppler real-time system; a positive ultrasonogram was defined by visualizing Doppler signals from the bladder to the ureter during the course of bladder filling. RESULTS: Of the 70 ureters assessed, 28 were refluxing on DUS and 29 on VCUG; there were two false-positive and three false-negative results. Comparing the two methods showed DUS to be 90% sensitive with a specificity of 93% for detecting VUR. Four patients underwent reimplantation during their treatment. DUS findings correlated well with standard VCUG in these patient as a method of follow-up. CONCLUSION: DUS can be used as an alternative to standard VCUG for screening and following VUR. In addition, DUS avoids the danger of exposure to ionizing radiation and the unpleasant catheterization that many of these children fear.

Aortic origin of right hepatic artery and superior mesenteric origin of splenic artery: two rare variations demonstrated angiographically.

Anatomical variations of the celiac trunk and superior mesenteric artery are not infrequent. Knowledge of the existing aberrations is important in planning and conducting surgical or radiological procedures. A case of right hepatic artery arising independently from the aorta supplying an hepatocellular carcinoma was identified, through which transarterial chemoembolization was successfully performed. A second case is presented with a common splenomesenteric trunk branching into the splenic and superior mesenteric arteries. These two cases represent exceptional arterial variations in the upper abdomen.