Delayed presentation of a traumatic diaphragmatic rupture with intrapericardial herniation.

Thoracic and abdominal blunt traumas are the major causes of diaphragmatic rupture. These ruptures may be recognized at the time of the initial trauma, but are diagnosed months or even years later during the workup for related symptoms. We present herein a patient who suffered from abdominal pain and dyspnea years after a motor vehicle accident. A chest computed tomography (CT) demonstrated diaphragmatic rupture with intrapericardial herniation of intraabdominal organs. Exploratory laparotomy confirmed the diagnosis. In this report, we describe our management of this unusual diaphragmatic rupture.

Septic pulmonary embolism: three case reports.

We present three cases of septic pulmonary embolism which occurred as a result of three different causes. The first case, was a 23 year old woman suffering from cough, sputum, hemopthisis and pleuritic chest pain. She had a right subclavian port. On her thorax computed tomography (CT) scans there were widespread bilateral, irregular parenchymal nodular infiltrates and some of them beginning to cavitate. Meticilin resistant stafilococus aureus (MRSA) was isolated from the blood culture and septic embolism was diagnosed. A month after antibiotic theraphy her parenchymal nodules have considerably decreased in size. The second case was a 40 year old woman admitted to our hospital with the same complaints. Her radiological findings were similar. Meticilin sensitive stafilococus aureus (MSSA) was isolated from the blood cultures and antibiotic theraphy was initiated. To investigate the etiology of the nodules due to septic embolism, echocardiography was performed and infective endocarditis was diagnosed. After the antibiotic theraphy and a tricuspid valve operation her parenchymal nodules disappeared. The final case involved a 51 year old man suffering from fever, fatigue, cough and pain in the left arm for one week. His general status was bad. His radiological findings were also similar to the others. Staphillococcus aureus was isolated from blood and wound culture. Following clinical and radiological findings we thought it was a case of septic pulmonary embolism and antibiotic theraphy was started. Despite the therapy we did not take fever response and he died five days after antibiotic therapy. In conclusion, septic pulmonary embolism should be considered in bilateral cavitary nodular infiltrates and must be managed fast.

Intracranial lipoma with extracranial extension through foramen ovale in a patient with encephalocraniocutaneous lipomatosis syndrome.

We present CT and MR features of a large intracranial lipoma located in the left sphenocavernosal region in a patient with a history of spinal intradural lipoma excision. The lipomatous lesion surrounded the internal carotid artery and trigeminal nerve and extended extracranially into the infratemporal region through a smoothly dilated foramen ovale.

A rare cause of cervical spinal stenosis: posterior arch hypoplasia in a bipartite atlas.

We describe CT and MRI of a previously unreported combination of atlantoaxial anomalies consisting of posterior arch hypoplasia in a bipartite atlas with an os odontoideum, in a 30-year-old woman presenting with neck and left arm pain. MRI showed the os odontoideum, marked stenosis of the spinal canal at the level of the atlas, with cord compression and evidence of myelopathy. CT revealed a bipartite atlas with midline clefts in anterior and posterior arches, thickening in the anterior arch and hypoplasia of the posterior arch with incurving of both hemiarches. Flexion and extension radiographs demonstrated atlantoaxial instability.

Frontal sinus mucocele: a rare complication of craniofacial fibrous dysplasia.

We present plain radiographic, computed tomographic and magnetic resonance imaging (MRI) findings in a 25-year-old female patient with craniofacial fibrous dysplasia (FD). Although FD has a tendency to involve craniofacial bones in a unilateral fashion, the involvement was bilateral and extensive in this case. An additional feature was the presence of a frontal sinus mucocele, presumably due to the involvement of the sinus recess by the dysplastic process. This complication of the craniofacial FD has been reported very infrequently in the literature.

Sonographic findings in ectopic cervical thymus in an infant.

We present the case of a 28-day-old boy with ectopic thymic tissue in the neck. Sonography showed a well-delineated, homogeneous lesion in the left submandibular region that was isoechoic relative to the mediastinal thymus. The lesion had angular margins and lacked a mass effect despite its large size (3 x 2 cm). On power Doppler imaging, arteries with an intermediate-impedance flow pattern were seen entering the lesion from the inferior and lateral margins. On both T1- and T2-weighted MR images, the lesion was isointense relative to the mediastinal thymus and had higher and lower signal intensity than muscle and fat, respectively. A sonographically guided needle biopsy confirmed the diagnosis of ectopic thymus.

Gadolinium-enhanced three-dimensional MR angiography in jugular phlebectasia and aneurysm.

True jugular vein aneurysms and phlebectasias are very rare abnormalities, which are usually discovered in children. Though their ultrasonographic features have been well described, magnetic resonance angiographic appearance of these lesions has not been reported in the radiology literature. We describe gadolinium-enhanced MR angiographic findings in two patients with internal jugular vein phlebectasia and one patient with anterior jugular vein aneurysm. The jugular venous system and its abnormalities were successfully depicted in the coronal plane, much like the images of coronal angiography.

Radiographic, CT, and MRI findings in primary pulmonary angiosarcoma.

We report a rare instance of primary pulmonary angiosarcoma presenting as a large solitary mass in the left upper lobe with mediastinal invasion. In particular, we emphasize the magnetic resonance (MR) imaging features, which included a markedly heterogeneous pattern consisting of hyperintense areas scattered throughout a background of intermediate signal intensity, rendering the lesion a cauliflower-like appearance especially on T2-weighted images. Being unreported so far in primary pulmonary angiosarcomas, these distinct MR imaging findings may be helpful in the differentiation of these neoplasms from lung cancers.

Gray-scale and color Doppler sonographic findings in intratesticular varicocele.

PURPOSE: We studied the gray-scale and color Doppler sonographic findings in intratesticular varicoceles in 7 testes in 5 patients. METHODS: The study group comprised 5 infertile men referred for scrotal sonography and found to have intratesticular varicocele. Patients were examined at rest and during Valsalva's maneuver in supine and standing positions. A diagnosis of intratesticular varicocele was made when intratesticular veins visible on gray-scale sonography showed retrograde flow on color Doppler sonography either spontaneously or during Valsalva's maneuver. The maximum diameter of dilated intratesticular veins and the predominant site of venous dilatation (mediastinum testis versus subcapsular) were recorded. RESULTS: Seven testes in 5 patients harbored visibly enlarged intratesticular veins that showed retrograde flow either spontaneously or during Valsalva's maneuver. The condition was bilateral in 2 patients and left-sided in 3 patients. The largest intratesticular vein measured less than 2.0 mm in diameter in 3 testes and was 2.0 mm or larger in 4 testes. In all affected testes, there was some degree of subcapsular venous dilatation, which in 3 testes was even more prominent than venous dilatation in the mediastinum testis. All intratesticular varicoceles were accompanied by extratesticular varicoceles. CONCLUSIONS: A threshold value of 2.0 mm seems inadequate for the diagnosis of intratesticular varicocele because obviously variceal venous structures with retrograde flow on color Doppler sonography may be smaller than 2.0 mm in diameter. Contrary to the previous descriptions of the entity, subcapsular veins may be affected to a greater degree than mediastinal veins in intratesticular varicocele.

Cross-sectional imaging in ureter tumors: findings and staging accuracy of various modalities.

We present cross-sectional imaging findings in eight patients with ureter tumors. Eight patients were examined by computed tomography (CT), seven by ultrasonography (US), and five by magnetic resonance imaging (MRI). All the lesions were detected by the three modalities. All modalities were accurate in excluding the periureteral invasion and lymphadenopathy in Stages 1 and 2 tumors. While CT and MRI identified the periureteral invasion and lymphadenopathy in four patients with advanced tumors, US failed to show the local invasion in three of four patients. Nevertheless, enlarged retroperitoneal lymph nodes could be detected sonographically in the three Stage 4 tumors. CT and MRI appear to have a high diagnostic sensitivity and staging accuracy in ureter tumors. Although US detects ureter tumors efficiently, this technique seems to be unreliable in showing local invasion in a substantial number of patients.

Post-traumatic intrasplenic pseudoaneurysms with delayed rupture: color Doppler sonographic and CT findings.

Post-traumatic intrasplenic pseudoaneurysms are very rare in children. Since pseudoaneurysms may expand a splenic hematoma and cause delayed splenic rupture, early diagnosis and treatment are crucial. In this report, we describe the case of a 12-year-old boy with a delayed splenic rupture caused by a splenic hematoma containing 2 pseudoaneurysms. Abdominal sonography showed free intraperitoneal fluid and a mildly enlarged spleen with a large heterogeneous area occupying the upper half of the organ. Two anechoic lesions (15 and 4 mm) were seen inside the hematoma near the splenic hilum. Color Doppler sonography demonstrated turbulent arterial flow within the lesions, suggesting pseudoaneurysms. On CT, the lesions enhanced simultaneously with the splenic artery in the arterial phase of contrast enhancement. CT also showed an intrasplenic arterial branch leading to the larger of the 2 pseudoaneurysms.

Psoas abscess secondary to tuberculous lymphadenopathy: case report.

Tuberculous psoas abscesses, a well-known sequel of tuberculous spondylitis, very rarely develop without concomitant spinal involvement. We report a unique case where a psoas abscess was secondary to retroperitoneal tuberculous lymphadenopathy in a 13-year-old boy who had no demonstrable findings of spinal tuberculosis. Computed tomography showed an obvious communication between the necrotic and calcified retroperitoneal lymph node and the psoas abscess. To the best of our knowledge, fistulization of tuberculous lymph nodes into the psoas sheath has not been reported in the English-language literature.

Tuberculous fibrosing mediastinitis: CT and MRI findings.

Fibrosing mediastinitis is a rare entity usually caused by granulomatous disease. Most cases develop as a complication of histoplasmosis. Mediastinal involvement caused by tuberculosis most often produces focally enlarged lymph nodes, with diffuse mediastinal involvement a very unusual manifestation of disease. The authors describe a patient with extensive tuberculous fibrosing mediastinitis, in whom fibrotic masses produced compression of airways and vascular structures with resultant parenchymal changes.

Three-dimensional CT of congenital esophageal atresia and distal tracheoesophageal fistula in neonates: preliminary results.

OBJECTIVE: Radiography was traditionally used in the preoperative treatment of neonates with tracheoesophageal atresia and tracheoesophageal fistula. The aim of this study was to assess the potential use of three-dimensional CT in the evaluation of this complex congenital malformation. CONCLUSION: Three-dimensional CT coupled with reformations in the three orthogonal planes may have a complementary diagnostic role in congenital esophageal atresia.

MR cholangiography in massive hepatobiliary ascariasis. A case report.

The ultrasonographic and MR cholangiographic findings in a patient with massive hepatobiliary ascariasis are described.

Radiologic findings in primary pulmonary leiomyosarcoma.

Leiomyosarcomas are uncommon smooth muscle tumors most commonly encountered in the female genital organs, gastrointestinal tract, and soft tissues. They are rarely encountered as primary pulmonary neoplasms. Herein we describe the conventional radiographic and computed tomographic findings in a patient with a pulmonary leiomyosarcoma.

Focal intrahepatic extramedullary hematopoiesis: color Doppler US and CT findings.

Focal intrahepatic extramedullary hematopoiesis is an extremely unusual condition that can mimic any other solid mass of the liver. Only seven cases have been reported in the literature. Color Doppler ultrasonographic findings of this rare entity have not been described. We report a case of focal mass in a myeloid metaplastic patient diagnosed as focal extramedullary hematopoiesis. Color Doppler findings of this rare condition are described and compared with computed tomography features.

Multimodality demonstration of primary splenic angiosarcoma.

Angiosarcomas are rare, accounting for only 1-2% of all soft tissue sarcomas. Primary abdominal angiosarcomas usually arise in the liver or spleen. We report the first color Doppler findings of a rare, low-grade splenic angiosarcoma in a 52-year-old woman.