Hydatid cyst of the cardiac interventricular septum: report of two cases.

Cardiac hydatid cysts are rare and represent less than 2% of all hydatid cases. They can occur as part of a widespread systemic infection or as an isolated event. Cardiac hydatid cysts rarely involve the interventricular septum. Here, we present two cases of cardiac hydatid disease in which one patient had the lesion in the interventricular septum and the other in both the interventricular septum and the apex of the heart. A brief overview of the disease and the role of echocardiography, dynamic enhanced multidetector computed tomography (MDCT) and MRI imaging in establishing the diagnosis are discussed.

1H MR spectroscopy evidence for the varied nature of asymptomatic focal brain lesions in neurofibromatosis type 1.

We present the MRI and 1H MR spectroscopy findings in six patients with neurofibromatosis type 1 (NF1) and asymptomatic focal brain lesions. Variations in imaging appearances were seen, including regression of a previously identified lesion. MR spectra for the lesions and corresponding areas of normal brain show significant differences. The lesions could be separated into two groups, one demonstrating only slight metabolite ratio changes relative to normal brain and the other group showing significant increase in choline and decrease in N-acetyl aspartate. The lesion which regressed fell into the second group. These findings are not in agreement with those previously reported and provide evidence for the varied and possibly transient nature of these asymptomatic lesions. The spectroscopy findings suggest that metabolite changes may be present without visible changes on MRI.

Paediatric pyogenic granuloma presenting as a unilateral nasal polyp.

The presence of a rapidly growing intranasal mass in a child is an alarming clinical sign that requires adequate clinical and radiological assessment and prompt histological diagnosis. We present two cases of children with unilateral intranasal pyogenic granulomas. There is only one previous report of this histological diagnosis in the nasal cavity in children. Pyogenic granuloma of the nasal cavity is rare. Pyogenic granuloma should be included in the differential diagnosis of an intranasal mass in the paediatric age group.

Magnetic resonance angiography in the management of aneurysmal subarachnoid haemorrhage: a study of 51 cases.

We report preliminary experience with the use of magnetic resonance angiography (MRA) in the assessment of intracranial aneurysms. The aims of the study were to confirm that aneurysms could be detected and to assess the quality of the images with a view to early surgery if clinically indicated. We studied 51 patients with recent spontaneous subarachnoid haemorrhage with MRA, using a three-dimensional time-of-flight technique. The results of MRA were subsequently confirmed on intra-arterial digital subtraction angiography (IA-DSA) for anatomical correlation, and were considered satisfactory in 38 patients (74.5%). In 20 patients early surgical obliteration of their aneurysm was possible on the MRA results without recourse to IA-DSA. A total of 37 aneurysms were identified in 32 patients, while the remaining 6 patients did not have an aneurysm. MRA was misinterpreted in 4 patients (7.9%), and in 9 other patients (17.6%) MRA was unsatisfactory due to movement artefacts.

Preliminary results of proton magnetic resonance spectroscopy in motor neurone disease (amytrophic lateral sclerosis).

Possible changes in brain metabolites in motor neurone disease/amytrophic lateral sclerosis (MND/ALS) were investigated using 1H magnetic resonance spectroscopy (MRS). A series of normal, healthy volunteer controls and MND patients have been studied using a spin echo (SE) 135 ms sequence, acquiring spectra from the region of the motor cortex. A further limited series of studies have been made for similar groups of volunteers and MND patients using a STEAM 20 ms sequence (stimulated echo). Analysis of the SE 135 ms spectra indicates there are statistically significant differences in the ratios of N-acetyl-aspartate to creatine and N-acetyl-aspartate to choline between controls and MND patients. Furthermore, metabolites identified using the STEAM 20 ms may be of great importance in the investigations of free radical mediated mechanisms, which have been postulated as being important contributors to the disease process. Preliminary results indicate that 1H MRS may provide important data to help understand the disease processes in MND and it could form a useful method for monitoring the effects of future trial treatment regimens.

A comparison of two sedation techniques for neuroradiology.

Two groups of 25 patients were sedated during neuroradiological investigation. The first group was sedated with fentanyl and midazolam while the other was given fentanyl and a two-stage infusion of propofol in a subanaesthetic dose. Both techniques resulted in satisfactory sedation and recovery, although those who received propofol were more likely to recall their journey from the X-ray department back to the ward. Sedation in both groups resulted in unacceptable PaO2 values in some patients which could subsequently be corrected by administration of supplementary oxygen.