Synchronous Volvulus of the Transverse Colon and Cecum Associated with Scleroderma and Lupus.

Colonic volvulus may infrequently occur in the transverse colon, and synchronous double volvulus is a rarely reported phenomenon in the literature. Additionally, intestinal volvulus is a rare but serious complication that has been reported in scleroderma and systemic lupus erythematosus (SLE) patients. We report a 26-year-old patient with a history of scleroderma-SLE overlap syndrome who presented with an acute abdomen. CT imaging revealed a transverse colon volvulus and a cecal bascule (cecal volvulus). To our knowledge, this is the first reported case of synchronous double volvulus of the transverse colon and cecum. Additionally, this is the second reported case of transverse colon volvulus occurring in a patient with scleroderma and the first case in a patient with scleroderma-SLE overlap syndrome.

Nodular fasciitis: characteristic imaging features on sonography and magnetic resonance imaging.

OBJECTIVES: The purpose of this study was to evaluate the imaging features of nodular fasciitis on sonography and magnetic resonance imaging (MRI). METHODS: A retrospective search of the radiologic and pathologic databases over the past 10 years for the diagnosis of nodular fasciitis was performed. Sonographic and MRI features were described. Pathologic specimens were reviewed. RESULTS: Six pathologically confirmed cases of nodular fasciitis were found. The mean patient age was 19.5 years (range, 8-33 years); 3 patients were male and 3 were female. Four patients had sonography only; 1 patient had both sonography and MRI; and 1 patient had MRI only. Three masses were located in the subcutaneous tissue adjacent to fascia; 2 were at the subcutaneous/muscular border; and 1 was intramuscular; however, all were in contact with fascia and showed a fascial tail on sonography and MRI. On sonography and MRI, masses were oval with poorly defined lobulated borders, averaging 2.6 cm (range, 1.8-3.5 cm). On sonography, all masses were hypoechoic. On MRI, the masses were isointense to muscle on T1-weighted sequences, hyperintense to muscle on fluid-sensitive sequences, and enhanced avidly but heterogeneously. The masses were surrounded by fat. CONCLUSIONS: When a rapidly growing oval mass in contiguity with a fascial plane is recognized, the diagnosis of nodular fasciitis should be entertained. More importantly, the possibility of an inaccurate diagnosis by core biopsy exists, which may warrant gross resection.

Orientation of lipid strands in the extracellular compartment of muscle: effect on quantitation of intramyocellular lipids.

Single-voxel (1)H NMR spectra from gastrocnemius and soleus muscle were acquired in healthy volunteers at 7T with the objective of measuring the concentration of intramyocellular lipid [IMCL] (note: throughout this article, square brackets indicate concentration). However, significant asymmetry in the resonance assigned to the methylene protons (-CH(2)-)(n) in extramyocellular lipids (EMCL) interfered with fitting the spectra. Since muscle fibers in these tissues are generally not parallel to B(0), the influence of variable orientation in strands of extracellular fat was examined using a mathematical model. Modest variation in orientation produced asymmetric lineshapes that were qualitatively similar to typical observations at 7T. Analysis of simulated spectra by fitting with a Voigt function overestimated [IMCL]/[EMCL] except when EMCL fibers were nearly parallel to B(0). Estimates of [IMCL]/[EMCL] were improved by including variations in fiber orientation in the lineshape analysis (fiber orientation modeling, or FOM). Calculated [IMCL] using FOM, 4.8 +/- 2.2 mmol/kg wet weight, was lower compared to most previous reports in soleus.