Coil embolization of a solitary congenital intrahepatic hepatoportal fistula.

Congenital hepatic artery-to-portal vein fistula, a rare type of arteriovenous malformation that may be intrahepatic or extrahepatic, is an uncommon cause of severe infantile portal hypertension. Many researchers believe that acquired intrahepatic arterioportal fistulas are best treated by embolization and that extrahepatic arterioportal fistulas require surgical intervention. The experience with congenital intrahepatic arterioportal fistulas is very limited and has required both embolization and surgical intervention. We report a case of solitary congenital arterioportal fistula successfully treated with coil embolization.

Acute disseminated encephalomyelitis and multiple sclerosis: magnetic resonance imaging differentiation.

The study was undertaken to compare the MR imaging features of acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) in a country with a high prevalence of ADEM. Magnetic resonance scans from 33 patients diagnosed clinically with MS (14 patients) or ADEM (19 patients) were reviewed concurrently by two radiologists blinded to the clinical diagnosis. The size, site, morphology and pattern of brain and spinal cord involvement were recorded and the MR imaging diagnosis was compared with the clinical diagnosis. The MR imaging findings matched with the clinical diagnosis in 11 of 14 patients with MS (sensitivity = 78.6%), and with the clinical diagnosis in 15 of 18 patients with ADEM (sensitivity = 78.9%). Three patients had non-specific findings and in a further three patients discordant imaging features were present. One patient with imaging features typical of Balo's concentric sclerosis was diagnosed clinically as suffering from ADEM. In a country with a high prevalence of ADEM, the majority of patients with ADEM and MS can be differentiated on MR imaging.

Vesical varix in cirrhosis of liver.

Vesical varices in portal hypertension are rare. We report a patient with portal hypertension who developed recurrent painless hematuria. Cystoscopy was normal. Doppler ultrasound and MR angiography showed a dilated paraumbilical vein within the falciform ligament coursing down to the urinary bladder wall and draining into the right internal iliac vein. He underwent liver transplantation for decompensated chronic liver disease. He is in good health and has not had further episodes of hematuria.

Cysticercosis of the cerebellopontine angle cistern mimicking epidermoid inclusion cyst.

We report a case of a cystic lesion in the left cerebellopontine (CP) angle cistern. The magnetic resonance (MR) imaging features closely resembled an epidermoid inclusion cyst, and was interpreted as such. However, at surgery and on histopathological examination the lesion was found to be a cysticercus cyst. It may be impossible to distinguish between the two by imaging. The MR imaging findings of cysticercosis, epidermoid and other common differentials are discussed.

Acquired dural fistulae in benign intracranial hypertension: a short case report.

Venous sinus thrombosis has been regarded as a known cause of intracranial hypertension. We report a case of long-standing raised intracranial hypertension (ICT) that presented with deteriorating vision in both eyes. Magnetic resonance (MR) imaging of the brain and cerebral angiography showed blockage of superior saggital sinus and sigmoid sinuses with bilateral dural arteriovenous fistulae (DAVF) formation.

Balo's concentric sclerosis: value of magnetic resonance imaging in diagnosis.

We report two cases of Balo's concentric sclerosis that demonstrate the typical magnetic resonance imaging (MRI) findings of concentric rings of demyelination involving the superficial and deep white matter and sparing the cortex. In both cases biopsy was not performed as MRI findings and multi-mode evoked potential studies were consistent with demyelinating illness. The theories regarding the pathogenesis of this peculiar appearance are briefly reviewed.

Pulmonary hydatid disease mimicking sequestration: differentiation on magnetic resonance imaging.

A case of hydatid disease of the lung proven by thoracotomy and histopathological evaluation is described. It was clinically and radiologically suggestive of a complicated pulmonary sequestration or non-resolving consolidation.

Subacute sclerosing panencephalitis : CT and MR imaging in a rapidly progressive case.

We report the findings on CT and MR imaging in a patient with rapidly progressive subacute sclerosing panencephalitis (SSPE), which correlated with the clinical progression of the disease. In view of the rapid neurological deterioration and CSF pleocytosis, a brain biopsy was done and this confirmed the diagnosis.

Sacral hydatidosis: value of MRI in the diagnosis.

We present a case of primary hydatid disease of the sacrum. The diagnosis was made on MR imaging obtained to evaluate the spine for recurrent disc disease. The patient had previously undergone laminectomy elsewhere for L4-5 radiculopathy. Ultrasound-guided aspiration and visualisation of scolices confirmed the diagnosis. No other site of involvement was found.

Curvilinear reconstruction of 3D magnetic resonance imaging in patients with partial epilepsy: a pilot study.

In an attempt to better delineate the abnormalities associated with focal cortical dysgenesis, we performed curvilinear reformatting of the cortex from 3D magnetic resonance (MR) images. Illustrative patients with partial seizures and conventional orthogonal MRI evaluation show that small regions of cortical thickening suggestive of focal dysplastic lesions may not be recognized. In three such patients the curvilinear reformatting demonstrated two additional focal abnormalities of the cortical gyri and better defined the two focal lesions found on conventional orthogonal MR images. This method promises to be a useful tool in the evaluation of epileptic patients with proven or suspected subtle structure cortical abnormalities, particularly focal neuronal migration disorders where cortical thickening, abnormal gyral pattern, and poor delineation of the gray-white matter transition are the main findings.