Multiple system atrophy-cerebellar: A case report and literature review.

We reported a case of a 48-year-old female patient admitted to the hospital due to balance disorder which progressed rapidly within 1 week. Cerebral magnetic resonance imaging showed significant atrophy and hyperintensities at the middle cerebellar peduncles and the "hot cross bun" sign of the pons. The final diagnosis was probable multiple system atrophy, cerebellar subtype. The clinical and imaging findings will be discussed as well as a brief literature review.

Magnetic resonance imaging as a first-choice imaging modality in carpal tunnel syndrome: new evidence.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common type of peripheral nerve compression. Magnetic resonance imaging (MRI) is becoming more popular in practice in the evaluation of CTS. PURPOSE: To evaluate the diagnostic value of MRI in CTS. MATERIAL AND METHODS: A cross-sectional study of 39 wrists was conducted. Clinical and nerve conduction study findings were evaluated and graded according to the Boston Carpal Tunnel Questionnaire (BCTQ) and the American Association of Neuromuscular and Electrodiagnostic Medicine. MRI was performed using a 1.5-T scanner. MRI parameters included cross-sectional area (CSA) of the median nerve and the ratio change in CSA at four levels: distal radioulnar joint (DRUJ-CSA); pisiform (p-CSA); middle of the carpal tunnel (i-CSA); and hook of hamate. The ratio change in CSA was expressed as p-CSA/DRUJ-CSA and ΔCSA (difference between iCSA and DRUJ-CSA), the flattening ratio of the median nerve, the thickness of the flexor retinaculum, flexor retinaculum bowing ratio, signal intensity ratio of the median, nerve and hypothenar muscle signal intensity. RESULTS: With a cutoff point of 10.9 mm2 of the p-CSA, MRI had a sensitivity and specificity of 97.4% and 80% for diagnosis of CTS, respectively. There was a significant association between the clinical and electrophysiological stage with MRI findings (P < 0.001). There was a positive correlation between the BCTQ score and MRI parameters (0.5 < r < 0.7, P < 0.01). CONCLUSION: MRI has good diagnostic value in evaluating CTS. We recommend using p-CSA ≥10.9 mm2 and ΔCSA ≥2.3 mm2 as MRI diagnostic criteria of CTS.

Complicated breast augmentation via self-injection of ultrasound gel and shoe glue: A case report.

Various types of dermal fillers have been developing for soft tissue augmentation. Even though many fillers have been approved and strictly regulated by authorities, homemade products for body contouring procedures are widely available and easily purchased on websites without prescriptions. It is challenging for radiologists to interpret radiological findings of complicated breast augmentation of unknown origin. While ultrasound is the modality of choice for initial work-up, magnetic resonance imaging (MRI) plays a role as the gold standard in evaluating the integrity of prosthetic implants. Using silicone or water-only MRI sequences may also be able to distinguish them. We report a rare case of breast abscess of a young female patient after self-injection of the mixture of ultrasound gel and shoe glue. The clinical and imaging aspect, especially MRI imaging, will be discussed.

Hereditary multiple exostoses: A case report and literature review.

Osteochondroma is the most common bone tumor representing 20%-50% of all benign bone tumors and 10%-15% of all bone tumors. Osteochondroma has similar radiological appearance in both solitary and multiple forms; the latter is an autosomal dominant disorder termed hereditary multiple exostoses. Associated complications of osteochondroma include deformity, fracture, neurovascular compromise, bursa formation, and malignant transformation. Measurement of the cartilage cap thickness is an important index suggesting secondary malignancy of osteochondroma. The upper limit of cap thickness after skeletal maturation is 1.5 cm which can be reliably measured on ultrasound or magnetic resonance imaging. Hereditary multiple exostoses are linked to the mutations of different exostoses genes located on chromosome 8, 11, and 19. We reported cases of two siblings presented with multiple osteochondromas managed by surgical excision. We evaluated their clinical and radiological presentation, genetic correlations and compared with the literature.

Isolated arterial pulmonary malinosculation without sequestration in an adult: A case report and literature review.

Abnormal connections between systemic and pulmonary vascular systems are rare conditions and have been mostly documented in the pediatric population. We report a case of type B isolated arterial pulmonary malinosculation in an adult. The patient's chief complaint was intermittent hemoptysis during physical exertion. He had a dual arterial supply from the anomalous systemic artery and the pulmonary artery to the left lower lobe and the venous drainage was through the pulmonary vein. The bronchial connection appeared normal. The fistula was identified on chest computed tomography and was treated endovascularly. The patient remains asymptomatic at 1-year follow-up.

Giant lumbar spinal schwannoma: a case report and literature review.

We report a case of a 40-year-old female patient admitted to the hospital due to lumbar pain that spread to both legs and was associated with weakness of the lower extremities. Magnetic resonance imaging revealed an intradural - extramedullary tumor at the level of the T12 - L2 vertebra. The lesion was over 7 cm in greatest diameter and compressed the conus medullaris. The patient underwent surgery to remove the entire tumor. Postoperative pathology confirmed the diagnosis of schwannoma. The symptoms resolved almost completely without significant complications.

Synchronous Renal Cell Carcinoma and Hepatocellular Carcinoma.

The coexistence of multiple synchronous primary malignancies is uncommon. The coexistence of hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) is even rarer. We present a case of a 44-year-old male patient with a history of chronic hepatitis B and a right renal mass treated by radical nephrectomy. At the 2-month follow-up, a new lesion was detected in the left lobe of the liver. Postsurgery histologic evaluation with immunohistochemical study of both lesions confirmed the renal and hepatic lesions to be RCC and HCC, respectively.

Evaluation of the Insall-Salvati Ratio Among the Vietnamese Population: Application for Diagnosis of Patellar Malalignment.

INTRODUCTION AND PURPOSE: An abnormal patellar position has been proven to be associated with anterior knee pain and several other conditions that affect the patellofemoral joint. The purpose of this study was to determine the incidence of patella alta and patella baja and the applicability of the normal range of the Insall-Salvati ratio in the Vietnamese population. METHODOLOGY: Magnetic resonance imaging (MRI) was used to examine 455 Vietnamese subjects' knees. The Insall-Salvati ratio-the ratio of patellar ligament length (LL) and patellar length (PL)-was measured using sagittal T1-weighted images. RESULTS: The overall mean LL/PL ratio was 1.02 (standard deviation 0.15). No significant differences in the LL/PL ratio were observed between sexes. The frequencies of patella alta (Insall-Salvati ratio >1.32) and patella baja (Insall-Salvati ratio <0.72) were 0.9% and 2.4%, respectively. CONCLUSION: The Insall-Salvati ratio is applicable to Vietnamese populations in which high flexion activities such as kneeling and sitting cross-legged are customary. According to our measurement, the normal range of the ratio among Vietnamese subjects was 0.72 to 1.32.

Cerebral venous thrombosis: report of 2 cases of hemorrhagic venous infarction.

Cerebral venous thrombosis (CVT), a rare but potentially severe cerebrovascular disease, is defined as the thrombosis of a cortical or deep cerebral vein, or a cerebral venous sinus. This article reports 2 cases of CVT. In the first case, the patient is a 40-year-old woman with a history of 2 miscarriages, using oral contraception and presenting intense headache, cervical irradiation, and drowsiness. The second case reports a 43-year-old woman with a history of Crohn disease and daily use of oral contraception, presenting headache, neck pain, and hypersensitivity to noise and light. Noncontrast CT, CT venography, magnetic resonance imaging (MRI) and MR venography (MRV), first-line noninvasive diagnostic modalities in clinical practice, led us to the diagnosis of CVT: hypoplastic lateral sinus CVT in the first case and deep cerebral vein CVT complicated by hemorrhagic infarction in the second case. The early diagnosis of CVT is extremely important, but often a challenge due to highly variable clinical presentation and radiographic findings. MRI and the MRV play a crucial role in case of anatomical variant and in better assessing the extension of thrombus, as well as parenchyma involvement and complications.