Imaging Findings of Angiomyxolipoma of the Spermatic Cord Mimicking Inguinal Hernia

We report the case in a 72-year-old man who presented with a right inguinal mass and with a one month history that was initially interpreted as an inguinal hernia. Ultrasonography (US) and computed tomography (CT) demonstrated a right inguinal mass, including myxoid and fat component, extending from the right spermatic cord to the right inguinal subcutaneous layer. Mass excision was performed, and the diagnosis turned out to be angiomyxolipoma. Angiomyxolipoma is a rare tumor and the preoperative diagnosis of this disease is very difficult. However, angiomyxolipoma of the spermatic cord should be considered in the differential diagnosis in patients with an irreducible inguinal mass. Imaging diagnosis, such as US and CT may help to make a preoperative diagnosis.     

Mirror-image right aortic arch: A proposed mechanism in symptomatic vascular ring

We describe a rare case of right aortic arch with mirror-image branching and a left ductus arteriosus that form an anomalous vascular ring. The unusual feature of this symptomatic vascular ring is presence of a left (posterior) circumflex descending aorta in lieu of an aortic diverticulum which usually represents the posterior element of the vascular ring associated with right aortic arch and mirror-image branching. This we believe is the seventh reported case of Type 1 right aortic arch and only the third such case with a left circumflex descending aorta. Accurate diagnosis was made by barium esophagogram and angiocardiogram and was confirmed surgically. We propose a new theory as to why some vascular rings formed by the right aortic arch are symptomatic while others are not.     

Visualization of right atrial thrombus associated with constrictive pericarditis by indium-111 oxine platelet imaging

A right atrial thrombus is not often seen and only a few reports of visualization have been described. We report a 44-yr-old man who had a large atrial thrombus associated with constrictive pericarditis. Two-dimensional echocardiography and computed tomography showed a large right atrial mass. Indium-111 oxine platelet deposition was demonstrated on the surface of thrombus by platelet imaging. Platelet imaging was useful for differential diagnosis from cardiac tumor, and as an indication for surgical treatment, since right atrial thrombus may have a high risk of pulmonary embolism or severe right heart failure.     

Use of the right external jugular vein as the preferred access site when the right internal jugular vein is not usable

PURPOSE: The present study describes the authors' experience with central venous access through the right external jugular vein (EJV) when the right internal jugular vein (IJV) is not available. MATERIALS AND METHODS: A retrospective study of 23 patients in whom a central venous catheter placement was attempted via the right EJV was conducted. The reasons for catheterization via the right EJV included clinically silent occlusion of the right IJV (n = 17), localized skin infection overlying the right IJV related to a previous catheterization (n = 3), presence of an existing Hickman catheter in the right IJV (n = 1), and concern regarding the risk of catheter-related infection secondary to right IJV catheterization in patients with a tracheostomy tube device adjacent to the presumed site of right IJV catheterization (n = 2). Technical success, procedural complications, and follow-up results including catheter dwell time and delayed or late complications (eg, symptomatic venous thrombosis, catheter-related infection, and catheter malfunction) were assessed. Adverse events were expressed as events per 100 catheter-days of use. RESULTS: Technical success was achieved in 22 of 23 patients (96%). There were no procedural complications. The catheter dwell time ranged from 2 to 182 days, with a mean dwell time of 62.7 days. There were four delayed or late complications (three catheter-related infections, 0.22 per 100 catheter-days; one catheter malfunction, 0.07 per 100 catheter-days). No cases of symptomatic venous thrombosis were noted. CONCLUSION: The right EJV is an acceptable and preferred access site when the right IJV is not available for central venous catheterization.     

Metastatic thyroid carcinoma causing superior vena caval obstruction diagnosed on I-131 scan

An 80-year-old woman was referred for a painless mass arising in right side of her neck of 4 months' duration. Ultrasound revealed a multinodular goiter, but cytology confirmed a follicular carcinoma. Thyroid function was normal. Total thyroidectomy was performed with evidence of tumor infiltration into the strap muscles extending up to the right submandibular gland and right internal jugular vein, which was completely occluded. Radioiodine was considered as the treatment of choice postoperatively. This is an unusual case of SVC obstruction caused by tumor embolus diagnosed on I-131 scan.     

对人脑执行功能激活区域间关系的因果分析研究

目的 探讨任务状态下注意网络中执行功能的脑激活状态,以及激活区域间的因果关系.方法 利用GE公司Signa1.5T磁共振成像系统,采用注意网络实验范式,对15例（男性8例,女7例）健康受试者在任务态下进行功能磁共振扫描,根据激活位置选取感兴趣区,利用系数Granger因果分析方法计算每两个感兴趣区之间的Granger因果关系,生成Granger因果数据,利用SPSS 18.0软件对所得数据进行统计分析.结果 被试的行为学数据符合实验需要,激活区域为前扣带回、背外侧前额叶皮质、右顶上小叶、右顶下小叶.Granger因果分析结果显示前扣带回与背外侧前额叶皮质构成因果关系,背外侧前额叶皮质、右顶上小叶、右顶下小叶构成因果关系并形成单向回路.结论 在注意网络实验范式下,执行功能是由前扣带回、背外侧前额叶皮质、右顶上小叶、右顶下小叶共同参与完成的,其中前扣带回主要功能为发现冲突,而背外侧前额叶及其所形成的单向环路主要功能为解决冲突.     

Metastatic renal cell carcinoma manifesting as a nasal mass: CT findings

The clinical and radiological findings in a 71-year-old woman with a metastatic renal cell carcinoma to the right nasal cavity are presented. The kidney tumor manifested clinically as epistaxis. Computed tomography revealed an expansile lesion in the right nasal cavity with extension to the right antrum, right ethmoid sinus, and left nasal cavity. There was no lytic bone destruction, but there was displacement of bone caused by the expansile tumor mass.     

Aggressive intraabdominal fibromatosis

BACKGROUND: Intraabdominal or mesenteric fibromatosis is a rare benign nonmetastatic neoplasm that appears as a sporadic lesion or in patients with familiar polyposis. Its evolution is unpredictable. About 10% of the cases shaw a very aggressive growth. CASE REPORT: We presented a 22-year-old woman in whom an aggressive intraabdominal fibromatosis had appeared during the first pregnancy as a well circumscribed ovoid tumor, involving the terminal ileum, the caecum, the ascending colon, the right kidney, the ureter, and the right common iliac artery. The tumor was excised with right colectomy, nephroureterectomy and resection of the involved artery using arterial reconstruction with graft interposition. Two years after the surgery the patient developed an inoperable tumor recurrency with a fatal outcome. CONCLUSION: In spite of a successful surgical excision during the original surgery intraabdominal or mesenteric fibromatosis might have an aggressive evolution leading to an inoperable tumor recurrency and a fatal outcome.     

A case of right double inferior vena cava with circumcaval ureter

Congenital inferior vena cava (IVC) anomalies are silent and detected incidentally on imaging. Double IVC is the most common IVC anomaly and is usually characterized by the presence of an IVC on each side of the abdominal aorta. In contrast, right double IVC, which is defined as two post-renal IVCs positioned to the right of the abdominal aorta, is seldom recognized. We report a rare case of a complete right double IVC with a circumcaval ureter that was incidentally detected by CT and describe the embryological and clinical implications.     

Upper pole of a duplex kidney mimicking adrenal incidentaloma in 18F-fluoro-2-deoxy-D-glucose positron emission tomography: a pitfall in diagnosis

18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has proved to be valuable in the diagnosis and management of a variety of malignancies, but is still limited in providing detailed anatomical information. According to the literature, an adrenal incidentaloma with high FDG uptake usually indicates malignancy and requires further investigation. However, accurate localization of the adrenal gland in FDG-PET is difficult without the presence of surrounding well-visualized organs, such as the kidney or liver. If these organs have a congenital anomaly or are altered due to a previous operation, misdiagnosis can occur. We present a case with right partial duplex kidney accompanied by abnormal urine retention in the upper pole, which was misinterpreted as an adrenal incidentaloma in FDG-PET. A subsequent CT scan revealed a normal right adrenal gland, but a right partial duplex kidney. Fusion of the PET and CT images showed that the right adrenal lesion seen in the PET image corresponded to the upper pole of the duplex kidney.     

Giant right atrium after mitral valve replacement: plain film findings in 15 patients

We reviewed the radiographs of 166 patients who had undergone mitral valve replacement and found 15 (9%) with giant right atrium. It was confirmed in 13 cases by angiography and/or echocardiography. It was proved at autopsy in one case and confirmed by a Swan-Ganz catheter delineating the lateral right atrial wall in another case. Tricuspid insufficiency of varying severity was present in all patients. Progressive bulging of the right heart border on frontal radiographs and an anterior masslike density on lateral radiographs were the important findings. The bulging right heart border was seen in all 15 patients. The anterior masslike density was noted in seven of nine patients with lateral radiographs; its upper border was sharp in four and indistinct in three. Giant right atrium may be misdiagnosed as pleural effusion, pericardial effusion, and mediastinal neoplasm. Correct diagnosis is important so that unnecessary procedures are not performed.     

Efficacy of the left gastric artery as a route for catheterization of the right gastric artery

OBJECTIVE: Our aim was to evaluate the efficacy of the left gastric artery as a route for embolization of the right gastric artery before port-catheter implantation for hepatic artery infusion chemotherapy. MATERIALS AND METHODS: In 88 patients (61 men and 27 women; mean age, 63.4 years; range, 25-83 years) with unresectable advanced liver cancer, retrograde catheterization of the right gastric artery through the left gastric artery was performed to embolize the right gastric artery. RESULTS: The right gastric artery was successfully catheterized and embolized in 79 patients (89.8%). In two of the nine patients in whom the procedure was not successful, we found that no right gastric artery existed after we succeeded in retrograde advancement of the microcatheter toward the hepatic site. The only procedure-related complication was misplacement of a microcoil into the hepatic artery site in two patients. CONCLUSION: The left gastric artery is an appropriate route for selective embolization of the right gastric artery as preparation for long-term hepatic artery infusion chemotherapy.     

Systemic plumbism following remote ballistic injury

We report an unusual case of systemic lead poisoning, i.e., plumbism, following a remote gunshot injury to the right femur. Plumbism is a rare side-effect of penetrating projectiles and has been shown to be directly related to the degree of ballistic fragmentation, as well as to the impact location, with intra-synovial, intra-osseous, head, spine and maxillofacial injuries having the highest correlation. Our patient, a 44-year-old male, presented to the ER with a 3-week history of mid epigastric cramping abdominal pain and intermittent vomiting as well as mild mental status changes. Abdominal radiographs and ultrasound were noncontributory. Laboratory findings were notable for underlying microcytic anemia with basophilic stippling observed on peripheral blood smear. Serum iron studies were normal. Lead levels were found to be elevated at 306 μg/dl. Prior EGD had demonstrated mild erosive gastritis with subsequent multiple negative gastric lavages. The patient’s past medical history was notable for a previous gunshot injury to the right femur with open fracture 2 years previously. Radiographs of the proximal right lower extremity, subsequent ultrasound and CT demonstrated an uncomplicated healed fracture of the mid right femoral diaphysis with an adjacent partially cystic lesion, an approximately 7-cm collection in the medial soft tissues containing internal ballistic fragments. Mottled surrounding capsular density was observed with mural calcific and micrometallic fragments. Systemic plumbism was suspected in relation to the remote ballistic injury and chelation therapy was initiated. Following surgical removal of the encapsulated fluid collection, systemic lead levels were observed to decline precipitously. The abdominal and CNS symptoms resolved in due course and the patient was discharged on oral chelation therapy.     

Endovascular Treatment of Hemoptysis by Abnormal Systemic Pulmonary Artery Supply

We report the case of a 29-year-old man with hemoptysis. The patient came to the emergency department, where a laboratory test and chest radiograph were reported as normal. The following day the patient again had hemoptysis, though less than previously. He reported no chest pain, dyspnea, fever, catarrh, changes in urine or feces, contact with patients with bacillus disease or constitutional symptoms. Doppler ultrasound of the chest showed right basal parenchymatous condensation containing a vessel with arterial flow (in the opposite direction to the aortic flow) compatible with an aberrant vessel, possibly a sequestration, leaving the aorta above the celiac trunk. Because of the findings of the chest echogram and magnetic resonance study, thoracoabdominal computed tomography angiography was undertaken; this showed right basal condensation and an anomalous vessel originating 1 cm above the celiac trunk, supplying the right lower lobe. An aortic and pulmonary arteriogram via an arterial and right femoral vein approach confirmed the findings. The patient was treated successfully with percutaneous embolization with coils. The relevant literature is reviewed.     

Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm Associated with a Right Aortic Arch and a Left Subclavian Artery Arising from a Kommerell’s Diverticulum

This case report describes the endovascular repair of a right-sided descending thoracic aortic aneurysm associated with a right aortic arch and an aberrant left subclavian artery. A 76-year-old male with multiple comorbidities was incidentally found to have a right-sided descending thoracic aortic aneurysm with a maximum diameter of 6.2 cm. Additionally, there was a right aortic arch with a retroesophageal segment and separate arch branches arising in the following order: left common carotid artery, right common carotid artery, right subclavian artery, and left subclavian artery that was aberrant, arising from a Kommerrell’s diverticulum. The aneurysm was successfully excluded by deployment of a Zenith TX1 36 × 32 × 20-mm stent-graft using wire traction technique via the left femoral and right brachial arteries in order to deal with two severe aortic angulations. At 18-month follow-up the patient was doing well, with aneurysm sac shrinkage to 5.9 cm and no signs of endoleak or migration. Endovascular repair of right-sided descending thoracic aortic aneurysms with a right arch and aberrant left subclavian artery is feasible, safe, and effective. In such rare configurations, which demand considerably increased technical dexterity and center experience, endovascular repair emerges as an attractive therapeutic option.     

磁性药物靶向治疗中MRI检测磁流体体内分布的实验研究

目的:利用MRI技术探讨在磁性药物靶向治疗中磁流体作为药物载体的体内靶向性.材料和方法:取大鼠6只,实验组和对照组各3只.将对照组大鼠从股静脉注射磁流体,同时将实验组大鼠的右肾部位置于C型磁体中,从股静脉注射磁流体后持续置于磁体中1小时,取出半小时后同对照组大鼠一同进行MR扫描,分别检测磁流体在各大鼠右肾部位的分布情况.结果:从MRI图像中可以明显看出大鼠右肾部位的信号强度大大减小,有较高浓度的磁流体在右肾部位聚集.结论:采用磁流体作为药物的载体,在外磁场作用下可实现靶向控制,提高药物在靶部位的聚集浓度.选用磁共振成像技术检测磁流体在体内的聚集情况是行之有效的.     

Situs inversus with congenital absence of left circumflex artery and a superdominant left-sided right coronary artery: A case report

Situs inversus with a coronary artery defect is an extremely rare congenital anomaly, which is often only incidentally detected during cardiac imaging studies, particularly when the patient is complaining of chest pain. We present a case study of a 37-year-old man who presented with a 3-month history of chest pain. A chest X-ray revealed dextrocardia with stomach gas in the lower right diaphragm. A CT examination showed that the right lung had 2 lobes, and the left lung had 3 lobes. This confirmed that the patient had dextrocardia with situs inversus, where the heart, organs and coronary arteries are inverted to the opposite side of the body. It is also known as a mirroring image, as the arrangement of the anatomy is unaffected. The patient''s right coronary artery was prominently inversed to the left side, while the left main coronary artery was inversed to the right side and continued toward the anterior interventricular sulcus, eventually becoming the left anterior descending (LAD) artery. The left circumflex artery was absent in the atrioventricular groove. There was also a plaque in the right-sided LAD with no significant stenosis. The patient received conservative medical therapy and had frequent follow-ups to check for potential complications.     

Aberrant subclavian arteries: cross-sectional imaging findings in infants and children referred for evaluation of extrinsic airway compression

OBJECTIVE: The purpose of our study was to describe patterns of airway compression identified on cross-sectional imaging in infants and children with either right aortic arch and aberrant left subclavian artery or left aortic arch with aberrant right subclavian artery. MATERIALS AND METHODS: Data from MR imaging and CT performed to evaluate pediatric patients for extrinsic airway compression were reviewed for cases that revealed an aberrant right or left subclavian artery. Clinical, endoscopic, and imaging findings in identified cases were reviewed. Recurrent patterns of extrinsic compression were reviewed among cases. RESULTS: Twelve patients with right aortic arch with aberrant left subclavian artery and nine patients with left aortic arch and aberrant right subclavian artery were identified. All 12 with right aortic arch with aberrant left subclavian artery had airway compression shown, with multiple sites or diffuse compression in six. Of these 12 patients, nine had compression at the level of the arch and aberrant subclavian artery (10 had Kommerell's diverticulum), and nine had compression of the distal airway in association with a midline descending aorta. Five of the nine patients with left aortic arch and aberrant right subclavian artery had airway compression shown, all at the level of the arch and aberrant subclavian artery. None of these compressions was associated with either Kommerell's diverticulum or midline descending aorta. CONCLUSION: Both right and left aberrant subclavian arteries can be associated with symptomatic airway compression, but the patterns of compression are different. The airway compression in right aortic arch with aberrant left subclavian artery is often associated with either Kommerell's diverticulum or midline descending aorta, whereas compression associated with left aortic arch and aberrant right subclavian artery is not.     

Anomalous origin of the right pulmonary artery from the ascending aorta: Diagnosis by magnetic resonance imaging

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital anomaly. Magnetic resonance imaging (MRI) was performed on three patients with anomalous origin of the right pulmonary artery from the ascending aorta. ECG-gated, Tlweighted, spin-echo MRIs and cine MRIs were obtained. In one patient, postoperative MRI was also obtained. Echocardiography and cardiac catheterization were performed in three patients and angiocardiography was performed in two. MRI clearly showed anomalous origin of the right pulmonary artery from the posterior aspect of the ascending aorta, as well as combined anomalies including patent ductus arteriosus, aortopulmonary window, and interruption of the aortic arch in all three patients. Echocardiography missed this anomaly in all three. We suggest that MRI is an accurate imaging modality in diagnosing anomalous origin of the right pulmonary artery from the ascending aorta, obviating the need to perform angiocardiography     

Embolization of the Systemic Arterial Supply via a Detachable Silicon Balloon in a Child with Scimitar Syndrome

Scimitar syndrome is a rare congenital disorder. It is characterized by partial or total abnormal venous drainage of the right lung into the inferior vena cava, which is often associated with anomalous systemic arterial supply to the right lung, congenital cardiac anomalies, hypoplasia of the right lung and bronchial anomalies. Symptoms depend on the degree of the shunt and severity of the associated anomalies, which determine the treatment. We present a 6-year-old boy who was diagnosed as having the adult form of scimitar syndrome during evaluation for recurrent pulmonary infections, and underwent embolization with a detachable silicon balloon of the anomalous systemic arterial supply from the abdominal aorta to the right lower lung lobe. Successful elective surgery was performed 6 months later, in which right pulmonary veins were directed to the left atrium using a Gore-Tex patch by creating an intra-atrial tunnel. The patient has been symptom-free period during 6 months of follow-up, which supports the idea that recurrent pulmonary infections can be eliminated by embolization of the anomalous arterial supply.