Giant coronary artery bypass graft pseudoaneurysm presenting as a haemothorax

Coronary artery bypass graft pseudoaneurysms are rare. A case of a giant coronary artery pseudoaneurysm with probable intrapleural leakage and resulting haemothorax 14 years after coronary artery bypass surgery (CABG) is presented. The computed tomography (CT) and angiographic appearances are described. To our knowledge, this clinical presentation of a CABG pseudoaneurysm has not been described. Walsh, G. (2001). Clinical Radiology56, 74-75.     

Atlantoaxial synovial cyst causing isolated unilateral hypoglossal nerve paralysis

Cervical synovial cysts are rare entities that are, most of the time, asymptomatic. They can cause nerve root or spinal cord compression, especially when acute haemorrhage or a marked increase in size occurs. Isolated unilateral hypoglossal nerve paralysis caused by compression of its cisternal segment is also an extremely rare condition. We report the case of a 51-year-old woman who presented with dysarthria and tongue fasciculation. MRI revealed an atlantoaxial synovial cyst that extended cranially through the hypoglossal canal and compressed the fibres of the left XII nerve on its cisternal segment. To our knowledge, this is the first case report of XII nerve paralysis being caused by an atlantoaxial synovial cyst.Spinal synovial cysts are usually found in the lower lumbar spine, being rare in the cervical spine [1–5]. Isolated unilateral hypoglossal nerve paralysis is also a very rare condition [6]. We present a case of an atlantoaxial synovial cyst causing isolated unilateral compressive hypoglossal nerve paralysis in a 51-year-old woman. To the best of our knowledge, this is the first report of a XII nerve paralysis caused by an atlantoaxial synovial cyst.     

Isolated hypoglossal nerve palsy due to skull base metastasis from breast cancer

We describe a 44-year-old woman who presented with an isolated unilateral hypoglossal nerve paralysis caused by a skull base metastasis from breast cancer. The patient had a modified radical mastectomy followed by local radiotherapy and adjuvant chemotherapy. Fourteen months later she presented with difficulty in speaking. Physical examination revealed an isolated left hypoglossal nerve paralysis. The MRI scan showed a mass lesion involving the left occipital condyle extending into hypoglossal canal.     

Intracranial hypoglossal neurinoma: Report of a case

Summary A case of intracranial hypoglossal neurinoma is reported. The diagnostic importance of an enlarged hypoglossal canal with isolated hypoglossal nerve palsy is emphasized. The computed tomography and angiographic findings are described.     

Isolated unilateral hypoglossal neuropathy caused by dural arteriovenous fistula.

We report a case of isolated hypoglossal nerve paralysis caused by a dural arteriovenous fistula. Diagnosis is discussed with emphasis on conventional and MR angiography. The anatomy of the hypoglossal nerve is reviewed along with more common causes of pathologic conditions.     

面-舌下神经显微吻合术治疗外伤性面神经瘫痪（附5例报告）

本文报告用面-舌下神经显徽吻合术治疗外伤性面神经瘫痪5例，效果良好。5例均为中颅底骨折所致的面神经损伤，早发性面瘫。4例行神经束膜吻合，1例行神经外膜吻合，神经束膜吻合较外膜吻合更有利于神经的生长、修复，作者认为面-舌下神经显微吻合术是重建面神经功能的适宜手术。     

喉返神经麻痹的CT表现

目的 分析喉返神经麻痹的CT表现，探讨其解剖和病理形态变化基础，提高对其影像学表现的认识。方法 搜集2001至2003年经临床诊断的喉返神经麻痹患者32例，回顾性分析CT资料。所有患者均行全颈部CT增强扫描，范围从舌骨水平到上胸部水平，层厚及间隔均为5mm。结果 喉返神经麻痹后，CT检查可出现一系列相应表现：杓会厌皱襞、杓状软骨及环杓关节前内侧移位，同侧梨状窝扩张、松弛27例（84．4％）；喉室扩大16例（50．0％）；声带不对称且固定11例（34．4％）等。结论 喉返神经支配除环甲肌以外的所有喉内肌，其麻痹后所支配的肌肉群可以发生去神经性萎缩。CT扫描可以有效地显示其相应改变，同时有助于明确麻痹原因。     

CT and MR findings of denervated tongue after radical neck dissection.

PURPOSETo describe the CT and MR findings in the denervated tongue after a radical neck dissection.METHODSWe retrospectively evaluated the radiologic findings in seven patients who had hypoglossal paralysis following radical neck dissection. None of the patients had clinical or radiologic evidence of tumor recurrence.RESULTSThe side of the tongue operated on showed low density on CT scans. At MR imaging, denervated tongues were clearly seen as hyperintense relative to muscle on T2-weighted images; on T1-weighted images, the signal was hypointense to hyperintense, representing increased extracellular water or fatty degeneration.CONCLUSIONIn patients who have undergone a neck dissection for a malignant process, abnormal imaging findings in the tongue not only might indicate a recurrence of tumor involving the hypoglossal nerve but also suggest the possibility of postoperative change. Our findings emphasize the importance of the denervated tongue in differentiating inflammatory from neoplastic diseases of the the tongue.     

Imaging the hypoglossal nerve

The hypoglossal nerve is a pure motor nerve. It provides motor control to the intrinsic and extrinsic tongue muscles thus being essential for normal tongue movement and coordination. In order to design a useful imaging approach and a working differential diagnosis in cases of hypoglossal nerve damage one has to have a good knowledge of the normal anatomy of the nerve trunk and its main branches. A successful imaging evaluation to hypoglossal diseases always requires high resolution studies due to the small size of the structures being studied. MRI is the preferred modality to directly visualize the nerve, while CT is superior in displaying the bony anatomy of the neurovascular foramina of the skull base. Also, while CT is only able to detect nerve pathology by indirect signs, such as bony expansion of the hypoglossal canal, MRI is able to visualize directly the causative pathological process as in the case of small tumors, or infectious/inflammatory processes affecting the nerve. The easiest way to approach the study of the hypoglossal nerve is to divide it in its main segments: intra-axial, cisternal, skull base and extracranial segment, tailoring the imaging technique to each anatomical area while bearing in mind the main disease entities affecting each segment.     

Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography

PURPOSE: To determine the sensitivity and specificity of helical computed tomographic (CT) angiography in the diagnosis of carotid and vertebral arterial injuries caused by penetrating neck trauma. MATERIALS AND METHODS: A prospective study was conducted during 24 months in 60 patients with penetrating neck trauma who were referred for conventional angiography owing to clinical suspicion of arterial injury. In the patient population, 146 arteries (77 carotid, 69 vertebral) were studied by means of conventional angiography. In all patients, conventional angiography and helical CT angiography were completed within 6 hours. Two radiologists interpreted helical CT angiographic studies by means of consensus. Conventional angiography was the standard of reference for determining the sensitivity and specificity of helical CT angiography. RESULTS: Conventional angiograms showed arterial injuries in 10 (17%) of 60 patients. Conventional angiographic findings were arterial occlusion (n = 4), arteriovenous fistula (n = 2), pseudoaneurysm (n = 3), pseudoaneurysm with arteriovenous fistula (n = 1), and normal arteries (n = 136). Nine of 10 arterial injuries and all normal arteries were depicted adequately at helical CT angiography. Sensitivity of helical CT angiography was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 98%. CONCLUSION: The sensitivity and specificity of helical CT angiography are high for detection of major carotid and vertebral arterial injuries resulting from penetrating trauma.     

舌下神经鞘瘤的CT和MRI表现及其病理基础(附4例报告)

目的 研究舌下神经鞘瘤的CT、MRI特征性表现。方法 回顾分析了4例经手术病理证实的舌下神经鞘瘤CT和MRI表现。结果 从病变部位看，右侧3例，左侧1例；颅内段2例，颅内与颅外段同时受累2例。CT表现：舌下神经孔扩大和骨质破坏，并见软组织块影2例。MRI表现：舌下神经径路上出现圆形、椭圆形的软组织块影4例，T1WI为等信号，T2WI为等信号和高信号；有明显的强化。结论 舌下神经径路上出现软组织块影是其特点；MRI对舌下神经鞘瘤的诊断优于CT，特别是MRI增强扫描。     

Recurrent laryngeal nerve paralysis: a laryngographic and computed tomographic study

Vocal cord paralysis is a relatively common entity, usually resulting from a pathologic process of the vagus nerve or its recurrent laryngeal branch. It is rarely caused by intralaryngeal lesions. Fourteen patients with recurrent laryngeal nerve paralysis (RLNP) were evaluated by laryngography, computed tomography (CT), or both. In the evaluation of the paramedian cord, CT was limited in its ability to differentiate between tumor or RLNP as the cause of the fixed cord, but it yielded more information than laryngography on the structural abnormalities of the larynx and pre-epiglottic and paralaryngeal spaces. Laryngography revealed distinct features of RLNP and is the procedure of choice for evaluation of functional abnormalities of the larynx until further experience with faster CT scanners and dynamic scanning of the larynx is gained.     

Pre- and postoperative CT and MR in pseudoaneurysms of the heart.

Pseudoaneurysms of the heart have a propensity to rupture and surgery is indicated. Usually in these cases diagnostic imaging is based on angiographic and/or echocardiographic studies. We have attempted to determine in pre- and postoperative studies the value of CT and ECG-gated MRI in patients with pseudoaneurysm. Seven patients with a pseudoaneurysm and/or dyskinesia of the posterolateral or diaphragmatic wall of the left ventricle were investigated with CT and/or ECG-gated MR studies, in addition to angiography, echocardiography, and radionuclide studies, prior to cardiac surgery. Postoperative follow-up studies with CT in six and MR in five patients were also carried out. Both CT and ECG-gated MRI allowed us to visualize the neck and CT also confirmed the communication between the cavities with or without demonstrating the conduit. In addition, disruption of the epicardial fat layer by the pseudoaneurysm was seen on both CT and MR, and the presence of intrapericardial adhesions was visualized on MR. Finally, CT and MRI, in postoperative follow-up studies, may indicate a myocardial discontinuity adjacent to the surgical patch.     

Dual-isotope SPECT diagnosis of a skull-base metastasis causing isolated unilateral hypoglossal nerve palsy

We describe a 48-year-old female with an isolated unilateral hypoglossal nerve palsy caused by a skull base metastasis from breast cancer. The patient had a medical history of conservative breast therapy for breast cancer. Although the cause of such a neurological deficit includes various pathologies, the reports focusing on metastatic tumor have been limited in number. Radiologic investigation showed a mass involving both the right hypoglossal canal and the clivai edge. Swelling of the hypoglossal nerve was observed in views including its canal. Three-dimensional CT images demonstrated the tumor protruding from the enlarged external orifice of the hypoglossal canal. In the present report we mentioned a nuclear medicine procedure to visualize and characterize the small, abnormal tissue in the skull base. Dual-isotope SPECT confirmed an abnormal uptake of^99mTc-HMDP around the hypoglossal canal and a²⁰¹Tl-positive elongated lesion running along the hypoglossal nerve.     

Intracranial arterial dissection

We review the angiographic and CT findings, precipitating factors and clinical features in nine patients with ten intracranial arterial dissections. The internal carotid artery was involved in five cases, the vertebral artery in four and the posterior inferior cerebellar artery in one. Angiography revealed irregular stenosis in four cases, irregular stenosis and a pseudoaneurysm in two, irregular stenosis and irregular dilatation in one, arterial occlusion in two and a pseudoaneurysm in one. CT demonstrated an infarct in four cases, a dense middle cerebral artery in two and subarachnoid haemorrhage in one. A possible precipitating factor was identified in five cases. Six patients recovered well, while three had persisting neurological deficits. Received: 30 August 1997 Accepted: 31 October 1997     

Successful closure of large pseudoaneurysm of peroneal artery using transluminal temporary occlusion of the neck with the catheter

Pseudoaneurysm is well-known complication resulting from surgical or interventional vascular procedures. We present the case of a 51-year-old patient with a large iatrogenic pseudoaneurysm of the peroneal artery, a very rare location. The pseudoaneurysm developed after orthopedic surgery of the knee. Swelling and vascular insufficiency of the calf ensued a few days later. The large peroneal pseudoaneurysm and compression of the anterior and posterior tibial arteries were confirmed by ultrasound and angiography. The pseudoaneurysm was too deep for ultrasound-guided compression or percutaneous obliteration and too large to be occluded by coil embolization alone. Because the pseudoaneurysm failed to occlude even after four coils were introduced into the lumen, pseudoaneurysm thrombosis was achieved by temporary occlusion of its neck with the angiographic catheter. During the occlusion of the neck of the pseudoaneurysm, the patency of the crural arteries and the development of the thrombus in the pseudoaneurysm cavity were monitored with color Doppler ultrasonography. Follow-up examinations after 3 and 6 months showed permanent closure of the pseudoaneurysm and patent crural arteries.     

Pseudoaneurysm of the Internal Mammary Artery as an Unusual Cause of Post-sternotomy Hemorrhage: The Role of Multislice Computed Tomography in the Diagnosis and Treatment Planning

Pseudoaneurysm of the internal mammary artery (IMA) following median sternotomy is extremely rare. To date, the reported cases are only in single figures. The majority of these pseudoaneurysms were suspected from the clinical presentation, echocardiography or computed tomography (CT) but were only confirmed on contrast angiography. This case report demonstrates the current ability to carry out detailed vascular imaging on a 16-slice CT scanner. This accurate delineation of the pseudoaneurysm allowed targeted therapeutic embolization to be performed without unnecessary angiographic imaging.     

A rare case of Reidel thyroiditis with associated vocal cord paralysis: CT and MR imaging features

Reidel thyroiditis is extremely rare and not only involves the thyroid gland but usually extends to neighboring structures in the neck. A rare complication of this disease is entrapment of the recurrent laryngeal nerve causing a vocal cord paralysis. In fact, to our knowledge, this is likely the only benign thyroid disease to cause such a paralysis. We present a case of a 57-year-old woman with Reidel thyroiditis and a recurrent laryngeal nerve paralysis. The CT and MR imaging features are presented as well as a brief review of this disease.     

Endovascular treatment of visceral aneurysms associated with pancreatitis and a suggested classification with therapeutic implications

PURPOSE: To describe a 10-year experience of endovascular and percutaneous treatment of aneurysms and pseudoaneurysms complicating pancreatitis, and to analyze this experience and propose a classification based on computed tomography (CT) and angiographic findings that has therapeutic implications. This may reduce the rate of recurrent bleeding after surgery or endovascular treatment. MATERIALS AND METHODS: Twenty-three patients with aneurysms or pseudoaneurysms associated with acute pancreatitis were treated by endovascular or percutaneous methods. All underwent CT and angiography. The early development of a simple classification based on the CT and angiographic findings was used to guide treatment decisions. In accordance with this classification, 19 patients were treated by primary coil embolization and four were treated by primary percutaneous thrombin injection. RESULTS: Among the 19 patients treated by primary coil embolization, there were two early recurrences of the pseudoaneurysm. All four patients treated by percutaneous thrombin injection exhibited late recurrences and were successfully treated by percutaneous thrombin injections. Twenty-one patients (91.3%) were alive at 6 months. CONCLUSIONS: Endovascular and percutaneous treatment of aneurysms and pseudoaneurysms complicating pancreatitis is safe and effective and is associated with good outcomes, but careful follow-up is necessary. The decision of which treatment option is most appropriate can be made in accordance with a classification based on CT and angiographic appearance.     

Hemorrhaged cystic hygroma and facial nerve paralysis: CT and MR findings

The association of peripheral facial nerve paralysis and cystic hygroma is rare, this being only the third reported case. In this patient paralysis was secondary to hemorrhage within the cyst and nerve compression. Although the magnetic resonance studies allowed the diagnosis to be made eventually, the complex signal intensities due to excessive bleeding within the cyst confused the issue. In this case, CT allowed an immediate diagnosis to be established.