Automatic implantable cardiac defibrillator implantation may precipitate effort-induced thrombosis in young athletes: a case report and literature review

Upper extremity deep vein thrombosis (DVT) is a common finding after implantation of an automatic implantable cardiac defrillator (AICD). We describe the case of a patient who developed a left upper extremity DVT 4.5 months after implantation of an AICD and was found to have a lead-induced stenosis with possible underlying Paget–Schroetter syndrome (PSS) in the midbrachiocephalic vein on venography. While his symptoms resolved after the combination of pharmacomechanical thrombolysis, angioplasty, and anticoagulation, his long-term management is complicated by the presence of both PSS and lead-induced stenosis. Herein, we discuss his presentation, treatment, and future management options.     

MRI Appearance of Prostatic Stromal Sarcoma in a Young Adult

Prostatic stromal sarcoma (PSS) is quite rare. Herein, we describe magnetic resonance imaging (MRI) features of a PSS identified in a 26-year-old man with dysuria and hematuria. MRI clearly depicted the extent and multinodular appearance of the tumor, which was mainly located in the central zone of the prostate. The tumor appeared as a heterogeneously signal-hyperintense mass with a pseudocapsule on T2-weighted imaging. Contrast-enhanced T1-weighted MRI showed necrotic portions in the gradually enhanced solid mass, and diffusion-weighted imaging permitted the accurate assessment of the local extent of the tumor. Thus, the appearance on MRI was quite different from that of adenocarcinoma of the prostate.     

Budd-Chiari综合征的MRI诊断

目的 探讨ＭＲＩ对Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的诊断价值。材料与方法 分析１９例Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的ＭＲＩ表现,并与超声和静脉造影进行对比。结果 肝脏增大１８例（９５％）,肝尾叶增大１４例（７４％）,肝脏信号不均匀１４例（７４％）,７例（３７％）显示下腔静脉阻塞,４例（２１％）下腔静脉内见有血栓,肝静脉狭窄或阻塞１９例（１００％）,１７例（８９％）显示有肝内侧支血管,１７例（８９％）显示     

Hippocampal malrotation with normal corpus callosum in a child with Opitz syndrome

We present cranial magnetic resonance imaging (MRI) findings in a 6-year-old boy with Opitz syndrome. The electroencephalogram revealed epileptiform abnormalities in both frontal regions. MRI showed normal callosal development, but a rounded shape of the left hippocampus due to malrotation. The temporal horn was slightly dilated on the left side. These features were consistent with isolated hippocampal malrotation.     

Pure sensory stroke caused by a cerebral hemorrhage: clinical-radiologic correlations in seven patients

BACKGROUND AND PURPOSE: Pure sensory stroke (PSS) usually is caused by a lacunar infarct; reports of PSS caused by cerebral hemorrhage have been rare. We correlated clinical and neuroradiologic findings in patients with PSS caused by cerebral hemorrhage. METHODS: We retrospectively studied seven patients with appropriate clinical findings and lesions revealed by X-ray CT and MR imaging (five men, two women; age range, 46-64 years; mean age, 55.9 years). RESULTS: Hemorrhages involved the thalamus, pons, internal capsule, or cerebral cortex. MR imaging revealed thalamic PSS was located in the ventral posterior lateral (VPL) or ventral posterior medial (VPM) nucleus; a lesion producing a thalamic cheiro-oral syndrome was situated on the border between the VPL and VPM. Pontine PSS involved the medial lemniscus together with the ventral trigeminothalamic tract, sparing the anterior and lateral spinothalamic tracts. Accordingly, pontine PSS, but not thalamic PSS, selectively affected vibration and position sense while leaving pinprick and temperature perception intact, and oral sensory involvement was bilateral when cheiro-oral syndrome had a pontine origin. MR imaging revealed hemorrhage in the postcentral gyrus in the cortical variety of PSS and in the posterior part of the posterior limb (thalamocortical sensory pathway) in PSS of internal capsular origin. The postcentral gyral lesion impaired stereognosis and graphesthesia. CONCLUSION: Focal hemorrhages can lead to purely sensory stroke syndromes, and the clinical deficits are fairly well linked with the locations of the bleeds.     

Successful Endovascular Treatment of Iliac Vein Compression (May-Thurner) Syndrome in a Pediatric Patient

A 10-year-old boy presented to our clinic with left lower extremity swelling present for 1 year with deterioration of symptoms during the prior month. Laboratory investigation for deep vein thrombosis was negative. Venography and computed tomography scan of the pelvis showed compression of the left common iliac vein by the right common iliac artery. A diagnosis of iliac vein compression syndrome was made. After venography, endovascular treatment was planned. The stenosis did not respond to balloon dilatation and a 12 mm Wallstent was placed with successful outcome. The patient’s symptoms improved but did not resolve completely, probably due to a chronically occluded left superficial femoral vein that did not respond to endovascular recanalization. To the best of our knowledge, this is the first case of successful endovascular treatment of iliac vein compression syndrome with stent placement in a pediatric patient.     

Treatment of Budd-Chiari syndrome by metallic stent as a bridge to liver transplantation

A 49-year-old male with Budd-Chiari syndrome complicated by liver cirrhosis and intractable ascites is reported. The left hepatic vein was stenosed by a short subocclusive ostial web; the right and medial hepatic veins were thrombosed. A spontaneous intrahepatic portosystemic shunt had developed between the left portal and left hepatic veins. After ineffective balloon angioplasty, the left hepatic venous outflow was restored by placement of a 10-mm-diameter Wallstent across the web via a femoral approach. The hepatic venous pressure dropped from 29 to 12 mmHg. Rapid clinical improvement followed. The patient underwent liver transplantation 3 months later in stable condition.     

磁共振静脉造影诊断Cockett综合征的价值

目的 评价磁共振静脉造影(MRV)非增强髂静脉成像诊断Cockett综合征的价值.方法 采用Ingenia 3.0T超导型MRI系统,选择腹部表面线圈,扫描序列为M2DIPEAR (TR/TE=45/5.8 ms,翻转角60°)、THRIVE(TR/TE=6.8/3.5 ms,翻转角10°)、BTFE-SPAIR(TR/TE=3.4/1.7 ms,翻转角80°)和FLAIR(TR/TE=9 000/120 ms,翻转角90°),层厚均为3 mm,平均采集次数3次.结果 Cockett综合征MRV表现为受压骼静脉前后径变窄,横径增宽,血管前缘可见弧形压迹,侧支血管形成等;轻、中、重患者左侧髂静脉平均直径分别为7.52、4.83、2.76 mm,平均受压率分别为37％、69％、83％.结论 非增强MRV是可行的髂静脉狭窄诊断方法,尤其适用于特定人群检查需要.     

硬膜窦血栓形成的MRI表现(附6例分析)

目的：探讨硬膜窦血栓形成的ＭＲＩ表现。方法：６例硬膜窦血栓形成，均做了ＭＲＩ检查，其中２例用了ＳＴＩＲ，１例用了ＦＬＡＩＲ序列，３例作了增强检查（Ｇｄ－ＤＴＰＡ），５例作了ＭＲＶ。结果：右横窦栓塞２例，左横窦１例，上矢状窦３例，脑肿胀５例，静脉性脑栓塞２例，脑血肿１例。增强检查，脑皮质及皮质静脉增强１例。结论：ＭＲＩ对硬膜窦血栓形成的诊断有独特的价值。硬膜窦流空信号消失和硬膜窦狭窄、闭塞是直接征像。脑肿胀、静脉性脑梗塞、脑血肿是间接征像     

What is the fate of disconnected brain tissue in a child with Rasmussen syndrome? A case report

We describe a case of Rasmussen syndrome in a 7-year-old boy, presenting with epilepsia partialis continua, hemiplegia, and progressive mental deterioration. The initial MRI examination was normal, followed by progressive left hemispheric cortical atrophy and abnormal high signal intensity over the left occipital, parietal, and cingulate gyral areas over an 18-month period. On the basis of the clinical diagnosis and biopsy findings of Rasmussen syndrome, functional hemispherectomy was carried out at 7.5 years of age with alleviation of clinical seizures for the following 44 months. The follow-up MRI demonstrated atrophic changes involving the remaining left hemisphere with increased signal and cortical volume loss, as well as the absence of abnormal signal in the right hemisphere at 10 years of age. Our MRI findings are consistent with the progression of Rasmussen syndrome in the ipsilateral hemisphere even after functional-hemispherectomy without clinical seizures.     

综合介入治疗左下肢深静脉血栓合并Cockett综合征临床分析

目的探讨急性左下肢深静脉血栓形成合并Cockett综合征的综合腔内介入治疗方法的应用价值。方法 2010年7月～2011年6月对57例左下肢急性深静脉血栓形成合并Cockett综合征患者采用下腔静脉滤器置入术、左下肢深静脉置管溶栓术及左髂静脉闭塞或狭窄段球囊扩张内支架术治疗,观察患者手术前后左下肢症状及体征,通过造影观察左下肢深静脉通畅情况。结果 57例患者均经下肢深静脉造影检查明确诊断,本组技术成功56例,患者下肢肿胀、疼痛等消失,盆腔侧枝循环消失。1例患者仅行抗凝治疗,下肢肿胀好转。治疗过程中患者未发生滤器、支架移位等情况,未发生血栓复发、肺动脉栓塞、出血并发症等。术后口服抗血小板药物至少3～6个月,随访2～12个月,11例患者左下肢肿胀,7例患者出现下肢静脉曲张,所有患者未发生下肢溃疡,6、12个月后复查造影无支架内阻塞病例。结论综合介入治疗左下肢深静脉血栓形成合并Cockett综合征微创、安全,术后口服抗凝药物可提高下肢深静脉通畅率,临床疗效确切。     

Dynamic susceptibility contrast enhanced MRI in reversible posterior leukoencephalopathy syndrome associated with haemolytic uraemic syndrome

We describe a case of reversible posterior leukoencephalopathy associated with haemolytic uraemic syndrome. Following remission confirmed on MRI, the patient relapsed several months later. Neuroimaging findings on conventional MRI and FLAIR sequences and dynamic susceptibility contrast enhanced MRI are described. White matter abnormalities may be shown on CT or MRI in this syndrome. However, dynamic susceptibility contrast enhanced MRI showed far more extensive abnormality within the brain. In addition, phase contrast angiographic measurement of flow in the carotid and basilar arteries indicated a significant elevation of cerebral blood flow, suggesting a decrease in global cerebrovascular resistance. These observations support existing theories that the disorder is manifested by autoregulatory disturbance in small cerebral vessels. Our findings suggest that this abnormality is far more extensive than is demonstrated on T2 weighted MR images and that it is associated with global abnormality of cerebrovascular autoregulation.     

Hepatic mass in Budd-Chiari syndrome: CT and MRI findings

We describe a case of Budd-Chiari syndrome, secondary to a hypercoagulable state, which produced a mass lesion on computerized tomography (CT) and magnetic resonance imaging (MRI) examinations. The mass simulated a tumor, but proved to be an area of hemorrhagic necrosis upon biopsy. The finding of a space occupying lesion may not always indicate a tumor in a patient with the Budd-Chiari syndrome. The causes, pathologic changes, and radiologic findings of Budd-Chiari syndrome are discussed.     

Spinal subarachnoid hemorrhage caused by scleroderma-induced aneurysm: a case report

We introduce a 58-year-old woman who suffered from progressive systemic scleroderma (PSS) associated with trigeminal sensory neuropathy for approximately 10 years. She then had a stroke from spinal subarachnoid hemorrhage (SSAH). Spinal digital subtraction angiography (DSA) revealed two aneurysms and smaller dilations of the afferent vessel that could also be seen by MRI. Three asymptomatic brain infarctions in different vascular regions could be revealed by CCT. The SSAH, ischemic lesions and aneurysms were probably caused by vasculitic affections induced by PSS. Correspondence to: J. Müller     

Joubert syndrome with atrial septal defect and persistent left superior vena cava

Joubert syndrome is a rare disorder characterized by hypotonia, ataxia, episodic hyperpnoea, psychomotor delay, abnormal ocular movements, and molar tooth sign on magnetic resonance imaging (MRI). This syndrome is inherited as an autosomal recessive trait, but the molecular basis and specific chromosomal locus have not yet been identified. MRI features are the most important diagnostic criteria. Molar tooth sign was previously described in Joubert syndrome and was found in 85% of patients with Joubert syndrome. Many authors now claim that this finding can be present in other syndromes, including Dekaban-Arima, Senior-L?ken, COACH, and Varadi-Papp. We present a 7-month-old girl with Joubert syndrome in whom MRI showed the typical features of this condition. She also had polydactyly, atrial septal defect, and persistent left superior vena cava.     

The cranial computed tomographic findings in patients with pure sensory stroke

We reported three patients compatible with the clinical syndrome of pure sensory stroke (PSS). The computed tomography (CT) scan suggested the lesions responsible for the deficits were posterior thalamus, corona radiata, and parietal lobe. PSS could conceivably arise anywhere along the sensory systems and CT scan is reliable method for discussing the lesion responsible for PSS.     

Magnetic resonance angiography of the renal arteries using three-dimensional balanced turbo field-echo sequence with progressive spin saturation.

We developed a new method employing a balanced turbo field-echo (b-TFE) sequence with progressive spin saturation (PSS) for magnetic resonance angiography (MRA) of the renal arteries during breath-holding without the use of contrast agents. We compared our new method with conventional dynamic MRA of renal arteries. For all portions, renal MRA using b-TFE with PSS was clearer to define (p<0.002) than did conventional dynamic MRA. We confirmed that angiography of renal arteries using b-TFE with PSS was more useful than conventional dynamic MRA.     

A single focus of probable multiple sclerosis in the cervical spinal cord mimicking a tumour

A case of probable multiple sclerosis (MS) in the cervical cord without brain involvement, mimicking a tumour is reported. The patient had a progressive left Brown-Séquard syndrome. The diagnosis was suggested by MRI. In spite of intensive corticotherapy, the neurological status worsened, in parallel with the radiological findings. Biopsy excluded an intramedullary tumour and supported the diagnosis of MS.     

MR demonstration of a giant cavernous carotid aneurysm with occlusion of the contralateral intracranial carotid artery: an unusual complication of cavernous sinus thrombosis

We present an unusual combination of vascular complications of cavernous sinus thrombosis in a 7-year-old girl. MRI and MR angiography showed occlusion of the intracranial portion of the left internal carotid artery and a contralateral giant cavernous carotid aneurysm. This combination of vascular findings may influence the management in such cases. Received: 1 April 1997 Accepted: 13 August 1997     

Inadvertent embolic obstruction of abdominal aorta from left atrial thrombus after percutaneous mitral valvuloplasty

Inadvertent embolic obstruction of the distal abdominal aorta and left renal artery during a percutaneous mitral valvuloplasty procedure in a patient with mitral stenosis is reported. The embolism was from a left atrial thrombus which was detected by magnetic resonance imaging (MRI) but not by transesophageal echocardiography.