Intracranial dural arteriovenous fistula with spinal medullary venous drainage

We report on a 46-year-old patient in whom an intracranial dural arteriovenous (AV) fistula, supplied by a branch of the ascending pharyngeal artery, drained into spinal veins and produced rapidly progressive symptoms of myelopathy and brainstem dysfunction including respiratory insufficiency. Magnetic resonance imaging studies demonstrated brainstem oedema and dilated veins of the brainstem and spinal cord. Endovascular embolization of the fistula led to good neurological recovery, although the patient had been paraplegic for 24 h prior to embolization. This case demonstrates the MRI characteristics of an intracranial dural AV fistula with spinal drainage and illustrates the importance of early diagnosis and treatment. Even paraplegia may be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible. Received: 25 May 1999; Revised: 25 January 2000; Accepted: 15 February 2000     

Imaging of diffuse esophageal leiomyomatosis: two case reports and review of the literature

Diffuse esophageal leiomyomatosis is a rare disorder which may be found in association with leiomyomas in other locations or with other disorders. We report two cases in men, one with associated tracheobronchial involvement, which illustrate the value of imaging in differentiating this entity from other causes of dysphagia and in establishing a diagnosis. Received: 24 December 1998; Revised: 10 May 1999; Accepted: 10 May 1999     

Iatrogenic dissection of the portal vein during TIPS procedure

Dissection of the portal vein is a rare entity which has been rarely described during transjugular intrahepatic portosystemic shunt (TIPS) procedure. We report three cases of dissection during this procedure and their complications. One dissection was immediately treated with coaxial stents. The two others were complicated either by a thrombus or by a false aneurysm. In the first case a second parallel stent was used to treat this complication. The patient with the portal vein false aneurysm was transplanted 4 days after this diagnosis. Portal vein dissection in TIPS procedure appeared to be less rare than has been reported and must be considered as a potential cause of TIPS dysfunction. Received: 5 May 1999; Revised: 14 July 1999; Accepted: 14 July 1999     

Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement

Spontaneous and isolated dissection of the superior mesenteric artery is a rare and often fatal event which has been successfully treated by surgery in several reported cases. We present a patient with acute mesenteric ischemia due to superior mesenteric artery dissection who was successfully treated by percutaneous endovascular placement of a Wallstent. Received: 8 November 1999; Revised: 5 May 2000; Accepted: 9 May 2000     

Chondrosarcoma of the hyoid bone

The CT and MRI findings in a case of chondrosarcoma of the hyoid bone are reported. Although chondrosarcoma is the second most common primary malignant bone tumor, only 10 % of chondrosarcomas occur in the head and neck region. The hyoid bone is a rare site of involvement with only seven cases reported previously. Received: 19 February 1999; Revised: 19 April 1999; Accepted: 11 May 1999     

Bilateral xanthogranulomatous perinephritis without renal parenchymal involvement

A case of isolated bilateral xanthogranulomatous perinephritis, which presented as a symmetrical irregular perirenal rim of soft tissue, is reported. Differential diagnosis and image features on ultrasound, computed tomography, and magnetic resonance are discussed. Received: 20 May 1999; Revised: 20 July 1999; Accepted: 22 July 1999     

3D MR imaging of coronary arteriovenous fistulas

Coronary arteriovenous fistula are uncommon if not rare, but represent the most prevalent hemodynamically significant congenital malformations of the coronary arterial circulation. The goal of this report is to evaluate the use of 3D volume rendering from transaxial breathhold coronary MR angiograms to visualize coronary arteriovenous fistulas. Coronary MR angiography offers a new non-invasive technique that accurately defines the anatomy of these malformations, setting the stage for surgical intervention. Received: 15 July 1999; Revised: 13 October 1999; Accepted: 15 October 1999     

Solitary myofibromatosis of the skull

We present a case of solitary infantile myofibromatosis of the skull in a 3-month-old boy. A right parietal subcutaneous lump was found at birth, and it increased in size over the ensuing 3 months. Surgery was performed, and a diagnosis of myofibromatosis was confirmed histopathologically. Solitary myofibromatosis of the skull is extremely rare. The radiographical, CT, and MR appearances, as well as histopathological findings, are described in this article. Received: 30 December 1998; Revised: 21 April 1999; Accepted: 11 May 1999     

Intramural leiomyoma of the bladder

Mesodermal tumors of the urinary bladder are rare and the majority of them are malignant. We report a case of an intramural leiomyoma of the bladder presenting with symptoms of a mild lower urinary tract infection. The patient was managed with partial cystectomy and the outcome was excellent. Received: 31 May 1999; Revised: 21 September 1999; Accepted: 21 September 1999     

Delayed posttraumatic adrenal hematoma

Posttraumatic adrenal hemorrhage is a frequent finding after severe abdominal trauma and can have important clinical implications if it is bilateral. With the increased use of helical CT in the evaluation of trauma patients, posttraumatic adrenal hematoma is more frequently diagnosed. We present the CT findings of a unilateral posttraumatic adrenal hemorrhage where the diagnostic findings only appeared in the follow-up study. We think that mild enlargement of the adrenal gland in a trauma patient can be an early sign of an impending adrenal hemorrhage. Received: 10 May 1999; Revised: 28 July 1999; Accepted: 18 August 1999     

Abdominal wall hernias: imaging with spiral CT

Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other diseases such as hematomas, abscesses and neoplasia. In this study we examined the CT images of 94 patients affected by abdominal wall hernias observed over a period of 6 years. Computed tomography clearly demonstrates the anatomical site of the hernial sac, the content and any occlusive bowel complications due to incarceration or strangulation. Clinical diagnosis of external hernias is particularly difficult in obese patients or in those with laparotic scars. In these cases abdominal imaging is essential for a correct preoperative diagnosis and to determine the most effective treatment. Received: 20 May 1999; Revised: 10 August 1999; Accepted: 13 August 1999     

Pelvic digit: an uncommon developmental anomaly

The radiological features of seven cases of pelvic digit discovered incidentally on plain radiographs are described and differentiation from other causes of new bone formation is discussed. Its recognition as a benign anomaly is important to avoid unnecessary investigation or intervention. An embryological theory of development of pelvic digit is proposed. Received: 18 November 1998; Revised: 9 March 1999; Accepted: 7 May 1999     

Secondary involvement of breast with non-Hodgkin's lymphoma in a paediatric patient presenting as bilateral breast masses

We report a paediatric case of non-Hodgkin's lymphoma with secondary breast involvement. On US exam there were bilateral multiple well-defined masses. Contrast-enhanced thorax CT demonstrated the breast lesions as well as enhancing masses. To our knowledge, this type of lymphomatous breast involvement in a child is rare and its CT features are very rarely demonstrated. Received: 16 October 1998; Revision received: 21 April 1999; Accepted: 28 May 1999     

Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis

A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures. Received: 14 January 1999; Revised: 21 May 1999; Accepted: 9 June 1999     

Computed tomography of the small bowel in adult celiac disease: the jejunoileal fold pattern reversal

The aim of this retrospective study was to establish whether the distinctive intestinal fold pattern of celiac disease (CD), known by barium studies as jejunoileal fold pattern reversal (JFPR) may be recognized at CT. The number of intestinal folds per 2.5 cm, seen at CT, were counted in the jejunum and in the ileum of 22 adult patients with CD and compared with the folds of 30 consecutive subjects in whom an intestinal disease had been excluded. The results were submitted to statistical analysis by Student's t-test. In the control group the number of folds per 2.5 cm were 4.88 (SD ± 0.78) in the jejunum and 2.84 ( ± 0.62) in the ileum; in the CD group the number of folds were 2.42 ( ± 1.61) in the jejunum and 5.11 ( ± 1.24) in the ileum. There was a statistically significant difference in the number of jejunal and ileal folds between the CD patients and the control group (in both cases p < 0.001). The JFPR was seen in 15 patients with CD (68.2 %) but in none of the controls. Our study shows that JFPR is not a normal finding and can be demonstrated by CT in the majority of patients with CD. Received: 21 January 1999; Revised: 25 May 1999; Accepted: 26 May 1999     

Recent experience with Moyamoya disease in Turkey

A series of moyamoya patients is presented. Angiographic findings, outcome of revascularization surgery and a young case with moyamoya disease and hyperphosphatemia are reported. Thirteen patients (6 males and 7 females; age range 2–50 years) were included in the study group. Findings of the patients at presentation were intracranial haemorrhage in two adult cases and sequelae of cerebral ischemia in the rest of the group. One young girl had hyperphosphataemia. Angiography showed distal internal carotid or proximal anterior and middle cerebral artery stenosis, unique collaterals, microaneurysm of the posterior lateral choroidal artery and flow-related changes in the posterior circulation. In 3 patients, encephalo-duro-arterio-synangiosis (EDAS) and burrholes were performed at surgery. Follow-up angiograms of these patients showed revascularization. Moyamoya, a rare but potentially devastating disease, must be addressed as a cause of haemorrhagic and ischaemic cerebral events. Received: 19 January 1999; Revised: 14 April 1999; Accepted: 17 May 1999     

Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases

The aim of this study was to evaluate the incidence, radiographic appearance, time of onset, outcome and risk factors of non-infectious and infectious pulmonary complications following liver transplantation. Chest X-ray features of 300 consecutive patients who had undergone 333 liver transplants over an 11-year period were analysed: the type of pulmonary complication, the infecting pathogens and the mean time of their occurrence are described. The main risk factors for lung infections were quantified through univariate and multivariate statistical analysis. Non-infectious pulmonary abnormalities (atelectasis and/or pleural effusion: 86.7 %) and pulmonary oedema (44.7 %) appeared during the first postoperative week. Infectious pneumonia was observed in 13.7 %, with a mortality of 36.6 %. Bacterial and viral pneumonia made up the bulk of infections (63.4 and 29.3 %, respectively) followed by fungal infiltrates (24.4 %). A fairly good correlation between radiological chest X-ray pattern, time of onset and the cultured microorganisms has been observed in all cases. In multivariate analysis, persistent non-infectious abnormalities and pulmonary oedema were identified as the major independent predictors of posttransplant pneumonia, followed by prolonged assisted mechanical ventilation and traditional caval anastomosis. A “pneumonia-risk score” was calculated: low-risk score ( < 2.25) predicts 2.7 % of probability of the onset of infections compared with 28.7 % of high-risk ( > 3.30) population. The “pneumonia-risk score” identifies a specific group of patients in whom closer radiographic monitoring is recommended. In addition, a highly significant correlation (p < 0.001) was observed between pneumonia-risk score and the expected survival, thus confirming pulmonary infections as a major cause of death in OLT recipients. Received: 19 May 1999; Revised: 24 September 1999; Accepted: 29 October 1999     

Iliocaval thrombosis: percutaneous treatment with hydrodynamic thrombectomy

Mechanical thrombectomy is of growing importance for the treatment of thrombus. Although there are numerous reports about dialysis fistulae and arterial thrombosis, venous applications are currently not well known. We report that an extensive venous thrombotic occlusion can be treated with mechanical thrombectomy, without additional local lysis. This report deals with the indication and technique of venous mechanical thrombectomy and discusses the possible applications. Received: 22 February 1999; Revised: 20 May 1999; Accepted: 29 July 1999     

Primary renal and retroperitoneal actinomycosis

A case of the rare condition of renal and retroperitoneal actinomycosis is presented. The clinical and imaging (ultrasonography and computed tomography) findings are described and attention is drawn to the diagnostic difficulties in this rare disease. Received: 26 October 1998; Revised: 5 February 1999; Accepted: 7 May 1999     

Helical CT appearance of glomus tumor of the stomach

Glomus tumor occurs only rarely in the stomach. This benign intramural mass is located most frequently in the distal half of the stomach. We experienced two cases of glomus tumor of the stomach which were examined with helical CT and were confirmed pathologically. Both tumors were well-marginated solitary lesions, located in the gastric antrum. On the early-phase helical CT, an intact overlying mucosa was demonstrated in both cases, and both tumors showed a dense homogeneous contrast enhancement, which persisted to the delayed phase. Received: 26 January 1999; Revised: 18 May 1999; Accepted: 2 July 1999