Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging

Intramedullary dermoid tumors are unusual. Traditional methods of diagnosing spinal tumors have included clinical suspicion, plain roentgenography, myelography, and computed tomography. A case of intramedullary tumor provisionally diagnosed preoperatively by traditional methods and specifically as dermoid tumor with the assistance of magnetic resonance imaging is presented. Diagnosis and treatment of spinal dermoid tumors with an emphasis on magnetic resonance imaging is discussed.     

Rathke's cleft cyst: computed tomographic and magnetic resonance imaging appearances

A case of symptomatic Rathke's cleft cyst was studied preoperatively with x-ray computed tomographic and magnetic resonance imaging. A Rathke's cleft cyst may be differentiated from other cystic-appearing sellar masses.     

Multiple cerebral hydatid disease: case report with magnetic resonance imaging study.

A case of multiple hydatid cysts of the brain is reported. Computed tomographic and magnetic resonance imaging scanning revealed a thick and calcified pericystium. These findings allowed appropriate surgical planning, with a marked recovery of the neurological deficits and absence of relapse in the follow-up period.     

Long segment spinal intramedullary dermoid cyst: A case report

IntroductionSpinal intramedullary dermoid is very rare, accounting for <1% of intraspinal tumors. It can be congenital or acquired. They usually present in 2nd or 3rd decade of life in adults. It may or may not associated with spinal dysraphism. It is asymptomatic in most cases, manifest acutely if it ruptures.Long segment involvement of spinal intramedullary tumor in adult without the history of trauma makes this case unique. Fat suppression imaging helps to distinguish adipose tissue from lesions causing hematomyelia in patients presented with intramedullary hyperintensity in both T1 & T2 sequences of MRI spine.Case presentationWe report here a rare case of 30 years old male who presented to us with sudden urinary retention followed by rapidly progressive quadriparesis and paresthesia in his right arm. In MRI, spinal intramedullary tumor was noted from medulla till D5 vertebra. We performed subtotal excision of tumor and sample sent for histopathology which proved it to be intramedullary spinal dermoid cyst.ConclusionLong segment involvement of spinal intramedullary dermoid cyst in adult without history of trauma makes this case different. Fat suppression imaging must be done in patients with intramedullary hyperintensity in both T1 and T2 sequences of MRI spine. Early diagnosis and appropriate management will be helpful in reducing morbidity.     

Multiple giant intra abdominal lipomas: A rare presentation

INTRODUCTION

Solitary or multiple lipomas, composed of mature fat, represents by far the most common benign mesenchymal neoplasm occurring throughout the whole body, but they rarely originate in the intestinal mesentery.

PRESENTATION OF CASE

A 60-year-old male presented with left sided abdominal distension and pain since 4 months, ultrasonography and computerized tomography abdomen was suggestive of multiple well-defined fat density lesions in the lower abdomen and pelvis. USG guided fine needle aspiration cytology was conclusive of a spindle cell lesion. Exploratory laparotomy was performed and multiple major fat tissue swellings were excised. Histopathology confirmed it to be spindle cell type of lipoma.

DISCUSSION

Because of the silent nature the exact prevalence of lipomas is unknown. It can arise in any location in which fat is normally present, reported intra abdominal lipomas have been very rare. Clinical manifestations depend on the size and location of the growth. In most patients, symptoms are few or absent. USG and CT scan abdomen are used for the diagnosis. Complete surgical excision being the only treatment.

CONCLUSION

Intra abdominal lipoma is a very rare entity, and many cases might be ignored due to their silent nature. They might or might not present with any symptoms. Complete surgical excision being the only treatment, with a very good prognosis.     

Feasibility of cervical intramedullary diffuse glioma resection using intraoperative magnetic resonance imaging

Intraoperative magnetic resonance imaging (iopMRI) actually has an important role in the surgery of brain tumors, especially gliomas and pituitary adenomas. The aim of our work was to describe the advantages and drawbacks of this tool for the surgical treatment of cervical intramedullary gliomas. We describe two explicative cases including the setup, positioning, and the complete workflow of the surgical approach with intraoperative imaging. Even if the configuration of iopMRI equipment was originally designed for cranial surgery, we have demonstrated the feasibility of cervical intramedullary glioma resection with the aid of high-field iopMRI. This tool was extremely useful to evaluate the extent of tumor removal and to obtain a higher resection rate, but still need some enhancement in the configuration of the headrest coil and surgical table to allow better patient positioning.     

Children with cerebral venous thrombosis diagnosed with magnetic resonance imaging and magnetic resonance angiography.

From 1985 to 1991, 13 children were diagnosed at the University of Illinois College of Medicine at Peoria, Saint Francis Medical Center, with cerebral venous thrombosis (CVT) by magnetic resonance imaging scan. Ages ranged from newborn to 5 years. Six children were premature neonates, five were term neonates and two were 5 years old. In the premature neonates, thrombosis was usually associated with other problems. All the term neonates had seizures. In all neonates, thrombosis resolved without any specific treatment. In the two older children, one presented with pseudotumor cerebri and one with coma. These children required neurosurgical intervention. Follow-up magnetic resonance imaging scans were obtained in 9 of 13 children and showed thrombus resolution in each case. Three children were studied in the acute and convalescent stages by magnetic resonance angiography using time-of-flight techniques. Each follow-up magnetic resonance angiogram showed improvement in venous flow consistent with their clinical course and other imaging studies. We conclude that 1) CVT in children encompasses a range of clinical conditions which may or may not require neurosurgical intervention; 2) magnetic resonance imaging is superior to other modalities for the diagnosis of CVT; and 3) magnetic resonance angiography is an alternative means to monitor the evolution of CVT and efficacy of therapeutic intervention.     

Rib chondrosarcoma with intramedullary progression completely resected by magnetic resonance imaging: useful short inversion time inversion recovery sequence

Chondrosarcoma is the second most common bone sarcoma, for which complete resection is the only effective treatment. Herein, we report a case of completely resected rib chondrosarcoma protruding through the bone marrow. An intramedullary lesion was revealed with magnetic resonance imaging using short inversion time inversion recovery sequence (STIR-MRI), but was not depicted by computed tomography. STIR-MRI is highly sensitive for the detection of bone tumors due to the suppression of peritumoral soft tissue signals, and is critical for radical resection of chondrosarcoma.     

Multiple penile schwannomas and their magnetic resonance imaging characteristics

Penile schwannoma is a rare encapsulated nerve sheath tumor of the peripheral nerve in the penis. Here, we report a case of multiple, painful, beadlike, nodular tumors in the penis of a 40-year-old man. The nodules showed well-defined margins and hypoechoic areas on gray-scale ultrasonograms. They showed high signal intensity on fat-saturated T2-weighted magnetic resonance imaging (MRI) and intense enhancement on gadolinium-enhanced T1-weighted MRI, compatible with their myxoid content. The nodules pressed against the tunica albuginea and some caused inward indentation, which we considered as indirect evidence of the tumor location. In conclusion, the MRI characteristics and location of the nodules together enable presurgical diagnosis of penile schwannomas, which is especially useful in asymptomatic patients and those unwilling to undergo surgery.     

Identifying the optimal inlet for antegrade tibial intramedullary nailing via magnetic resonance imaging

IntroductionTibial shaft fractures treated with antegrade rigid tibial intramedullary nailing has been supported worldwide. However, the optimal inlet for nailing is still controversial. Practically, varied inlets may significantly affect the tibial alignment. This retrospective study intended to utilize magnetic resonance imaging (MRI) to investigate the optimal inlet for antegrade tibial nailing.MethodsMRIs of 100 consecutive adult patients (50 men and 50 women, average 27 years) were used in this study. All patients had MRIs for meniscus or knee ligament injuries. There were no fractures or prior bony anomalies. The center of the tibial width (TW) at the level of the tibial tubercle (TT) was considered the optimal inlet and was positioned on the axial view of the MRIs. Various related anatomic landmarks were investigated concomitantly. All parameters were compared statistically.ResultsThe medial edge of the patellar tendon (PT) was 55% from the lateral end of the TW. The apex of the TT was 38% from the lateral end of the TW. The lateral edge of the PT was 19% from the lateral end of the TW. The TT was 2.5 cm distal to the tibial articular surface. The PT width was 2.3 cm. Except for the TW, the distance from the TT to the articular surface, and PT width between genders (p < 0.001), all other parameters showed no statistical significance (p > 0.05).ConclusionsThe optimal inlet for antegrade rigid tibial intramedullary nailing may be at a site 3 mm laterally to the medial edge of the PT. There are normally no differences for the nail inlet between men and women. The PT splitting approach for nail insertion may require modification.     

Meniscal allografts: evaluation with magnetic resonance imaging and correlation with arthroscopy.

PURPOSE: To correlate clinical results to magnetic resonance imaging (MRI) and arthroscopy after cryopreserved nontissue-antigen-matched meniscal transplantations.TYPE OF STUDY: Blinded; the observers were blinded for each others' assessment. MATERIALS AND METHODS: Sixteen consecutive patients were included in the protocol. First, clinical evaluation and MRI were performed. Second, within 24 hours, arthroscopy was performed. RESULTS: The clinical results showed better correlation between clinical results and arthroscopy than between clinical results and MRI. In the present study, MRI was not beneficial in evaluating meniscal transplants. CONCLUSIONS: Using more sophisticated MRI techniques, the correlation between clinical results, arthroscopy, and MRI could probably be improved.     

Stereotactic magnetic resonance angiography.

Visualization of the surgical trajectory with respect to the cerebral vasculature may enhance the safety of some stereotactic neurosurgical procedures. Traditional stereotactic angiography is tedious and, being an invasive procedure, poses some risk to the patient. A technique of projecting a stereotactically defined surgical trajectory onto magnetic resonance angiograms is presented.     

Bladder pheochromocytoma: evaluation with magnetic resonance imaging

A 17-year-old black woman with a large vesical pheochromocytoma was managed successfully by hemicystectomy and ureteroneocystotomy. Preoperatively, in addition to the routine diagnostic evaluation, magnetic resonance imaging was performed. Magnetic resonance imaging proved to be an extremely useful modality to assess the integrity of the bladder wall and extent of extravesical involvement.     

Osteitis--imaging with magnetic resonance tomography

Between January 1985 and December 1988 41 patients with clinically suspected osteomyelitis were examined by MRI. All cases were proved either by surgery or by clinical follow-up. Evidence of osteomyelitis on MRI consisted of abnormalities of the bone marrow with decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. Other abnormalities such as degeneration of the intervertebral disc, fatty degeneration of the muscles and thickening of tendon sheaths with fluid were also seen on the same images. The sensitivity of the MRI for the diagnosis of osteomyelitis was 100%, the specificity was 86% and the accuracy 96%. We conclude that MRI is a reliable method in diagnosing osteomyelitis because of its high sensitivity and high specificity.     

Multiple intracranial aneurysms: magnetic resonance imaging for determination of the site of rupture. Report of a case

In a patient with multiple intracranial aneurysms, the clinical examination, computed tomographic brain scan, and cerebral angiogram failed to disclose which of five aneurysms had ruptured. Magnetic resonance imaging (MRI) revealed high signal intensity compatible with hemorrhage in the lower portion of one cerebellar tonsil, and a corresponding posterior inferior cerebellar artery aneurysm was successfully obliterated. We would add MRI to the list of useful adjuncts in identifying which of multiple aneurysms bled.