Case report: An unusual angiogram in a patient with gastrointestinal bleeding

A patient presenting with upper gastrointestinal bleeding had two visceral angiograms, the second of which demonstrated the hepatic veins in the late phase of the hepatic arterial injection. This observation led to the correct diagnosis of hepatic telangiectasia with arteriovenous shunting and the suspicion, subsequently confirmed at endoscopy, of similar-lesions in the gastrointestinal tract. Visualisation of hepatic veins in visceral arteriography is unusual but may, as discussed, be normal.     

CT arteriography-guided embolization in hepatic bleeding: a case report

A 33-year-old man with hepatic bleeding was transferred to our hospital. Conventional plain and enhanced spiral computed tomography (CT) with a Siemens Somatom Plus-S scanner (Siemens AG, Erlangen, Germany) revealed a large hepatic hematoma and active extrahepatic bleeding. A unified spiral CT and angiography system (IVR-CT/Angio system; Toshiba Medical Systems, Tokyo, Japan) was employed, and selective catheterization-aided CT arteriography (CTA) showed additional active extrahepatic bleeding. These findings were not detected on conventional spiral CT or angiography. The CTA findings led us to successful transarterial embolization (TAE). After TAE, CT scan revealed that the contrast material injected in the hepatic artery was diffusing into the periportal space. Twenty-four days after TAE, a central bisegmentectomy of the liver was performed. Unfortunately, the cause of the hepatic bleeding was not clear pathologically.     

Fatality following a sternal bone marrow aspiration procedure: a case report

A 58-year-old man was admitted to hospital for the investigation and treatment of pancytopaenia and anaemic heart failure but four days later he died following a sternal bone marrow aspiration procedure. The autopsy revealed a significant haemopericardium as a result of a puncture wound of the heart. The thickness the body of the sternum was 2 to 3 mm. No other significant pathology was noted and death was ascribed to a haemopericardium due to a puncture wound of the heart associated with bone marrow aspiration. An inquest was held at which the doctor who undertook the procedure was found not to be negligent.     

F-18 FDG uptake in a bone infarct: a case report.

PURPOSE: The authors describe a patient with F-18 fluorodeoxyglucose (FDG) uptake resulting from a bone infarct of a rib. MATERIALS AND METHODS: A 52-year-old woman with a history of left breast cancer and total mastectomy 5 years earlier was examined for pain in her left rib cage in the past 2 weeks. A bone scan showed diffusely increased uptake in the left fifth rib, possibly suggestive of a metastasis. An FDG positron emission tomographic (PET) scan was performed to rule out metastatic disease. RESULTS: The FDG PET images showed two focal areas of increased uptake in the fifth and sixth left ribs, consistent with bone metastases. The patient underwent excision of a long segment of her left fifth rib and the pathological findings were consistent with bone infarct, without definite signs of metastatic disease. CONCLUSION: Bone infarct can take up FDG, probably as a result of an inflammatory process.     

Diffuse, intense lung uptake on a bone scan: a case report

PURPOSE: Clinical and scintigraphic findings are described in a patient with unexpected diffuse lung uptake on bone scan after a heroin overdose. METHODS: The patient's Tc-99m MDP bone scan is reviewed along with the pertinent clinical history and laboratory findings. RESULTS: Marked diffuse and symmetric lung uptake is present on bone scintigraphy in a patient with a history of acute renal failure and a markedly elevated calcium-phosphate product but normal renal function and laboratory values at the time of the examination. CONCLUSIONS: The incidental observation of metastatic calcification by bone scintigraphy is important, because it may aid in the diagnosis of a previously unsuggested elevated calcium-phosphate product, renal failure, or both. Furthermore, the intensity of tracer localization on bone tracer-specific imaging may help evaluate the activity of the metastatic calcification process.     

Fibrous dysplasia with barely increased uptake on bone scan: a case report

Fibrous dysplasia, in general, appears as an area of markedly increased uptake on bone scintigraphy. Therefore, the possibility of fibrous dysplasia is likely to be excluded when the lesion shows no or slightly increased uptake. The authors report a case of incidentally detected fibrous dysplasia that appeared as slightly increased uptake on bone scintigraphy and was found to harbor a bone infarction along with typical fibrous dysplasia by pathologic examination of a specimen sampled by curettage. Barely increased bone uptake in fibrous dysplasia may be associated with decreased vascularity and osteoblast activity of the lesion as a result of concurrent bone infarction. The authors suggest that not every case of fibrous dysplasia appears as an area of intensely increased uptake on a bone scan. Clinicians should be cautious in interpreting bone scans of radiographically indicated fibrous dysplasia.     

Idiopathic hepatic uptake of (99m)Tc methylene diphosphonate: a case report

OBJECTIVE: Two sequential (99m)Tc methylene diphosphonate (MDP) scans were performed on a 42-y-old woman with insulin-dependent diabetes mellitus, chronic right pyelonephritis and anemia. The initial scan showed reduced skeletal uptake with intense and diffuse hepatic uptake. Because these findings were similar to those seen when excessive hydrolyzed-reduced (99m)Tc colloids are present in the radiopharmaceutical, the scan was repeated after an adequate time delay. Increased skeletal uptake was evident in the second scan, but the hepatic uptake persisted. Although there are numerous causes of soft tissue activity on (99m)Tc MDP bone scans, the responsible pathologic entity is not always clear. This study reviews several possible reasons for such uptake, although the exact mechanism in this case remains conjectural.     

导管栓塞治疗下消化道反复多发性出血一例

患者女,77岁。因外伤致腰骶部疼痛伴活动受限3个月入院。入院诊断:腰椎压缩性骨折,重症肌无力。患者有重症肌无力、支气管哮喘病史3年,自服泼尼松片10片5 mg/片1年余;半年前曾有黑便史,无呕血、血便史。入院后出现消化道大量出血,血小板较低,重度贫血,营养不     

Nuclear cardiological examination for evaluation of hypertrophic cardiomyopathy with midventricular obstruction and apical aneurysm: a case report

Midventricular hypertrophy (MVO) is a rare and complicated myocardial disease. Its pathophysiology and prognosis remain unknown, and few nuclear cardiological findings for MVO were reported. On a 44-year old man with MVO, thallium-201 (Tl) myocardial scintigraphy and gated blood pool scintigraphy (GPS) were performed to evaluate their usefulness. GPS revealed a characteristic hour-glass deformity of the left ventricular cavity, apical aneurysm and asynchrony due to obliteration of the midventricle. Anteroseptal hypertrophy in midventricle and myocardial damage in apico-inferior region were detected by Tl. Thus, nuclear cardiological studies are proved to be useful and essential in not only diagnosis but also evaluating pathophysiology and observing natural history noninvasively.     

The "SAPHO" syndrome: a case report of a patient with unusual bone scan findings.

PURPOSE: The authors describe the clinical and bone scintigraphic findings of the SAPHO syndrome, which is characterized by synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. The case report illustrates the significance of bone scintigraphy in the diagnosis. It shows that Tc-99m MDP scanning can detect signs of arthritis not seen with other imaging methods, because the arthritis is inflammatory in nature and does not always cause bone erosion. Thus it is not visualized on plain radiographs. Knowledge of this disorder may help in the differential diagnosis of arthritis. MATERIALS AND METHODS: Tc-99m MDP bone scintigraphy was used to diagnose arthritic changes. Whole-body and multiple delayed spot images were obtained in a 39-year-old diabetic, hypertensive woman who had tenderness in the plantar aspect of her heels. Swelling of the small and large joints of the feet, ankles, knees, hips, right sacroiliac joints, and shoulders was noted. She also had hydradenitis suppurativa and a history of a previous episode in which the arthritis improved after surgical treatment for the hydradenitis. RESULTS: All active joint lesions were visualized on the bone scan, including the arthritis, which was not detected with other imaging methods. They were all well demonstrated in the bone scintiscan. The scan findings, along with the presence of hydradenitis, led to the correct diagnosis of SAPHO syndrome. CONCLUSION: Tc-99m MDP bone scanning may be helpful in diagnosing arthritis as associated with the SAPHO syndrome.     

Reduced hemithoracic uptake on 99mTc-MDP bone scintigraphy: an underrecognized sign of massive pleural effusion--a case report

The uptake of (99m)Tc-methylene diphosphonate (MDP) in malignant pleural effusions and, rarely, in nonmalignant pleural effusions has been well documented in the literature. Although the exact mechanism of uptake in these conditions remains unclear, there have been attempts to use the bone scintigraphic features of pleural effusion to predict sensitivity and specificity for malignancy based on pleural fluid cytology. It has been suggested that activity in the chest increases with an increase in effusion volume. We report here, however, a case of malignant pleural effusion, that showed reduced hemithoracic activity in contrast to the expected increased activity. Our experience highlights the need for an open and inquisitive mind to avoid diagnostic pitfalls when confronted with a bone scintigram showing reduced uptake unilaterally or bilaterally in the chest.     

Percutaneous drainage of a thigh haematoma: case report of an unusual radiographic appearance.

We present a case of fat necrosis in the thigh of a ten year old girl, resulting in unusual multiple, ovoid filling defects seen in the residual cavity following drainage of a subcutaneous haematoma. No similar cases have been found on review of the literature. The appearance is described to aid diagnosis at the time of initial cavity drainage, avoiding the need for further investigation.     

自体骨髓干细胞经肝动脉移植治疗急性肝损伤的实验研究

目的 评价自体骨髓干细胞经肝动脉移植对兔急性肝损伤模型的治疗效果,了解促肝细胞生长素(pHGF)在干细胞移植治疗中的协同作用.方法 新西兰雄性大白兔15只,皮下注射50%CCl4橄榄油溶液0.8 ml/kg连续4 d制作急性肝损伤模型.模型动物随机分为实验组A(干细胞移植组),实验组B(干细胞移植+pHGF组)和对照组(各5只).实验组经兔双侧胫骨抽取骨髓约5 ml,采用密度梯度离心法分离骨髓干细胞,制成5 ml细胞悬液,透视下经股动脉插管将骨髓干细胞经肝动脉注入肝脏,对照组注人生理盐水.实验组B在干细胞移植后隔日静脉注射pHGF 2.0 mg/kg共20 d.干细胞移植后2、4、8周抽血进行肝功能检测,8周后取兔肝脏组织标本进行病理学观察.结果 骨髓干细胞肝动脉移植后肝功能逐渐改善,至移植后8周,各组血清AST、ALT活性和TBIL、ALB含量均显著低于术前指标,而球蛋白含量高于术前(P均<0.05),而且各组之间仍有明显差异.病理组织学观察显示实验组肝纤维组织增生程度和肝细胞变性较对照组明显减轻.免疫组化染色可见肝组织内散在分布有CD34阳性肝样细胞,实验组A较对照组多,实验组B最多.结论 自体骨髓干细胞经肝动脉移植对肝损伤有明显治疗作用,可改善肝功能,促进肝组织结构重建,抑制纤维组织增生;pHGF能加速肝组织的修复和肝功能的改善.     

Sudeck's bone atrophy after leg phlebography - a case study of an unusual complication (author's transl)

In a 39-year old man, a painful oedema had formed at the back of the foot perimalleolary one day after paravasal contrast medium injection following ascending phlebography. 8 weeks later, the x-ray film showed a maculate Sudeck's bone atrophy in the region of the toes, ankles and the heel. Sudeck's bone atrophy had obviously developed on account of a specific vegetative reactivity, subsequent to the local inflammation.     

Bilateral dentigerous cysts: review of the literature and report of an unusual case

Dentigerous cysts are common cysts of the jaws. They are associated with the crowns of permanent teeth, most frequently associated with impacted mandibular third molars. Bilateral dentigerous cysts are rare and generally occur in association with a developmental syndrome or systemic disease, such as mucopolysaccharidosis and cleidocranial dysplasia. Bilateral dentigerous cysts in the absence of a syndrome are rare and to date only 17 cases have been described. The following is a report of a case of unusual bilateral non-syndromic dentigerous cysts associated with mandibular second molar and maxillary third molar and a review of the literature. Bilateral dentigerous cysts in these locations have not been previously reported.     

Multiple hepatic angiolipomas: a case report and review of literature

Follow-up of two hepatic angiolipomas in a patient without evidence of tuberous sclerosis is reported. Initially, the lesions presented as homogenously enhancing masses, which were nearly isodense to normal liver tissue on plain CT scans. Focal nodular hyperplasia was assumed. One year later, fat was detected in the growing tumors and percutaneous core biopsy revealed hepatic angiolipomas. Natural history of these rare lesions is unknown, and this is to the best of our knowledge the first observation of fatty metamorphosis in such a benign, mesenchymal hepatic neoplasm. Received: 8 October 1997; Revision received: 19 March 1998; Accepted: 11 May 1998