A giant intradiploic epidermoid cyst with perforation of the dura and brain parenchymal involvement

A patient with a long-standing intradiploic epidermoid cyst with perforation of the dura and brain parenchymal involvement is reported. A 69-year-old man, who had previously presented with a subcutaneous mass on the left frontoparietal scalp, developed a sudden grand mal seizure. Magnetic resonance imaging showed a well-defined mass in the frontoparietal scalp with destruction of the skull. Penetration of the dura allowed for communication with the intracranial structures. Surgical resection and cranioplasty were performed. There were no well-defined margins in the deep portion and the mass was subtotally removed. Histological examination showed that the cystic structure was lined by squamous epithelium containing laminated keratin material. The pathologic findings were consistent with the diagnosis of an epidermoid cyst.     

超声引导下注射无水酒精治疗肾囊肿的疗效分析

目的探讨超声引导下肾穿刺注射无水酒精治疗肾囊肿的临床疗效。方法本组肾囊肿患者共118例,采取卧位,局麻,在彩色多普勒超声引导下经皮穿刺肾囊肿抽液后向肾囊肿内注射无水酒精,保留5分钟后抽出,观察其临床效果及并发症发生情况。结果118例共137个肾囊肿,经无水酒精治疗后复查发现总治愈率为84％,总显效率为98％,其中,9例患者在治疗后,出现不程度的头晕,恶心等,13例患者注入无水酒精后或拔出针后出现腰部胀痛或不同程序腹痛,休息后均可缓解,无出血、感染、剧痛等严重并发症。结论彩色多普勒超声导向能成功避开肾大血管,该方法具有疗效好、穿刺准确、方法简便、经济、安全等优点。     

外伤性脾破裂64例临床分析

目的探讨外伤性脾破裂的临床诊治。方法对64例外伤性脾破裂进行回顾性总结。结果手术治疗59例,其中脾修补术12例,脾切除后脾片自体移植术28例,脾切除术19例,非手术治疗5例。治愈63例,死亡1例。结论外伤性脾破裂治疗以手术为主,并且积极选择保脾术。     

Conservative management of a ruptured pulmonary hydatid cyst

Pulmonary hydatid cysts in children frequently develop complications such as infection and air leaks. Surgery combined with medical therapy remains the standard form of treatment. We report a 7-year-old child who developed rupture of a large pulmonary hydatid cyst following chest trauma; conservative management resulted in successful expulsion of the cyst.     

Alcohol Ablation Therapy of an Atypically Located Symptomatic Bronchogenic Cyst: A Case Report

Bronchogenic cyst is a rare developmental lesion. It is usually asymptomatic and most frequently located in the middle mediastinum and lung parenchyma. It can cause symptoms only when infected or pressing on neighboring structures. The MRI findings in a 34-year-old woman with an 8 months history of back pain were evaluated and revealed a cystic lesion in the left paravertebral area. The histopathologic evaluation of the material aspirated with CT guidance was reported to be bronchogenic cyst. A simultaneous alcohol ablation was accomplished. After the procedure the patient’s pain disappeared and the follow-up MRI scan 1 year later revealed no relapse. Paravertebrally located bronchogenic cysts are very rare and only 3 cases were found to be reported in the medical literature prior to this one. While aspiration alone is sufficient for diagnosis, it is insufficient to treat the lesion and prevent the recurrences. This paper reports a paravertebral bronchogenic cyst which was symptomatic despite of its small size. CT-guided aspiration was accomplished and simultaneous alcohol ablation was carried out to prevent recurrences.     

Omental pseudocyst

Diagnostic image features of the omental cyst remain to be fully understood because of its rarity. We present here a case of omental cyst in a 29-year-old man involving several diagnostic image features. Contrasted computed tomography showed thin ring-like enhancement, and angiography revealed the feeding arteries that branched from the right gastroepiploic artery. The cyst was excised surgically, and the final pathological diagnosis was an omental pseudocyst.     

Ganglion cysts at the gastrocnemius origin: a series of ten cases

Objective To describe ganglion cysts arising close to the origin of the medial and lateral head of gastrocnemius as identified on magnetic resonance (MR) imaging. Design and patients We present a series of ten cases of ganglion cysts arising close to the gastrocnemius origin from the medial and lateral femoral condyles. These were collected over a 6-year period from our imaging database. All patients attended for routine MR imaging of the knee with a variety of clinical presentations. Data collected included patient demographics, ganglion size, ganglion site, clinical presentation and ancillary MR imaging findings. The ten patients in this series consisted of seven males and three females, five right and five left knees, age range 27–68 years, mean age 40.6 years. Results The mean maximal dimension of the ganglion cysts was 26 mm, range 15–40 mm. The medial gastrocnemius origin was involved in eight patients and the lateral origin in two patients. The MR imaging findings consisted of both uni- and multi-loculated cysts, often containing numerous septations with fluid signal characteristics. The cysts were extra-capsular with no clear communication with the joint. One patient presented with a popliteal soft tissue mass and none of the cases required surgical intervention for cyst removal. Conclusions MR imaging may identify ganglion cysts arising in an intra- or extra-articular site around the knee. This series documents the MR imaging characteristics of ganglion cysts arising close to the gastrocnemius origin and discusses the relevance of this imaging finding.     

The forgotten organ: contrast enhanced sonography of the spleen

OBJECTIVE: Ultrasound contrast agents in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging in several organs. Contrast enhanced sonography (CES) of second-generation contrast media have shown a spleen-specific uptake of the microbubble contrast agent. The aim of this review is to illustrate indications for the use of CES in patients with suspected (peri-)splenic pathology. METHODS: This review based on the experience of transcutaneous CES in 200 patients with (peri-)splenic pathology diagnosed by B-mode sonography at an internal medicine center. CES studies were performed with a contrast-devoted unit (Acuson, Sequoia, Siemens medical solution) that had contrast-specific, continuous-mode software. A low mechanical index was used. A sulfur hexafluoride-based microbubble contrast medium (Sonovue, Bracco SpA, Milan, Italy) was injected. RESULTS: On our experience, there are several clinical conditions which may show an diagnostic advantage of CES in comparison to B-mode US. CES should be performed to investigate: (1) the perisplenic tumor to diagnose or exclude accessory spleen, (2) the small-sized spleen to diagnose functional asplenia/hyposplenia, (3) the inhomogenous spleen of unknown cause to diagnose focal lesions within the spleen, (4) the incidentally found hypoechoic splenic tumor to diagnose high vascular splenic hemangioma, (5) focal lesions suspect for splenic abscess, hematoma, infarction to confirme diagnosis, and (6) patients with abdominal trauma to diagnose or exclude splenic injury. CONCLUSION: CES is of diagnostic value in several clinical circumstances to diagnose accessory spleen, functional asplenia, small-sized splenic involvement, high vascular splenic hemangioma, and vascular splenic pathology like splenic infarction, splenic abscess, and splenic laceration.     

Dissapearance of arachnoid cyst after rupturing into subdural space

Summary Arachnoid cysts are developmental anomalies usually diagnosed in childhood. The most important complications of arachnoid cysts are subdural haematomas and hygromas and intracystic haemorrhage. In our case we present a 7-year-old boy whose arachnoid cyst ruptured into the subdural space following a mild head injury and disappeared after draining the subdural haematoma by burr-holes.     

Gamma knife radiosurgery for intracranial haemangioblastomas

Summary Background. The results of gamma knife radiosurgery for haemangioblastomas were retrospectively studied to assess the efficacy for tumour growth control and clarify the clinical indications for gamma knife radiosurgery in these tumours. Methods. The medical records of 22 patients with 67 tumours, 12 men and 10 women aged 20–73 years (mean 51.9 years), who underwent gamma knife radiosurgery for haemangioblastomas between January 1993 and January 2006, were retrospectively reviewed. Ten patients with 54 lesions had von Hippel-Lindau disease. The mean tumour volume was 1.69 cm³ (range 0.0097–16.4 cm³). Nineteen patients had undergone 1–4 open surgery procedures (mean 1.5) before gamma knife radiosurgery. Tumours without a cystic component, (the solid type), were found in 54 lesions and tumours associated with cyst, (the mural nodule with cyst type), in 13 lesions. The marginal dose was 8–30 Gy (mean 14.0 Gy). Findings. Follow-up magnetic resonance (MR) imaging was performed at 9–146 months (mean 63 months). The control rate for tumour growth was 83.6%. The only factor affecting tumour growth control was the presence of a cystic component at the time of gamma knife radiosurgery in both univariate and multivariate analysis. No complication such as radiation-induced peritumoural oedema or radiation necrosis occurred. Conclusion. The presence of cystic components at the time of gamma knife radiosurgery was the only factor significantly correlated with unfavourable tumour growth control by gamma knife radiosurgery for haemangioblastomas. Gamma knife radiosurgery is effective for solid type tumours, even if the marginal dose is relatively low. Surgical removal is recommended for mural nodule with cyst type tumours, when possible.