MRI of neurologic complications in end-stage renal failure patients on hemodialysis: pictorial review

End-stage renal disease patients who have been on long-term hemodialysis tend to develop central nervous system complications. The most common neurologic complications in this patient group include white matter changes, cerebral atrophy, osmotic demyelination syndrome, dialysis encephalopathy, hypertensive encephalopathy, intracranial hemorrhage, infarct, sinus thrombosis, and infection. Clinical evaluation of these patients is somehow complicated and MRI is important before establishment of the therapy. The purpose of this article is to illustrate the range of MRI findings of neurologic complications in end-stage renal failure patients on hemodialysis with etiologic factors.

Primary tuberculosis in the gluteal muscle of a patient with chronic renal failure. A rare presentation

Patients suffering from chronic renal failure (CRF) are at increased risk for contracting tuberculosis (TB) due to their impaired immunity. In this patient group, extrapulmonary involvement is more common than the pulmonary form of TB, and symptoms tend to be milder and less distinctive than those seen in the general population. Pyomyositis secondary to TB is relatively rare. We report a case of TB pyomyositis in the setting of CRF. The nonspecific symptoms that are typical of CRF patients with TB make it particularly difficult to establish the diagnosis in this patient group. In order to avoid diagnostic delays, which may increase the risk of complications and mortality, TB should be kept in mind in any case of ongoing fever and infection that does not respond to seemingly appropriate therapy. In addition, TB should always be suspected in endemic areas, even in the absence of osseous involvement.

Pachymeningitis and optic neuritis in rheumatoid arthritis: successful treatment with cyclophosphamide

Pachymeningitis is a rare complication of rheumatoid arthritis. The case of a 52-year-old male rheumatoid arthritis patient with pachymeningitis and optic neuritis who was successfully treated with intravenous cyclophosphamide is described.

Polysplenia syndrome with hepatic artery of superior mesenteric artery origin and a circumaortic renal vein

An 8 1/2-month-old girl with biliary atresia and polysplenia syndrome having multiple vascular anomalies without cardiac anomalies is reported. Interruption of the inferior vena cava with azygous continuation, which is a common anomaly, was seen in conjunction with origin of the common hepatic artery from the superior mesenteric artery and with a circumaortic renal vein. The case has particular importance in that no hepatic artery or renal vein variations have been described with biliary atresia and polysplenia syndrome in the literature thus far to our knowledge. The anomalies were shown using different radiological examinations including computed tomography, echocardiography, angiography, venography and magnetic resonance imaging.

CT features of a pericardial gossypiboma

We report a case of surgically retained pericardial sponge as a cause of paracardiac mass in a woman who had thoracotomy 3 weeks prior for replacement of mitral valve prosthesis. Computed tomography examination showed a thin-walled mass containing relatively high-density material in the central part with low-density rim at the periphery suggesting a haematoma with clot formation at first. Surgically removed mass was a retained sponge between right atrium and pericardium. Gossypiboma should be included in the differential diagnosis of an intrathoracic mass besides haematoma and abscess formation in any patient who has had previous thoracotomy.

Pachymeningitis and optic neuritis in rheumatoid arthritis: MRI findings

Rheumatoid arthritis is a systemic disease in which cerebral and eye involvement is neither common nor fully understood. Although it is rarely the cause of pachymeningitis and optic neuritis, rheumatoid arthritis should always be kept in mind in these two conditions. We present a 52-year-old male with an 8 month history of rheumatoid arthritis who was referred to the neurology department with headache and decreasing vision and was diagnosed as having rheumatoid pachymeningitis and optic neuritis on the basis of MRI findings.

Primary choriocarcinoma of the stomach and pancreas: CT findings

In this report we present the CT findings of two non-gestational, extragonadal choriocarcinomas, one arising within the stomach and one in the pancreas. These are rare tumours and a pancreatic primary site has not been previously described.

MRI of hydatid disease of the liver: a variety of sequences

Hydatid disease is a parasitic manifestation that is most commonly seen in the liver. Diagnosis of this condition in the liver is usually straightforward and achieved through US and CT. Complicated cases and the often bizarre appearance of the disease can frequently create problems for the diagnostician, however. MRI has become an important diagnostic tool in the evaluation of complicated liver masses, with routine application of fat-suppressed, fast, and breath-hold techniques. In this pictorial essay, we demonstrate various features of hydatid disease using these new methods.

Osmotic demyelination syndrome with a dysequilibrium syndrome: reversible MRI findings

Neurological disorders may be seen in end-stage renal disease patients due to uraemia or to complications of dialysis. A dysequilibrium syndrome may be seen, usually soon after or towards the end of haemodialysis. This group of patients has no particular findings on MRI. On the other hand, the osmotic demyelination syndrome has definitive MRI findings, not to date reported with the dysequilibrium syndrome. We report a patient with end-stage renal disease and the dysequilibrium syndrome who showed findings of osmotic demyelination on MRI. The patient had a convulsion after a first haemodialysis, with quadriparesis and hyperactive deep tendon reflexes and bilateral Babinski signs. The upper motor neurone signs lasted for a week. Meanwhile, he was also dysarthric and had dysphagia. He recovered neurologically without any residuum following appropriate treatment and there was improvement on MRI.

Pulmonary arterial embolism secondary to hydatid cyst of the liver

Complications may develop after spontaneous or traumatic rupture of hydatid cysts. A rare complication is pulmonary embolism after rupture of such a cyst into the venous system. The authors present the pulmonary radiologic findings for a patient whose pulmonary complaints gradually increased after surgical removal of a hepatic hydatid cyst.