Late Infection of a Dacron Carotid Endarterectomy Patch

This unique case reports the nonsurgical management of a late (2 years) methicillin-resistant Staphylococcus aureus neck infection around a Dacron-patched carotid endarterectomy. Because the patient was elderly with multiple serious risk factors and no drainable material, IV and oral antibiotics were selected as initial management. Follow-up computed tomography of the neck, however, documented complete resolution of the phlegmon. While the authors remain uncertain of the long-term outcome the patient is free of local infection 2 years after diagnosis and nonoperative treatment.

MR of the head and neck: comparison of fast spin-echo and conventional spin-echo sequences

PURPOSE

To compare conspicuousness of head and neck lesions on fast spin-echo sequences and conventional spin-echo sequences.

METHODS

Forty consecutive patients with 61 head and neck lesions were evaluated. Lesion conspicuousness was qualitatively compared on conventional spin-echo and fast spin-echo sequences, using both spin-density and T2-weighted images. Thirty-six lesions had surgical or pathologic confirmation, and 25 were assigned a presumptive diagnosis based on clinical evaluation and imaging findings seen on conventional spin-echo T1- and T2-weighted sequences. Forty lesions were related to neoplasms; 21 lesions consisted of infectious, vascular, or inflammatory abnormalities.

RESULTS

Fast spin-echo sequences provided improved lesion conspicuousness in 91% of spin-density images, in 77% of T2-weighted images, and in 84% of the combined spin-density and T2-weighted images.

CONCLUSION

By providing shorter imaging times and equal or superior lesion conspicuousness, long-repetition-time fast spin-echo sequences can replace long-repetition-time conventional spin-echo sequences in evaluation of the head and neck.

Inversion-recovery fast spin-echo MR imaging: efficacy in the evaluation of head and neck lesions

To compare the efficacies of fast spin-echo (FSE) and inversion-recovery FSE (IRFSE) magnetic resonance (MR) imaging in evaluating head and neck disorders, the authors evaluated 46 lesions in 23 consecutive patients. Twenty-seven lesions were related to neoplasms; 19 lesions resulted from infectious, allergic, or radiation-induced inflammation. Conventional T1-weighted, FSE, and IRFSE images were obtained in all patients. The FSE and IRFSE images were qualitatively compared in an unblinded manner for conspicuity of lesion margins and extent. IRFSE imaging improved conspicuity of 22 lesions (48%) and showed equal conspicuity of 18 (39%). IRFSE imaging proved most useful for small lesions with long T2 relaxation times that were surrounded by fat. IRFSE imaging improved visibility of small optic nerve gliomas, salivary gland inflammation, peripheral nerve tumors, and small lymph nodes. Early changes secondary to spread of tumor across fascial planes were also well visualized with IRFSE sequences. In six lesions (13%) that did not have long T2 relaxation times, the FSE images provided better conspicuity. The authors conclude that by improving conspicuity of small lesions adjacent to or surrounded by fat, IRFSE sequences can supplement FSE sequences in imaging the head and neck.

Incidental paranasal sinus abnormalities on MRI of the brain

T2-weighted magnetic resonance imaging (MRI) presents paranasal sinus pathology with remarkable clarity. However, it has yet to be demonstrated that all MRI findings represent true pathology and not minor or incidental findings of no consequence. In an effort to resolve this question, we have analysed retrospectively 263 consecutive T2-weighted MRI examinations of the head performed for indications not associated with possible sinus pathology. We examined these studies for abnormally increased signal in the paranasal sinuses and the sites of involvement. Mucoperiosteal thickening, mucus retention cysts, air-fluid levels or total sinus opacification were recorded. Of the 263 studies examined, 65 (24.7%) demonstrated abnormalities in the paranasal sinuses. We conclude that because of its great sensitivity MRI will often detect abnormalities in the paranasal sinuses which are unrelated to the patients' presenting problems.