Multiorgan involvement in a pediatric patient with hydatid disease

Human Echinococcus infection still remains an important health problem in endemic regions. Herein, we report a 5-year-old boy with hydatid disease who has spleen, lung, kidney and liver involvement simultaneously. To our knowledge, there is no pediatric case with hydatid disease in the literature reporting simultaneous involvement of spleen, kidney, liver and lungs as in our case.

Solid pseudopapillary tumor of the pancreas as a cause of recurrent pancreatitis

Solid pseudopapillary tumor (SPT) of the pancreas is a rare pancreatic tumor mostly seen in young women. We here report a twelve-year-old girl presenting with recurrent attacks of pancreatitis. No history of a systemic disease, trauma, drug usage or infection was present. All other etiologic factors like familial, hypertriglyceridemia, hypercalcemia, cystic fibrosis, medications were excluded. On abdominal ultrasound a heterogeneous mass was noticed at the tail of pancreas. Computerized tomography and magnetic resonance imaging proved that the mass was cystic. The mass was surgically removed. The diagnosis was pancreatic solid cystic papillary epithelial neoplasm. Although acute pancreatitis due to SPT was exceptionally reported, this is the first description of SPT leading to recurrent pancreatitis especially in children.

A case report of an unusual sternal fracture

Most sternal fractures are transverse, and a lateral chest radiograph is diagnostic. We report a case of vertical sternal fracture that was not seen on plain radiographs but was revealed using computed tomography (CT). Thoracic CT with coronal reformatted images can also demonstrate sternal fracture lines, supernumerary synchondrosis, and costosternal joint abnormalities.

Transient neonatal hypoglycemia: cranial US and MRI findings

A case of transient neonatal hypoglycemia with patchy hyperechogenic white matter abnormalities in the frontal and parietooccipital lobes on cranial US is presented. An MRI examination revealed T1 and T2 shortening of the lesions in the occipital and frontal white matter. Follow-up cranial US demonstrated recovery of white matter changes in the patient with normal neurological outcome.

Metastatic hypervascular lymph nodes in malignant glomus vagale tumor: angiography findings

Malignant vagal paraganglioma is very uncommon and the diagnosis of malignancy is made on the basis of presence of distant metastasis rather than the histological findings. We report angiography findings of metastatic cervical lymph nodes in a case of malignant vagal paraganglioma.

Short-term follow-up of the juvenile rheumatoid knee with fat-saturated 3D MRI

OBJECTIVE

To determine the correlation between clinical status and 3D, fat-saturated contrast-enhanced MRI findings in assessing the response to treatment in patients with knee-joint involvement from juvenile rheumatoid arthritis (JRA).

MATERIALS AND METHODS

Synovial hypertrophy, effusion, cartilage and epiphyseal status were scored using spin-echo (SE) T1-weighted, SE T2-weighted and contrast-enhanced, fat-suppressed 3D MRI in 42 knees of 21 patients. MRI findings were evaluated by scoring results and compared with the clinical scoring results. Progression, improvement and equivalence were analysed between 0-3 and 3-6 months, both clinically and by MRI.

RESULTS

Fat-suppression imaging generated high contrast between cartilage, synovium, effusion and bone. Correlation coefficients according to progression, improvement and equivalent findings of months 1-3 and months 3-6 comparison of clinical and MRI scores were found to be 0.50 and 0.70, respectively.

CONCLUSION

Contrast-enhanced 3D MRI with fat suppression provides good discrimination between synovial hypertrophy and fluid. Fat-suppressed imaging offers better contrast between cartilage and synovium. Long-term MRI follow-up of JRA improves direct follow-up of pathological changes and helps in modifying treatment regimens.

Spinal epidural gas after cardiac surgery

The authors describe a patient with severe lower back and left leg pain in the early postoperative period after cardiac surgery. Radiologic examination revealed gas in the spinal epidural space at the level of L4-5. The pain could not be relieved with analgesics and the patient underwent lumber surgery after cardiac surgery. After decompression, the patient improved and was discharged with no symptoms.

Differentiation of recurrent rectal cancer and scarring with dynamic MR imaging

The accuracy of dynamic contrast enhanced magnetic resonance (MR) imaging in the differentiation of malignant and benign pelvic lesions during follow-up of patients with treated colorectal tumours was evaluated prospectively. 19 patients (11 men, 8 women; age range 35-70 years; mean 57 years) with suspected local recurrence of colorectal malignancy were evaluated with MR imaging. Dynamic MR imaging with axial Turbo-FLASH gradient echo imaging and bolus injection of contrast medium was performed. Dynamic images, each consisting of one slice in the same location, were acquired at 5, 10, 15, 20 and 30 s, and at 1, 2, 3, 4, 5 and 10 min. The maximum change in signal intensity (Emax), the acceleration rate of the time-intensity curve (TIC) and the ratio of the signal intensity of the lesions to the signal intensity of the iliac artery (SIL/SIA) were used as the enhancement parameters. The TIC and SIL/SIA ratio at 60 s were found to be valuable in the differential diagnosis; Emax had no significance in differentiating benign and malignant lesions. Sensitivity was 83% for each calculated parameter. SIL/SIA has the highest specificity and accuracy among the parameters.

Diagnostic value of MR arthrography in detection of intrinsic carpal ligament lesions: use of cine-MR arthrography as a new approach

Twenty-five patients with chronic wrist pain and a preliminary diagnosis of carpal instability were examined with conventional MR imaging and MR arthrography with single compartment intra-articular injection. A new cine-MR arthrography technique, with image acquisition at every 5 s during intra-articular injection, was performed in 17 subjects. The purpose of this study was to determine the diagnostic value of MR arthrography in ligamentous lesions of the wrist and to assess the value of cine-MR arthrography in comparison with arthroscopy and/or surgery. Magnetic resonance arthrography, a semi-invasive technique, increased the diagnostic accuracy of intrinsic carpal ligament injuries. Cine-MR arthrography can be considered as a promising technique especially for the evaluation of lunatotriquetral and scapholunate ligament injuries of the wrist.