An Unusual Cause of Right Heart Failure: Hemorrhagic Pericardial Cyst Presenting as a Pericardial Mass and Constrictive Pericarditis.

Congenital pericardial cysts are very rare neoplasms of the middle mediastinum. We report a case of a young woman who was referred to the surgical department with abdominal pain. The ultrasound done showed moderate ascites and pleural effusion. Further evaluation with computed tomography (CT) chest revealed a calcified mass in the pericardium. Follow-up echocardiography showed an echogenic mass in the pericardium. Magnetic resonance imaging (MRI) revealed a hyperintense mass with a delayed enhancement of the contents with features of right heart failure. So, an emergency surgical resection was done that showed a large hemorrhagic mass with pultaceous material in the pericardial cavity. The pathological report confirmed the diagnosis of a hemorrhagic pericardial cyst with organized material.

Functional Language Network Connectivity in Children of Women with Epilepsy with Selective Antenatal Antiepileptic Drug Exposure.

PURPOSE: Children of women with epilepsy and antenatal antiepileptic drug (AED) exposure have increased risk of language dysfunction. Our objective was to compare language related functional MRI network connectivity (FC) of children with women with epilepsy with antenatal AED exposure (CAED) with that of healthy children (COAED) for delineating functional basis of the language dysfunction. METHODS: CAED under prospective follow up in Kerala Registry of Epilepsy and Pregnancy were consecutively sampled. COAED were identified from volunteers with normal brain MRI. Clinical Evaluation of Language Fundamentals score (CELF) was used to assess language. Functional MRI done using verb generation paradigm to activate language areas and key language network nodes were identified. A multivariate ROI-to-ROI and Seed-to-Voxel based FC was done using the selected seed regions in the language areas located in the right and left hemisphere in all subjects using the CONN functional connectivity toolbox in SPM8 under MATLAB. RESULTS: Strong connectivity was observed within the identified language network between all language nodes bilaterally in CAED compare to controls. The mean connectivity strength of language network (LN) on the left side in CAED was 9.63 ± 4.62 (Mean ± SD) while for COAED it was 6.96 ± 3.67 (p=0.0001). The mean connectivity strength of LN between CAED (4.86 ± 1.07) and COAED (4.32 ±1.2) on the right hemisphere was not statistically significant (p=0.18). CONCLUSION: CAED with impaired language function had significantly increased functional connectivity which may indicate poor differentiation and localization of language centers.

Analyzing functional, structural, and anatomical correlation of hemispheric language lateralization in healthy subjects using functional MRI, diffusion tensor imaging, and voxel-based morphometry.

CONTEXT: To evaluate the efficacy of diffusion fiber tractography (DFT) and voxel-based morphometry (VBM) for lateralizing language in comparison with functional magnetic resonance imaging (fMRI) to noninvasively assess hemispheric language lateralization in normal healthy volunteers. AIMS: The aim of the present study is to evaluate the concordance of language lateralization obtained by diffusion tensor imaging (DTI) and VBM to fMRI, and thus to see whether there exists an anatomical correlate for language lateralization result obtained using fMRI. SETTINGS AND DESIGN: This is an advanced neuroimaging study conducted in normal healthy volunteers. SUBJECTS AND METHODS: Fifty-seven normal healthy subjects (39 males and 18 females; age range: 15-40 years) underwent language fMRI and 30 underwent direction DTI. fMRI language laterality index (LI), fiber tract asymmetry index (AI), and tract-based statistics of dorsal and ventral language pathways were calculated. The combined results were correlated with VBM-based volumetry of Heschl's gyrus (HG), planum temporale (PT), and insula for lateralization of language function. STATISTICAL ANALYSIS USED: A linear regression analysis was done to study the correlation between fMRI, DTI, and VBM measurements. RESULTS: A good agreement was found between language fMRI LI and fiber tract AI, more specifically for arcuate fasciculus (ArcF) and inferior longitudinal fasciculus (ILF). The study demonstrated significant correlations (P < 0.05) between blood-oxygen-level dependent (BOLD) fMRI activations, tract-based statistics, and PT and HG volumetry for determining language lateralization. CONCLUSIONS: A strong one-to-one correlation between fMRI, laterality index, DTI tractography measures, and VBM-based volumetry measures for determining language lateralization exists.

Arcuate fasciculus laterality by diffusion tensor imaging correlates with language laterality by functional MRI in preadolescent children.

INTRODUCTION: Language lateralization is unique to humans. Functional MRI (fMRI) and diffusion tensor imaging (DTI) enable the study of language areas and white matter fibers involved in language, respectively. The objective of this study was to correlate arcuate fasciculus (AF) laterality by diffusion tensor imaging with that by fMRI in preadolescent children which has not yet been reported. METHODS: Ten children between 8 and 12 years were subjected to fMRI and DTI imaging using Siemens 1.5 T MRI. Two language fMRI paradigms--visual verb generation and word pair task--were used. Analysis was done using SPM8 software. In DTI, the fiber volume of the arcuate fasciculus (AFV) and fractional anisotropy (FA) was measured. The fMRI Laterality Index (fMRI-LI) and DTI Laterality Index (DTI-LI) were calculated and their correlation assessed using the Pearson Correlation Index. RESULTS: Of ten children, mean age 10.6 years, eight showed left lateralization while bilateral language lateralization was seen in two. AFV by DTI was more on the left side in seven of the eight children who had left lateralization by fMRI. DTI could not trace the AF in one child. Of the two with bilateral language lateralization on fMRI, one showed larger AFV on the right side while the other did not show any asymmetry. There was a significant correlation (p < 0.02) between fMRI-LI and DTI-LI. Group mean of AFV by DTI was higher on the left side (2659.89 ± 654.75 mm(3)) as compared to the right (1824.11 ± 582.81 mm(3)) (p < 0.01). CONCLUSION: Like fMRI, DTI also reveals language laterality in children with a high degree of correlation between the two imaging modalities.