Incomplete partition type II in its various manifestations: isolated, in association with EVA, syndromic, and beyond; a multicentre international study.

PURPOSE: Incomplete partition type II (IP-II) is characterized by specific histological features and radiological appearance. It may occur in isolation or in association with an enlarged vestibular aqueduct (EVA). Among those with IP-II and EVA, a subset has a diagnosis of Pendred syndrome. This study aimed to explore the prevalence of isolated IP-II, IP-II with EVA, and cases with a genetic or syndromic basis in our cohort. METHODS: From a large, multicentre database of dysplastic cochleae (446 patients, 892 temporal bones), those with imaging features of IP-II were examined in detail, including whether there was a genetic or syndromic association. RESULTS: A total of 78 patients with IP-II were identified. Among these, 55 patients had bilateral IP-II and EVA (only 12 with typical Mondini triad), 8 with bilateral IP-II and normal VA, 2 with bilateral IP-II and unilateral EVA, and 13 with unilateral IP-II (9 with unilateral EVA). Among the group with bilateral IP-II and bilateral EVA in whom genetic analysis was available, 14 out of 29 (48%) had SLC26A4 mutations and a diagnosis of Pendred syndrome, 1 had a FOXI1 mutation, and a few other genetic abnormalities; none had KCNJ10 pathogenic variants. CONCLUSION: Bilateral IP-II-bilateral EVA may be seen in the context of Pendred syndrome (SLC26A4 or FOXI1 mutations) but, in the majority of our cohort, no genetic abnormalities were found, suggesting the possibility of unknown genetic associations. IP-II in isolation (without EVA) is favored to be genetic when bilateral, although the cause is often unknown.

Isolated Congenital Lacrimal Gland Agenesis.

Congenital alacrima is an uncommon condition marked by a lack of tear production that is present from birth. This condition often occurs in conjunction with various syndromes but can also result from isolated lacrimal gland agenesis. Congenital alacrima should be evaluated in the differential diagnosis for pediatric patients presenting with symptoms of dry eyes, especially in cases without xerostomia or other systemic rheumatologic findings. Following a thorough history and examination, noninvasive imaging techniques can be utilized to assess for potential lacrimal gland agenesis and aid in confirming the diagnosis.

The Efficacy and Safety of Lumbar Accessed Catheter-Assisted Epidural Blood Patch in Cervical and Thoracic Cerebrospinal Fluid Leakage.

OBJECTIVE: To evaluate the clinical and radiological results of lumbar accessed catheter-assisted epidural blood patch (LACA-EBP) technique in treatment of spontaneous intracranial hypotension secondary to cervicothoracic cerebrospinal fluid leakage. METHODS: Patients presenting with spontaneous intracranial hypotension where magnetic resonance imaging cisternography confirmed and localized the cerebrospinal fluid leakage at cervicothoracic levels were treated with LACA-EBP. Visual analog scale (VAS) score for headache at baseline, third day after treatment, and during long-term follow-up was used to assess the treatment response. Posttreatment VAS score ≤3 on the third day defined treatment success, and VAS score ≥4 indicated treatment failure. RESULTS: LACA-EBP was performed in 10 patients (7 females, 3 males) with a mean age of 38.4 ± 10.5 years. Orthostatic headache was the most common presenting symptom (10/10; 100%) followed by nausea (5/10; 50%). Pituitary gland enlargement was the most commonly observed finding on pretreatment cranial magnetic resonance imaging (9/10; 90%). On magnetic resonance imaging cisternography, 8 patients had cervical and/or thoracic fistulas, whereas 2 patients had multiple-level fistulas. LACA-EBP was successful in all patients with no complications. All patients showed a treatment response with a 72-hour VAS score ≤3. Follow-up VAS scores were available for 8 patients with a clinical follow-up duration of 1-74 months (median 7.5 months). During clinical follow-up, headache recurred in 2 patients. CONCLUSIONS: In our study cohort, LACA-EBP was a safe and efficacious technique in treatment of cerebrospinal fluid leakage at cervical and thoracic levels.

Right- Versus Left-Sided Approach for Transhepatic Tunneled Catheter Placement: Is There a Difference?

OBJECTIVE: We aimed to compare the technical difficulties, complications, long-term efficacy, and risks between right- and left-sided approach transhepatic tunneled catheterization. METHODS: We retrospectively evaluated transhepatic tunneled catheter placement cases in our institution between May 2012 and November 2019. Demographic and procedural parameters were recorded. Statistical tests were used to compare the complication rates of right- and left-sided approach. Furthermore, Cox regression analyses were used to investigate the relationship between functional catheter days and included parameters. RESULTS: A total of 83 procedures were performed in 46 patients, with a female to male ratio of 1.88 and a mean age of 55.5 ± 18.2 years. Indication for catheter placement was chronic renal insufficiency and loss of central venous access through traditional routes in all cases. Median functional catheter durations were 28 days (1-382) and 55.5 days (1-780) for right-sided and left-sided access, respectively. Complication rates were similar for both sides. There was no difference between primary and revision procedures in terms of safety and efficacy outcomes. In univariate Cox regression analysis, gender was the only variable which was found to be statistically significant (HR = 2.014 (1.004-4.038)) for functional catheter days. In multivariate Cox regression model, gender and access side were included which failed to reach statistical significance. CONCLUSIONS: In our study, both right- and left-sided approaches provided similar safety and efficacy outcomes, suggesting that both techniques can be employed based on physician's preference.

Imaging Features to Predict Response to Olfactory Training in Post-Traumatic Olfactory Dysfunction.

OBJECTIVES/HYPOTHESIS: Prognosis of post-traumatic olfactory dysfunction is poor, with medical treatment options showing limited success rates. Olfactory training (OT) has been introduced as a potential therapeutic option in olfactory dysfunction. We aimed to identify the imaging features that would predict a better response to OT and create an imaging-based prognostic scale. METHODS: We retrospectively reviewed 52 patients that underwent OT at our center for post-traumatic olfactory dysfunction. Olfactory functions at the time of initial presentation and at completion of OT were evaluated using Sniffin' Sticks test and threshold discrimination identification (TDI) scores were calculated. Patients were divided into responders (ROT group: 16 cases) and non-responders (n-ROT group: 36 cases) to OT based on TDI score change (cut-off 5.5 point). Morphological measurements of olfactory fossa, olfactory bulb volume and signal abnormalities, olfactory nerve filia integrity, siderosis, encephalomalacic changes in olfactory cortex, and other cortical regions were reviewed. RESULTS: There was no significant difference between the two groups in terms of age, gender distribution, olfactory dysfunction duration, head-trauma severity, and initial TDI scores. A model incorporating five variables: cribriform plate fracture, olfactory fossa depth (cut-off: 4.9 mm), olfactory bulb encephalomalacia, olfactory bulb volume (cut-off: 27.1 mm3 ), and siderosis was developed. This model had an area under the curve (AUC) of 0.950, and a cut-off value of 1 had 76.5% sensitivity and 97.1% specificity in prediction of response to OT. CONCLUSIONS: We developed an imaging-based scoring system with good specificity that can be used as an adjunctive tool for patient counseling, and optimal selection of management options. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2243-E2250, 2021.

Predictors of antegrade ureteral stenting failure: a single-center experience in patients with malignant and benign ureteral obstruction.

OBJECTIVE: To determine the potential predictors of antegrade ureteral stenting (AUS) failure in patients with malignant and benign ureteral obstruction. METHOD: We retrospectively evaluated 116 AUS procedures performed in 80 patients for ureteral obstruction due to malignant and benign causes. Variables such as etiology for obstruction, ureter shape, previous treatment regimen, history of ileal loop diversion, and presence of percutaneous nephrostomy were recorded. Univariate and multivariate logistic regression methods were used between these variables and stent failure. RESULTS: Antegrade ureteral stenting was performed as single stage in 24 procedures (n: 24/116, 21%) and performed as a two-step approach after percutaneous nephrostomy in 92 procedures (n: 92/116, 79%). Ureteral stent was successfully deployed in 112 AUS procedures (n: 112/116, 96.5%). In 35 of these successful procedures, the patients were referred to our department due to prior failed retrograde ureteral stenting (RUS). Subsequent stent failure occurred in 40 procedures after a median interval of 39 days. Pre-stenting percutaneous nephrostomy (PN) was a statistically significant risk factor for stent failure (p: 0.041), and age showed an inverse relationship with stent failure (p: 0.008). Complications in early (within the first 30 days after procedure) and late stage occurred in a total of 17 procedures. Early complications included urinary tract infection (n: 11), stent migration (n: 3), and malposition (n: 1). Late complications (after 30 days) were urinary tract infection (n: 1) and stent migration (n: 1). CONCLUSION: This study suggests that AUS can be performed effectively in both benign and malignant ureteral obstructions including cases with prior failed RUS. Two-step AUS after percutaneous nephrostomy was found to be a significant risk factor for subsequent stent failure in our study cohort.

Brain MRI Findings in Patients in the Intensive Care Unit with COVID-19 Infection.

Online supplemental material is available for this article.

A technical note on intra-arterial cone-beam computed tomography for the evaluation of flow-diverter stents: Image quality differences between diluted and non-diluted contrast medium.

BACKGROUND: Design of flow-diverter stents for flexibility, tractability, and low profile limits their radiopacity on conventional digital subtraction angiography. Cone-beam computed tomography (CBCT) offers higher spatial resolution for the evaluation of flow-diverter stents. However, CBCT requires optimal dilution and timing of contrast medium for simultaneous visualization of the stent, arterial lumen, and vessel wall. There are only limited data on the effects of different contrast dilutions on CBCT image quality in neurointerventional applications. MATERIALS AND METHODS: In our institution, intra-arterial CBCTs were acquired during stent deployment and at follow-ups with 10% diluted contrast. We had recently started acquiring intra-arterial CBCTs with non-diluted contrast. Retrospective analysis of our flow-diverter data identified eight cases with different aneurysm locations who had intra-arterial CBCT with 10% diluted contrast immediately after flow-diverter stent deployment and with non-diluted contrast technique during follow-ups. For each case, the image quality between diluted and non-diluted contrast techniques was compared qualitatively by assessing stent visualization and quantitatively by plotting gray-scale intensity values along the vessel lumen. RESULTS: In two sets of CBCT images per each case, there was no substantial difference between diluted and non-diluted CBTC techniques for the evaluation of stent architecture and lumen opacification. Gray-scale intensity values perpendicular to the lumen revealed similar intensity values along the neighboring parenchyma, vessel wall, and lumen for the two different contrast techniques. CONCLUSION: Intra-arterial CBCT angiography can be performed without contrast dilution and still achieve adequate image quality in certain cerebral aneurysms treated with flow diverter. The non-diluted contrast technique avoids the time loss during preparation of diluted contrast and installation of diluted contrast to the injector in angiography suites with a single power injector.

Unilateral Submandibular Gland Aplasia Mimicking Nodal Metastasis.

Aplasia of salivary glands is rare and usually involves several major salivary glands. Isolated unilateral submandibular gland aplasia or aplasia accompanied by hypertrophy of contralateral submandibular gland or sublingual glands is a rare entity. The majority of cases are incidentally detected findings in asymptomatic patients; however, imaging findings may mimic mass-like lesions, posing diagnostic challenges in cancer patients. We presented 2 cases, a case with melanoma and an asymptomatic case, who had asymmetric lesion at left submandibular space, demonstrated to represent left submandibular gland accompanied by right submandibular gland aplasia. We aimed to highlight the imaging features for correct identification of these mass-like lesions as normal contralateral salivary gland accompanied by unilateral submandibular gland aplasia.

Correlation of imaging and intraoperative findings in Pott's puffy tumour.

INTRODUCTION: Pott's puffy tumour is characterised by frontal bone osteomyelitis accompanied by subperiosteal abscess. It can be further complicated by intracranial extension of the infectious process. CASE PRESENTATION: A 12-year-old boy initially presented with signs and imaging findings of pan-sinusitis. Despite antibiotic therapy, there was progressive swelling of the forehead region. Subsequent imaging studies revealed osteomyelitis of frontal bone, subcutaneous abscess and extension into intracranial space. The abscesses were surgically drained, and craniectomy for osteomyelitis was carried out. CONCLUSION: The initial symptoms of Pott's puffy tumour can be subtle, and antibiotic use may mask the underlying sinister involvement of intracranial structures. Imaging plays an important role both in diagnosis and detection of possible intracranial complications.

Central venous catheter insertion into the false lumen of a complicated aortic dissection.

Thoracic endovascular repair is considered the first-line treatment in complicated acute type B dissection. Central venous catheters provide valuable vascular access during endovascular treatments. However, central venous catheters are not without complications. Herein, we report a case of central venous catheter insertion into the false lumen of a complicated acute type B aortic dissection by direct aortic puncture. The tip of the central venous catheter was in the false lumen. The central venous catheter was left in place initially and was removed after graft stent deployment. This case illustrates the importance of image guidance during central venous catheter insertion, which may further complicate an already complicated aortic dissection case.

Endovascular treatment of inadvertent left internal mammarian artery to great cardiac vein fistula.

Inadvertent left internal mammarian artery to coronary sinus anastomosis is a rare complication of coronary artery by-pass graft surgery. Management of this iatrogenic complication is controversial with conservative, surgical and endovascular options possible. Endovascular treatment offers a minimally invasive approach with a wide variety of embolic agents with different success rates. Herein we present a case of an iatrogenic left internal mammarian artery to coronary sinus anastomosis treated by detachable coil embolization. Use of detachable coil offers more precise deployment that is essential in the treatment of an iatrogenic left internal mammarian artery to coronary sinus anastomosis which can present challenges due to high flow rates and coil migration.

Detection of wall and neck calcification of unruptured intracranial aneurysms with flat-detector computed tomography.

OBJECT: Microsurgical clipping is a widely used surgical technique in intracranial aneurysm treatment. It can be difficult in large sized aneurysms, and those with wide necks, thick walls and calcification located in the vicinity of the neck. This study reviewed calcification of the intracranial aneurysm wall and its relation to patient age, gender, location and size of the aneurysm. A possible cut-off value after which the aneurysm calcification rate increases was also investigated to classify patients' risk factors for microclipping. METHODS: A retrospective review of all unruptured intracranial aneurysms that underwent digital subtraction angiography at a single centre was performed. Flat-detector computed tomography images of the aneurysm were reviewed for aneurysm location, size and calcification. The independent samples t test and χ(2) test were used to show the relation between aneurysm wall calcification and patient age, gender, aneurysm localisation and size. RESULTS: None of the reviewed factors were statistically significantly related to aneurysm calcification except aneurysm size (P < 0.01). Receiver operating characteristic curves showed aneurysms greater than 10.5 mm could be predicted to be calcified with a sensitivity of 80% and specificity of 63%. CONCLUSION: In this study, the presence of calcification was related to aneurysm size. Larger aneurysms were more likely to be calcified. Aneurysms greater than 10.5 mm should be further investigated with a modality such as flat-detector computed tomography to show the calcification in detail, especially if microclipping is considered.

Intrathoracic gossypiboma after spinal operation.

Gossypiboma is a rare surgical complication, with an estimated incidence of 1/1,000 to 1/10,000 per operation. Gossypiboma is an aseptic foreign body reaction with fibrosis and granuloma formation secondary to retained surgical sponges. The main sites of involvement are the abdomen, pelvis, and thorax. Intrathoracic gossypiboma poses diagnostic challenges because the surgical history may include extrathoracic operations and imaging findings can be atypical. We describe a patient with intrathoracic gossypiboma secondary to posterior vertebral body screw fixation after a traumatic injury. This case illustrates that thoracotomy history may not necessarily be found in intrathoracic gossypiboma.