A case of osteopetrosis with pelvic ectopic spleen: an unusual association.

A three-month-old girl was admitted to the hospital with a history of pallor. On physical examination, the liver was enlarged and a solid mass was palpated in the left abdomen. Laboratory evaluation revealed anemia and thrombocytopenia. Bone marrow was hypocellular with reduced number of megakaryocytes. Radiographic findings and scintigraphic study of the long bones were consistant with osteopetrosis. In the imaging studies, including ultrasonography, computerized tomography, magnetic resonance imaging and scintigraphic study, an ectopic spleen expanded into the bony pelvis was observed. We report here unique case of infantile osteopetrosis associated with pelvic ectopic spleen.

Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid.

OBJECTIVES: The objective of this study was to determine whether there is any association between the protein concentration in the synovial fluid and (i) the amount of articular hydrops, as graded in magnetic resonance (MR) images, and (ii) joint pain in temporomandibular joints (TMJs) with and without displacement of the disc. PATIENTS AND METHODS: This study involved 16 joints in 16 patients referred to our clinic with the complaint of pain and limited mouth opening. The control group consisted of 15 joints in 15 patients with unilaterally normal disc and condyle relationship and no pain while the opposite side had a non-painful joint with disc displacement without reduction (DDwoR). The subjects and controls were different individuals and only a single joint was used for each. Pain and dysfunction were evaluated by visual analogue scale. Bilateral proton density and T2 weighted images of the TMJs of the 31 subjects were analysed for fluid and condyle bony changes as well as disc position. The amount of fluid, identified as an area of high signal intensity in the region of the upper and lower joint spaces, was characterized as none, minimal, moderate or marked. Arthrocentesis was performed both for synovial fluid analysis of total protein concentration and the treatment of the joints with DDwoR. Total protein concentration was measured by using protein dye binding on spectrophotometry. RESULTS: All patients experienced a significant (P<0.01) increase in maximal mouth opening immediately post-arthrocentesis. In the study group, the disc was displaced most frequently in an anteriormedial direction (75%) and deformation of disc form was seen in 13 joints. Condylar bony changes were seen in 27% of joints in the control group and in 81% of joints in the study group. A statistically significant association was found between joints with disc displacement, disc form and condylar bony changes (P<0.05). In the control group, only one joint, which had an osteophyte, showed joint effusion (JE) with moderate fluid. In the study group, only four joints had no fluid (25%). JE was found in 10 (63%) joints with disc displacement on anteromedial direction, in 10 (63%) joints with disc deformation and in 10 (63%) joints with osteophytes and erosion. Mean total protein concentration was 16.87+/-7.9 (range 7.4-34.1 mg dl-1) in control joints, 55.08+/-35.16 (range 21.5-153.9 mg dl-1) in study joints. There were significant differences in the mean total protein concentration between the control and study groups (P<0.01). Significant positive correlation was found between the total protein concentration and JE (r=0.65, P<0.01). No significant correlation was found between the level of pain and dysfunction and JE and total protein concentration in either control or study groups (P>0.05). CONCLUSION: Pain in the TMJ was not related to MR findings of effusion in internal derangement and synovial fluid aspirate findings of total protein concentration. However, total protein concentration was related to the amount of JE in DDwoR joints and painful joints were more likely to demonstrate the JE.

Omental fibroma: CT and US findings.

The US, CT, and X-ray findings in a patient with omental fibroma of the lesser omentum are described. Ultrasound showed a solid mass with cystic areas in the central region. At CT the lesion showed peripheral enhancement and central hypodensity. On X-ray studies with barium, there was border distortion in the lesser curvature of the stomach. The mass was resected surgically. A pathologic diagnosis of fibroma was confirmed.

Pulmonary embolism due to cardiac hydatid disease: imaging findings of unusual complication of hydatid cyst.

We report two cases of primary cardiac hydatid cyst in which hydatid materials caused recurrent embolizations in pulmonary arteries and pulmonary parenchyma. Cardiac hydatid cysts may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. The role of imaging techniques in diagnosis is discussed and the importance of dynamic enhanced CT, MR imaging, and enhanced MR angiography (MRA) is reported. Imaging findings were confirmed by surgery and pathology. Early diagnosis is essential because delayed treatment increases the morbidity and mortality rates.

Ultrasound-guided percutaneous drainage in the treatment of children with hepatic hydatid disease.

The present study was designed to establish the safety and efficacy of ultrasound-guided percutaneous drainage in the treatment of hepatic hydatid cysts in children. A total of 14 cysts in eight patients were drained under aseptic conditions and continuous ultrasound guidance. An 18-G needle was used for puncture and silver nitrate solution as the scolecoidal agent. All procedures were successful. During follow-up, repeated ultrasound examinations revealed a progressive decrease in cyst size and an alteration in the cyst echopattern. None of the patients had a rise in hydatid antibody titer. There were no immediate or late complications. We conclude that the safety and efficacy of ultrasound-guided percutaneous drainage are satisfactory for the treatment of hepatic hydatid cysts in children.