"Million dollar nerve" magnetic resonance neurography: first normal and pathological findings.

OBJECTIVES: To evaluate prospectively the feasibility of magnetic resonance neurography (MRN) in identifying the anatomical characteristics of thenar muscular branch (TMB) of the median nerve, also known as the "million dollar nerve," in patients and controls. METHODS: Thirteen patients affected by carpal tunnel syndrome (CTS) and four healthy controls had their hands scanned on a 3-T MR imaging scanner for TMB visualization. Median nerve anatomical variations were classified into four groups according to Poisel's classification system modified by Lanz. TMB signal intensity and diameter were assessed for the diagnosis of neuropathy. RESULTS: TMB was successfully identified in all patients and subjects by using MRN. The most suitable pulse sequences to identify and measure nerve diameter were 3D DW-PSIF and T2-FS-TSE. The axial oblique and sagittal oblique planes are complementary in demonstrating its entire course. TMB had mostly an extraligamentous course with radial side origin (93.8%, each). All patients experienced increased T2 signal intensity (p < 0.001) and thickened nerves. Mean TMB diameters were 1.27 ± 0.21 mm (range, 1.02-1.74 mm) and 0.87 ± 0.16 mm (0.73-1.08 mm) (p = 0.008) in the patient and control groups, respectively. CONCLUSION: MRN is a reliable imaging technique for identification and anatomical characterization of TMB in patients affected by CTS. This innovative imaging workup may therefore be included in the preoperative evaluation of patients scheduled for carpal tunnel release, especially in CTS with TMB involvement or even in isolated TMB neuropathy. KEY POINTS: • Magnetic resonance neurography allows precise visualization of the thenar muscular branch of the median nerve. • Thenar muscular branch anatomical variations can be correctly identified. • Preoperative scanning can contribute to reducing the risk of iatrogenic injuries during carpal tunnel release, especially in carpal tunnel syndrome with thenar muscular branch involvement or even in isolated thenar muscular branch neuropathy.

Case report: Myelitis and ganglionitis, an atypical presentation of Hansen's disease.

Hansen's disease, or leprosy, is a disease characterized by dermatological and neurological disorders. A neural form also exists, in which peripheral neuropathy occurs in the absence of skin lesions. However, cases of leprosy that involve the central nervous system and proximal nerves are rare in the literature. We describe the case of an oligosymptomatic patient diagnosed with the neural form of leprosy with involvement of peripheral nerves, dorsal root ganglion, and cervical spinal cord in an atypical presentation of the disease. Through complementary examinations and nerve biopsies, the bacillus was identified, and treatment was subsequently initiated. This case highlights the importance of investigating the suspicion of leprosy, even in cases with atypical manifestations, as early diagnosis and treatment can reduce neurological damage and deformities.

Congenital inferior vena cava anomalies: a review of findings at multidetector computed tomography and magnetic resonance imaging / Anomalias congênitas da veia cava inferior: revisão dos achados na tomografia computadorizada multidetectores e ressonância magnética

Inferior vena cava anomalies are rare, occurring in up to 8.7% of the population, as left renal vein anomalies are considered. The inferior vena cava develops from the sixth to the eighth gestational weeks, originating from three paired embryonic veins, namely the subcardinal, supracardinal and postcardinal veins. This complex ontogenesis of the inferior vena cava, with multiple anastomoses between the pairs of embryonic veins, leads to a number of anatomic variations in the venous return from the abdomen and lower limbs. Some of such variations have significant clinical and surgical implications related to other cardiovascular anomalies and in some cases associated with venous thrombosis of lower limbs, particularly in young adults. The authors reviewed images of ten patients with inferior vena cava anomalies, three of them with deep venous thrombosis. The authors highlight the major findings of inferior vena cava anomalies at multidetector computed tomography and magnetic resonance imaging, correlating them the embryonic development and demonstrating the main alternative pathways for venous drainage. The knowledge on the inferior vena cava anomalies is critical in the assessment of abdominal images to avoid misdiagnosis and to indicate the possibility of associated anomalies, besides clinical and surgical implications.

Anomalias da veia cava inferior são incomuns, ocorrendo em até 8,7% da população, quando consideradas as anomalias da veia renal esquerda. A veia cava inferior se desenvolve da sexta à oitava semanas de gestação, originada de três veias embrionárias pareadas: veias subcardinais, supracardinais e pós-cardinais. A complexidade da ontogenia da veia cava inferior, com numerosas anastomoses entre essas três veias embrionárias, pode levar a uma grande variedade do retorno venoso do abdome e membros inferiores. Algumas dessas anomalias têm implicações clínicas e cirúrgicas significativas, associadas a outras anomalias congênitas, e em alguns casos, associadas a trombose venosa de membros inferiores, principalmente em pacientes adultos jovens. Foram revistos os exames de dez pacientes com anomalias da veia cava inferior, três deles com trombose venosa profunda de membros inferiores. Foram salientados os principais aspectos das anomalias da veia cava inferior, nos exames de tomografia computadorizada multidetectores e ressonância magnética, correlacionados com a embriologia e demonstrando as principais vias alternativas de drenagem venosa. O conhecimento das anomalias da veia cava inferior é fundamental na avaliação dos exames de imagem do abdome, evitando erros de interpretação e indicando a possibilidade de anomalias associadas, implicações clínicas e cirúrgicas.

Leiomiomatose peritoneal disseminada: relato de caso / Leiomyomatosis peritonealis disseminata: a case report

Neste trabalho relata-se o caso de uma paciente de 46 anos de idade com queixa de aumento de volume periumbilical e dor leve antes da menstruação. O quadro evoluiu com aumento gradativo da dor. Foram realizados ultra-som, tomografia computadorizada e ressonância magnética. Após laparotomia exploradora, foi retirado material para biópsia que confirmou o diagnóstico de leiomiomatose peritoneal disseminada.

The present study reports the case of a 46-year-old female patient complaining of mild premenstrual pain and increase in the volume of the periumbilical region. The condition progressed with a gradual increase of the pain intensity. Ultrasonography, computed tomography and magnetic resonance imaging were performed. Biopsy of tissue collected during exploratory laparotomy confirmed the diagnosis of leiomyomatosis peritonealis disseminata.