Imaging of the meningeal lymphatic network in healthy adults: A 7T MRI study.

BACKGROUND AND PURPOSE: Meningeal lymphatic vessels (MLVs) along the dural venous sinuses are suspected to be important in connecting the glymphatic and peripheral lymphatic system. Understanding the topography of MLVs may clarify the role of the glymphatic system in neurological diseases. The aim of this analysis was to use high resolution pre- and post-contrast FLAIR 7T MRI to identify and characterize the morphology of MLV in a cohort of healthy volunteers. MATERIALS AND METHODS: MRI examinations of seventeen healthy volunteers enrolled as controls in a larger 7T MRI study were reviewed. Pre- and post-contrast 3-D FLAIR subtractions and MP2RAGE sequences were spatially normalized and reviewed for signal intensity and enhancement patterns within putative MLVs along pre-determined dural and venous structures. Frequency of occurrence of MLVs at the above-described locations and patterns of their enhancement were analyzed. RESULTS: Putative MLVs are commonly located along the superior sagittal sinus (SSS) and cortical veins. A "fixed enhancement" signal pattern was more frequent at these locations (p<.05). The morphology of MLVs along the SSS qualitatively changes in an antero-posterior direction. Lack of signal was more frequent along the straight and transverse sinuses (p<.05). CONCLUSION: Putative MLVs in healthy individuals are concentrated along the SSS and cortical veins. FLAIR signal and enhancement characteristics suggest these structures may transport proteinaceous fluid. Pathways connecting MLVs to cervical lymph nodes however remain unclear.

Postoperative Computed Tomography for Facial Fractures.

In order for a radiologist to create reports that are meaningful to facial reconstructive surgeons, an understanding of the principles that guide surgical management and the hardware employed is imperative. This article is intended to promote efficient and salient reporting by illustrating surgical approaches and rationale. Hardware selection can be inferred and a defined set of potential complications anticipated when assessing the adequacy of surgical reconstruction on postoperative computed tomography for midface, internal orbital, and mandible fractures.

Small Bowel Obstruction with a Transition Point in a Patient on Peritoneal Dialysis.

Small bowel obstruction (SBO) is a rare complication of peritoneal dialysis (PD) that is usually seen in patients with encapsulating peritoneal sclerosis. We present a case of SBO that was caused by mechanical obstruction from omental adhesions around the PD catheter. This is the case of 71-year-old female with end-stage renal disease who was recently started on PD and presented with recurrent syncopal episodes and altered mental status. During hospitalization, the patient began experiencing incomplete drainage of the PD solution. Abdominal computerized tomography revealed SBO with a transition point near the PD catheter. The patient then underwent laparoscopy, which revealed omental adhesions around the PD catheter near the obstruction area, but no adhesion of the intestine was observed. The adhesions were dissected by laparoscopy, and the PD catheter was removed. This case highlights the challenges of PD access.

Lyme Carditis: A Case Involving the Conduction System and Mitral Valve.

Lyme disease is the most common tick-borne infection in the Northern hemisphere. Cardiac manifestations of Lyme disease typically include variable atrioventricular nodal block and rarely structural heart pathology. The incidence of Lyme carditis may be underestimated based on current reporting practices of confirmed cases. This case of a 59-year-old man with Lyme carditis demonstrates the unique presentation of widespread conduction system disease, mitral regurgitation, and suspected ischemic disease. Through clinical data, electrocardiograms, and cardiac imaging, we show the progression, and resolution, of a variety of cardiac symptoms attributable to infection with Lyme. [Full article available at http://rimed.org/rimedicaljournal-2017-02.asp].