Bow hunter's syndrome causing vertebrobasilar insufficiency in a young man with neck muscle hypertrophy.

Vertebrobasilar insufficiency is characterized by impaired blood flow within the posterior circulation, producing symptoms of vertigo, nausea, vomiting, visual disturbances, and syncope. Given these nonspecific symptoms, the diagnosis of vertebrobasilar ischemia may be difficult to distinguish from more benign conditions. A healthy 37-year-old man presented to our clinic with near syncope upon turning his head to the left. Dynamic angiography revealed occlusion of the left vertebral artery at C7 with 90° head rotation to the left, consistent with bow hunter's syndrome. No obvious bony abnormalities were identified on computed tomography or magnetic resonance imaging scans. Transient rotational vertebral artery syndrome, a rare cause of vertebrobasilar insufficiency, has most often been reported at the C1-2 level, and the majority of cases occur in patients >50 years of age because of degenerative osteophytes and contralateral atherosclerosis. We present the unusual case of a young man with symptoms of vertebrobasilar insufficiency and discuss the potential effects of weightlifting and neck muscle hypertrophy on vertebral artery flow dynamics.

Percutaneous fluoroscopically guided removal of a deep retroperitoneal foreign body with a laparoscopic trocar and grasping device.

Traditionally, soft tissue foreign body removal is performed surgically. Superficial foreign body removal under ultrasonographic and fluoroscopic guidance has been reported. Herein, the authors report a case of percutaneous removal of a retroperitoneal foreign body under fluoroscopic guidance by using a modified laparoscopic trocar device and a laparoscopic grasping device. Iodinated contrast medium administered via the trocar device allowed visualization of the foreign body and distended the retroperitoneal space to allow for manipulation of the foreign body. The procedure was completed in a relatively short time and the patient made an excellent rapid postoperative recovery.

Tips and tricks for the trauma patient.

Interventions on the trauma patient are an essential component of the complete scope of care that is provided to the multiply injured patient today. The active participation by the interventional radiologist along the entire spectrum of clinical care is very important to optimize patient outcomes. Suggestions on how to establish a clinical presence are presented. A few of the newer concepts and terminology applicable to trauma care are reviewed. Tips useful in the trauma room, in the interventional radiology suite, and during the postprocedural period are discussed.

CT, MRI, PET, PET/CT, and ultrasound in the evaluation of obstetric and gynecologic patients.

The role of imaging in obstetrics and gynecology has undergone a revolution over the past few decades. Well-established methods such as endovaginal ultrasound have had a central role in the evaluation of nongravid patients with pelvic pain, as well as in the workup for ectopic pregnancy and evaluation of adnexal masses. Additional tools include MRI in the evaluation of appendicitis and other potentially surgical conditions in pregnant patients and MRI and CT in the evaluation of surgical complications. Newer tools in the radiology armamentarium include PET scanning which, alongside MRI and CT, are often helpful in staging gynecologic malignancy. The role of imaging in the obstetric and gynecology patient will continue to change as new modalities and techniques are introduced.

CT differentiation of adenomyomatosis and gallbladder cancer.

OBJECTIVE: The purpose of this study was to determine the accuracy of CT in differentiating adenomyomatosis from gallbladder cancer. MATERIALS AND METHODS: We retrospectively identified the cases of 36 patients with pathologically proven adenomyomatosis (n = 22) or gallbladder cancer (n = 14) who had undergone preoperative abdominal CT. Two reviewers independently evaluated the presence and nature of morphologic gallbladder abnormalities, including the presence of intramural diverticula (i.e., small cystic-appearing spaces within the gallbladder wall). The reviewers used a five-point scale (1, definitely absent; 5, definitely present) to rate the overall likelihood of the presence of adenomyomatosis and gallbladder cancer. Ratings were dichotomized such that a diagnosis was considered present at a rating of 4 or 5 and considered absent at lower ratings. RESULTS: Reviewer 1 detected a morphologic gallbladder abnormality in 17 patients and correctly characterized the abnormality in 14 (82%) of the patients (eight with adenomyomatosis and six with gallbladder cancer). Reviewer 2 detected an abnormality in 18 patients and was correct for 13 (72%) of the patients (eight with adenomyomatosis and five with gallbladder cancer). In particular, reviewer 1 detected intramural diverticula in eight patients, and all had the pathologic diagnosis of adenomyomatosis, whereas reviewer 2 detected intramural diverticula in 11 patients, and eight (73%) had the pathologic diagnosis of adenomyomatosis. CONCLUSION: CT is limited in the detection and differentiation of adenomyomatosis and gallbladder cancer, but the diagnosis of adenomyomatosis can be made with reasonable accuracy when thickening of the gallbladder wall is seen to contain small cystic-appearing spaces.

A case of scrotal venous malformation mimicking a failed varicocelectomy.

A 21-year-old man presented to interventional radiology department with several years of left scrotal pain, which exacerbated by prolonged standing and walking. The patient had undergone a left varicocelectomy at the age of 10, after which he had a persistent scrotal mass. As he grew older, the left scrotal mass continued to increase in size, and symptoms progressively worsened. Physical examination revealed a non-tender, firm left scrotal mass which remained unchanged in size after Valsalva manoeuvres. Initial ultrasound examination revealed an extratesticular, intrascrotal mass with minimal internal flow. MRI revealed a heterogeneously enhancing, low-flow venous malformation centred in the midscrotum involving multiple tissue planes. Two sessions of percutaneous sclerotherapy failed to relieve his pain. Three months after the second sclerotherapy, the patient underwent surgical resection. At the time of his postoperative visit, his left scrotal pain had significantly improved and pain with prolonged standing and walking had resolved completely.

Herlyn-Werner-Wunderlich syndrome: a rare presentation with pyocolpos.

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome, is a rare syndrome with only a few hundred reported cases described since 1922. Only a handful of these cases have been associated with pyocolpos. Mullerian duct anomalies have an incidence of 2-3%. While OHVIRA constitutes 0.16-10% of these Mullerian duct anomalies. Symptoms usually present shortly after menarche when hematocolpos develops during menstruation resulting in dysmenorrhea and a pelvic mass. The pelvic mass is the collection of blood products within the obstructed hemivagina. The first study in the diagnostic work-up is usually ultrasonography, which typically demonstrates a pelvic fluid collection which can simulate other disease processes thus confounding the diagnosis. MRI findings of the pelvis reveal a didelphic uterus. Imaging of the abdomen reveals agenesis of the ipsilateral kidney. MRI is beneficial in characterizing the didelphic uterus and vaginal septum for pre-operative planning. Understanding the imaging findings, in conjunction with the clinical presentation, is critical for early diagnosis in attempting to prevent complications such as endometriosis or adhesions from chronic infections with subsequent infertility.