Urinothorax: an unexpected cause of severe dyspnea.

We report an unusual cause of the pleural effusion due to extravasation of urine from the retroperitoneal space into the thoracic cavity. In our case, the urinoma occurred owing to obstructing urinary tract lesion due to opaque stone. Although rare, urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma.

MRI and muscle signal intensities in alcoholics compared with control subjects.

OBJECTIVE: To evaluate by magnetic resonance imaging (MRI) the difference in muscle signal intensities between alcoholics and control subjects. METHODS: Thirty-four healthy subjects and 46 alcohol-dependent individuals were assessed. MRI was carried out using a low-field magnet (0.2 Tesla) and a limb-dedicated coil. The presence of muscle changes was evaluated by measuring signal intensities at the medial (MG) and lateral heads of the gastrocnemius muscle by T1-/T2-weighted and gradient-echo short tau inversion recovery sequences. The mean signal intensities of the two sample groups were compared by ANCOVA with age as a covariate. In the alcohol-dependent group, correlations between signal intensities and plasma levels of muscular and hepatic enzymes, in addition to years of high-risk consumption and lifetime dose of ethanol consumed, were assessed. The mean signal intensities were also compared with the different degrees of pain by ANOVA. RESULTS: Compared with healthy subjects, the alcohol-dependent group had mean higher signal intensities in both gastrocnemius heads in all sequences. The difference in the MG in T2-weighted sequences was significant (F = 48.28, p < 0.01). A modest correlation between the years of high-risk consumption and the signal intensity was found in T2-weighted sequences in the MG (r = 0.288, p = 0.057), whereas a correlation with the lifetime dose consumed was not found. Significant correlations between signal intensities and plasma levels of muscular and hepatic enzymes were not found. There were also no significant group differences on different degrees of pain. CONCLUSION: MRI was shown to be a sensitive, well-tolerated, and inexpensive procedure capable of detecting changes in signal intensities in the muscles of alcoholics. This technique could be included among other diagnostic tools for alcoholic myopathy with further improvements and if the signal alterations can be corroborated by biopsy evidence.

[MRI evaluation of morpho-structural alterations of the retrodiscal tissue in condylo-meniscal incoordination of the TMJ: usefulness of individualised T2-weighted TSE sequences].

PURPOSE: To assess and evaluate morpho-structural alterations of the retrodiscal tissue of the temporomandibular joint (TMJ) that may be seen in chronic trauma of the condylo-meniscal incoordination through magnetic resonance (MR), using T2-weighted TSE sequences. MATERIALS AND METHODS: The study included 40 patients, 6 male and 34 female, age range 12-66 years, mean age 28.5 years. According to the Wilkes classification, TMJs of patients were graded as follows: 10 grade 1 TMJs; 28 grade 2, 16 grade 3, and 26 grade 4. Scans were obtained with a 1.5 T MRI unit, and a dedicated surface coil, using T2-weighted TSE sequences (TR 3000-3500, TE 90-100), 2 acquisitions, 256x256 matrix, 3-mm section thickness, with a 0-mm interval, and 2'30" duration for a single acquisition. Scans were obtained both during opening and during closure of the mouth, on 3 planes: sagittal oblique, perpendicular to the condylar long axis; coronal oblique, perpendicular to the anteroposterior axis of the discs; and axial, perpendicular to coronal scans. Parameters used were the following: presence or absence of retrodiscal fibrosis; morphology of the retrodiscal fibrosis in scans taken during mouth opening in the four grades of the Wilkes classification; dimensions of the retrodiscal fibrosis in scans taken during mouth opening, in the four grades of the Wilkes classification, in an anteroposterior direction, measuring the longest distance on parasagittal planes on a horizontal line touching the outer edge of the disc and the most-distal point of fibrosis, and in a vertical direction, measuring the distance between the highest and lowest points of fibrosis; signal intensity features within the fibrotic area. RESULTS: In all TMJs analysed, it was possible to confirm the presence of retrodiscal tissue fibrosis, which was more or less evident according to the grading of the dysfunction/disease, to the extent of mouth opening, and to displacement with or without reduction of the articular disc. In grade 1 TMJs, fibrosis looked like a truncated cone; in grade 2, fibrosis looked like a cone; in grade 3, it was either shaped like a mushroom placed horizontally, with the stalk towards the disc, or else ribbon-shaped; in grade 4, it had an inhomogeneous, irregular ribbon shape. CONCLUSIONS: MR studies of TMJ dysfunction through T2-weighted TSE sequences allowed us to evidence in all cases the sclerotic alterations of the retrodiscal tissue, and to assess their form and dimensions. Furthermore, it was possible to evidence both the pathognomonic features of retrodiscal tissue fibrosis resembling a mushroom, and the characteristic brace-shape the upper and lower layers take on during mouth opening in TMJs with a disc displacement with reduction.