Incidental discovery of a sacral rib: a case report.

PURPOSE: The observation of an accessory bone joined to the sacrum (suggestive of a sacral rib) prompted us to describe the structure's morphology and its anatomic relationships and to consider its morphogenesis and clinical implications. METHOD: A 38-year-old woman underwent computed tomography, to characterize the extension of a thoracic mass. We compared our observations with the literature data. RESULTS: We observed a voluminous accessory bone located behind and to the right of the sacrum. The bone was articulated with the third sacral vertebra and featured a head and three processes. These characteristics were suggestive of a sacral rib. We also observed involution of the gluteus maximus. CONCLUSION: This accessory bone probably resulted from overdevelopment of a costal process and an absence of fusion with the primitive vertebral body. Sacral ribs are rare and usually asymptomatic but appear to be more prevalent in young women. The adjacent muscles are often abnormal. Awareness of the potential presence of this bone is essential for surgeons who operate on the lumbosacral junction.

Whole-body MRI in generalized cystic lymphangiomatosis in the pediatric population: diagnosis, differential diagnoses, and follow-up.

OBJECTIVE: Generalized cystic lymphangiomatosis is a particularly rare disease with variable involvement of skeletal and extraskeletal sites. The key role of imaging in the diagnosis of this disease is no longer in doubt. The aim of our study was to demonstrate the contribution of whole-body magnetic resonance imaging (WB-MRI) at the diagnostic stage and during the follow-up in the pediatric population. SUBJECTS AND METHODS: Three children were included from 2008. The inclusion criteria were radiological images (conventional radiographs, computed tomography, and MRI) compatible with histological confirmation. Each child included received WB-MRI at the diagnosis stage and during follow-up. RESULTS: WB-MRI detected multiple hypointense T1 and hyperintense T2-STIR cystic bony lesions. One unnoticed mass in the retroperitoneum on computed tomography was easily detected by MRI. Mediastinal involvement was observed in one asymptomatic case. Histology was contributory in all cases. Preventive intramedullary nailings was done in one case. Follow-up WB-MRI detected new asymptomatic lesions in all cases. One child presented a third episode of lymphangitis of the right thigh during follow-up. CONCLUSIONS: Due to its high sensitivity to diagnose, ability to eliminate differential diagnoses and make exhaustive lesions assessment, and its non-radiating character for long-term follow-up, WB-MRI is highly recommended for generalized cystic lymphangiomatosis in the pediatric population.

A relapsing macrodactyly.

Lipofibromatous hamartoma is an uncommon benign tumor, usually unknown or misdiagnosed. We report the case of a 61-year-old patient presenting an acquired painful macrodactyly of the left thumb with paresthesia in the median nerve territory. Clinical examination reveals a tumefaction of the volar side of the wrist. She had a medical history of amputation of the forefinger for macrodactyly without any diagnosis. Paraclinical exploration guided us to the correct diagnosis; hypertrophic bone structures of the affected finger were detected on radiographs. The left median nerve appeared hypertrophic, with a fatty infiltration on the ultrasound exploration. These pathological findings revealed a late discovered lipofibromatous hamartoma of the median nerve, a rare entity often associated with macrodactyly and diagnosed in childhood. Therefore, we retrospectively made the same diagnosis for the amputated index finger with the analysis of her ancient paraclinical exams. Lipofibromatous hamartoma remains an obscure pathology and its treatment stays controversial.

Posterior Cerebral Infarction following Loss of Guide Wire.

Stroke after internal jugular venous cannulation typically leads to acute carotid or vertebral arteries injury and cerebral ischemia. We report the first case of delayed posterior cerebral infarction following loss of guide wire after left internal jugular venous cannulation in a 46-year-old woman with a history of inflammatory bowel disease. Our observation highlights that loss of an intravascular guide wire can be a cause of ischemic stroke in patients undergoing central venous catheterization.

Isolated rupture of the subscapularis tendon in children: a case report and literature review.

We report the case of an 11-year-old, male, competitive hockey player with a complete rupture of the subscapularis insertion but no avulsion fracture of the lesser tuberosity. Ultrasound and MRI were performed before surgical repair with suture anchors. The boy regained a normal range of movement after 4 weeks of immobilization and 2 months of rehabilitation. This unique case (with the absence of lesser tuberosity avulsion) is compared with the 16 other cases of paediatric subscapularis avulsion fracture reported in the literature.

Hematogenous Staphylococcus aureus discitis in adults can start outside the vertebral body.

BACKGROUND: Textbooks describe hematogenous discitis in adults as starting in the anterior vertebral body near the endplates. CASE REPORT: Hematogenous Staphylococcus aureus discitis developed at L1-L2 in an 81-year-old woman. On the first magnetic resonance imaging (MRI) scan performed 4 days after symptom onset, the only abnormalities were high signal from the disk on T2-weighted images, gadolinium enhancement of the soft tissues anterior to L1-L2, and epidural involvement. The endplates and vertebral bodies were normal. A subsequent MRI scan showed features typical of infectious discitis. DISCUSSION: We found a single similar case report in the medical literature, indicating that discitis starting outside the anterior vertebral body is rare. Nevertheless, an increasing number of similar cases may be diagnosed in the future, as MRI is being performed increasingly early in patients with a clinical suspicion of infectious discitis. CONCLUSION: Hematogenous infectious discitis in adults may start in some patients within the disk, soft tissues anterior to the disk, or epidural space. To avoid diagnostic and therapeutic delays, physicians should be aware of this unusual presentation of infectious discitis on very early MRI scans. When the clinical picture suggests discitis and findings from the early MRI scan are atypical, a repeat MRI scan should be obtained 1 week later to confirm the diagnosis.

Incomplete posterior circle of willis: a risk factor for migraine?

BACKGROUND: Migraine is associated with vascular risk factors and white matter abnormalities (WMA). Cerebral hypoperfusion is known to be one mechanism underlying WMA and a few studies have shown that an incomplete circle of Willis (CW) may predispose to cerebral hypoperfusion. This study assessed the relationship between the morphologic characteristics of the CW and migraine. METHODS: This case-control study was carried out in the Amiens University Hospital. Patients undergoing 3-dimensional time of flight magnetic resonance angiography of the CW from January 1 to June 30, 2006 were included (n = 124). A definitive diagnosis of migraine was established in 47 patients: 23 (48.9%) experienced migraine without aura and 24 (51.1%) migraine with aura. The remaining 77 patients with other neurologic disorders constituted the control group. The posterior CW was graded as complete when both posterior communicating arteries and the P1 segments of the posterior cerebral artery were present on visual examination and incomplete when one of these vessels was missing (interobserver agreement: K(total) = 0.746). RESULTS: Incomplete posterior CW was significantly more common in migraineurs than in the control group (49% vs 18%; P < .001). On multivariate analysis, incomplete posterior CW was the sole independent factor associated with migraine (OR: 6.5; 95% CI: 2.6-16.2; P < .001). No difference was found between migraineurs with and without aura. CONCLUSIONS: Despite some methodological limitations, our results showed that incomplete posterior CW was associated with migraine.

Multiple reversible MRI abnormalities associated with SESA syndrome.

The authors report the imaging findings in a patient with a long history of alcoholism, who presented with delirium and recurrent left hemiparesis meeting the criteria of subacute encephalopathy with seizures in alcoholics (SESA) syndrome. MRI revealed fully reversible signal intensities (T2, diffusion-weighted imaging with a decreased apparent coefficient) throughout the right hemisphere. This case suggests that the MRI characteristics of SESA syndrome resemble those of status epilepticus.