Neuroimaging findings in acute ethylene glycol poisoning.

The CT and MR findings of a patient with acute ethylene glycol poisoning are presented. Basal ganglia hemorrhagic infarction especially involving the putamen was detected. The differential diagnosis includes other toxic and hypoxic encephalopathies.

Case report: recognizing pneumatosis intestinalis: a case of bowel ischemia presenting as renal colic.

The clinical diagnosis of bowel ischemia is often difficult and the diagnosis can easily be missed unless there is a high index of clinical and radiological suspicion. Bowel ischemia and or infarction must be considered in the differential diagnosis in the older patient with pre-existing coronary artery or generalized vascular disease, cardiac failure, or arrhythmias especially atrial fibrillation and hypertension. An elderly patient with caecal infarction is presented who was initially diagnosed and treated for renal colic.

Sonography of gangrenous cholecystitis.

Gangrenous cholecystitis is an acute surgical emergency, which requires early cholecystectomy. Differentiation of patients with gangrenous cholecystitis from those with non-gangrenous cholecystitis can be difficult, both clinically and with imaging. Careful attention to the following sonographic signs suggests the presence of gangrenous cholecystitis decreased focal wall perfusion on Color Doppler, irregular gall bladder mucosal outline, gall bladder wall thickening with signs of de-lamination, gas within the gall bladder, absence of calculi, and large peri-cholecystic collections. Both sonogram with color flow imaging and contrast-enhanced Computed tomography are complementary investigations to establish this important diagnosis in critically ill patients.

The role of ultrasound in the management of intestinal obstruction.

Intestinal obstruction (IO) is a common cause of acute abdominal pain. The recent increased use of sonography in the initial evaluation of abdominal pain has made point-of-care ultrasound a valuable tool for the diagnosis of IO. Sonography is as sensitive, but more specific, than plain abdominal X-ray in the diagnosis of IO. Point-of-care ultrasound can answer specific questions related to IO that assist the acute care physician in critical decision making. Sonography can also help in the resuscitation of patients by serial measurement of the IVC diameter. We review the sonographic findings of IO and the role of point-of-care ultrasound in the management of patients having IO.

Transient involvement of the cerebral cortex in a flare of Behçet's syndrome.

We describe a flare of Behçet's syndrome in a 42-year-old man who presented with florid mucocutaneous manifestations, headache and vomiting, but without meningeal or neurologic signs. A single, non-enhancing cortical lesion was found in the frontal lobe by computed tomography and magnetic resonance (MR) imaging studies. Diffusion-weighted analysis and MR spectroscopy were consistent with focal inflammation. The patient improved with colchicine, and after 5 months, a repeat MR scan demonstrated resolution of the inflammatory changes suggesting that involvement of the cerebral cortex may be a self-limiting phenomenon, distinct from other more frequent and destructive parenchymal manifestations of neuro-Behçet's disease.

Neuroimaging findings in a case of fluoxetine overdose.

Brain MRI and ¹8F-FDG PET/CT scans were performed in a patient who had survived a suicide attempt by fluoxetine overdose. The patient presented with the following clinical signs and symptoms, and neuroimaging findings: severe signs of serotonin toxicity, including comatose state, akinetic rigid syndrome and dysautonomia; bilateral globus pallidus changes consistent with extensive pallidal necrosis and subsequent reversible diffuse ischemic changes in white matter, with posterior predominance, involving the splenium of the corpus callosum on brain MRI; and marked hypometabolism in the frontal, parietal and temporal cortical regions as well as in both caudate nuclei on ¹8F-FDG PET/CT performed 37 days later. These findings suggest that acute severe serotonin toxicity can induce structural and long-standing functional changes in multiple cortical and subcortical brain regions that are associated with cognitive and extrapyramidal syndromes.

Musculoskeletal fungal infections.

Fungal infections of the musculoskeletal system are uncommon. They are often found in immunosuppressed or patients with the acquired immunodeficiency syndrome or in patients with a history of travel to an endemic region. Infections often present with multifocal chronic osteomyelitis or chronic mono- or polyarthritis resembling osteoarticular tuberculosis. A clinical clue to the correct diagnosis is the presence of overlying skin sinuses. Radiologists can suggest the correct diagnosis with a good clinical history, although a biopsy and/or fungal culture is usually necessary before beginning treatment.

Clinical ultrasound physics.

Understanding the basic physics of ultrasound is essential for acute care physicians. Medical ultrasound machines generate and receive ultrasound waves. Brightness mode (B mode) is the basic mode that is usually used. Ultrasound waves are emitted from piezoelectric crystals of the ultrasound transducer. Depending on the acoustic impedance of different materials, which depends on their density, different grades of white and black images are produced. There are different methods that can control the quality of ultrasound waves including timing of ultrasound wave emission, frequency of waves, and size and curvature of the surface of the transducer. The received ultrasound signal can be amplified by increasing the gain. The operator should know sonographic artifacts which may distort the studied structures or even show unreal ones. The most common artifacts include shadow and enhancement artifacts, edge artifact, mirror artifact and reverberation artifact.

Pulmonary artery aneurysm as a cause of massive hemoptysis: diagnosis and management.

Massive hemoptysis is a life-threatening medical emergency. Prompt radiological diagnosis and management are essential. I present a case of an inflammatory pulmonary aneurysm (Rasmussen aneurysm) from active pulmonary tuberculosis. This is an uncommon cause for massive hemoptysis which was successfully treated by endovascular coiling.

Do knees survive the Comrades Marathon?

OBJECTIVE: To detect by magnetic resonance imaging (MRI) the presence and type of knee injuries in non-professional runners after running an ultra-marathon, and to determine whether ultra-marathon running exacerbates pre-existing knee injuries or results in new permanent injuries. DESIGN: A prospective MRI study of one knee of 10 randomly selected participants who completed the Comrades Marathon between 1997 and 2002. Their knees were scanned 48 hours before the race, and 48 hours and 1 month after the race. SETTING: All scans were performed at the Radiology Department, Wentworth Hospital, Durban, and the University of KwaZulu-Natal. MAIN OUTCOME MEASURES: Scores of all knee injuries detected on MRI scans immediately before the race, compared with the scores after the race. RESULTS: All scanned knees demonstrated an abnormal amount of joint fluid before the race; this increased immediately after the race in 5 runners and remained unchanged in another 5. At 1 month, 5 knees showed decreased joint fluid and 5 remained unchanged, but these were not the same runners as in the post-race groups. There was increased signal intensity in the distal patellar and quadriceps tendons in 4 runners before the race, which increased or remained the same on post-race scans in 6 knees. There was a decrease in signal intensity on scans taken 1 month later in 3 runners, with complete resolution in 2 and no change in 1. Old injuries to ligaments, tendons or other knee structures were unaffected by the race. No bone bruising, cartilage defects or meniscal abnormalities were observed. There was no significant difference in the pre- and post-race or 1-month scan scores. CONCLUSIONS: The race appears to have had a detrimental effect on runners who started the ultra-marathon with tendinopathy, which worsened post-race by MRI criteria. One month after the race, the scan appearance of the overuse injury had either improved or resolved completely. Bone bruising or meniscal damage did not appear to occur, and the presence of increased joint fluid probably relates to stress or injury.

MR-angiography as a method for evaluating endovascular coiled cerebral aneurysms.

BACKGROUND: The aim was to compare digital subtraction angiography (DSA) with magnetic resonance angiography (MRA) in evaluating intracranial aneurysms embolized with Guglielmi Detachable Coils (GDCs) and to assess 3D TOF MRA source data, maximum intensity projection (MIP), and 3D iso-surface reconstruction in the follow-up of patients with cerebral aneurysms treated with GDC. MATERIAL/METHODS: 3D TOF MRA source data, MIPs, and 3D iso-surface reconstructions of 32 GDC coiled aneurysms were compared with DSA images in the follow-up of 28 patients. Images were assessed for parent and branch artery flow, the presence of neck recurrence, and aneurysm regrowth. RESULTS: In the DSA follow-ups of the 32 aneurysms there was no flow in the embolized aneurysm in 20 (62.5%), flow between the coil loops was found in 11 (34%), and the neck flow was observed in 8 (25%). There was good correlation for all these features when the 3D iso-surface MRA and source data were compared with DSA. The correlation between MIP MRA and DSA was less robust. The correlation was very good in 21 of the 32 aneurysms (65.62%), good in 6 (18.75%), acceptable in 3 (9.37%), and weak and non-diagnostic in 2 (6.25%). Additional information can be obtained by performing plain film x-rays of the skull to demonstrate a change in the coil ball configuration. MRA did not detect any residual aneurysm neck in 2 cases. CONCLUSIONS: MRA is a promising technique to evaluate GDC coiled cerebral aneurysms; however, it cannot substitute DSA.

Imaging of neuro-AIDS.

The pathogenesis of the human immunodeficiency virus (HIV) infection of the central nervous system and the imaging presentation of patients with neurological complications from HIV/AIDS are discussed. Imaging findings are often nonspecific; however, correlations with patient's clinical signs and CD4 count allow a working diagnosis to be made.

Management of severe hemoptysis from pulmonary aspergilloma using endovascular embolization.

PURPOSE: To determine the effectiveness of endovascular embolization as a temporizing measure in the management of severe hemoptysis caused by intracavitary pulmonary aspergilloma. METHODS: Patients presenting with hemoptysis, estimated to be more than 300 ml in the preceding 24 hr, in whom a radiological diagnosis of pulmonary aspergilloma was made on chest radiographs and/or computed tomography of the chest were subjected to bronchial and systemic arteriography and embolization using triacryl microspheres. RESULTS: Twelve patients with upper lobe intracavitary aspergillomas were managed with embolization. In 11 patients hemoptysis stopped within 24 hr and with no recurrence over the next 4 weeks. In 1 patient hemoptysis persisted and an upper lobe lobectomy was performed. CONCLUSION: Embolization of bronchial and systemic arteries is an effective method for treating acute severe hemoptysis from intracavitary aspergillomas, allowing the patient time to recover for definitive surgical management.

Imaging of cerebrovascular and cardiovascular disease in AIDS patients.

OBJECTIVE: The purpose of this article is to show the imaging findings in patients who have cerebrovascular and cardiovascular complications caused by AIDS. CONCLUSION: Detection of multifocal aneurysms, unexplained cardiomyopathy, and venous thrombosis in high-risk patients should suggest the possibility of AIDS.

Bronchial artery embolization for life-threatening hemoptysis using tris-acryl microspheres: short-term result.

A prospective study of 70 patients with life-threatening hemoptysis who had bronchial and systemic artery embolization with tris-acryl linked microspheres was performed over 15 months. The procedure was technically successful in 90% of patients and at 24 hr after the procedure (87%). Recurrent hemoptysis occurred in 13% of patients within the first week. Chest pain was experienced following embolization in 7% of patients. The mortality was 10% due to the inclusion of patients with pulmonary metastases. Bronchial artery embolization using microspheres is an effective and well-tolerated treatment for patients with life-threatening hemoptysis who are not surgical candidates.

Diffusion-weighted magnetic resonance imaging of spinal infection and malignancy.

BACKGROUND AND PURPOSE: Pyogenic and tuberculous spondylitis can mimic malignancy. The purpose of this study was to deter mine the efficacy of diffusion-weighted magnetic resonance imaging in differentiating spinal infection and malignancy. METHODS: Fifty-one consecutive patients with suspected spinal infection or malignancy were enrolled in the study. Apparent diffusion coefficients (ADCs) of paraspinal soft tissue mass and normal and abnormal vertebral bone marrow were determined on the diffusion-weighted magnetic resonance images of the spine. The mean ADCs of normal and abnormal vertebral bodies in patients with confirmed infection or malignancy were compared using nonparametric tests. RESULTS: ADCs of 69 tuberculous, 9 pyogenic, and 50 malignant vertebral marrow lesions were significantly higher than ADCs of normal marrow. ADCs of malignant bone marrow and 5 paraspinal soft tissue lesions were significantly lower than tuberculosis and pyogenic infection. There was no significant difference between the ADCs of 44 adult and 25 pediatric tuberculous bone lesions or between tuberculosis and pyogenic infection. Using the cutoff ADC of 1.02x10(-3)mm2/s for bone marrow, the sensitivity, specificity, and accuracy were 60.26%, 66.00%, and 62.50%, respectively, for distinguishing infection from malignancy. The sensitivity, specificity, and accuracy increased to 94.12%, 82.35%, and 90.20%, respectively, when the ADCs of associated soft tissue lesions were higher than 1.17x10(-3)mm2/s. CONCLUSIONS: Diffusion-weighted magnetic resonance imaging has limited usefulness for differentiating spinal infection and malignancy.