Calcific Tendinitis of the Longus Colli Muscle.

BACKGROUND: A 49-year-old man presented at the emergency department with neck pain for one week but also with subfebrility, sore throat and difficulties for swallowing for 3 days. Physical examination showed limited neck movement and tenderness of the trapezius muscles. Blood test showed an elevated C-reactive protein level and a mild leukocytosis. Tracheolaryngoscopy was normal.

Isolated synchronous meningioma of the external ear canal and the temporal lobe.

BACKGROUND: Extracranial meningiomas are common tumours but may occur in unexpected locations. Awareness can avoid misdiagnosis and inappropriate management of these tumours. We report the case of a 54-year-old Caucasian male with en plaque meningioma of the external ear canal and an intracranial temporal lobe meningioma. INTERVENTION: The patient underwent extended canal wall down atticomastoidectomy with preservation of the ossicular chain and tympanic membrane and en bloc resection of the bony posterior canal wall, tumour, and overlying skin. RESULTS: Radical removal of a grade I meningothelial meningioma was achieved. The tegmen tympani and dura were not breached. No connection with the temporal lobe meningioma was demonstrated. The patient recovered completely and experienced a marked improvement in hearing. No clinical signs of recurrent or residual tumour have occurred. CONCLUSION: Careful clinical examination and extensive radiological workup is required to avoid missing the unusual diagnosis of concurrent meningioma of the temporal bone and temporal lobe, and miss the chance to treat this disease adequately.

Accuracy of CT angiography in the assessment of a fetal origin of the posterior cerebral artery.

An uncommon cause of cerebral ischemia in the territory of the posterior cerebral artery (PCA) is the combination of a fetal origin of the PCA and atherosclerotic disease in the internal carotid artery. This study compared the accuracy of CTA with DSA in the assessment of a fetal origin of the PCA. Patients in whom an intracranial DSA and CTA had been performed were reviewed. A fetal origin was defined as a normal-sized patent posterior communicating artery (PCoA) with hypoplasia or aplasia of the ipsilateral P1 segment. One hundred PCAs in 51 patients were analyzed. A fetal origin was present in ten vessels (10%, eight patients). CTA revealed all of them. CTA considered an additional three vessels as having a fetal origin, while DSA revealed a PCoA with the same diameter as the P1 segment of the PCA. Sensitivity and specificity of CTA in the assessment of a fetal origin could be estimated at 100 and 97%, respectively. Positive and negative predictive values were 77 and 100%, respectively. CTA can be considered a valid diagnostic tool for the assessment of a fetal origin of the PCA in patients with a cerebral ischemic event in the territory of the PCA.

Giant intraluminal duodenal diverticulum: conventional barium study and computed tomography findings.

A case is reported of an asymptomatic intraluminal duodenal diverticulum (IDD) in a 21-year-old male patient with associated congenital abnormalities. During endoscopy for anemia an ostium in the duodenum was visualized, presumed to be the entry to an extraduodenal diverticulum. Upper gastrointestinal (UGI) barium examination showed, however, findings compatible with IDD. This diagnosis was supported by an abdominal computed tomographic (CT) examination. Surgical resection revealed a web in D2 with coexistent large IDD.

Cirsoid renal arteriovenous malformation treated by endovascular embolization with n-butyl 2-cyanoacrylate.

The authors report a rare case of renal arteriovenous malformation (rAVM) which was diagnosed by arteriography years after onset of intermittent haematuria. The rAVM of the cirsoid type was superselectively catheterized and embolized in toto with n-butyl 2-cyanoacrylate. Diagnostic imaging modalities and the technique of embolization are discussed.

Leptomeningeal metastases from ethmoid sinus adenocarcinoma: clinico-radiological correlation.

A patient with sinonasal adenocarcinoma is presented with leptomeningeal metastases affecting multiple cranial nerves and spinal nerve roots. Head and neck cancer is known to be an extremely rare source for leptomeningeal metastatic spread. The cranial nerves, the spinal cord and roots and the cerebral hemispheres can be affected in case of leptomeningeal metastatic spread. Examination of the CSF is the hallmark of the diagnosis if leptomeningeal metastatic spread is suspected, but this case illustrates that the combination of specific clinical features on one hand and specific lesions on the Gd-enhanced T1-weighted MRI study on the other hand is reliable enough to make a presumed diagnosis if the CSF analysis remains negative. We suggest that in our patient direct leptomeningeal spread occurred through the cribriform plate to the CSF, followed by further spread in a gravity dependent way.

Schwannoma of the tip of the nose: MRI.

We report a schwannoma with a rare location at the tip of the nose in a 20-year-old woman with an otherwise unremarkable medical history. The imaging findings underline the usefulness of MRI in narrowing down the differential diagnosis of masses in this region. Once the diagnosis was focussed on a neural origin of the mass, the exact nature of the tumour could not be predicted from the MRI, although the presence of a capsule on imaging studies as well as at operation suggested it was probably a schwannoma. A schwannoma must be considered when one encounters a sharply delineated mass at the tip of the nose, showing high signal on T2-weighted images and strongly contrast enhancement.