Atretic Cephalocele.

BACKGROUND: A 1-year-old girl was referred to the neurosurgery department. The patient presented with a swelling on the vertex of the head which was present at birth but increased gradually over time. There were no perinatal problems and the child developed normally. The swelling produced no discomfort nor pain, and measured 2 cm Å~ 3 cm. The child was followed during 6 months because there was a chance of involution. The patient was reevaluated 6 months later.

Repair of distal biceps tendon ruptures using a suture anchor and an anterior approach.

In a prospective study, eight consecutive patients with nine ruptures of the distal biceps tendon underwent repair through a single incision. All patients were satisfied with their clinical results and had full ranges of elbow and forearm motion. There were no radial nerve injuries and no radio-ulnar synostoses. Isokinetic testing, after correction for dominance, demonstrated a 6% strength deficit, but 7% higher endurance in the repaired extremity for the flexion-concentric test, and no strength deficit and 13% higher endurance for supination. The improved endurance is probably explained by initial reduced effort due to apprehension which minimized subsequent fatigue.

Neurovascular compression by a subpectoral lipoma. A case report of a rare cause of thoracic outlet syndrome.

BACKGROUND: Lipomas are benign soft tissue tumours, progressively expanding in volume. Beside frequent aesthetic consequences, lipomas can also exert pressure on surrounding tissues and structures. MATERIALS AND METHODS: A case of a subpectoral infraclavicular lipoma compressing the axillo-subclavicular neurovascular bundle, produced unilateral brachialgia, thereby simulating a Thoracic Outlet Syndrome. The expansive, but non-infiltrative, nature of the lipoma allowed local excision in the vicinity of the brachial plexus and infraclavicular vascular structures. RESULTS: Surgical removal of the lipoma resulted in complete remission of symptoms in the left arm and hand. CONCLUSIONS: In the presence of unilateral brachialgia, a subpectoral tumour causing a Thoracic Outlet Syndrome should always be excluded in the absence of other relevant pathology.

Hemangiopericytoma of the parotid gland: CT and MR features.

Hemangiopericytomas are uncommon vascular neoplasms with rare occurrence in the head and neck region. They originate from the pericytes, which are small, oval cells encircling capillaries. Hemangiopericytomas traditionally appear in the retroperitoneum and in the capillaries of the extremities. A case of hemangiopericytoma of the parotid gland is presented. The clinical, surgical, histologic, and radiologic features are described and discussed.

Hypertrophy and pseudohypertrophy of the lower leg following chronic radiculopathy and neuropathy: imaging findings in two patients.

Enlargement of the ipsilateral muscle compartment is an exceptional finding in patients with chronic radiculopathy, peripheral nerve injury, anterior horn cell diseases, or acquired peripheral neuropathy. We report radiographic, ultrasonographic, CT and MRI findings in a patient with chronic S1 radiculopathy and another with chronic neuropathy of the common fibular nerve (L4-S2), both presenting with painless enlargement of the calf muscles.

Intralobar pulmonary sequestration supplied by the right coronary artery.

Bronchopulmonary sequestrations are malformations that are often congenital; they consist of isolated nonfunctioning lung segments having no communication with functional tracheobronchial elements of the surrounding lung. They are supplied by single or multiple branches from the distal thoracic or proximal abdominal aorta, or from the celiac, splenic, intercostal, subclavian, or pulmonary artery. Due to the absence of ventilation, the lung tissue can become chronically infected. We describe an intralobar pulmonary sequestration with arterial supply from the right coronary artery.

Occipital pain in osteoid osteoma of the atlas. A report of two cases.

STUDY DESIGN: Two cases of occipital pain caused by an osteoid osteoma of the atlas are presented. OBJECTIVES: To describe the management of occipital pain in two young patients. SUMMARY OF BACKGROUND DATA: Osteoid osteoma is a benign lesion mostly affecting the long bones. A spinal location is uncommon. To the authors' knowledge, there are only five other reports of an osteoid osteoma located in the atlas. METHODS: Occipital headache, which was relieved by salicylates, was the major symptom reported by the two adolescents. In the first patient, a lesion of C1 was seen on plain radiographs. In the second patient, the diagnosis of osteoid osteoma was suggested by scintigraphic imaging and subsequently by computed tomography. RESULTS: Pain disappeared in both cases after surgical excision of the lesion. Histologic examination disclosed characteristic features of osteoid osteoma. CONCLUSIONS: Occipital pain in adolescents, which is relieved by aspirin, should raise suspicion about the possibility of an osteoid osteoma of the atlas. If standard cervical spine radiographs are negative, isotope scanning and computed tomography can help to establish the diagnosis. Complete excision eliminates the lesion and produces immediate relief for the patient.

Pelvic congestion syndrome: demonstration and diagnosis by helical CT.

Pelvic pain is a common gynaecological complaint, sometimes without any obvious etiology. We report a case of pelvic congestion syndrome, an often overlooked cause of pelvic pain, diagnosed by helical computed tomography. This seems to be an effective and noninvasive imaging modality.

Non-invasive diagnostic assessment of extensive vertebral artery tortuosity with enlargement of the intervertebral foramen.

Two cases with an incidental finding of a widened intervertebral foramen due to extensive tortuosity of the vertebral artery are presented. Computed tomography angiography and magnetic resonance imaging/magnetic resonance angiography (MRA) both proved to be useful as non-invasive techniques to provide the diagnosis. In-plane saturation is a disadvantage seen with the two-dimensional time-of-flight MRA technique.

Mycotic pseudo-aneurysm of the extracranial carotid artery.

A rare case of mycotic pseudo-aneurysm of the common carotid artery as a complication in an immunosuppressed paediatric patient is presented. Treatment of pseudo-aneurysms of the common carotid artery is generally considered to be an emergency, necessitating quick and accurate diagnosis. In patients with septicemia, angiography has to be avoided. We were able to provide the surgeon with the exact diagnosis and accurate topographical information with helical CT with 3D reformation.

Basilar and distal vertebral artery occlusive disease: correlation of MR imaging and MR angiography.

The purpose of this study is to evaluate the correlation of brain lesions seen on magnetic resonance imaging with vascular occlusive disease of the basilar and distal vertebral arteries as documented on MR angiography. The clinical findings are also correlated with the findings on MR imaging and MR angiography. The clinical records of twenty-one patients with proven occlusive disease of the distal vertebral and/or basilar arteries were retrospectively reviewed. All the patients were imaged utilizing either the Siemens Magnetom 1.5 T SP 4000 and the Siemens 1.0 T Impact systems. Dual MR angiographic techniques were employed including two-dimensional (2D) and three-dimensional time-of-flight. The 2D sequences utilized fast low angle shot gradient echo sequences. The 3D sequences utilized fast image steady-state precession gradient echo sequences. Gadolinium contrast was utilized for increased angiographic detail in one patient. Magnetization transfer contrast was used in three patients. The individual partitions as well as the maximum intensity pixel projection images were evaluated in each case. The most extensive brain lesions were seen in the group of patients with severe basilar and/or combined vertebrobasilar disease. One-half of these patients showed non-specific scattered foci of T2 lengthening similar to the findings found in a group of patients with noncritical stenosis. MR imaging invariably demonstrated more lesions than were clinically suspected. Even though the brain lesions tended to be more extensive in patients with severe vascular disease, the amount of brain tissue damage was not an adequate parameter to document the degree of vascular narrowing. The degree of vascular narrowing was useful in therapy planning. Such data was obtained by the MR angiograms, but not by MR imaging. MR angiography is a useful complementary examination when lesions in the basilar and distal vertebral vascular territories are diagnosed on MR imaging. MR angiography can differentiate critical from noncritical stenosis and can thus play a key role in the therapeutic decision making process.

[The history of tomography]. / De historiek van de tomografie.

It is easily forgotten that not yet a hundred years ago the only way to look into the patients' body was via invasive procedures. Within the year of the discovery of X-rays by Conrad Röntgen the need for three dimensional imaging had been voiced. The driving force behind this development was undoubtedly clinical motivation. Planar X-radiographs were not satisfactory to the clinicians who urged the radiologists to provide them with tomographic images. Between 1910 and 1940, classical tomography has been the product of individuals rather than collective groups. It is only in the mid thirties that scientists found out about each other and started to correspond vigorously. Mayer was the first to suggest in 1914 the idea of tomography. Bocage, Grossman and Vallebona all developed the idea further and built their own equipment. In 1931 Ziedses des Plantes published the most extensive and thorough study on tomography. In the forties and fifties a stagnation is noticed, only further refinements to the existing equipment are carried out. Although Frank and Takahashi published the basic principles of axial tomography in the mid forties, we had to wait for the necessary developments in electronics before Hounsfield was able to develop and commercialize the first axial computer tomography in 1972 (EMI-Scanner). At the time all the big radiology companies rushed into the field and soon, second, third and fourth generation CT scanners became available. Only a few years later a new way of generating images without using ionizing radiation was introduced. Lauterbur and Damadian produced the first low quality images with magnetic resonance, a technique called zeugmatography by its inventors. In 1974 the first images of a living subject were published and initial scepticism was replaced by euphoria. This resulted in the spectacular evolution in Magnetic Resonance that we are now observing. While it is impossible to predict the future, the development of networks, the increase in data acquisition and storage will spread a new light on our specialty. A closer cooperation between radiologists, pathologists and clinicians will undoubtedly be necessary, as well as a partial redefinition of the radiologists task.