Can occipital lobe bending, Gibraltar sign of superior sagittal sinus groove and jugular foramen dimensions predict transverse sinus dominance?

BACKGROUND: Asymmetry between the transverse sinuses (TS) is quite common. We sought to test the possible hypothesis that certain anatomical features - namely, occipital lobe bending, Gibraltar sign of superior sagittal sinus groove (SSS) and jugular foramen (JF) dimensions - can predict dominance of the transverse sinuses on routine axial T1- and T2-weighted images. MATERIALS AND METHODS: One hundred consecutively acquired combined MRI-MRV studies of brain were reviewed. On non-contrast axial T1WI, each reviewer assessed the occipital lobe bending, and Gibraltar sign of SSS groove; on axial T2-weighted images, JF dimensions were measured. TS cross-sectional area was measured on non-contrast sagittal 2-dimensional phase contrast MRV images and served as the reference standard. RESULTS: Of the 51 subjects with right-dominant TS, 37 had occipital bending to the right side and 35 showed sloping of the Gibraltar sign to right side. Of the 18 subjects with left dominant TS, 10 had occipital bending to left side and 13 showed left-sided sloping of the Gibraltar sign. Of the 31 subjects with co-dominant TS, 15 had no occipital bending and 20 showed no sloping of the Gibraltar sign. Mean right and left JF dimensions were higher in the right and left dominant TS respectively with no significant differences in patients with co-dominant sinus (p < 0.02). CONCLUSION: Right occipital bending had a good association with right TS dominance. The other two parameters- Gibraltar sign of superior sagittal sinus groove and jugular foramen dimensions - did not have a very good association with respect to TS dominance.

Newly proposed classification of celiac artery variations based on embryology and correlation with computed tomography angiography.

Purpose: We studied the prevalence of celiac trunk and its anatomical variations on diagnostic computed tomography angiography (CTA) studies and have proposed a new classification to define the celiac artery (CA) variations based on embryology. Material and methods: We retrospectively assessed the celiac trunk variations in 1113 patients who came to our department for diagnostic CTA for liver and renal donor workup. The patient data were acquired from the Picture Archiving and Communication System of our institutions. We analysed the celiac trunk's origin and branching pattern, including the superior mesenteric artery (SMA) and inferior phrenic artery (IPA). Results: We evaluated the CTA studies of 1050 patients. A normal trifurcation pattern, the most common type, was observed in 39% of cases. Variation with CA + left IPA was the most common subtype. Other variations noted in the study and their incidences are listed in the table below. We attempted to propose a new classification based on embryo-logy, which comprises 6 main types and their subtypes. We also analysed previous studies from the literature, including cadaveric, post-mortem, CTA, and digital subtraction angiography studies and compared them with the present study. Conclusions: Because variations of CA classifications reported to date do not encompass all CA branching pattern variants, we have proposed a new classification that incorporates most of the variants. We reiterate the clinical importance of anatomical variants of CA, IPA, and SMA in surgical and interventional radiology procedures.

Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication.

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of "Bear Paw Sign." An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.

A case report of bilateral mirror feet with varus deformity.

OBJECTIVES: To describe a rare case of bilateral mirror feet with varus deformity and review of literature. METHODS: AP and oblique radiographs of both feet were taken. RESULTS: On radiographs, right foot showed eight toes and seven metatarsals while left foot showed eight toes and seven metatarsals, the three extra toes were present preaxially (on hallux side) in both feet, showing characteristics of postaxial toes termed as "mirror foot". Varus deformity was noted at the subtalar joint, otherwise tarsal bones appeared normal. No any syndromatic association was present. CONCLUSION: Mirror foot is a very rare congenital anomaly, we put forward this case for its rarity and unusual late presentation at the age of 22.

Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of "Bear Paw Sign." An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.

Imaging of Pharyngocele: An Occupational Overuse Syndrome.

Pharyngocele is a rare pathology of the pharynx caused by the laxity of the thyrohyoid membrane. Only about 60 true lateral pharyngocele cases have been reported in the literature over the last 133 years. Laryngocele is a close differential, and the two are difficult to tell apart. Though they have been described well in the literature, they are often misdiagnosed or interchangeably diagnosed. The acquired type of pharyngocele is due to prolonged increased intrapharyngeal pressure and pharyngeal wall weakness, and it is more common than congenital pharyngoceles. Close differential diagnoses include Zenker's diverticulum, laryngocele, and jugular venous phlebectasia. Acquired lateral pharyngoceles are seen in wind instrument musicians and glassblowers. Hence, these diverticula are described as 'overuse syndrome'. We present a case of bilateral neck swelling, which occurred doing the Valsalva maneuver with imaging studies.

Unanticipated diagnosis of skeletal muscle Kaposi sarcoma: a case report.

Kaposi sarcoma (KS) is a cancer, characteristically manifesting as red or purple patches of abnormal tissue growing subcutaneously around the mouth, nose, and throat. Primary musculoskeletal KS is a never reported as skeletal muscles sarcomas are first differentials. Pertaining to the musculoskeletal system complicity of KS, African and classic KS lesions are inclined to manifest lesion in the peripheral skeleton. On the other hand AIDS-related KS routinely involves the maxillofacial bones and/or axial skeleton. KS distinguishably involves the tempo-parietal bones, paranasal sinus, hands and feet and other facial bones. Asymmetric involvement of the bones by KS is the rule. Though reported, involvement of the joints in KS is unusual. Skeletal muscle involvement has only sparingly been reported in AIDS-related KS patient. A primary KS of the skeletal muscle in an otherwise normal patient with no skin manifestations has never been reported thus far. The occurrence of KS in any atypical site may pose as difficulty to diagnose it. It is important for the radiologist to acquaintance with the spectrum of imaging manifestations of KS in various affected organs. Particularly in asymptomatic patients, lesions go unrecognized on routine imaging studies (e.g. KS on plain x-ray films) and clinicians are unwary of their existence. Awareness that KS can occur in any of these unusual locations may help avoid potential misdiagnosis with serious consequences (e.g. spinal cord compression) and/or mis-management.