Anatomy of the Origin of the Gonadal Veins on CT.

PURPOSE: To study gonadal vein (GV) anatomy on multidetector computed tomography (CT) and define guidelines to aid their identification. MATERIALS AND METHODS: A total of 106 multidetector CT examinations obtained for abdominal pain were reviewed by three independent readers. The location and three-dimensional orientation of the GV ostia were investigated. Six studies were excluded because the GVs were incompletely visualized. RESULTS: The anatomy of the right and left GVs was defined in 100 and 99 cases, respectively. On the left side, 97 of 99 inserted directly into the inferior wall of the left renal vein (> 85% within 45 mm of the edge of the inferior vena cava [IVC] or within 10 mm of the edge of the spine). Two patients showed variant caval anatomy, and the GV directly joined the variant IVC. On the right side, 92 of 100 inserted directly into the IVC (> 83% within 25 mm below the renal vein ostium). The right GV ostium was anterolaterally located (ie, between 270° and 360°) in the majority of cases. Eight right GVs joined the right renal vein within 2 cm of the renal vein ostium. CONCLUSIONS: When searching for the right GV, the right anterolateral quadrant should be searched first, as much as 25 mm caudal to the right renal vein ostium. If unsuccessful, the inferior wall of the right renal vein within 2 cm of its origin should be interrogated. On the left side, the inferior wall of the left renal vein should be examined. If a left-sided IVC is found, the GV will join it directly.

Radiologic appearance of hereditary adrenal and extraadrenal paraganglioma.

OBJECTIVE: There is a wide spectrum of established and emerging genetic mutations associated with intraadrenal and extraadrenal paragangliomas. In this review, we present the typical radiologic patterns of disease associated with six well-characterized genetic mutations and discuss other inherited and nonfamilial syndromes currently under characterization. CONCLUSION: Contrary to previous understanding, recent genotype advances suggest that the majority of paragangliomas may be genetically predisposed.

Postmortem MRI of bladder agenesis.

We report a 35-week preterm neonate with bladder agenesis and bilateral dysplastic kidneys. A suprapubic catheter was inadvertently inserted into one of the larger inferior cysts of the left dysplastic kidney. A postmortem MRI scan was performed with the findings being confirmed on autopsy. We are unaware of another postmortem MRI study demonstrating bladder agenesis.

A young woman with myalgia.

We describe the case of a young female presenting with myalgia, mildly raised creatine kinase and a rash. The discussion emphasises the importance of a systematic approach to muscle symptoms, the value of a detailed hand examination and the importance of magnetic resonance imaging in the investigation of muscular symptoms.

Meniscal injuries and imaging the postoperative meniscus.

Meniscal injuries are common. Magnetic resonance imaging is considered the imaging modality of choice in diagnosing meniscal pathologic conditions in the nonoperative knee. Meniscal-preserving surgery is becoming more frequent, with a resultant increase in postoperative meniscal imaging, which is particularly challenging for the reporting radiologist. This article provides a review of the anatomy, pathologic conditions, and diagnostic pitfalls of meniscal injury, with a synopsis of the issues faced with postoperative meniscal imaging.

Clinicoradiological manifestations of paraganglioma syndromes associated with succinyl dehydrogenase enzyme mutation.

BACKGROUND: Paragangliomas are rare tumours derived from the autonomic nervous system that have increasingly been recognised to have a genetic predisposition. Mutations of the enzyme succinyl dehydrogenase (SDH) have proven to result in paraganglioma formation. There are four subunits (A through D) that form the enzyme complex and are associated with different genophenotypic expressions of disease. SDHB and SDHD mutations are more common, whereas SDHA and SDHC mutations are rare. Patients with SDHB mutations are prone to extra-adrenal pheochromocytomas, malignant disease and extra-paraganglial neoplasia, whereas SDHD mutations have a greater propensity for multiple, benign head and neck paragangliomas. METHODS: Diagnosis of a sporadic paraganglioma or pheochromocytoma should lead to a full genetic workup of the patient and family if SDH mutations are found. RESULTS: Further annual screening will be required depending on the mutation, which can have a significant impact on radiologists and the resources of the radiology department. CONCLUSION: We present our imaging experience with a series of patients with proven SDH mutations resulting in paragangliomas with a review of the literature.

Is talc pleurodesis safe for young patients following primary spontaneous pneumothorax?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether talc used for pleurodesis in young patients with a spontaneous pneumothorax has any long-term adverse effects. One hundred and eighty-one papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that talc pleurodesis in young patients with a spontaneous pneumothorax appears to have minimal long-term adverse consequences.