Three-dimensional image of Bochdalek diaphragmatic hernia; a case report.

A 60-year-old man was found to have a mass shadow on the left posterior diaphragm by chest roentgenogram. He was examined by spiral computed tomography (CT) using the Somatom Plus-S. Transaxial, coronal, sagittal, and three-dimensional (3D) imagings were performed. Transaxial, coronal, and sagittal images of CT scans demonstrated not only a large defect of the posteromedial portion of the left diaphragm, but also two small defects on the right side. The spleen was identified through the left-side defect, and subdiaphragmatic fat through the right-side defects. He was diagnosed as having bilateral Bochdalek hernia. 3D Imaging was also useful for stereographic perception of Bochdalek hernia. Although Bochdalek hernia is not rare, to our knowledge, this is the first case of Bochdalek hernia observed by spiral CT 3D imaging.

Germinoma arising in the basal ganglia in early stage: CT and MR findings.

We report a patient with a germinoma originating in the left basal ganglia. Unenhanced computed tomography (CT) revealed a relatively well-defined high-density lesion, which was slightly enhanced with contrast medium. No tumor stain was noted on angiography. The mass showed hypointensity on T1-weighted magnetic resonance imaging (MRI), and heterogeneous hyperintensity on T2-weighted imaging. The lesion was homogeneously enhanced after the administration of Gd-DTPA. To our knowledge, the MR findings of basal ganglia germinoma have been retrospectively reviewed in just four reported cases, only two of which were examined with Gd-DTPA enhancement. The two cases revealed relatively large masses with cysts and peritumoral edema, and were slightly enhanced after the intravenous injection of Gd-DTPA. Our case was thought to be in the early stage, and its CT and MR findings were slightly different from those of previously reported cases.

Intracaval invasion of left adrenal cortical carcinoma extending into the right atrium.

A case of adrenal carcinoma with advanced inferior vena cava (IVC) involvement is reported. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large mass over the upper pole of the left kidney, with tumor thrombus from the IVC to the right atrium of the heart. Angiography demonstrated that this mass received its blood supply mainly from the left superior adrenal artery, and, parasitically, the left middle adrenal artery, splenic artery, and lumbar arteries. Venacavography revealed obstruction of the IVC and the collateral, dilated azygos vein. Radical surgery was performed, including resection of the tumor and the tumor thrombus in the IVC and right atrium with the aid of cardiopulmonary bypass. Although renal carcinoma with tumor thrombus invasion of the IVC or atrium is common, adrenal tumor thrombus invasive to the atrium is very rare.

Reference lines for oblique axial MR imaging of the brain.

Reference lines that correspond to the three reference lines used at computed tomography were determined on 50 normal midsagittal magnetic resonance brain images. Lines were drawn from the mammillary body to the posterior tentorial attachment to the sinus (orbitomeatal), from the center of the pituitary gland to the posterior tentorial attachment to the sinus (Reid baseline), from the mammillary body to the posterior edge of the fourth ventricle (supraorbitomeatal).

Amyloid arthropathy of the hip joint: MR demonstration of presumed amyloid lesions in 152 patients with long-term hemodialysis.

The aim of this study was to determine the spectrum of MR findings of presumed amyloid arthropathy of the hip joints in patients on long-term hemodialysis. We prospectively performed T1- and T2-weighted spin-echo imaging on 152 consecutive patients on hemodialysis. The duration of hemodialysis ranged from 5 months to 24 years, 2 months (mean: 8 years, 8 months). The frequency, location, and signal intensity of bone lesions were assessed. In 12 cases with contrast-enhanced MR examination, enhancement pattern of bone lesions, synovial lesions, and intra-articular lesions were characterized. Bone lesions presumed to be amyloid deposits were identified in 60 patients (39%). Magnetic resonance imaging revealed that amyloid lesions were more extensive than anticipated by plain radiographs. All bone lesions showed decreased signal intensity on T1-weighted images. On T2-weighted images, bone lesions showed increased signal intensity in 32 patients (54%), decreased signal intensity in 11 patients (18%), and both increased and decreased signal intensity in 17 patients (28%). Following intravenous injection of gadolinium-based contrast, all bone lesions showed moderate enhancement. Synovial thickening could not be identified on T1- and T2-weighted images. However, contrast-enhanced images showed thickened synovial membrane, which could be differentiated from joint fluid. Intra-articular nodules showed decreased or intermediate signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images; the intra-articular nodules were contiguous with subchondral bone lesions. Magnetic resonance imaging is useful for evaluating the distribution and extent of amyloidosis of the hip joints in patients undergoing long-term hemodialysis.

Stabilization of a percutaneously implanted port catheter system for hepatic artery chemotherapy infusion.

A port catheter system for hepatic artery infusion chemotherapy was implanted percutaneously via the left subclavian artery in 41 patients for treatment of unresectable liver metastases. The catheter tip was inserted into the gastroduodenal artery (GDA), the end hole was occluded with a guidewire fragment, and a side-hole for infusion was positioned at the bifurcation of the proper hepatic artery and the GDA. The GDA was embolized with steel coils around the infusion catheter tip via a transfemoral catheter. This procedure is designed to reduce the incidence of hepatic artery occlusion and infusion catheter dislocation.

Transcatheter embolization of arteriovenous malformations in Cowden disease.

A patient with Cowden disease and multiple arteriovenous malformations (AVMs) that resulted in high output heart failure is described. Cowden disease is a familial syndrome characterized by endodermal, mesodermal and ectodermal dysplasia causing benign and malignant tumors of the skin, breast, gastrointestinal tract, and thyroid gland. Our patient had gastrointestinal polyposis, a right renal tumor, a left lung tumor, an adenomatous goiter, and typical dermatologic findings such as facial papules, acral keratosis, gingival papillomatosis and hemangiomas. AVMs were observed in the pelvis, cervical vertebra, liver, and right supraclavicular area. Transcatheter embolization was performed 7 times for the pelvic AVMs, but the effect decreased with repetition and the patient died of heart failure 2 years after the first embolization. The serum levels of tissue plasminogen activator (t-PA), platelet-derived growth factor (PDGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and transforming growth factor beta1 were high, suggesting that these angiogenic molecules may play a role in the pathogenesis of AVMs in Cowden disease.