Post varicella hepatic actinomycosis in a 5-year-old girl mimicking acute abdomen.

Actinomycosis is an indolent, slowly progressive infection caused by gram-positive, anaerobic or microaerophilic bacteria. Hepatic involvement is rare and generally secondary to abdominal or thoracic actinomycosis. Hepatic actinomycosis in children may mimic a wide variety of diseases and thus make the diagnosis much more challenging. Here, we report a 5-year-old girl with apparently primary hepatic actinomycosis mimicking acute abdomen 2 weeks after varicella. The diagnosis was made by ultrasonic guided fine needle aspiration biopsy of a hypoechoic lesion of 3.5 cm diameter in the liver showing sulfur granules surrounded by neutrophils. Hepatic actinomycosis should be taken into account when evaluating acute abdomen symptoms in children.

Preoperative evaluation of the congenital aural atresia on computed tomography; an analysis of the severity of the deformity of the middle ear and mastoid.

OBJECTIVE: To compare the development of temporal bone in normal and atretic ears and to assess some radiological landmarks that could be important in the hearing restoration interventions in such patients. MATERIAL AND METHODS: Thirty-five patients with 40 atretic external ears were evaluated with temporal bone CT and compared to a control group of 40 normal ears retrospectively. Using comparable slice levels in all patients, the course and the caliper of the facial canal, the surface area of the incus and malleus, the level of mastoid aeration, the location and anteroposterior diameters of the jugular bulb and sigmoid sinus, the direction and the caliber of the tympanic bony part of the Eustachian tube, area of the middle ear cavity, distance from facial nerve to incudomalleolar joint, to the vestibule and to the jugular bulb were included in the assessment. Non-parametric and parametric statistical tests were used for comparison. RESULTS: In atretic ears middle ear sectional area was found to be smaller at the equivalent plane as compared to control subjects (mean area index: 19.3mm(2) versus 47.4mm(2)). Mastoid aeration was low in general and the ossicles in the atretic ears were hypoplastic (mean ossicular sectional area: 8.3mm(2) versus 11 mm(2)). The distance from the jugular bulb to the facial nerve was significantly lower (mean: 6.2mm versus 6.8mm) (p<0.05) in the atretic ears. Facial canal caliber, distance from the facial canal to the incudomalleolar joint and distance from the facial canal to the vestibule in the atretic ears (means: 1.49, 2.93 and 1.82, respectively) did not show statistically significant difference from the control subjects (means: 1.44, 2.91 and 1.83, respectively) (p>0.05 for all). CONCLUSION: External ear atresia is significantly associated with middle ear and mastoid abnormalities. The ossicles were underdeveloped which always have to be considered during reconstructive surgery. Radiologically, in the atretic ears anterior-posterior length of the temporal bone was more influenced as compared to superior-inferior portion, which justifies abnormal route of the facial nerve canal. However, there is no abnormality in the development of the facial nerve as the caliper is similar to the control subjects.

Pseudo-reorganization of language cortical function at fMR imaging: a consequence of tumor-induced neurovascular uncoupling.

A left-handed patient with a grade II left frontal lobe astrocytoma had spontaneous seizures causing speech arrest and uncontrolled right upper extremity movements. Word-generation functional MR (fMR) imaging showed activity nearly exclusively in the right inferior frontal gyrus. The clinical history of the speech arrest and the intraoperative mapping proved left-hemisphere language dominance. Tumor involvement of the left inferior frontal gyrus caused uncoupling of the blood oxygenation level-dependent (BOLD) and neuronal response, leading to the erroneous fMR imaging appearance of right-hemisphere language dominance. Discrepancies between BOLD and intraoperative mapping in areas near lesions illustrate the complementary nature of these techniques.

Multiple globoid meningiomas associated with craniomandibular fibrous dysplasia: case report.

A 20-year-old male with craniomandibular deformity and almost total visual loss of the right eye due to bilateral optic atrophy underwent cerebral nonenhanced computed tomography (NECT) examinations. He had multiple sphenoidal-temporoparietal meningiomas, with adjacent hyperostoses and distant calvarial hyperdense lesions, as well as sclerotic expansion of right mandibular condyle. History, clinical and imaging findings were suggestive of associated fibrous dysplasia (FD), which explained the visual loss due to optic nerve compression through sphenoidal optic foramens. Cranial and mandibular FD and concurrent multiple globoid meningiomas in this case may suggest a mutual influence, which may explain the etiopathogenesis of FD lesions and/or bone hyperdensities adjacent or distant to meningiomas.

Multidetector computed tomography in post-traumatic ventricular pseudoaneurysm.

We report a 20-year-old male with rare asymptomatic aneurysm of the left ventricle that was concluded to be a pseudoaneurysm given its calcified walls and the history of severe blunt chest trauma 8 years ago. Multidetector computed tomography (CT) angiography of the coronary vessels helped exclude vascular insult and suggest traumatic intramyocardial dissection as underlying etiopathogenesis, besides providing a good view of aneurysm and cardiac morphology in relation to coronary vessels.

Value of magnetic resonance imaging in the depiction of intravenous leiomyomatosis extending to the heart.

Intravenous leiomyomatosis is a seldom neoplasia characterized by invasion of venous channels by a benign smooth muscle tumor originating either from a uterine myoma or from vessel wall. Extension to the heart may cause mechanical obstruction and is frequently misdiagnosed as a right-atrial myxoma. We present a case of recurrent intravenous leiomyomatosis with previous hysterectomy because of uterine leiomyoma which have different magnetic resonance characteristics than that of the former reports.