1/33. Unusual manifestations of soft tissue metastasis.We present a patient with pulmonary adenocarcinoma metastatic to the left forearm. The magnetic resonance imaging (MRI) revealed no discrete tumor, but an infiltrative signal change of the subcutaneous tissue and muscle. The lymphatic invasion by cancer cells explains this unusual manifestation of image findings.- - - - - - - - - - ranking = 1keywords = magnetic resonance, resonance (Clic here for more details about this article) |
2/33. granular cell tumor of the mediastinum.Mediastinal granular cell tumor is an exceptionally rare tumor; there are only a few previously reported cases. We report a 21-year-old man with a granular cell tumor in the right posterior mediastinum. Chest computed tomography scans and magnetic resonance imaging revealed a 15x20 mm well circumscribed, homogeneous mass, which was closely associated with the vertebral column. The T1-weighted magnetic resonance image showed low intensities, and moderate intensities were found on the T2-weighted magnetic resonance image. Gd-DTPA enhancement was remarkable on the tumor surface. The present case differed from ordinary neurogenic tumors in magnetic resonance imaging findings. Thoracoscopic resection of the tumor was performed. The tumor was associated with the sympathetic nerve. Histologic analysis revealed a benign granular cell tumor.- - - - - - - - - - ranking = 4keywords = magnetic resonance, resonance (Clic here for more details about this article) |
3/33. Castleman disease of the pleura: experience with eight surgically proven cases.BACKGROUND: Castleman disease of the pleura is unusual, and we present our experience with eight surgically proven cases. methods: Between 1980 and 2002, 8 patients (7 women and 1 man; age range, 20 to 53 years; mean, 26.5 years) with surgically proven, pleural Castleman disease (six hyaline vascular type, one plasma cell type, and one mixed type) were encountered. Their clinical, imaging, and surgical findings were reviewed. RESULTS: Five patients were asymptomatic, 1 had dyspnea, 1 had cough, and 1 experienced chest discomfort. Chest radiography showed a well-circumscribed interlobar, cardiophrenic, or paraaortic mass in 6 patients, a massive effusion in 1, and a focal diaphragmatic bulge in 1. Six tumors showed varying degrees of contrast enhancement (10 to 95 HU; mean, 46 HU) on computed tomography. Three cases appeared as well-defined, heterogeneously hyperintense pleural masses on magnetic resonance imaging. The masses varied in size from 3 to 10 cm (mean, 5.2 cm). Five masses greater than 5 cm had prominent pleural arterial blood supply and severe adhesions requiring thoracotomy and resection of nearby structures for radical tumor excision. blood loss from patients varied between 100 and 850 mL (mean, 620 mL). No tumor recurrence was noted during follow-up (range, 1 to 16 years; mean, 6.5 years). CONCLUSIONS: Pleural Castleman disease predominately affects young women and manifests as a well-circumscribed mass with a varying degree of contrast enhancement on computed tomography and heterogeneity on magnetic resonance imaging. Tumors greater than 5 cm have profuse pleural blood supplies and severe adhesion necessitating open thoracotomy and resection of neighboring structures. Radical resection can produce a satisfactory outcome.- - - - - - - - - - ranking = 2keywords = magnetic resonance, resonance (Clic here for more details about this article) |
4/33. Extramedullary sarcoid lesion mimicking intraspinal tumor.BACKGROUND CONTEXT: Spinal sarcoidosis is rare. Most spinal sarcoid lesions are intramedullary, and only three cases of extramedullary sarcoid lesions have been reported. PURPOSE: To describe a case of an extramedullary sarcoid lesion in a patient that did not have systemic involvement and to review the literature of spinal sarcoidosis. STUDY DESIGN/SETTING: Case report and review of the literature. PATIENT SAMPLE: Case report. OUTCOME MEASURES: Report of resolution of symptoms. methods/DESCRIPTION:The patient was a 33-year-old woman who had neck pain and pain radiating to the right scapula area and down the right arm into her hand and wrist. She also complained of numbness, tingling, muscle spasms and tremors, and had difficulty with writing. magnetic resonance imaging showed a mass that was extramedullary in the right lateral aspect of the spinal canal at the level of C5 and extending into the right C5-6 neuroforamen. Admitting diagnosis of neurofibroma was made. The patient underwent C4, C5 and C6 laminoplasty and gross total resection of an intradural extramedullary tumor. The lesion encroached on the neuroforamen on the right side involving the C6 nerve root, was grossly adherent to some of the rootlets and looked like a Schwannoma. Gross total resection of the tumor was performed. Pathological examination of the specimen showed a noncaseating granulomatosis consistent with sarcoid. Postoperative testing did not reveal systemic involvement of sarcoidosis. The patient was treated with corticosteroids. RESULTS: The patient made a satisfactory recovery, returned to work full-time, and had no complaints of neurological symptoms. CONCLUSIONS: An extramedullary sarcoid lesion is rare. Unlike intramedullary sarcoid lesions, it can be totally removed. If no systemic sarcoidosis is present, the patient can have a satisfactory recovery.- - - - - - - - - - ranking = 0.20098003562753keywords = resonance (Clic here for more details about this article) |
5/33. Successful surgical management of a case of spontaneous epidural hematoma of the spine during pregnancy.BACKGROUND CONTEXT: A spontaneous epidural hematoma of the spine occurring during pregnancy is extremely rare. The development of a significant neurologic deficit may be rapid. Therefore, the neurosurgeon should be aware of the presentation, diagnosis and treatment options available. PURPOSE: The authors report a case of a spontaneous epidural hematoma of the spine during the third trimester of pregnancy, which was successfully managed with surgical evacuation. The case is unique in that the patient demonstrated a subacute presentation. STUDY DESIGN: The authors report a case of a 27-year-old primagravada presented with the subacute onset of progressive paraparesis. She became nonambulatory before admission. A magnetic resonance imaging study (MRI) demonstrated ventral epidural compression in the upper thoracic region. methods: A retrospective review of a case of spontaneous epidural hematoma of the spine during pregnancy was performed. The inpatient and outpatient charts were used to gather clinical information of the case, and the pertinent radiographs and images were reviewed. RESULTS: An urgent cesarean section was performed followed by evacuation of the epidural hematoma. The decompression was performed by means of a thoracic laminectomy with partial facetectomy. The patient had a prompt return of neurologic function. CONCLUSION: Spontaneous epidural hematoma of the spine should be suspected in the setting of acute back or neck pain with or without an associated progressive neurologic deficit. spine surgeons and obstetricians should also recognize that a spinal epidural hematoma during pregnancy may also present subacutely, as illustrated in our case. Prompt diagnosis may be made with MRI, and evacuation of the hematoma should be performed, ideally before the onset of neurologic signs or symptoms. The prognosis for return of neurologic function is good after urgent evacuation.- - - - - - - - - - ranking = 1keywords = magnetic resonance, resonance (Clic here for more details about this article) |
6/33. Dercum's disease (adiposis dolorosa): a new case-report.Dercum's disease, or adiposa dolorosa, is a rare condition characterized by the development of multiple painful subcutaneous lipomas. Postmenopausal women are selectively affected. The ankle area is an uncommon site of involvement. We report a case with lipomas about the ankle, and we review the relevant literature. CASE-REPORT: This 46-year-old perimenopausal woman receiving follow-up for depression presented in December 1997 for swelling and mechanical pain in the right ankle. Lumps behind and under the malleoli were removed surgically and found to have the typical histological features of lipomas. In January 2000, a lump developed behind and under the malleoli of the left ankle, and the lumps on the right recurred. The physical examination showed obesity, with a body mass index of 32.04 kg/m(2). Firm, mobile, painless lumps were felt under and behind the malleoli on both sides. The ankles were painful, although range of motion was normal. Examination of the back found two similar lumps. The erythrocyte sedimentation rate was 10 mm/h and the c-reactive protein level was 6 mg/l. serum lipid levels were normal. Findings were normal from plain radiographs of the ankles. Ultrasound scanning of the ankles confirmed that the lumps were composed of adipose tissue. magnetic resonance imaging visualized an arc-shaped lipomatous mass on the left. Whole-body bone density measurement found an increase in fat mass of the lower limbs with normal bone mass. The ankle lipomas were removed surgically. At last follow-up 18 months later, she was free of recurrence. DISCUSSION: Dercum's disease is a rare condition of unknown etiology characterized by multiple, often painful lipomas. paresthesia in the overlying skin is common. Lipomas about the joints cause mechanical arthralgia. The diagnosis, which is often delayed, rests on ultrasonography and, above all, magnetic resonance imaging. A combination of medications, surgery, and psychiatric care is usually needed. The treatment aims at relieving the pain and restoring a normal appearance.- - - - - - - - - - ranking = 1.2009800356275keywords = magnetic resonance, resonance (Clic here for more details about this article) |
7/33. Limited Wegener's granulomatosis presenting with complete heart block.Complete heart block associated with Wegener's granulomatosis (WG) is rare, and has not previously been reported with 'limited' WG. The case of a 36-year-old man who presented with complete heart block due to 'limited' WG [positive cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) on indirect immunofluorescence, positive serum antibodies to proteinase-3, and inflammatory sinus disease seen on computerized tomography (CT) without renal or pulmonary involvement] is presented. In addition, a gallium-scan fused with a myocardial perfusion scan and cardiac magnetic resonance imaging (MRI) suggested focal inflammation near the atrioventricular (AV) node.- - - - - - - - - - ranking = 1keywords = magnetic resonance, resonance (Clic here for more details about this article) |
8/33. Traumatic anterior dislocation of the hip associated with ipsilateral femoral shaft fracture in a child: a case report.Traumatic anterior dislocation of the hip joint in children is rare, and only one case with ipsilateral femoral fracture has been reported in japan. We report a case of such dislocation and a review of the literature. The patient was a 31-month-old girl who was injured in a car accident while asleep on a tilted front passenger seat. Radiographic examination showed dislocation of the right obturator foramen and transverse fracture of the ipsilateral femoral shaft. The dislocation of the right hip was easily reduced without anaesthesia during radiography. We applied Bryant traction after reduction for 4 weeks, followed by cast application for 3 weeks. walking with support and full weightbearing were permitted 14 weeks and 16 weeks after the injury, respectively. radiography at 4.5 years after the injury showed a mildly enlarged right femoral head and femur overgrowth of approximately 8 mm. magnetic resonance imaging showed no evidence of suspected avascular necrosis of the femoral head. The patient has no subjective or objective symptoms, and is able to engage in all usual activities. The detailed mechanism of the injury is unknown. We assume that the lower leg was dislocated through abduction during flexion, or abducent, external flexion, considering that the child was sleeping at the time of the accident. Since she was hurled to the back seat, it was assumed that strong external force was vertically added to the femur, which caused the abducent force.- - - - - - - - - - ranking = 0.20098003562753keywords = resonance (Clic here for more details about this article) |
9/33. Multiple enchondromatosis Ollier's disease with two primary brain tumors.A rare case of multiple enchondromatosis associated with 2 primary brain tumors is reported. A 21-year-old female who has diagnosed as Ollier's disease at the age of 9-years was admitted to the hospital with complaint of diplopia and progressive right upper and lower limb weakness. magnetic resonance imaging of the brain depicted 2 intra-axial mass lesions. Stereotactic biopsy showed low grade fibrillary astrocytoma in both lesions. This report emphasizes that patients with Ollier's disease are at a higher risk for primary brain tumors than has been previously recognized.- - - - - - - - - - ranking = 0.20098003562753keywords = resonance (Clic here for more details about this article) |
10/33. Intravenous pyogenic granuloma or intravenous lobular capillary hemangioma.Lobular capillary hemangioma is a vascular neoplasm that commonly occurs as a cutaneous tumor. When it involves the skin and mucosal surfaces, ulceration and suppuration may occur, hence the classic term of pyogenic granuloma. Intravenous pyogenic granuloma is a rare solitary form of lobular capillary hemangioma that usually occurs in the veins of the neck and upper extremities. We report the ultrasonographic and magnetic resonance imaging findings of a pyogenic intravenous granuloma localized in the right cephalic vein. The imaging and pathological findings and the differential diagnoses are discussed.- - - - - - - - - - ranking = 1keywords = magnetic resonance, resonance (Clic here for more details about this article) |
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