Search

Background: Osteomyelitis is a progressive infection of bone and bone marrow by microorganisms, resulting in inflammatory destruction of bone, bone necrosis, and new bone formation. Skull involvement is a rare occurrence which mainly affects children with chronic inflammatory diseases of paranasal sinusitis, or malignant otitis. In adults, cranial vault osteomyelitis can occur after cranial surgery or head trauma., Case Description: We describe an unusual case of chronic cranial osteomyelitis occurred 3 months following a mild traumatic brain injury. The causative mechanisms along with the diagnostic modalities are discussed., Conclusion: Focal cranial vault osteomyelitis, in the absence of severe trauma, can be challenging to diagnose. Imaging findings and patient history should be carefully investigated to make a correct diagnosis., Competing Interests: There are no conflicts of interest.

We report a rare case of iatrogenic right coronary artery (RCA) dissection complicated by a retrograde subtle aortic dissection, which occurred during a primary percutaneous transluminal coronary angioplasty (PTCA). A 65-year-old female, with acute anterior ST-elevation myocardial infarction (STEMI), promptly underwent primary PTCA in the left anterior descending artery. After 5 h, the patient's condition becomes worse with recurrence of chest pain and new electrocardiogram modifications suggestive of inferior STEMI. A second coronary angiography revealed a spiral dissection extending from the ostium to the medium tract of the RCA. At the same time, a contrast media extravasation due to coronary ostium fissure occurred. Coronary stents were implanted from the medium tract of the right coronary to the ostium, to promptly arrest the active bleeding and to treat the dissection. After cardiosurgical advice, the patient was referred to the radiology department, where she underwent computed tomography angiography (CTA), which showed a small hematoma in the anterior wall of the ascending aorta. The stable clinical conditions of the patient suggested a conservative therapeutic approach. During the following 6 weeks CTA and transesophageal echocardiography were performed to rule out any other complication, and the patient was fortunately discharged with almost complete resolution of the hematoma., Competing Interests: There are no conflicts of interest.

Clinical evaluation and ultrasound examination are the first steps in the evaluation of a patient with a swelling of the parotid region. After the detection of a nodular lesion, cytological or histological confirmation is usually performed to achieve the diagnosis, while the choice of cross-sectional imaging (computed tomography scan and magnetic resonance imaging) may significantly vary from one physician to another, on the basis of the degree of confidence that both radiologist and surgeon have with this kind of imaging. This work focuses on some essential "reporting points" in cross-sectional imaging evaluation of parotid nodules, chiefly helpful to the radiologist when the ultrasonography assessment is considered incomplete and requires a further evaluation., Competing Interests: There are no conflicts of interest.

BACKGROUND Superior mesenteric artery syndrome is caused by vascular compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. It may occur with acute or chronic symptomatology, such as vomiting or postprandial abdominal pain, and it is usually caused by a lack of mesenteric fat pad under conditions of severe weight loss. Crohn's disease can be one of them. CASE REPORT We report 2 cases of Crohn's disease patients with clinical suspicion of jejunal stricture who underwent MR-enterography with a novel approach. In fact, the examinations were performed including prone position of the patients inside the scanner, drinking of contrast medium during the examination, and prompt acquisition of fluoroscopic sequences. Both the exams showed an abrupt termination of the duodenum on its third portion and a decreased aortomesenteric distance, allowing the diagnosis of superior mesenteric artery syndrome. CONCLUSIONS A correlation between Crohn's disease and superior mesenteric artery syndrome has never before been reported in the literature. The present study provides some practical steps that may be useful in order to improve MRE standard protocol in recognizing this condition while evaluating Crohn's disease bowel lesions.

Systemic lupus erythematosus (SLE) increases the risk of cerebrovascular events due to vascular changes, resulting in the weakening of the vessel walls. Moreover, patients with SLE have more incidence of arterial lesions such as dissections. Internal carotid dissection (ICA) is an infrequent cause of ischemic stroke, representing 2% of all ischemic events. We present a case of ischemic stroke, caused by a spontaneous dissection of intracranial ICA, treated with endovascular stent implantation, in a 22-year-old woman affected by SLE, newly diagnosed. ICA dissection with consequent ischemic stroke is an unusual first presentation of SLE disease. Our case highlights how, despite an infrequent occurrence, ICA dissection should be considered for young adults presenting with ischemic stroke, especially in those affected by SLE. This paper also shows the good technical result in the use of stenting in case of intracranial ICA dissection.

Background: Intramedullary spinal ependymoma is a tumor, hardly characterizable with conventional magnetic resonance (MR) imaging only. MR diffusion tensor imaging (DTI) with three-dimensional fiber-tracking reconstructions allows the evaluation of the relationship between neoplasm and white matter fiber tracts, being a powerful tool in presurgical planning. We present DTI findings in a case of a young female with an extensive cervicothoracic spinal ependymoma., Case Description: The patient complained of a 2-month history of acute urinary retention, weakness and numbness on the lower limbs and the upper left limb. She underwent MR imaging that showed an extensive cervicothoracic spinal mass, difficult to characterize with conventional MR sequences. DTI showed peripherally displacement of fibers, without involvement of the spinal cord, findings consistent with an ependymoma. The patient underwent surgery with a complete resection " en bloc " of the lesion, which showed clear cleavage planes, as detected by DTI. Histopathological findings confirmed the diagnosis of ependymoma., Conclusions: DTI is a useful tool in presurgical planning, helping in differentiating not infiltrating neoplasms, such as spinal ependymomas, from other infiltrative and more aggressive neoplasms, which are considered not resectable., Competing Interests: There are no conflicts of interest.

BACKGROUND MR cholangiopancreatography is widely performed before laparoscopic cholecystectomy to rule out choledocholithiasis and to avoid iatrogenic injuries that may be related to the high frequency of anatomical variations of the biliary tree. Although most of these variants have already been demonstrated surgically and by endoscopic retrograde cholangiopancreatography and CT cholangiography, there are no references in which MR cholangiopancreatography has shown a cystic duct draining into the right hepatic biliary duct. CASE REPORT A 51-year-old woman with a history of recurrent abdominal pain underwent an abdominal ultrasound in an outside center, which revealed gallbladder cholelithiasis. In this patient, an MR cholangiopancreatography was performed and the laboratory data were obtained. Laboratory findings showed only a mild increase of cholestasis. MRCP did not reveal significant dilatation of intra- or extrahepatic biliary ducts, while the cystic duct showed an atypical insertion, draining directly into the right hepatic duct. CONCLUSIONS To avoid unintentional bile duct injuries, MRCP evaluation of the biliary anatomy is particularly important for pre-operative evaluation of patients undergoing laparoscopic cholecystectomy. In particular, in the case we describe, the right hepatic duct might have been mistaken for the cystic duct, with potentially severe surgical complications and clinical consequences.

Neoplasms of retromolar trigone have important peculiarities due to their spatial relationships with the surrounding structures. Tumours that involve this area can extend to nearby muscles; adipose spaces; and other anatomic structures, such as the soft palate, the tonsillar fossa, the parapharyngeal space, and the floor of the mouth. In spite of a relatively quick diagnosis, the real extent of these tumours is typically underestimated at clinical examination. Our purpose was to propose a systematic approach to the use of multiplanar computed tomography reconstructions to evaluate normal retromolar trigone anatomy and the main pathways of spread for tumours that arise in this area. To our knowledge, only few reports exist in literature about this topic and none are about the usefulness of multidetector computed tomography and multiplanar reconstructions., (Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.)

Rationale and Objectives: To investigate the value of diffusion-weighted (DW), perfusion-sensitive, and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) techniques in assessing the response of bone metastases from breast cancer to radiotherapy, with particular emphasis on the role of intravoxel incoherent motion (IVIM)-DW parameters as a potential valuable imaging marker of tumor response., Materials and Methods: Fifteen women having breast cancer and bone metastases underwent MRI before and after radiotherapy (3 weeks [time 1], 2 months [time 2], and 4 months [time 3]), consisting of DW, perfusion-sensitive (IVIM), and DCE acquisitions. MR-based DW and perfusion parameters, including water diffusivity (D), perfusion fraction (f), pseudodiffusion (D*), total apparent diffusion coefficient (ADC-total), fractionated ADCs (ADC-high and ADC-low), and initial area under the gadolinium concentration curve after the first 60 seconds (IAUGC60), were determined. The morphologic MRI findings were also recorded. A one-way repeated measures analysis of variance was used to compare the value of MR-based parameters at the different time points., Results: A significant variation between pretreatment (time 0) and post-treatment (times 1, 2, and 3) was found for ADC-total and D parameters (P < .001). A statistically significant reduction was also found for IAUGC60 values between times 0 and 3 (P < .001). A significant change across the different time points was observed for D* and IAUGC60 parameters (P < .001). On the contrary, there was no statistically significant change over time for parameters ADC-total, D, f, and IAUGC60 comparing response between each metastasis, that is, the response to therapy was similar for each metastasis., Conclusions: DW, IVIM, and DCE-MRI techniques show effectiveness in assessing the response to radiotherapy in bone metastases from breast cancer., (Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.)

Background: The State-Trait Anger Expression Inventory 2 (STAXI-2) is a psychometric instrument measuring anger experience and expression. Associations between the STAXI-2 and risk of breast cancer (BC) are rarely considered together in a prospective study., Patients and Methods: A total of 117 women with breast symptoms referred for breast examination were selected and assessed before any diagnostic procedures., Results: Twenty-four patients with BC, 44 with benign breast disease (BBD) and 49 healthy individuals (HHS) were included. Scores for parameters state anger/feel like expressing anger physically (SANGP) were significantly higher in the HHS group (HHS vs. BBD: p=0.027; HHS vs. BC: p=0.025). BC patients showed a trend to lower scores in almost all scales of STAXI-2, except for the scales trait anger/angry temperament (TANGT), anger expression-in (AX-I), and anger control-out (AC-O), that were higher than the two other groups' scores., Conclusion: The results of this study do not support a specific link between STAXI-2 and breast cancer risk., (Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)