Iranian Journal of Radiology
Year:2008 | Volume:5 | Issue:4|Papers Count:13

Congenital intestinal lymphangiectasia is a rare protein-losing enteropathy that usually affects children and young adults. Major symptoms include peripheral edema, mild non-bloody diarrhea, and chylous effusions that may develop during the course of the disease. In this disorder intestinal lymphatic vessels show fibrous occlusions that lead to pressure elevation of the lymphatic flow and rupture of the small lymphatic vessels. Transudation of lymph fluid into the different layers of the intestinal wall and lumen then occurs.

Mature teratomas are the most common type of mediastinal germ cell tumors. They typically occur in young adults (15 to 35 years) and 95% of these teratomas occur in the anterior mediastinum. Herein, we report a case of a huge mediastinal teratoma in a 16-year-old boy who presented with a history of chest pain, cough, exertional dyspnea, and fever. Chest X-ray and spiral computed tomography (CT) revealed a bulky mass of 20cm×15cm in the right side of the posterior mediastinum. The operative finding was a large cystic mass in the posterior mediastinum adherent to the neighbor organs. The cyst was filled with sebum, hair and calcified materials.The resected tumor was in the posterior mediastinum, although most of these tumors occur in the anterior mediastinum. To the best of our knowledge, this is the first documented report in Iran.

Background/Objective: Foreign body in the esophagus is a common emergency presentation. Conventional x-ray imaging is usually obtained to aid the diagnosis during the initial evaluation. The decision for surgical intervention is usually based on a suspicious history, physical examination and radiologic findings. Our hypothesis is that radiographic imaging should not alter the decision for surgical intervention in patients with a suspicious history and appropriate findings on physical examination. Patients and Methods: Seven hundred and five adult patients with suspected impaction of an esophageal foreign body were reviewed from 1994 to 2006 at Imam Khomeini Hospital, Ahwaz. Plain films were performed in every patient with suspected esophageal foreign body (EFB). Patients were included in this review if they were older than 15 years of age, initially presented for ingested foreign body evaluation, and underwent radiographic imaging prior to surgical intervention. Only adults satisfying all 3 criteria were included. Results: The study group contained 705 patients (528 male and 177 female) with the male female ratio of 3:1. Of the total 705 cases, 636 patients had a radiologic study suggestive of FB and 623 cases (98%) had an FB at the time of esophagoscopy. The remaining 69 patients did not have an FB at the time of esophagoscopy. The sensitivity and specificity of conventional radiographs in the diagnosis of an ingested FB were 100% and 84.2%, respectively. Chicken bones were the most frequently responsible foreign body and the area just below the cricopharyngeus muscle was the most frequent level of impaction. Rigid esophagoscopy was used successfully for foreign body removal in 97.6%. Conclusion: The approach towards a patient with a foreign body in the esophagus comprises a thorough history and systematic examination followed by relevant investigations. Ingested FBs are commonly investigated with cervical x-ray studies.

Background/Objective: It has been proposed that a narrow intercondylar notch may increase the risk of anterior cruciate ligament (ACL) injury but the data are conflicting. We performed this cross-sectional study to investigate if a narrow intercondylar notch width is a risk factor for ACL tears. Patients and Methods: All adult patients with knee problems, who were referred to the MRI department of Poursina Hospital, Rasht, Iran, from October 2006 to October 2007, were included in this study. Axial and longitudinal MRI was performed using a 1-T Phillips machine with the patient's knee in an extended position. In all patients, the femoral notch and the distal condylar width were measured. Cases with normal ACL were used as control and patients with a complete or incomplete tear of ACL were chosen as case group. Because of the effect of osteoarthritis in decreasing the intercondylar notch index, cases with obvious osteoarthritis were not included in the study. Independent sample Student’s t test was used to compare the means. Results: 328 patients were enrolled in the study. The age range was 18–72 years. We found no significant difference in the mean notch width index (NWI) in patients with (0.296) and without (0.298) an ACL tear (P>0.05). In addition, there was no significant difference in the frequency of ACL tears in patients with and without critical notch stenosis (P>0.05). Conclusion: We did not find a relationship between narrow intercondylar notch width and ACL tears and we do not recommend a knee MRI to predict the probability of ACL injury.

Background/Objective: Multislice computed tomographic (MSCT) angiography is a rapid and minimally invasive method for the detection of intracranial aneurysms. The purpose of this study was to compare MSCT angiography with digital subtraction angiography (DSA) in the diagnosis of cerebral aneurysms. Patients and Methods: In this cross sectional study we evaluated 111 consecutive patients [42(37.8%) male and 69(62.2%) female], who were admitted under clinical symptoms and signs, suggestive of harboring an intracranial aneurysm by using a four detector MSCT angiography. Then we compared results of MSCT angiography with DSA results as a gold standard method. DSA was performed by bilateral selective common carotid artery injections and either unilateral or bilateral vertebral artery injections, as necessary. MSCT angiography images were interpreted by one radiologist and DSA was performed by another radiologist who was blinded to the interpretation of the MSCT angiograms. Results: The mean±SD age of the patients was 49.1±13.6 years (range: 12-84 years). We performed MSCT in 111 and DSA in 85 patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratio (LR) of MSCT angiography, when compared with DSA as the gold standard, were 100%, 90%, 87.5%, 100%, 10 and 0, respectively.Conclusion: MSCT angiography seems to be an accurate and non-invasive imaging modality in the diagnosis of intracranial aneurysms.

Background/Objective: The problem of localization of speech associated cortices using noninvasive methods has been of utmost importance in many neuroimaging studies, but the results are difficult to resolve for specific neurosurgical applications. In this study, we used fMRI to delineate language-related brain activation patterns with emphasis on the Broca’s area during the execution of two Persian language tasks. Patients and Methods: The subjects comprised of nine healthy right-handed men who participated voluntarily in this study. They performed two consequent fMRI paradigms namely; "Word Production" and "Reverse Word Reading". The fMRI data were collected and analyzed. Then, functional images were registered to anatomical images using FSL software. The laterality indices were also calculated in regions of interest with different threshold levels. Results: The results indicate that Broca’s area, as the classical language-production center, was robustly activated while performing these two tasks. In eight out of nine subjects, the left hemisphere dominancy and Broca’s area activation were observed and in one case activation was prominent in the homologous area in the right hemisphere. Conclusion: Similar pattern of cortical activation during Persian word production and Anglophone languages such as English was revealed. fMRI is a valuable means for brain mapping in language studies.

Tuberous sclerosis is an autosomal dominant genetic disease that involves multiple organs. Hamartomas are the predominant lesions. Classically, tuberous sclerosis has been characterized by a classical clinical triad of facial angiofibromas (90%), mental retardation (50-80%), seizure (80-90%) and all three in 30% of the patients. Two major features or one major feature plus two minor features are necessary for the definite diagnosis of this disease. We had some patients admitted with different presentations of tuberous sclerosis and a past history of convulsion from childhood, skin lesions and also mental retardation with a new onset headache and a changed pattern of convulsion. In physical examination, facial angiofibromas and subungual fibrom as were apparently detected. Brain CT scan study with contrast showed multiple calcified nodules associated with tubers, ventriculomegaly and also enhancing enlarged nodules at the foramen of Monro, which were suggestive of subependymal giant cell astrocytoma (SGCA). MRI showed the same brain findings (tubers, white matter lesions and subependymal nodules associated with SGCA), which were detected better. After surgery, SGCA was proved. In abdominal and pelvic CT scan and ultrasonography, massive bilateral angiomyolipomatosis and focal hypo dense hyper echoic liver lesions were detected.

Background/Objective: Pulmonary tuberculosis (TB) is a common worldwide lung infection. It remains an important cause of morbidity and mortality. Radiographic manifestations of pulmonary tuberculosis are diverse and varied. This study was performed to define the various radiographic manifestations of this infection in the pediatric age group in children who were referred to Mofid Children’s Hospital. Patients and Methods: We reviewed chest x-rays of 30 pulmonary TB patients admitted to our hospital to ascertain the extent of parenchymal and mediastinal involvements on chest x-ray. Results: Male to female ratio was 1.7:1. The patients’ age ranged from 2-163 months with a mean age of 36.9 months. Mediastinal lymphadenopathy was detected in 90% of the cases and pulmonary involvement, especially alveolar shadowing was seen in 83.3% of the cases (of which 43.3% had an air-space pattern and 40% had an interstitial pattern). 19 of the 30 patients (66.3%) were under 36 months, in which 17 of the 19 patients (89.5%) revealed lymphadenopathy. Therefore 63% of all detected lymphadenopathies were seen in this age group. Mediastinal lymphadenopathy was more common on the right side (73.3%). Furthermore, 60% of all alveolar infiltrations were seen on the right side. Conclusion: Pulmonary tuberculosis most commonly represents as a mediastinal and thereafter as a parenchymal involvement. Hilo-mediastinal lymphadenopathy is the most common presentation in infants and young children.

Pneumoscrotum is a rare condition that occurs following a variety of procedural and pathological causes. We report a case of multiple trauma, pneumothorax and surgical emphysema, who presented with a swollen scrotum.

Presented here is a 47-year-old man for whom right central venous chemo port catheterization was performed without radiological guidance. Within 8 days, the catheter became nonfunctional and non-contrasted thoracic CT was performed to trace its course. The tip of the catheter appeared to have perforated the opposite wall of the ipsilateral brachiocephalic vein and entered the adjacent brachiocephalic artery. It then maintained its course along the ascending aorta to perforate, once again, the opposite wall of the aorta before finally resting in the aortopulmonary soft tissue. Migration of chemo port is not uncommon, and may present in many ways. However, it is rare for a migration to occur in the way described here and only present with catheter blockage. Radiological guidance of any central vascular catheterization greatly reduces the risk of complications.

A young boy presented with difficulty in speech discrimination and tinnitus in the left ear. Audiometry showed high frequency hearing loss in the left ear.

Arachnoids cysts limited to the internal auditory canal are rare. They are found in about 0.5% of operations for suspected neoplasm of the internal auditory canal. A 14-year-old boy presented with difficulty in speech discrimination and tinnitus in the left ear. There were no other complaints. His general and systemic examinations were normal.

The differential diagnosis of ACTH-dependent Cushing syndrome is a challenging issue for clinical endocrinologists.MRI is commonly used to diagnose Cushing disease and remains the obvious technique to identify pituitary microadenomas in a noninvasive manner but it has proved to be problematic in some cases.Bilateral inferior petrosal sinus sampling (BIPSS), despite being invasive, is established as a highly accurate diagnostic procedure in distinguishing pituitary from ectopic sources of ACTH.