Alfonso Iglesias

MR imaging findings in granular cell tumor of the neurohypophysis: a difficult preoperative diagnosis.

Abstract. Granular cell tumor is a rare neoplasm arising within the neurohypophysis. We describe the MR imaging findings in two symptomatic patients. In one patient with history of panhypopituitarism, MR images showed a large sellar and suprasellar mass. The other patient presented with acute loss of vision in her left eye, and MR images showed a suprasellar mass with compression of the optic chiasm.

Percutaneous transhepatic treatment of a posttransplant portal vein thrombosis and a preexisting spontaneous splenorenal shunt

Percutaneous transhepatic treatment of portal vein thrombosis after liver transplantation in a patient with a preexisting high volume spontaneous splenorenal shunt is presented. Local thrombolysis with urokinase and balloon angioplasty of the main portal vein stenosis were performed followed by shunt embolization to restore hepatopetal portal blood flow.

Relationship between radiologic morphology of the bone lengthening formation and its complications.

The objective was to study the different types of lengthened bone regeneration and their development during the various phases of the process to correlate them with patient factors and the surgical technique used, and to establish a possible relation between the development of the bone lengthening formation and the problems or complications. The authors studied the radiographs of a random group of 55 patients taken at three points during the course of treatment. The callus was classified with regard to its transverse diameter and the presence or absence of hypodense areas. The overall callus type was significantly influenced by the etiology, the osteotomy site, and the percentage lengthened. The percentage by which the limb was lengthened at the beginning of the process influences the overall morphology of the callus. Poor callus had been lengthened the most, atrophic callus the least. There was a correlation between the morphology of the overall callus at the end of treatment and the percentage lengthened, and between the percentage lengthened and the presence of bands at the end of treatment. The authors also found a significant correlation between age and the appearance of bands at the end of distraction. A central band was found among younger patients. The type of osteotomy affected the overall callus at the end of distraction and at the end of treatment and also influenced the transverse diameter. All the elongations with poor bone formation at the end of treatment were found to have undergone a diaphyseal osteotomy. The most common complication at the first follow-up and at the end of distraction was angulation. The diameter of the callus and the presence of bands at the end of treatment were significantly related to the complications. Fracture occurred in the first 2 weeks after removal of the external fixator in 88% of cases and in the third and fourth week in the rest. However, the segment had no significant influence on the appearance of complications. Lengthened callus with incomplete trabecular formations and hypodense areas at the end of the treatment has a high risk of fracture at the end of treatment. Callus with axial deviation, hypodense areas, or an insufficient transverse diameter during the lengthening procedure must be manipulated so that it reaches the maturing phase in better condition.

Tumoral calcinosis presenting as an extradural mass: MR findings and pathological correlation.

Abstract. Two cases of idiopathic tumoral calcinosis presenting as an extradural mass are reported. There are few reports in the literature of this pathological process presenting as extradural masses, so both cases represent very unusual locations for tumoral calcinosis. Magnetic resonance imaging features and pathological correlation of these two cases are presented. Tumoral calcinosis might be considered as a rare but possible cause of extradural mass.

MR imaging findings of neurosarcoidosis of the gasserian ganglion: an unusual presentation

Abstract. We report the MR imaging findings of an unusual case of neurosarcoidosis of the gasserian ganglion associated with trigeminal neuralgia. No other neurological or extraneurological localization was found. Magnetic resonance imaging demonstrated a mass in the Meckels diverticulum that was isointense on T1-weighted images and hypointense on T2-weighted images. Gadolinium-enhanced MR imaging showed heterogeneous enhancement. Although rare, sarcoid infiltration of the gasserian ganglion must be considered in the differential diagnosis of an isolated mass in this localization in patients with trigeminal neuralgia.

Quiste aracnoideo complicado con hemorragia intraquística y hematoma subdural espontáneo: hallazgos en resonancia magnética

Los quistes aracnoideos son colecciones intraaracnoideas, rellenas de liquido cefalorraquideo. Son lesiones benignas y mayoritariamente de origen congenito. Habitualmente son asintomaticos, sin embargo pueden sangrar y hacerse sintomaticos. El quiste aracnoideo asociado a hemorragia intraquistica y hematoma subdural de forma espontanea es una complicacion poco frecuente, sin embargo es una causa conocida de urgencia neuroquirurgica. Presentamos los hallazgos en un nino de 10 anos diagnosticado de quiste aracnoideo complicado con hemorragia intraquistica y hematoma subdural espontaneo, efectuado el diagnostico con resonancia magnetica.

Unusual presentation of a pancreatic insulinoma in helical CT and dynamic contrast-enhanced MR imaging: case report

Abstract Insulinomas are pancreatic neoplasms that can be radiologically characterized typically because of their tendency to present intense and early contrast enhancement with a wash-out phenomenon. In this sense, we report an unusual case of a hypovascular solid pancreatic insulinoma confirmed with surgery and pathologic analysis, in a patient with normal serum insulin levels. In the two-phase helical CT, the mass behaved as a hypodense lesion with respect to the surrounding pancreatic parenchyma during the arterial phase and as a hypointense lesion during the dynamic contrast-enhanced MR imaging. Pathologic examination demonstrated a hypercellular tumor with poor vascularization of intervening stroma which showed prominent amyloid deposits.

Transvenous Liver Biopsy in Patients with Cirrhosis with Use of the Femoral Venous Approach and a Flexible Forceps

Jose I. Bilbao, MD Jesus Sola, MD Alfonso Iglesias, MD Felix Contreras, MD Bruno Sangro, MD Jesus M. Longo, MD Jesus J. Vazquez, MD P m c u T A N E o u s liver biopsy is often essential in the definitive diagnosis of liver diseases. However, parenchymal liver diseases are sometimes associated with coagulation disorders or ascites. In such cases, the conventional percutaneous approach is contraindicated due to the high risk of hemorrhage, which could lead to death (1). When both thrombocytopenia and prolonged prothrombin time are present, different approaches to the classic technique have been suggested, like plugging of the needle tract ( 2 4 ) or transjugular liver biopsy, for which extensive experience (5) and good histologic results have been reported (5-7). These techniques, however, are not without risk of bleeding. For this reason, a new transvenous approach consisting of the introduction of forceps through femoral vein puncture has been reported for patients with and without cirrhosis (8,9). We have used this approach in the performance of biopsies in 30 consecutive patients with known or suspected cirrhosis.

Gallbladder perforation and bile leakage: diagnosis by colour Doppler sonography and percutaneous treatment

Nowadays, ultrasound examination is routinely utilized in the diagnosis of acute cholecystitis and its complications. Perforation of the gallbladder wall is usually suspected from indirect, non-specific sonographic findings, i.e. pericholecystic fluid collections, free peritoneal fluid, irregular gallbladder wall thickening, gallbladder distention, gallstones, coarse intracholecystic echogenic debris, and a complex mass in the gallbladder fossa (Forsberg et al, 1988; Chen et al, 1990). Sonographic visualization of the gallbladder perforation itself is rarely achieved (Chau et al, 1988; Takada et al, 1989; Chen et al, 1990). We report a case in which colour Doppler sonography allowed direct visualization of the biliary leakage across the gallbladder wall, thus providing the diagnosis. In addition, percutaneous catheter drainage of both the gallbladder and adjacent collection allowed the perforation to heal, hence avoiding surgery.

Primary amyloidosis presenting as renal infarction

We report a case of primary amyloidosis affecting the kidney and presenting as a renal infraction on computed tomography and ultrasound examination. To our knowledge, it is the first case in the radiological literature with these imaging characteristics.