Anthony R. Lupetin

The impact of magnetic resonance on the diagnostic evaluation of acute cervicothoracic spinal trauma

From 1984 to 1987 magnetic resonance (MR) imaging was performed on 100 patients suffering acute spinal trauma. MR demonstrated one or more injuries to the cervicothoracic region in 31 patients. It displayed a spectrum of spinal cord injury ranging from mild compression and swelling to complete transection. MR was also useful in evaluating alignment at the cervicothoracic junction, in depicting ligamentous injury, in establishing the presence of disc herniation, and in identifying unsuspected levels of injury. We present a diagnostic algorithm that incorporates the role of MR in evaluating acute cervicothoracic spinal trauma and emphasizes the replacement of myelography by MR in the initial assessment of neurologic deficit.

Magnetic resonance imaging in acute tendon ruptures

The diagnosis of acute tendon ruptures of the extensor mechanism of the knee or the Achilles tendon of the ankle may usually be made by clinical means. Massive soft tissue swelling accompanying these injuries often obscures the findings, however. Magnetic resonance imaging (MRI) can rapidly demonstrate these tendon ruptures. Examples of the use of MRI for quadriceps tendon, and Achilles tendon rupture are presented.

Ultrasonographic findings in acute acalculous cholecystitis

Acute acalculous cholecystitis (AAC) is usually seen as a complication of major surgery or trauma. Although this entity is well-known in the surgical literature, little has been written about it in the radiologic literature. A review of patient records from 1975 through 1982 revealed 16 patients with pathologically confirmed AAC on whom at least 1 sonographic study had been performed. Thickening of the gallbladder wall, a subserosal “halo” of edema, pericholecystic abscess, and marked gallbladder distention were consistent findings in AAC. In the proper clinical setting, these otherwise nonspecific findings allow a prompt and accurate diagnosis.

MRI diagnosis of aortocaval fistula secondary to ruptured infrarenal abdominal aortic aneurysm

MRI was utilized to demonstrate the exact site of fistula between a ruptured saccular aneurysm of the infrarenal abdominal aorta and the inferior vena cava in a 64-year-old man.

Radiation-induced leiomyosarcoma of the great vessels presenting as superior vena cava syndrome

A patient with a pleomorphic intravascular leiomyosarcoma of the great vessels of the neck and mediastinum presented clinically with a superior vena cava syndrome. A latent period of 29 years elapsed between receiving orthovoltage radiation to the neck and right side of chest to treat recurrent ganglioneuroblastoma, and the appearance of a leiomyosarcoma and subsequent recurrences. The patient underwent partial resection of the tumor, received adjunct chemotherapy, and was shown to be free of disease by clinical tests and by magnetic resonance imaging (MRI) 17 months after completion of chemotherapy. The criteria for the diagnosis of radiation‐induced sarcomas are reviewed in relation to the present case. The critical role of magnetic resonance imaging in both the diagnosis and continued follow‐up of the patient is described. This would appear to be the first reported case of radiation‐induced intravascular leiomyosarcoma of the great vessels of the neck and mediastinum presenting as a superior vena cava syndrome.

AORTOCORONARY SAPHENOUS VEIN GRAFT ANEURYSM

An aortocoronary saphenous vein graft aneurysm was diagnosed with computed tomography and selective arteriography in a 79-year-old woman with a history of multiple coronary bypass graft surgeries. Aneurysms of saphenous vein grafts are rare complications of bypass surgery but need to be considered when evaluating bypass patients who present with a mediastinal or paracardiac mass.

Diffuse cavernous hemangioma of the rectum: Evaluation and MRI

Computed tomography (CT) and magnetic resonance imaging (MRI) were used preoperatively to stage the extent of a diffuse rectal hemangioma in a 37-year-old man with recurrent rectal bleeding. On T2-weighted MR scans, the lesion demonstrated a heterogeneous signal intensity with large portions displaying the hyperintensity characteristic of hemangiomas of solid organs. MRI did not depict calcified phleboliths evident on CT and barium enema.

Chondrosarcoma of the larynx: report of a case with characteristic computed tomography findings

Chondrosarcoma of the larynx is a rare lesion. Computed tomography was able to suggest this diagnosis preoperatively and aided in surgical planning by defining the extent of the mass in a 67-year-old man who presented with signs and symptoms of airway obstruction.

Magnetic resonance imaging diagnosis of an aortocoronary saphenous vein graft aneurysm.

Magnetic resonance imaging (MRI) allowed the diagnosis of an atherosclerotic aneurysm of a long-standing aortocoronary saphenous vein graft, initially not depicted by selective coronary graft arteriography due to low flow within the lumen, caused by a stenosis of the proximal graft limb.

Leiomyosarcoma of the superior vena cava: Diagnosis by cardiac gated MR

A primary leiomyosarcoma of the superior vena cava was diagnosed with magnetic resonance imaging. MRI demonstrated tumor extension into the right heart and innominate veins and compared favorably with the superior vena cavagram.