Ghi Jai Lee

Magnetic Resonance Imaging Findings of Surgically Proven Medial Meniscus Root Tear : Tear Configuration and Associated Knee Abnormalities

Objective: To evaluate magnetic resonance imaging (MRI) findings of medial meniscal root tear and the correlation of medial meniscal root tear with other associated knee abnormalities. Methods: We retrospectively assessed preoperative magnetic resonance images of 39 patients with arthroscopically confirmed medial meniscal root tear. Magnetic resonance imaging findings were retrospectively reviewed by 2 experienced musculoskeletal radiologists for consensus. We evaluated the configuration of meniscal root tear and the other associated knee abnormalities on MRI for direct correlation with arthroscopic findings. Results: At arthroscopy, there were 36 radial tears and 3 complex tears involving the medial meniscal posterior horn roots. All 36 radial tears could be correctly diagnosed by MRI, with findings showing ghost sign on sagittal images in 100% (36/36), vertical linear defect on coronal images in 100% (36/36), and radial linear defect on axial image in 94% (34/36). However, all 3 complex tears were misdiagnosed as radial tears on MRI. Medial meniscal root tears displayed a strong association with degenerative joint disease in 97% (38/39). Medial meniscal root tears were also found in association with cartilage defects of the medial femoral condyle and medial meniscal extrusions (≥3 mm) in 89% (34/38) and 67% (26/39), respectively. Conclusions: Medial meniscal root tears were usually posterior horn root radial tear. A high association with degenerative joint disease, cartilage defects of the medial femoral condyle, and medial meniscal extrusions (≥3 mm) were also noted.

Fitz-Hugh–Curtis syndrome: CT findings of three cases

Clinical manifestations and computed tomography (CT) findings of Fitz-Hugh–Curtis syndrome (FHCS) are relatively well stabilized as right upper quadrant abdominal pain and hepatic capsular enhancement because of perihepatitis associated with pelvic inflammatory disease caused by N. gonorrhoeae and C. trachomatis. We encountered three patients with serial FHCS associated with pelvic inflammatory disease, who visited the emergency room with right upper quadrant abdominal pain. Abdominal CT revealed hepatic capsular or pericapsular enhancement along the anterior surface of the liver on the arterial phase. Recently, multi-detector CT has evolved as the first-line imaging modality of acute abdomen at the emergency room; we reemphasized the importance of the CT findings of this syndrome for differential diagnosis of right upper quadrant abdominal pain in sexually active young women. Physicians at the emergency room acknowledge the syndrome and should perform dynamic abdominopelvic CT including the arterial phase.

The Incidence and Clinical Implications of Congenital Defects of Atlantal Arch

OBJECTIVE Atlantal arch defects are rare. Few cadaveric and imaging studies have been reported on the variations of such anomalies. Our goal in this study was to examine the incidence and review the clinical implications of this anomaly. METHODS A retrospective review of 1,153 neck or cervical spine computed tomography (CT) scans was performed to identify patients with atlantal arch defects. Neck CT scans were performed in 650 patients and cervical spine CT scans were performed in 503 patients. Posterior arch defects of the atlas were grouped in accordance with the classification of Currarino et al. In patients exhibiting this anomaly, special attention was given to defining associated anomalies and neurological findings. RESULTS Atlantal arch defects were found in 11 (11/1153, 0.95%) of the 1,153 patients. The type A posterior arch defect was found in nine patients and the type B posterior arch defect was found in two patients. No type C, D, or E defects were observed. One patient with a type A posterior arch defect had an anterior atlantal-arch midline cleft (1/1153, 0.087%). Associated cervical spine anomalies observed included one C(6-7) fusion and two atlantal assimilations. None of the reviewed patients had neurological deficits because of atlantal arch anomalies. CONCLUSION Most congenital anomalies of the atlantal arch are found incidentally during investigation of neck mass, neck pain, radiculopathy, and after trauma.

Two Cases with Persistent Falcine Sinus as Congenital Variation

The falcine sinus is an abnormal anatomic structure located in the falx cerebri that is closed after birth and is rarely observed. We describe two cases of persistent falcine sinus. A 60-year-old woman presented with headache. An 11-year-old girl presented with intermittent headache and a palpable scalp mass in the middle of the high parietal area. The straight sinuses were absent in both patients. In both patients, drainage of the galenic system took place through a sinus within the falx, also known as a falcine sinus. Suspicious dysplastic tentorium cerebelli was observed in one patient. It can be concluded that a mesenchymal disorder can be the primary cause for a persistent falcine sinus.

Leiomyosarcoma of the Ovarian Vein: a Case Report with Radiological Findings

Leiomyosarcomas of the ovarian vein are very rare. Four cases have been reported in the English language clinical literature. We present a case of leiomyosarcomas where the use of multi-detector CT had a substantial role in the establishment of the preoperative diagnosis. The radiological images as well as intraoperative features are illustrated. We also discuss the radiological findings of the ovarian vein leiomyosarcoma in comparison with those of other venous or retroperitoneal leiomyosarcomas. We expect that the use of multi-detector CT will be the choice for the diagnostic work-up of vascular leiomyosarcomas.

Persistent Trigeminal Artery Variant Detected by Conventional Angiography and Magnetic Resonance Angiography -Incidence and Clinical Significance-

OBJECTIVE Persistent trigeminal artery variant (PTAV) is an anastomosis between the internal carotid artery (ICA) and the cerebellar artery without any interposing basilar artery segment. We discuss its probable embryological origin and emphasize clinical implications. METHODS Retrospectively 1250 conventional cerebral angiograms and 2947 cranial magnetic resonance angiographies (MRAs) were evaluated for the patients with PTAV. RESULTS Five patients (four men and one woman, 23 to 76 years of age, median age 65 years) had a PTAV. Three patients who underwent MRA had a PTAV (3/2947=0.1%). Four of the patients who underwent cerebral angiography had a PTAV (4/1250=0.32%). Two of 143 patients who underwent both conventional angiography and cranial MRA showed PTAV. The PTAV was an incidental finding in all five patients. The PTAV originated from the cavernous segment of the left ICA in four patients and from the cavernous segment of the right ICA in one patient. The terminal branch of the PTAV was the anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA) in two patients and the AICA only in the other three patients. CONCLUSION Neurosurgeons should be aware of possible presence of PTAV. Manipulation of this vessel during a surgical approach to the parasellar region and percutaneous gasserian ganglion procedure may result in hemorrhage or ischemia.

Diagnosis of Persistent Primitive Olfactory Artery Using Computed Tomography Angiography

Persistent primitive olfactory artery (PPOA) is a rare anomaly of the anterior cerebral artery. We present one case of PPOA incidentally diagnosed with the aid of computed tomography (CT) angiography. A 24-year-old woman was admitted to our hospital after sudden onset of vertigo. Three-dimensional CT angiography revealed an anomalous artery arising from the terminal portion of the right internal carotid artery. The proximal portion of the anomalous artery coursed anteromedially and made a hairpin turn posterosuperior to the midline. PPOA may be overlooked because of its rarity, but CT angiography can be useful in detecting this rare vascular anomaly. Follow-up study is necessary in our case to confirm whether an aneurysm occurs on the PPOA.

Primary intracranial ectopic craniopharyngioma in a patient with probable Gardner's syndrome

The authors describe a patient with an adamantinomatous craniopharyngioma (CPG) arising in the cerebellopontine angle (CPA), who also had probable Gardners syndrome. This 31-year-old man presented with headache and dizziness. Brain CT and MRI showed a 5 × 4-cm lesion with multiple small calcifications in the left CPA. The patient underwent suboccipital craniotomy with tumor removal. Histopathological findings indicated an adamantinomatous CPG. This patient also showed characteristics of Gardners syndrome. Although this syndrome is associated with intracranial neoplasms, it is unclear whether patients with both Gardners syndrome and CPG are part of the heterogeneity of Gardners syndrome.

An angiographic lesion mimicking pseudo-aneurysm in cerebral arteriovenous malformation.

Summary In cerebral arteriovenous malformations (AVMs), a pseudo-aneurysm represents rupture site, and its presence is known as a factor for rebleeding. We report a case of cerebral AVM presenting with intracerebral haemorrhage in which cerebral angiography showed a lesion mimicking pseudo-aneurysm. Although the patient needed urgent surgical decompression, it was delayed because early haematoma evacuation would induce rebleeding from the rupture site. The authors attempted to occlude the pseudoaneurysm interventionally before surgery. After surgical excision, the lesion that was believed to be a pseudo-aneurysm was revealed as a partially thrombosed venous sac having a thick fibrous wall. In this report, the authors discuss the pitfalls in the interpretation of pseudo-aneurysms in angiographic AVM architecture.

A Case Report of the Occurrence of a Rare Middle Mediastinal Thymoma in a Young Woman.

Thymomas are the most common form of primary tumor in the anterior mediastinum. However, the occurrence of thymomas in the middle mediastinum is rare. To the best of our knowledge, no cases have been reported in young patients. Here, we report the CT and MRI findings of a middle mediastinal thymoma case in a 21-year-old woman.