J. Powell Williams

The Clinical Spectrum of Cardiac Fibroma with Diagnostic and Surgical Considerations: Noninvasive Imaging Enhances Management

A cardiac fibroma was successfully resected from the interventricular septum of a 25-year-old woman. The clinical data were correlated with a review of the data on 144 other patients, thereby providing a clinical profile and management strategy for this type of tumor. Initial manifestations of a fibroma were determined to be congestive heart failure (21%), tachyarrhythmias (13%), and chest pain (3.5%). A majority of patients were asymptomatic (36%) with abnormal physical findings or an abnormal chest roentgenogram. Finding the tumor at autopsy incidentally or on sudden death (23%) indicated the lethal potential. A few (3.5%) of the reports on patients with cardiac fibroma were without clinical data. Noninvasive imaging by echocardiography, computed tomography, and nuclear magnetic resonance improved the diagnosis. Surgical treatment was successful in 53 of the 84 patients for whom it was attempted.

Benign cystic pineal lesions by magnetic resonance imaging.

In the course of examining 1,000 patients with various neurological complaints, 17 were found to have abnormalities in the region of the pineal gland. Fourteen had no hydrocephalus or symptoms referable to the region of the midbrain but a well-defined region of the high signal on T2 weighted images was demonstrated on magnetic resonance imaging. The other three patients proved to have pineal tumors. All patients had computed tomography examinations prior to magnetic resonance imaging. We believe that the pineal lesion in the 14 asymptomatic patients is a benign cyst not previously reported prior to the advent of magnetic resonance imaging. These benign lesions should be kept in mind in evaluating masses of the pineal region.

Magnetic resonance and CT imaging correlated with clinical status in SSPE

Five patients afflicted with subacute sclerosing panencephalitis were studied with computed tomography and magnetic resonance imaging. Computed tomography documented changes of nonspecific cerebral atrophy and low attenuation in the subcortical white matter. Magnetic resonance imaging revealed bilateral, symmetric, and diffuse abnormal increased signal in the white matter of the cerebral hemispheres with normal posterior fossa structures in 4 of 5 patients. Magnetic resonance imaging was superior to computed tomography in demonstrating the total extent of abnormality and may be the imaging modality of choice for this childhood disease.

NEUROSARCOIDOSIS: EVALUATION USING COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING

Two patients with unusual central nervous system sarcoid were investigated using computed tomography and magnetic resonance imaging, as well as other x-ray studies. A patient with intramedullary involvement of the spinal cord as well as nerve root involvement was examined. Follow-up examination after treatment with steroids showed a return to normal. The second patient had optic nerve involvement as well as two intracranial parenchymal lesions and granulomatous arachnoiditis. In this patient magnetic resonance imaging offered no advantages over computed tomography in the orbit but was significantly more accurate intracranially.

Magnetic resonance imaging in neuronal ceroid lipofuscinosis

Neuronal ceroid lipofuscinosis is a group of neurodegenerative disorders characterized by accumulation of lipofuscin and/or ceroid within the tissues of the body. These entities are manifest by visual, intellectual, and motor deterioration as well as recurrent seizures. Computed tomography has been shown to demonstrate changes of cerebral atrophy in more severely affected patients. Seven patients with neuronal ceroid lipofuscinosis were examined with both computed tomography and magnetic resonance imaging, and the results were correlated with the clinical severity of the disorder. Two less severely affected patients had normal results on computed tomography and magnetic resonance imaging studies. Varying degrees of cerebral atrophy were seen in the remaining five patients with both computed tomography and magnetic resonance imaging. Severity of atrophy correlated with the severity of disability in these patients. Abnormal white matter was seen in the two most severely affected patients only with magnetic resonance imaging. Although the findings in patients with neuronal ceroid lipofuscinosis were nonspecific, the increased sensitivity of magnetic resonance imaging for subtle white matter abnormalities over computed tomography may prove helpful in monitoring the progression of this rare disorder.

Enhancing transdural lumbar disk herniation

Transdural migration of an intervertebral disk fragment is accompanied by more severe clinical manifestations than the more common extradural disk herniation. We report on two patients with transdural lumbar disk herniation who had had no previous surgery. In both, there was intense enhancement of the intradural disk material on magnetic resonance imaging. The pathological specimen showed vascularization of the intradural fibrocartilage in one patient.

Subdural hematoma secondary to ruptured intracranial aneurysm: computed tomographic diagnosis

This case report illustrates a cerebral aneurysm that bled into the subdural space without any clinical or radiographic evidence of subarachnoid hemorrhage. Both the aneurysm and the subdural hematoma were easily demonstrated on computed tomography scan. The incidence of this lesion and its possible etiology are discussed.

Computerized tomographic findings in two cases of congenital fibrosis syndrome

Two patients with congenital ptosis and extraocular muscle fibrosis are described. The first patient showed marked atrophy of the left inferior rectus muscle. The second patient showed bilateral changes in all extraocular muscles. Computed tomographic evaluation of the extraocular muscles was performed in both patients. The characteristic changes of this phenomenon were seen in both individuals and solidified the diagnosis.

Lissencephaly: Computed tomographic diagnosis

Lissencephaly is a rare congenital condition with distinctive brain changes. Most of these changes were demonstrated on computed tomography, and include lack of cortical sulci and gyri; calcification in the region of paraphysis; wide, shallow sylvian fissures; colpocephaly; poor development of white matter; and persistent cavum septum pellucidum and cavum vergae.

Brain abscess following dilatation of esophageal stricture

A case of right parietal abscess following esophageal dilatation for peptic stricture secondary to hiatus hernia with reflux in an 18-month-old male child is reported. Prior cases of brain abscess following esophageal dilatation are reviewed. The combination of history, clinical findings, and computed tomography scan in the current case allowed confident preoperative diagnosis of brain abscess and allowed emergency treatment of the lesion by simple aspiration through a burr hole.