Jan Casselman

Solitary or predominantly right-sided varicocele: A possible sign of situs inversus

Among more than 850 patients undergoing outpatient sclerotherapy of the internal spermatic vein, only 1 unilateral and 1 predominantly right sided varicocele were encountered. In both patients with this finding a total situs inversus was present, with inversion of normal anatomy, enlarged “right” internal spermatic vein draining into the renal vein, and the “left” internal spermatic vein entering the inferior vena cava directly. Total situs inversus should be considered whenever right-sided varicocele is solitary or predominant.

CT Findings in Synovial Chondromatosis of the Temporomandibular Joint

The purpose of this report is to document an additional case of synovial chondromatosis of the temporomandibular joint and to present its radiological features with emphasis on the CT findings. It should be stressed that the value of the radiologic examination primarily depends on the extent of calcification of the loose, intraarticular particles.

Computed tomography of infected epiglottic cyst.

A case of infected ductal epiglottic cyst demonstrated by CT is reported. Computed tomography appears to be an excellent, noninvasive examination that provides the exact diagnosis and clear extent of the disease.

Delayed Intraventricular Pneumocephalus Following Shunting for Normal-Pressure Hydrocephalus

BACKGROUND Pneumocephalus is usually seen in trauma or cranial surgery. It is rarely reported as a delayed complication of ventriculoperitoneal shunt placement for hydrocephalus secondary to trauma, tumor, or aqueduct stenosis. We describe a case of intraventricular pneumocephalus manifesting 10 months after placement of a shunt for normal-pressure hydrocephalus. CASE DESCRIPTION A pressure-regulated ventriculoperitoneal shunt was implanted in an 81-year-old patient after diagnosis of normal-pressure hydrocephalus. He showed postoperative clinical improvement. Routine computed tomography performed 2 months after the procedure showed no abnormalities. He presented 10 months after shunting with a subacute deterioration of gait. Imaging revealed major intraventricular pneumocephalus and a left-sided temporal porencephalic cyst with a small, bony defect in the left petrous bone. A middle fossa approach was performed, and the temporal defect was covered with fascia of the temporal muscle. This resulted in a gradual resolution of pneumocephalus. CONCLUSIONS Pneumocephalus after shunting for NPH is rare and described as a complication only during the first 2 postoperative months. This case is unique, as the pneumocephalus developed 10 months after shunting. The combination of an occult, possibly congenital, skull base defect and the insertion of a shunt resulted in delayed intraventricular and intraparenchymal pneumocephalus.