Jessie Aw

Results of Screening for Intracranial Aneurysms in Patients with Coarctation of the Aorta

BACKGROUND AND PURPOSE: IAs are found in 2.3% of adults; the mean age at detection is 52 years. Prevalence is <0.5% in young adults. Early studies suggest that 10%–50% of patients with aortic coarctation have IAs. Screening recommendations are variable. We sought to examine the prevalence of IAs through screening with MRA. MATERIALS AND METHODS: Consecutive patients older than 16 years of age with coarctation undergoing brain MRA between May 1999 and October 2007 were included. MRA was performed by using a 1.5T scanner with a 3D time-of-flight protocol; simultaneous MR imaging was performed of the heart and aorta. Cerebral MRAs were double-reported by a neuroradiologist. Statistics are described as mean ± SD and median ± range. Continuous variables were compared by using Student t tests and Mann-Whitney U tests (categoric variables, by using the Fisher exact test). RESULTS: One hundred seventeen MRAs were double-reported. The median age was 29 ± 11 years (range, 16–59 years). IAs were found in 12 patients (10.3%). The mean diameter of IAs was 3.9 mm (range, 2.0–8.0 mm). Patients with aneurysms were older (median, 37 years; range, 16–50 years) than those without (median, 23 years; range, 16–59 years; Z = −2.01, P = .04). Hypertension was more common in those with IAs (IA 83% versus no IA 43%, P = .01). There was no association between ascending aortopathy, bicuspid aortic valves, and IAs. CONCLUSIONS: Patients with coarctation have a higher prevalence of IAs, occurring at an earlier age than in population studies. Whether routine screening is appropriate for this group of patients is unclear. Hypertension is likely to be an important pathophysiologic factor.

Cervical Tracheal Compression in a Patient with Achalasia: An Uncommon Event

SUMMARY: We report a case of a 79-year-old woman with long-standing achalasia that resulted in respiratory stridor and dyspnea. She was evaluated for tracheal compression with use of CT on inspiration and expiration. Airway obstruction and acute respiratory distress secondary to achalasia have been reported in the clinical literature. The importance of recognizing these rare manifestations is crucial for the appropriate treatment of these patients. In this patient, the CT evaluation of tracheal compression provided useful information on the degree of narrowing caused by the dilated esophagus.

Isolated submandibular metastasis from a contralateral thyroid papillary microcarcinoma: An unusual case

Papillary carcinoma is the most common form of thyroid cancer. It is a relatively indolent disease, which commonly remains clinically silent until its incidental histological diagnosis in surgical material or at autopsy. A tumour less than 10 mm in size is termed a papillary microcarcinoma. Papillary microcarcinoma may present with clinical symptoms, most commonly jugulodigastric and pretracheal lymphadenopathy with or without palpable thyroid nodules. Isolated submandibular metastases are rare. We present the case of a submandibular metastasis arising from a solitary 3 mm papillary microcarcinoma of the thyroid on the contralateral side in a 46-year-old woman. We describe the ultrasound and MRI characteristics of the submandibular mass. The ultrasound findings in particular were suggestive of a thyroid malignancy and prompted detailed examination of the thyroid gland. Clinical and radiological examination of the thyroid was normal. To the best of our knowledge, we present the first report of a papillary microcarcinoma of the thyroid presenting as a contralateral and isolated submandibular mass.

Stone deaf: the petrified ear. Case report and review of the literature

Of the many causes of conductive hearing impairment, few are as rare as the petrified ear. Petrified ears describe auricular cartilage hardening, due usually to ectopic calcification or, less commonly, ossification. The process can affect the auricle either completely or partially without any visible external change. It is an uncommon clinical entity, identified mainly in dermatology texts and unreported in the adult radiology literature. Only 12 histologically proven cases have been reported in the English-language literature of auricular ossification. We report a case of idiopathic bilateral auricular calcification presenting with a conductive hearing impairment in an adult female. The diagnosis was made on imaging alone. We discuss the systemic causes associated with this unusual clinical entity and review the literature on “petrified ears.”

Final FRCR 2B Long Cases: A Survival Guide

The purpose of this pocket book is to present a series of imaging cases displaying a wide range of pathology, to help radiology candidates develop a format to discuss cases in a coherent approach and deliver a relevant differential diagnosis. These radiology candidates will be taking the Fellowship of the Royal College of Radiologists (FRCR) part 2B examination, which is the final examination for fellowship. The final FRCR Part 2B examination consists of a reporting session, a rapid reporting session, and an oral examination. This guidebook concentrates only on the reporting session. The whole process for admission into the FRCR is described on the FRCR Web site. This pocket book is the product of 12 contributing authors and is divided into 10 packets with 6 cases in each packet. The cases in each packet are assorted and of varying complexity. Each is discussed in a consistent format, consisting of imaging examination, findings, interpretation, diagnosis, differential diagnosis, management, a short discussion of the diagnosis, and a brief reference list. Although aimed toward radiology residents preparing for the final radiology examination for the FRCR, this pocket book could also be used by non-FRCR radiology residents preparing for their final radiology examination in other countries. In addition, board-certified radiologists facing recertification could benefit from reading the material in this pocket book. Radiology reference libraries could also provide this pocket book for trainees. Given the paper quality, the display of the images varies, with better images seen in those cases that use CTand MRI. Some of the plain images of the chest, abdomen, and pelvis are difficult to interpret given the image quality. However, this pocket book is aimed at the reporting session only. No PET or PET/CT studies are available, nor are there cases involving child abuse, complex pelvic cases in a young woman, or cases involving quality assurance or interventional radiology. These types of cases may have been tested on other parts of the FRCR examinations. The authors are commended for presenting this format to discuss these radiology cases, which should be introduced to and used by first-year residents. Other formats are also available in other teaching files, such as those provided by the American College of Radiology, those appearing in the American Journal of Roentgenology, and those posted on the Internet by other institutions.The purpose of this pocket book is to present a series of imaging cases displaying a wide range of pathology, to help radiology candidates develop a format to discuss cases in a coherent approach and deliver a relevant differential diagnosis. These radiology candidates will be taking the Fellowship of the Royal College of Radiologists (FRCR) part 2B examination, which is the final examination for fellowship. The final FRCR Part 2B examination consists of a reporting session, a rapid reporting session, and an oral examination. This guidebook concentrates only on the reporting session. The whole process for admission into the FRCR is described on the FRCR Web site. This pocket book is the product of 12 contributing authors and is divided into 10 packets with 6 cases in each packet. The cases in each packet are assorted and of varying complexity. Each is discussed in a consistent format, consisting of imaging examination, findings, interpretation, diagnosis, differential diagnosis, management, a short discussion of the diagnosis, and a brief reference list. Although aimed toward radiology residents preparing for the final radiology examination for the FRCR, this pocket book could also be used by non-FRCR radiology residents preparing for their final radiology examination in other countries. In addition, board-certified radiologists facing recertification could benefit from reading the material in this pocket book. Radiology reference libraries could also provide this pocket book for trainees. Given the paper quality, the display of the images varies, with better images seen in those cases that use CT and MRI. Some of the plain images of the chest, abdomen, and pelvis are difficult to interpret given the image quality. However, this pocket book is aimed at the reporting session only. No PET or PET/CT studies are available, nor are there cases involving child abuse, complex pelvic cases in a young woman, or cases involving quality assurance or interventional radiology. These types of cases may have been tested on other parts of the FRCR examinations. The authors are commended for presenting this format to discuss these radiology cases, which should be introduced to and used by first-year residents. Other formats are also available in other teaching files, such as those provided by the American College of Radiology, those appearing in the American Journal of Roentgenology, and those posted on the Internet by other institutions.