Mukbil Hourani

Thoracic spinal intradural arachnoid cyst: report of two cases and review of literature

Abstract. We report two cases of spinal intradural arachnoid cyst at the thoracic level, presenting with long-standing symptoms of spinal cord compression and MRI findings that were overlooked for sometime initially. Because of the rarity of this disease, and because of the subtle changes on MRI, there was a definite delay in the diagnosis. In this report we emphasize the value of MRI and CT myelography in this disorder, and the need for them to be strongly correlated with the progression of the clinical picture.

Trauma-associated growth of suspected dormant micrometastasis

BackgroundCancer patients may harbor micrometastases that remain dormant, clinically undetectable during a variable period of time. A traumatic event or surgery may trigger the balance towards tumor growth as a result of associated angiogenesis, cytokine and growth factors release.Case presentationWe describe a patient with non-small lung cancer who had a rapid tumor growth and recurrence at a minor trauma site of his skull bone.ConclusionThis case is an illustration of the phenomenon of tumor growth after trauma or surgery and its associated cellular mechanisms. This phenomenon deserves further investigation and study.

MR imaging findings in autosomal recessive hereditary spastic paraplegia.

BACKGROUND AND PURPOSE: Hereditary spastic paraplegia (HSP) is a disorder characterized by degeneration of the corticospinal tracts and posterior column of the spinal cord. Previously described radiologic findings included nonspecific brain abnormalities such as brain atrophy and white matter lesions, as well as atrophy of the spinal cord. In our study, we aimed to better characterize brain and spine MR imaging findings in a series of patients with HSP. MATERIALS AND METHODS: Nine patients from 4 different Lebanese families with the autosomal recessive form of HSP were included in the study. All patients underwent brain and whole-spine MR imaging. We assessed the presence of white matter abnormalities mainly along the corticospinal tracts, brain atrophy, thinning of the corpus callosum, and the presence of spinal cord atrophy or abnormal signal intensity. RESULTS: Imaging revealed mild brain atrophy (44%), atrophy of the corpus callosum (55%), white matter lesions (67%), abnormal T2 high signal intensity in the posterior limb of the internal capsule (55%), and mild spinal cord atrophy (33%). CONCLUSIONS: The MR imaging findings of HSP are nonspecific and variable; however, the most prominent features include atrophy of the corpus callosum, T2 signal intensity in the posterior limb of the internal capsule, and spinal cord atrophy.

The use of TNF-α blockers in Cogan’s syndrome

A 37-year-old woman, previously healthy, who in September 2001 noted sudden onset of erythema in both eyes, followed by vertigo, vomiting, tinnitus in both ears, and hearing loss in the left ear then in the right over 1-week period. Slit lamp examination revealed bilateral interstitial keratitis. Her physical examination was essentially unremarkable except for decreased hearing bilaterally, more so on the right. An audiogram conWrmed the presence of severe bilateral sensorineural hearing loss (SNHL), more so on the right. Brainstem auditory evoked response testing revealed delay of all waves on the left and no waves on the right. A gadolinium enhanced MRI of the brain conWrmed the presence of inXammation around the cochlea bilaterally. Her laboratory tests at that time showed a sedimentation rate of 26 mm/h, with a negative ANA, rheumatoid factor, anti-SSA and anti-SSB, anticardiolipins (IgG, IgM), c-ANCA and p-ANCA, and VDRL. A lumbar puncture was normal. Her chest X-ray, electrocardiogram and echocardiography were also normal. Accordingly, the diagnosis of Cogan’s syndrome was made. Therapy was initiated with topical steroid eye drops and oral prednisone at 1 mg/kg/day. The ocular symptoms improved within few days but after 3 weeks, the patient denied any clinical improvement in her hearing and audiogram conWrmed worsening of the SNHL on the left. After 3 weeks from the diagnosis of Cogan’s syndrome the Wrst dose of inXiximab was initiated at 3 mg/kg for three doses at 0, 2 and 6 weeks. After the Wrst dose of inXiximab, the patient reported decrease in the sensation of aural fullness and vertigo and subjective improvement in hearing, associated with improvement on the audiogram in the left ear. Methotrexate as 12.5 mg/week was added after the second dose of inXiximab. Because the hearing conditions remained stable oral prednisone was reduced gradually. Patient was lost of follow up after the third dose of inXiximab and returned after 2 years. She has stopped her medications since then and found to have subjective and objective deterioration for which she underwent left cochlear implant.

Use of limited MR protocol (coronal STIR) in the evaluation of patients with hip pain

ObjectiveTo assess the role of a limited MR protocol (coronal STIR) as the initial part of the MR examination in patients with hip pain.Design and patientsEighty-five patients presenting with hip pain, and normal radiographs of the pelvis, and who underwent our full MR protocol for hips were included retrospectively in the study. The full protocol consists of coronal T1-weighted and short tau inversion-recovery (STIR), and axial T2-weighted sequences. Ninety-three MR examinations were performed. Two radiologists interpreted the STIR (limited) examinations and the full studies separately, masked to each others findings and to the final diagnosis. Comparison between the two protocols was then undertaken.ResultsFor both readers, all normal MR examinations on the coronal STIR limited protocol were normal on the full protocol, with an interobserver reliability of 0.96. The STIR protocol was able to detect the presence or absence of an abnormality in 100% of cases (sensitivity). The STIR-only protocol provided a specific diagnosis in only 65% of cases (specificity).ConclusionA normal coronal STIR study of the hips in patients with hip pain and normal radiographs precludes the need for further pelvic MR sequences. Any abnormality detected on this limited protocol should be further assessed by additional MR sequences.

Catheter fracture and migration into the coronary sinus—an unusual migration site: case report and review

Catheter fracture and cardiac migration are rare but known complications. Most reported cases have developed between the clavicle and the first rib as a consequence of catheter pinching between these two bony structures. To our knowledge, this is the first reported case of catheter migration into the coronary sinus. The broken fragment was successfully retrieved using loop-snare technique.

Radiology of terror injuries: the American University of Beirut Medical Center experience.

OBJECTIVE This study aimed to report our experience with regard to imaging of mass casualty incidents (MCIs). SUBJECTS AND METHODS Following a bomb attack, 150 casualties were referred to our hospital. Radiographs and nonenhanced CT scans were performed in 28 individuals. RESULTS Major injuries were seen in 12 individuals, which were limited only to the brain (n=2), facial bones (n=2), and extremities and soft tissues (n=8). CONCLUSION In MCIs, imaging should be fast, in order to help identify major injuries that need immediate management and to help in the triage of injured individuals.

Fibroblastic and myofibroblastic tumors of the head and neck: Comprehensive imaging-based review with pathologic correlation

Fibroblastic and myofibroblastic tumors of the head and neck are a heterogeneous group of disorders characterized by the proliferation of fibroblasts, myofibroblasts, or both. These tumors may be further subclassified on the basis of their behavior as benign, intermediate with malignant potential, or malignant. There are different types of fibroblastic and myofibroblastic tumors that can involve the head and neck including desmoid-type fibromatosis, solitary fibrous tumor, myofibroma/myofibromatosis, nodular fasciitis, nasopharyngeal angiofibroma, fibrosarcoma, dermatofibrosarcoma protuberans, fibromatosis coli, inflammatory myofibroblastic tumor, ossifying fibroma, fibrous histiocytoma, nodular fasciitis, fibromyxoma, hyaline fibromatosis and fibrous hamartoma. Although the imaging characteristics of fibroblastic and myofibroblastic tumors of the head and neck are nonspecific, imaging plays a pivotal role in the noninvasive diagnosis and characterization of these tumors, providing information about the constitution of tumors, their extension and invasion of adjacent structures. Correlation with the clinical history may help limit the differential diagnosis and radiologists should be familiar with the imaging appearance of these tumors to reach an accurate diagnosis.

Left-sided Cervical Aortic Arch Associated With Pseudocoarctation, Aneurysm Formation, and Anomalous Left Brachiocephalic Vein: Appearance on Mdct and Mr Angiography

Cervical aortic arch (CAA) is a rare congenital aortic anomaly. It can be associated with several cardiovascular abnormalities including aortic aneurysm, valvular disease, and pseudocoarctation. In this report, we present a case of CAA with combined association of both aneurysm formation and pseudocoarctation. This combination of anomalies is extremely uncommon, described in only 4 cases in the literature. In addition, our patient had an anomalous subaortic left brachiocephalic vein that, to our knowledge, was not previously described in the literature to be associated with CAA. The radiographic, multidetector computed tomography scan, and magnetic resonance angiography imaging findings are presented.

Tibial and fibular developmental fields defects

Abstract. Malformations of the lower limbs are rare and heterogeneous anomalies. To explain the diversity and complexity of these abnormalities, authors introduced the concept of tibial and fibular developmental fields. Defects in these fields are responsible for different malformations, which have been described, to our knowledge, in only one report in the radiology literature. We present a case of a newborn with femoral bifurcation, absent fibulae and talar bones, ankle and foot malformations, and associated atrial septal defect. Our case is an example of defects in both fibular and tibial developmental fields.