Oliver Hennessy

Prevertebral swelling in cervical spine injury: Identification of ligament injury with magnetic resonance imaging

In a retrospective analysis of 27 consecutive patients with acute cervical spine injury who underwent Magnetic Resonance (MR) Imaging, 14 had prevertebral soft tissue swelling on initial lateral radiographs, of whom 13 had anterior longitudinal ligament disruption on MR. Of the eight patients who had isolated prevertebral swelling in the absence of vertebral body fracture or significant subluxation, seven had anterior longitudinal ligament disruption shown on MR imaging. Of the patients with MR documented ligament injury, three had dynamic flexion-extension radiographs within 2 weeks of injury and all demonstrated cervical instability. As cervical prevertebral swelling following trauma was indicative of ligament injury in nearly half the patients, this finding should prompt clinical and radiographic follow-up to exclude spinal instability.

Delayed fatal cardiac perforation by an indwelling long introducer sheath following transjugular intrahepatic portocaval stents (TIPS).

Iatrogenic cardiac perforation is a recognized complication of central venous catheterization. We report a fatal complication by a 10F introducer sheath which was left in place and resulted in perforation of the right atrial wall 8 h later. This case is reported to emphasize the increased risk of cardiac perforation from large caliber rigid sheaths which should be withdrawn immediately after completion of the procedure.

Case report 709

Figs. 1 and 2, Mid-thoracic spine computed tomography (CT) scans after the introduction of intrathecal contrast demonstrate a lesion of soft-tissue density partially replacing the T8 vertebral body (open arrow) and small, bilateral, paravertebral lesions of soft-tissue density (small arrows). An extradural lesion of soft-tissue density (large arrow) is also demonstrated posterior to and compressing the thoracic dural sac Address reprint requests to: Gregory Fitt, M.B.B.S., Department of Radiology, Austin Hospital, Studley Road, Heidelberg, Victoria, 3084 AustraliaThis case demonstrates the potential pitfall of obtaining CT images in the axial plane alone, with a fracture parallel to the imaging plane mimicking vertebral body destruction and associated epidural mass mimicking neoplasm. Chan et al. have discussed the value of reformatted CT images in coronal and sagittal planes to define better transverse vertebral fractures. The case also demonstrates the potential danger of bypassing plain radiographs with the aim of facilitating a rapid diagnosis. Plain films, performed in this case only after CT myelography, clearly demonstrated a transverse pathological fracture in an ankylosed spine with no evidence of neoplastic destruction, enabling easy diagnosis of SEH on the CT appearance. The delayed onset of neurological deficit after fracture reinforces the importance of education of the patient with AS. This principally involves altering patients to the fragility of their spine and to the importance of avoiding spinal trauma. However, patients with known AS should be warned to seek medical advice after even minor spinal trauma with the aim of minimizing the incidence of delayed neurological complications such as occurred in this patient.

Selecting the right technique to reform a reverse curve catheter (Simmons style): Critical review

Reformation of the curve of the Simmons sidewinder catheter may be difficult in some patients, and the originally described technique using the left subclavian artery may be unsuccessful. We review the techniques available for curve reformation, identifying the limitations and problems associated with each technique. We believe that reformation in the descending aorta without a guidewire is the method of choice in most patients. Knowledge of a number of different techniques is advisable.

Networked electronic information services at the Austin Hospital, Melbourne

A wide area computer network has been installed at the Austin Hospital, Melbourne. The network consists of optic fiber segments between buildings, an ethernet spine through the main buildings and ethernet segments throughout each department. The network is connected to Internet via an ISDN link to the University of Melbourne computer network. The Austin hospital network is used for intra-hospital image distribution, external image distribution, internal and external electronic mail via Internet, electronic information access, file transfer via Internet, and remote login to Internet networked computers. Present and future developments include secure patient record access for internal users, confidential information transmission using public key encryption techniques, external dial-up connectivity for teleradiology, and research and development into medical image processing and analysis.