Stephen Machnicki

MRI of Patients With Cardiac Pacemakers: A Review of the Medical Literature

OBJECTIVE Numerous studies testing the use of pacemakers with MRI have been published. Our aim was to analyze these trials to determine the safety of MRI for patients with cardiac pacemakers. We performed a systematic search of peer-reviewed databases. A total of 31 articles were reviewed. CONCLUSION The data are heterogeneous with regard to MRI being considered for patients with pacemakers, and the benefits of the imaging should outweigh the risks.

Superior Mesenteric Artery Syndrome

1Division of Gastroenterology; 2Department of Radiology, Lenox Hill Hospital, New York, New York, USA Correspondence: Dr Truptesh H Kothari, Division of Gastroenterology, Lenox Hill Hospital, 100 East 77th Street, New York, New York 10075, USA. Telephone 212-434-2176, fax 678-716-8710, e-mail itskots@gmail.com Received for publication September 14, 2011. Accepted September 26, 2011 case presentation A 24-year-old woman with no significant medical history presented to the hospital with complaints of nausea and vomiting for one day. The patient had experienced associated symptoms of abdominal distension, which worsened after meals, for the previous six months. The patient denied weight loss. The laboratory results were unremarkable. On physical examination, her abdomen was soft, with minimal tenderness in the epigastric area without guarding or rigidity. Bowel sounds were heard in all four quadrants, and there were no signs of organomegaly, ascites or asterixis. Diagnosis superior mesenteric artery syndrome An abdominal computed tomography (CT) scan with contrast revealed the narrowing of the third portion of the duodenum compressed by the superior mesenteric artery (SMA), with dilation of the portion of the duodenum proximal to the compression. An abdominal CT scan and ultrasound with Doppler was used to measure the aortomesenteric (AO) angle and the AO distance. The normal AO angle is between 45° and 60° (1); the AO angle in this patient was 18° (Figure 1). The normal AO distance is between 10 mm and 20 mm (1); the AO distance in this patient was 5 mm to 6 mm (Figures 2 to 4); hence, the diagnosis was consistent with SMA syndrome.

Cavitary Lung Diseases: A Clinical-Radiologic Algorithmic Approach

&NA; Cavities occasionally are encountered on thoracic images. Their differential diagnosis is large and includes, among others, various infections, autoimmune conditions, and primary and metastatic malignancies. We offer an algorithmic approach to their evaluation by initially excluding mimics of cavities and then broadly classifying them according to the duration of clinical symptoms and radiographic abnormalities. An acute or subacute process (< 12 weeks) suggests common bacterial and uncommon nocardial and fungal causes of pulmonary abscesses, necrotizing pneumonias, and septic emboli. A chronic process (≥ 12 weeks) suggests mycobacterial, fungal, viral, or parasitic infections; malignancy (primary lung cancer or metastases); or autoimmune disorders (rheumatoid arthritis and granulomatosis with polyangiitis). Although a number of radiographic features can suggest a diagnosis, their lack of specificity requires that imaging findings be combined with the clinical context to make a confident diagnosis.

Adrenal renal fusion confusion: a case report of an adrenal cortical adenoma with adrenal-renal fusion

We report a case of laminaria hypersensitivity treated with diphenhydramine and corticosteroids. A literature review identified 10 previously reported cases, with 8 recognized as anaphylaxis, and good outcomes with corticosteroids and antihistamines despite limited epinephrine utilization. Laminaria hypersensitivity is likely IgE mediated with an increased anaphylaxis risk with prior exposure.

A rare case of lymphoma involving the tricuspid valve

A 66-year-old woman presented with complaint of palpable masses throughout her body. A contrast-enhanced, electrocardiogram-gated CT angiogram of the heart using a 256-channel scanner showed a large mass arising from the tricuspid valve. A biopsy of a mass in the patients breast showed diffuse large B-cell lymphoma. Cardiac lymphoma usually presents as part of widespread disease. Involvement of the right atrium is typical, but the valves are usually spared, making this case atypical. On CT, cardiac lymphoma often manifests as an infiltrating, ill-defined epicardial or myocardial mass.

Acute purulent erosive appendicitis diagnosed during colonoscopy.

Our patient is a 27-year-old woman who presented for colonoscopy for rectal bleeding. On examination, vital signs and abdominal examination was completely normal in addition to other systems. On colonoscopy, the cecum revealed an erythematous appendiceal orifice with whitish purulent bloody discharge seen exuding from the appendiceal orifice (Fig. 1). The terminal ileum was easily intubated and appeared normal. Biopsies were obtained from the appendiceal orifice, which were suggestive of stromal abscess and cryptitis consistent with acute appendicitis. Computed tomography of the abdomen with contrast imaging was suggestive of dilated appendix. The patient had laparoscopic appendectomy and the gross specimen of the appendix revealed hemorrhagic pus in the lumen. The pathology result of the appendix revealed acute purulent erosive appendicitis with granulomatous disease (Fig. 2). Gomori methenamine silver stain and acid fast bacilli stain were found to be negative for fungi and tuberculosis, respectively. The patient was discharged home on antibiotics and recovered well without any complications. There are few reported cases of acute appendicitis diagnosed during colonoscopy.

A 28-Year-Old Woman With Branching Opacity and Chest Pain

&NA; A 28‐year‐old female patient presented through her primary care physician with symptoms of atypical chest pain and chronic cough. Her pain was described as pleuritic and intermittently radiating to the right arm. Her medical history was significant for recurrent respiratory infections, gastritis, and a left ovarian cyst treated with ipsilateral salpingo‐oophorectomy. She denied any history of smoking, known lung disease, or extrapulmonary infections.

Combined pulmonary venous thromboembolism and renal artery thrombosis in a patient with non-small cell lung cancer.

The incidence of clinically significant thrombosis in a cancer patient varies from 5 to 60%. Venous thrombosis remains more common than arterial thrombosis, and combined arterial and venous thrombosis in cancer patients is rare [1]. We report a rare case of combined pulmonary thromboembolism and complete thrombotic occlusion of the renal artery in a patient with non-small cell lung cancer (NSCLC) while receiving chemotherapy.