Sumru Tanju

Muscular and condylar response to rapid maxillary expansion. Part 3. Magnetic resonance assessment of condyle-disc relationship

INTRODUCTION The aim of this prospective study was to assess temporomandibular joint (TMJ) condyle-disc positions at the sagittal and coronal planes of magnetic resonance images (MRIs) before and after rapid maxillary expansion (RME). METHODS The study included 18 subjects (11 girls, 7 boys) with a mean age of 12.54 years with unilateral or bilateral posterior crossbite that included at least 3 posterior teeth. The clinical and radiographic assessments of the TMJ were done before (T1) and 18 weeks after (T2) RME. A Haas-type expansion appliance was used for an average treatment time of 3.5 weeks. RESULTS A visual MRI analysis of pretreatment condyle-disc positions showed that 8 TMJs had medial disc displacement, 3 had anteromedial disc displacement, and 2 had lateral disc displacement. The disc positions remained unchanged at T2 except in 1 subject, who developed unilateral anterior disc displacement. Unilateral joint sounds developed in 3 subjects without changes in the disc positions. CONCLUSIONS Posterior crossbite can be considered a minor risk factor for temporomandibular disorder (TMD). RME is neither a risk factor nor a prevention for TMD. Coronal MRIs contribute complementary information for optimal diagnosis of TMD.

Intrabiliary Rupture of Hepatic Hydatid Cysts: Diagnostic Accuracy of MR Cholangiopancreatography

OBJECTIVE The purpose of this study was to establish the role of MR cholangiopancreatography (MRCP) in the diagnosis of biliary rupture in hepatic hydatid disease. We sought to determine whether the morphologic features of cysts and bile duct abnormalities detected on MRCP are specific enough for identification of intrabiliary rupture. CONCLUSION If one of the following MRCP findings of apparent connection between hydatid cyst and biliary system, deformation of cyst, focal defect in cyst wall, or beaklike projection extending from cyst wall was present in a patient with hepatic hydatid cyst, the sensitivity of MRCP was 91.7% and the specificity was 82.8% for identification of intrabiliary rupture.

Right Cervical Aortic Arch and Pseudocoarctation of the Aorta Associated with Aneurysms and Steal Phenomena: US, CTA, and MRA Findings

A 55-year-old woman presented with right cervical aortic arch with pseudocoarctation of the aorta further complicated by the presence of multiple aneurysms and a high-grade stenosis at the origin of the left subclavian trunk from the aorta causing a discrepancy in blood pressure between the right and left arms. The branching pattern and the resulting complex steal syndromes involving the left carotid and the subclavian system are unique. The computed tomography angiography, magnetic resonance angiography, and Doppler ultrasound findings are described.

Placement of an Inferior Vena Cava Filter in a Patient with Azygos Continuation Complicated by Pulmonary Embolism

A 53-year-old man presented with dyspnea, hemoptysis, and a painful, swollen left leg. During physical examination the left leg was tender. He had a history of inguinal hernia 1 month previously. Tests for thrombophilia, including protein C, protein S, antithrombin III, homocysteine, antiphospholipid antibody, and tumor markers, were all within normal limits. Thus, a thrombotic tendency was not detected. Duplex sonography of the lower extremities demonstrated multiple acute thrombi in the left deep venous system. The deep and superficial veins of the right leg were all patent. A contrast-enhanced CT scan showed extensive thrombosis in the right and left main pulmonary arteries, and lack of contiguity between the prerenal and the hepatic segments of the IVC. An enlarged azygos vein (Fig. 1) and a retroaortic left renal vein were also identified. The pulmonary and cardiac pattern did not show any congenital anomalies. A diagnosis of infrahepatic IVC interruption with azygos continuation was made. The patient was given anticoagulation therapy with intravenous unfractionated heparin and oral warfarin. He was discharged after a short hospitalization. However, 6 months later he returned to the hospital complaining of bilateral leg swelling and pain. Duplex sonography showed multiple thrombi in the deep venous structures of both lower extremities. Placement of an IVC filter for prophylaxis against PE was suggested because deep venous thrombosis (DVT) had progressed despite adequate anticoagulant therapy. A right transfemoral inferior vena cavogram performed with 6 Fr pigtail catheter to determine the level of the renal veins prior to filter placement, demonstrated the enlarged azygos vein draining into the superior vena cava (SVC) (Fig. 2). The right common femoral vein was used as a route for placement of a TrapEase filter (TrapEase, Cordis Europa, Roden, The Netherlands). A guidewire was directed, under fluoroscopic guidance, beyond the orifices of the renal veins into the enlarged azygos vein. The hemiazygos and paravertebral collateral veins were not enlarged. The TrapEase filter carrier was then passed over the guidewire, and the filter was discharged at the level of the third lumbar vertebra (Fig. 3). A final venogram revealed continued patency of the azygos vein following placement of the filter. In the 6 months since the placement of the filter, there has been no clinical evidence of pulmonary emboli. On follow-up abdominal radiographs, there has been no evidence of filter migration.

Opposed phase imaging in lumbar disc disease: An option providing faster image acquisition times

To investigate the utility of opposed phase imaging (OPI) (in‐phase and out‐of‐phase) in lumbar disc disease.