2,3,4 A 58-year-old female presented with sudden-onset pain and tenderness at the lateral aspect of the right pelvis occurring after long-distance walking. Physical examination showed a normal range of movements. Magnetic Resonance Imaging (MRI) was performed in order to exclude a stress fracture. Coronal fatsuppressed intermediate weighted images (WI) showed focal thickening and increased signal at the proximal insertion of the right iliotibial tract (ITT) at the iliac tubercle. There was also increased signal surrounding the deep and superficial layers of the ITT (Fig. A, arrows). Axial fatsuppressed T2-WI demonstrated also subtle muscular edema in the adjacent anterior part of the gluteus medius muscle (Fig. B, arrow). There was no evidence of tendon rupture. Based on the imaging findings, the diagnosis of proximal iliotibial band enthesopathy was made. The patient was treated with local infiltration of corticosteroids followed by kinesitherapy. Comment Enthesopathy of the proximal ITT is an uncommon condition, often neglected in medical literature. It occurs most frequently in female athletes (runners, golfers, dancers) or older overweighted women. The pathogenesis is believed to be related to acute or repetitive micro traumatic injuries at the insertion of the ITT at the iliac tubercle of the iliac crest. The ITT is anatomically intimately related to the anterior part of the gluteus medius muscle. Although the tensor fasciae latae does not play a major role in hip movements, it acts as a supporting muscle in flexion and abduction. An imbalance between the system of agonist and antagonist hip muscles, their dynamic relations and postural factors such as increa sed anterior pelvic tilt may cause overloaded forces acting on tensor fasciae latae during any sport activity. Radiographs do usually not contribute to the diagnosis in the acute phase of the disease. Enthesophyte formation at the anterior aspect of the iliac crest and adjacent calcifications are rarely specific. If the pain is localised at the iliac crest, ultrasound is the preferred examination, showing thickening of the ITT (Fig. C, arrow) and adjacent gluteus medius muscle, loss of normal fibrillar architecture and sometimes signs of hypervascularity on color Doppler in up to 50% of cases. As the complaints and clinical examination are often misleading, particularly in chronic overuse injuries, MRI is often performed as initial examination to exclude a stress fracture or other more common peri-articular hip patholo gy. MRI typically shows thickening and increased T2-signal in and around the ITT. Adjacent muscular edema in the anterior part of the gluteus medius muscle and subtle bone marrow edema in the iliac tubercle may be seen as well. To allow an appropriate diagnosis, it is of utmost importance that the Field of View (FOV) of the coronal images of the pelvis is large enough to visualise the iliac crest. The main differential diagnosis include partial or complete tear of the tendon, an avulsion fracture of the anterior superior iliac spine, injury of the sartorius muscle, bone or soft tissue neoplasm in this region, and neuropathy of the cutaneous femoris lateralis nerve. The treatment consists of local infiltration with corticosteroids, kinesitherapy, and recommendations on avoiding any improper loading forces during sport activities.
examinations are performed every year in Belgium. With a mean dose 0,5 mSv, the annual collective dose from CT could induce up to 450 cancer. This number has to be compared to the 45 000 observed new cancers yearly. The deleterious effect of scanner radiation is thus undetectable among cancers induced by smoking, alcohol, and western diet. Risk from radiation is based on cancer mortality rates observed among atomic bomb survivors who underwent high level radiation. Overestimation of collective radiation risks in the filed of low level radiation (below 0,2 Sv) as used for CT is suspected first because a majority of patients undergoing CT are aged 60 years or more, and second because the numerous defense mechanisms that prevent cancer induction at lowdoses in human bodies are not taken into account by the linear no threshold model of carcinogenesis used as legal rule for risk calculations. On the other hand, CTis a rapid and efficient technique that providesaccurate diagnosis of various disorders such as acute appendicitis complete staging of severely injured patients, reliable monitoring of tumors and therapy guidance or planning. CT yields very high confidence in diagnosis that is required for treatment. The balance between radiation risk from CT and clinical benefit is thus almost always very high. However, because of its success and performance, overuse of CT is suspected. This overuse has been addressed by RIZIV / INAMI When a CT is performed, according to guidelines, radiologists are in duty of limiting the delivered radiation dose by optimizing the CT technique. This is the practical application of the ALARA principle (As Low As Reasonably Achievable). The process of optimization is under the control of the Federal Agency for Nuclear Control (FANC/AFCN). The method for dose limitation is based on surveys. With the collaboration in collabo ration with the Consilium Radiologicum. Objective is to promote guidelines for an appropriate use of medical imaging tests and to reduce the rate of unjustified examinations. The expected effect should be a collective dose reduction but also financial. JBR–BTR, 2011, 94: 100-102.
Exogenous lipoid pneumonia is a rare condition caused by aspiration of mineral, vegetable or animal oils. The aspiration of mineral oil is the most common cause of lipoid pneumonia in children. We present a 27-year-old man with a lipoid pneumonia with a history of daily use of Vaseline applied to cotton balls for ear plugging before swimming and shower.
The authors report an interesting case of right retroesophageal aortic arch (REAA) with pulmonary embolism that presented like the dissection of the aortic aneurysm but eventually diagnosed by means of spiral CT Right REAA should be considered as a rare cause of mediastinal widening in the patients in whom significant difference between the blood pressure and pulse intensity of both extremities is evident to prevent the erroneous diagnosis and treatment.
We report the CT findings in a 77-year-old woman with left-sided aryepiglottic fold metastasis from breast cancer diagnosed 7 years previously. The lesion obliterated the left piriform sinus, had a lobulated contour and showed mild and heterogeneous enhancement on a post-contrast CT examination. Biopsy of the lesion revealed metastasis from poorly differentiated adenocarcinoma, compatible with metastasis of the breast carcinoma. Before detection of the laryngeal lesion, a second primary tumor in the right ovary was diagnosed. After right oopherectomy, histopathology revealed clear cell adenocarcinoma. The patient also had multiple subcutaneous metastases and bilateral cervical lymphadenopathies. Chemotherapy was applied to the patient.
Background: A 15-year-old boy was referred to the hospital 4 days after a blow to his right orbital region. He had double vision and restriction of upward and downward eye movement. Computer tomography (CT) of the orbital region was performed. The boy had surgery and, because of residual restriction of eye movements post-surgery two weeks later, magnetic resonance imaging (MRI) of the orbital region was performed.
A 22 year old female patient presented with a three month history of pelvic discomfort and dysmenorrhoea. A pelvic MRI demonstrated a large mass measuring 10 x 6 cm in size. On T1 and T2 weighted images the mass was noted to be predominantly cystic. The mass also contained peripheral solid components as well as a large fat fluid level. Following excision, histological examination revealed a lesion with mature teratomatous elements but with a significant component (> 50%) being composed of mature thyroid tissue. A 2cm area within the lesion had the morphological pattern of a classical papillary thyroid carcinoma. A diagnosis of strum a ovarii was made. Struma ovarii is a rare ovarian neoplasm generally arising in a teratoma and accounts for less than 1% all ovarian neoplasms. Here we present the above case of struma ovarii in a young patient and discuss the radiological characteristics of the disease.
Buerger's disease is a non-arteriosclerotic, segmental, inflammatory vascular occlusive disease, primarily affecting medium and small sized arteries of limbs. Mesenteric vascular involvement of this entity is a rarely seen manifestation. In this report, we present a case of Buerger's disease in which intestinal involvement was diagnosed by means of multi-detector CT.
Testicular tumors are the most common solid tumors in young adult males. Patients with testicular tumor often present with painless scrotal mass. Rarely, symptoms are related to metastases. We describe the case of a patient presenting with abdominal pain due to retroperitoneal lymphadenopathy. We describe the magnetic resonance imaging findings of lumbar spine osseous metastasis.
In the management of breast neoplasms, two breast MR examinations are performed, one before initiation of neoadjuvant chemotherapy (NAC) and one at the end. However, a third MR exam may be performed between two courses of chemotherapy in order to assess tumor response to treatment. The assessment criterion currently used is measurement of tumor diameter according to RECIST (Response Evaluation Criteria In Solid Tumors) and WHO. But according to the preliminary results of the American College of Radiology Imaging Network protocol, using measurement of tumor volume as a reference may be valuable. Larger series are therefore necessary to estimate the value of diffusion MR, spectroscopy and diffusion studies.
Background: A 1-year-old infant with Beckwith-Wiedemann syndrome presented for a follow-up ultrasound examination. She had no apparent symptoms.
The observation of a recent case of an acute venous thrombosis of a renal transplant is the opportunity to review and present the role of color.Doppler sonography for the early detection of such a severe and uncommon complication.
A 65-year-old man, without medical history except facial rosacea, presented at the dermatology department with progressive swelling of frontal subcutaneous soft tissues and palpebral oedema, that had developed 3 months previously. No systemic sign was present. A skin biopsy revealed sebaceous gland hyperplasia (phyma) due to rosacea with deep lymphocytic infiltration. At the time, a diagnosis of benign tissue hyperplasia due to rosacea was retained. Because dermatologic treatment failed to improve the disease course, Ultrasound studies were performed and showed aspecific dermal thickening with infiltration of the facial cavities. Additional CT and MR examinations confirmed these results; MR best depicted soft tissue changes which clearly appeared as a malignancy (Fig. A) and CT demonstrated concomitant bone changes but of quite lesser extension and severity (Fig. B). Tumoral infiltration extended into ethmoidal, orbital and lacrymo-nasal cavities. Additional involvement of the right temporal and masseter muscles was observed, together with broad left cervical adenomegalies. Tumoral tissues presented an important and homogeneous enhancement after contrast material injection, on CT and MRI. Discrepancy between severity of soft tissue and slight bone involvement and concomitant presence of nodal masses suggested lymphoma. Diagnosis was performed by histopathologic examination of surgically resected specimens from both deep facial soft tissues and cervical lymph nodes. Final diagnosis was aggressive (Ki67 > 85%!) primary facial diffuse large B-cell lymphoma (DLB-CL), of germinal-center cells type. Unexpectedly, systemic biological work up was negative with normal LDH and b2 microglobulin blood levels as well as whole-body imaging work-up which included thoracal-abdominal CT and whole-body FDG-PET. The patient underwent chemotherapy combining CHOP cycles with Rituximab (Deprezol). Post-treatment MR follow-up examination showed complete subsidence of softtissue swelling.
SPECT and PET play a complementary role in the presurgical evaluation of patients with refractory epilepsy. Perfusion SPECT can identify the ictal onset zone and PET can delineate the functional deficit zone. Both modalities have a role in localization and characterization of the epileptic focus and can help in the guidance of invasive EEG and in detecting subtle lesions on MRI.
