A 74-year-old man presented with abdominal discomfort, low back pain, and emaciation. Hematocrit and hemoglobin levels were 33 and 11 g/dL, respectively. Erythrocyte sedimentation rate was normal. Serological tests for rheumatic disorders were negative. Multidetector computed tomography scan of the abdomen was performed to identify the cause of pain. At the level of T7 vertebra, thoracic aorta was measured 49 mm in diameter, and at the level of T6–L1 vertebra irregular aortic aneurysm was seen. Mural thrombus and calcified plaques of the thoracic aorta were seen. An aneurysm 67 mm in diameter was seen from 1 cm distal to the origin of the right renal artery and 1.5 cm distal to the origin of the left renal artery to aortic bifurcation level. Multidetector computed tomography scans of the abdomen showed the aneurysm eroding the body of the fourth lumbar vertebra and hematoma abutting ruptured aneurysm (Figure). The margins of the vertebral lesions were well corticated. The erosion extended to the posterior third and the fourth lumbar vertebral body. Abdominal aortic aneurysm should be considered as a cause of low back pain in patients who have risk factors (age >65, family history, male, smoker, etc.) for this disease.

A 76-year-old woman was admitted to our hospital with complaints of right buttock pain and sciatica. Magnetic resonance imaging was performed. The magnetic resonance imaging showed right ischiofemoral narrowing, edema, and increased signal intensity within the quadratus femoris muscle (Fig. 1). The initial visual analogue scale was 8–9. Computerized tomography-guided percutaneous steroid and local anesthetic injection was performed. Then non-steroidal anti-inflammatory drug treatment and exercise program was initiated. After 12 weeks of treatment, pain of the right hip was decreased gradually to visual analogue scale 2–3. Ischiofemoral space is the smallest distance between the ischial tuberosity and lesser trochanter of the femuron axial T1-weighted images. Ischiofemoral impingement is characterized by abnormalities of quadratus femoris muscle and narrowing of the space between the lesser trochanter of the femur and the ischial bone ( [1] Torriani M. Souto S.C.L. Thomas B.J. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. Am J Roentgenol. 2009; 193: 186-190 Crossref PubMed Scopus (218) Google Scholar ). It is usually seen in women and is a rare cause of sciatica. The common causes are history of surgery, fracture or arthrosis, hamstrings tendinopathy, or congenital.

A 51-year-old man was admitted to our hospital with complaint of slowly growing lump on posterior cervical region and atypical pain on his back. There was no history of trauma. The physical examination revealed an immobile, non-tender mass on the left posterior cervical region. Magnetic resonance imaging was performed and showed a mass in the left paraspinal muscles. The lesion appeared heterogeneously hyperintense on T2-weighted imaging (T2WI), mildly hypointense on T1-weighted imaging, and showed contrast enhancement after intravenous administration of contrast. Additionally, multiple intramedullary lesions were detected in cervicothoracic spine on T2WI (Figure). Ultrasound-guided core biopsy from cervical mass was performed, and the final diagnosis was Ewing sarcoma. Intramedullary lesions were evaluated in favor of metastasis of Ewing sarcoma. The lesion on the posterior cervical region was excised surgically, and radiotherapy was performed on intramedullary lesions afterward. The patient felt relief from the mass effect, and the pain caused by metastatic lesions decreased. Intramedullary spinal cord metastasis is uncommon and generally occurs with advanced disease. Magnetic resonance imaging is valuable for diagnosis of intramedullary spinal cord metastasis. Lesions are usually solitary, hyperintense on T2WI, isointense on T1-weighted imaging, and located in the cervicothoracic region. Cystic or hemorrhagic change of lesions is very rare [ [1] Rykken J.B. Diehn F.E. Hunt C.H. Schwartz K.M. Eckel L.J. Wood C.P. et al. Intramedullary spinal cord metastases: MRI and relevant clinical features from a 13-year institutional case series. AJNR Am J Neuroradiol. 2015; 36: 587-593 Crossref Scopus (13) Google Scholar ].

A 47-year-old man with a history of right radical nephrectomy caused by renal cell carcinoma (RCC) presented with back pain. Physical examination and laboratory test results were normal. Magnetic resonance imaging of thoracic spine revealed minimal expansile masses with irregular borders in the vertebral bodies between the T4 and T6 levels. They were mildly hypointense on T1-weighted images, and mildly hyperintense on T2-weighted images relative to muscle (Fig. 1). Postcontrast images demonstrated intense enhancement of the lesions. The lesions had enhancing soft tissue components. They extended posteriorly into the spinal canal, resulting in compression on spinal cord and neural roots, which was probably the cause of back pain (Fig. 2). Magnetic resonance imaging findings were consistent with multiple vertebral metastases of RCC. Bone metastases of RCC are expansile lytic lesions and most commonly located in the axial skeleton. Vertebral bodies are involved more often than the pedicles. They can cause spinal cord compression. They are associated with intense pain and may lead to pathologic fractures [ [1] Brufau B.P. Cerqueda C.S. Villalba L.B. Izquierdo R.S. González B.M. Molina C.N. Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted antiangiogenic therapy by using multidetector CT. Radiographics. 2013; 33: 1691-1716 Crossref PubMed Scopus (88) Google Scholar ]. Fig. 2Precontrast axial T2-weighted (Left), T1-weighted (Middle), and postcontrast axial T1-weighted images (Right) show extension of the T6 vertebral body lesion posteriorly into the spinal canal, causing compression on the spinal cord (arrows). View Large Image Figure Viewer Download Hi-res image

PURPOSEWe aimed to examine the incidence of patent foramen ovale (PFO) and atrial septal aneurysms (ASA) in the Turkish population using coronary computed tomography angiography (CTA); assess the feasibility of coronary CTA for PFO diagnosis by conducting a comparison with transthoracic echocardiography (TTE); and determine the diagnostic role and characteristics of the interatrial tunnel, free flap valve (FFV), and shunts.METHODSThe present study was conducted retrospectively and included a sample of 782 patients. Coronary CTA results for all patients were evaluated for the following parameters: the presence of PFO, the degree of contrast jet (if present due to PFO), ASA existence, free flap valve (FFV) length, and PFO tunnel diameters (1 and 2). Coronary CTA and TTE results for PFO detection were also compared for 19 patients who underwent both procedures.RESULTSPFO was present in 118 patients (15%). In 19 patients who underwent both CTA and TTE, the shunt was present in 15 patients on TTE compared with nine patients on CTA. The sensitivity and specificity of CTA for shunt existence were 53% (8/15) and 75% (3/4), respectively. FFV was observed on CTA in 118 patients (15%). No significant relationship was observed between shunt existence and FFV length (P = 0.148), or between shunt existence and tunnel diameter-1 (P = 0.638) or diameter-2 (P = 0.058). ASAs were present in 16 patients (2%), while accompanying PFO was present in three patients (2.4%).CONCLUSIONCoronary CTA constitutes a more practical and efficient alternative to TTE for PFO diagnosis. Further, it allows the clear visualization of anatomical details of the interatrial tunnel, shunts, and associated abnormalities and detects ASAs.

EchocardiographyVolume 32, Issue 1 p. 195-195 Letter to the Editor Two Different Presentations of Sinus of Valsalva Aneurysm Muzaffer Saglam M.D., Muzaffer Saglam M.D. Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, TurkeySearch for more papers by this authorErsin Ozturk M.D., Ersin Ozturk M.D. Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, TurkeySearch for more papers by this authorMehmet Ak M.D., Mehmet Ak M.D. Department of Radiology, Maresal Cakmak Military Hospital, Erzurum, TurkeySearch for more papers by this authorKemal Kara M.D., Kemal Kara M.D. Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, TurkeySearch for more papers by this authorHakan Mutlu M.D., Hakan Mutlu M.D. Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, TurkeySearch for more papers by this author Muzaffer Saglam M.D., Muzaffer Saglam M.D. Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, TurkeySearch for more papers by this authorErsin Ozturk M.D., Ersin Ozturk M.D. Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, TurkeySearch for more papers by this authorMehmet Ak M.D., Mehmet Ak M.D. Department of Radiology, Maresal Cakmak Military Hospital, Erzurum, TurkeySearch for more papers by this authorKemal Kara M.D., Kemal Kara M.D. Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, TurkeySearch for more papers by this authorHakan Mutlu M.D., Hakan Mutlu M.D. Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, TurkeySearch for more papers by this author First published: 06 January 2015 https://doi.org/10.1111/echo.12747Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume32, Issue1January 2015Pages 195-195 RelatedInformation

A 63-year-old woman presented with complaint of chronic cervical pain. Computed tomography scan showed elevation and rotation of the left scapula, partial fusion of the C2–C7 vertebrae, and cervical scoliosis. An abnormal osseous connection between the superomedial border of the scapula and the left lamina of C6 vertebra was also seen (Figs. 1 and 2). Imaging findings were compatible with omovertebral bone with Sprengel deformity. Sprengel deformity is the gestational failure of caudal migration of the scapula to its normal position.

A 58-year-old man was admitted to our hospital with back pain after falling and landing on his back. He had history of ankylosing spondylitis. Physical examination revealed exaggerated dorsal kyphosis and tenderness to palpation of spine at thoracolumbar region. Radiographs of the thoracic and lumbar spine showed no evidence of fracture. Computerized tomography and magnetic resonance imaging were performed, and these showed a horizontal fracture of the T11 vertebra, bamboo spine, and fusion of sacroiliac joints (Figure). Posterior decompression and stabilization were performed. Vertebral fractures may occur even after minor trauma in patients with ankylosing spondylitis. The risk of vertebral fractures is increased up to four times than the general population in patients with ankylosing spondylitis.

Noncompaction ventricular myocardium is an unusual cause of cardiomyopathy. It is association with congenital heart defects, most often with outflow obstructive lesions or coronary anomalies. However, no factor could explain the arrest of development of myocardial structure (isolated form). The pathogenesis of isolated noncompaction is thought to be an arrest in endomyocardial morphogenesis. It has been reported that myocardial noncompaction could present as acquired disease. The most common site of involvement is the left ventricle, with right ventricular involvement being reported in a few cases. In this report, we present a case with noncompaction of the right ventricle (RV). Cardiac computed tomography angiography and magnetic resonance imaging demonstrated morphological abnormalities of the RV.

A 53-year-old man presented with chest pain. Laboratory and electrocardiography findings were normal. Echocardiography showed a normokinetic wall motion with left ventricular ejection fraction at 60%. Coronary computed tomography angiography identified no evidence of atherosclerosis and stenosis. However, an aberrant long left anterior descending (LAD) artery originating from the right coronary sinus and a short LAD originating from the left main coronary artery (LMCA) were observed. After running from the right coronary sinus, the long LAD segment coursed intramyocardially within the septal crest and entered the anterior interventricular groove (AIVG) below the termination point of the short LAD. The short LAD terminated high in the AIVG after originating from the LMCA (Fig. 1A, B). The septal perforators originated from both short and long LAD, and the diagonal branches originated from the short LAD (Fig. 2A, B). Dual LAD is a rare anomaly and has been categorised into 6 subtypes based on the origin, course, and termination of the short and long LAD (Table 1) [Maroney J, Klein LW. Catheter Cardiovasc Interv, 2012; 80: 626–629]. Because of its influence on surgical or angiographic intervention strategies, recognition of this anomaly is important. In dual LAD, there are a short and a long LAD segments within the AIVG. The short LAD typically arises from the LMCA and terminates high in the AIVG. The long LAD may have a more variable origin, course around the short segment, and return to the AIVG distally [Spindola Franco H et al. Am Heart J, 1983; 105: 445–455; Agarwal PP, Kazerooni EA. Am J Roentgenol, 2008; 191: 1698–1701]. We present a novel type of dual LAD — type VII — which does not fit within the traditional classification system.

A 20-year-old man presented with a complaint of low back pain. There was no history of recent trauma. Computed tomography scan revealed the presence of unilateral osseous bridging (OB) and pseudoarthrosis between the adjacent right transverse processes of the L2, L3, and L4 vertebrae (Fig. 1, Fig. 2). An old fracture with non-union of the fracture fragments at the right transverse process of L4 vertebra was also seen. Imaging findings were compatible with traumatic OB. Fig. 2Three-dimensional (3D) volume-rendering reconstruction of the computed tomography image shows unilateral osseous bridging of lumbar transverse processes (white arrows). View Large Image Figure Viewer Download Hi-res image

A 54-year-old man presented with complaints of low back pain and sacrococcygeal numbness. His past medical history was unremarkable. Physical examination revealed a palpable mass in the right parasacral region. Magnetic resonance imaging showed a relatively well-circumscribed soft tissue mass (45×40×38 mm), which was located within the paraspinal muscle in the right parasacral region (Fig. 1). The lesion extended to the sacrum anteriorly, and the right gluteus maximus muscle posteroinferiorly. It was iso- to mildly hypointense to muscle on T1-weighted images, and heterogeneously hyperintense on T2-weighted images. Post-contrast images demonstrated heterogeneous, intense enhancement of the lesion (Fig. 2). Computed tomography scan showed the absence of calcifications within the lesion. Density of the lesion was similar to adjacent muscle. The lesion extended into the S2 right neural foramen, and caused thinning and remodeling of the adjacent sacral cortex (Fig. 1). Ultrasonography guided core biopsy of the lesion was performed, and histologic examination revealed the diagnosis of malignant fibrous histiocytoma. Malignant fibrous histiocytoma, which is also known as pleomorphic undifferentiated sarcoma, is the most common type of soft tissue sarcoma in adults. Histiocytomas can occur anywhere in the body but most commonly involve the proximal extremities (70%–75%) and retroperitoneal space (15%). They are generally confined to the soft tissues but sometimes may arise in or from bone. They usually manifest as painless and large soft tissue masses with progressive enlargement [ [1] Murphey M.D. Gross T.M. Rosenthal H.G. From the archives of the AFIP. Musculoskeletal malignant fibrous histiocytoma: radiologic-pathologic correlation. Radiographics. 1994; 14: 807-826 Crossref PubMed Scopus (88) Google Scholar ]. Fig. 2Contrast-enhanced T1-weighted images with fat suppression in the axial (Left) and sagittal (Right) plane show a heterogeneous, prominent enhancement of the lesion (arrows). View Large Image Figure Viewer Download Hi-res image

A 21-year-old man was admitted to our hospital with a 3-year history of gradually increasing bladder and bowel dysfunction. Magnetic resonance imaging revealed an expansive destructive cystic lesion at the S2 and S3 vertebral levels, extending superiorly to the inferior S1 vertebral body and posteriorly into the spinal cord leading to the narrowing of the spinal canal. The lesion appeared isointense on T1-weighted images and hyperintense on T2-weighted images (Fig. 1). The fluid-fluid level was not observed inside the lesion. The post-contrast evaluation showed a fine rim enhancement of the septa and lesion wall (Fig. 2). Following the biopsy performed on the lesion, aneurysmal bone cyst diagnosis was made. Aneurysmal bone cyst can be often seen in the spine, but rarely in the sacrum [ 1 Papagelopoulos P.J. Choudhury S.N. Frassica F.J. Bond J.R. Unni K.K. Sim F.H. Treatment of aneurysmal bone cysts of the pelvis and sacrum. J Bone Joint Surg Am. 2001; 83-A: 1674-1681 PubMed Google Scholar , 2 Campanacci M. Tumorlike lesions of bone. Bone and soft tissue tumors. 2nd ed. Springer Verlag, Wein New York1999: 725-751 Google Scholar ]. The presence of fluid-fluid level in the magnetic resonance imaging is typical of aneurysmal bone cyst, but its absence does not exclude the diagnosis. In patients lacking the presence of the typical fluid-fluid levels, biopsy should be performed for differential or final diagnosis. Fig. 2Axial contrast-enhanced fat-saturated T1-weighted magnetic resonance (MR) images show a well-defined lesion with peripheral enhancement of the sacrum. The fluid-fluid level was not observed inside the lesion. View Large Image Figure Viewer Download Hi-res image