BACKGROUND: Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 years of age. Computed tomography (CT) is an effective technique in the initial emergent evaluation of the abdomen and head following blunt trauma. Most chest indies are not seen on conventional chest radiography, or may be underestimated. But routine use of CT in the initial emergent evaluation of chest trauma is controversial. CT, however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the efficacy of emergent CT in patients with blunt trauma on the chest. METHODS: To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram(CXR) was carried out on 121 patients with blunt trauma on the chest. The interval between CXR and CT was less than 1 hour. RESULTS: Among 121 patients, 42 patients had normal initial chest roentgenogram in whom 19 patients showed normal CT findings. Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (49.3%and 45.1%respectively), whereas 65.7% (44/67) of patients had thoracostomy only by CXR. CONCLUSIONS : Although sometimes abused in patients with chest trauma, CT of the thorax is an effective method of detecting thoracic injuries and provides accurate information regarding their pattern and extent in the initial emergent diagnosis.
Abdomen ; Cause of Death ; Diagnosis ; Emergencies* ; Head ; Humans ; Pleural Effusion ; Pneumothorax ; Radiography ; Retrospective Studies ; Thoracic Injuries ; Thoracostomy ; Thorax* ; Tomography, X-Ray Computed

No abstract available.
Contrast Media* ; Magnetic Resonance Imaging*

A lipomatous tumor originating in the uterus is a rare benign neoplasm, and most reported cases have been of the mixed type. Authenticated cases of pure lipomas of the uterus are extremely rare. We report one such case in which the findings of magnetic resonance imaging provided the basis for preoperative diagnosis.
Diagnosis ; Lipoma* ; Magnetic Resonance Imaging ; Uterine Neoplasms ; Uterus

Fibrous dysplasia is a benign bony disorder that contains trabeculae of poorly calcified primitive bone formed by osseous metaplasia. It is also characterized by replacement of normal spongiosa by abnormal fibrous tissues. We retrospectively analyzed the computed tomographic (CT) findings of 29 cases with clinically and radiologically diagnosed craniofacial fibrous dysplasia. In 2 cases, only cranial bones were involved and in 7 cases only facial bones were involved. Involvements of both cranial and facial bones were noted in the remained 20 cases. The commonly involved bones in the decreasing order of frequency were as follows: frontal, sphenoidal, ethmoidal and temporal bones in cranium and maxilla, zygoma, lacrimal bones and mandible in facial bones. Even though plain films are enough to diagnose the fibrous dysplasia, we think that CT is useful in more accurate diagnosis by demonstrating amorphous "ground-glass" appearance in the lesion and defining the exact extent of craniofacial fibrous dysplasia.
Diagnosis ; Facial Bones ; Mandible ; Maxilla ; Metaplasia ; Retrospective Studies ; Skull ; Temporal Bone ; Zygoma

The falcine sinus is an abnormal anatomic structure located in the falx cerebri that is closed after birth and is rarely observed. We describe two cases of persistent falcine sinus. A 60-year-old woman presented with headache. An 11-year-old girl presented with intermittent headache and a palpable scalp mass in the middle of the high parietal area. The straight sinuses were absent in both patients. In both patients, drainage of the galenic system took place through a sinus within the falx, also known as a falcine sinus. Suspicious dysplastic tentorium cerebelli was observed in one patient. It can be concluded that a mesenchymal disorder can be the primary cause for a persistent falcine sinus.
Child ; Drainage ; Encephalocele ; Female ; Headache ; Humans ; Hypogonadism ; Middle Aged ; Mitochondrial Diseases ; Ophthalmoplegia ; Parturition ; Scalp

PURPOSE: To assess changes in MR signal intensity in the pars interarticularis and adjacent structures in pa-tients with lumbar spondylolysis. MATERIALS AND METHODS: The MR images of 36 patients with lumbar spondylolysis, confirmed by plain radiographs, were retrospectively analyzed. Using a 1.0T unit, we evaluated the signal intensity of a total of 216 parts interarticulares and adjacent structures from L3 to L5, as seen on sagittal images, and differences between areas with and without spondylolysis. The signal intensity of T1-and T2-weighted images was graded 0 (more hypointense than spinal body), 1(as isointense as spinal body), 2(more hyperintense than spinal body and more hypointense than epidural fat), or 3(as isointense as epidural fat). Signal intensity change in end-plates and degree of spondylolisthesis were analyzed, and the relationship between these factors was deter-mined. RESULTS: Spondylolysis was noted at L5 in 61 cases, at L4 in 22, and of L3 in no case. In three cases spondylolysis was unilateral, and in the remainder it was bilateral. The degree of signal intensity was the same on T1- and T2-weighted images, and no case was grade 0. Eighty-six of 133 areas without spondylolysis were grade 1, 43 were grade 2, and four were grade 3. In 42 of 47 cases, signal intensity change was localized at pedicles. Among 83 areas with spondylolysis, on the other hand, nine were grade 1, 48 were grade 2, and 26 were grade 3. Signal intensity change was most commonly observed at the pars interarticularis, pedicle, and lamina (50/74) (p<0.001). Signal intensity change at the pars interarticularis and adjacent structures was accompanied in most cases by degenerative endplate change(10/11) and spondylolisthesis(11/13) (p<0.001). CONCLUSION: In patients with spondylolysis, signal intensity was frequently higher at the pars interarticularis and adjacent structures, and is thought to have a close relationship with degenerative endplate change and spondylolisthesis. Increases in signal intensity at the pars interarticularis and adjacent structures can help diagnose spondylolysis in patients without spondylolisthesis.
Hand ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spondylolisthesis ; Spondylolysis*

No abstract available.
Angioplasty*

Persistent primitive olfactory artery (PPOA) is a rare anomaly of the anterior cerebral artery. We present one case of PPOA incidentally diagnosed with the aid of computed tomography (CT) angiography. A 24-year-old woman was admitted to our hospital after sudden onset of vertigo. Three-dimensional CT angiography revealed an anomalous artery arising from the terminal portion of the right internal carotid artery. The proximal portion of the anomalous artery coursed anteromedially and made a hairpin turn posterosuperior to the midline. PPOA may be overlooked because of its rarity, but CT angiography can be useful in detecting this rare vascular anomaly. Follow-up study is necessary in our case to confirm whether an aneurysm occurs on the PPOA.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Carotid Artery, Internal ; Female ; Follow-Up Studies ; Humans ; Vertigo ; Young Adult

PURPOSE: The purpose of this experimental study was to evaluate early CT and MRI findings of cerebral sparganosis, to correlate the imaging findings with histopathologic findings, and to determine capability of CT and MRI to differentiate live worm from the dead. MATERIALS AND METHODS: After scolices of three to four spargana, which were obtained from naturally infected snakes, were introduced into cerebral hemispheres of 21 mongrel cats, sequential brain CT and MRI were performed at the 2nd, 4th, 8th and 12th week, and the imaging findings were analyzed and compared with the histopathologic findings. RESULTS: Spargana were found in 16 sites of 10 cat brains(48%);they were located in basal ganglia(5 cases), periventricular white matter and centrum semiovale(4 cases), subdural(2 cases) or subarachnoid spaces(1 case), and lateral ventricle(2 cases). The larvae were also observed in the contralateral hemisphere(3 cases). The lesions without larvae(presumably tracts) were found in 22 sites of 14 cat brains(67%) ;they were located in periventricular white matter and centrum semiovale(11 cases), basal ganglia(5 cases), midbrain(3 cases) and frontal 10be(2 cases). The lesions without larvae were also found in the contralateral hemi- sphere (7 cases). On CT, the lesions with larvae showed high density in 75%(9/12) and were enhanced in 38%(3/8) as a nodular pattern. On MRI they showed iso-(7/11) or low signal intensity(4/11) on Tl-weighted images, mainly isosignal intensity on proton density- weighted images, and variable signal intensity on T2-weighted images. Contrast enhancement of variable shapes was seen in 50%(4/8). The lesions without larvae showed iso-(14/22) or low density(6/22) on CT and were rarely enhanced(2/17). On MRI they mostly showed isosignal intensity on both T1-weighted and proton density- weighted images, and variable signal intensity on T2- weighted images. They were enhanced in 29%(5/17) on contrast-enhanced MRI. Dilatation of ipsilateral ventricle was found in 43% (9/21) ;it was seen as early as the second week in 5 cats. On histopathologic examinations, there was only mild degree of inflammation and edema around both the larvae and the lesions without larvae in most cases. Granulation tissues, small calcifications, and small morrhages were observed nearby the larvae in six, one and two cases, respectively. At the lesions without larvae, small calcifications and hemorrhages were found in three and nine cases, respectively. It was not possible to determine the viability of the larvae by using CT or MRI findings and even by histopathologic findings. CONCLUSION: The results indicate that the spargana actively move within brain tissue in early stage, cause mild degree of inflammation and edema around the larvae and the tracts, but presumably produce early degeneration of cerebral white matter, resulting in dilatation of ipsilateral ventricle. Additionally, CT may differ. entiate the lesions with worms from tracts(the lesions without worms), but viability of the larvae can not be determined by either CT or MRI.
Animals ; Brain ; Cats ; Cerebrum ; Diagnosis* ; Dilatation ; Edema ; Granulation Tissue ; Hemorrhage ; Inflammation ; Larva ; Magnetic Resonance Imaging ; Protons ; Snakes ; Sparganosis*

An infraoptic course of the anterior cerebral artery (ACA) is a rare anomaly of the anterior part of the circle of Willis. About 56 cases have been reported, often in association with cerebral aneurysm. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. A 52-year-old man experienced a sudden onset of severe headache without focal neurological deficits. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Three-dimensional computed tomographic angiography and conventional angiography revealed a saccular aneurysm in the left middle cerebral artery. An anomalous arterial branch, originating from the right internal carotid artery at the level of the ophthalmic artery was also visible. This vessel followed an infraoptic course. The aneurysm was successfully embolized with coils. We review the literature for the possible genesis of this anomaly and consider treatment of the associated aneurysm.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Circle of Willis ; Glycosaminoglycans ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Middle Cerebral Artery ; Ophthalmic Artery ; Optic Nerve ; Subarachnoid Hemorrhage