Symmetric abnormality involving the cerebellar white matter and posterior limb of the internal capsule is characteristic of heroin vapor inhalation toxicity, although involvement may be more extensive, depending on the severity of the condition. MR imaging and CT appear to be essential for making this diagnosis because clinical history is often unreliable and findings at physical examination are nonspecific.
MRI showed the classically reported finding of central globular high signal intensity with a low-signal-intensity rim in only two of the five cases. We noted peripheral contrast enhancement, which to our knowledge has not been reported previously, in three of our five cases. Other patterns such as amorphous, cloudlike stranding and a serpentine appearance were also encountered. In reviewing the literature, we found that the MRI appearance of fat necrosis is more varied than previously thought.
Lipoma arborescens is a rare disease that has generally been considered to be unilateral. We report a case of bilateral disease in a patient with associated marked premature osteoarthritis of the knees. We postulate a possible association between these two conditions and explain a possible underlying mechanism. We suggest that lipoma arborescens be considered as a rare underlying cause of young patients with bilateral premature osteoarthritis, and recommend MRI as the definitive imaging modality.
MRI provided considerable additional information compared with sonography and affected clinical decision making in a substantial number of patients. MRI should be considered in all patients being evaluated for uterine artery embolization.
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