Background:A 74-year-old woman was admitted to the emergency department with severe epigastric pain, nausea and dyspnea. On physical examination the epigastric region was tender.
Since the incidence of amyloidosis is increasing, the purpose of this article is to review the imaging features of intrathoracic amyloidosis. Amyloidosis forms a heterogeneous group of disorders characterised by the extracellular deposition of a homologous protein complex. The heart is the most commonly involved organ in the chest. Respiratory amyloidal deposition is much less common and may be generalised, when it occurs as a part of a systemic disease, or it may be restricted only to the respiratory system. Although, the abnormalities are considered non-specific, recent literature suggests-especially for cardiac amyloidosis-specific patterns of abnormalities.
We report a child with Borrelia burgdorferi meningoradiculitis. This entity, also known as Bannwarth syndrome, is rare and its presentation with low back pain only is even more unusual. The MRI findings can suggest the diagnosis.
A 67-year-old Caucasian woman with no medical history was referred to the hospital with severe neck pain radiating to the left arm.A plain X-ray and non enhanced CT scan of the cervical spine was performed.CT scan (Fig. A, B) revealed a dorsolateral V-shaped hyperdensity in the spinal canal at the level of the ligamentum flavum at C6 level with narrowing of the vertebral canal and compression of the spinal cord.In retrospect the plain X-ray (Fig. C) showed two nodular opacities projecting posterior on the cervical canal.These imaging findings were diagnostic for an ossification of the ligamentum flavum. CommentOssification of the ligamentum flavum (OLF) usually occurs in the lower thoracic and lumbar spine and is uncommon in the cervical spine. The relative incidence of OLF in the cervical spine is approximately 0.9%. It is usually seen in East Asian populations and exceptionally reported in Caucasian people.OLF can be isolated or it can be associated with degeneration of other osseous ligaments of the vertebral column such as ossification of the posterior longitudinal ligament (OPLL) and diffuse idiopathic skeletal hyperostosis (DISH).The etiopathogenesis remains unclear. Some have correlated it to systemic diseases (diabetes mellitus, haemochromatosis, fluorosis and disorders of calcium and phosphorus), others have highlighted the importance of repeated mechanical stress causing degeneration and ossification.Symptomatology involves neck or back pain, sensory disturbance of upper and lower extremities, numbness, gait disturbance and tetraparesis.CT remains the investigation of choice to demonstrate ossification as a "V"shaped hyperdensity.MRI and particularly T2-weighted images are useful in showing the degree and extent of spinal cord compression. On MRI the ossified ligamentum flavum appears as a linear or nodular hypo-intens lesion posterior to the thecal sac on both T1 and T2-weighted images.It is therefore indicated to combine CT and MR imaging. The treatment of choice is a posterior decompressive laminectomy with removal of the thickened, ossified ligament.Prognosis is good, depending on the severity of myeolopathy, with a neurological improvement in most operated patients. This is an exceptional case because our patient is Caucasian, the ossification is present at cervical level and is symptomatic.
A 43-year-old textile worker consulted our hospital with a severalyear history of a painless, slowgrowing ankle mass. He had noticed the mass for the first time approxiConventional lateral radiograph of the left ankle showed a non-specific but well-defined soft-tissue mass in the posterior ankle region without obvious calcifications (Fig. 1A). The mass was located along the expected course of the Achilles tendon. Ultrasound examination clarified a well-defined lesion which was situated adjacent to the Achilles tendon and characteristics of intralesional reflections and retro-acoustic shadowing (Fig. 1B). The mass was noncompressible and no internal calcifications were seen.On MR the mass had a heterogeneous low to intermediate signal intensity pattern on theT2 weighted imaged images ( Fig. 2A), the T1-weighted appearance was consistent, with a homogeneously low to mately 5 years previously as a small lump, painlessly increasing in size over time.The medical history of the patient revealed that he had visited an orthopaedic surgeon 12 months earlier for anterior knee pain which was conservatively treated. Physical examination noted a normal gait. Inspection and palpation showed an obvious, firm and mobile mass situated in the posterior-medial aspect of the ankle and adjacent to the Achilles tendon. It was tender, measuring approximately 2,5 cm. His muscle bulk, strength, reflexes, and sensation were enterily normal. No obvious vascular findings were found. The patient had a normal neurologic status with no Tinel's sign of the sural nerve. , 2015, 98: 34-36. JBR-BTR Pseudotumoral toPhaCeous involvement of the aChilles ParatenonT. Ryckaert, I. Crevits, S. Brijs, G. Debakker, F. Rosseel, A. Tieleman, R. De Man 1 Gout is the most common form of microcrystalline arthropathy which usually does not pose a diagnostic challenge when patients have typical presentation, appropriate biochemical picture and classical radiographic appearance. however, formation of gouty tophi in unusual locations and with atypical presentations may mislead clinicians and radiologists, thereby justifying gout nickname as the "great mimicker". When interpreting images of tendon related masses, radiologists should be aware of gouty tophi as a possible differential given its variable and nonspecific imaging appearance. in this article, we present a case of a patient with a painless tophaceous gout nodule, adjacent to the achilles tendon.
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