Lemmel syndrome is a pancreaticoduodenal disease caused by compression of the mid or distal common bile duct by a periampullary diverticulum. This condition should be considered a rare complication of a duodenal diverticulum and an unusual cause of obstructive jaundice. Because of its infrequent occurrence and non-specific clinical presentation, Lemmel syndrome can mimic other conditions. We herein report the clinical and imaging findings (computed tomography, magnetic resonance imaging) of a patient who presented with intermittent abdominal pain and jaundice. Large air-filled outpouching lesions of the duodenum compressed the biliary duct, resulting in upstream biliary ductal dilatation that led to the diagnosis of Lemmel syndrome.
Purpose To describe the role of SWI compared with other MR imaging sequences and CT in diagnosis of cerebral gnathostomiasis. Materials and methods CTs and MRIs of patients with cerebral gnathostomiasis were retrospectively reviewed. The types of intracranial hemorrhage, including intraparenchymal hemorrhage (IPH), subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), and their locations were recorded. Results Four patients proven as cerebral gnathostomiasis were included. Intracranial hemorrhage was detected in all patients. There was IPH in all patients, SAH in 2 patients, and SDH in 2 patients. All patients (4/4) revealed hemorrhagic tracts which were very conspicuously seen on SWI. Other imaging sequences could also reveal hemorrhagic tracts in 3 patients (3/4) but are less conspicuously seen than SWI. None of the CT brains could detect hemorrhagic tracts. Conclusions Intracranial hemorrhage associated with hemorrhagic tract, best demonstrated by SWI, is the key imaging characteristic in diagnosis of cerebral gnathostomiasis.
Madelung disease is defined by multiple symmetric fatty accumulations, usually involving the upper trunk, and may sometimes have excessive fat deposition in the prevertebral space. On magnetic resonance imaging (MRI), findings of fat that are hyperintense on T1w and T2w images, may simulate subacute hematoma and mimic cervical spine injury. This is the first reported case of Madelung disease with prevertebral fat deposition mimicking prevertebral hematoma found in cervical spine injury on MRI. Fat suppression techniques are helpful in order to differentiate between these two conditions, which should be taken into consideration during routine clinical practice.
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