Parto Teb Azma

Patient ID:        8812151   female 24 yr 8812977

History (HX):
Localized pain and paraparesis

Findings:
Extradural mass in anterior epidural space from T8-9 to midportion of T11 with extension into the adjacent neural foramina bilaterally with intermediate signal intensity on both T1W and T2WI and enhancement on post-Gd images and marked cord compression. Involvement of T10 vertebral body is also noted.

History (HX):
An aphan man coming to Iran recently with headache, convulsion altered mental status and nuchal rigidity

Findings:
Mild communicating hydrocephalus with suspicious signal change at basal cistern on FLAIR images. On post-contrast MRI which has done 3 days later leptomeningeal enhancement is seen. Communicating hydrocephalus  is increased.

Diagnostic (DX):
T.B meningitis

Discussion:
Polymerase chain reaction (PCR) CSF was positive for Tuberculosis

Patient ID:        881179 female 53 yr

History (HX):

Recent trauma and pain at lateral aspect of the ankle, swelling and edema

Findings:
Abnormal signal change in sinus tarsi high signal on fluid sensitive sequences and low signal on T1WI replacing fat with disruption of interosseous and cervical ligaments.

Diagnostic (DX):
Sinus tarsi syndrome

History (HX):
Palpable mass at distal forearm

Findings:
Large solid mass at dorsal aspect of distal forearm invading the interosseous membrane, heterogeneously high signal on T2WI and isosignal to muscles on T1WI. The extensor tendons are partially engulfed by this mass.
No apparent bony invasion is identified.

Diagnostic (DX):
MFH (Malignant Fibrous Histiocytoma ) proved by biopsy

History (HX):
Enlarging mass over the volar aspect of the hand and wrist  from infancy

Findings:
A large lobulated mass beginning at the carpal tunnel and extending distally at volar aspect of the hand.
Linear hypointensities are present within the mass related to nerve bundles with extensive fat interspersed between the nerve fascicles

Diagnostic (DX):
Fibrolipomatous Hamartoma of the nerve (proved)

Discussion:
There is a very rare slowly growing tumor in infants and  children. It has a characteristic appearance on MRI that is often pathogonomonic and allows a confident diagnosis without the need for biopsy

History (HX):
Intermittent claudication and long standing history of smoking

Findings:
Total occlusion of infrarenal aorta and occlusion of common iliac arteries is noted. Reconstritution of flow in the external iliac arteries is via circumflex iliac arteries and inferior epigastric arteries . Occlusion of the left renal artery and stenosis at proximal portion of the right renal artery and SMA are present.

Diagnostic (DX):
Aortoiliac occlusive disease and severe atherosclerotic changes (Leriche Syndrome)

History (HX):
Fever, headache, seizures, altered mental status

Findings:
In first breast MRI FLAIR images demonstrate increased signal intensity at medial aspect of temporal lobes bilaterally. Herpes and Limbic encephalitis was suggested for patient.
On the second MRI which was done about 2 weeks later extensive increased signal intensity is noted in temporal lobes, inferomedial aspect of frontal lobes and cerebellar hemispheres with leptomeningeal and patchy enhancement on post-Gd images.

Diagnostic (DX):
Herpes Encephalitis

Discussion:
PCR (polymerase chain reaction) of CSF was positive (sensitivity / specificity of approximately 95-100% in CSF)

History (HX):
Hypertension, limb claudication

Female   35 yr

Findings:
Multifocal stenotic segment at descending thoracic and abdomina aorta most marked between the origin of celiac trunk and SMA. Occlusion of proximal portion of left subclavian artery, stenosis at proximal portion of left common carotid and midportion of right subclavian arteries

Discussion:
A primary arteries which involves the aorta and its major branches in addition to pulmonary artery

History (HX):
Flank pain and hematuria

Findings:
MRU (MIP and thick slab images shows ) staghorn calculus and mild hydronephrosis in right kidney, small stone at UPJ of left kidney resulting in hydronephrosis and 3 other stones in lower calyceal group. All stones are signal void.

Discussion:
MR urography is currently considered the method of choice for imaging of the renal parenchyma and the collecting systems who cannot undergo routine radiographic studies such as pregnant women , pediatric patients, patient’s allergic to iodinated contrast agents or patients with impaired renal function.

History (HX):
Progressive lower extremity weakness

Male   36 yr

Findings:
Sagital T2WI show multiple small flow void, along the dorsal surface of cord related to enlarged pial veins, on  post-contrast images these show mild enhancement. No abnormal signal within the cord to suggest venous hypertensive myelopathy.

Discussion:
The most common spinal vascular malformation. These are AV shunts that occur within the dural corening  of the spinal cord