Biomedical subjects
Publications and source records attributed to Kanehiro Hasuo.
A 36-year-old man fell from his bicycle and struck his lower abdomen on the end of the handlebar. Computed tomography (CT) showed a small bowel loop protruding into the subcutaneous fat layer of the abdominal wall. We present this case of handlebar hernia, a rare type of traumatic abdominal wall hernia, and the usefulness of CT in diagnosing such injuries.
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We reported a 68-year-old man of dural arteriovenous fistula at the cranio-cervical junction with dysesthesia ascending from his both toes. He recognized dysesthesia at his both toes 10 months previously. Thereafter dysesthesia ascended to his girdle which was stronger as far as his girdle and gait disturbance developed. Somatosensory evoked potential (SEP) revealed delayed central conduction time. Cervical MRI showed a swelling of the spinal cord and intramedullary hyperintense lesion from the C2 to C7 level on the T2-weighted image. Moreover flow void behind the mudulla oblongata on the T2-weighted MRI was outstanding. Angiogram through right ascending pharyngeal artery revealed enlarged and tortuous anterior and posterior spinal veins at the early arterial phase. We diagnosed as dural arteriovenous fistula (AVF) and conducted intraarterial embolization. After treatment, the swelling and hyperintense lesion of the cervical spinal cord improved on MRI, and flow void behind medulla oblongata was extinguished. Gait disturbance also improved. We think that the valves of veins in the spinal cord are responsible for the tendency of higher venous pressure in outer circumference, which results in the symptom dominating in the lower extremities. We recommend that dural AVF at the cranio-cervical junction should be considered as a differential diagnosis in case with the similar clinical course to our case.
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We reported the outcomes of computed tomography (CT)-guided percutaneous acetic acid injection therapy for functioning adrenocortical adenomas. With the patient in a prone position, the puncture needle was inserted vertically downward into the adenoma with frequent CT scanning. After confirmation by pilot injection with contrast medium, a small aliquot of 40-50% acetic acid was injected and repeated. Between 1997 and 2002, 18 sessions of CT-guided injection therapy, including one session of ethanol injection, were performed on 10 patients (five patients with primary aldosteronism and five patients with Cushing's or subclinical Cushing's syndrome) without any complications except transient upper abdominal pain during the acetic acid injection. The follow-up period ranged from 5-69 months. The treatment resulted in almost an extirpation of the adrenocortical hyperfunction in seven patients after one or two sessions. CT-guided percutaneous acetic acid injection might be a simple, cost-effective, and far less invasive treatment for small functioning adrenocortical adenomas.
A 31-year-old man was referred to our hospital because of a chest X-ray abnormality. Computed tomography showed an extra-pulmonary mass along the left 8th rib. T1-weighed magnetic resonance imaging (MRI) revealed a mass lesion with intermediate signal intensity. T2-weighed MRI showed a high signal intensity in peripheral and multiple central portions with intermediate signal intensity, which yielded a bead-like appearance. Gadopentetate dimeglumine-enhanced T1-weighted MRI showed marked contrast enhancement in the central zone of the mass. En bloc resection of the mass with the left 8th rib was performed. The tumor resembled a rosary in gross appearance, and histological examination confirmed the diagnosis of a benign schwannoma arising from the intercostal nerve. The bead-like appearance in the MRI was unique and had never been reported before for such a tumor. The postoperative course was uneventful, and the patient has been well for eighteen months.
Radiological evaluation of the non-neoplastic intramedullary lesions of the spinal cord includes lesion detection and characterization in order to make definitive diagnosis or to narrow differential diagnoses. Radiologist may be able to guide clinicians as to next diagnostic step when definitive diagnosis cannot be made. Treatment effect can be also assessed. Among other radiological modalities, MRI plays the most important role in the evaluation of the spinal lesions, particularly of the intramedullary lesions. MRI findings of intramedullary lesions can be divided into morphological and signal abnormalities. Morphological abnormalities include presence of an abnormal structure, deviation or deformity of normal structures, and enlargement or atrophy of the spinal cord. Signal abnormalities include T2 prolongation (often associated with T1 prolongation), T1 and T2 shortening, and abnormal contrast enhancement. There may be only one finding, or multiple findings may be present in combination. Signal changes and abnormal contrast enhancement with or without cord enlargement are the most common but important findings. There are a few disease entities with pathognomonic MRI findings, but it is often difficult to make definitive diagnosis based on MRI findings alone. It is imperative not only to have thorough knowledge of imaging findings various diseases, but also to pursuit radiological evaluation correlating with clinical and laboratory findings.
Granular cell tumor (GCT) is an uncommon benign tumor, which is thought to originate from a Schwann cell. GCT may involve any part of the body, but in our knowledge, there has been only one previous report of GCT, which arose in the intradural extramedullary space of the spine. We report a case of GCT, which occurred in the intradural extramedullary space.