MRI of the Budd-Chiari syndrome

Five of six patients with angiographically proved Budd-Chiari syndrome (hepatic venous outflow obstruction) showed multiple specific MRI abnormalities: striking reduction in caliber or complete absence of the hepatic veins, "comma-shaped" intrahepatic collateral vessels, and/or marked constriction of the intrahepatic inferior vena cava. The sixth patient had angiographically proven sinusoidal hepatic venous obstruction and patent central hepatic veins; MRI showed ascites but revealed no specific features of the Budd-Chiari syndrome. Patients with end-stage cirrhosis also showed compressed, distorted hepatic veins; however, these cirrhotic livers were distinguished by their small size, nodular surface, and extrahepatic collateral varices. In patients without cirrhosis or the Budd-Chiari syndrome, normal hepatic, portal, and inferior caval veins were routinely seen when technically adequate MRI examinations were obtained (94 of 100 cases). Four of the six patients with Budd-Chiari syndrome had been treated surgically. In three, MRI identified patent portocaval shunts. In the fourth, angiographically confirmed shunt stenosis was demonstrated by MRI.     

Gorham-Stout syndrome of the mandible

A 16-year-old female complained of loosening of several teeth in the lower jaw. Radiography revealed bone resorption of the tooth sockets. The osteolytic process extended throughout the alveolar crest of the mandible and caused a complete loss of teeth within 2 years. Microscopic sections showed angiomatous tissue of Gorham-Stout-syndrome. Radiotherapy with 35 Gy controlled the mandibular osteolysis. Recurrent meningitis and osteolytic defects of the frontal skull base hint at an additional manifestation of the disease at this site.     

Death on the needle syndrome

A toxicological analysis is mandatory in the investigation of sudden deaths, which in drug abusers may be due to many factors. In some instances the toxicology may be essentially negative and requires an explanation for the cause of death. The case report illustrates a challenge for forensic practitioners when 'death on the needle' may be the mode of death with an anaphylactoid reaction.     

Acetabular protrusion in the Marfan syndrome

The Marfan syndrome is a genetic disorder of connective tissues resulting in ocular, cardiovascular, and musculoskeletal deformities. The authors reviewed 22 cases of Marfan syndrome. Forty-five percent (ten of 22) of the patients had acetabular protrusion, with one-half of these being unilateral and one-half bilateral. Scoliosis was associated with acetabular protrusion in 90% of cases (nine of ten). The authors conclude that acetabular protrusion is a common skeletal finding in the Marfan syndrome.     

Radiological findings in the iliolumbar syndrome

Radiological and clinical findings were compared in 440 patients with the iliolumbar syndrome, a frequently observed but often unrecognized affection. Anatomical and clinical features relating to the iliolumbar ligament, this illustrious unknown part of the body, are discussed, together with the pain syndromes that arise from it and which are often dissimulated under more familiar terms such as lumbosciatica, too frequently employed as an alibi. Original data concerning the radiological appearances in patients with this syndrome are presented.     

Chest radiography in the carcinoid syndrome

The chest films of 44 patients with liver metastases from intestinal carcinoid tumors were reviewed in order to evaluate the frequency of significant carcinoid heart disease. Only two patients had obvious signs of cardiac involvement, which is contradictory to most other studies.