This patient presented with bilateral sensorineural hearing loss and dizziness. The axial T2-weighted MR image above shows signal loss over the cerebellar folia, a characteristic finding in leptomeningeal (a.k.a. superficial) haemosiderosis.

Leptomeningeal haemosiderosis typically presents with hearing loss and vestibular dysfunction as the vestibulocochlear nerve is particularly sensitive to it. Presentation may be with other cranial neuropathies, or cerebellar dysfunction. The condition may also be asymptomatic. The aetiology is considered to be repeated subarachnoid haemorrhages, and a search for a source is indicated. This should include spinal MR. Amyloid angiopathy has been described as a cause.

Reference: Linna J, et al. Subarachnoid hemosiderosis and superficial cortical hemosiderosis in cerebral amyloid angiopathy. AJNR 2008;29:184-186

Manifestations in the spleen include splenomegaly in childhood, with splenic infarction and autosplenectomy in adults.

Skeletal manifestations include avascular necrosis of the femoral head and H -shaped vertebrae.

This AXR shows massive splenomegaly and bilateral femoral head AVN.

Reference: eMedicine

A sagittal transvaginal ultrasound image of the cervix at 21 weeks gestation shows funnelling of the proximal cervix, and reduction of the functional length to 10mm.
Cervical incompetence is variably defined, however a cervical length of <25mm is often used. The risk of preterm delivery is inversely proportional to cervical length - 18% for <25mm and 25% for <20mm. The presence of funnelling is important. Greater than 50% funnelling before 25 weeks is associated with 80% risk of preterm delivery.

Patients at high risk for preterm delivery include: uterine anomalies; previous cervical trauma or surgery; history of recurrent spontaneous or therapeutic abortion; history of preterm (<32 weeks) birth. Transvaginal sonography is most commonly used to assess the cervix, however translabial and transperineal techniques have been used.

Management is controversial, with conflicting results, particularly regarding the efficacy of cerclage. Bed-rest, tocolysis, cerclage, and administration of steroids to accelerate foetal lung maturity are all treatment options to be considered. A recent metaanalysis suggests that cerclage is effective in reducing preterm births by 26% in singleton pregnancies (3).

References:
1. Callen PW Ultrasonography in Obstetrics and Gynecology. 4th edition. WB Saunders, 2000
2. Woodward PJ Pocket Radiologist Obstetrics Top 100 Diagnoses 1st edition. Amirsys / WB Saunders, 2003
3. Berghella V, et al Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstetrics & Gynecology. 106(1):181-9, 2005 Jul.

Gossypiboma is the name given to a retained surgical sponge, pad, or towel (gossypium (Latin), cotton; + plboma (Swahili), place of concealment). Retained foreign bodies can cause either an acute inflammatory response or a chronic fibrinous response and so there is a very wide variation in the time course in which they are discovered, as evidence in a diverse array of case reports in the surgical and radiologic literature. The sponge in the above picture was found over a decade after an exploratory laparotomy for trauma as an incidental finding on a study performed for an unrelated reason.

Policies and procedures such as thorough surgical instrument counts and intraoperative x-rays are designed to prevent this complication, however retained surgical instruments continue to be occur at a rate estimated to be around one in 1500 laparotomies. It has been proposed that routine intraoperative x-rays are cost effective and should be performed for high-risk procedures despite correct instrument counts.

Surgical sponges are easily identified by the use of barium-impregnated threads woven into one side of the cloth.

Reference: N Engl J Med. 2003;348(3):228, 229-235

This axial T2-weighted MR image shows a high signal lesion in the petrous apex region, also involving the clivus. The lesion is expansile and there is evidence of bone destruction. Histopathology demonstrated chondrosarcoma.

Chondrosarcomas of the skull base are typically off-midline, destructive lesions with high T2 signal and strong but heterogeneous contrast-enhancement. Approximately 50% demonstrate chondroid matrix calcification (best seen on CT).

Skull base chondrosarcoma has a better prognosis than skull base chordoma, with an 80% 5-year progression-free survival after resection and radiotherapy.

References:
1. Osborn A. Diagnostic Neuroradiology Mosby 1994
2. Cho YH, et al. Chordomas and chondrosarcomas of the skull base: comparative analysis of clinical results in 30 patients. Neurosurg Rev 2008;31(1):35-43

Coronal T2W MRI of the head and neck of a 20 year-old male. There are areas of high signal with a trans-spatial distribution: base of tongue; the tonsillar region; the masticator space; the subcutaneous tissues of the neck; and the deep neck spaces including the larynx and upper trachea. This appearance is characteristic of vascular malformation. There are areas of low signal within some of the vascular spaces, consistent with phleboliths.

Vascular malformations are classified according to Mulliken & Glowacki, 1982. They may be low-flow (venous, capillary, lymphatic, or mixed) or high-flow (arteriovenous) malformations. Vascular malformations are non-proliferative congenital abnormalities. They should be differentiated from capillary haemangioma of infancy, a common proliferative lesion. Vascular malformations (especially mixed type) are associated with Klippel-Trenaunay, Osler-Weber-Rendu, Maffucci, blue-rubber-bleb naevus, and other syndromes. Frequently there is associated tissue hypertrophy, although atrophy may also occur. Lesions are typically trans-spatial, involving subcutaneous, muscle, joint, bone and organ compartments.

Clinical presentation of venous malformation may be with cosmetic deformity, pain, haemorrhage, thrombosis, loss of function, or compression of vital structures. Management of these complex lesions is best undertaken in a multidisiplinary team environment, in specialised vascular birthmark clinics. Treatment may be with surgical excision or sclerotherapy. Surgical excision is often complicated by recurrence, as complete excision is rarely possible. Sclerotherapy with ethanol or foamed surfactants has been shown to be efficacious in reducing the symptoms and complications, and the complication rate is low. Complications of sclerotherapy include skin ulceration, sclerosant embolisation and nerve palsy.

References:
1. Mulliken JB & Glowacki J. Hemangiomas and Vascular Malformations in Infants and Children: A Classification Based on Endothelial Characteristics. Plast. Reconst. Surg. 1982; 69(3):412-420
2. Burrows PE. Percutaneous Treatment of Low Flow Vascular Malformations. J Vasc Interv Radiol. 2004; 15:431-445

This lateral radiograph of the foot demonstrates the typical findings of neuropathic osteoarthropathy. The most common cause is diabetes mellitus. Findings include bone sclerosis, new bone formation, articular destruction and deformity, loose bodies, and subluxations / dislocations. Soft tissue swelling and joint effusions are also a feature.

Reference: Dahnert W. Radiology Review Manual 5th ed. Lippincott, Williams & Wilkins 2003

Reference: Uchino A, et al. Anterior cerebral artery variations detected by MR angiography. Neuroradiology 2006;48:647-652