A 77-year-old man was admitted after a fall in which he struck his head and pelvis. Neurologic examination was unremarkable. CT and MRI scans of the head (figure, A and B) revealed fat droplets in the cerebral ventricles and subarachnoid spaces. CT and MRI scans of the pelvis (figure, C-F) demonstrated a sacral fracture extending into a Tarlov (perineurial) cyst within the S2 foramen.We hypothesize that fatty bone marrow migrated from the fracture site to brain through a meningeal breach at the Tarlov cyst. No specific treatment was required.Dissemination of free fatty material from the spinal subarachnoid space to the brain has been previously reported in a patient with spina bifida occulta following a traumatic sacral pseudomeningocele 1 and following the rupture of spinal dermoid tumors.
Eight infants with systemic-pulmonary Blalock-Taussig shunts were evaluated by spin-echo ECG-gated MRI. Contrary to Echocardiography, MRI using coronal oblique projections successfully visualized all palliative shunts entirely in one single plane (including one carried out on a right aberrant subclavian artery). MRI allowed assessment of size, course and patency of the shunt, including pulmonary and subclavian insertion. The proximal portion of the pulmonary and subclavian arteries were also visualized. We conclude that MRI with axial scans completed by coronal oblique planes is a promising, non invasive method for imaging the anatomical features of Blalock-Taussig shunts.
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