External landmark puncture may be difficult in a considerable number of patients since the IJV might not be situated in the presumed location anteriorly or laterally to the CCA, or a normal lumen may not be present in approximately 1/3 of cancer patients. This study supports the use of ultrasound-guided techniques for central venous catheters particularly in haematological and oncological patients.

INTRODUCTIONThis report discusses the unique presentation and outcome of a patient with a conus medullaris enterogenous cyst. The incidence of enterogenous cysts, differential diagnosis, imaging, presentation, and management are discussed. The unique aspects of this case presentation include a patient of advanced age with an atypical enterogenous cyst at clinical presentation and postoperative motor recovery despite prolonged cord compression. CASE PRESENTATIONA 66-year-old white woman presented with a 2-year history of constant pain in her left anteromedial thigh and knee. She had experienced multiple falls due to left knee buckling, although she had experienced no specific left knee injury to cause the weakness. Due to this left lower extremity weakness, she required a walker to ambulate. There was no history of trauma, fever, back pain, recent weight loss, paresthesias, or changes in bowel or bladder. Her medical history was significant for obesity and hypothyroidism. Review of systems was otherwise unremarkable. Results of a physical examination revealed visible left thigh atrophy (thigh circumference was 6 cm smaller on the left side). Manual muscle testing demonstrated left iliopsoas and quadriceps strength of 2/5. Bilateral gluteus medius, hamstring, anterior tibialis, gastrocsoleus complex, and extensor hallucis longus strength, and right iliopsoas and quadriceps strength were all 5/5. Sensory examination was normal for light touch, pinprick, and vibration, with the exception of anesthesia in the left anterior and lateral thigh that extended to the proximal medial tibial region. Deep tendon reflexes were normal, with the exception of an absent left quadriceps reflex. Toes were downgoing bilaterally to plantar stimulation.Electrodiagnostic testing of the bilateral lower extremities and related paraspinals revealed a left L2-L4 radiculopathy (anterior limb muscles and posterior paraspinal denervation evident). There was no evidence of right lumbosacral radiculopathy or plexopathy. Magnetic resonance imaging (MRI) of the lumbar spine without contrast performed to evaluate for a presumed diskal-structural lesion revealed a cystic structure in the distal cord-conus medullaris. A thoracic spine MRI with contrast demonstrated an expansile lesion of T1 and T2 prolongation signal in the distal cord-conus medullaris that was approximately 15 ϫ 15 ϫ 40 mm in the anterior and posterior, transverse, and cephalocaudad diameter, without pathologic contrast enhancement (Figure 1).Initial conservative treatment included physical therapy, adaptive equipment, and observation because the patient was concerned about potential paraplegia with surgical intervention on the distal spinal cord. Needle electromyogram examination demonstrated the presence of active denervation of the left anterior thigh musculature. Physical therapy was initiated to strengthen the involved musculature, to instruct in compensatory gait mechanics and/or assistive device use, and to prevent falls. The strength of the left anterior thigh musculature did...

In a group of 25 patients the coronal views of plain and Gd-DTPA-enhanced MRI studies were correlated with CT and operative findings. All series included sagittal, transverse and coronal FLASH sequences (GE 500/6, flip angle 70 degrees), sagittal proton density-(SE 2500/15) and T2-(SE 2500/70) weighted images. MR diagnosis proved to be correct in all cases. Compared to CT and axial MRI herniated disk material in the lateral intravertebral space and its relationship to nerve roots was demonstrated more clearly on coronal views.