MR imaging findings of endophthalmitis

Endophthalmitis is a sight-threatening ophthalmologic emergency. The clinical diagnosis is often challenging, and delayed diagnosis may exacerbate the poor visual prognosis. B-scan ultrasonography or spectral domain optical coherence tomography are imaging aids at the clinician\u27s office. Cross-sectional imaging such as CT and particularly MRI can also help in the assessment of disease extent or complications. MR imaging findings are rarely described in the literature. Here, we discuss the spectrum of imaging findings of endophthalmitis and correlate them with key anatomic and pathophysiologic details of the globe. Early disease is often subtle on MR imaging with thick uveal enhancement, while advanced disease demonstrates retinal/choroidal detachment, vitreal exudates and peribulbar inflammation. Other noninfectious inflammatory diseases of the globe can show similar findings; however, MR diffusion-weighted images help identify infectious exudates and evaluate response to therapy. Knowledge of the spectrum of imaging findings of this disease is important for radiologists and help in the management decision process

A Difficult Day with Double Trouble (.pdf)

"A 59 year old woman with a history of hypothyroidism, an inner ear implant and lupus (complicated by autoimmune hemolytic anemia and raynaud's disease) presented with 1 week of intermittent horizontal binocular diplopia. She denied headache and giant cell arteritis symptomatology. Examination demonstrated normal afferent function, full ductions and an incomitant esotropia worse in right gaze. She was diagnosed with a subtle microvascular right sixth nerve palsy. Two weeks later, she developed intractable bifrontal headaches and photosensitivity. On neuro-ophthalmic evaluation she had bilateral limitation of abduction, left greater than right, and slight limitation of elevation of both eyes. A head CT with enhancement demonstrated slightly enlarged extraocular muscles and crowding of the orbital apex bilaterally. Bloodwork was significant for a slightly elevated WBC count with a longstanding microcytic anemia (Hb 10.4) and thrombocytosis. Thyroid function studies and myasthenia gravis work-up was normal. However, antithyroglobulin antibody was elevated at 59 (N<2). Thyroid orbitopathy was considered a probable diagnosis at this time. However, the patient's complaint of relentless headaches prompted persuing an MRI brain and orbits with contrast that demonstrated diffuse pachymeningeal enhancement, abnormal enhancing soft tissues in the orbital apices bilaterally particularly surrounding the intercanalicular segments of the optic nerves and enlarged enhancing extraocular muscles. Lumbar puncture demonstrated an opening pressure of 24 cm H20 with normal constituents. Blood ACE, lysozyme, RPR, VDRL, ANCAs, complement level and inflammatory markers were unremarkable. The patient improved significantly upon solumedrol although diagnosis was unclear. An immunoglobulin and IgG4 level was ordered and the serum IgG4 level was significantly elevated.

Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association

BACKGROUND: The use of ultrasound-guided ablation procedures to treat both benign and malignant thyroid conditions is gaining increasing interest. This document has been developed as an international interdisciplinary evidence-based statement with a primary focus on radiofrequency ablation and is intended to serve as a manual for best practice application of ablation technologies. METHODS: A comprehensive literature review was conducted to guide statement development and generation of best practice recommendations. Modified Delphi method was applied to assess whether statements met consensus among the entire author panel. RESULTS: A review of the current state of ultrasound-guided ablation procedures for the treatment of benign and malignant thyroid conditions is presented. Eighteen best practice recommendations in topic areas of preprocedural evaluation, technique, postprocedural management, efficacy, potential complications, and implementation are provided. CONCLUSIONS: As ultrasound-guided ablation procedures are increasingly utilized in benign and malignant thyroid disease, evidence-based and thoughtful application of best practices is warranted