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Case Reports In Radiology[JOURNAL]

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An Uncommon Case of Bilateral Breast Enlargement Diagnosed as Tumoral Pseudoangiomatous Stromal Hyperplasia: Imaging and Pathological Findings.

Sollozo-Dupont I, Domínguez-Hernández HA, Pavón-Hernández C … +7 more , Villaseñor-Navarro Y, Shaw-Dulin R, Pérez-Sánchez VM, España-Ferrufino AJ, Álvarez-Guadarrama LM, Porras-Reyes FI, Pérez-Badillo MP

Case Rep Radiol · 2017 · PMID 29333311 · Full text

The incidence of reported pseudoangiomatous stromal hyperplasia (PASH), as well as the variability and severity of clinical presentations, is increasing in the literature. In parallel, several authors posit the need for... The incidence of reported pseudoangiomatous stromal hyperplasia (PASH), as well as the variability and severity of clinical presentations, is increasing in the literature. In parallel, several authors posit the need for an improved classification of PASH to avoid possible variables associated with this diagnosis. Here, we present a 25-year-old woman with PASH accompanied by severe bilateral and symmetrical breasts enlargement, highlighting an uncommon clinical presentation of PASH as much as the careful interdisciplinary review and correlation of histology and all available imaging studies to confirm the definitive diagnosis.

Pyogenic Odontoid Osteomyelitis with Sinus Thrombosis.

Aiyer R, Hwang J, Yu EH

Case Rep Radiol · 2017 · PMID 29214092 · Full text

71/F presented with left sided headaches and neck pain with nuchal rigidity progressively worsening over 3 weeks with no other neurologic symptoms. Odontoid osteomyelitis with epidural abscess was discovered on further w... 71/F presented with left sided headaches and neck pain with nuchal rigidity progressively worsening over 3 weeks with no other neurologic symptoms. Odontoid osteomyelitis with epidural abscess was discovered on further workup with neuroimaging. Concurrent jugular vein and transverse sinus venous thrombosis was also found and suspected to be secondary to the pyogenic odontoid osteomyelitis. Patient was treated with intravenous antibiotics for the osteomyelitis as well as intravenous heparin for the venous thrombosis. To our knowledge, this is the first case reported in literature of transverse sinus venous thrombosis secondary to odontoid osteomyelitis.

Superinfection of a Dead Hepatic Echinococcal Cyst with a Cutaneous Fistulization.

Cicero G, Blandino A, Ascenti G … +7 more , D'Angelo T, Frosina L, Visalli C, Salamone I, Marino MA, Cavallaro M, Mazziotti S

Case Rep Radiol · 2017 · PMID 29181218 · Full text

Cystic echinococcosis (CE), also known as "hydatid disease" (HD), is a zoonotic infection caused by the larval stage of , which infects humans as intermediate hosts through the orofecal route. Carried by the intestinal v... Cystic echinococcosis (CE), also known as "hydatid disease" (HD), is a zoonotic infection caused by the larval stage of , which infects humans as intermediate hosts through the orofecal route. Carried by the intestinal venous blood, the embryos released by the eggs of the tapeworms can reach every organ, especially the liver, turning into a hydatid cyst. Usually asymptomatic, the cysts can be incidentally detected through radiological examinations performed for other reasons. We show an unusual case of superinfection of a hydatid cyst with typical radiological features of inactivity (WHO-type CE5) with an even rarer skin fistulization passing through a subcutaneous-abdominal abscess involving the right iliac muscle.

Traumatic Haemorrhagic Cervical Lymphadenopathy with Underlying Infectious Mononucleosis.

Rahmani G, Power S

Case Rep Radiol · 2017 · PMID 29181217 · Full text

A 16-year-old male presented to the Emergency Department with a painful 3 × 3 cm left-sided neck swelling six hours following blunt trauma to the neck from a heavy swinging door. A CT angiogram was performed which reveal... A 16-year-old male presented to the Emergency Department with a painful 3 × 3 cm left-sided neck swelling six hours following blunt trauma to the neck from a heavy swinging door. A CT angiogram was performed which revealed a large haemorrhagic lymph node as well as generalised cervical lymphadenopathy. The patient was eventually diagnosed with infectious mononucleosis. This case report describes a rare case of traumatic haemorrhagic cervical lymphadenopathy with an underlying diagnosis of infectious mononucleosis.

Endovascular Repair with a Stent Graft in a Patient with Aortoduodenal Fistula after Radiation Therapy.

Morikawa K, Ashida H, Nozawa Y … +5 more , Motohashi K, Igarashi T, Ojiri H, Kanaoka Y, Ohki T

Case Rep Radiol · 2017 · PMID 29181216 · Full text

Primary aortoduodenal fistula (ADF) is a direct communication between the abdominal aorta and the gastrointestinal tract without any previous vascular intervention and represents a rare but critical cause of repeated and... Primary aortoduodenal fistula (ADF) is a direct communication between the abdominal aorta and the gastrointestinal tract without any previous vascular intervention and represents a rare but critical cause of repeated and massive gastrointestinal bleeding. Primary ADF often occurs as a result of atherosclerotic aneurysm and infection, but ADF involving a normal-size aorta is rare; furthermore, ADF related to radiation therapy is extremely rare. We present the case of a 56-year-old man with a history of bowel obstruction due to radiation enteritis who was admitted with severe hematemesis and hemorrhagic shock. Gastroduodenal endoscopy and contrast-enhanced computed tomography findings were unremarkable. Aortoduodenal fistula was suspected based on the diffuse calcification of the abdominal aorta confined to the radiation field and the presence of an aortoduodenal communication on angiography. Endovascular repair with a stent graft seemed to be a safer option than open surgery and was suited to the rapid control of bleeding from ADF because of the patients' unstable hemodynamic state and the presence of intestinal adhesions. The fistula was successfully sealed by endovascular stent graft placement. Hematemesis did not recur postoperatively and anemia gradually improved. The patient died from pneumonia 33 days later.

Carotidynia: A Rare Diagnosis for Unilateral Neck Pain Revealed by Cross-Sectional Imaging.

Santarosa C, Stefanelli S, Sztajzel R … +2 more , Mundada P, Becker M

Case Rep Radiol · 2017 · PMID 29147596 · Full text

Idiopathic carotidynia (IC) is a rare and poorly understood syndrome consisting of unilateral neck pain, tenderness, and increased pulsations over the affected carotid bifurcation. A growing body of evidence supports the... Idiopathic carotidynia (IC) is a rare and poorly understood syndrome consisting of unilateral neck pain, tenderness, and increased pulsations over the affected carotid bifurcation. A growing body of evidence supports the hypothesis that IC is a distinct clinicopathologic entity with characteristic imaging features. We report the case of a 34-year-old Caucasian male presenting with intense unilateral neck pain in the emergency setting. Computed tomography and ultrasonography revealed fusiform eccentric thickening of the ipsilateral carotid bifurcation without vessel narrowing. Contrast-enhanced magnetic resonance imaging depicted major perivascular enhancement without evidence of dissection. Further imaging and laboratory work-up excluded vasculitis. The diagnosis of IC was made. The patient was treated with nonsteroidal anti-inflammatory drugs and symptoms and imaging findings disappeared within a few weeks. Cross-sectional imaging allows not only ruling out IC mimickers but also making the correct diagnosis of this rare condition, in particular, as the clinical presentation of IC is often nonspecific.

Radiological Diagnosis of a Rare Premature Aging Genetic Disorder: Progeria (Hutchinson-Gilford Syndrome).

Nazir HM, Ramesh Baabhu A, Muralidharan Y … +1 more , Cheppala Rajan S

Case Rep Radiol · 2017 · PMID 29138706 · Full text

Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare disease with a combination of short stature, bone abnormalities, premature ageing, and skin changes. Though the physical appearance of these patients is characteristi... Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare disease with a combination of short stature, bone abnormalities, premature ageing, and skin changes. Though the physical appearance of these patients is characteristic, there is little emphasis on the characteristic radiological features. In this paper, we report a 16-year-old boy with clinical and radiological features of this rare genetic disorder. He had a characteristic facial appearance with a large head, large eyes, thin nose with beaked tip, small chin, protruding ears, prominent scalp veins, and absence of hair.

A Case of Ruptured Pulmonary Hydatid Cyst of the Liver and Review of the Literature.

Bulut N, Dagıstanlı S

Case Rep Radiol · 2017 · PMID 29098107 · Full text

BACKGROUND: Hydatid cyst is an endemic disease frequently localized to the liver. It is frequently observed in Southeast Europe, Middle East, and Turkey. Although the cyst rupture can occur spontaneously, it can also occ... BACKGROUND: Hydatid cyst is an endemic disease frequently localized to the liver. It is frequently observed in Southeast Europe, Middle East, and Turkey. Although the cyst rupture can occur spontaneously, it can also occur upon albendazole treatment. Its surgical treatment includes cystotomy, capitonnage, and wedge resection. MATERIAL-METHOD: A 56-year-old male immigrant was admitted with fever, pain, and cough. Albendazole treatment was initiated and elective surgery was planned. Upon his admission to emergency service, he was diagnosed with pneumonia, and a spontaneous cyst rupture was detected. RESULT: Thoracotomy and cystotomy were performed. Bile leakage aspiration and lung wedge resection were also performed. CONCLUSION: Different surgical methods are used in the treatment of hydatid cysts depending on the localization and complications. Follow-up with antihelminthic drugs such as albendazole and mebendazole is recommended in medical treatment.

Primary Neuroendocrine Breast Carcinoma in a 13-Year-Old Girl: Ultrasonography and Pathology Findings.

Tchaou M, Darré T, Folligan K … +6 more , Sabi A, Sonhaye L, Boumé A, Bassowa A, Adani-Ifé S, Napo-Koura G

Case Rep Radiol · 2017 · PMID 29082059 · Full text

Neuroendocrine carcinoma (NEC) of the breast is a rare disease and has been scarcely reported by African authors. The authors report a case of breast NEC in a 13-year-old African girl initially diagnosed as an atypical a... Neuroendocrine carcinoma (NEC) of the breast is a rare disease and has been scarcely reported by African authors. The authors report a case of breast NEC in a 13-year-old African girl initially diagnosed as an atypical adenofibroma by ultrasonography. Ultrasound-guided biopsy and conventional histological examination indicated two potential diagnoses: primary malignant non-Hodgkin's lymphoma and undifferentiated carcinoma. According to immunohistochemistry performed on paraffin blocks in France, infiltrating ductal carcinoma with a strong neuroendocrine component was confirmed by CD56, CD57, and chromogranin A markers.

Imaging, Histopathologic, and Treatment Nuances of Pulmonary Carcinosarcoma.

Gleason T, Haas M, Le BH

Case Rep Radiol · 2017 · PMID 29075544 · Full text

A 76-year-old female with coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus type II, and 40 pack-year smoking history presented with a four-day history of cough, productive of green-yellow... A 76-year-old female with coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus type II, and 40 pack-year smoking history presented with a four-day history of cough, productive of green-yellow sputum. Chest X-ray revealed opacification of the left upper lung field, and computed tomography (CT) of the chest showed a large cavitary lesion invading the T2-T3 vertebral bodies, extending into the epidural space, giving rise to mild cord compression. Biopsy of the lesion revealed a poorly differentiated neoplasm composed of distinct epithelial and mesenchymal components, consistent with carcinosarcoma. A metastatic workup was negative. Primary lung carcinosarcoma is a rare tumour that can demonstrate an especially aggressive clinical course; diagnosis is often nuanced by limited sampling at initial presentation, especially in a setting of advanced disease and debility that precludes consideration for upfront resection or more extensive, invasive sampling.

Prenatal and Postnatal Sonographic Confirmation of Congenital Absence of the Ductus Venosus in a Child with Noonan Syndrome.

Newman CL, Wanner MR, Brown BP

Case Rep Radiol · 2017 · PMID 29057136 · Full text

The ductus venosus serves as an important vascular pathway for intrauterine circulation. This case presents a description of an absent ductus venosus in a female patient with Noonan syndrome, including both prenatal and... The ductus venosus serves as an important vascular pathway for intrauterine circulation. This case presents a description of an absent ductus venosus in a female patient with Noonan syndrome, including both prenatal and postnatal imaging of the anomaly. In the setting of the anomalous vascular connection, the umbilical vein courses inferiorly to the iliac vein in parallel configuration with the umbilical artery. This finding was suspected based on prenatal imaging and the case was brought to attention when placement of an umbilical catheter was thought to be malpositioned given its appearance on radiography. Ultrasound imaging confirmed the anomalous course. This is in keeping with prior descriptions in the literature of an association between Noonan syndrome and aberrant umbilical venous drainage. This case illustrates the need for awareness of this condition by the radiologist, allowing for identification on radiographs and the recommendation for further confirmatory imaging. Further, the case illustrates the value of paying particular attention to the fetal course of the umbilical vessels in patients with suspected Noonan syndrome, as this population is particularly at risk for anomalous vasculature.

The Monitoring of Preoperative External Detorsion with Diffusion-Weighted Imaging in a Patient with Acute Testicular Torsion.

Beyazal M, Beyazal Çeliker F, İnecikli MF … +3 more , Kadioğlu ME, Aydın HR, Durakoğlugil T

Case Rep Radiol · 2017 · PMID 28932616 · Full text

Testicular torsion is one of the main causes of acute scrotum and may result in permanent damage of the testicular tissue. Color Doppler imaging has been frequently used in the diagnosis of testicular torsion and posttre... Testicular torsion is one of the main causes of acute scrotum and may result in permanent damage of the testicular tissue. Color Doppler imaging has been frequently used in the diagnosis of testicular torsion and posttreatment follow-up period of the disease. There are some studies reporting the value and usefulness of diffusion-weighted imaging in the diagnosis of testicular torsion. However, to the best of our knowledge, there is no report regarding the monitoring of preoperative external detorsion in testicular torsion with diffusion-weighted imaging examination. In this article, diffusion-weighted imaging findings in the management of preoperative external detorsion in a case with testicular torsion were presented.

Breast Abscessed Cancer in Nonlactating Women in Tropical Environment: Radiological, Bacteriological, and Anatomopathological Features about 3 Cases.

Tchaou M, Darre T, Amavi AK … +5 more , Kanassoua KK, N'Timon B, Sonhaye L, Agoda-Koussema LK, Adjenou K

Case Rep Radiol · 2017 · PMID 28932615 · Full text

The association of breast cancer and abscess is rare in daily practice. The authors report a short series of 3 cases of cancer of the breast in nonlactating women presented as breast abscess, reviewing aspects in radiolo... The association of breast cancer and abscess is rare in daily practice. The authors report a short series of 3 cases of cancer of the breast in nonlactating women presented as breast abscess, reviewing aspects in radiology (ultrasound and mammography), correlating them with the histopathology findings and the bacteriological profile of the isolated germs.

A Rare Cause of Obstructive Sleep Apnea Syndrome: Retropharyngeal Lipoma.

Dilek O, Kaya O, Yilmaz C … +3 more , Soker G, Gulek B, Akin MA

Case Rep Radiol · 2017 · PMID 28912996 · Full text

Lipoma is the most common benign mesenchymal neoplasm. About 16% of lipomas arise in the head and neck region, especially in the posterior neck. Large lipomas that originate from the retropharyngeal space may cause dyspn... Lipoma is the most common benign mesenchymal neoplasm. About 16% of lipomas arise in the head and neck region, especially in the posterior neck. Large lipomas that originate from the retropharyngeal space may cause dyspnea, dysphagia, and snoring and occasionally may lead to obstructive sleep apnea syndrome (OSAS). Herein, we report a 45-year-old male patient with OSAS caused by a giant retropharyngeal lipoma with emphasis on CT findings.

New Insights about Pulmonary Epithelioid Hemangioendothelioma: Review of the Literature and Two Case Reports.

Mesquita RD, Sousa M, Trinidad C … +2 more , Pinto E, Badiola IA

Case Rep Radiol · 2017 · PMID 28884037 · Full text

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare neoplasm of vascular origin. There are three different major imaging patterns identified in thoracic manifestation of epithelioid hemangioendothelioma: (1) multi... Pulmonary epithelioid hemangioendothelioma (PEH) is a rare neoplasm of vascular origin. There are three different major imaging patterns identified in thoracic manifestation of epithelioid hemangioendothelioma: (1) multiple pulmonary nodules; (2) multiple pulmonary reticulonodular opacities; and (3) diffuse infiltrative pleural thickening. Radiographically, presence of bilateral multiple nodules is the most common pattern of presentation. The diagnosis is made on the basis of histopathological findings and confirmed by positive immunohistochemistry staining. Although the prognostic factors for PEH have not yet been well established, a better prognosis is usually associated with the multinodular pattern. We report two different imagological presentations of this rare disease, based on two institutional experiences, along with a review of the relevant literature.

Osteoblastic Metastases Mimickers on Contrast Enhanced CT.

Al-Lhedan F, Samaan S, Zeng W

Case Rep Radiol · 2017 · PMID 28815098 · Full text

Secondary osseous involvement in lymphoma is more common compared to primary bone lymphoma. The finding of osseous lesion can be incidentally discovered during the course of the disease. However, osseous metastases are i... Secondary osseous involvement in lymphoma is more common compared to primary bone lymphoma. The finding of osseous lesion can be incidentally discovered during the course of the disease. However, osseous metastases are infrequently silent. Detection of osseous metastases is crucial for accurate staging and optimal treatment planning of lymphoma. The aim of imaging is to identify the presence and extent of osseous disease and to assess for possible complications such as pathological fracture of the load-bearing bones and cord compression if the lesion is spinal. We are presenting two patients with treated lymphoma who were in complete remission. On routine follow-up contrast enhanced CT, there were new osteoblastic lesions in the spine worrisome for metastases. Additional studies were performed for further evaluation of both of them which did not demonstrate any corresponding suspicious osseous lesion. The patients have a prior history of chronic venous occlusive thrombosis that resulted in collaterals formation. Contrast enhancement of the vertebral body marrow secondary to collaterals formation and venous flow through the vertebral venous plexus can mimic the appearance of spinal osteoblastic metastases.

Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review.

Degheili JA, El Chediak A, Dergham MYR … +2 more , Al-Kutoubi A, Hallal AH

Case Rep Radiol · 2017 · PMID 28815097 · Full text

Pancreaticoduodenal artery aneurysms (PDA) are rare visceral aneurysms. Celiac trunk stenosis represents a common attributable aetiology for those aneurysms. Therefore, an alternative treatment approach, which differs fr... Pancreaticoduodenal artery aneurysms (PDA) are rare visceral aneurysms. Celiac trunk stenosis represents a common attributable aetiology for those aneurysms. Therefore, an alternative treatment approach, which differs from those isolated aneurysms, is recommended. We hereby present a 77-year-old male patient who was admitted with sudden onset of severe abdominal pain and significant drop in haemoglobin, occurring within a 24-hour interval. Contrast-enhanced computed tomography revealed a ruptured visceral aneurysm arising from the anterior branch of the inferior pancreaticoduodenal artery. A severe stenosis was also noted at the take-off of the celiac trunk. Selective catheterization of the supplying branch of the superior mesenteric artery, followed by coil embolization of the aneurysm, was performed, resulting in cessation of flow within the aneurysm, with preservation of the posterior branch, supplying the celiac territory. PDAs are usually asymptomatic and discovered incidentally at rupture. The risk of rupture is independent of the aneurysmal size and is associated with a 50% mortality rate. The consensus on coping with aneurysms is to treat them whenever they are discovered. Selective angiography followed by coil embolization represents a less invasive, and frequently definitive, approach than surgery. The risk for ischemia mandates that the celiac territory must not be compromised after embolization.

Spontaneous Hematoma of the Rectus Sheath: Urgent Embolization with Squidperi Liquid Embolic Device.

Torcia P, Rossi UG, Squarza S … +1 more , Cariati M

Case Rep Radiol · 2017 · PMID 28785502 · Full text

We treated a 78-year-old female affected by nontraumatic spontaneous rectus sheath hematoma. We decided to perform the embolization with the new liquid agent Squidperi. Complete exclusion of the bleeding vessel was obtai... We treated a 78-year-old female affected by nontraumatic spontaneous rectus sheath hematoma. We decided to perform the embolization with the new liquid agent Squidperi. Complete exclusion of the bleeding vessel was obtained without complications. Its use should be considered for treatment of nontraumatic rectus sheath hematoma.

Primary Osteosarcoma of the Breast Arising in an Intraductal Papilloma.

Alghofaily KA, Almushayqih MH, Alanazi MF … +2 more , Salamah AAB, Benediktsson H

Case Rep Radiol · 2017 · PMID 28713607 · Full text

INTRODUCTION: Primary osteosarcoma of the breast is extremely rare, and an osteosarcoma arising from an intraductal papilloma is exceptional. CASE PRESENTATION: A 72-year-old Saudi Arabian woman presented with a solid, b... INTRODUCTION: Primary osteosarcoma of the breast is extremely rare, and an osteosarcoma arising from an intraductal papilloma is exceptional. CASE PRESENTATION: A 72-year-old Saudi Arabian woman presented with a solid, bone-containing breast mass that was diagnosed as primary osteosarcoma of the breast on biopsy. She had a history of untreated intraductal papilloma. Treatment was completed with a modified mastectomy after excluding extramammary metastases. However, she subsequently developed multiple recurrent lesions at the same site. CONCLUSION: Primary osteogenic sarcomas of the breast are very rare. Although the main treatment is resection the optimal management remains uncertain and prognosis is poor.

Magnetic Resonance Enterography Findings of Intestinal Behçet Disease in a Child.

D'Angelo T, Gallizzi R, Romano C … +2 more , Cicero G, Mazziotti S

Case Rep Radiol · 2017 · PMID 28630777 · Full text

Behçet's disease (BD) is a multisystem disorder of unknown aetiology, characterized by recurrent oral ulcers, genital ulcers, uveitis, skin lesions, and pathergy. Gastrointestinal disease outside the oral cavity is well... Behçet's disease (BD) is a multisystem disorder of unknown aetiology, characterized by recurrent oral ulcers, genital ulcers, uveitis, skin lesions, and pathergy. Gastrointestinal disease outside the oral cavity is well recognized and usually takes the form of small intestinal ulcers, with the most significant lesions frequently occurring in the ileocaecal region. Symptoms usually include nausea, vomiting, colicky abdominal pain, and change in bowel habit and it is not unusual that patients may present late, with life-threatening complications requiring surgery. Diagnosis has been hindered for many years by limitations in imaging the small bowel and it is usually achieved by means of endoscopy and CT of the abdomen. Magnetic resonance enterography (MRE) is a relatively new technique, which has a high diagnostic rate in patients with Crohn's disease (CD). Although many similarities between CD and intestinal BD have already been described in literature, the role of MRE in the evaluation of intestinal BD has never been defined up to now. We report a case of a 12-year-old female patient with diagnosis of BD who presented at our institution for recurrent colicky abdominal pain and diarrhoea. The patient underwent MRE that demonstrated the gastrointestinal involvement.
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