Wassef B, Masry M, Ghali M
… +2 more, Makaryus JN, Makaryus AN
Case Rep Radiol
· 2022 · PMID 35223124
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Dynamic imaging of heart valves and specifically prosthetic valves is a central benefit of echocardiography. Most bioprosthetic heart valves degenerate over a given time and hence require repeat valve replacement which c...Dynamic imaging of heart valves and specifically prosthetic valves is a central benefit of echocardiography. Most bioprosthetic heart valves degenerate over a given time and hence require repeat valve replacement which carries a significant risk of morbidity and mortality. Reoperation is the standard of care and may still be required after the first successful surgery due to complications disrupting either mechanical or bioprosthetic valves. Such complications can be delayed or even prevented if optimal prosthesis selection is individualized according to patients' medical and postimplantation follow-up. We present the case of an 84-year-old woman where an open-heart valve-in-valve approach, implanting a mechanical valve in a failed bioprosthetic valve, produced a unique image on transthoracic echocardiography which needs to be recognized by imagers for appropriate patient diagnosis and management.
Vitellas C, Mangeb IB, Regalado L
… +1 more, Amadi CC
Case Rep Radiol
· 2021 · PMID 34888110
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Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreat...Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.
Jrad M, Zlitni H, Boumediene M
… +2 more, Nasr AB, Bouzrara M
Case Rep Radiol
· 2021 · PMID 34853709
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Inner ear hemorrhage is an extremely rare cause of sudden sensorineural hearing loss with few cases reported in the literature. We report the case of a 30-year-old male who presented with a sudden left ear hearing loss,...Inner ear hemorrhage is an extremely rare cause of sudden sensorineural hearing loss with few cases reported in the literature. We report the case of a 30-year-old male who presented with a sudden left ear hearing loss, with no tinnitus nor vertigo. The audiogram revealed a profound left sensorineural hearing loss. An MRI of the brain and internal auditory canal was performed 3 weeks after and revealed an increased signal intensity on T1-weighted (T1W) and T2 fluid-attenuated inversion recovery (FLAIR) images in the left cochlea. No other abnormalities were found, in particular no enhancement after intravenous administration of gadolinium. The CISS 3D sequence showed a signal of discreetly lower intensity in the left cochlea compared to the right one. The diagnosis of intracochlear hemorrhage was made. No improvement of the hearing loss has been noted after medical treatment and hyperbaric oxygen therapy.
Kanj A, Ayoub A, Aljoubaie M
… +4 more, Kanj A, Mohanna A, Chehade F, Rouhana G
Case Rep Radiol
· 2021 · PMID 34820144
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Expansion of a primary spontaneous intracranial hemorrhage (PSICH) has become lately of increasing interest, especially after the emergence of its early predictors. However, these signs lacked sensitivity and specificity...Expansion of a primary spontaneous intracranial hemorrhage (PSICH) has become lately of increasing interest, especially after the emergence of its early predictors. However, these signs lacked sensitivity and specificity. The flood phenomenon, defined as a drastic increase in the size of a PSICH during the same magnetic resonance study, was first described in this paper based on the data of a university medical center in Lebanon. Moreover, further review of this data resulted in 205 studies with presumed diagnosis of primary spontaneous intracranial hemorrhage within the last 10 years, of which 29 exams showed typical predictors of hematoma expansion on computed tomography. The intended benefit of this observation is to draw the radiologists' attention towards minimal variations in the volume of the hematoma between the two extreme sequences of the same MRI study, in order to detect inconspicuous flood phenomena-a direct sign of hematoma expansion.
Bellew E, Lee S, Hiren Patel
… +3 more, Levy CF, Goldfisher R, Amodio J
Case Rep Radiol
· 2021 · PMID 34796034
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We present a 14-year-old boy with peritoneal epithelial malignant mesothelioma (PEMM). While pathology is required to make this diagnosis, radiology plays a crucial role throughout the clinical course of this disease. Th...We present a 14-year-old boy with peritoneal epithelial malignant mesothelioma (PEMM). While pathology is required to make this diagnosis, radiology plays a crucial role throughout the clinical course of this disease. The key imaging characteristics of peritoneal mesothelioma have been previously well-described in the adult population, but there are rare reports in the pediatric population. This pediatric report highlights the multidimensional use of imaging in this disease, from the initial evaluation to therapeutic supplementation and subsequent follow-up.
Case Rep Radiol
· 2021 · PMID 34721918
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COVID-19 has various imaging manifestations, most commonly peripheral ground-glass opacities with a basilar posterior predominance. Less common imaging manifestations include consolidations, findings typical of organizin...COVID-19 has various imaging manifestations, most commonly peripheral ground-glass opacities with a basilar posterior predominance. Less common imaging manifestations include consolidations, findings typical of organizing pneumonia, such as "halo" or a "reverse halo" sign, and vascular enlargement. Our case describes a "target sign" on CT, which is uncommon but is increasingly being recognized. The target sign consists of a central nodular opacity with surrounding ground-glass opacity, then a surrounding relatively lucent ring, and a more peripheral ring of consolidation or ground-glass opacification. This may be the sequela of focal vascular enlargement, endothelial injury, microangiopathy, and perivascular inflammation. The case described involves a 46-year-old male who presented with subjective fevers, nonproductive cough, and hypoxia, subsequently diagnosed with COVID-19. CT imaging performed as part of initial work-up revealed multifocal ground-glass opacities scattered throughout the lung parenchyma, as well as multiple target sign lesions. Although it is a rare finding, the target sign, when present, may suggest the diagnosis of COVID-19.
Maaloul I, Moussaoui M, Salah A
… +4 more, Feki W, Fourati H, Charfi N, Mnif Z
Case Rep Radiol
· 2021 · PMID 34671496
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INTRODUCTION: Meningeal melanocytoma (MM) is a very rare neuroectodermal neoplasm arising from the leptomeninges. Primary suprasellar melanocytomas are exceedingly rare, with only a handful of cases reported. The systemi...INTRODUCTION: Meningeal melanocytoma (MM) is a very rare neuroectodermal neoplasm arising from the leptomeninges. Primary suprasellar melanocytomas are exceedingly rare, with only a handful of cases reported. The systemic spread of a nontransformed meningeal melanocytoma is an unusual occurrence. Herein, we report the first case of a primary sellar melanocytoma with cerebral and spinal meningeal seeding. . A 30-year-old male with no previous medical history presented to the endocrinology department with a loss of body hair. The endocrine workup concluded with isolated hypogonadotropic hypogonadism. The Magnetic Resonance Imaging (MRI) of the brain and sella revealed a large suprasellar mass continuous with the infundibulum of the pituitary gland. It was heterogeneously hyperintense on T1-, T2-, and FLAIR-weighted images and was enhanced with contrast, along with cerebral and spinal leptomeningeal spread. The patient was referred to the neurosurgery department, and a lumbar spine biopsy was indicated. The histopathological examination was suggestive of a grade I meningeal pigmented melanocytoma. CONCLUSION: Thus, primary sellar melanocytomas with leptomeningeal spread are an extremely rare phenomenon. Metastatic malignant melanoma should be ruled out. Being aware of differential diagnosis and the unusual behavior of meningeal melanocytoma will be necessary to manage the patient appropriately. Complete tumor resection is the best treatment whenever possible, and radiotherapy should be considered in case of unresectability or partial resection.
Matsushima H, Kageyama K, Yamamoto A
… +8 more, Jogo A, Sohgawa E, Nota T, Murai K, Ogawa S, Nakano M, Shimono T, Miki Y
Case Rep Radiol
· 2021 · PMID 34426775
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Uterine artery embolization (UAE) is a type of noninvasive treatment for symptomatic uterine fibroids. One of the complications of UAE is fibroid expulsion. Here, we report a case of a 45-year-old woman who underwent UAE...Uterine artery embolization (UAE) is a type of noninvasive treatment for symptomatic uterine fibroids. One of the complications of UAE is fibroid expulsion. Here, we report a case of a 45-year-old woman who underwent UAE for an intramural fibroid, which resulted in fibroid expulsion. To the best of our knowledge, there are only few reports of expulsion of intramural fibroids. The process of fibroid protrusion from the myometrium into the uterine cavity was depicted on magnetic resonance imaging (MRI) in this case. We discuss the risk factors and mechanisms of fibroid expulsion after UAE.
Case Rep Radiol
· 2021 · PMID 34422426
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A 60-year-old female presented for further assessment of a new right breast lump (November 2020). She had a history of a stage I (T1bN0M0) right breast invasive mammary carcinoma, grade 2 (score 7/9) with receptors ER/PR...A 60-year-old female presented for further assessment of a new right breast lump (November 2020). She had a history of a stage I (T1bN0M0) right breast invasive mammary carcinoma, grade 2 (score 7/9) with receptors ER/PR-negative, HER2/neu-positive, diagnosed four years prior to her current presentation. At that time, she was treated with a right breast lumpectomy and local radiation. Breast assessment with contrast-enhanced mammography showed new skin thickening with associated enhancement within the palpable region. Histology of subsequent ultrasound-guided biopsy found radiation-induced breast angiosarcoma. Breast angiosarcoma is a rare entity that represents less than 1% of all breast cancers. To our knowledge, this is the first case describing the imaging findings of breast angiosarcoma on contrast-enhanced mammography.
Abate A, Querques G, Giovanazzi R
… +6 more, Di Bella C, Besostri V, Gisabella M, Maino C, Ippolito D, Corso R
Case Rep Radiol
· 2021 · PMID 34367709
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We report the case of a 45-year-old woman with a slow-growing palpable nodule on the left breast, confirmed as a well-defined opacity on mammography, corresponding to a 5 cm hyperechoic lesion on ultrasound, and consider...We report the case of a 45-year-old woman with a slow-growing palpable nodule on the left breast, confirmed as a well-defined opacity on mammography, corresponding to a 5 cm hyperechoic lesion on ultrasound, and considered, on the basis of clinical examination and radiological findings, to be consistent with a lipoma. One year later, the patient represented with an enlarged left breast mass and underwent further imaging investigation with subsequent diagnosis of primary breast angiosarcoma obtained via a Vacuum-Assisted Breast Biopsy. The patient developed metastatic disease and succumbed to the disease one year after definitive diagnosis. Primary breast angiosarcoma is a rare malignant vascular neoplasia, characterized by aggressive patterns, poor prognosis, and absence of pathognomonic radiological features. Currently, there are no evidence-based guidelines regarding treatment, even though wide surgical resection followed by chemo- and radiotherapy appears to improve survival.
Ferreira C, Fraga J, Antunes C
… +2 more, Gonçalo M, Donato P
Case Rep Radiol
· 2021 · PMID 34194862
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Ovarian cancer is the most fatal gynecologic malignancy. The incidence of ovarian cancer among female-to-male transsexuals receiving treatment with testosterone is unknown, and few cases have been reported in the literat...Ovarian cancer is the most fatal gynecologic malignancy. The incidence of ovarian cancer among female-to-male transsexuals receiving treatment with testosterone is unknown, and few cases have been reported in the literature. We report a recent case in our institution, a 23-year-old female-to-male transsexual patient who received testosterone supplementation. The patient underwent a pelvic magnetic resonance imaging to study an ovarian complex cyst that revealed the presence of a bilateral ovarian tumor with imaging features of borderline serous tumor. These masses were surgically removed and the pathology report confirmed the diagnosis associated with noninvasive peritoneal implants and the presence of numerous androgen receptors in the tumor cells. Although there is still insufficient data to validate a direct correlation between hormonotherapy and ovarian cancer in these patients, this case may reinforce previous reports on this association and highlights the relevance of radiological follow-up and bilateral salpingo-oophorectomy as part of gender reassignment surgery.
Pakray A, Hayden N, Sokhandon F
… +1 more, Olsen J
Case Rep Radiol
· 2021 · PMID 34136301
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We demonstrate a rare case of inferior mesenteric artery arteriovenous malformations leading to ischemic colitis in a 76-year-old female. Our patient presented with three months of nausea, vomiting, and diarrhea. Colonos...We demonstrate a rare case of inferior mesenteric artery arteriovenous malformations leading to ischemic colitis in a 76-year-old female. Our patient presented with three months of nausea, vomiting, and diarrhea. Colonoscopy displayed diffuse mucosal vascular congestion while CTA and MRA displayed AVMs in the region of the IMA; however, cohesive clinical agreement on AVM from multiple specialties was difficult given its rare occurrence and nonspecific clinical, histopathologic, and directly visualized findings. The three noted dominant AVMs were eventually selected with coil and liquid embolization with successful cessation of symptoms and no major complications. Our discussion focuses on intervention and stressing the importance of radiologic findings, as IMA AVMs, rarely present as ischemic colitis and therefore can clinically masquerade as other etiologies.
Case Rep Radiol
· 2021 · PMID 34094613
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Cerebral cavernous malformations (CCMs) are dilated blood vessels which can develop sporadically or in familial form and are the commonest malformations of blood vessels in the spinal cord and brain. The familial form is...Cerebral cavernous malformations (CCMs) are dilated blood vessels which can develop sporadically or in familial form and are the commonest malformations of blood vessels in the spinal cord and brain. The familial form is an autosomal dominant gene mutation disorder. This condition can be diagnosed with magnetic resonance imaging (MRI) and computed tomography (CT) scan, but the modality of choice is MRI because of its high sensitivity. We report a case of a 73-year-old woman with an asymptomatic multiple familial cerebral cavernous malformation (FCCM) which was previously misdiagnosed as multiple cerebral metastases on CT scan. A brain MRI performed correctly diagnosed her condition as FCCM based on the typical MRI appearances. In order not to misdiagnose brain lesions like CCM on CT scan, for cerebral metastases in resource-poor settings, radiologists must recommend advanced imaging modalities like MRI for further evaluation, thereby avoiding unnecessary invasive surgical biopsies.
Choayb S, Adil H, Ali Mohamed D
… +3 more, Allali N, Chat L, El Haddad S
Case Rep Radiol
· 2021 · PMID 34040814
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Pantothenate kinase-associated neurodegeneration (PKAN) is a rare disorder associated with brain iron accumulation caused by a recessive mutation in pantothenate kinase 2 gene (PANK2). We present a case of an 11 year-old...Pantothenate kinase-associated neurodegeneration (PKAN) is a rare disorder associated with brain iron accumulation caused by a recessive mutation in pantothenate kinase 2 gene (PANK2). We present a case of an 11 year-old boy presenting extrapyramidal signs and developmental regression. T2-weighted images showed the classic eye of the tiger sign seen in pantothenate kinase-associated neurodegeneration.
Ali HOE, Ghorab T, Cameron IR
… +1 more, Marzouk AMSM
Case Rep Radiol
· 2021 · PMID 34040813
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Worldwide breast malignancy is the most common cancer in women; however, metastases to the breast from extramammary malignancies are very rare and only a few sporadic cases are reported in the international literature. I...Worldwide breast malignancy is the most common cancer in women; however, metastases to the breast from extramammary malignancies are very rare and only a few sporadic cases are reported in the international literature. In this article, the authors report a case of a 73-year-old woman, who underwent nephrectomy for clear cell renal cell carcinoma and 3 years later presented with a breast metastasis from renal cell carcinoma (clear cell type).
Case Rep Radiol
· 2021 · PMID 33815859
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Fistulous communications between the ventricular cavities and the coronary arterial tree can be found in the presence of hypoplasia of the left ventricle, especially when the ventricular septum is intact and mitral steno...Fistulous communications between the ventricular cavities and the coronary arterial tree can be found in the presence of hypoplasia of the left ventricle, especially when the ventricular septum is intact and mitral stenosis and aortic atresia subtype are present. The cardiac CT provides excellent anatomic information especially in the evaluation of extracardiac vessels and coronary arteries. In this case study, we report a newborn with ventriculocoronary fistulas (VCFs) with the hypoplastic left disease diagnosed with cardiac CT. Transthoracic echocardiography of a term baby showed hypoplastic left heart syndrome (HLHS) with mitral stenosis and aortic atresia. The patient immediately underwent a Sano variation of the Norwood procedure. On the postoperative second day, the clinical status of the patient deteriorated. A prospective electrocardiogram-gated axial technique was performed within a single heartbeat for the patient and large VCFs were detected and a second operation were performed to close the VCFs that failed. On the nineteenth day after the operation, the baby passed away. According to us, cardiac CT can also be performed free-breathing and without anesthesia in the neonatal period for the definition of complex cardiac anatomy with the lower radiation dose from the latest scanners, radiation risk of CT should be weighed against the anesthesia risk of cardiac MRI and intraoperative risk of conventional cardiac angiography. Pre-operative cardiac CT may increase surgical success.
Sabawi M, Alhasson A, Abualruz AR
… +1 more, Al-Taie AA
Case Rep Radiol
· 2021 · PMID 33815858
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INTRODUCTION: Obesity is one of the leading causes of morbidity and mortality in countries all over the world, and its prevalence has been increasing dramatically in recent years. Bariatric surgery is considered the gold...INTRODUCTION: Obesity is one of the leading causes of morbidity and mortality in countries all over the world, and its prevalence has been increasing dramatically in recent years. Bariatric surgery is considered the gold standard of care for patients who failed conservative management. Laparoscopic sleeve gastrectomy (LSG) is of increasing popularity. One of its vicious consequences is the development of acquired fistula between the stomach and the tracheobronchial tract due to intractable gastric leak. . We are presenting a case of a 25-year-old man who underwent laparoscopic sleeve gastrectomy for morbid obesity, which was complicated with the development of gastrobronchial fistula, despite an unremarkable postoperative course. CONCLUSION: Acquired gastrobronchial fistula due to bariatric surgery is not reported widely in radiologic literature; hence, there is lack of consensus of the diagnostic modality of choice. However, there is a myriad of tests available for diagnosing gastrobronchial fistula, with contrast study of the upper gastrointestinal tract which is the widely accepted diagnostic test.
Case Rep Radiol
· 2021 · PMID 33763277
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The development of inoperable biliary obstruction in patients with liver, biliary, and pancreatic neoplasia is commonplace particularly in the advanced stages of these diseases. Under these circumstances, restoring bile...The development of inoperable biliary obstruction in patients with liver, biliary, and pancreatic neoplasia is commonplace particularly in the advanced stages of these diseases. Under these circumstances, restoring bile flow to the gut is paramount in reestablishing homeostasis. Hitherto, this has been achieved by utilizing passive, gravity-dependent bilioenteric conduits with the use of perforated plastic catheters or metallic stents inserted either in a percutaneous transhepatic fashion or via endoscopic techniques. A frequent untoward event of biliary decompression utilizing percutaneous transhepatic catheters (PTC) is the development of pain, cholangitis, hyperbilirubinemia, or pericatheter bile leak due to the suboptimal normalization of bile flow. In some instances, the etiology of PTC malfunction can be correctly ascribed to catheter malposition and/or catheter lumen obstruction; however, in the majority, it remains radiographically occult on transcatheter cholangiography-the "gold standard." Regardless of findings, the management remains fluoroscopic repositioning or exchanges for larger diameter catheters to attempt to seal the pericatheter potential space and prevent bile seepage. Unfortunately, these maneuvers are met with limited and unpredictable levels of success. We present the successful management of an instance of recalcitrant external pericatheter bile leak mitigated by employing a hybrid closed loop biliary catheter-pump system by employing an assortment of FDA approved off-the-shelf medical devices.
Abouhanine O, Belgadir H, Ndayishimiye V
… +4 more, Amriss O, Merzem A, Moussali N, El Benna N
Case Rep Radiol
· 2021 · PMID 37601337
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Brachial plexus lesions most often occur in multiple trauma. We report a case of a 37-year-old patient who presented an upper left limb total sensitivomotor deficit and amyotrophy after a cervical and upper limb trauma....Brachial plexus lesions most often occur in multiple trauma. We report a case of a 37-year-old patient who presented an upper left limb total sensitivomotor deficit and amyotrophy after a cervical and upper limb trauma. Cervical magnetic resonance imaging (MRI) was performed. It noted pseudomeningoceles at the levels of C6-C7, C7-D1, and D1-D2 in T1 hyposignal , T2 and STIR hypersignal , not enhanced by the injection of Gadolinium extending in foraminal and extraforaminal spaces without visualization of the corresponding rootlets. Traumatic brachial plexus injury is a potentially serious debilitating injury which can be well explored on MRI.
Smarda M, Manes K, Fagkrezos D
… +4 more, Argiropoulos D, Laios K, Triantopoulou C, Maniatis P
Case Rep Radiol
· 2021 · PMID 33628566
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A 65-year-old woman with a long surgical history was referred to our hospital's Colorectal Unit for ileostomy management. The patient retained an ileostomy for almost a decade after a series of complicated operations she...A 65-year-old woman with a long surgical history was referred to our hospital's Colorectal Unit for ileostomy management. The patient retained an ileostomy for almost a decade after a series of complicated operations she had undergone, which had several side effects such as electrolyte imbalances, high output, weight loss, and a parastomal hernia. Our hospital's colorectal surgeon proposed to replace the ileostomy with a permanent sigmoidostomy and asked for an imaging evaluation of the parastomal hernia content before the surgery. A computed tomography of the abdomen was performed using our Computed Tomography Department's 64-detector row CT scanner after oral administration of contrast media, without intravenous contrast media injection due to allergy. Concerning the parastomal ileostomal hernia, besides small bowel loops with intraluminal gastrografin, inside the parastomal hernial sac, there also was an almost rounded cystic lesion. Absence of the gallbladder at its typical position and no record of cholecystectomy raised suspicion for gallbladder projection inside the sac. Our suspicion was confirmed during the surgery. Nonexisting acute cholecystitis allowed easy reduction of the gallbladder along with the small bowel loops inside the peritoneal cavity, without proceeding to cholecystectomy at the same time. Finally, ileostomy was annulated and an end colostomy was established. Four days after the surgery, the patient was discharged from the hospital and was happy to live an almost normal life thereafter.