Case Rep Radiol
· 2018 · PMID 30363967
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Retroodontoid pseudotumor (ROP) is a nonneoplasic lesion of unknown etiology, commonly associated with inflammatory conditions, and the term of pannus is usually used. Less frequently, ROP formation can develop with othe...Retroodontoid pseudotumor (ROP) is a nonneoplasic lesion of unknown etiology, commonly associated with inflammatory conditions, and the term of pannus is usually used. Less frequently, ROP formation can develop with other noninflammatory entities, with atlantoaxial instability as most accepted pathophysiological mechanism for posttraumatic or degenerative ROP. As it can clinically and radiologically mimic a malignant tumor, it is paramount for the radiologist to know this entity. Magnetic resonance imaging is the modality of choice to reveal the possible severe complication of ROP in the form of a compressive myelopathy of the upper cervical cord. The purpose of the surgical treatment is the regression or complete disappearance of ROP, with posterior decompression by laminectomy and posterior C1-C2 or occipitocervical fixation. We present the case of an elderly patient with retroodontoid soft tissue mass secondary to a chronic atlantoaxial instability on os odontoideum, an extremely rare cause of ROP. The patient developed a posttraumatic cervical myelopathy related to the decompensation of this C1-C2 instability responsible for the formation of a compressive ROP. We will overview the retroodontoid pseudotumor and its differential diagnosis.
Sharif F, Sander PS, Sharif A
… +2 more, Montenegro G, Garrett R
Case Rep Radiol
· 2018 · PMID 30345139
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Internal hernias involve herniation of viscera into an abdominal compartment through a defect in the mesentery or peritoneum. Herniation may occur through normal anatomic structures or through pathologic defects secondar...Internal hernias involve herniation of viscera into an abdominal compartment through a defect in the mesentery or peritoneum. Herniation may occur through normal anatomic structures or through pathologic defects secondary to congenital abnormality, inflammation, trauma, or surgery. Patients with an internal hernia most commonly present with acute bowel obstruction. While internal hernia is an uncommon cause of bowel obstruction, making up approximately 0.2-0.9% of cases (Choi, 2017), the incidence is increasing due to greater use of techniques such as Roux-en-Y for liver transplant and gastric bypass. There are multiple types of internal hernia, including paraduodenal, Foramen of Winslow, sigmoid mesocolon, pericecal, transmesenteric, transomental, supravesical, and pelvic. We present a case in which a transverse colon epiploic appendage adhesion to the ascending colon mesentery resulted in a closed loop obstruction mimicking a pericecal internal hernia. Radiologists should be aware of the imaging findings of closed loop obstruction related to internal hernia and maintain a high index of suspicion in patients with history of prior abdominal surgery presenting with bowel obstruction. It is useful for radiologists to understand that adhesions may result in internal hernias, which mimic the classically described categories.
Chandra V, Wajswol E, Shahid M
… +2 more, Kumar A, Contractor S
Case Rep Radiol
· 2018 · PMID 30210895
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Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative interventional procedure used to manage refractory Budd-Chiari syndrome (BCS) when conservative medical therapy has failed. However, TIPS is not alwa...Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative interventional procedure used to manage refractory Budd-Chiari syndrome (BCS) when conservative medical therapy has failed. However, TIPS is not always technically successful because of hepatic vein thrombosis and inability to catheterize the hepatic veins. In these situations, direct intrahepatic portosystemic shunt (DIPS) with access to the portal vein from the IVC has been shown to be a viable alternative that may ameliorate portal hypertension in these patients. Typically, DIPS involves the use of transabdominal ultrasound to target the portal vein. Herein a case in which a 39-year-old female underwent DIPS without the use of ultrasound guidance is presented. Instead, a hepatic venogram generated using collateral circulation was used to opacify and guide access to the portal vein.
Case Rep Radiol
· 2018 · PMID 30186655
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Various typical and atypical imaging findings for pulmonary sarcoidosis have been described in the literature. Ground-glass opacities are one of the atypical manifestations, reported as diffuse or patchy ill-defined opac...Various typical and atypical imaging findings for pulmonary sarcoidosis have been described in the literature. Ground-glass opacities are one of the atypical manifestations, reported as diffuse or patchy ill-defined opacities frequently associated with additional findings and interstitial nodules. We performed a literature review to determine if our case had previously been described. The literature describes cases of mass-like consolidations, but there are no reports of mass-like ground-glass opacities. The appearance of the ground-glass opacities in our case is unique, appearing as discrete well-defined mass-like ground-glass opacities in a peribronchovascular distribution without additional parenchymal findings typically seen in sarcoidosis.
Case Rep Radiol
· 2018 · PMID 30186654
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Gastrointestinal Bleeding Scintigraphy (GIBS) of Tc-labelled red blood cells is a relatively simple examination to perform, with high diagnostic accuracy and a relatively lower radiation dose. A positive scan can either...Gastrointestinal Bleeding Scintigraphy (GIBS) of Tc-labelled red blood cells is a relatively simple examination to perform, with high diagnostic accuracy and a relatively lower radiation dose. A positive scan can either suggest surgery without further investigation or can indicate angiography, a more targeted procedure. Whipple pancreatoduodenectomy is most often performed for tumors of the head of the pancreas. Pancreatoduodenectomy has 30%-40% morbidity and mortality, and while post-pancreatoduodenectomy hemorrhage is seen in less than 10% of patients, it accounts for 11%-38% mortality. The role of imaging in patients to detect relative hemodynamic stability is essential. Computed tomography angiography (CTA) shows the cause, site, and nature of bleeding, while digital subtraction angiography (DSA) has a diagnostic as well as a therapeutic role. We present a patient who presented with active gastrointestinal bleeding (GI) bleeding after undergoing a Whipple procedure, to highlight the role of GIBS in the successful localization of a bleeding site and the guidance of digital DSA in the embolization and control of the active bleeding.
Case Rep Radiol
· 2018 · PMID 30174979
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Chest tube malpositioning is reported to be the most common complication associated with tube thoracostomy. Intraparenchymal and intrafissural malpositions are the most commonly reported tube sites. We present a case abo...Chest tube malpositioning is reported to be the most common complication associated with tube thoracostomy. Intraparenchymal and intrafissural malpositions are the most commonly reported tube sites. We present a case about a 21-year-old patient with cystic fibrosis who was admitted due to bronchiectasis exacerbation and developed a right-sided pneumothorax for which a chest tube was inserted. Partial initial improvement in the pneumothorax was noted on the chest radiograph, after which the chest tube stopped functioning and the pneumothorax remained for 19 days. Chest computed tomography was done and revealed a malpositioned chest tube in the right side located inside the thoracic cavity but outside the pleural cavity (intrathoracic, extrapleural). The removed chest tube was patent with no obstructing materials in its lumen. A new thoracostomy tube was inserted and complete resolution of the pneumothorax followed.
Ryan W, Dako F, Cohen G
… +4 more, Pryluck D, Panaro J, Cuthbertson E, Niman D
Case Rep Radiol
· 2018 · PMID 30174978
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Patients with liver disease and portal hypertension who have had surgical formation of an abdominal stoma are at risk of developing peristomal varices. These varices have a predilection for bleeding. Ideally, portal deco...Patients with liver disease and portal hypertension who have had surgical formation of an abdominal stoma are at risk of developing peristomal varices. These varices have a predilection for bleeding. Ideally, portal decompression via TIPS procedure is performed, with or without direct embolization of the bleeding varix. When TIPS is not an appropriate option due to significant liver disease and hepatic encephalopathy there are other approaches to treat peristomal variceal hemorrhage. We report the embolization of such a varix via direct percutaneous puncture under ultrasound guidance when portal decompression was not an appropriate option.
Mrabet FZ, Achrane J, Sabri Y
… +3 more, El Hassani FE, Hammi S, Bourkadi JE
Case Rep Radiol
· 2018 · PMID 30112245
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Hydatic disease has always been the most common in countries where large amount of sheep and cattle is raised, but increased travel and immigration have made this condition a serious worldwide public problem. Cyst hydati...Hydatic disease has always been the most common in countries where large amount of sheep and cattle is raised, but increased travel and immigration have made this condition a serious worldwide public problem. Cyst hydatid may affect all parts of the human body like the heart, the bone marrow, the eye, the brain, the kidney, and the spermatic cord. Humans can become infested by accidentally ingesting the eggs that are passed in the feces from definitive hosts (usually a canid, such as a wolf, fox, or dog). Even in endemic countries, the primitive pleural hydatid cyst is exceptional, and it is very difficult to distinguish from other pleural and parietal cystic masses especially that in majority of cases the immunologic tests are negative. We report two cases of pleural hydatid cyst discovered in two young patients, with a nonspecific clinical presentation. The interest of this paper is to raise the primordial role of imaging in the positive diagnosis of primary pleural hydatid cyst.
Case Rep Radiol
· 2018 · PMID 30112244
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Intussusception of the appendix is a relatively rare event that is usually asymptomatic but can present similar to other acute and chronic abdominal conditions. We present two separate cases of suspected appendiceal intu...Intussusception of the appendix is a relatively rare event that is usually asymptomatic but can present similar to other acute and chronic abdominal conditions. We present two separate cases of suspected appendiceal intussusception mimicking cecal masses. The authors also present a cursory review of the limited number of literatures available concerning this entity to help the radiologist avoid misdiagnosis and potentially unnecessary invasive intervention.
Case Rep Radiol
· 2018 · PMID 30112243
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Segmental arterial mediolysis of an omental artery is an exceptionally rare condition. A 69-year-old man presented with haemoperitoneum six days after being hospitalized due to pneumogenic sepsis. Computed tomography of...Segmental arterial mediolysis of an omental artery is an exceptionally rare condition. A 69-year-old man presented with haemoperitoneum six days after being hospitalized due to pneumogenic sepsis. Computed tomography of the abdomen showed a short segment dilatation of an omental artery in the left upper abdomen, compatible with segmental arterial mediolysis. Angiographic examination revealed alterations of omental branches of the right gastroepiploic artery and an aneurysm of the left omental artery, both characteristic of segmental arterial mediolysis. Embolization of the left omental artery with use of N-butyl-2-cyanoacrylate was performed. The postinterventional course was uneventful with increase of haemoglobin levels and without symptoms of omental infarction. Transcatheter embolization in the setting of haemoperitoneum due to segmental arterial mediolysis of an omental branch is technically feasible and a valuable alternative to emergency operation.
Case Rep Radiol
· 2018 · PMID 30073109
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BACKGROUND: Abernethy malformation is a rare splanchnic vascular abnormality characterizing extrahepatic abnormal shunts that is classified into types I and II. Abernethy malformation type I has a female predilection and...BACKGROUND: Abernethy malformation is a rare splanchnic vascular abnormality characterizing extrahepatic abnormal shunts that is classified into types I and II. Abernethy malformation type I has a female predilection and is associated with a variety of concurrent hepatic benign or malignant tumours while type II with concurrent tumours is very rare in females. CASE REPORT: We report a rare female case of Abernethy malformation type II with concurrent occupying lesion in the right liver, which was successfully transplanted; the occupying lesion was pathologically proven to be nodular hyperplasia. CONCLUSION: This case might provide further knowledge regarding Abernethy malformation. On imaging, the anatomy of portal vein should be carefully investigated to categorize Abernethy malformation, and a wide variety of differential diagnosis of concurrent occupying lesions should be taken into account.
Fonseka CL, Kariyawasam AGTA, Singhapura SDAL
… +5 more, Singhapura SAGL, de Silva CM, Kanakkahewa TE, Senarathna IGTM, Bodinayake CK
Case Rep Radiol
· 2018 · PMID 30057844
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BACKGROUND: Prolonged pyrexia and weight loss are recognised paraneoplastic manifestations of renal cell carcinoma (RCC). Stauffer's syndrome is a rarely described paraneoplastic manifestation, which is described early i...BACKGROUND: Prolonged pyrexia and weight loss are recognised paraneoplastic manifestations of renal cell carcinoma (RCC). Stauffer's syndrome is a rarely described paraneoplastic manifestation, which is described early in the course of RCC. We report a patient who presented with unresolving fever with multiple pulmonary opacities with biochemical evidence of hepatic choleastasis and was later diagnosed to have metastatic RCC with Stauffer's syndrome. CASE PRESENTATION: We report a 54-year-old female who was investigated for a poorly resolving fever and recent weight loss for two months. During her course of illness, she developed bilateral multiple opacifications in the chest radiograph with negative pyogenic, mycobacterial microbiological studies. Despite intravenous antibiotics, her fever continued. She was found to have elevated alkaline phosphatase and gamma-glutamyl transferase and she underwent imaging with ultrasound scan of abdomen twice, which did not reveal demonstrable abnormalities. Later, contrast CT of abdomen and chest was performed and detected a renal cell carcinoma of the right upper pole of the kidney with multiple lung metastases, which was concluded as a metastatic RCC with paraneoplastic Stauffer's syndrome. CONCLUSION: Prolonged pyrexia with loss of weight and Stauffer's syndrome could be features to suggest renal cell carcinoma in the absence of positive microbiological studies. Isoechoic RCC could be missed in routine ultrasonography. When a RCC is suspected in the setting of a pyrexia of unknown origin, ultrasound with doppler or a contrast CT should be requested to aid diagnosis.
Siritho S, Tantinikorn W, Wichiwaniwate P
… +1 more, Pongpirul K
Case Rep Radiol
· 2018 · PMID 30026995
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A 59-year-old male who presented with a nonspecific headache at the vertex, resembling retrobulbar optic neuritis, was treated as such but did not show any improvement. Although optic nerve compression from sphenoid muco...A 59-year-old male who presented with a nonspecific headache at the vertex, resembling retrobulbar optic neuritis, was treated as such but did not show any improvement. Although optic nerve compression from sphenoid mucocele was finally discovered, the delayed diagnosis and improper treatment led to a permanent visual loss. Optic neuritis could be caused by a common problem, "mucocele/sinusitis," but might be easily overlooked in general practice. Rhinogenic optic neuropathy should, therefore, be considered in every case of optic neuritis whenever atypical presentation occurs or is unresponsive to high-dose steroid treatment.
Kikuchi T, Fujii H, Fujita A
… +2 more, Sugiyama T, Sugimoto H
Case Rep Radiol
· 2018 · PMID 30009075
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Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a disorder characterized by pustular skin lesions and osteoarticular lesions. Mandibular involvement of SAPHO syndrome is clinically rare, and i...Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a disorder characterized by pustular skin lesions and osteoarticular lesions. Mandibular involvement of SAPHO syndrome is clinically rare, and it is difficult to reach a diagnosis of SAPHO syndrome from only mandibular manifestations. This report describes the case of a 26-year-old woman who presented with mandibular osteitis. Orthopantomogram and computed tomography showed sclerotic change of the right body of the mandible with periosteal reaction without odontogenic infection, which suggested the possibility of SAPHO syndrome. Detailed medical interview found that she had a history of palmoplantar pustulosis treated at a local dermatology clinic and additional bone scintigraphy showed diffuse increased uptake in the right mandible, as well as in the sternum and the sternocostoclavicular joints. She was eventually diagnosed as having SAPHO syndrome. We should consider SAPHO syndrome when we encounter a patient with mandibular osteitis of unknown etiology.
Torcia P, Squarza S, Rossi UG
… +4 more, Rigamonti P, Pescatori LC, Damiani G, Cariati M
Case Rep Radiol
· 2018 · PMID 29992075
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A 79-year-old man, suffering from atrial fibrillation and on anticoagulation therapy, was admitted at the emergency department of our institution because of a worsening respiratory insufficiency. After a diagnostic work-...A 79-year-old man, suffering from atrial fibrillation and on anticoagulation therapy, was admitted at the emergency department of our institution because of a worsening respiratory insufficiency. After a diagnostic work-up, he was found to suffer from pneumonia, and antibiotic therapy was settled. He was kept under observation for his pulmonary conditions but, within a week, he developed a spontaneous iliopsoas hematoma, due to a sudden dysregulation of anticoagulation therapy subsequent to new in-hospital treatments. An endovascular approach was attempted and the bleeding vessels were embolized with a new liquid agent, named Squidperi (Emboflu, Switzerland). Complete exclusion of the diseased vessels was obtained and no complications occurred after the procedure. We conclude that Squidperi can be considered as an option for treatment of spontaneous iliopsoas hematomas.
Case Rep Radiol
· 2018 · PMID 29984032
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Sarcoidosis is an idiopathic systemic inflammatory disorder characterized histologically by noncaseating granulomas. The pathogenesis likely includes genetic, immunologic, and environmental factors. The lungs, skin, and...Sarcoidosis is an idiopathic systemic inflammatory disorder characterized histologically by noncaseating granulomas. The pathogenesis likely includes genetic, immunologic, and environmental factors. The lungs, skin, and eyes are most commonly affected. Although bone involvement is possible, sarcoidosis of the humerus is rare, with few cases reported. Furthermore, we are unaware of any reports of sarcoidosis of the upper humerus with a coexisting rotator cuff tear. We report the case of a 50-year-old female with sarcoidosis of the humerus and a coexisting tear of the supraspinatus tendon. Her medical history includes type 2 diabetes, depression, and fatigue. She had chronic shoulder pain that worsened after her dog jerked on the leash. Radiographs were grossly normal. Subsequent magnetic resonance imaging (MRI) demonstrated a possible small full-thickness rotator cuff tear. Multiple rounded lesions were also noted within the proximal humerus. A biopsy demonstrated noncaseating granulomas, confirming the diagnosis of sarcoidosis. There was concern that her sarcoid lesions would compromise bone quality, limiting options for surgical repair of her rotator cuff tear. However, it was determined that her lesion did not involve cortical bone, and surgery was performed. During surgery, the supraspinatus tendon was found to be partially torn and was treated with arthroscopic debridement and acromioplasty. An excellent result was ultimately achieved after her rheumatologist started adalimumab injections. This case demonstrates that there can be a rare incidental finding of osseous sarcoid lesions in the upper humerus where the bone might be compromised in the location of a planned rotator cuff repair.
Yoshida K, Miyagawa M, Kido T
… +7 more, Ide K, Sano Y, Sugawara Y, Takahata H, Monden N, Furuya M, Mochizuki T
Case Rep Radiol
· 2018 · PMID 29971177
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Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disease characterized by skin fibrofolliculomas, pulmonary cysts, spontaneous pneumothoraces, and renal cancers. Oncocytomas are benign epithelial tumors that ar...Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disease characterized by skin fibrofolliculomas, pulmonary cysts, spontaneous pneumothoraces, and renal cancers. Oncocytomas are benign epithelial tumors that are also rare. Recently, there have been a few case reports of BHD with a parotid oncocytoma that appears to have a BHD phenotype. Here we document the eighth known case and describe the magnetic resonance imaging features of the parotid oncocytoma, which mimicked Warthin's tumor. Radiologists should be aware of the association between these rare disorders.
Rodrigues JR, Brito MJ, Pais RPF
… +1 more, Carvalho S
Case Rep Radiol
· 2018 · PMID 29888021
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Myeloid sarcoma (MS), granulocytic sarcoma or chloroma, is defined as a localized extramedullary mass of blasts of granulocytic lineage with or without maturation, occurring outside the bone marrow. MS can be diagnosed c...Myeloid sarcoma (MS), granulocytic sarcoma or chloroma, is defined as a localized extramedullary mass of blasts of granulocytic lineage with or without maturation, occurring outside the bone marrow. MS can be diagnosed concurrently with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). The authors report a case of sacral MS occurring as a relapse of myeloid leukemia in a 5-year-old girl who was taken to the emergency department with radiculopathy symptoms.
Case Rep Radiol
· 2018 · PMID 29862112
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Splenic artery pseudoaneurysms (PSA) are rare entities and far less common than true aneurysms of the splenic artery. The most common etiology is pancreatitis, recurrent either in the setting of chronic pancreatitis or a...Splenic artery pseudoaneurysms (PSA) are rare entities and far less common than true aneurysms of the splenic artery. The most common etiology is pancreatitis, recurrent either in the setting of chronic pancreatitis or as an episode of acute pancreatitis. Less common causes include trauma, peptic ulcer disease, or iatrogenic causes. Almost all of the trauma-related case reports have been due to blunt trauma. We believe this to be the first reported case of a splenic artery PSA presenting with massive hematemesis at a significant time frame after penetrating trauma. Successful transcatheter treatment was performed and alternative techniques are also discussed.
Phung T, Nguyen T, Tran D
… +2 more, Phan N, Nguyen H
Case Rep Radiol
· 2018 · PMID 29862111
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A 22-year-old woman with myasthenia gravis (MG) presented with ptosis and mild muscle weakness symptoms for one year. Computed tomography (CT) presented a diffuse bilobulate enlargement gland with a high density of soft...A 22-year-old woman with myasthenia gravis (MG) presented with ptosis and mild muscle weakness symptoms for one year. Computed tomography (CT) presented a diffuse bilobulate enlargement gland with a high density of soft tissue. Magnetic resonance imaging (MRI) showed the gland with no suppression on the opposed-phase chemical shift. After the thymic tumor diagnosis, she underwent thoracoscopic surgery for tumor resection. The postoperative histopathological finding was thymic lymphoid hyperplasia. This case suggests chemical shift MRI is not enough in distinguishing, and supplementary examination is essential to avoid unnecessary thymic biopsy and surgery.