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Hepatic parenchymal rupture is a rare but potentially fatal condition that can be caused by trauma, iatrogenic factors, spontaneous causes, etc. This case report describes the diagnostic and therapeutic steps employed in a patient with spontaneous hepatic parenchymal rupture. An older woman came to the emergency department with diffuse stomach pain. After clinical evaluation, she underwent computed tomography. The first computed tomography did not reveal a full-blown parenchymal rupture. Owing to data ambiguity, indicating that the abdominal discomfort could be caused by renal or biliary colic, obtaining an early diagnosis was very difficult. In truth, only few hypodense oval shapes with characteristic suprafluid densitometry were found in the liver parenchyma. However, after a few days, the discomfort persisted, and as the condition worsened, the patient underwent additional radiological examinations, which revealed the rupture of the liver parenchyma that required arteriography, and a long hospital stay until clinical resolution.

Nowadays, computed tomography urography and multiparametric magnetic resonance are the most often used imaging techniques in patients with bladder cancer; however, dual-energy computed tomography is making its way into the oncological field. This narrative review article aimed to show the fundamentals of dual-energy computed tomography by outlining its physical principles, techniques, protocols, and postprocessing images to help those who used this cutting-edge technology as the first approach to fully understand its emerging applications in the evaluation of bladder cancer, a field yet to be explored. In particular, we discuss the usefulness of dual-energy computed tomography by focusing on the main images obtained, such as the iodine map, comparing them to the images obtained with conventional computed tomography scans. Dual-energy computed tomography applications may be beneficial for bladder cancer diagnosis, staging, and treatment planning. Nevertheless, its application is limited to its availability in healthcare structures and the training of healthcare personnel who can perform and interpret the scans correctly.

We describe a rare case of secondary breast angiosarcoma in a 72-year-old woman with a history of breast cancer who presented to our clinic with a painless palpable mass in the outer upper quadrant of the left breast. The diagnosis required a multidisciplinary approach involving a senologist, anatomopathologist, and oncologist. Imaging modalities such as mammography, ultrasonography, and magnetic resonance imaging made it possible to assess the extent of the tumor, lymph node involvement, and distant metastases. The diagnosis was confirmed by a tissue biopsy. Herein, a rare case is presented, with the main educational purpose of describing the clinical presentation and complex diagnostic evaluation and discussing the differential diagnosis and management. Indeed, secondary mammary angiosarcoma is a rare and aggressive neoplasm, and understanding its unique features is essential for clinical decision-making and patient outcomes. The tumor has a worse prognosis because of its late diagnosis, higher risk of rapid distant spread, and limited treatment options. Such cases require close monitoring, aggressive strategies, and supportive care.

Rare complications of acute epididymitis include ischemia and infarction of the testicles. Both clinically and radiologically, it is challenging to distinguish testicular torsion. In this article we have tried to expand the library of digital images of radiological diagnostic methods used for fast and accurate differential diagnostics. This case emphasizes the significance of a comprehensive radiological assessment and how a multidisciplinary approach is necessary to guarantee an accurate diagnosis. A 24-year-old man experienced severe left testicular pain and came to the hospital 2 weeks later. At the radiology department, he reported that he had for some time painful ejaculations, pain during intercourse (dyspareunia), scrotal redness/swelling, genital inflammation, chills, swollen inguinal lymph nodes, dysuria, and scrotal pain. All diagnostic procedures were performed, first ultrasonography and then magnetic resonance imaging, as required by the urologist. The imaging studies revealed left testicular ischemia, and based on the referred clinical history, a chronic orchid-epididymitis was suspected. Thus, the condition was resolved, not with a left orchidectomy but with medical therapy because the ischemia area was not too large. The patient also had a left varicocele. Images acquired with different magnetic resonance imaging sequences were carefully examined. A rare instance of epididymal orchitis is described as a potentially dangerous complication of epididymitis and must be considered if sudden, severe scrotal pain is experienced to avoid severe consequences. This case can help with optimal patient management and prevent unnecessary interventions.

Calyceal diverticula, also known as pyelogenic cysts, are a relatively uncommon condition, which is usually asymptomatic and incidentally diagnosed during routine imaging. In some cases, they may lead to concerning symptoms such as hematuria and flank pain, mimicking a renal tumor. In this case report, the patient suffered from hematuria that was initially suspected as a renal malignancy but was ultimately attributed to a calyceal diverticulum. The presented case allows evaluating one of the rarest and underestimated causes of hematuria and describes the main imaging features of calyceal diverticula. In particular, ultrasonography, computed tomography urography, dual-energy computed tomography, and magnetic resonance urography were performed. Subsequently, this case report also serves an educational purpose.

Hypoplasia of the inferior vena cava is a rare congenital vascular defect with various forms; thus, identifying a specific anatomical variant in the literature is challenging. In some cases, the inferior vena cava may also be interrupted. Herein, we present a unique case of of an unknown subrenal hypoplasia of the inferior vena cava with azygos and hemiazygos hypertrophy and the creation of several collateral circles, particularly in the anterior wall of the abdomen, in an asymptomatic 75-year-old man. This report not only describes this unusual instance but also quickly demonstrates the variations of the venous system in the abdomen, particularly on the right side, and the inferior vena cava and the azygos system, and explains the significance of imaging in recognizing vascular anomalies. The case was explored using a multiphase computed tomography technique, which correctly identified this complex vascular anomaly. The patient had never experienced symptoms associated with the same vascular defect previously. Moreover, his symptoms did not appear to be related; therefore, a periodic follow-up was recommended.

Background. Breast cancer is a leading type of cancer in women. Imaging techniques (ultrasound, mammography, and magnetic resonance imaging (MRI)) play a crucial role in tumor detection and evaluation. The last emerging technique is contrast-enhanced mammography (CEM) which provides both morphological and functional information.Objective: to evaluate CEM accuracy in measuring breast tumor lesions. Material and methods. The study involved 69 patients followed by the Breast Unit from January 2018 to September 2023. Breast tumor dimensions measured in CEM in the pre-operative stage by three experienced radiologists were compared to the dimension obtained at the histological examination, the current gold standard in assessing tumor size. Results. We observed a slight overestimation by CEM compared to histology, with a difference between the two measurements not more than 10 mm. CEM underestimated the dimensions in 12 of 69 cases. Conclusion. The study demonstrated excellent CEM accuracy in preoperative assessment of breast tumors, consistent with previous findings in the literature. CEM could prove to be a valid and safer alternative to MRI in preoperative breast tumor measuring.

Benign situs inversus totalis of the viscerum is often diagnosed accidentally, rarely in adults, and more frequently in children and neonates, affecting both sexes. In this report, a young female patient accidentally discovered a situs inversus totalis after computed tomography for acute abdominal pain. In this uncommon anatomical abnormality, the major visceral organs are reversed in the opposite direction. This report highlights the importance of being aware of and considering situs inversus in clinical practice, particularly when interpreting imaging findings and planning medical procedures. This is critical for differential diagnosis and comorbidities that may affect those patients. The cause of situs inversus totalis is still unknown; however, this condition is frequently asymptomatic, particularly in infants, and is sometimes associated with other syndromes. The patient arrived at the emergency department with left flank pain, nausea, and fever. In the first ultrasonography, a strange anatomy was suspected; thus, a contrasted computed tomography was performed. The patient had never had a computed tomography scan before. The identification of situs inversus totalis was unexpected and coincidental; the computed tomography images were carefully examined. In patients with chest or abdominal pain, clinicians may consider situs inversus totalis based on computed tomography, particularly if without clinical and imaging history. This knowledge can help in the differential diagnosis, avoiding unneeded interventions. Moreover, comorbidities that affect several systems, particularly cardiovascular and pulmonary systems, affect quite a few patients with situs inversus totalis, who require careful examination and lifelong monitoring.

Multiple biliary hamartomas are a benign incidental finding in the liver. They are not easily detected if one has never seen them, and if appropriate imaging tests are unavailable, and also can be challenging to differentiate from other liver lesions based on imaging alone. Thus, this study aimed to expand the radiologist’s digital image library, enabling a quick and precise differential diagnosis. This paper also highlights the importance of thorough radiological assessment and need for a multidisciplinary approach, involving radiologists, hepatologists, and pathologists, to ensure a precise diagnosis. The patient presented at the hospital for a computed tomography scan and an abdominal magnetic resonance imaging recommended by his general practitioner to assess the biliary tree (magnetic resonance cholangiopancreatography), owing to persistent abdominal pain. The patient had never undergone an abdominal magnetic resonance imaging previously; hence, the discovery of hepatic lesions was incidental and unexpected. Magnetic resonance imaging revealed multiple benign lesions in both the hepatic lobes comparable to the Von Meyenburg complex. These lesions are multiple hamartomas and behave differently in all magnetic resonance imaging sequences. Images acquired with different magnetic resonance imaging sequences were carefully examined. Multiple lesions were found scattered throughout the liver; however, the lesions were benign and consistent with the diagnosis of multiple biliary hamartomas. Medical practitioners should examine the presence of multiple biliary hamartomas and consider them in the differential diagnosis when patients present with hepatic abnormalities. This can prevent unnecessary interventions and guide appropriate patient management.

Adult intussusceptions are a rare cause of abdominal obstruction and are usually associated with a neoplastic disease; idiopathic forms are extremely rare. We report a case of enterocolic intussusception in a young woman who experienced symptoms of abdominal obstruction. Imaging findings were reported. On histological examination, no underlying diseases were found. The patient presented at the hospital for computed tomography because of persistent abdominal pain. Computed tomography revealed an enterocolic invagination involving the ileocecal valve and cecum and widespread edematous thickening of the colonic parietal walls. Idiopathic enterocolic intussusception is an uncommon abdominal urgency in adults. Symptoms can be vague and persistent, delaying an accurate diagnosis. Imaging is crucial in these circumstances to make a diagnosis. Some computed tomography findings, such as a target-like bulk, may be suggestive.

This review explains the role of multiparametric magnetic resonance imaging, particularly in prostate biopsy, in the detection of prostate cancer. The use of multiparametric magnetic resonance imaging in the diagnosis of prostate cancer has also allowed its use in magnetic resonance imaging-guided biopsies, which according to many studies present high sensitivity and specificity in early diagnosis and staging, in patients with persistently high prostate-specific antigen levels despite previous negative prostate biopsies, and in the follow-up of patients under active surveillance. To perform a targeted prostate biopsy, three types of magnetic resonance imaging guidance are available: cognitive fusion, direct magnetic resonance imaging-guided biopsy performed within a tomograph (in-bore biopsies), and software coregistration of stored magnetic resonance images with real-time ultrasound using a fusion device, with multiparametric magnetic resonance imaging findings digitally overlaid on real-time transrectal ultrasound images for targeted biopsy. Each method has its advantages and disadvantages. Magnetic resonance imaging-targeted biopsy improves the quality of histological results compared with other approaches, with approximately 90% correct detection of significant index lesions. Correct staging allows the selection of the best therapeutic options, adequate evaluation of the prognosis, and reduction of the incidence of new biopsies and complications. The current objective is to make magnetic resonance imaging-guided biopsy increasingly available and standardize the technique to minimize inter-operator variability depending on the available system.

This narrative review describes the current status of imaging in the evaluation of bladder cancer, considering conventional technologies such as ultrasonography, computed tomography urography, and magnetic resonance imaging, as well as novel technologies such as contrast-enhanced ultrasonography and dual-energy computed tomography. The article is organized by first presenting an introduction on both the anatomy of the bladder (to understand its normal appearance on imaging) and the main features of bladder cancer with reference to epidemiology, clinical picture, classification, and treatment. Subsequently, the role of imaging is discussed, with an explanation of the technique and applications in bladder cancer assessment for each modality. Imaging plays a critical role in the detection and staging of bladder cancer. In particular, the role of magnetic resonance imaging is expanding because it enables differentiating muscle-invasive bladder cancer from non-muscle-invasive bladder cancer using the Vesical Imaging-Reporting and Data System (VI-RADS), along with conventional technologies, such as computed tomography urography and ultrasonography. Contrast-enhanced ultrasound and dual-energy computed tomography are new imaging modalities that offer special advantages and provide the right approach to patients with oncological conditions. This review ends with the presentation of integrated imaging modalities such as positron emission tomography combined with computed tomography or magnetic resonance imaging, which are promising methods for bladder cancer staging.

AIMS: to assess radiological and clinical outcomes, in terms of safety and efficacy, of symptomatic vertebral fractures with and without posterior wall and\or both endplates involvement, treated with vesselplasty technique (Vessel-X, Dragon Crown Medical Co., Ltd Shandong, China). MATERIALS AND METHODS: We retrospectively evaluated 66 Patients who underwent 92 vesselplasty procedures, performed for the treatment of symptomatic vertebral body fractures from March 19 to September 2020. We divided the fractures in two subgroups: 36 vertebral fractures with posterior wall and/or both endplates involvement, which we defined complex, while all the others were defined simple. Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) values has been registered 1 day before the procedure and at 1, 6 and 12 months follow-up. We also evaluated vertebral height restoration by comparing pre-interventional with post-interventional imaging. RESULTS: 92 vertebrae were treated (58 lumbar, 34 thoracic), with 24 multilevel procedures. We observed a technical success rate of 100%, without major complications; a single case of asymptomatic paravertebral cement leak was reported. Both simple and complex subgroups registered a significative statistical difference in NRS and ODI between preoperative and at 1, 6 and 12 months (p 0.05). A significant statistical difference was demonstrated in vertebral height comparing pre-operative and post-operative data (p 0.05). No significant difference in vertebral height restoration was observed between simple and complex vertebral fractures groups. CONCLUSIONS: Vesselplasty represents a safe and effective technique for the treatment of both simple and complex painful vertebral fractures, granting a significant reduction of symptoms, excellent cement leakage control and proper vertebral height restoration.

The premature fusion of some of the sternal ossification centers and the obliteration of the manubrio-sternal joint caused a rare deformity called CurrarinoSilverman syndrome. Patients present an abnormally short sternum with a forward angulation at the manubrio-sternal junction. Cardiopulmonary diseases and spinal deformities are the most frequent related disorders. It was also described as a component of Turners and Noonans syndromes. Herein, we present the case of a 66-year-old woman who presented to our clinic for follow-up computed tomography after surgery and chemotherapy for breast cancer with frequent episodes of dyspnea, wheezing, bronchitis, and mild dyspnea annually, which was more frequent during childhood. Computed tomography showed the absence of metastatic lesions and other accompanying diseases, except for a rare deformity of the anterior chest wall, the so-called, a superior pectus carinatum, a chondromanubrial deformity with a dorsal-open angle of 130, and a sternum body length of 9 cm, which is not depressed in the lower third.

Pterygoid plate fractures are often associated with Le Fort fractures and accompanied by other facial fractures such as frontal sinus and naso-orbital-ethmoid fractures; isolated pterygoid plate fractures are extremely rare. Le Fort fractures must be surgically treated with fixation of unstable fracture segments to re-establish bone form and function, and the pterygoid process must be surgically stabilized; however, surgical treatment is unnecessary in isolated pterygoid plate fractures. Here, we report a rare case of isolated unilateral fracture of the pterygoid process in a 71-year-old female patient who had a syncopal episode with secondary head injury and a hematoma at the base of the right orbit. A computed tomography scan showed unilateral right pterygoid plate fracture with signs of emphysema in the ipsilateral masticatory space. The patient also had a fracture of the medial wall of the right maxillary sinus with hemosine, but no fractures of the skull base or theca. She was treated conservatively.

Testicular rupture after a blunt scrotal trauma is characterized by tearing of the tunica albuginea that result in the extrusion of the seminiferous tubules. Imaging, particularly ultrasonography, plays a crucial role in the assessment of scrotal trauma and directs patient management toward conservative or surgical treatment. Conventional B-mode and color Doppler ultrasonography are the main imaging techniques in the evaluation of the testicle in trauma but may underestimate the extent of injury. The most important information for the surgeon is the integrity or interruption of the tunica albuginea and the extent of vital testicular tissue. The latter is often difficult to assess with conventional ultrasonography because the injured testicle is often hypovascular even in vital regions due to testicular edema that compromises vascular flow. The selective use of advanced techniques such as contrast-enhanced ultrasonography is important in identifying testicular viability when color Doppler ultrasonography is equivocal. This case report describes the evaluation and management of a blunt testicular trauma in a 15-year-old football player.

Fibrous dysplasia is a rare non-neoplastic tumor-like congenital bone disease that is most likely associated with GNAS gene mutations, with a broad spectrum of clinical presentations, ranging from isolated monostotic and polyostotic forms to other extra-skeletal associated manifestations as in McCuneAlbright syndrome. It is responsible for bones weakening and increased fragility, making it prone to fractures. A 65-year-old female patient was referred to our radiology department for cervical and dorsal pain, with a previous diagnosis of incidental cervical and dorsal bone lesions that are suspected for metastases. X-ray, computed tomography, and magnetic resonance imaging were performed with a precise diagnostic suspicion of fibrous dysplasia that is confirmed by bone biopsy. Fibrous dysplasia principally affects the bone and is characterized by bone replacement itself by dysplastic fibrous tissue. According to the number of affected bones and their association to endocrine alterations, it is classified into three categories monostotic, polyostotic, and Albrights disease. Differential diagnosis with multiple myeloma among others and the best treatment decision was made.

The physics of earthquakes was contriubuted to by the concept of proper time of the source of a strong earthquake, which is different from universal (calendar) time. The earlier idea of proper time was implicit and has been considered only in relation to the physics of aftershocks. The present paper extends the applicability of the concept of proper time, proposes a possible way of its measuring, and provides an example to illustrate the procedure for sequential ordering of earthquakes by proper time. The object of this study is a global activity of strong (M≥7) earthquakes. We consider the sequence of earthquakes as a Poisson-type random process. Comparatively weak earthquakes are used as the "underground clock", the tick of which marks the proper time. The Poisson distribution is compared with the distributions for two sequences of strong earthquakes. One of the sequences is ordered by universal time, and another - by proper time. The studies indicate the distribution of events ordered by proper time is closer to the Poisson distribution than that of events ordered by universal time. We attribute this to the non-stationarity of the geological medium, which is an immanent property of the Earth's lithosphere.

Osteopoikilosis is a rare inherited benign bone dysplasia incidentally found on radiological exams. It is characterized by a specific radiological pattern: diffuse, round or oval, symmetrically shaped sclerotic bone areas distributed throughout the skeleton. It is essential to do a correct diagnosis because these lesions could be easily confused with bone metastasis. We reported a case of an osteopoikilosis patient presenting to our clinic with transient loss of consciousness and without any numbness, tingling and weakness in the legs or other parts of the body. The computed tomography scan showed multiple small sclerotic foci bone islands, scattered throughout the thoracic and lumbar spine, ribs, pelvic bone, sacrum and bilateral proximal femur. No significant increase in the activity was detected in technetium-99m whole-body bone scintigraphy. The patient was diagnosed with characteristic radiological findings of osteopoikilosis and was followed up.

The case of a 26-year-old male patient with perforation of Meckels diverticulum, a rare complication of the most common congenital anomaly of the gastrointestinal tract, is reported in this article. This congenital condition can remain asymptomatic for a long time, and it can get complicated with diverticulitis, enteroliths, neoplasms, and rarely perforation, as in this case. A preoperative radiological assessment is of fundamental importance for proper diagnostic and therapeutic management of the patient. In this article, we present the typical tomographic imaging features of this infrequent complication to assist radiologists in detecting it.

Teletandem (TT) is as a computer assisted language learning environmentin which two students communicate in order to learneach other’s native language. In the case of a program focused onLanguage for Specifi c Purposes (LSP), TT offers the possibility ofputting into contact two people with interests in the same scientific or professional areas, thus confi guring a symmetrical relationshipwhich allows mutual help in specialistic areas where accessto traditional language teaching may be problematic. In fact, thecompetence of teachers does not necessarily extend to the highlyspecialized fi elds of knowledge mastered by these learners. TT canprovide an environment where it is possible to overcome the gapbetween meaning (which the learner can verbalize in his/her nativelanguage) and the linguistic forms required for expression in thetarget language. The aim of this paper is to present the strengthsof TT for LSP and to discuss its critical issues.