Search

In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.

Background: The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. Objectives: We aimed to review the role of the ‘ideal’ ratio on predicting residual PUV post-ablation. Methods: A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included ‘Urethral Ratio and Posterior urethral valve ablation’. All cited reference lists were further evaluated for additional inclusive studies. Results: Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 ( p = 0.001), 2.5–3 and 3.5. Conclusion: Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2–3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.

Spontaneous or self-induced pneumoparotid, which usually manifests as acute unilateral gland enlargement, is caused by insufflation of air from the oral cavity via Stensen's duct. A 9-year-old patient, with known Down's syndrome, presented with a progressively enlarging, painless, spontaneous, left neck mass. Computed tomography showed features consistent with pneumoparotid, without underlying associated pathology. Identification of true cases of spontaneous pneumoparotid is crucial, as these require a holistic management approach to prevent recurrence and complications.

Background: The use of computed tomography (CT) for estimation of split renal function (SRF) has been reported previously. However, most of these studies have small samples, and many do not account for the renal attenuation at CT. Objective: The aim of this study was to compare multidetector computed tomography (MDCT) volumetry-attenuation-based SRF with that obtained via Tc99m-diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy in voluntary renal donors. Methods: Between January 2017 and January 2020, 526 voluntary renal donors were enrolled prospectively. All donors underwent contrast CT and DTPA scan before surgery. The semiautomatic region of interest (ROI) tool was applied slice by slice on axial CT images acquired in the arterial phase. The renal contour was drawn semiautomatically with mouse clicks around the renal parenchyma, and the renal volume was ascertained. Using renal volume and attenuation, SRF was determined and compared with results obtained at DTPA imaging. Results: The mean age was 44.91 ± 10.97 years (mean ± s.d.). There was no significant difference in SRF based on DTPA and MDCT volumetry for the left kidney (49.18% ± 3.40% vs. 49.15% ± 3.38%, p = 0.540) and for the right kidney (50.82% ± 3.40% vs. 50.86% ± 3.39%, p = 0.358). A very good correlation was observed between the two methods for the left kidney ( r = 0.953, p = 0.000) and the right kidney ( r = 0.955, p = 0.000). On simple linear regression analysis, 90.8% of DTPA SRF values for the left kidney and 91.3% of DTPA SRF values for the right kidney could be predicted correctly using the corresponding MDCT SRF values. Conclusion: MDCT volumetry-attenuation-derived estimation of SRF for living renal donors could be an alternative to renal scintigraphy-based SRF estimation.

Agenesis of the piriformis muscle is an extremely rare occurrence. Knowledge about this anatomic variant is important because of its close proximity with the sciatic nerve and sacral plexus. The piriformis muscle also serves as an important anatomic landmark for image-guided intervention and hip surgery. We report a case of piriformis muscle agenesis in a 28-year-old woman, incidentally detected on magnetic resonance imaging of the lumbosacral spine and pelvis, performed for low back pain.

Chronic physeal stress injuries in children can result from ongoing, repetitive compression, distraction and/or shear forces during sports-related activity, and manifest as physeal widening on imaging. We present an 11-year-old soccer athlete with focal physeal widening of her great toe metatarsal and postulate that ongoing or repetitive stress from soccer play may manifest as this imaging appearance. We suggest that recognition of this entity in growing children might explain pain, if present, and guide conservative treatment.

Background: Oculomotor nerve palsy (ONP) is a common clinical presentation of posterior communicating artery (PcomA) aneurysms. It remains unclear if patients have a better rate of recovery after surgical clipping or endovascular coiling. Objectives: The main objectives of this study were to assess the overall rate of ONP recovery after endovascular coiling of PcomA aneurysms, as well as to determine the associated predictive factors of oculomotor nerve recovery. Method: We retrospectively evaluated the demographic, clinical, and radiological characteristics and the outcome of consecutive patients presenting with PcomA aneurysms treated by endovascular coiling from January 2012 to November 2016 with at least 1 year clinical and radiological follow-up. Statistical analysis was applied to determine the association between ONP recovery and the demographic, clinical and radiological variables. Results: A total of 91 patients with PcomA aneurysms were treated endovascularly. Thirty-four patients (22 women and 12 men) with ONP related to PcomA aneurysms were included. The mean age of the patients was 49.8 years. Subarachnoid haemorrhage was present in 27 patients. The mean aneurysm size was 6.7 mm. The overall rate of recovery was 88.2%. Complete nerve recovery was seen in 16 (47%) patients and partial recovery was observed in 14 (41.2%) patients, whilst 4 (11.8%) patients remained unchanged after treatment. The non-posterolateral direction of the aneurysm showed a tendency towards better recovery compared to the posterolateral projection ( p = 0.06). Conclusion: Endovascular coiling of PcomA aneurysms in patients with ONP resulted in a cure or improvement of oculomotor nerve dysfunction in the majority of patients.

No abstract available.

The placenta is a highly vascularized organ with unique structural and metabolic complexities. As the primary conduit of fetal support, the placenta mediates transport of oxygen, nutrients, and waste between maternal and fetal blood. Thus, normal placenta anatomy and physiology is absolutely required for maintenance of maternal and fetal health during pregnancy. Moreover, impaired placental health can negatively impact offspring growth trajectories as well as increase the risk of maternal cardiovascular disease later in life. Despite these crucial roles for the placenta, placental disorders, such as preeclampsia, intrauterine growth restriction (IUGR), and preterm birth, remain incompletely understood. Effective noninvasive imaging and image analysis are needed to advance the obstetrician’s clinical reasoning toolkit and improve the utility of the placenta in interpreting maternal and fetal health trajectories. Current paradigms in placental imaging and image analysis aim to improve the traditional imaging techniques that may be time-consuming, costly, or invasive. In concert with conventional clinical approaches such as ultrasound (US), advanced imaging modalities can provide insightful information on the structure of placental tissues. Herein we discuss such imaging modalities, their specific applications in structural, vascular, and metabolic analysis of placental health, and emerging frontiers in image analysis research in both preclinical and clinical contexts.

A 15-year-old boy presented with left-sided hip pain and imaging consistent with the diagnosis of femoroacetabular impingement. Following hip arthroscopy, which included an osteochondroplasty, labral repair, and capsular repair, the patient's anterior hip pain improved. However, his deep aching hip pain persisted until an ischial osteoid osteoma was identified and treated with radiofrequency ablation. At 3 years follow-up, the patient reports high satisfaction and minimal pain. We present this case to illustrate the importance of considering all potential causes of persistent hip pain following hip arthroscopy, including benign bone tumors which may be difficult to visualize on plain radiographs.

Cannonball lesions are numerous, well-circumscribed, round pulmonary lesions and may be identified on plain radiograph or advanced imaging. This morphology can be associated with infectious causes, rheumatologic disease and metastatic disease. Classically, when cannonball lesions are associated with metastatic disease, they are seen in renal cell carcinoma and choriocarcinoma. We report a case of a 62-year-old Middle Eastern male who presented with shortness of breath, chest pain and fatigue and was found to have bilateral multiple pulmonary cannonball lesions and mass in the pancreas. Biopsy of one the lung lesions was consistent with pancreatic cancer. Our case adds to the limited literature available regarding cannonball lung lesions in the setting of pancreatic cancer. Health care providers should be aware of the various etiologies of cannonball lesions.

Epiploic appendagitis is a rare cause of acute to subacute lower quadrant abdominal pain. It has 2 subtypes: primary and secondary Epiploic appendagitis. Primary epiploic appendagitis is characterized by inflammation of the epiploic appendages caused by torsion or thrombosis of the draining vein of the appendage whereas secondary Epiploic appendagitis may occur in association with other inflammatory etiologies in the abdomen and pelvis. Due to its similarity to other causes of acute abdomen, patients with primary epiploic appendagitis often undergo unnecessary treatment with antibiotics and surgical intervention. We present a case of a middle-aged male who was diagnosed with primary epiploic appendagitis based on imaging studies and was successfully managed with conservative treatment.

A 43-year-old woman was found to have active post-primary tuberculosis and a lateral neck radiograph showing a thickened epiglottis. Bronchoscopy-guided biopsies of the epiglottis and lung were acid fast bacilli stain positive. Histopathology from both showed multiple caseating granulomas. The patient’s condition improved with RIPE therapy. This case illustrates the importance for physicians to be aware of possible laryngeal involvement in tuberculosis and that it can present even without evidence of active or latent tuberculosis.

Inverted Meckel's diverticulum is an entity often discovered incidentally or through a clinical evaluation for gastrointestinal bleeding. While rare, inverted Meckel's diverticulum should be considered in the evaluation of a patient presenting with gastrointestinal bleeding, intestinal obstruction, or intussusception. In this case, a 67-year-old female with a remote history of surgically treated breast cancer presents to an urgent care facility with weakness and fatigue. She was found to be anemic with hemoglobin of 4. Imaging revealed a blind-ending pouch in the mid to distal ileum consistent with an inverted Meckel's diverticulum. Inverted Meckel's diverticulum is identified on computerized tomography as an intraluminal, blind-ending structure in the mid to distal ileum. The possibility of a lead point should be investigated and surgical resection is indicated to prevent intestinal obstruction.

Brain abscess is a focal intracranial infection that may present as a life-threatening emergency. Brain abscess can present with a wide range of clinical syndromes, and it results in high morbidity and mortality worldwide. Here we describe a rare case of the polymicrobial right parietal brain abscess, especially associated with Actinomyces in a 59-year-old male who presented with acute onset of left-sided weakness and altered mental status. The patient underwent surgical treatment (burrhole aspiration) and antibiotics with good improvement. Prompt diagnosis and treatment are critical for brain abscess and ultimately lead to better patient outcomes.

An ectopic pregnancy is the implantation of a fertilized ovum in a location other than the main cavity of the uterus. Ectopic pregnancies are reported in approximately 1%-2% of pregnancies, and while 95% of ectopic pregnancies are in fallopian tubes, only 3% are in ovarian, cervical, or abdominal sites. We present a case of a 38-year-old female with acute onset of severe lower abdominal pain, sepsis, chills, and diarrhea who was evaluated with a CT of the abdomen and pelvis with IV contrast only. The imaging revealed a likely second trimester age fetal skeleton with a partially collapsed calvarium within the peritoneal cavity and an abnormal complex cystic lesion in the right adnexal area. In this case, the patient successfully underwent exploratory laparotomy with removal of both the abdominal ectopic pregnancy and the tubo-ovarian mass.

Hirayama disease is a cervical flexion myelopathy that typically causes upper extremity weakness in young male patients. We present two male patients (age 15 and 29) with MRI findings of thoracic ligamentous laxity similar in appearance to Hirayama disease. However, patients presented with atypical symptoms, specifically back pain and paresthesia of the upper and/or lower extremities, likely correlating to the abnormal thoracic spinal levels involved. Flexion/extension MRI sequences demonstrated the forward displacement of the dorsal dura and compression the thoracic cord with prominence of the posterior epidural space and venous plexus. Follow-up MRAs were negative for a spinal vascular malformation. Patients were managed conservatively with no surgical intervention. Clinical history, thoracic MRI, and follow-up flexion and angiographic imaging sequences may help confirm a diagnosis of Hirayama-like thoracic ligamentous laxity.

Medulloepithelioma is a rare and highly malignant tumor of infancy and early childhood, and classified as a primitive neuroectodermal tumor. Considering that most cases occur in the central nervous system, development in atypical sites associated with secondary comorbidities, such as peritoneal carcinomatosis, becomes an extremely rare association due to its high morbimortality. This study reports a rare case of peripheral medulloepithelioma with peritoneal carcinomatosis in an 11-year-old boy, with a 4-year history of intestinal constipation alternated with fecal incontinence, taken to the emergency room due to increasing abdominal pain and urinary retention. This report aims to contribute to a better understanding of this rare pathology, as well as assist in the establishment of early diagnosis and treatment.

Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extrapulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the organizing/late stage. We highlight a 59-year-old gentleman who presented a back swelling masquerading as a deep-seated abscess, in which the diagnosis of ET had not been established early. The principles of treatment are treating the underlying condition such as pneumonia, pleural drainage and debridement, full re-expansion of the collapsed lung by performing chest physiotherapy, and improving nutrition. ET is a condition with a dynamic process due to diverse etiologies, either localized or involving the entire pleural cavity. The gold standard in diagnosing ET is the pleural aspiration of fluid from the pleural space, whereas the management of ET may include non-surgical and/or surgical treatments based on the basic principles of ET treatment.

Urinary bladder hemangiomas are a rare cause of gross hematuria in young patients. Multimodality imaging with ultrasound, computed tomography, and magnetic resonance imaging help define the site and extent of hemangioma. We describe a case of an otherwise healthy 9-year-old male presenting with recurrent gross hematuria. The initial US did not demonstrate a bladder mass, but subsequent cystoscopies showed progressive enlargement of an extensive sessile and partially pedunculated vascular mass. Imaging with ultrasound, computed tomography, and magnetic resonance imaging persistently demonstrated a hypervascular bladder mass without extravesical extension. Ultimately, biopsy of the mass made the diagnosis of bladder hemangioma.

Heterotaxy syndrome is a rare condition characterized by the abnormal arrangement of thoracoabdominal organs across the left-right axis of the body. It is generally classified as right and left atrial isomerism or asplenia and polysplenia syndrome, even though there are overlaps and uncertainties. The diagnosis of isomerism is typically made by echocardiography. However, multidetector computed tomography and MRI can help in obtaining detailed data on the morphology of the heart, great vessels, the anatomy of the internal organs, and their mutual arrangement that make an accurate diagnosis of heterotaxy syndrome. The authors present here the imaging findings of the heterotaxy polysplenia syndrome in a 21-year-old female with a complete endocardia cushion defect and a duplicated right renal vein.

We have reported 2 cases of pulmonary hamartoma focusing on detecting intranodular fat, which is one of CT features suggestive of pulmonary hamartoma, using dual-energy CT analyses. For patient 1, a 73-year-old man was pointed out to have a nodular opacity on chest radiograph of pretreatment workup for retinal detachment. In patient 2, a 66-year-old woman with uterine carcinoma admitted for preoperative assessment. Both patients underwent dual-energy CT examination and the pulmonary lesions exhibited a downward-sloping curve at lower X-ray energies on attenuation curve of virtual monochromatic images, which suggested fatty tissue. Dual-energy CT analysis can help diagnose pulmonary hamartoma with detection of intralesional fatty tissue.

Chondrosarcoma of the head and neck region is a rare disease, representing approximately 0.1% of all head and neck neoplasms. Parapharyngeal location is extremely rare and low-grade ones are even rarer. Surgery alone or followed by adjuvant radiotherapy is the treatment of choice. In this article, we report a case of a 67-year-old male with low-grade parapharyngeal chondrosarcoma who presented with a 3-month history of dysphagia. A cervical magnetic resonance imaging was performed that shows a well-defined mass located at the right parapharyngeal space, causing medial deviation of the mucosal space. Surgical resection of the tumor without neck dissection followed by adjuvant radiotherapy was undertaken with a favorable response. The purpose of this article is to add our case to the limited literature for good management of parapharyngeal chondrosarcomas.

Dural arteriovenous fistula (dAVF) of the anterior cranial fossa is an aggressive entity with a high risk of intracranial hemorrhage. A 38-year-old woman presented to our institution with nasal obstruction and discharge. Computed tomography (CT) scans performed for suspected sinusitis revealed erosion of the crista galli predominantly on the left side. The frontal and ethmoidal sinuses adjacent to the crista galli were clear and did not communicate with the crista galli. Contrast computed tomography scans revealed ectatic vessels adjacent to the crista galli, coursing on the cortical surface. Cerebral angiography identified an anterior fossa dAVF supplied by the bilateral anterior and posterior ethmoidal arteries and drained by the dilated cortical veins. Based on these findings, we assumed that long-term compression by the pulsatile draining veins caused the erosion. The patient underwent successful microsurgical disconnection procedure of the dAVF with an uneventful postoperative course. We concluded that external erosion of the crista galli could be a sign of aggressive dAVF and requires careful examination.

Aggressive hemangioma is a rare vertebral lesion in pediatric patients which can present with deteriorating neurological function. It can mimic malignancy on imaging, particularly as it regularly has an extrasosseous soft tissue component. We present a case of a 13-year-old male who presented with a three month history of lower extremity weakness that was found to have an infiltrative mass at T10 with associated cord compression from epidural extension of the lesion. In this report we review the characteristic imaging findings associated with aggressive hemangioma, including its appearance on read-out segmented diffusion-weighted images. It is imperative that radiologists who interpret studies of children be aware that this lesion exists and what it looks like, as it can be associated with massive hemorrhage if encountered unexpectedly during surgery.

Pseudoaneurysms are rare complications in urological surgery. Typically, they would present with pain, haematuria or anaemia. We report a 60-year-old patient who was found to have a chronic pseudoaneurysm via a corona mortis vascular variant, 3 months after a robotic-assisted prostatectomy. Unlike other rare reports of delayed vascular complications after minimally invasive urological surgery, the patient was entirely asymptomatic.Apart from careful intraoperative dissection, a high index of suspicion and low threshold for imaging are also required in the follow up period. Percutaneous trans-arterial embolization is safe and effective in dealing with post-surgical pseudoaneurysms.

Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal disease. Although high-resolution computed tomography (HRCT) is important for the diagnosis of IPF, the changes in the HRCT findings in IPF are not fully understood. The patient was a 66-year-old man. His HRCT findings had atypically developed from a probable usual interstitial pneumonia pattern to a nonspecific interstitial pneumonia (NSIP) like pattern over 6 years. On the basis of the histologic examination and multidisciplinary discussion, IPF was diagnosed, and nintedanib, administered. This case can be useful for the differential diagnosis of IPF and NSIP.

Mediastinal cavernous hemangioma is a rare lesion requiring diagnosis without invasive procedure due to the risk of hemorrhage, which can be massive and even fatal. Here we describe the successful diagnosis of such a lesion using technetium-99m diethylenetriamine penta-acetic acid human serum albumin (99mTc-HSA-D) scintigraphy. A 36-year-old female with a 3-week back pain underwent endoscopic ultrasonography, contrast-enhanced CT, and MRI dynamic study which together revealed a submucosal tumor of the esophagus; likely to be either hemangioma or lymphangioma. Because of poor or no enhancement, it was impossible to distinguish the nature of the lesion. However, using delayed blood-pool imaging of 99mTc-HSA-D (at 40 minutes postinjection), and the characteristic accumulation, the tumor was clearly identifiable as an esophageal hemangioma. This case shows 99mTc-HSA-D scintigraphy to be an effective noninvasive imaging method to capture the characteristic hemodynamics of hemangioma.

Dermoid cysts are lined by keratinizing squamous epithelium and consist of skin appendages such as hair follicles, apocrine glands, and sebaceous glands. They are usually diagnosed during infancy or early childhood, commonly reported in the head and neck region. A dermoid cyst on the back is extremely rare, with only three cases in the pediatric and adult populations. We report a rare case of a dermoid cyst in the subcutaneous layer of the back in an adult. A 75-year-old man presented with a soft, painless mass on his left upper back. Computed tomography revealed a low-density mass nearly identical to the subcutaneous fat in the subcutaneous layer with nodular soft-tissue density components. It was a heterogeneously hyperechoic mass without internal vascularity on ultrasonography. On magnetic resonance imaging, the lesion showed nearly identical signal intensity (SI) to subcutaneous fat on T1 and T2-weighted images. The soft tissue component was intermediately hyperintense on T1- and T2- weighted images with enhancement. This lesion was pre-operatively suspected as a lipoma variant or a well-differentiated liposarcoma/atypical lipomatous tumor because of the fat density or SI and enhancing portion. We demonstrated and reviewed the multimodality imaging features of dermoid cysts at an unusual location and suggested imaging features that could help readers differentiate dermoid cysts from lipomatous tumors. When a mass shows fat density or SI with or without enhancing soft tissue components at the trunk or extremity, dermoid cysts as well as lipomatous tumors could be considered in the differential diagnosis.

Appendiceal mucinous neoplasms are rare findings defined by an accumulation of mucus within the vermiform appendix, and can be caused by a variety of conditions. Appendiceal mucinous neoplasms are important to consider because they can develop into pseudomyxoma peritonei as a consequence of perforation. We report a case of a 55-year-old man who initially presented with increasing abdominal girth, constipation, anorexia, and unintentional weight loss. Computed tomography examination of the abdomen and pelvis demonstrated a huge thin-walled cystic mass causing significant displacement of the surrounding abdominal and pelvic structures. The mass was amenable to resection and removed without perforation. Gross pathologic examination demonstrated a 44.0 × 40.0 × 23.0 cm unilocular cystic mass with a section of attached bowel. Microscopic examination revealed high-grade appendiceal mucinous neoplasm arising in a background of low-grade appendiceal mucinous neoplasm. This case report provides an evidence to include appendiceal mucinous neoplasms in the differential diagnosis of large abdominal cystic masses.

While Ewing sarcoma of bone is the second most common primary osseous malignancy in childhood where it typically involves the diaphysis or metadiaphyses of long bones of skeletally immature patients, primary epiphyseal involvement of the long bone in skeletally mature patients is rare with no cases reported in the literature to our knowledge, rendering this case the first of its kind. We present the first case of primary Ewing Sarcoma of the epiphyses of the long bones in a skeletally mature 20-year-old male patient. The patient initially presented with left knee stiffness and pain that was empirically treated with non-steroidal anti-inflammatory medications. His pain progressed despite treatment. An x-ray of the left knee was obtained 5 months later demonstrating an irregular lucent lesion in the medial femoral condyle. A subsequent MRI revealed an enhancing lesion in the medial femoral condyle, and when biopsied it was consistent with Ewing sarcoma (positive for EWSR1gene rearrangement by fluorescence in situ hybridization). The lesion was resected surgically, and the patient underwent neoadjuvant chemotherapy with a good clinical outcome.

In this paper, we described 2 cases with COVID-19 pneumonia, who developed pulmonary emphysema, bullae, and pneumothorax during therapy. In a 48-year-old man with mechanical ventilation, parts of ground glass opacities and consolidations transformed into emphysema and giant bulla, and bilateral pneumothorax were also observed. In a 35-year-old man, localized emphysema and pulmonary bullae were seen in subpleural area in bilateral upper lobes, where no previous lesions were presented. In conclusion, pulmonary emphysema, bullae, and pneumothorax could be complications of COVID-19. On one hand, surgical emphysema in ventilated COVID-19 patients was observed as in SARS patients. On the other hand, more serious destruction of lung parenchyma was found in COVID-19 patients.

Gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) is the main contrast agent used in MRI, known for its good tolerance and rare toxicity. Even intrathecal injection of limited doses of Gadolinium can be performed in some indications. To our knowledge, only 3cases of accidental intraventricular injection of Gadolinium have been yet reported in the literature. We report the case of a 40-year-old male patient, who presented with headaches and vomiting. Brain MRI showed a right parietal abscess. The patient underwent emergent surgery for drainage of the septic collection. Postoperative MRI showed the development of a hydrocephalus related to a ventriculitis. Another surgery was performed to set up an external ventricular shunt, which lead to an improvement of the neurological status. A control brain MRI was scheduled for the patient, which revealed extensive abnormal enhancement inside the right lateral ventricle, on the basal cisterns as well as a leptomeningeal enhancement. Shortly after Gadolinium injection, the patient presented a tonic-clonic seizure. This clinico-radiological context leads to discover of the inadvertent intraventricular administration. Afterward, the patient's condition quickly deteriorated. Two days after the MRI he presented a cardiorespiratory arrest followed by death. Direct administration of Gadolinium into a ventriculostomy mistaken for intravenous catheter is a rare but harmful situation. Despite their rarity, such cases prove the importance of tracing all lines to their insertion sites to be confident of their appropriateness for injection.

We present a rare case of pediatric scurvy in a 9-year-old male who presented with nontraumatic knee pain. MRI was obtained due to the puzzling presentation. MRI demonstrated a systemic bone marrow abnormality which led to a conversation with the clinician and further elucidation of an extremely narrow diet lacking sufficient vitamin C (ascorbic acid). Diagnosis was confirmed biochemically with undetectable ascorbic acid level and clinically with compatible exam and history. This case highlights a thought process for unexpected bone marrow abnormality on MRI.

Multiple studies and reports have suggested that coronavirus disease-19 (COVID-19) promotes arterial and venous thrombotic events in multiple organ systems, although the mechanism leading to a hypercoagulable state is still unknown. Few cases of splenic infarction associated with COVID-19 have been reported, of which half were found incidentally upon autopsy. This may be due to a clinically silent presentation or the symptoms being wrongfully attributed to pain caused by the effects of COVID-19. Due to the rarity of the condition and its lack of consistent symptomatology, splenic thromboembolism can be difficult to diagnose. Awareness of the condition and high clinical suspicion will help the clinician identify and manage the problem. Hemorrhage in patients with COVID-19 is uncommon in the hypercoagulable state that threatens thrombus formation in patients with COVID-19 infection. Despite prophylactic treatment with anticoagulation therapies, patients are more prone to developing clots. It is also well-known that therapeutic anticoagulation can place patients at a higher risk of bleeding. Thus, this unique population is at risk of developing both thrombotic and hemorrhagic events. We report a rare case of splenic infarction in a patient with confirmed COVID-19 infection despite prophylactic treatment with low-molecular-weight heparin which was found incidentally during workup for 2 other rare conditions: spontaneous rectus sheath hematoma and microhemorrhage or thrombus of the mesenteric vessels.

Nodular regenerative hyperplasia (NRH) of the liver may lead to noncirrhotic portal hypertension with subsequent development of portosystemic shunts. While extrahepatic and macrovascular shunts are readily visualized with imaging or endoscopy, there is no standard technique to detect intrahepatic microvascular portosystemic shunting and quantitatively assess shunt burden. We present a case of a 53-year-old female with suspected NRH and hepatopulmonary syndrome with inconclusive liver biopsies and absent portosystemic shunts per abdominal imaging. A percutaneous transportal infusion of Technetium-99m labeled macroaggregated albumin (99mTc-MAA) successfully identified intrahepatic microvascular portosystemic shunting and quantified a lung shunt fraction of more than 30%. NRH was subsequently confirmed with a surgical wedge biopsy and the patient was successfuly treated with a liver transplant. Transportal 99mTc-MAA could be used to both identify and quantify otherwise occult microvascular portosystemic shunts in patients with clinical sequelae of portal hypertension.

Fetus in fetu (FIF) is a rare anomaly of diamniotic monochorionic twins, in which a malformed fetus resides in its twin's body. This report shows a case with the prenatal diagnosis of FIF at Tu Du hospital. A 23-year-old woman, first-time pregnant, presented at the hospital with an abdominal mass in the fetus at 31 weeks and 4 days of gestation. The ultrasound showed an abnormal mass with the images of calcified features located in the left hypochondriac region and the kidney's upper pole. These images had shapes of skull, femur, spine and became more apparent as the fetus grew. Then, the patient was monitored and delivered at our hospital. The infant was moved to the Children's Hospital 1 and diagnosed with FIF by ultrasound. The surgical resection was performed at 12 days of birth.

A 37-year-old female was admitted with worsening neurologic function. On arrival from an outside hospital, the patient was obtunded and intubated. Magnetic resonance imaging of the brain revealed nodular enhancement of the leptomeninges, intracranial osteolytic lesions, and diffuse vasogenic edema causing mass effect. Imaging of the thoracic spine revealed pathologic compression fractures of 4 thoracic vertebrae. On review of the patient's electronic medical record, the patient had previously received treatment for secondary syphilis with intramuscular benzathine penicillin G. Surgical biopsies of the frontal bone and dura showed diffuse, chronic inflammation while a biopsy of the adjacent brain parenchyma revealed replicating spirochetes. The patient was subsequently prescribed dexamethasone and benzathine penicillin G. She regained neurologic function but later signed out against medical advice without completing her treatment regimen.

Annular pancreas is a rare congenital intestinal obstruction to be found in infants. It is characterized by nonbilious vomiting, abdominal distention, and feeding intolerance that share similar symptoms with other intestinal obstructions. We reported a case of 11-month-old female infant with a history of nonbilious vomiting after coughing as much as 6 times per day 1 day before admission. The patient had an incorrect provisional diagnosis of hypertrophic pyloric stenosis based on ultrasound. Later on, an upper gastrointestinal series showed dilatation of the second part of the duodenum which was successfully treated by a duodenostomy during laparotomy procedure. It is suggested that treating an intestinal obstruction needs a further investigation when the symptoms were continuously repeated.

In the 2016 World Health Organization renal tumor classification, the mixed epithelial and stromal tumor family was introduced as a new entity. This family encompasses a spectrum of tumors, ranging from predominantly cystic tumors (adult cystic nephromas) to tumors that are variably solid (mixed epithelial and stromal tumors). The majority of previous studies incorporating “mixed epithelial and stromal tumor” in the titles were actually reports of imaging findings of adult cystic nephroma. Thus, the solid component of mixed epithelial and stromal tumors has not been well evaluated. In this study, we present 2 cases of mixed epithelial and stromal tumors, as defined by the 2016 World Health Organization classification, showing a predominantly solid component. The characteristic findings of the solid component of these tumors were T2-hypointensity on magnetic resonance imaging and hyperattenuation on unenhanced computed tomography. Angiomyolipoma with epithelial cysts and epithelioid angiomyolipoma should be considered in the differential diagnosis of mixed epithelial and stromal tumors.

Background Since the announcement of COVID-19 as a pandemic infection, several studies have been performed to discuss the clinical picture, laboratory finding, and imaging features of this disease. The aim of this study is to demarcate the imaging features of novel coronavirus infected pneumonia (NCIP) in different age groups and outline the relation between radiological aspect, including CT severity, and clinical aspect, including age, oxygen saturation, and fatal outcome. We implemented a prospective observational study enrolled 299 laboratory-confirmed COVID-19 patients (169 males and 130 females; age range = 2–91 years; mean age = 38.4 ± 17.2). All patients were submitted to chest CT with multi-planar reconstruction. The imaging features of NCIP in different age groups were described. The relations between CT severity and age, oxygen saturation, and fatal outcome were evaluated. Results The most predominant CT features were bilateral (75.4%), posterior (66.3%), pleural-based (93.5%), lower lobe involvement (89.8%), and ground-glass opacity (94.7%). ROC curve analysis revealed that the optimal cutoff age that was highly exposed to moderate and severe stages of NCIP was 38 years old (AUC = 0.77, p < 0.001). NCIP was noted in 42.6% below 40-year-old age group compared to 84% above 40-year-old age group. The CT severity was significantly related to age and fatal outcome (p < 0.001). Anterior, centrilobular, hilar, apical, and middle lobe involvements had a significant relation to below 90% oxygen saturation. A significant negative correlation was found between CT severity and oxygen saturation (r = − 0.49, p < 0.001). Crazy-paving pattern, anterior aspect, hilar, centrilobular involvement, and moderate and severe stages had a statistically significant relation to higher mortality. Conclusion The current study confirmed the value of CT as a prognostic predictor in NCIP through demonstration of the strong relation between CT severity and age, oxygen saturation, and the fatal outcome. In the era of COVID-19 pandemic, this study is considered to be an extension to other studies discussing chest CT features of COVID-19 in different age groups with demarcation of the relation of chest CT severity to different pattern and distribution of NCIP, age, oxygen saturation, and mortality rate.

Background There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema. Results Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial coronary lesions and edema were assessed. Myocardial edema was not assessed in thirteen patients (35%) due to significant intra myocardial hemorrhage (T2 mapping p = 0.79), nor in the LV basal, mid, and apical segments’ edema (p = 0.69, 0.5, and 0.8 respectively). The upper and lower limits of agreements were tested between the TIRM and the T2 mapping of total edema mass, basal segments, mid, and apical ventricular segments were = 18 and − 7.7 g, 11.3 and − 5.1 g, 12.3 and − 5.2 g, and 15.5 and − 7.8 g respectively. Conclusion This study supports the proof of the principle that there is no statistical significant difference per myocardial segments between the T2 mapping and routine edema’s sequences. Larger studies are recommended to assess the impact in clinical outcome.

We report on a 29-year-old woman who presented with abdominal right upper quadrant pain after an outpatient liposuction procedure. A contrast-enhanced computed tomography scan revealed 4 hepatic perforation tracts with subcapsular liver hematoma and hematoperitoneum. The patient was treated by intravenous tranexamic acid and isotonic fluids and monitored on an intensive care unit. No intervention or surgery was necessary during her hospital stay. Follow-up imaging after 3 days using contrast-enhanced ultrasound still showed the perforation tracts in the liver but no expansion of subcapsular hematoma. After 7 days, the patient was discharged home with stable hemoglobin and reduced pain. Liver perforation is a rare complication of liposuction procedures. In patients with abdominal pain after liposuction, contrast-enhanced imaging studies should be performed to identify and characterize solid organ injury. Teams with expertise in angiography and visceral surgery need to be on standby.

Background Patients with unresectable advanced cutaneous squamous cell carcinoma (cSCC) are generally treated with palliative intent. Immune checkpoint blockade has significant activity in the palliative setting in patients with recurrent or metastatic cSCC. This single arm phase 2 prospective study aims to investigate the combination of curative intent chemoradiation and durvalumab (anti-PD-L1 checkpoint inhibitor) for this patient cohort. Methods Patients with unresectable locally and or regionally advanced pathologically confirmed cSCC (stage III-IVa) deemed fit for CRIO by consensus of the Multidisciplinary meeting will be eligible. In the first stage of a two-stage minimax design, we aim to recruit a total of 15 patients. If fewer than 7 patients achieved a complete response in the first stage, we will conclude the treatment is not more effective than standard treatment. The co-primary endpoints of CRIO are the safety of treatment (acute and late toxicities) and the rate of complete response. Secondary endpoints would include overall survival, progression free survival, and locoregional control. Translational research endpoints including biomarkers (CD73, CD39, PD-1, PD-L1) will also be explored utilising multiplex immunohistochemistry on tumour biopsy samples obtained prior to commencing treatment and during treatment (week 2). In addition, the utility of CXCR-4 PET/CT scan will be explored. Discussion CRIO is a novel trial evaluating the combination of curative intent chemoradiotherapy with concurrent and adjuvant durvalumab for patients with unresectable stage III-IVa cSCC. Trial registration: Trial registered with the Australian New Zealand Clinical Trial Registry (ACTRN12618001573246)

There hasn't been a previous case report of the anterior interosseous nerve injury secondary to the presence of the muscle of Gantzer in a patient with myasthenia gravis in literature before. The anterior interosseous nerve compressive syndrome, also known as Kiloh-Nevin syndrome, is a rare disorder comprising less than 1% of all upper limb neuropathies. Establishing the etiology of anterior interosseous nerve compressive syndrome is challenging because of the lack of specific clinical findings or testing. Herein is the case of a 46 years-old male presented with left eye ptosis, ophthalmoparesis, diplopia, and right-hand weakness. On physical examination, the Pinch Grip test was positive. Electromyography studies showed neurogenic atrophy in the muscles innervated by the anterior interosseous nerve, as well as a pathological decrement of the muscle action potential of more than 10% on repetitive nerve stimulation. Concluding that the presence of the Gantzer muscle caused anterior interosseous nerve compressive syndrome was mainly a diagnosis of exclusion, after careful consideration of other possible etiologies including carpal tunnel syndrome, cervical radiculopathy, and Parsonage-Turner Syndrome. Even though anterior interosseous nerve compressive syndrome is very rare, clinical suspicion ought to arise in the presence of weak radial flexor digitorum profundus and flexor pollicis longus muscles. This case highlights the importance of a thorough medical history, a meticulous physical examination, and particularly the significance of electromyography studies in diagnosing different neuropathological entities. When appropriate, these steps offer information crucial to the differential diagnosis and eventual surgical management, assisting physicians in making informed and accurate treatment decisions.

Background Positron Emission Tomography (PET) imaging of the Synaptic Vesicle glycoprotein (SV) 2A is a new tool to quantify synaptic density. [18F]UCB-H was one of the first promising SV2A-ligands to be labelled and used in vivo in rodent and human, while limited information on its pharmacokinetic properties is available in the non-human primate. Here, we evaluate the reliability of the three most commonly used modelling approaches for [18F]UCB-H in the non-human cynomolgus primate, adding the coupled fit of the non-displaceable distribution volume (VND) as an alternative approach to improve unstable fit. The results are discussed in the light of the current state of SV2A PET ligands. Results [18F]UCB-H pharmacokinetic data was optimally fitted with a two-compartment model (2TCM), although the model did not always converge (large total volume of distribution (VT) or large uncertainty of the estimate). 2TCM with coupled fit K1/k2 across brain regions stabilized the quantification, and confirmed a lower specific signal of [18F]UCB-H compared to the newest SV2A-ligands. However, the measures of VND and the influx parameter (K1) are similar to what has been reported for other SV2A ligands. These data were reinforced by displacement studies using [19F]UCB-H, demonstrating only 50% displacement of the total [18F]UCB-H signal at maximal occupancy of SV2A. As previously demonstrated in clinical studies, the graphical method of Logan provided a more robust estimate of VT with only a small bias compared to 2TCM. Conclusions Modeling issues with a 2TCM due to a slow component have previously been reported for other SV2A ligands with low specific binding, or after blocking of specific binding. As all SV2A ligands share chemical structural similarities, we hypothesize that this slow binding component is common for all SV2A ligands, but only hampers quantification when specific binding is low.

Malignant rhabdoid tumors (MRT) represent a very rare group of tumors in infants that have an aggressive clinical behavior, are refractory to therapy, and have a high mortality rate. We present two cases that demonstrate the importance of early diagnosis for further treatment. The first case was a 4 and a half month old boy that presented with an enlarged liver and was treated as hepatoblastoma with metastatic changes in the lung parenchyma after the diagnosis. The second case was a female neonate presenting with hardening on the right side of the abdomen which was treated as MRT of the liver after radiological and clinical evaluation. In both cases, the initial histopathologic diagnosis was hepatoblastoma, but later analyses confirmed the diagnosis of MRT. From our experience, imaging findings can be a valuable tool in directing further evaluation since even histopathologic differentiation from the small cell undifferentiated hepatoblastoma is a real challenge.

Greater trochanteric pain syndrome may be caused by atypical femoral fractures, and this should be taken into consideration in the diagnostic workout. A 63-year-old woman was referred to our orthopedic outpatient hip clinic with a history of greater trochanteric pain syndrome without known trauma for 1 year. Initially X-ray of the hip and magnetic resonance imaging were found without pathology, and she was given a diagnosis of gluteus medius tendinopathy. As physiotherapy and steroid injections did not resolve her pain, a second look on the magnetic resonance imaging and X-ray revealed a discrete atypical femoral fracture in the lateral cortex with the presence of an isolated Looser zone, which were attributed to her pain syndrome. Two years after onset of symptoms, and with no pain relief on medical treatment, she was treated with an intramedullary nail. One-year postoperative the patient was pain free. This case emphasizes the important utility of magnetic resonance imaging in refractory greater trochanteric pain syndrome.

Breast metastasis from primary renal cell carcinoma is a rare entity and infrequently reported in the literature. We present a case of a 65-year-old lady who presented to breast clinic with a 4-month history of rapidly growing right sided breast lump. She previously had a left mastectomy for breast cancer and a hysterectomy for endometrial cancer. Radiological evaluation with mammography and ultrasound revealed a large heterogeneous right breast lump with prominent vascularity which was biopsied. Histopathological and immunohistochemical features were not supportive of a primary breast carcinoma and favored metastasis from a renal tumor. The patient was unfortunately admitted to hospital due to increasing confusion and neurological symptoms and underwent whole-body cross-sectional CT imaging which demonstrated a giant tumor originating from the right kidney with associated intrathoracic, breast and intracranial metastasis. She was diagnosed with eosinophilic variant metastatic renal cell carcinoma. This case highlights the importance of considering alternative diagnoses to primary breast carcinoma in the context of an initial presentation of a unilateral breast lump.

Reversed Robin Hood Syndrome (RRHS) was first described in 2007 as a cause of worsening neurological deficit in the setting of an acute ischemic event. RRHS is the shunting of cerebral blood flow to nonstenotic vascular territories due to impaired vasodilation bought on by hypercapnia. A 77 year old lady presented with acute onset left hemiparesis and an exacerbation of her underlying chronic obstructive pulmonary disease (COPD). CT angiography and perfusion visualized RRHS and appropriate treatment was initiated. Treatment strategies for RRHS differ considerably to those for acute ischemic stroke. Choosing the correct treatment strategy is decisive for good clinical outcome.