European Journal of Radiology Extra最新文献

Traumatic pseudoaneurysms of the superficial temporal artery (STA) are uncommon. The appearance of a pulsatile preauricular mass after a traumatism is highly suggestive of the diagnosis. Diagnostic techniques are echo-doppler, CT-scan and arteriography. The most common treatment is surgical. Embolization may prove to be an alternative to surgery in some cases. We report a rare case of pseudoaneurysm arising from STA caused by blunt injury.

Reactive lymphoid hyperplasia is a benign inflammatory condition. It has been described at a variety of anatomical sites but reactive lymphoid hyperplasia of the liver is rare. We present a case, describe its appearances using a variety of imaging modalities and review the appearances of previously described cases. The difficulties of diagnosing the condition from imaging alone are discussed, given the extensive overlap with the appearances of malignant diseases of the liver.

Metastases of the parotid gland occur infrequently and usually originate from head and neck malignant melanoma or squamous cell carcinoma. We report on the extremely rare case of a late onset parotid metastasis 11 years after nephrectomy due to renal cell carcinoma. With the application of high-resolution B-mode ultrasound, colour-Doppler imaging and the new ultrasound techniques, contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) imaging, we were able to perform precise tumour description and modify treatment modalities. We suggest the evaluation of CEUS and ARFI imaging for an improved visualisation of parotid tumours and discuss the impact for the differential diagnosis of parotid masses.

We report an unusual case of an artery running alongside a common hepatic artery aneurysm. The artery running alongside the aneurysm was thought to be either an anatomical variation or dissection (true lumen) with reentry, both of which are atypical. Here, we document our experiences working with this unusual case of aneurysm formation in a common hepatic artery, in which we performed coil embolization.

Intradural extramedullary tuberculoma in the spinal cord is a rare disease, which follows tuberculous meningitis with negative human immunodeficiency virus. We present a case of 31-year-old man with intradural extramedullary tuberculoma at the cervical and thoracic spine following tuberculous meningitis.

A rare case of mobile thrombus in the ascending aorta causing peripheral embolization is reported. Transesophageal echocardiography (TEE) could not clearly delineate this lesion, as portions of ascending aorta are not well visualized by TEE due the interposition of right main stem bronchus and the trachea. We performed dynamic cardiac CT angiography, which clearly visualized the lesion allowing detailed preoperative planning and successful surgical excision.

A 57-year-old man presented with dysphagia and voice change for 4 month's duration and swallowing difficulty for 1-month duration. He underwent neck CT and right pyriform sinus cancer was found. Initial CT scan revealed two small radiolucent lesions in C5 and C6 vertebra bodies. On follow up CT scans obtained after 16 weeks later, the small radiolucent lesion in C5 vertebral body was enlarged from 5 mm to 9 mm. However, the small radiolucent lesion in C6 vertebral body was not changed.

Objective

Peripheral atrophy/central hypertrophy (PACH) complex has been described in various chronic liver diseases but never in chronic hepatic Schistosoma mansoni infection. This study describes the imaging and anatomic features of PACH complex in four patients using high resolution cross-sectional imaging with 3D reconstructions and pathologic correlation.

Materials and methods

Two radiologists assessed imaging studies from four patients with proven chronic hepatic S. mansoni infections for presence of PACH complex, hepatic surface lobulations, capsular thickening, periportal fibrosis, hepatic calcification, gallbladder wall enhancement and thickening, and splenomegaly. 3D volume rendering and curved planar and oblique reformation in the planes of the hepatic veins were performed to better evaluate the 3D position of the hepatic veins relative to the liver parenchyma and capsule.

Results

All four patients had PACH complex and hepatic surface lobulations. 3D volume rendered images demonstrated severe peripheral atrophy with migration of hepatic veins on the capsular surface of the liver. Multiplanar reconstruction demonstrated coexisting hypertrophy about the central portal veins and atrophy of the peripheral liver parenchyma with thinned or no parenchyma between the hepatic veins and the liver capsule. All patients also had capsular thickening, splenomegaly, and no calcifications. While all patients had enhancement of the gallbladder wall in the arterial phase without thickening, three patients had dilated veins on the surface of the gallbladder wall. Three patients also had periportal fibrosis.

Conclusion

This study is the first to report PACH complex in chronic hepatic S. mansoni infection. Atrophy results in crowding of smaller hepatic veins in the periphery of the liver. Finally, hepatic capsular thickening on imaging is a further sign of this infection.

Teratomas are the most frequent extra-gonadal non-seminomatous germ cell tumors (NSGCTs). Retroperitoneum is the third most common site for teratomas and 30–40% of them may have immature tissue. The use of 18F-FDG PET in NSGCTs has been recently investigated. Here we report a 22 year-old male patient with metastatic immature teratoma, followed by PET/CT according to the existence of 18F-FDG avid metastatic lesions. According to our experience, functional imaging with PET/CT has an additive effect to anatomical imaging modalities in NSGCT patients when the tumoral tissue contains more primitive immature elements.

We report one case of jejunal free perforation as the initial manifestation of small bowel lymphoma in a 46 year-old man with unsuspected celiac disease. Perforation was the revealing feature of the lymphoma and led to recognition of latent, long standing celiac disease. Multidetector row computed tomography (MDCT) showed pneumoperitoneum, fluid effusion and findings suggestive for celiac disease including diffuse small bowel thickening, paucity of jejunal folds, enlarged mesenteric lymph nodes and focal jejunal mass. Histopathological analysis confirmed perforation of jejunal pleomorphic large cell, enteropathy-associated T-cell lymphoma (EATL) with marked changes of jejunal mucosa consistent with long standing celiac disease. Immunohistochemical staining on jejunal lesion was positive for CD3, CD8, and CD30 but negative for CD56 and CD57. Atrophic mucosa did not contain clonal expansion of an aberrant intraepithelial lymphocyte population. A favorable outcome was observed after emergency surgery, chemotherapy, and gluten-free diet and the patient was still alive 46 months after the initial symptoms. This case teaches us that free perforation of EATL in celiac disease may have a favorable outcome, EATL may develop in long standing celiac disease in the absence of clonal expansion of an aberrant intraepithelial lymphocyte population, and that MDCT may suggest the diagnosis preoperatively.