Case Reports in Radiology最新文献

Background: Renal transplantation success depends on precise preoperative vascular mapping. This case report documents a rare instance of simultaneous dual renal artery variations in a prospective kidney donor.

Procedure: A healthy 27-year-old male underwent MDCT renal angiography following standard protocols. The patient fasted for 8 h, received 80 mL of iohexol contrast at 1 mL/kg via a 20-gauge cannula, and was imaged using a 32-slice CT scanner. Scanning was performed from the descending aorta (just above the celiac trunk) to the iliac bifurcation using bolus tracking for optimal arterial enhancement.

Ct findings: The CT scan demonstrated complex renal vascular anatomy. The right kidney was supplied by a main renal artery along with two accessory arteries, one originating laterally at L1 and another from the anterior aortic wall at L2. The left kidney exhibited a main renal artery with a single accessory branch arising immediately above its origin.

Discussion: The embryological persistence of multiple aortic branches underlies these variations. Recognition of such anomalies is crucial as they may complicate donor nephrectomy through increased risk of intraoperative bleeding, complex vascular reconstructions, and compromised graft perfusion.

Implications and recommendations: Routine use of high-resolution MDCT angiography is recommended for comprehensive donor evaluation. Enhanced interdisciplinary collaboration between radiologists and transplant surgeons is essential for tailoring surgical approaches and ensuring optimal outcomes.

Conclusion: Detailed preoperative imaging is vital for identifying rare renal vascular anomalies, thereby optimizing surgical planning and promoting donor safety.

Second primary malignancies in the head and neck are a major cause of morbidity and mortality and include mucosal epithelial, hematologic, and cutaneous malignancies. Much is known about the imaging features of metastatic cervical lymphadenopathy in a single disease process; however, information on the imaging evaluation of cervical lymph nodes in the setting of multiple concurrent primary cancers is limited. Cancer multiplicity can make imaging evaluation challenging, but accurate interpretation is vital to appropriate workup and treatment. Here, we present four cases of concurrent head and neck malignancies with cervical lymphadenopathy and guidance on how to approach them with attention to lymph node location and morphologic abnormalities.

Proteus syndrome is an uncommon, sporadic disorder characterized by progressive and heterogeneous overgrowth of tissues, resulting in distorted and asymmetric development. In most individuals, Proteus syndrome has minimal to no manifestations at birth but progresses during childhood and adolescence. Clinical manifestations of the disease include isolated asymmetric hemihyperplasia, isolated asymmetric macrodactyly, subcutaneous masses, plantar and palmar cerebriform fibrous overgrowth, exostoses, epidermal nevi, and scoliosis. Cardiothoracic structures are less commonly involved, and the manifestations include cystic lung changes, pulmonary thromboembolism and varicosities, and pulmonary nodules. Patients with Proteus syndrome have an increased risk of early death due to deep venous thrombosis and pulmonary embolism. We report a case of an adult female who was diagnosed with Proteus syndrome at the age of 5 years who had multiple pulmonary manifestations of the disease.

Xanthogranulomatous pyelonephritis (XPN) is a rare chronic renal infection associated with obstructive nephrolithiasis and recurrent urinary tract infections. Emphysematous pyelonephritis (EPN) is an even rarer necrotizing infection characterized by intrarenal gas, most commonly seen in patients with uncontrolled diabetes mellitus. Concurrent presentation of XPN and EPN is exceedingly uncommon, with only a few cases reported. We present a case of a 61-year-old female with no history of diabetes who presented with left flank pain, systemic symptoms, and laboratory evidence of infection and microcytic anemia. Abdominal CT revealed imaging features consistent with XPN-including hydronephrosis, a staghorn calculus, and the classic "bear paw" sign-alongside intrarenal gas, consistent with EPN. Urine culture grew Proteus mirabilis. The patient underwent nephrectomy and recovered uneventfully with antimicrobial therapy. This case is notable for the rare co-occurrence of XPN and EPN in a euglycemic patient, supporting the hypothesis that chronic obstruction and infection may be sufficient to induce gas-forming infections, even in the absence of hyperglycemia. Awareness of atypical presentations is essential, as early recognition and surgical management are critical to reducing morbidity in these severe renal infections.

Positron emission tomography (PET) radiotracers targeting prostate-specific membrane antigen (PSMA) are now widely used in the evaluation of prostate cancer. However, PSMA activity has also been described in several nonprostatic malignancies, where PSMA is primarily expressed in tumor neovasculature. Here, we describe to the best of our knowledge the first case of a PSMA-avid Merkel cell carcinoma (MCC) inguinal lymph node metastasis, detected incidentally in an 80-year-old man with advanced metastatic prostate adenocarcinoma. Clinical history and disease distribution prompted the need for a diagnostic biopsy, confirming PSMA-avid metastatic MCC. This case highlights the importance of recognizing nonprostatic causes of PSMA uptake, as synchronous malignancies can alter diagnostic interpretation and treatment planning.

Clear cell renal cell carcinoma (ccRCC) is typically prostate-specific membrane antigen (PSMA)-avid, likely related to PSMA expression in the tumor neovasculature, suggesting a potential role for evaluation by PSMA PET/CT. We describe a 77-year-old patient with prostate cancer who was incidentally found to have ccRCC on imaging with PSMA PET/CT, with subsequent staging by FDG PET/CT. He was diagnosed with prostate cancer 17 years prior and treated with radical prostatectomy and radiation therapy within a year of diagnosis. Biochemical recurrence with PSA of 1.0 ng/mL prompted imaging with PSMA PET/CT, which showed an unexpected finding of abnormal uptake within the right renal vein and inferior vena cava (IVC), suggesting possible tumor thrombus (SUVmax 8.8), with mild uptake corresponding to a suspected right renal mass. In addition, there was a PSMA-avid right paratracheal nodal metastasis measuring 3.3 cm (SUVmax 8.4). Subsequent FDG PET/CT again showed the renal mass, tumor thrombus (SUVmax 3.6), and only low-level uptake in the right paratracheal mass (SUVmax 2.3). Right nephrectomy was performed, confirming the presence of ccRCC in the right kidney with tumor thrombus extending to the right renal vein and IVC. FDG PET/CT restaging showed no recurrence in the nephrectomy bed and a stable FDG-avid right paratracheal mass. After stereotactic body radiation therapy (SBRT) directed to the right paratracheal mass, follow-up PSMA PET/CT showed decreased uptake (SUVmax 4.8), suggesting its usefulness for detecting and monitoring ccRCC.

Background: Cherubism is a rare genetic disorder characterised by multilocular cystic lesions in the mandible and/or maxilla, which result in the typical cherub-like face. Two forms of cherubism exist-hereditary (familial) and nonhereditary (nonfamilial)-and it usually occurs amongst children aged 2-7 years. The disorder is caused by a mutation in the SH3BP2 gene on Chromosome 4p16.3, essential for jaw development. The prognosis of cherubism shows that lesions increase in size and plateau at puberty, after which the lesions begin to regress and become undetectable. We present the first case of cherubism to be reported from Ghana.

Case presentation: Our case is a nonhereditary (nonfamilial) cherubism in a 21-year-old Ghanaian woman. The patient presented with bilateral asymmetrical facial swelling, jaw pain, trismus, toothache, tooth mobility and tooth loss. Also, the patient had facial disfigurement, weight loss, cough, headache, seizures and dizziness. Her family history was noncontributory. The results of a head computed tomography (CT) scan indicated chronic left sphenoid sinusitis and an enlargement of the entire mandible, with multilocular expansile lytic (soap bubble) appearance. The mandibles had ground glass matrix areas associated with subtle cortical destruction and dental deformities suggestive of Grade III cherubism.

Discussion and conclusion: Our patient had the onset of the disorder at age 12 but presented to the hospital at the age of 21. The reason why our patient did not seek medical help beforehand could be attributed to sociocultural beliefs, financial constraints and/or limited access to healthcare amenities. Treatment protocols for cherubism may include observation, surgery and medical therapy. Our patient resorted to the use of traditional medicine and spiritual/religious consultations for treatment. Our patient experienced discrimination due to the disease and had lost job, friendship and romantic relationship opportunities because of cultural beliefs, stereotypes and stigmatisation. Her facial disfigurement and the deformities are associated with bad omens and negative spirits in Ghana. When diagnosed, patients suffering from cherubism must be encouraged to seek information, education and appropriate individualised evidence-based management from hospitals. Treatment of the disease should be supported with psychological counselling and community sensitisation wherever possible.

We report a case of a 55-year-old woman diagnosed with sarcoidosis involving multiple intrapulmonary lymph nodes that were clearly visualized on vessel-suppressed CT imaging. Intrapulmonary lymph node involvement in patients with sarcoidosis has been reported less frequently and has not been well discussed. This may be attributed to the fact that intrapulmonary lymph nodes present as small nodular lesions located along pulmonary vessels, making them difficult to detect on conventional imaging. Vessel-suppressed CT enhances visualization of pulmonary lesions by selectively suppressing vascular structures. This case highlights the clinical utility of vessel-suppressed CT for improved detection of intrapulmonary lymph node lesions in the diagnosis of sarcoidosis.

Aesthetic facial and neck procedures increasingly rely on radiographic imaging for surgical planning and complication management. Cone-beam computed tomography (CBCT) offers high-resolution, three-dimensional imaging, but foreign materials such as cosmetic fillers and metallic implants can mimic pathology, generate artifacts, and complicate surgery. This case report with an integrated literature review highlights the radiographic identification of such materials and their implications for aesthetic procedures, illustrated by a patient case where CBCT revealed high-density inclusions in the submental region, correlating with intraoperative fibrosis and extended surgical time. CBCT proved superior in visualizing foreign bodies with lower radiation exposure than conventional CT, emphasizing the need for standardized imaging protocols and AI-driven artifact reduction to enhance diagnostic accuracy and optimize surgical outcomes.

A 40-year-old female with estrogen receptor-positive breast cancer underwent an initial staging using a technetium-99m methylene diphosphonate (Tc-99m MDP) bone scan, which revealed abnormal uptake in the femur without a patient history of prior trauma or associated symptoms. Subsequently, an MRI confirmed the presence of a well-defined lesion in the upper left femur. To rule out metastatic disease, an 18F-fluoroestradiol (FES) PET/CT was performed, demonstrating no ER expression. Following the PET/CT, a biopsy confirmed the presence of an enchondroma. This case underscores the importance of early utilization of 18F-FES PET/CT in breast cancer staging to minimize unnecessary additional procedures/imaging.