Case Reports in Radiology最新文献

Cerebral air embolism is a rare and potentially fatal medical condition that requires prompt recognition and management. Iatrogenic causes such as laparoscopic procedures, hysteroscopy, or central venous catheter (CVC) manipulation are well-documented etiologies. This article presents a case of an 80-year-old female who developed iatrogenic air emboli from CVC manipulation leading to left middle cerebral artery (MCA) syndrome due to suspected right-to-left shunt from pulmonary arteriovenous malformation (pulmonary AVM) or patent foramen ovale (PFO). Preexisting neurological deficits, elevated lactate levels, and sepsis with evidence of systemic hypoperfusion on admission hindered the early detection and treatment of air emboli. This case highlights the need for heightened awareness of CVC-related iatrogenic air embolism, particularly in patients with predisposing conditions such as pulmonary AVM and PFO. Comprehensive treatment strategies, including hyperbaric oxygen therapy, remain critical for achieving better outcomes.

This case study presents an 87-year-old female patient with a history of chronic abdominal pain and NSAID use who was admitted with symptoms of hematemesis and melena, indicative of upper gastrointestinal bleeding. Upon examination, she was found to be hemodynamically stable but exhibited signs of moderate protein-calorie malnutrition. Imaging studies, including a multiphasic CT angiogram, revealed a contained rupture in the distal stomach, and a cystic artery pseudoaneurysm measuring 4.2 mm. Despite the presence of a perforated ulcer, there was no significant pneumoperitoneum or hemoperitoneum, leading to a diagnosis of contained perforation. The management plan included conservative treatment with IV antibiotics, proton pump inhibitors, and monitoring of hemodynamic status. On the third day of admission, the decision was made to embolize the cystic artery, as the risk of gallbladder ischemia was deemed low. This case underscores the critical need for prompt diagnosis and intervention in patients presenting with upper GI bleeding, particularly in the elderly, where the mortality rate can be significantly high. The findings emphasize the importance of imaging in localizing the source of bleeding and guiding appropriate management strategies.

Leiomyosarcoma of inferior vena cava is a rare sarcoma subtype of vascular origin. It has a spectrum of clinical manifestations depending on the affected segment of inferior vena cava, which also determines the treatment and prognosis. We present a patient with metastatic leiomyosarcoma of inferior vena cava. Clinical presentation, radiological findings and management are discussed. In particular, we highlight the key features to consider on imaging to assist with preoperative planning.

Wandering spleen is a rare condition resulting from the absence or laxity of peritoneal attachments, allowing the spleen to migrate within the abdominal cavity. While some patients may remain asymptomatic, others can develop life-threatening complications such as splenic torsion, infarction, and bowel obstruction. This case report highlights one of the complications of wandering spleen and the importance of timely diagnosis and intervention.

Primary poorly differentiated liposarcoma of the spine represents an exceptionally rare clinical entity. We present a 68-year-old patient with a poorly differentiated liposarcoma originating in the thoracic paraspinal region that was initially misdiagnosed as spinal tuberculosis. Although surgical decompression and subsequent biopsy confirmed the diagnosis of liposarcoma, the patient declined adjuvant chemotherapy and experienced disease recurrence within 2 months. This case underscores the critical consideration that differentiated spinal sarcomas may be radiologically indistinguishable from spinal tuberculosis, necessitating histopathological confirmation for accurate diagnosis.

Neurofibromatosis (NF) is a common disorder that affects the nerves and skin. There are two main types: neurofibromatosis Type 1 (NF-1) (also called von Recklinghausen's disease) and neurofibromatosis Type 2 (NF-2) (previously known as bilateral acoustic NF or central NF). NF-1 makes up approximately 85% of cases, with a prevalence of 1 in 5000 in the general population. In 30%-50% of NF-1 cases, there is no family history, suggesting that these cases likely result from germ cell mutations, often from the father. Here, we present the case of a 7-year-old boy with skin and radiological features of NF-1. NF-1 is the most common neurocutaneous syndrome, requiring long-term monitoring for related complications. In this case, we aimed to highlight the typical clinical and radiological features of NF-1 in a child.

Tumefactive demyelinating lesions and brain neoplasms often present as a diagnostic challenge due to overlapping radiographic features among conventional imaging modalities ultimately resulting in uncertainty if a biopsy is warranted to establish a definitive diagnosis. Synthetic MRI (SyMRI) is a novel imaging technique providing myelin maps to aid with diagnosis, yet its use in pediatric patients remains largely unexplored. Therein, we report a pediatric case utilizing SyMRI to assist in differentiating tumefactive demyelination from a recurrent glioma. This 16-year-old female with a history of ganglioglioma, presented with sudden left-sided weakness. The initial MRI suggested either a glial neoplasm or a demyelinating lesion, prompting consideration of a biopsy. SyMRI revealed a unique "rim of decreased myelination," challenging the initial diagnosis. Within 1 week from admission, the patient's symptoms resolved without recurrence. Immunotherapy resolved the demyelinating lesion, supporting the initial SyMRI finding. The case demonstrates the potential of SyMRI in pediatric neuroradiology, highlighting a distinct "rim of demyelination" and its comparison to gliomas aiding in the diagnostic process.

Background: Thoracic endometriosis syndrome (TES) is a rare form of endometriosis characterized by the presence of functioning endometrial tissue in the thoracic cavity. Patients are women of reproductive age, with a genetic link as a significant risk factor. Patients present with long-standing chest symptoms and signs that mimic pulmonary tuberculosis (PTB). The crucial issue for establishing the diagnosis is the cyclicity of signs and symptoms which occur along with the menstrual cycle. Clinical Case: A 34-year-old businesswoman had recurrent pelvic pain and heavy menses for 6 years, recurrent chest pain for 5 years, and recently coughing blood for 3 days. Symptoms peaked during menstruation. She reported a maternal grandmother with similar symptomatology. For the past 6 years, she was treated for recurrent pneumonia and PTB without improvement. Examination revealed right-sided pleural effusion and generalized pelvic tenderness. The catamenial nature of her symptoms led to a suspicion of TES, with PTB. Pleural fluid analysis showed exudative effusion, and Gene X-pert for MTB was negative. CA-125 was elevated, a nonspecific endometriosis marker. Pelvic ultrasound revealed features of pelvic endometriomas. Serial chest X-ray and CT scan showed right hydropneumothorax, lung mass, lung collapse, and pulmonary fibrosis. Multiple chest tubes were placed for the recurrent hydropneumothorax management. Exploratory laparotomy with bilateral ovarian cystectomy was done, and histology revealed ovarian hemorrhagic cysts and salpingitis. Hormonal suppression initiated as mainstay of treatment. She is monitored monthly as an outpatient to assess treatment efficacy and condition progression. Conclusion/Learning Points: TES is a form of endometriosis involving the thoracic cavity, affecting women of reproductive age. TES may mimic PTB but symptoms correlate with the menstrual cycle (catamenial in nature). In Tanzania, diagnostic challenges persist due to its nonspecific symptoms, inadequate clinicians' awareness, and lack of treatment guideline national wide.

Ultrasound is the first-line and established imaging modality for the diagnosis of testicular masses and neoplasms, with high sensitivity. Conventional ultrasound can very reliably detect presence of an intratesticular mass although it may not specifically characterize them as benign or malignant and neoplastic or nonneoplastic or classify the type or subtype of neoplasm in every case. Contrast-enhanced ultrasound (CEUS) is a technique in which injected intravenous microbubbles can supplement the characterization of focal testicular masses through observation of real-time perfusion of the testis and the target mass. Testicular masses have been documented to demonstrate unique enhancing patterns on CEUS. We report a unique case involving a young male presenting with a palpable testicular mass in which CEUS aided in the diagnosis of testicular germ cell tumor. The diagnosis was subsequently confirmed by histopathological examination after surgery. This case report highlights the utility of CEUS as a useful complementary adjunct in diagnosing and characterizing nonseminomatous germ cell tumors of the testes with a review of the literature.

In this case, we describe a rare presentation of a uterine myoma in a 42-year-old female patient who presented with a progressively enlarging abdominopelvic mass and heavy menstrual bleeding for 1 month. Initial work showed that the patient has a low hemoglobin count and elevated CA-125 tumor marker. A pelvic ultrasound revealed a cystic pelvic lesion with an undetermined origin. Subsequent follow-up after 6 weeks showed significant enlargement of the mass, prompting a pelvic MRI to be performed; the MRI showed a large, completely cystic uterine myoma arising from the anterior myometrium. This case highlights the atypical presentation of a common gynecological condition that can result in a diagnostic dilemma and the importance of advanced imaging such as MRI to be a problem-solving tool.