Case Reports in Radiology最新文献

Background: Uterine sarcomas are uncommon malignant tumors with a grim prognosis, accounting for less than 1% of all gynecologic malignancies. Radiological series often include a limited number of patients, and diagnostic approaches can vary. While the presence of low T2 signal intensity in leiomyomas on MRI has been proposed as a criterion to exclude sarcoma, exceptions to this rule exist. We present two cases that challenge this notion. Case reports: The first patient was a 48-year-old woman presenting with metrorrhagia. MRI revealed a large intramural leiomyoma characterized by extensive hypointensity on T2-weighted imaging (T2WI) and a small intraleiomyoma focus with intermediate signal intensity. Histopathological examination confirmed leiomyosarcoma. The second patient was a 51-year-old woman presenting with menometrorrhagia. MRI showed a subserosal myoma with zones of T2WI hypointensity interspersed with a region of intermediate signal intensity. Histopathological examination confirmed low-grade endometrial stromal sarcoma. In both cases, diffusion-weighted imaging (DWI) revealed an intratumoral zone of restricted diffusion, with an apparent diffusion coefficient (ADC) value ≤ 0.86 × 10^-3 mm²/s. Conclusion: MRI is crucial for distinguishing leiomyomas from sarcomas. We propose combining T2WI and DWI with ADC for this purpose, noting limitations in each sequence's reliability. Suggestive MRI criteria for malignancy in sarcomas are identified, emphasizing the need for comprehensive imaging analysis. In characterizing uterine smooth muscle tumors, particularly when analyzing leiomyoma variants, DWI emerges as the dominant sequence, with T2WI serving as a secondary sequence. ADC values aid in histopathological hypothesis, but caution is warranted due to overlap with benign lesions. This approach may refine preoperative diagnosis and guide therapeutic management.

Situs ambiguous is a rare congenital condition characterized by the abnormal arrangement of thoracoabdominal organs along the left-right axis. This condition often presents as either left or right isomerism, leading to complex anatomical variations and associated clinical challenges. We present the case of a 44-year-old female who was incidentally discovered to have situs ambiguous with polysplenia and left atrial appendage isomerism during the evaluation of abdominal pain and urinary symptoms caused by a ureteral calculus. Notably, the patient exhibited normal bronchopulmonary anatomy. The patient underwent a ureteroscopy, laser lithotripsy, stone extraction, and right ureteral stent placement. The patient was discharged shortly thereafter. We believe our case underscores the critical importance of recognizing the potential dissociation between thoracic and abdominal isomerism. It also highlights the need for further investigation into the embryological processes that contribute to these unusual presentations.

Breast amyloidoma is an extremely rare and potentially underdiagnosed entity with underreported diagnostic implications. Breast amyloidomas typically present as painless masses with varying imaging characteristics ranging from nonspecific asymmetries to mammary carcinoma mimics. Calcifications are visualized in many described cases in the literature with a characteristic histopathologic appearance following Congo red staining under polarized light. While breast amyloidomas are benign lesions, there are proposed associations with systemic autoimmune and hematolymphoid disorders in the literature. This suggests the need for standardized management parameters following diagnosis, as the treatment of localized amyloidosis differs greatly from that of its systemic counterpart. To date, no consensus guidelines for follow-up or management of breast amyloidomas exist, owing to its rarity and dearth of cases in the literature. Due to the necessity of employing specific staining to establish the diagnosis, underdiagnosis and occasionally misdiagnosis may contribute to its apparent rarity. In this radiologic-pathologic correlation, a unique case of breast amyloidoma is presented to highlight the imaging characteristics, underlying histopathology, and proposed clinical management, with the goal of improving understanding of this rare entity.

We report a case of a 69-year-old female smoker who presented with multiple pulmonary micronodules incidentally noted during imaging for aortoiliac occlusive disease. A growing right lower lobe nodule was resected, revealing adenocarcinoma alongside benign minute pulmonary meningothelial-like nodules (MPMNs). MPMNs, often found incidentally, in association with malignancies, can mimic metastatic disease but are benign and stable. Recognizing MPMNs is essential to prevent misdiagnosis and unnecessary treatment in patients with coexisting malignancies. On chest CT, these nodules are typically peripherally located along the interlobular septa, consistent with their close vascular association around the small pulmonary veins observed in pathology.

Introduction and Importance: Dyke-Davidoff-Masson syndrome (DDMS) is a rare neurological condition characterized by focal or generalized drug-resistant epilepsy, hemiparesis, face or body asymmetry with atrophy, and cognitive impairment in early childhood and adulthood. DDMS is generally diagnosed in the paediatric age group. Neuroimaging shows skull bone thickening with cerebral hemiatrophy and hyperpneumatization of sinuses. Case Presentation: Here is a case of a middle-aged female presenting with a history of multiple episodes of seizure since childhood. MRI showed diffuse atrophy of the left cerebral hemisphere with hypertrophy of the contralateral hemisphere, hyperpneumatization of the left frontal sinus, and thickened calvaria, all characteristics of DDMS. Based on the history, clinical findings, and MRI reports, it was diagnosed as a case of DDMS. Discussion: DDMS can be due to injury to the brain, either intrauterine or during early childhood. The features can be confused with other conditions like Rasmussen encephalitis, hemiconvulsion-hemiplegia-epilepsy (HHE syndrome), Sturge-Weber syndrome, Silver-Russell syndrome, basal ganglia germinoma, Fishman syndrome, and linear nevus syndrome. Before making a diagnosis, a proper antenatal and postnatal history with early childhood presentations should be taken. Occupational therapy, physiotherapy, and seizure control improve the patient's quality of life. Conclusion: Though DDMS is usually diagnosed during early childhood, a few missed cases lead to later findings in life, resulting in late medical consults and affecting an individual's lifestyle. Management includes only symptomatic relief. Paediatricians, radiologists, neurologists, and gynaecologists need to be well-informed about the case for its early diagnosis and management.

We describe a 30-year-old woman who had meningitis retention syndrome (MRS) with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS), which occurred with fever, urinary retention, and weakness in both legs. A case of MRS with MERS is rare among adults, and its clinical course and treatment planning remain unknown. In the present, we highlighted the change in magnetic resonance imaging, blood tests, and cerebrospinal tests along with the treatment. A multidisciplinary approach by a radiologist and neurologist led to the diagnosis and appropriate treatment.

Solitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin that is primarily found in the lungs but can be found in other locations such as the retroperitoneum, deep soft tissues of the proximal extremities, abdominal cavity, head, and neck. Moreover, SFTs found in the breast are extremely rare and, oftentimes, are found incidentally during screening mammography. Our case presents an exceptionally rare occurrence of a SFT in the breast of a 40-year-old woman. This rarity is underscored by its classification as a SFT and its unusual location within the breast tissue as well as this patient's young age. This case emphasizes the importance of a thorough evaluation with both imaging and histopathology for diagnosing SFTs. It also addresses the potential difficulties that may arise during this process, especially for radiologists who may have limited experience encountering SFTs.

The patient presented with abdominal pain for the first time 10 years ago and was diagnosed with a left ureteral calculus, left hydronephrosis, and hydroureter. The patient's abdominal pain disappeared after palliative treatment, but he refused any treatment measures for his calculus and hydrops. He was readmitted due to chronic pelvic pain 8 years ago and was diagnosed with a pelvic abscess and left renal atrophy after imaging examination. We performed pus aspiration treatment under the guidance of transrectal B-mode ultrasound and used antibiotic fluid for purulent cavity rinse, followed by intravenous injection of antibiotics. The abscess shrank in follow-up magnetic resonance imaging (MRI), and the pain symptom disappeared in his pelvic. We followed up with the patient for 6 months, and he had no symptoms related to his pelvic abscess that was diagnosed before. Recent abdominal computed tomography (CT) images revealed that his left kidney atrophy still exists, and a pelvic stone was found at the site of the original abscess. This case once again proves that a ureteral calculus should be treated in time; otherwise, it can lead to serious complications such as a pelvic abscess and renal atrophy. A pelvic stone can be caused by a ureteral calculus migration. Minimally invasive treatments have minimal damage to the body and are widely applicable, and the patient was cured by one of them, abscess aspiration, which implies that they can also be used for patients who cannot tolerate surgical procedures.

This case highlights an atypical but important consideration in young males presenting with persistent gastrointestinal and/or genitourinary symptoms. Zinner syndrome (ZS) develops from embryologic maldevelopment of the distal mesonephric duct, resulting in ejaculatory duct atresia with consequent obstruction of the seminal vesicle and concomitant ureteral bud malformation, leading to renal agenesis/dysplasia. The lack of distinct clinical symptoms makes ZS a difficult diagnosis to reach: Abdominal pain and dysuria are often mistaken for prostatitis or cystitis. However, the use of modern imaging modalities aids in establishing the diagnosis. Early identification of ZS may delay progression to infertility as the duct obstruction may not be as extensive, though further research is needed to establish this connection.

Tetralogy of Fallot (TOF) is a significant cause of cyanotic congenital heart disease (CHD) encountered in childhood with few cases manifesting in adulthood. It has four classical features (ventricular septal defect, overriding of aorta, hypertrophy of right ventricular hypertrophy, and right ventricular outflow tract obstruction), but the clinical presentation and course can be variable. Due to various anatomical variations and complex anatomy, presurgical planning and postoperative follow-up by pulmonary computed tomographic angiography (CTA) have a very important role. With continued technological advances and the availability of 128-slice computed tomographic (CT) scans, they now play an important role in TOF preoperative evaluation and workup, assisting by minimizing routine invasive digital subtraction catheter angiography. The fast scan of a 128-slice CTA with very sensitive detectors is a very useful modality for studying the complex anatomy and variations as well as its utilization for postoperative management. In this article, we report four cases of TOF where we used a 128-slice scan for performing pulmonary angiography (Optima 660, GE 128, 2180 Premier Row, Orlando, FL 32809, U.S.A.) for preoperative diagnosis and management of three cases and work up for revision surgery for an already operated case with a nonfunctional modified Blalock-Taussig shunt with additional lung parenchymal findings simultaneously. This study will explain the advantageous role of the 128-slice CT scanner over the lesser-slice CT scanners with the ability of pulmonary CTA to facilitate accurate diagnosis and postoperative management.