BJR Case Reports最新文献

Emphysematous osteomyelitis accompanied by necrotizing fasciitis (NF) is a rare life-threatening condition requiring immediate recognition and aggressive management. We report a case of a 47-year-old male who initially presented to the Emergency Department (ED) with fever, shoulder pain, and leukocytosis. The patient was discharged with analgesics for presumed musculoskeletal pain after an unremarkable chest radiograph. Over the following days, he developed a progressive chest and neck erythema, prompting his return to the ED. Bloodwork revealed a progression of leukocytosis. Contrast-enhanced CT identified emphysematous osteomyelitis of the first rib with sternoclavicular joint infection, accompanied by extensive NF of the upper mediastinum and lower neck, necessitating multiple emergent surgical interventions. This case underscores the importance of early cross-sectional imaging in suspected osseous and deep soft tissue infections, as plain radiography may appear deceptively normal. It also highlights the radiology's pivotal role in assessing disease severity and guiding timely, potentially life-saving intervention.

Chronic expanding haematoma is defined as a haematoma that gradually increases in size for ≥1 month. It is mostly related to trauma or surgery and can develop at any location in the body. Herein, we describe a case of a chronic expanding haematoma in the left kidney in a patient with a history of long-term hydronephrosis. The patient was a man in his 70 s who had undergone surgery for seminoma with lymph node metastasis 40 years prior. Following the procedure, he had been in an extended state of hydronephrosis. Computed tomography performed during the follow-up period revealed nodules in his persistently dilated left renal pelvis. A left nephrectomy was performed because the possibility of another malignancy could not be ruled out. Pathological examination revealed that the mass was a haematoma that had originated from the left kidney. To the best of our knowledge, this is the first clinical report in the literature of chronic expanding haematoma in the kidney.

Totally implantable venous access devices provide long-term venous access for patients requiring extended therapies, such as chemotherapy, with lower risks of infection and extravasation. These devices are typically placed in the subclavian or internal jugular vein and connected to a subcutaneous port. Following implantation, a chest X-ray is used to confirm catheter placement, detect early complications, and identify the "pinch-off sign"-a warning of potential catheter compression between the clavicle and first rib. Complications include malposition, pneumothorax, infection and catheter dysfunction such as pinch-off syndrome (POS), catheter fracture, and migration. POS can cause catheter dysfunction, fracture, and migration, potentially leading to severe cardiovascular or neurological complications, including cardiac perforation and pulmonary embolism. In some cases, catheter migration is asymptomatic and discovered incidentally. When catheter fragments migrate, removal via a percutaneous transvenous approach is preferred to avoid complications. However, in asymptomatic patients, observation may be a suitable alternative if the fragment adheres to the vessel. We report the case of a 25-year-old patient under surveillance for metastatic medullary thyroid carcinoma, whose catheter migrated to the pulmonary artery and remained complication-free for 6 years. This case highlights the importance of routinely checking for pinch-off syndrome whenever a central catheter is placed, and it suggests that removal of migrated catheter fragments may not be necessary in asymptomatic patients.

Brown tumours, reactive osteolytic lesions caused by hyperparathyroidism, are usually identified by X-ray, computed tomography, and magnetic resonance imaging, with ultrasonography of brown tumours being only rarely reported in the literature. In this paper, we present a case of brown tumours initially detected during ultrasound examination and subsequently confirmed. We describe the ultrasonographic characteristics in detail and discuss the clinical value of ultrasound as a screening and diagnostic tool. Furthermore, we summarise the clinical characteristics, imaging features, and treatment options of brown tumours based on a thorough analysis of the available literature.

Rhabdomyosarcoma (RMS) is rare but is the most common soft tissue sarcoma in children and teenagers. Alveolar rhabdomyosarcoma (ARMS), a subtype of RMS, primarily affects teenagers aged between 10 and 25 years old and is associated with early lymphatic and hematogenous metastases. This case report describes a 13-year-old girl with ARMS in the right thigh, accompanied by multiple bone and bone marrow metastases. Contrast-enhanced CT/MRI revealed a mass with marked heterogeneous enhancement and an enhancing pseudocapsule, while pathological examination confirmed the diagnosis through immunohistochemical markers (MyoD1 (+), Myogenin (+), Desmin (+)). This case highlights the aggressive nature of ARMS and the importance of characteristic imaging findings.

This case report presents a 62‑year‑old male with chronic pilonidal disease that underwent malignant transformation into squamous cell carcinoma (SCC), followed 18 months later by incidental detection of a gastric gastrointestinal stromal tumour (GIST) during routine oncologic surveillance. Initial contrast‑enhanced CT revealed the gluteal SCC, which was surgically excised and treated with adjuvant radiotherapy. Subsequent CT scan indicates a well‑circumscribed mass in the submucosa of the stomach. MRI and endoscopic biopsy confirmed a submucosal gastric GIST, which was completely resected. No recurrence of either malignancy has been observed on follow‑up. This case underscores the pivotal role of multimodality imaging in diagnosis, staging, and longitudinal care.

Peritoneal metastasis (PM, or peritoneal carcinomatosis) is often associated with dismal prognosis. The treatment of peritoneal metastasis depends on several factors, including the type of primary cancer, the extent of metastasis and the patient's overall health condition. Apart from systemic chemotherapy and cytoreductive surgery (CRS), locoregional therapies such as hyperthermic intraperitoneal chemotherapy (HIPEC) or pressurized intraperitoneal aerosol chemotherapy (PIPAC) may improve tumour control. CRS is a complex procedure with high morbidity, performed only in approximately 25% of all eligible patients and the efficiency of other non-surgical therapies is not well known. The place of radiation therapy needs to be defined. A 62-year-old woman was referred for surgery for a few days' history of large bowel obstruction. A previous abdominopelvic CT showed an obstructive 3-cm mass in the proximal ascending colon, associated with small bowel dilatation. Right hemi-colectomy was performed. Work-up demonstrated on MRI (magnetic resonance imaging) sub-centimetric secondary liver lesions. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) ruled out other metastatic lesions. After multidisciplinary discussion, peri-operative systemic therapy based on FOLFOX-Bevacizumab was offered and was associated with stable disease for 7 months. Unfortunately, peritoneal progression was detected on PET/CT imaging. FOLFIRI-Bevacizumab was offered as second line systemic therapy followed by resection of residual masses. The patient was considered in remission for 5 months thereafter. A second isolated peritoneal relapse occurred involving the same 2 distinct sites. Second line chemotherapy was re-challenged. The oligorecurrent PM lesions were considered as non-operable. After multidisciplinary team discussion, stereotactic body radiation therapy (SBRT) was decided. The relapse sites were treated with 48 Gy, delivered in 6 fractions of 8 Gy given every other day. At the 22-month follow-up, the patient showed no signs of relapse on CT imaging and no treatment-related toxicities. Isolated peritoneal oligometastatic metastases are associated with poor prognosis. Cytoreductive surgery remains the historical standard of care treatment but represents a minority of all eligible patients. Our case and few other reports suggest that SBRT is a safe, reasonable, and non-invasive treatment option.

A 41-year-old man with a neonatal history of Erb's palsy presented with severe bilateral gnawing radicular arm pain. A detailed neurological examination detected no abnormality. Imaging revealed right hemi spinal cord T2 hyperintensity together with an occluded left vertebral artery to the V4 segment. The clinical syndromes and mechanisms of spinal cord infarction are discussed. A hypothesis for the lack of sensorimotor signs is put forward.

Radiation therapy is not mentioned in various guidelines for primary treatment of uterine sarcoma. Radiation therapy is considered useful for palliative purposes, but an optimal radiation schedule has not been established. An 85-year-old woman was recommended to undergo surgery for locally advanced uterine sarcoma of unknown histological subtype, but she refused because of her poor physical and social circumstances. She instead received chemotherapy; however, the lesion progressed, and the patient opted for best supportive care. Palliative radiation therapy was indicated for genital bleeding. She thereafter received the QUAD shot regimen, in which 3.7 Gy was administered twice a day for 2 consecutive days and repeated every 4 weeks for a total dose of 44.4 Gy in 3 cycles. The lesion significantly decreased in size, and no new regional or distant metastases were identified. Although only palliative radiation therapy was initially intended, the favourable response with no new lesion development prompted us to offer additional brachytherapy for curative intent, and the patient accepted. She underwent 2 sessions of uterine cervical intracavitary and interstitial brachytherapy using a gel spacer, and local control of the lesion was achieved at 1-year and 3 months follow-up of treatment without major adverse events. In select patients for whom a favourable response is achieved after the QUAD shot, the addition of intracavitary and interstitial brachytherapy with a gel spacer may result in curative treatment. This therapy could be a very promising and attractive option for patients with uterine sarcoma who have complications or special social circumstances.

Adenocarcinoma of the urachus is a rare but highly aggressive malignancy that arises from the urachal remnant. Due to its non-specific symptoms and potential to mimic more common and benign conditions, accurate and early diagnosis through imaging is crucial. This report will discuss the role of imaging in urachal adenocarcinoma regarding the characteristics and diagnosis of this tumour, with a focus on CECT, MRI, and ultrasound for detection, staging, and treatment planning. Since urachal adenocarcinoma is a rare and complex disease, optimal results can be achieved only with a combined approach, where close cooperation among urologists, radiologists, oncologists, and pathologists is absolutely necessary. This investigation underlines the importance of increased awareness and expertise in the early and accurate imaging of this malignancy and advocates that optimal survival and quality of life can be best achieved in these patients by a well-coordinated, expert-driven approach.