BJR Case Reports最新文献

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.

Breast radiotherapy, typically administered using tangential fields in the supine position, employs various strategies to improve dose uniformity and minimize radiation exposure to sensitive organs. However, managing patients with large or pendulous breasts presents technical challenges, leading to the investigation of prone position radiotherapy, which has shown benefits in reducing skin reactions and lung radiation dose. Herein, we present a technical note detailing the implementation of a customized Vac-Lok prone pillow setup for adjuvant radiotherapy in a patient with extremely large pendulous breasts. The use of polystyrene foam slabs of 7 cm each and a Vac-Lok over it with a groove to place the ipsilateral breast hanging down and away from the midline and arms extended overhead on a customized prone pillow, enabled a comfortable position for the patient. Compared to the plan generated in the supine position, the prone plan showed a significant reduction in radiation dose to the ipsilateral lung.

Epstein-Barr Virus-positive mucocutaneous ulcers (EBVMCU) are a rare disease entity that causes mucocutaneous ulcerations in the gastrointestinal tract, oropharynx, and skin. Typically associated with immunosuppressed patients, individuals may present with nonspecific symptoms and scan findings similar to those of malignancies. Treatment usually responds favourably to conservative management or withdrawal of immunosuppression, although rarely patients require more aggressive therapies including surgery, immuno-, chemo-, or radio-therapy. We encountered an unusual case of a patient with EBVMCU who presented with cough, dysphagia, and weight loss. Imaging features on [18F]-FDG PET/CT as well as initial biopsy results were nonspecific. The colonoscopic features were highly concerning for malignancy, with the diagnosis only finally being confirmed following surgical resection. To our knowledge, this is the first case report to describe the FDG PET/CT findings of EBVMCU within the bowel, and readers should consider this as a differential to avoid potential misdiagnosis and unnecessary intervention.

Spinal infections are defined as infections within the vertebral column, intervertebral disc space, spinal canal, and surrounding soft tissues. Mycobacterium tuberculosis is the most prevalent pathogen worldwide, and Staphylococcus aureus accounts for more than half of European cases. However, Escherichia coli is a rare organism causing spondylodiscitis. Early diagnosis is vital for the effective management of spinal infections, as it helps prevent mortality and significant morbidity. We present a case of spondylodiscitis caused by E. coli bacteraemia, an atypical pathogen in this setting. The patient's history of cancer and immunocompromised condition complicated the diagnostic process. This case emphasises the importance of thorough evaluation with imaging and highlights the role of multidisciplinary teams in overcoming diagnostic challenges.

The perinephric space is a retroperitoneal compartment that can harbour various types of lesions. Among these, fat-containing lesions represent a specific subset that narrows the differential diagnosis. Perinephric myxoid pseudotumor of fat (PMPFT) is a rare and less-known entity within this category; its imaging features may overlap with other conditions such as well-differentiated liposarcoma and IgG4-related disease. We report the case of a 73-year-old man in whom bilateral perinephric fat-containing lesions were incidentally discovered during an abdominal ultrasound. Further imaging with CT and MRI was performed to better characterise the lesions. Two biopsies were subsequently undertaken; only the second one, performed laparoscopically, yielded diagnostic material, leading to a diagnosis of PMPFT. However, one year later, follow-up CT revealed an increase in size of the left perinephric mass, which also contained more evident soft tissue foci. The patient underwent a third biopsy that demonstrated an IgG4-positive plasma cell infiltrate, introducing a diagnostic dilemma.

Uterine smooth muscle tumour of uncertain malignant potential (STUMP) is a rare and diagnostically challenging entity, lying on the spectrum between benign leiomyomas and malignant leiomyosarcomas. Its unpredictable biological behaviour and potential for metastasis and progression to leiomyosarcoma necessitate surgical removal and long-term surveillance for late recurrence and malignant transformation. We present a case of uterine STUMP in a 49-year-old woman with a large uterine mass exhibiting suspicious magnetic resonance imaging (MRI) features preoperatively. She underwent a hysterectomy with histological confirmation of STUMP. Through radiologic-pathologic correlation, we highlight key MRI features that can suggest the diagnosis of STUMP and aid in differentiating it from benign leiomyomas. While differentiating STUMP from leiomyosarcoma on imaging remains challenging due to its rarity and overlapping imaging characteristics, imaging plays a crucial role in detecting complications and guiding follow-up. Multidisciplinary management in tertiary centres with gynaecologic oncology expertise is essential for comprehensive patient care.

Bilateral renal lymphangiectasia is a rare, benign lymphatic disorder that causes the perirenal, parapelvic, and intrarenal lymphatic channels to dilate. Because it is rare and has varying radiologic appearances, it might be confused with other cystic renal illnesses, such as polycystic kidney disease, which can lead to misdiagnosis and unnecessary treatments. In this case review, a 51-year-old female patient who presented with abdominal pain was diagnosed with bilateral renal lymphangiectasia based on imaging findings. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) revealed bilateral intrarenal and perirenal cysts. We comprehensively reviewed 56 cases of bilateral renal lymphangiectasia in adults published in the literature until June 2025. Conservative treatment was the preferred approach in about half of the cases. In cases where there were symptoms or complications, treatments such as percutaneous drainage, marsupialization, or nephrectomy were done. While aggressive treatment methods such as nephrectomy were commonly used in the 1980s, percutaneous interventional procedures and conservative treatments began to be used more frequently starting in the 1990s. Haematuria, ascites, hypertension, polycythaemia, pleural effusion, and renal vein thrombosis are rare complications reported. The aim of this case and literature review is to improve diagnostic accuracy by highlighting the clinical spectrum and imaging findings of bilateral renal lymphangiectasia. Accurate diagnosis based on imaging modalities is important to avoid unnecessary interventional and surgical procedures.

Cytomegalovirus (CMV) is a viral infection that is generally considered benign in immunocompetent patients; however, it can be life-threatening in immunocompromised patients. We present the case of a 46-year-old patient with severe primary CMV encephalitis. The patient presented to the hospital emergency department with impaired alertness and speech. A brain scan and initial lumbar puncture (LP) were normal. However, the patient's state of consciousness deteriorated rapidly with the onset of seizures, prompting a brain MRI scan, which revealed lesions suggestive of encephalitis. Polymerase Chain Reaction (PCR) detection of cytomegalovirus was confirmed on a second lumbar puncture. Following the confirmation of the diagnosis, the patient was commenced on appropriate antiviral treatment, which resulted in a favourable outcome. Our aim is to report on the clinical manifestations and the contribution of imaging to the diagnosis of CMV encephalitis in immunocompetent persons.

Pneumoparotid is an unusual condition involving retrograde insufflation of air via the mouth into the parotid gland. In rare circumstances it can be complicated by subcutaneous emphysema. We describe a highly unusual case of rapid-onset facial swelling and limited eye-opening in an otherwise clinically well 13-year-old female. Computed tomography imaging showed pneumoparotid and extensive surgical emphysema involving the cervicofacial soft tissues and mediastinum. A detailed history revealed habitual Valsalva-related behaviours, including ear-popping and blowing bubbles in drinks. She was diagnosed with subcutaneous emphysema secondary to pneumoparotid, and her symptoms resolved with conservative management.

Fibrocartilaginous mesenchymoma is a locally aggressive intraosseous lesion first described in 1984, which most commonly presents in the long bones of children and young adults. It is rare-less than 40 cases have been reported to date. The typical radiological features are those of an expansile lytic lesion with chondroid calcification, cortical destruction and frequent extraosseous extension, suggesting an aggressive benign or low-grade malignant tumour. On MRI the lesion returns low T1 and high T2 signal and usually shows intense contrast enhancement. Histologically the lesion is characterised by a spindle cell proliferation, areas of ossification and benign cartilage nodules resembling the epiphyseal plate, the latter considered the hallmark of this tumour. We present a case of fibrocartilaginous mesenchymoma in the rib of a 28-year-old female, a very uncommon location for this tumour. The case is also exceptional because of the age of the patient and its unusual imaging appearances: the lesion showed no evidence of chondral-type matrix mineralisation, displayed profound T2 hypointensity and only minimal enhancement following intravenous Gadolinium administration.