BJR Case Reports最新文献

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.

May-Thurner physiology (MTP) can lead to various congestion syndromes due to compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA). This compression may result in venous reflux through the lumbar vein, leading to congestion of the spinal epidural venous plexus (EVP), which could contribute to refractory headaches. This case report details the clinical course of a patient with severe refractory new daily persistent headache associated with MTP who underwent ascending lumbar vein (ALV) embolization. The patient is a 59-year-old female with a 3-year history of daily persistent headache which failed multiple migraine prevention therapies and minimally invasive procedures. Imaging studies revealed significant LCIV compression by the RCIA, retrograde ALV flow, and EVP congestion. The patient underwent ALV embolization, resulting in significant symptomatic relief. At the 22-month follow-up, headache severity reduced by 80%, with the patient no longer requiring routine headache medications. Additionally, treatment of associated pelvic congestion syndrome through gonadal vein embolization resolved longstanding associated pelvic pain and pressure. This case highlights the role of venous congestion in refractory headache syndromes and underscores the potential of targeted venous interventions, such as embolization, in their management. The findings expand on emerging evidence linking venous compression syndromes to headache pathophysiology and support exploring interventional strategies as viable treatment options for selected patients. Further research is needed to validate these findings and establish evidence-based guidelines for clinical practice.

Fibrous dysplasia (FD) is a benign condition affecting osteoblasts, which fail to undergo proper differentiation and maturation, resulting in the replacement of normal osteoid matrix with ground glass fibrous tissue. Aneurysmal bone cyst (ABC) is a benign, expansile, lytic lesion characterized by multiple blood-filled cystic cavities containing haemorrhagic products at varying stages. Secondary ABC arising from craniofacial FD is extremely rare. To date, only 10 cases have been reported in the literature. This report highlights the clinical presentation, imaging findings, and histopathological confirmation of a secondary ABC in a patient with polyostotic craniofacial FD.

The appearance of intracranial haemorrhage on magnetic resonance imaging (MRI) is complex and depends on its evolution over time. The ability of the MRI to detect hyperacute haemorrhage has been debated as it seems to depend on several factors (ie, delay of imaging, MRI field strength, imaging technique). We present the first case of intracranial haemorrhage occurring during MRI acquisition in a 61-year-old female suffering a severe hypoxic-ischaemic encephalopathy from a suicide attempt by hanging. The imaging characteristics of the haematoma differ from what has been described in the past, as it lacks the typical peripheral T2 and T2* hypointensity usually seen in hyperacute haematomas. We discuss previous literature in order to explain these peculiar imaging features.

We report a rare case of idiopathic, isolated, and bilaterally symmetrical brachymetacarpia of the fifth metacarpal bones in a 60-year-old woman followed for seropositive rheumatoid arthritis. Despite the radiographic anomaly, the patient remained asymptomatic and had normal hand function. Extensive investigations ruled out syndromic or metabolic causes. This case emphasizes the importance of recognizing rare skeletal variants in rheumatologic evaluations.

Selective embolization is the treatment of choice for traumatic renal pseudoaneurysm (PSA) in stable patients. N-Butyl-2-cyanoacrilate (NBCA) is an embolic agent frequently used to embolize peripheral lesions. N-Butyl-2-cyanoacrilate is one of the most widely used embolic materials because it is easy to prepare, it acts quickly and is highly cost-effective. Its use, however, requires a learning curve before becoming confident and being able to handle it safely. We describe a case of embolization of a renal traumatic PSA without clear pre-procedural CT-evidence of artero-calyx fistula in which the migration of NBCA in the renal pelvis occurred during the procedure. We report the successful multidisciplinary management of this complication.

Aneurysmal bone cyst (ABC) is a locally destructive benign tumour-like condition of the bones with blood-filled cystic cavities. The talus is an extremely rare site for an ABC, with <20 reported cases till 2012 based on a PubMed database search. Aneurysmal bone cyst recurrence in the talus after curettage and bone grafting is extremely rare. To the best of our knowledge, no detailed reports of resection and adjuvant therapy with artificial bone packing of recurrent ABC of the talus have been published. We report a case of ABC in the talus of a 9-year-old boy. As the initial surgery consisted of only lesion resection and artificial bone (beta-tricalcium phosphate [TCP]) packing, local recurrence was diagnosed. Reoperation was performed 5 months after the initial surgery. The recurrent lesion was resected using a curette, and the bone cavity septum was shaved with a high-speed burr. Phenol-ethanol ablation was used as an adjuvant with artificial bone (beta-TCP) packing to prevent recurrence. No local recurrence was observed 36 months after the reoperation. This extremely rare case of resection and adjuvant therapy with artificial bone packing of recurrent ABC of the talus highlights the need for careful observation to assess the progression of ankle joint osteoarthrosis.

Heterotopic pregnancy refers to the concomitant presence of an intrauterine pregnancy and an ectopic pregnancy (EP). It is rare and more frequently found in women who have undergone medically assisted procreation. An abdominal location of the ectopic gestational sac is even less common, accounting for 1.4% of all ectopic pregnancies, conferring a high risk of morbidity and mortality. Diagnosis can sometimes be difficult, and pelvic ultrasound alone may not be sufficient. Additional pelvic MRI may be useful to confirm the diagnosis with certainty. Heterotopic pregnancy requires urgent management and is mainly treated surgically, although there are certain situations where medical treatment may be indicated. We report the case of a 29-year-old patient admitted with pelvic pain and mild metrorrhagia, with an elevated beta-hCG level suggesting the diagnosis of an EP, which was confirmed by ultrasound and MRI, revealing the presence of 3 foetuses: 1 was developing in the abdominal cavity while the other 2 were normally present in the uterine cavity.