BJR Case Reports最新文献

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.

Third inflow refers to the additional blood supply to the liver from a third source, apart from its dual blood supply. Aberrant right and left gastric veins, Sappey and Barlow veins, and the parabiliary venous system are considered the most significant examples of third inflow. Clinically, the third inflow is important due to its association with hepatic pseudolesions and its role in increasing surgical complication risks in hepatobiliary and gastric procedures. Our case series includes 8 cases of aberrant left gastric vein (ALGV) and 1 case of a Sappey vein. In addition to presenting examples of ALGV and Suppey vein, we also highlight ischemic complications of the liver observed in a liver transplant donor and a gastric cancer case. Our aim is to emphasize ALGV-related surgical risks and the importance of assessing vascular variations in preoperative imaging.

Dengue fever is common in Southeast Asia, including Nepal, caused by the Flavi virus transmitted through mosquito bites of Aedes aegypti species. Symptoms include high-grade fever, skin rash, headache and arthralgia, with a low case fatality rate of less than 1%. Severe forms are characterized by low platelet count, vascular leakage, and low blood pressure, often leading to life-threatening complications. Common imaging findings include gall bladder wall thickening, hepatosplenomegaly, ascites, pericardial effusion, and pleural effusion. Dengue was initially considered non-neurotropic, but recent studies suggest that the virus can invade the central nervous system, indicating its neurotropic potential presenting with encephalitis and meningitis. In this case series, we have described atypical imaging findings of 7 patients in patients with laboratory confirmed dengue fever, which revealed imaging features of psoas hematoma in 1 case, diffuse pulmonary haemorrhage in 1 case, multifocal pneumonia in 1 case, hemorrhagic stroke with venous thrombosis in 1 case, dengue meningoencephalitis in 2 cases and dengue encephalitis with Cytotoxic lesion of the corpus callosum in 1 case. This case series emphasizes the important role of imaging findings in severe dengue patients with suspicion of unusual complications as early detection and prompt treatment are crucial for recovery and to prevent fatal complications.

Haemoptysis in patients with lymphoma and leukaemia can present a therapeutic challenge, given that it is often associated with underlying impairments of haemostasis and immunosuppression. Bronchial artery embolization (BAE) is a mainstay in the treatment of haemoptysis, typically in those requiring emergent management. In this case series, the role of BAE in patients with lymphoma and leukaemia was evaluated. A total of 5 patients were identified between August 2010 and August 2022. Three patients were diagnosed with lymphoma (classical Hodgkin's lymphoma, diffuse large B-cell lymphoma and extra-nodal marginal zone lymphoma) and 2 patients were diagnosed with leukaemia (1 patient with acute myeloid leukaemia and the other with chronic lymphocytic leukaemia). All patients were thrombocytopenic [77.6 ± 28.5 × 10⁹/L (mean ± SD)], at presentation. Three patients had concurrent lung infection at the time of their presentation. Technical success was achieved in 4/5 patients (80%). Clinical success was obtained in 4/5 patients (80%). Recurrence following embolization was seen in 2 patients. Three patients died within 30 days following embolization (from deteriorating respiratory function). Bronchial artery embolization for haemoptysis in patients with lymphoma and leukaemia is safe and feasible. Concurrent lung infection is potentially of significance with regard to initial presentation and overall outcomes following embolization. In select patients, BAE may provide a therapeutic option, though further investigation is required.