BJR Case Reports最新文献

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.

Primary central nervous system (CNS) mucosa-associated lymphoid tissue (MALT) lymphoma is a rare condition frequently mistaken for meningioma. Since these conditions require distinct treatment approaches, recognizing their imaging characteristics is essential for accurate clinical decision-making. A 69-year-old woman presented with headaches and forehead swelling, prompting MRI of the CNS. Suspecting an intracranial meningioma, the tumour board recommended surgical resection. However, histopathological analysis identified the lesion as a primary CNS MALT lymphoma. Follow-up revealed secondary cutaneous tumour infiltration, leading to a delay in adjuvant radiotherapy. Understanding the differential diagnoses of meningioma is critical for neuroradiologists and neurosurgeons to ensure appropriate treatment planning. This case highlights a misdiagnosis of meningioma that was ultimately identified as a primary CNS MALT lymphoma, emphasizing key imaging and clinical characteristics essential for distinguishing between the most important differential diagnoses of primary CNS MALT lymphoma.

Accessory spleen torsion is a rare but important cause of acute abdominal pain, often presenting with non-specific symptoms that overlap with more common abdominal pathologies. This case report discusses a 19-year-old female who presented with left-sided flank pain and leucocytosis. Imaging with abdominal CT and MRI revealed a well-defined lesion near the spleen and kidney, with mild vascular engorgement and surrounding inflammation. While these findings raised suspicion for accessory spleen torsion, the diagnosis was not immediately clear. The lesion's location, vascular congestion, and absence of typical characteristics for other pathologies, such as haematomas, abscesses, mesothelial cysts, or lymphangiomas pointed towards torsion, but confirmation required surgical intervention. During laparoscopic exploration, a 5 cm accessory spleen with ischaemic changes due to torsion of its pedicle was identified and successfully removed without complications. Accessory spleens, present in 10%-30% of the population, are usually asymptomatic but can become problematic if torsion, rupture, or infarction occurs. Imaging plays a critical role in identifying torsion, with CT and MRI revealing the characteristic "whirlpool sign" and vascular congestion. Early recognition is crucial to prevent complications such as necrosis and rupture, and surgical intervention, typically laparoscopic splenectomy, is the treatment of choice. This case highlights the importance of considering accessory spleen torsion in the differential diagnosis of acute abdominal pain, particularly in young patients with non-specific symptoms. Awareness of this condition can improve early diagnosis and outcomes, preventing severe consequences.

Bronchocentric granulomatosis is a rare form of granulomatous disease characterized by peribronchiolar or peribronchial necrotizing granulomas.¹ The imaging findings are non-specific and include nodular or mass-like lesions and pneumonic consolidation.² We present a case of bronchocentric granulomatosis in a patient with Pre-B-cell acute lymphoblastic leukaemia. The aim of the case report is to make the radiologist aware of this condition and emphasize the importance of multimodality approach which along with clinical findings helps in reaching a diagnosis and managing this rare complication.

Transjugular intra-hepatic porto-systemic shunt (TIPS) is a proven strategy for the management of portal hypertension (PH) complications. Here, we report on a complex case of haemorrhagic shock due to the rupture of gastro-oesophageal varices in the context of PH originally sustained by idiopathic, likely congenital, high-flow intrahepatic arterioportal fistulas (IAPFs) preceded by extensive bowel ischaemia. While the occlusion of the IAPFs potentially controlled the steal of arterial splanchnic blood into the portal circulation, it failed to manage PH related bleeding, necessitating the placement of a salvage TIPS. Porta-caval pressure gradient persisted markedly increased after IAPFs occlusion, indicating an independent intra-hepatic component causing PH. Moreover, hepatic histology demonstrated a pre-sinusoidal/sinusoidal barrage response of the hepatic parenchyma secondary to long-standing IAPFs, causing the onset of an intra-hepatic component of PH. For these reasons, the combined interventional approach led to resolution of the refractory portal hypertensive bleeding, avoiding fatal evolution of diffuse bowel infarction.

Polyarteritis nodosa (PAN) is a systemic small to medium vessel vasculitis. It is often associated with hepatitis B infection and classically presents with cutaneous, gastrointestinal, or nervous system involvement. We present a case of a 56-year-old male who presented with a chief complaint of painful scrotal swelling. Initial ultrasound demonstrated concern for epididymitis, and the patient was started on appropriate antibiotics without improvement of symptoms, resulting in admission. Due to continued scrotal pain, fevers, and negative infectious work-up, F-18 fluorodeoxyglucose (FDG) PET/CT was obtained, revealing diffuse hypermetabolic activity throughout the medium to small arterial vasculature, concerning for vasculitis. Abdominopelvic angiography confirmed the diagnosis, and the patient was started on steroids with plans to initiate cyclophosphamide. Clinical testicular involvement is a rare presentation of PAN, although it is often seen at autopsy. Previously reported cases have presented with similar scrotal pain and tenderness in addition to constitutional symptoms, as well as treatment with steroids and immunosuppressive agents. While biopsy with histopathology or angiography often serves as the gold standard for the diagnosis of PAN, this case also demonstrates the diagnostic utility of nuclear medicine with F-18 FDG PET/CT. Polyarteritis nodosa typically demonstrates hypermetabolic activity of the small- to medium-sized vasculature on F-18 FDG PET/CT, most often in the lower extremities. With similar findings, this case contributes to reports that show the utility of nuclear imaging in diagnosing vasculitides.

Pancreatic dermoid cyst is an extremely rare benign neoplasm of the pancreas. Pre-operative diagnosis is often difficult due to its rarity and overlapping features with other pancreatic cystic neoplasms. We report a case of a 55-year-old male with an incidental finding of a lobulated complex cystic lesion in the tail of the pancreas on imaging and the challenges to obtain a definitive diagnosis. Due to suspicious features on imaging and elevated CA 19-9 tumour marker, surgical resection was recommended at the Pancreatic Multidisciplinary Team Meeting. The patient subsequently underwent a distal pancreatectomy and splenectomy which confirmed a dermoid cyst.

Vulvar dermatofibrosarcoma protuberans (DFSP) is a rare pathology. So far, only limited number of cases have been reported in literature. In the present case, we discuss a 38-year-old female presented with a painful left vulvar mass. She had a prior history of a left vulvar mass excision which was histopathologically confirmed as benign spindle cell epithelioma. The current mass, extending from the left labia majora to the left gluteal fold, was assessed via contrast-enhanced magnetic resonance imaging (MRI), revealing a well-defined, lobulated lesion with proximity to the distal urethra and clitoris without definite invasion. The patient underwent a wide local excision, radical vulvectomy, and left inguinofemoral lymphadenectomy. Postoperatively, she experienced fever, vulvar swelling, and dysuria. Follow-up MRI demonstrated total resolution of the vulvar mass and collection with no recurrence. Histopathology identified the mass as DFSP, with all surgical margins negative.