BJR Case Reports最新文献

Setting the echo time to zero allows for the acquisition of bone images that were otherwise difficult to obtain with conventional MRI and clear visualization of CT-like MR images. This technique is mainly useful for detecting compression fractures; however, studies examining bone tumours have been lacking. Furthermore, no reports to date have investigated the usefulness of MRI for evaluating images before and after radiotherapy (RT) for bone tumours. Therefore, plain CT and MRI (T1/T2-weighted image and CT-like MRI) were performed under the same conditions before and after radiation therapy (RT) and examined the obtained images. An 86-year-old man received RT (30 Gy/3 fraction) for painful lumbar metastasis from prostate cancer. At 2 months after RT, no changes in T2-weighted images and plain CT scans were noted, but CT-like MRI showed an increase in the signal inside the bone metastasis. Examining how the images change over time is imperative given the difficulty of predicting the duration of the pain relief effects of RT for bone metastases. Therefore, the current case report explored whether combining various modalities, such as CT and MRI, could predict prognosis. We highlight the importance of investigating whether signal changes are correlated with pain symptoms and whether MRI can be a predictor.

Isocitrate dehydrogenase 1 gene (IDH1, [NADP (+)] 1) encodes for an enzyme that catalyses the oxidative decarboxylation of isocitrate into α-ketoglutarate. However, it is well known that mutant IDH1 (mu/IDH1) promotes the accumulation of D2-hydroxyglutarate, an oncometabolite that stimulates tumourigenesis through various secondary, complex metabolic effects. IDH1 and also IDH2 gene mutations have been identified in several types of cancers, such as gliomas, conventional central and periosteal malignant cartilaginous tumours, cytogenetically normal acute myeloid leukaemia, and cholangiocarcinoma. Here, we present 4 cases of Chilean patients with different primary malignant tumours harbouring IDH1. One patient carried the IDH1 p. R132H mutation, the other has IDH1 p. R132L mutation, and the last 2, IDH1 p. R132C mutation. Of note, all these patients had a very poor response to chemotherapy and a rapid disease progression, resulting in a relatively swift death. Next-Generation Sequencing results highlighting mutations in those genes, and other cancer genes were further subjected to in silico study of protein-protein interactions, gene ontology, and pathway enrichment. We also include a state-of-the-art literature review about IDH1 and IDH2 molecular biology, biochemical properties, and the role of their mutations in cancer development and progression, along with insights into regional variations in cancer biology and treatment response.

Anaplastic thyroid carcinoma (ATC) is a highly aggressive thyroid malignancy, comprising 1%-4% of thyroid cancers, with rapid local invasion and distant metastasis. We report a 57-year-old male with ATC presenting with a neck mass, hoarseness, and dysphagia. Imaging showed cancer thrombus in bilateral internal jugular veins, with a biopsy confirming ATC. This case highlights the imaging and pathological features of ATC and emphasizes the importance of ultrasound in evaluating intravascular cancer thrombus, aiding accurate diagnosis and management.

Currently, portal vein (PV) resection is performed in 10%-40% of liver resections performed for hilar cholangiocarcinoma (HC). The defect is generally repaired with a patch of an autologous vein graft or end-to-end anastomosis after complete separation of the main PV trunk and the left PV. Postoperative PV thrombosis is a severe complication occurring in 2%-9% of patients requiring PV reconstruction. Here in, we presented a 55-year-old man with abdominal pain without hyperbilirubinaemia who was diagnosed with HC. The patient underwent right hepatectomy, extrahepatic biliary resection, and PV resection. The PV defect was repaired with autologous umbilical vein graft. Following the operation, acute PV thrombosis was encountered postoperative day 1. We conducted the treatment of the early acute PV thrombosis by intraportal tPA and PV stenting with endovascular approach.

Among the causes of ambulatory dysfunction, Lyme polyradiculitis is an uncommon but still essential aetiology to consider given its simple, effective treatment. We present a case of a man with 1 month of worsening bilateral leg paresis, paresthesia, and pain. He recalled no erythema migrans or tick bite. Initial screening showed negative serum Lyme and positive Epstein-Barr Virus testing. At our hospital, MRI revealed polyradiculitis with cauda equina nerve root enhancement. Subsequent serum and cerebrospinal results were positive for Lyme neuroborreliosis. He improved rapidly from a course of doxycycline. This case highlights the importance of timing for Lyme serologies in early neuroborreliosis, as well as converging clinical, radiological, and biofluid testing for diagnosis and management.

Emphysematous osteomyelitis (EO) is an uncommon but severe form of osteomyelitis that is characterized by gas formation within the bone. This case report highlights a case of particularly severe EO in an amputated foot, with key imaging findings across modalities emphasizing the diagnostic challenges and the importance of early detection. A 68-year-old male with a history of poorly controlled diabetes and a previous left third to fifth toe amputation for a non-healing ulcer presented to the emergency department with an infective picture and poorly controlled blood glucose levels. After clinical assessment, a focus of infection was found in the left foot and was subsequently assessed with plain radiography, MRI, and CT. The case highlighted the utility of each modality in such a complex presentation, including trabecular bony changes on the plain radiograph, soft tissue changes on MRI and confirmation of intraosseous pneumatosis on CT. This case highlights key imaging features of EO and underscores the need to use CT and MRI to guide timely surgical and medical management. This report adds to the limited literature on EO and presents a useful acronym of "LEAP" to describe key features when suspecting EO - lack of cortical destruction, extra-osseous soft tissue gas, associated comorbidities (diabetes, malignancy, etc), and pumice stone sign.

Rupture of the anterior cruciate ligament (ACL) is a common knee injury, and reconstruction via arthroscopy is popular for its safety and low complication rate, around 1%. Vascular injuries from this procedure are extremely rare, with an incidence of 0.003%-1%. Pseudoaneurysms following knee arthroscopy are even less frequent. This paper discusses a rare case of pseudoaneurysm after ACL reconstruction in the articular branch of the right inferomedial genicular artery (IMGA), originating from an anterior tibial artery with a high origin. A 47-year-old man with Von Willebrand disease developed a 24 mm pseudoaneurysm 30 days post-ACL reconstruction. CT-angiography showed the pseudoaneurysm near the tibial tunnel screw and an unusually high anterior tibial artery origin. Emergency angiography confirmed this, and embolization using Squid Peri 18 was successful, with no complications. The patient recovered well. Vascular injury is a rare knee arthroscopy complication, but early diagnosis and awareness of anatomical variations are essential. Endovascular treatment for iatrogenic pseudoaneurysms is safe and effective and facilitates rapid recovery.

Treating prostate cancer with radiation therapy in patients with a history of prior pelvic radiation may be limited by rectal dose constraints and the risk of rectal toxicity. Rectal spacers have been shown to improve rectal dosimetry in the treatment of prostate cancer. This study aimed to evaluate the safety and outcomes of hydrogel spacer placement, specifically SpaceOAR, between the rectum and prostate in prostate cancer patients who had previously undergone radiation therapy. In this retrospective case series, we analysed the medical records of 8 sequential patients undergoing reirradiation in the setting or prior pelvic radiation, who had received transperineal SpaceOAR placement. We documented the incidence of complications after SpaceOAR placement, before and after undergoing radiation therapy. There was a spectrum of complications in this patient cohort, ranging from pelvic pain to more severe complications such as rectal perforation abscess and fistula. Severe complications occurred in 2 of the 8 patients. Re-irradiation may increase the risk of normal tissue complications; however, hydrogel spacer placement using SpaceOAR in prostate cancer patients with prior pelvic radiation was associated with a higher rate of rectal complications than expected in a small series of patients. We urge caution when using SpaceOAR in this patient group.

Cystic adventitial disease is a rare cause of calf claudication and is characterized by the development of a mucinous, cystic mass within the outer layer (adventitia) of an artery. The popliteal artery is most commonly affected. Several theories and hypotheses exist regarding the aetiology of this disorder with no clear unifying cause accepted in the literature to date. We describe a case of a 32-year-old female with a one-year history of medial right knee pain and intermittent claudication who was diagnosed with a medial meniscal tear and a large parameniscal cyst communicating with the popliteal artery adventitia. She underwent arthroscopic meniscectomy and cyst decompression and achieved an excellent functional outcome with resolution of the claudication.

A 63-year-old male presented with acute onset of intermittent dizziness, visual disturbances, and left temporal headache. Investigations revealed a dural arteriovenous fistula (dAVF) at the left sigmoid sinus, classified as Cognard type IIb. Successful therapeutic transvenous embolization was performed using coils and Onyx, resulting in complete resolution of the dAVF without immediate complications. However, 3 days post-embolization, the patient developed headache, dizziness, visual discomfort, and alexia. MRI findings suggested vasogenic oedema in the left temporo-occipital area due to venous outflow obstruction. Despite treatment with enoxaparin and dexamethasone, the patient experienced progressive symptoms including difficulty in object naming, memory decline, and nonconvulsive seizures. Follow-up imaging indicated improvement of oedema and stable minimal focal gliosis. This rare case of a patient developing alexia following endovascular embolization of a dural AVF highlights the importance of post-procedural monitoring and suggests potential benefits of prophylactic anticoagulation to reduce the risk of probable complications.