BJR Case Reports最新文献

Chondromyxoid fibroma-like osteosarcoma (CMF-OS) is an exceptionally rare and low-grade variant of osteosarcoma, as classified by the World Health Organization. Misdiagnosis is common in CMF-OS, often leading to delays in definitive surgical intervention. CMF-OS exhibits variable imaging features, frequently mimicking chondromyxoid fibroma. It may present as osteolytic, osteogenic, or expansive lesions, often associated with soft tissue invasion, cortical disruption, and occasionally a periosteal reaction. Cases have been reported in diverse anatomical locations, including the craniofacial region and bones of the lower limbs. Histologically, CMF-OS is distinguished by its unique mucoid appearance, characterized by loose aggregates of stellate and spindle-shaped tumour cells embedded within a highly myxoid stroma. Surgical resection remains the cornerstone of treatment for CMF-OS, emphasizing the importance of accurate diagnosis to facilitate timely and appropriate management.

Idiopathic granulomatous mastitis (IGM) is an uncommon benign disease thought to have an autoimmune origin. After massive vaccination against COVID-19, mRNA vaccines have been associated with various possible adverse effects. Among those involving the breast, the most common are ipsilateral axillary lymphadenopathies and transient breast oedema. We present the case of a young woman who developed IGM after mRNA vaccination against COVID-19. We describe the clinical and imaging findings and management of this case, discussing the evidence for a possible link between vaccination and the development of this uncommon inflammatory process and underlining the importance of including this entity in the differential diagnosis in this scenario.

Fibular hemimelia (FH) is a rare congenital abnormality where the fibula is either totally or partially absent. It can occur alone or alongside other skeletal malformations, and in very few cases, it may occur along with non-skeletal anomalies. A 4-year-old female was diagnosed with unilateral right-sided FH, accompanied by limb shortening, a right-side ankle deformity, valgus foot, and 3 lateral rays that had been totally absent since the first week of birth. And she was incidentally diagnosed with spina bifida occulta at a 3-year-old age. FH is most commonly unilateral and mostly affects the right side, leads to a limb-length discrepancy, and maybe comes as a symptom of a syndrome such as Foetus-Fibula-Ulna syndrome and so on. Risk factors include prenatal history, drugs, and no supplementation intake. Together, these elements could be a contributing factor to our condition. The congenital limb abnormalities may be discovered during pregnancy by sonography. If present, other investigations need to be done to differentiate the diagnosis. Treatment according to degree: mild, moderate, and severe cases. In our case, the type 2 FH characteristic was shown by sonography, accompanied by limb shortening, lateral rays absent, and a non-skeletal anomaly (spina bifida). These anomalies very rarely come with each other at the same time. To the best of our knowledge, this case is exceptional in that FH is present at birth alongside spina bifida.

Spontaneous rupture of ovarian dermoid cysts is uncommon. We describe a case of a 32-year-old female who presented to the emergency room with abdominal pain and distension. The patient was discovered to have a ruptured dermoid cyst which caused chemical peritonitis and was managed surgically.

Giant cell tumours (GCTs) of the larynx are extremely rare. The most affected structure is the thyroid cartilage and only 44 cases are reported in the literature.¹ Clinically, their first manifestation is usually a palpable neck mass, often accompanied by hoarseness, dyspnoea, and/or dysphagia depending on size and location. GCTs are benign neoplasms, yet awareness of this entity is crucial as their aggressive local behaviour can cause significant morbidity with airway obstruction and can simulate a malignancy. The differential diagnosis is broad and remains a clinical and radiological challenge. Indeed, the final diagnosis is established by histology postoperatively. Surgery is the preferred treatment but may impair voice quality. For incomplete surgical resections and high surgical risk lesions, denosumab treatment is a valuable option. We share our experience on GCTs in a young adult presenting as a supraglottic mass.

Aneurysms of an aberrant right subclavian artery (ARSA) are rare but constitute a potentially lethal condition, especially with concomitant Marfan syndrome (MFS). A 27-year-old female with confirmed MFS presented with a relevant progression of a known aneurysm of an ARSA in MRI. The patient had undergone valve-sparing aortic root replacement (David procedure) 4 months prior. After interdisciplinary discussion, she underwent endovascular exclusion of the aneurysm using a combination of established vascular plugs and novel shape memory polymer embolization plugs to fill the large ARSA aneurysm volume. The shape memory polymer embolization plugs expand in the vessel to a porous scaffold, designed to support thrombus formation throughout its structure. The polymer is also radiolucent, which minimizes artefact and facilitates follow-up imaging. Development of a strategy for the treatment of ARSA aneurysms is challenging and different surgical, endovascular, and combined approaches have been published. Interdisciplinary discussion is crucial to minimize the overall risk and trauma. In our case of a young female and new mother, an endovascular approach was successfully and safely performed. The future need for surgery due to concomitant MFS is expected.

Gastric pneumatosis is a rare finding, and clinicians, when under pressure, find it challenging to immediately identify the cause and decide if the patient requires emergency surgery. We present a case where an initial CT scan demonstrated gastric pneumatosis involving only the greater curvature of the antrum caused by a strangulated hiatus hernia and malrotation of the distal stomach. The CT features suggested the patient required immediate surgery; however, a conservative approach was taken, and a follow-up CT scan 4 days after the onset demonstrated complete resolution and no long-term complications.

Hyperpneumatization is a rare pathological process where air-filled cavitation form within solid bone architecture occurring at sites where physiological pneumatization is not seen. Extension of this process into the atlanto-occipital region is considered extremely rare and is only quoted several times in the literature. In this case report, we present a 66-year-old man who presented with an 8-month history of a worsening frontal headache and blocked sensation in his left ear. Subsequent CT head evaluation revealed hyperpneumatization affecting C1 vertebra, temporal and occipital bones with extension into the clivus. A rare complication of epidural emphysema was seen. The aetiology of hyperpneumatization is uncertain, although it is thought to be either congenital or acquired. In our case, clinical suggestion of eustachian tube dysfunction and radiological findings of thickened sinus mucosa and a unilateral nasal polyp point to chronic recurrent coryzal illnesses, which may indicate an acquired mechanism. Management is mostly conservative with surgical management reserved for high risk or refractory cases.

Severe pancreatitis following retrograde cholangiopancreatography (ERCP) is an infrequent occurrence. Even rarer are the additional non-pancreatic symptoms that can emerge after ERCP-induced pancreatitis, such as panniculitis and polyarthritis. This combination of symptoms is recognized as the pancreatitis, panniculitis, and polyarthritis syndrome (PPPS). PPPS typically manifests as reddish subcutaneous nodules, primarily in the lower extremities. In some cases, the condition may progress into the bones, causing intramedullary fat necrosis/bone infarcts. Joint complications involve polyarthritis and affect both small and large joints. PPPS tends to develop 3-6 weeks after the peak of clinical pancreatitis. In this report, we present a case of PPPS that occurred as a complication following ERCP. This particular case became further complicated by the presence of bacteraemia and fungaemia, leading to the subsequent development of multi-focal osteomyelitis. The medical imaging included in this report provides a comprehensive overview of the entire clinical course, starting from the initial post-procedural complication and pancreatitis, followed by multi-modal imaging depicting panniculitis using ultrasound and MRI, and finally illustrating the development of multi-focal osteomyelitis. This case serves as an opportunity to explore and understand 2 rare complications associated with pancreatitis: PPPS and multi-focal osteomyelitis.

Ascaris lumbricoides is one of the most well-known helminthic parasites affecting humans. Ascariasis is prevalent in developing countries where inadequate water, sanitation, and hygiene facilitate human-to-human transmission. In this report, we present a case of a 20-year-old male who arrived at the emergency room with severe right flank pain, high-grade fever, and recurrent vomiting. Diagnostic evaluations were conducted, including a complete blood count test, urinalysis, stool analysis, abdominal ultrasound, and CT scan. The final diagnosis was A lumbricoides found in the distal part of the ureter. A ureteroscopy procedure confirmed the diagnosis and extracted the worm, which measured 6 cm in length, had a brown colour, and exhibited a tight elastic consistency. While Ascaris is commonly found in the gastrointestinal tract, its occurrence in the urinary tract is an extremely rare phenomenon. In our case, the most likely explanation is that the Ascaris accessed the distal ureter through retrograde migration, wherein the worm traverses from the bladder into the ureter.