BJR Case Reports最新文献

A 19-year-old woman presented to the emergency department with arrhythmia and signs of cardiogenic shock. After a 12-lead electrocardiogram ruled out acute myocardial infarction, and cardiac magnetic resonance showed no sign of cardiomyopathy, cardiac computed tomography angiography (CCTA) was performed, displaying ostial atresia of the right coronary artery. She was thus referred to a specialist centre for congenital cardiovascular disease, where an electrophysiological study observed an arrhythmogenic focus on the posteromedial papillary muscle, which was ablated, and she has been asymptomatic since. When dealing with patients presenting with arrhythmias or cardiogenic shock, and no signs of myocardial infarction or cardiomyopathy, performing CCTA to study the anatomy of the coronary arteries is vital.

Desmoid tumours are rare benign tumours that show locally aggressive and invasive features leading to potential complications. They can be quite challenging for the treating surgeon if they occur adjacent to neurovascular structures. The aetiology of these tumours is still unclear, but the incidence is higher in females and in patients with a history of trauma or surgical procedures, raising the possibility of genetic and hormonal factors as well as post-traumatic or post-operative inflammatory changes promoting the formation of desmoid fibromatosis. We report a case of a 34-year-old Asian female who presented to our hospital with a history of difficulty in swallowing due to an enlarging lump on the left side of her neck. Patient had a past medical history of previous cervical spinal disc surgery due to a herniated disc. Diagnostic imaging showed a large soft tissue mass centred between the left common carotid artery and the cervical vertebrae displacing the trachea and oesophagus to the right side. A biopsy was obtained, and histopathological examination was suggestive of a desmoid tumour. The patient underwent surgical resection of the tumour but returned later with recurrence and had to undergo the surgery again to achieve full cure.

Appendiceal diverticulitis, although rare, is an important differential diagnosis in cases of right iliac fossa pain. Previously, it has often been considered as a variant of acute appendicitis, due to its seemingly similar clinical presentation. However, recent research indicates that appendiceal diverticulitis is a distinct clinical entity, with demographic characteristics and clinical features that are different to acute appendicitis. It is also associated with higher risk of severe morbidity and mortality, necessitating timely diagnosis and management. In this report, we present a case of a 58-year-old male patient with diverticulitis of the vermiform appendix and review the relevant literature. We describe the classification of appendiceal diverticulosis and diverticulitis, their clinical presentation, and their potential complications. We outline the radiological findings of appendiceal diverticulitis and acute appendicitis and discuss the important role of diagnostic imaging in distinguishing between these 2 conditions.

A 77-year-old woman underwent CT to evaluate haematemesis. The images showed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The duodenal-jejunal junction and jejunum were located on the patient's right side. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, and a diagnosis of Mallory-Weiss syndrome was made. Repeat CT 7 days later revealed that the abnormal positioning of the intestinal tract had resolved spontaneously. Two months later, the patient experienced another episode of haematemesis, and CT revealed repeat deviation of the duodenal-jejunal junction and jejunum to her right side. Upper gastrointestinal endoscopy revealed another laceration at the gastric cardia, as in the previous study. On the basis of the initial CT findings showing the duodenal-jejunal junction in the right hemi-abdomen, intestinal malrotation was suspected. However, because the jejunum deviated repeatedly to the right side but resolved spontaneously, we diagnosed dysplasia of the ligament of Treitz. Laparotomy revealed a formed ligament of Treitz; however, fixation in the upper jejunum was incomplete. Additionally, CT revealed that the anterior pararenal space was loosely fixed and mobile. These factors may have caused the right-sided deviation of the small intestine. In this case, the third part of the duodenum likely flexed on the right side of the aorta, causing an obstruction that resulted in repeat vomiting episodes and Mallory-Weiss syndrome.

Conjoined twins, or Siamese twins as they are commonly called, are a rare and extreme form of monochorionic twinning. Imaging plays an essential role in the diagnosis and follow-up of conjoined twins. While ultrasound is often the screening modality of choice, MRI is carried out for better anatomical delineation and further characterization as and when necessary. We present a unique case of first trimester thoraco-omphalopagus conjoined twins with cystic hygroma who were comprehensively evaluated with sonography and MRI with imaging findings confirmed post-pregnancy termination. The case stresses upon the utility of advanced imaging techniques including foetal MRI that immensely contribute towards a reliable diagnosis.

Various respiratory, musculoskeletal, gastrointestinal, neurological, and urinary complications have been reported in Kawasaki disease. Here, we describe a rare case of atlantoaxial rotatory fixation (AARF) associated with incomplete Kawasaki disease. The case is of a healthy 4-year-old Japanese boy who had a high-grade fever, lymphadenopathy, and torticollis diagnosed with incomplete Kawasaki disease. Intravenous high-dose immunoglobulin and oral aspirin quickly resolved his fever and improved his lymphadenopathy, but torticollis remained. On orthopaedic examination, torticollis was observed with a marked restriction of rotation, and an open-mouth anteroposterior cervical radiograph and a CT scan confirmed rotational dislocation at the dens axis (AARF). Cervical collar fixation was immediately started, and the torticollis gradually normalized within a week. AARF is defined as torticollis due to dislocation or subluxation of the atlantoaxial joint. The diagnosis of AARF is difficult with routine plain cervical radiographs in 2 directions alone, and an additional cervical open-mouth anteroposterior radiograph and a CT scan aid the diagnosis. AARF associated with Kawasaki disease is uncommon, and only 24 cases have been reported in the literature. AARF may occur in Kawasaki disease patients with cervical lymphadenopathy. Still, torticollis is often transient and may not be recognized or ignored by family doctors and paediatricians. Reduction of the atlantoaxial joint can often be achieved spontaneously or with conservative treatment such as a collar or neck traction, but treatment is difficult if the diagnosis is delayed. Therefore, family doctors and paediatricians need to suspect the onset of AARF if torticollis is observed during treatment for Kawasaki disease, perform plain cervical radiographs including open-mouth anteroposterior view and a CT scan of the cervical spine, and have orthopaedists immediately intervene to avoid invasive surgery.

Non-ketotic hyperglycaemia (NKH)-induced hemichorea-hemiballismus (HC-HB) is an infrequent reversible condition observed in individuals with poorly controlled diabetes. In this report, we present a case of NKH-induced HC-HB exhibiting distinctive morphological and functional alterations on conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and ¹H magnetic resonance spectroscopy (MRS), followed by subsequent monitoring. A 70-year-old male with a 20-year history of diabetes presented with severe unilateral involuntary movement. Computer tomography revealed heightened attenuation in the left putamen and caudate nucleus. The conventional MRI revealed the presence of focal T2-hyperintensity, noticeable mass effect, and ring-like enhancement, which are indicative of glioma. Additionally, the DWI showed unrestricted diffusion of water molecules within the lesion. MRS analysis further demonstrated significantly elevated lactate (Lac) and lipids (Lip), minimal increased choline (Cho), basically stable creatine (Cr), and modest decreased N-acetylaspartate (NAA) levels (which remained larger than both Cho and Cr peaks), leading to a diagnosis of NKH-induced HC-HB. This report emphasizes the significance of acknowledging that NKH-induced HC-HB can manifest with imaging features that bear resemblance to those of glioma. The presence of a slightly elevated Cho/NAA ratio alongside a notable increase in Lac/Lip peak on MRS may aid in ruling out neoplastic conditions.

A 63-year-old man underwent transcatheter arterial embolization (TAE) using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil to treat acute gastrointestinal (GI) bleeding. The procedure was initially successful; however, the patient developed ileus >1 month later and subsequently underwent several surgeries to treat the multiple metachronous ileal stenoses. The flux of a small amount of off-target glue was the primary cause of these complications. As the patient had few symptoms in the first month post-TAE, however, affirming the diagnosis took time. A detailed review of plain CT scans was a decisive factor in achieving the final diagnosis. This case demonstrates that TAE using an NBCA-iodized oil mixture effectively treats acute GI bleeding. However, a complication such as off-target embolization is likelier to occur because of a combination of certain factors such as vascular anatomy, complexity of the procedure, and NBCA dilution. Close observation using plain CT should be performed for the identification of off-target embolization occurrence even in cases of successful TAE.

This case study describes a female patient in her late 70s who developed autoimmune cholangitis a year after finishing 35 cycles of pembrolizumab for the treatment of her non-small cell lung cancer. The diagnosis was initially missed and delayed; the patient's agoraphobia and the COVID-19 pandemic were noted as contributing factors.

Prostate adenocarcinoma metastasis to brain has been reported to occur only up to 0.6% of patients and these are mostly diagnosed in autopsy series. In the setting of biochemical recurrence of prostate cancer, a suspected PSMA-avid (prostate-specific membrane antigen) lesion in the brain is still strongly suggestive of an intracranial metastasis of prostate cancer. This needs, however, a thoroughly recurrency work-up due to other potentially PSMA-avid cranial lesions, as PSMA initially was developed for the imaging of primary CNS tumours. We report of a challenging clinical case of a 71-year-old-patient with a strongly PSMA-avid lesion at the skull base. Given the medical history of a meningioma at the skull base, the further diagnostic work-up with MRI could still not rule out a malignancy, so that the patient needed to undergo a surgical excision of the tumour mass. The histological and immunohistochemical examinations revealed a relapsed CNS WHO grade 1 meningioma. From the aspect of molecular imaging and critical analysis of regular clinical care in a third-level university hospital, we consider this result very intriguing. Hence, we analyse the decision-making process and clinical course of this case in the light of molecular imaging findings.