Journal of Radiology Case Reports最新文献

Scurvy, a disease caused by a severe lack of vitamin C in the diet, is most often associated with 17th-century sailors. Its 21st-century manifestation is a disease of the poor, sick, and those living in remote rural neighborhoods in which fresh, nutritious food is hard to come by. It is caused by a deficiency of Vitamin C and is rare in the United States. We describe the radiographic and MRI findings of a case of scurvy in a child with Noonan syndrome who is a "picky eater". MRI is rarely performed in scurvy as its radiographic findings are generally well known and sufficient for a diagnosis. However, due to the rarity of the disease in the US, MRI features of scurvy have been described in only a few case reports, to date. The rarity of this disease also causes scurvy to be kept lower, if at all in the differential diagnosis list.

An 84-year-old female with metastatic left breast cancer underwent a venous port insertion for chemotherapy. The port was inserted using standard techniques with image guidance under local anesthesia. She presented after 36 days with evidence of infection. A limited bedside ultrasound demonstrated free fluid surrounding the port. The port was subsequently removed the same day, at which time pus was expressed from the subcutaneous pocket. The culture from the pus grew Mycobacterium abscessus. She required removal of the port and wound debridement, wound dressings and a prolonged course of antibiotics. Mycobacterium abscessus is a group of rapidly growing, multidrug-resistant, non-tuberculous mycobacteria that are also relatively resistant to standard skin disinfectants. In recent years, this organism has been increasingly reported as the culprit in post-operative or post-procedural infections. Treatment is challenging due to multidrug resistance, and requires an extensive course of intravenous antimicrobial and macrolide-based combination therapy followed by oral antimicrobial therapy. Early treatment is essential as progression may result in disseminated infection. We discuss the peri-operative and post-operative care required in preventing and treating infection with this organism.

The calcification of ligamentum arteriosum occurs after the normal closure of the ductus arteriosus. Foreign body ingestion is a common event in the pediatric age, and it is frequently addressed in the Emergency Room. We report a case of foreign body in a patient with unknown calcification of the ligamentum arteriosum. His parents noted blood in the saliva, but he had no symptoms indicative of an acute clinical situation. The CT showed a hyperdense object in the aorto-pulmonary window with features compatible with a metallic object. The child underwent surgery, during which a calcified ligamentum arteriosum was found and no foreign body. This phenomenon has been described to be better identified using multi-section CT scans than X-Rays.

Splenic artery steal syndrome is a rare complication after liver transplant. It could lead to rapidly evolving major issues such as ischemic cholangiopathy and acute graft failure. Although the pathophysiology is not yet well understood, if diagnosed in time it could be easily managed with interventional radiology treatments. We present a case of a 47-year-old man presented to our institute with radiological findings typical for multifocal hepatocellular carcinoma in a cirrhotic liver. After therapy he underwent transplant. Some days after surgery he developed signs of acute liver failure. Steal syndrome was suspected by laboratory tests and radiology exams. The syndrome was confirmed by angiography and treated. The graft was saved, and the patient is still alive and free of disease. The purpose of this paper is to explain the importance of radiology exams in the diagnosis of splenic steal syndrome, explain its pathogenesis and describe the interventional management of this complication.

Primary central nervous system lymphoma (PCNSL) constitutes about 3% of all primary brain tumors and nearly 1 to 3% of all Non Hodgkin Lymphomas. In the recent years the incidence of primary CNS lymphoma is increasing in immunocompetent patients. As PCNSL are chemosensitive as well as radiosensitive, its early and accurate diagnosis is imperative for optimal management. Contrast enhanced Magnetic Resonance Imaging (MRI) is the recommended imaging modality for PCNSL; however, contrast enhanced Computed Tomography (CE-CT) is done in cases where MRI is contraindicated. Advanced imaging techniques like DWI (diffusion weighted imaging), MRS (MR Spectroscopy), MR perfusion, DTI (Diffusion tensor imaging) are important in diagnosis and help in its differentiation from other tumors.

Subcutaneous panniculitis-like T-cell lymphoma is a rare subtype of cutaneous T-cell lymphomas and represents less than 1% of non-Hodgkin's lymphomas. Currently, the diagnosis is based on clinical and histological findings although clinical features may be nonspecific. Often, it is localised to subcutaneous tissue without lymph node involvement. The literature is sparse but unusual presentations have been described to involve mesentery, breast and even eyelids. Fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography has been reported to be useful in assessing disease activity, extent and treatment response in subcutaneous panniculitis-like T-cell lymphoma but we find that it can also be a diagnostic aid for atypical presentations. In our case report, we describe a patient who presented with a neck lump but did not have any other obvious cutaneous lesions. This was biopsied and had histological features in keeping with subcutaneous panniculitis-like T-cell lymphoma. Due to the atypical presentation, positron-emission tomography was crucial for detecting the extracutaneous and likely primary site of disease in the peritoneum, which hence guided the subsequent biopsy to this affected area and confirmed the diagnosis.

A 45-year-old woman presented to our clinic with intermittent left flank pain. The family physician referred her for renal cystic mass with a calcified appearance. The non-contrast spiral abdominal computed tomographic (CT) scan demonstrated the mass-like cystic lesion with a densely calcified lesion in the lower pole of the kidney. A detailed history revealed that she underwent shock wave lithotripsy (SWL) for the lower pole renal stone one year ago. After SWL, the stone fragments migrated to the dependent diverticulum region and produced the misleading appearance of a Bosniak type III lesion. Contrast-enhanced computed tomography (CT) scan was done for further evaluation, and finally, the diagnosis of the calyceal diverticulum was confirmed in the lower pole of the kidney. Calyceal diverticula are the outpouching of the pyelocalyceal system lined by non-secretory transitional epithelium. It is a rare condition that occurs in less than 0.5% of the population. Most patients are asymptomatic and have been discovered incidentally in routine imaging modalities. As most of the patients are asymptomatic, many do not need intervention. However, in some instances, patients present with flank pain, hematuria, urinary tract infection, and stone formation in the diverticulum. They are in the differential diagnosis of renal cystic lesions such as simple renal cyst, renal cortical abscess, and parapelvic cyst. In renal cystic lesion besides of simple renal cyst or renal cystic mass, we should keep the differential diagnosis of the calyceal diverticulum type 2, especially in patients that underwent SWL for renal stones; the fragmented residual stone may have migrated to this dilated region and produce the deceptive appearance of a Bosniak type III lesion.

A radiographically lucent patellar lesion may represent a variety of etiologies, ranging from more commonly seen degenerative, metabolic, infectious, developmental, posttraumatic, postoperative causes to rarer benign and malignant neoplasms. Clinical symptoms, surgical history, laboratory values, and radiographic features may help narrow the differential. In addition, radiographic features such as circumscribed borders and sharply delineated margins favor benign lesions while ill-defined margins suggest malignant etiologies. This case series illustrates the imaging findings and explores relevant clinical findings in a variety of interesting lucent patellar lesions.

Posterior cruciate ligament (PCL) repair has been increasingly performed as opposed to conservative management of PCL tears, in order to protect against future osteoarthrosis and meniscal degeneration. Fixation of the graft to bone can be done with interference screws, of which those composed of a bioresorbable material such as polyetheretherketone (PEEK) are preferred, owing to their inertness, good fixation strength and superior MR imaging compatibility. However, PEEK screws (unlike titanium screws) are radiolucent, and can make accurate post-operative evaluation by radiographs challenging. This is the first reported case of loosening of PEEK screw post-PCL repair, which highlights the importance of MRI and potential pitfall of radiography in evaluating post-surgical ligament laxity.