Pub Date : 2025-12-13DOI: 10.1016/j.radcr.2025.11.007
YaDing Luo MD, YinSheng Lin PhD
Elevated hepatopulmonary shunt exceeding 20% is a strict contraindication for Y90-SIRT due to the risk of fatal radiation pneumonitis, posing a significant clinical challenge in the management of such HCC cases. We report a 45-year-old man with unresectable massive HCC and an initial HPS of 21.8% who was treated with a staged multimodal protocol involving arterioportal fistula embolization, drug-eluting bead transarterial chemoembolization (TACE), and systemic therapy. This strategy successfully reduced the HPS to 7.4%, which permitted curative-intent Y90-SIRT. Subsequent significant tumor regression enabled an R0 resection—defined as complete resection with negative margins. The patient showed no evidence of recurrence or postoperative complications during 6-month surveillance. This case highlights that a strategically sequenced combination of locoregional and systemic therapies can overcome absolute contraindications to Y90-SIRT, enabling conversion to resection in selected patients with advanced HCC.
{"title":"A novel triple-modality approach overcoming prohibitive hepatopulmonary shunt (HPS): Enabling yttrium-90 selective internal radiation therapy (Y90-SIRT) and subsequent curative resection in massive hepatocellular carcinoma (HCC)","authors":"YaDing Luo MD, YinSheng Lin PhD","doi":"10.1016/j.radcr.2025.11.007","DOIUrl":"10.1016/j.radcr.2025.11.007","url":null,"abstract":"<div><div>Elevated hepatopulmonary shunt exceeding 20% is a strict contraindication for Y90-SIRT due to the risk of fatal radiation pneumonitis, posing a significant clinical challenge in the management of such HCC cases. We report a 45-year-old man with unresectable massive HCC and an initial HPS of 21.8% who was treated with a staged multimodal protocol involving arterioportal fistula embolization, drug-eluting bead transarterial chemoembolization (TACE), and systemic therapy. This strategy successfully reduced the HPS to 7.4%, which permitted curative-intent Y90-SIRT. Subsequent significant tumor regression enabled an R0 resection—defined as complete resection with negative margins. The patient showed no evidence of recurrence or postoperative complications during 6-month surveillance. This case highlights that a strategically sequenced combination of locoregional and systemic therapies can overcome absolute contraindications to Y90-SIRT, enabling conversion to resection in selected patients with advanced HCC.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1099-1103"},"PeriodicalIF":0.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.radcr.2025.11.048
Biraj Bista MD , Sworup Thapa BS
Extramedullary relapse of acute myeloid leukemia (AML) refers to the infiltration of leukemic cells into tissues outside the bone marrow and is a rare occurrence involving central nervous system, particularly following allogeneic stem cell transplantation. We report a rare case of extramedullary relapse of acute myeloid leukemia (AML) presenting as a thoracic epidural mass with additional multiple vertebrae and acetabular leukemic involvement in a 28-year-old male, two years postallogeneic stem cell transplantation. The patient presented with progressive lower extremity weakness and paresthesia. Imaging revealed an extensive epidural mass causing spinal cord compression, along with increased 18F-fluorodeoxyglucose uptake in the mass, multiple vertebrae and the left acetabulum. Surgical decompression and biopsy of the spinal epidural mass confirmed leukemic infiltration. To our knowledge, this is the first reported case of extramedullary AML relapses simultaneously involving the epidural space, multiple vertebrae and acetabulum.
{"title":"Extramedullary relapse of acute myeloid leukemia presenting as an epidural spinal mass with vertebral and acetabular leukemic involvement: A case report","authors":"Biraj Bista MD , Sworup Thapa BS","doi":"10.1016/j.radcr.2025.11.048","DOIUrl":"10.1016/j.radcr.2025.11.048","url":null,"abstract":"<div><div>Extramedullary relapse of acute myeloid leukemia (AML) refers to the infiltration of leukemic cells into tissues outside the bone marrow and is a rare occurrence involving central nervous system, particularly following allogeneic stem cell transplantation. We report a rare case of extramedullary relapse of acute myeloid leukemia (AML) presenting as a thoracic epidural mass with additional multiple vertebrae and acetabular leukemic involvement in a 28-year-old male, two years postallogeneic stem cell transplantation. The patient presented with progressive lower extremity weakness and paresthesia. Imaging revealed an extensive epidural mass causing spinal cord compression, along with increased 18F-fluorodeoxyglucose uptake in the mass, multiple vertebrae and the left acetabulum. Surgical decompression and biopsy of the spinal epidural mass confirmed leukemic infiltration. To our knowledge, this is the first reported case of extramedullary AML relapses simultaneously involving the epidural space, multiple vertebrae and acetabulum.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1092-1095"},"PeriodicalIF":0.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.radcr.2025.11.062
Saxby Brown MBBS, MMedPhys , Eva A. Wegner BMed, FRACP, FAANMS, MHM , Monica A. Rossleigh MBBS, MD, FRACP, FAANMS
Diagnosing pediatric osteomyelitis can be challenging due to its often nonspecific symptoms and the potential for early or misleadingly normal laboratory results. Early and accurate diagnosis is essential to prevent long-term complications. This report discusses 2 cases: an 18-month-old girl with a 4-week history of a worsening right leg limp and refusal to weight-bear, presenting afebrile and with normal inflammatory markers, where triple-phase bone scintigraphy with SPECT/CT was crucial in diagnosing talar osteomyelitis; and a 14-month-old boy presenting with a 5-day history of refusing to walk and mildly raised inflammatory markers, where triple-phase bone scintigraphy with SPECT/CT identified the presence of L5 vertebral osteomyelitis. These 2 cases demonstrate the utility of whole body bone scintigraphy and the additional value in SPECT/CT acquisition in accurately localizing osteomyelitis in children, particularly when other investigations are nondiagnostic or symptoms are not clearly localized, or when MRI is logistically challenging due to the requirement for general anesthesia.
{"title":"Imaging pediatric osteomyelitis: The role of 99mTc-HDP bone scintigraphy and the additional value of SPECT/CT imaging","authors":"Saxby Brown MBBS, MMedPhys , Eva A. Wegner BMed, FRACP, FAANMS, MHM , Monica A. Rossleigh MBBS, MD, FRACP, FAANMS","doi":"10.1016/j.radcr.2025.11.062","DOIUrl":"10.1016/j.radcr.2025.11.062","url":null,"abstract":"<div><div>Diagnosing pediatric osteomyelitis can be challenging due to its often nonspecific symptoms and the potential for early or misleadingly normal laboratory results. Early and accurate diagnosis is essential to prevent long-term complications. This report discusses 2 cases: an 18-month-old girl with a 4-week history of a worsening right leg limp and refusal to weight-bear, presenting afebrile and with normal inflammatory markers, where triple-phase bone scintigraphy with SPECT/CT was crucial in diagnosing talar osteomyelitis; and a 14-month-old boy presenting with a 5-day history of refusing to walk and mildly raised inflammatory markers, where triple-phase bone scintigraphy with SPECT/CT identified the presence of L5 vertebral osteomyelitis. These 2 cases demonstrate the utility of whole body bone scintigraphy and the additional value in SPECT/CT acquisition in accurately localizing osteomyelitis in children, particularly when other investigations are nondiagnostic or symptoms are not clearly localized, or when MRI is logistically challenging due to the requirement for general anesthesia.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1086-1091"},"PeriodicalIF":0.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jejunostomy-related intussusception is an exceptionally rare postoperative complication, accounting for less than 1% of all small-bowel obstructions. It may result from mechanical irritation or altered motility around the feeding tube. We describe the case of a 63-year-old man with unresectable adenocarcinoma of the gastric cardia who underwent exploratory laparotomy with placement of a feeding jejunostomy, followed by palliative chemotherapy. A few days after surgery, he developed progressive abdominal distension and clinical signs of bowel obstruction. Abdominal CT revealed small-bowel dilatation and a characteristic “target sign’’ at the ileocecal valve, consistent with intussusception induced by the jejunostomy tube. Surgical exploration confirmed the diagnosis, and bowel resection was performed. This case underscores the importance of considering intussusception as a potential cause of postoperative bowel obstruction in patients with feeding jejunostomy and highlights the crucial role of early imaging and timely surgical intervention in preventing ischemic complications.
{"title":"A rare twist: Intussusception triggered by a jejunostomy tube","authors":"Chakir Mahfoud , Hatim Essaber , Anwar Kalali , Hamza Charif , Fatima Zahra Laamrani , Youssef Omor , Rachida Latib , Sanae Amalik","doi":"10.1016/j.radcr.2025.11.050","DOIUrl":"10.1016/j.radcr.2025.11.050","url":null,"abstract":"<div><div>Jejunostomy-related intussusception is an exceptionally rare postoperative complication, accounting for less than 1% of all small-bowel obstructions. It may result from mechanical irritation or altered motility around the feeding tube. We describe the case of a 63-year-old man with unresectable adenocarcinoma of the gastric cardia who underwent exploratory laparotomy with placement of a feeding jejunostomy, followed by palliative chemotherapy. A few days after surgery, he developed progressive abdominal distension and clinical signs of bowel obstruction. Abdominal CT revealed small-bowel dilatation and a characteristic “target sign’’ at the ileocecal valve, consistent with intussusception induced by the jejunostomy tube. Surgical exploration confirmed the diagnosis, and bowel resection was performed. This case underscores the importance of considering intussusception as a potential cause of postoperative bowel obstruction in patients with feeding jejunostomy and highlights the crucial role of early imaging and timely surgical intervention in preventing ischemic complications.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1096-1098"},"PeriodicalIF":0.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.radcr.2025.10.082
Dr. Shahid Hussain MBBS, FCPS
Intratesticular varicocele is a rare entity, often associated with extratesticular varicocele. Ultrasound with Doppler remains the gold standard for diagnosis. We present a 22-year-old male with right inguinal swelling diagnosed as reducible inguinal hernia. He also reported left scrotal discomfort. Ultrasound revealed a grade IV extra-testicular varicocele with extension into intratesticular parenchyma. Power Doppler confirmed venous flow within dilated intratesticular channels. A trace hydrocele was noted without testicular atrophy. Intratesticular varicocele is an uncommon but important condition. Awareness of this entity is crucial to avoid misdiagnosis. Ultrasound with Doppler remains a reliable diagnostic modality.
{"title":"A rare case of intratesticular varicocele: Diagnosed on ultrasound with power Doppler","authors":"Dr. Shahid Hussain MBBS, FCPS","doi":"10.1016/j.radcr.2025.10.082","DOIUrl":"10.1016/j.radcr.2025.10.082","url":null,"abstract":"<div><div>Intratesticular varicocele is a rare entity, often associated with extratesticular varicocele. Ultrasound with Doppler remains the gold standard for diagnosis. We present a 22-year-old male with right inguinal swelling diagnosed as reducible inguinal hernia. He also reported left scrotal discomfort. Ultrasound revealed a grade IV extra-testicular varicocele with extension into intratesticular parenchyma. Power Doppler confirmed venous flow within dilated intratesticular channels. A trace hydrocele was noted without testicular atrophy. Intratesticular varicocele is an uncommon but important condition. Awareness of this entity is crucial to avoid misdiagnosis. Ultrasound with Doppler remains a reliable diagnostic modality.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1078-1080"},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 63-year-old male smoker developed a refractory cervical chylous fistula following neck surgery for metastatic squamous cell carcinoma. Despite conservative management with a low-fat diet and subsequent surgical thoracic duct ligation, high-output chyle drainage persisted. On postoperative day 14, percutaneous thoracic duct embolization with lipiodol and n-BCA was successfully performed, resulting in immediate and sustained resolution of the leakage. The patient was discharged 48 hours later without recurrence. This case highlights thoracic duct embolization as a safe, minimally invasive, and highly effective therapeutic option for managing persistent cervical chylous fistulas when conventional treatments fail. The novelty of this report lies in demonstrating that timely image-guided embolization can provide definitive resolution even in severe, surgery-resistant cases, underscoring its growing role as a first-line intervention in selected patients.
{"title":"Minimally invasive radiologic approach to chyle leakage after oncologic cervical surgery: A case report","authors":"Adriele Silva , Natália Abrahão , Valmir Junior MD , Túlio Fabiano de Oliveira Leite MD, PhD","doi":"10.1016/j.radcr.2025.11.025","DOIUrl":"10.1016/j.radcr.2025.11.025","url":null,"abstract":"<div><div>A 63-year-old male smoker developed a refractory cervical chylous fistula following neck surgery for metastatic squamous cell carcinoma. Despite conservative management with a low-fat diet and subsequent surgical thoracic duct ligation, high-output chyle drainage persisted. On postoperative day 14, percutaneous thoracic duct embolization with lipiodol and n-BCA was successfully performed, resulting in immediate and sustained resolution of the leakage. The patient was discharged 48 hours later without recurrence. This case highlights thoracic duct embolization as a safe, minimally invasive, and highly effective therapeutic option for managing persistent cervical chylous fistulas when conventional treatments fail. The novelty of this report lies in demonstrating that timely image-guided embolization can provide definitive resolution even in severe, surgery-resistant cases, underscoring its growing role as a first-line intervention in selected patients.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1081-1085"},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.radcr.2025.11.018
Antonio Armando Caragliano MD , Agostino Tessitore MD , Giuseppe Cicero MD , Orazio Buonomo MD , Mariano Velo MD , Davide Vicari MD , Antonio Pitrone MD , Valeria Garufi MD , Marco Cavallaro MD , Sergio Lucio Vinci MD
Partially thrombosed basilar artery aneurysms are large or giant lesions with a poor prognosis, posing significant treatment challenges. Symptomatic cases may result in brainstem compression, increased stroke risk, or rupture leading to subarachnoid hemorrhage. Endovascular therapy is the preferred treatment over surgical clipping due to lower morbidity and mortality rates. However, outcomes depend on aneurysm location, morphology, and device selection. Stent-assisted coiling is widely used, with the Accero and Acclino stents offering distinct advantages. The Accero stent, a self-expanding braided design, provides excellent visibility, hemocompatibility, and vessel wall apposition due to its platinum-nitinol composition and BlueXide surface technology. The Acclino stent, a closed-cell laser-cut design, ensures seamless microcatheter compatibility and high occlusion rates. This work describes a case in which these 2 different endovascular stents were simultaneously and successfully used, demonstrating that individualized approaches are essential to optimize patient’s outcomes.
{"title":"Dissecting and partially thrombosed basilar artery aneurysm simultaneously treated with 2 different types of endovascular stents","authors":"Antonio Armando Caragliano MD , Agostino Tessitore MD , Giuseppe Cicero MD , Orazio Buonomo MD , Mariano Velo MD , Davide Vicari MD , Antonio Pitrone MD , Valeria Garufi MD , Marco Cavallaro MD , Sergio Lucio Vinci MD","doi":"10.1016/j.radcr.2025.11.018","DOIUrl":"10.1016/j.radcr.2025.11.018","url":null,"abstract":"<div><div>Partially thrombosed basilar artery aneurysms are large or giant lesions with a poor prognosis, posing significant treatment challenges. Symptomatic cases may result in brainstem compression, increased stroke risk, or rupture leading to subarachnoid hemorrhage. Endovascular therapy is the preferred treatment over surgical clipping due to lower morbidity and mortality rates. However, outcomes depend on aneurysm location, morphology, and device selection. Stent-assisted coiling is widely used, with the Accero and Acclino stents offering distinct advantages. The Accero stent, a self-expanding braided design, provides excellent visibility, hemocompatibility, and vessel wall apposition due to its platinum-nitinol composition and BlueXide surface technology. The Acclino stent, a closed-cell laser-cut design, ensures seamless microcatheter compatibility and high occlusion rates. This work describes a case in which these 2 different endovascular stents were simultaneously and successfully used, demonstrating that individualized approaches are essential to optimize patient’s outcomes.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1073-1077"},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unilateral pulmonary fibrosis (UPF) is an uncommon manifestation of interstitial lung disease that may arise from various causes. Among those, cardiovascular etiology is often overlooked because affected patients do not present history of exposure of any kind, are frequently asymptomatic or present only mild, subtle and nonspecific symptoms. As a result, these cases are usually identified incidentally on imaging performed for unrelated reasons, contributing to under recognition of their true prevalence. We report 3 patients with incidentally detected UPF on high-resolution computed tomography (HRCT), each associated with a distinct vascular abnormality, both congenital and acquired conditions: unilateral absence of the pulmonary artery, chronic pulmonary thromboembolism, and pulmonary artery branch hypoplasia. Our aim with this case series is to highlights the diverse radiologic patterns of vascular UPF, underscoring the importance of considering vascular causes in the differential diagnosis of unilateral fibrotic lung disease.
{"title":"Vascular etiologies of unilateral pulmonary fibrosis: Case series and literature overview","authors":"Diletta Cozzi MD , Luca Gozzi MD , Edoardo Cavigli MD , Chiara Moroni MD , Alessandra Bindi MD , Elisabetta Rosi MD , Sara Tomassetti MD , Vittorio Miele MD","doi":"10.1016/j.radcr.2025.11.010","DOIUrl":"10.1016/j.radcr.2025.11.010","url":null,"abstract":"<div><div>Unilateral pulmonary fibrosis (UPF) is an uncommon manifestation of interstitial lung disease that may arise from various causes. Among those, cardiovascular etiology is often overlooked because affected patients do not present history of exposure of any kind, are frequently asymptomatic or present only mild, subtle and nonspecific symptoms. As a result, these cases are usually identified incidentally on imaging performed for unrelated reasons, contributing to under recognition of their true prevalence. We report 3 patients with incidentally detected UPF on high-resolution computed tomography (HRCT), each associated with a distinct vascular abnormality, both congenital and acquired conditions: unilateral absence of the pulmonary artery, chronic pulmonary thromboembolism, and pulmonary artery branch hypoplasia. Our aim with this case series is to highlights the diverse radiologic patterns of vascular UPF, underscoring the importance of considering vascular causes in the differential diagnosis of unilateral fibrotic lung disease.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1067-1072"},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.radcr.2025.11.047
Jie Wang , Xuefeng Kang , Guangxiang Chen PhD
Congenital neural tube defects rarely manifest in adulthood, and malignant transformation of meningocele is exceptionally rare. This report describes a rare case of a 56-year-old male with a congenital lumbosacral meningocele that underwent malignant transformation to epithelioid angiosarcoma, coexisting with multiple spinal anomalies, including tethered cord and diastematomyelia. Following admission and diagnostic workup, the patient underwent surgical intervention. Tumor recurrence occurred 3 months after surgery, and received combined radiotherapy and targeted therapy. Follow-up magnetic resonance imaging demonstrated regression of the recurrent tumor; however, the patient died 1 year after surgery. This case highlights that chronically untreated meningoceles may undergo malignant transformation due to persistent irritation, necessitating vigilance for lesion changes and early biopsy.
{"title":"Congenital lumbosacral meningocele with malignant transformation to epithelioid angiosarcoma: A case report of complex spinal anomalies","authors":"Jie Wang , Xuefeng Kang , Guangxiang Chen PhD","doi":"10.1016/j.radcr.2025.11.047","DOIUrl":"10.1016/j.radcr.2025.11.047","url":null,"abstract":"<div><div>Congenital neural tube defects rarely manifest in adulthood, and malignant transformation of meningocele is exceptionally rare. This report describes a rare case of a 56-year-old male with a congenital lumbosacral meningocele that underwent malignant transformation to epithelioid angiosarcoma, coexisting with multiple spinal anomalies, including tethered cord and diastematomyelia. Following admission and diagnostic workup, the patient underwent surgical intervention. Tumor recurrence occurred 3 months after surgery, and received combined radiotherapy and targeted therapy. Follow-up magnetic resonance imaging demonstrated regression of the recurrent tumor; however, the patient died 1 year after surgery. This case highlights that chronically untreated meningoceles may undergo malignant transformation due to persistent irritation, necessitating vigilance for lesion changes and early biopsy.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1061-1066"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report the case of a 55-year-old woman with a history of multiple myeloma, osteoporosis, and long-term corticosteroid therapy, who presented with progressively worsening back pain. Imaging was pivotal for diagnosis and management. Magnetic resonance imaging (MRI) and computed tomography (CT) documented vertebral body osteonecrosis (VBON) occurring at different times and vertebral levels. In May 2024, MRI showed a fluid-filled intravertebral cleft within the L1 vertebral body, without collapse. Retrospective comparison with prior examinations (MRI and CT from 2019) demonstrated earlier VBON lesions at L4, progressing from fluid to gas phase, and a chronic collapse at T12. This case emphasizes the multifocal and temporal nature of VBON and highlights the teaching value of imaging, particularly MRI and CT, in distinguishing early osteonecrosis from neoplastic or purely osteoporotic fractures.
{"title":"Vertebral body osteonecrosis: Evolving imaging features over time","authors":"Federica Masino MD , Valentina Cianci MD , Chiara Locorotondo MD , Andrea Torrente MD , Gabriele Fanigliulo MD , Antonio Serinelli TSRM , Marina Balbino MD , Manuela Montatore MD , Eluisa Muscogiuri MD , Giuseppe Guglielmi MD","doi":"10.1016/j.radcr.2025.11.052","DOIUrl":"10.1016/j.radcr.2025.11.052","url":null,"abstract":"<div><div>We report the case of a 55-year-old woman with a history of multiple myeloma, osteoporosis, and long-term corticosteroid therapy, who presented with progressively worsening back pain. Imaging was pivotal for diagnosis and management. Magnetic resonance imaging (MRI) and computed tomography (CT) documented vertebral body osteonecrosis (VBON) occurring at different times and vertebral levels. In May 2024, MRI showed a fluid-filled intravertebral cleft within the L1 vertebral body, without collapse. Retrospective comparison with prior examinations (MRI and CT from 2019) demonstrated earlier VBON lesions at L4, progressing from fluid to gas phase, and a chronic collapse at T12. This case emphasizes the multifocal and temporal nature of VBON and highlights the teaching value of imaging, particularly MRI and CT, in distinguishing early osteonecrosis from neoplastic or purely osteoporotic fractures.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"21 3","pages":"Pages 1049-1054"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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