Radiology Case Reports最新文献

英文中文

Stage III xanthogranulomatous pyelonephritis with sarcomatoid degeneration 黄疽性肾盂肾炎Ⅲ期伴肉瘤样变性

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-25 DOI: 10.1016/j.radcr.2024.09.090

Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic condition characterized by destructive granulomatous disease of the kidney with uncertain etiology. Significant risk factors for XGP are represented by the coexistence of history of nephrolithiasis, diabetes mellitus, recurrent urinary tract infections and other immunocompromised conditions. It is also associated with higher risk of malignancy, reported in up to 11% of patients. We report a case of a 76-year-old female who presented to the emergency department with an insidious onset of abdominal and right lower back pain. She had a history of renal stones and diabetes mellitus. On physical examination, a painful fistulous orifice in skin on the right lumbar region was found. CT images showed a nonfunctioning right kidney replaced by multiple necrotic cavities with inflammatory involvement of the right hepatic lobe and a nephron-cutaneous fistula. These CT findings were strongly suggestive of XGP (III state). CT images obtained before and after the administration of intravenous contrast material showed also a hyper-vascularized renal mass with irregularly thickened walls confirmed by a targeted CEUS examination and suspicious for malignancy. Pathologic examination confirmed the chronic pyelonephritis and revealed evidence of a concomitant sarcomatoid lesion. This case underlines the central role of a multimodality imaging approach in the emergency department and how this affects the correct management and treatment of patients. In fact, MDCT is considered the current gold standard for the diagnosis and the staging of XPG but the contrast-enhanced ultrasound (CEUS) in selected patients can increase the diagnostic accuracy in the uncertain small renal masses detected on CT scans.

黄肉芽肿性肾盂肾炎（XGP）是一种不常见的慢性疾病，其特征是病因不明的肾脏破坏性肉芽肿病。XGP的重要危险因素是同时存在肾结石、糖尿病、反复尿路感染和其他免疫力低下的病史。此外，它还与较高的恶性肿瘤风险有关，据报道，有高达 11% 的患者会罹患恶性肿瘤。我们报告了一例 76 岁女性的病例，她因隐匿性腹痛和右下背部疼痛到急诊科就诊。她有肾结石和糖尿病病史。体检时发现右腰部皮肤有一个疼痛的瘘口。CT图像显示，无功能的右肾被多个坏死的空腔取代，右肝叶受到炎症影响，并出现肾-皮肤瘘管。这些 CT 结果强烈提示为 XGP（III 状态）。在静脉注射造影剂前后获得的 CT 图像还显示，肾脏肿块血管增生，肾壁不规则增厚，CEUS 靶向检查证实了这一点，并怀疑是恶性肿瘤。病理检查确诊为慢性肾盂肾炎，并发现了肉瘤样病变的证据。该病例强调了多模态成像方法在急诊科的核心作用，以及它如何影响对患者的正确管理和治疗。事实上，MDCT 被认为是目前诊断和分期 XPG 的金标准，但对于 CT 扫描中发现的不确定的肾脏小肿块，造影剂增强超声（CEUS）可提高对特定患者的诊断准确性。

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引用次数: 0

Varicella pneumonia in a healthy 31-year-old female with no prior varicella immunity and no skin rush: A case report 一名 31 岁的健康女性患上水痘肺炎，她之前没有水痘免疫力，也没有皮肤急疹：病例报告

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-25 DOI: 10.1016/j.radcr.2024.09.009

Varicella pneumonia represents a relatively uncommon yet severe complication arising from initial varicella infection. Between 5% and 15% of instances of adult varicella infection may result in various pulmonary conditions. Predominantly afflicting adults, its severity is compounded by factors like smoking, compromised immune systems, pregnancy, age, chronic obstructive pulmonary disease, and male gender. We represent the case of an adult female lacking prior immunity to varicella, who experienced heightened oxygen needs with severe hemoptysis without skin symptoms. Swift improvement was observed just a 2 following valacyclovir administration. Varicella pneumonia stands out as a significant complication stemming from primary varicella infection in adults, with early administration of acyclovir linked to both symptomatic relief and reduced mortality rates.

水痘肺炎是最初感染水痘后出现的一种相对少见但严重的并发症。在成人水痘感染病例中，有 5%-15%可能会导致各种肺部疾病。水痘肺炎主要发生在成年人身上，吸烟、免疫系统受损、怀孕、年龄、慢性阻塞性肺病和男性等因素都会加重水痘肺炎的严重程度。我们曾接诊过一例对水痘缺乏免疫力的成年女性患者，她在没有皮肤症状的情况下出现严重咯血，需要大量吸氧。在服用伐昔洛韦 2 天后，病情迅速好转。水痘肺炎是成人原发性水痘感染引起的一种重要并发症，早期使用阿昔洛韦可缓解症状并降低死亡率。

引用次数: 0

Aberrant oviduct pathway following vacuum aspiration: A case report and literature review 真空吸引术后输卵管路径异常：病例报告和文献综述

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-25 DOI: 10.1016/j.radcr.2024.09.031

We report the case of a patient addressed for abnormal uterine bleeding in the context of secondary infertility. Operative hysteroscopy under sedation showed multiple uterine adhesions (Asherman syndrome) and communication with the pelvic cavity suspecting uterine perforation. Combined laparoscopy showed that the right fallopian tube was incarcerated into the uterine wall. We conducted bilateral salpingectomy followed by uterine wall suture whose integrity was controlled by hysteroscopy. We highlight a rare, underdiagnosed complication of uterine perforation: oviduct incarceration into the uterine cavity.

我们报告了一例因继发性不孕而导致异常子宫出血的患者。在镇静状态下进行的宫腔镜手术显示多发性宫腔粘连（Asherman 综合征），并与盆腔相通，怀疑子宫穿孔。联合腹腔镜检查显示，右侧输卵管嵌顿在子宫壁内。我们进行了双侧输卵管切除术，随后进行了子宫壁缝合术，并通过宫腔镜检查控制了缝合的完整性。我们强调了子宫穿孔的一种罕见且诊断不足的并发症：输卵管嵌顿到子宫腔内。

引用次数: 0

Early postpartum unilateral vulvar edema leading to diagnosis of a Pfannenstiel incisional hernia following cesarean delivery 产后早期单侧外阴水肿导致诊断为剖宫产后 Pfannenstiel 切口疝

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-25 DOI: 10.1016/j.radcr.2024.08.133

Advantages of the low transverse Pfannenstiel incision include lower rates of incisional hernia, wound infection, hematoma formation, direct postoperative pain and distinctly improved aesthetic appearance. Relative disadvantages include insufficient intraoperative exposure of the upper abdomen and an increased incidence of superficial nerve entrapment. Incisional hernia following Pfannenstiel incision is a rare event with a reported incidence of between 0 and 0.5% while in contrast midline vertical incisions are considerably more common with a reported incidence of 5 to 30%. Symptomatology of Pfannenstiel incisional hernia has been reported to include: bulging, pain or discomfort, and distention of the surgical area. We report an unusual case of early postpartum unilateral vulvar edema, which led to imaging diagnosis of Pfannenstiel incisional hernia in a 41 year-old woman on Day 2 following Cesarean delivery due to preeclampsia with worsening severe features, at 30 weeks’ gestation.

Pfannenstiel 低位横切口的优点包括切口疝、伤口感染、血肿形成、术后直接疼痛的发生率较低，且明显改善了外观美感。相对缺点包括术中上腹部暴露不足和浅表神经卡压的发生率增加。Pfannenstiel 切口术后发生切口疝的情况很少见，据报道发生率在 0% 到 0.5% 之间，而中线垂直切口术后发生切口疝的情况要常见得多，据报道发生率在 5% 到 30% 之间。据报道，Pfannenstiel 切口疝的症状包括：隆起、疼痛或不适以及手术区域胀痛。我们报告了一例不寻常的产后早期单侧外阴水肿病例，该患者 41 岁，妊娠 30 周，因先兆子痫导致严重症状恶化，在剖宫产后第 2 天出现外阴水肿，影像学诊断为 Pfannenstiel 切口疝。

引用次数: 0

Primary nipple melanoma in a patient with breast cancer: A diagnosis to consider 乳腺癌患者的原发性乳头黑色素瘤：需要考虑的诊断

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-25 DOI: 10.1016/j.radcr.2024.08.156

Melanoma in situ of the nipple is an uncommon diagnosis, with only a few reports in the literature. Due to the variety of pathologies that can affect the nipple-areola complex, the diagnosis can be challenging. In this case report we describe a patient with cosmetic bilateral breast implants who presented with eczema of the left nipple-areola complex and suspicious microcalcifications in the lower inner quadrant of the ipsilateral breast on mammography, subsequently diagnosed with nipple melanoma and concomitant ductal carcinoma in situ.

乳头原位黑色素瘤是一种不常见的诊断，文献中仅有少数报道。由于影响乳头乳晕复合体的病变多种多样，因此诊断可能具有挑战性。在本病例报告中，我们描述了一名双侧乳房植入美容假体的患者，她出现左侧乳头乳晕复合体湿疹，乳房 X 光检查发现同侧乳房内下象限有可疑微钙化，随后被确诊为乳头黑色素瘤并伴有乳腺导管原位癌。

引用次数: 0

Beyond secondary hyperparathyroidism: Diagnosing primary parathyroid abnormalities in a patient with chronic kidney disease 超越继发性甲状旁腺功能亢进症：诊断慢性肾病患者的原发性甲状旁腺异常

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-25 DOI: 10.1016/j.radcr.2024.08.142

Chronic kidney disease (CKD) is a complex medical condition that extends beyond the progressive decline in renal function. It is associated with mineral and bone disorders, notably secondary hyperparathyroidism due to dysregulated calcium and phosphate metabolism. However, distinguishing between secondary and primary hyperparathyroidism can be challenging. We report the case of a 74-year-old male with CKD, who presented with elevated serum levels of parathyroid hormone (PTH), CKD, and unexplained hypercalcemia, despite management for secondary hyperparathyroidism. Advanced imaging techniques revealed a primary parathyroid adenoma, subsequently confirmed by histopathology. The successful surgical resection of the adenoma resulted in the calcium and PTH levels falling into a normal range, highlighting the need for a careful differential diagnosis in CKD patients.

慢性肾脏病（CKD）是一种复杂的内科疾病，它不仅仅是肾功能的逐渐衰退。它与矿物质和骨质紊乱有关，特别是由于钙和磷代谢失调引起的继发性甲状旁腺功能亢进。然而，区分继发性和原发性甲状旁腺功能亢进症可能具有挑战性。我们报告了一例患有慢性肾脏病的74岁男性患者，尽管他曾接受过继发性甲状旁腺功能亢进症的治疗，但仍出现血清甲状旁腺激素（PTH）水平升高、慢性肾脏病和不明原因的高钙血症。先进的成像技术发现了原发性甲状旁腺腺瘤，随后经组织病理学证实。手术成功切除腺瘤后，患者的血钙和PTH水平降至正常范围，突显了对慢性肾脏病患者进行仔细鉴别诊断的必要性。

引用次数: 0

Transdiaphragmatic extension of a thymoma invading the peritoneum and the spleen 侵犯腹膜和脾脏的胸腺瘤经膈肌扩展

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-24 DOI: 10.1016/j.radcr.2024.08.162

Thymoma, a rare tumor originating from thymic epithelial cells in the anterior mediastinum, presents various diagnostic and clinical challenges, particularly when exhibiting unusual invasive behaviors. We report a case involving a 66-year-old woman with progressive dyspnea and a dry cough, where a CT scan revealed a large, lobulated mass in the anterior mediastinum that had extended through the diaphragm into the abdominal cavity, infiltrating the pleura, spleen, and adjacent structures. Histopathological examination confirmed a type B2 thymoma, classified as T3N2M0 stage IV B. The case underscores the importance of early and accurate diagnosis, highlighting the need for a multidisciplinary approach involving radiologists, oncologists, and thoracic surgeons to manage such advanced thymoma cases. The unusual transdiaphragmatic extension into the peritoneum and spleen emphasizes the necessity of considering extensive local invasion in the staging and treatment planning of thymomas, which often necessitates a combination of chemotherapy and radiotherapy before potential surgical intervention.

胸腺瘤是一种起源于前纵隔胸腺上皮细胞的罕见肿瘤，它给诊断和临床带来了各种挑战，尤其是在表现出不寻常的侵袭行为时。我们报告了一例 66 岁女性患者的病例，患者出现进行性呼吸困难和干咳，CT 扫描显示前纵隔有一个巨大的分叶状肿块，肿块通过膈肌扩展到腹腔，并浸润胸膜、脾脏和邻近结构。组织病理学检查证实为 B2 型胸腺瘤，分类为 T3N2M0 IV B 期。该病例强调了早期准确诊断的重要性，突出了放射科医生、肿瘤科医生和胸外科医生多学科合作处理此类晚期胸腺瘤病例的必要性。胸腺瘤不寻常地经膈肌扩展到腹膜和脾脏，这强调了在胸腺瘤的分期和治疗计划中考虑广泛局部侵犯的必要性，这通常需要在可能的手术干预之前联合使用化疗和放疗。

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引用次数: 0

Embolization of a type 2 endoleak using a micropuncture introducer set and a triple-coaxial system through the deep iliac circumflex artery via the ipsilateral femoral artery 使用微型穿刺导入器组和三同轴系统通过同侧股动脉髂深环动脉栓塞 2 型内漏

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-24 DOI: 10.1016/j.radcr.2024.08.134

An 83-year-old man underwent embolization for a type 2 endoleak following endovascular aortic repair for an abdominal aortic aneurysm. The type 2 endoleak originated from the left iliac circumflex artery, which was located very close to the puncture site in the left femoral artery. This proximity made the embolization procedure challenging; however, by employing a combination of a micropuncture introducer set and a triple-coaxial system, embolization with N-butyl-2-cyanoacrylate was successfully achieved.

一名 83 岁的男性在接受腹主动脉瘤血管内修复术后，因 2 型内漏接受了栓塞治疗。2 型内漏源自左侧髂环动脉，该动脉距离左侧股动脉穿刺部位非常近。然而，通过结合使用微型穿刺导引器和三轴系统，成功地用N-丁基-2-氰基丙烯酸酯进行了栓塞。

引用次数: 0

Sudden abdominal pain in a patient with pneumonia reveals spontaneous splenic rupture in normal sized spleen 一名肺炎患者突发腹痛，显示脾脏大小正常的自发性脾破裂

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-24 DOI: 10.1016/j.radcr.2024.08.128

Splenic rupture is a life-threatening condition that is most frequently of traumatic etiology. Atraumatic or spontaneous splenic rupture is much rarer and less frequently reported. We present a case of an 84-year-old male patient initially hospitalized for pneumonia, who developed sudden abdominal pain and hemodynamic instability. Further investigations revealed a spontaneous splenic rupture. Histopathological examination postsplenectomy identified a splenic hamartoma, which had not been visualized on prior imaging studies.

脾破裂是一种危及生命的疾病，最常见的病因是外伤。创伤性或自发性脾破裂更为罕见，也较少报道。我们报告了一例 84 岁男性患者的病例，患者最初因肺炎住院，后突发腹痛和血流动力学不稳定。进一步检查发现其脾脏自发性破裂。脾切除术后的组织病理学检查发现了脾脏火腿肠瘤，而之前的影像学检查并未发现该瘤。

引用次数: 0

Interventional management of aspergillus-related pulmonary artery pseudoaneurysm and hemoptysis 曲霉菌相关肺动脉假性动脉瘤和咯血的介入治疗

Q4 Medicine

Radiology Case Reports

Pub Date : 2024-09-24 DOI: 10.1016/j.radcr.2024.08.148

Pulmonary artery pseudoaneurysms are rare but life-threatening vascular abnormalities. Only less than 10% hemoptysis cases are of pulmonary artery origin while most cases arise from bronchial arteries. When diagnosed, they are mostly found to accompany pre-existing cardiovascular disease, infection, (i.e. Tuberculosis or Aspergillosis), vasculitis, trauma and/or neoplastic conditions. There are rare reports of pulmonary artery pseudoaneurysms being caused by direct extension of invasive fungal infections. We report a case of a rapidly growing pulmonary artery pseudoaneurysm in a 20-year-old female with lymphoma involving the lung and mediastinum. The patient was hospitalized with complications, including hemoptysis in the setting of Aspergillus Pneumonia and respiratory failure requiring intubation. Interventional Radiology was consulted after multiple bronchoscopic interventions failed to stabilize the bleeding. Patient then underwent embolization of the left subsegmental pulmonary artery pseudoaneurysm, with resolution of hemoptysis the next day.

肺动脉假性动脉瘤是一种罕见但会危及生命的血管异常。只有不到 10%的咯血病例源于肺动脉，而大多数病例源于支气管动脉。在确诊时，它们大多与原有的心血管疾病、感染（如肺结核或曲霉菌病）、血管炎、外伤和/或肿瘤性疾病同时存在。关于肺动脉假性动脉瘤是由侵袭性真菌感染直接扩展引起的报道并不多见。我们报告了一例生长迅速的肺动脉假动脉瘤病例，患者是一名 20 岁女性，患有肺部和纵隔淋巴瘤。患者因并发症住院，包括曲霉菌肺炎引起的咯血和需要插管的呼吸衰竭。在多次支气管镜介入治疗未能稳定出血后，介入放射科接受了会诊。患者随后接受了左肺动脉节段下假性动脉瘤栓塞术，第二天咯血症状缓解。

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