Pub Date : 2024-09-24DOI: 10.1016/j.radcr.2024.09.018
Imaging remains an essential aspect in evaluating patients receiving liver transplants, especially in cases of complications such as portal vein thrombosis. Several imaging modalities are available to approach portal vein thrombosis, with portography as the gold standard. However, the development of noninvasive methods such as contrast-enhanced computed tomography (CECT) is preferred nowadays due to the fewer complications in nature. This case report presented a case of a giant varix of the portal vein with thrombus in a 20-year-old male receiving living-donor liver transplant, reliably visualized in both CECT and direct splenoportography. Detailed parameters and sequences required for accurate imaging in CECT are discussed in this study.
{"title":"Contrast-enhanced abdominal CT compared with splenoportography in postliver transplant with giant varix and thrombus in portal vein: Case report","authors":"","doi":"10.1016/j.radcr.2024.09.018","DOIUrl":"10.1016/j.radcr.2024.09.018","url":null,"abstract":"<div><div>Imaging remains an essential aspect in evaluating patients receiving liver transplants, especially in cases of complications such as portal vein thrombosis. Several imaging modalities are available to approach portal vein thrombosis, with portography as the gold standard. However, the development of noninvasive methods such as contrast-enhanced computed tomography (CECT) is preferred nowadays due to the fewer complications in nature. This case report presented a case of a giant varix of the portal vein with thrombus in a 20-year-old male receiving living-donor liver transplant, reliably visualized in both CECT and direct splenoportography. Detailed parameters and sequences required for accurate imaging in CECT are discussed in this study.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1930043324009646/pdfft?md5=28f0183be2435b87e563ab677a268026&pid=1-s2.0-S1930043324009646-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.radcr.2024.09.012
The retrotracheal left pulmonary artery, also known as “left pulmonary artery sling,” is a rare vascular malformation in which the left pulmonary artery (LPA) arises from the posterior aspect of the right pulmonary artery (RPA) and reaches the left pulmonary hilum by passing between the trachea and the esophagus, giving rise to the appearance of a sling, hence the name “sling.” This vascular anomaly can be associated with other cardiac malformations or abnormalities of the tracheobronchial tree.We present the case of a 4-month-old female infant who presented with laryngeal stridor. She underwent a chest X-ray, which was normal, but thoracic CT angiography revealed an aberrant LPA originating from RPA with a retrotracheal course. This case underscores the critical role of imaging in confirming the diagnosis and guiding patient management.
{"title":"The retrotracheal left pulmonary artery: A rare vascular malformation","authors":"","doi":"10.1016/j.radcr.2024.09.012","DOIUrl":"10.1016/j.radcr.2024.09.012","url":null,"abstract":"<div><div>The retrotracheal left pulmonary artery, also known as “left pulmonary artery sling,” is a rare vascular malformation in which the left pulmonary artery (LPA) arises from the posterior aspect of the right pulmonary artery (RPA) and reaches the left pulmonary hilum by passing between the trachea and the esophagus, giving rise to the appearance of a sling, hence the name “sling.” This vascular anomaly can be associated with other cardiac malformations or abnormalities of the tracheobronchial tree.We present the case of a 4-month-old female infant who presented with laryngeal stridor. She underwent a chest X-ray, which was normal, but thoracic CT angiography revealed an aberrant LPA originating from RPA with a retrotracheal course. This case underscores the critical role of imaging in confirming the diagnosis and guiding patient management.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1930043324009671/pdfft?md5=f2be225d397cda5006e091bebd53d788&pid=1-s2.0-S1930043324009671-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.radcr.2024.09.019
Twin pregnancy is considered high-risk pregnancy because of its various effects on maternal and fetal physiology. Twin pregnancy can be dizygotic or monozygotic, the latter being less common. Depending upon the period of separation of an embryo, monozygotic twins can share amniotic cavity and placenta with the monochorionic monoamniotic form being the least common type. Diprosopus tetrophthalmus is the rarest form of monozygotic monochorionic and monoamniotic conjoint twin, where there are 2 faces on 1 head with various degrees of duplication of facial and cranial structure. The exact etiology of diprosopus is still unknown however; there are many local environmental and oxidative theories for this anomaly. The incidence of diprosopus is 1 in 180,000 to 15 million births. Here we present a case of 20-year-old female who came for routine anomaly scan of her pregnancy in our hospital which showed the presence of diprosopus tetrophthalmus. Couples agreed to terminate pregnancy after proper counseling from treating physician. Ultrasonography images of anomaly scans as well as post-abortion images of the fetus are discussed in this case report.
{"title":"Prenatal diagnosis of the rarest conjoint twin “diprosopus tetrophthalmus” during anomaly scan: A case report","authors":"","doi":"10.1016/j.radcr.2024.09.019","DOIUrl":"10.1016/j.radcr.2024.09.019","url":null,"abstract":"<div><div>Twin pregnancy is considered high-risk pregnancy because of its various effects on maternal and fetal physiology. Twin pregnancy can be dizygotic or monozygotic, the latter being less common. Depending upon the period of separation of an embryo, monozygotic twins can share amniotic cavity and placenta with the monochorionic monoamniotic form being the least common type. Diprosopus tetrophthalmus is the rarest form of monozygotic monochorionic and monoamniotic conjoint twin, where there are 2 faces on 1 head with various degrees of duplication of facial and cranial structure. The exact etiology of diprosopus is still unknown however; there are many local environmental and oxidative theories for this anomaly. The incidence of diprosopus is 1 in 180,000 to 15 million births. Here we present a case of 20-year-old female who came for routine anomaly scan of her pregnancy in our hospital which showed the presence of diprosopus tetrophthalmus. Couples agreed to terminate pregnancy after proper counseling from treating physician. Ultrasonography images of anomaly scans as well as post-abortion images of the fetus are discussed in this case report.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1930043324009592/pdfft?md5=4803a3a90f0c37e5b837ac9d11dc89e4&pid=1-s2.0-S1930043324009592-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.radcr.2024.09.052
Protein S and C deficiency is a rare inherited thrombophilia that predisposes individuals to a hypercoagulable state, leading to clot formation in various locations, such as the deep veins of the legs, cerebral veins, and rarely the portal vein. We present the case of a 21-year-old male who came to the ER with hematemesis and melena secondary to chronic portal vein thrombosis (PVT) without any evidence of cirrhosis. Diagnostic investigations, including ultrasonography and computed tomography, confirmed the presence of thrombosis and cavernous transformation of the portal vein, splenic vein thrombosis, and splenomegaly. Coagulation profiling revealed diminished Protein S and C levels, thus confirming the diagnosis of a combined Protein S and C deficiency. Management involved indefinite anticoagulant therapy with direct oral anticoagulants to mitigate thromboembolic risks associated with the inherited thrombophilia. This case underscores the importance of considering rare coagulation disorders in young patients with unexplained thrombotic events, emphasizing the need for a comprehensive diagnostic approach and timely therapeutic interventions to minimize morbidity and mortality.
蛋白 S 和 C 缺乏症是一种罕见的遗传性血栓性疾病，易导致个体处于高凝状态，从而在不同部位形成血栓，如腿部深静脉、脑静脉和门静脉，但门静脉很少有血栓形成。本病例是一名 21 岁的男性患者，因慢性门静脉血栓形成（PVT）引起的吐血和黄疸就诊于急诊室，但无任何肝硬化迹象。包括超声波和计算机断层扫描在内的诊断检查证实，该患者存在门静脉血栓和海绵状变、脾静脉血栓和脾肿大。凝血分析显示，蛋白 S 和蛋白 C 水平降低，因此确诊为蛋白 S 和蛋白 C 合并缺乏症。治疗包括使用直接口服抗凝剂进行无限期抗凝治疗，以降低与遗传性血栓性疾病相关的血栓栓塞风险。本病例强调了对不明原因血栓事件的年轻患者考虑罕见凝血功能障碍的重要性，强调了采取综合诊断方法和及时治疗干预的必要性，以最大限度地降低发病率和死亡率。
{"title":"Portal vein thrombosis due to inherited combined deficiency of protein C and S in a young adult: A case report","authors":"","doi":"10.1016/j.radcr.2024.09.052","DOIUrl":"10.1016/j.radcr.2024.09.052","url":null,"abstract":"<div><div>Protein S and C deficiency is a rare inherited thrombophilia that predisposes individuals to a hypercoagulable state, leading to clot formation in various locations, such as the deep veins of the legs, cerebral veins, and rarely the portal vein. We present the case of a 21-year-old male who came to the ER with hematemesis and melena secondary to chronic portal vein thrombosis (PVT) without any evidence of cirrhosis. Diagnostic investigations, including ultrasonography and computed tomography, confirmed the presence of thrombosis and cavernous transformation of the portal vein, splenic vein thrombosis, and splenomegaly. Coagulation profiling revealed diminished Protein S and C levels, thus confirming the diagnosis of a combined Protein S and C deficiency. Management involved indefinite anticoagulant therapy with direct oral anticoagulants to mitigate thromboembolic risks associated with the inherited thrombophilia. This case underscores the importance of considering rare coagulation disorders in young patients with unexplained thrombotic events, emphasizing the need for a comprehensive diagnostic approach and timely therapeutic interventions to minimize morbidity and mortality.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S193004332401001X/pdfft?md5=c0d14099aed4fc2ea027204c62d7874f&pid=1-s2.0-S193004332401001X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.radcr.2024.09.010
Solitary pancreatic metastasis is a rare cause of pancreatic neoplasm. Pancreatic ductal adenocarcinoma is the primary differential consideration when a solitary pancreatic mass is diagnosed, as it is the most common solitary solid pancreatic neoplasm. A majority of pancreatic ductal adenocarcinomas arise in the region of the head of the pancreas; however, specific neoplastic and non-neoplastic lesions can occur at or adjacent to the pancreatic head, which can mimic a pancreatic ductal adenocarcinoma. Therefore, a histopathological diagnosis is essential for confirming pancreatic ductal adenocarcinoma. Isolated solitary metastasis from primary lung adenocarcinoma is a rare cause of a solitary pancreatic head mass. We report a case in which imaging and pathology were integral to the diagnosis of a solitary lung adenocarcinoma metastasis to the head of the pancreas, which ultimately guided appropriate patient management.
{"title":"Solitary metastasis to the head of the pancreas from lung adenocarcinoma mimicking pancreatic ductal adenocarcinoma: A case report","authors":"","doi":"10.1016/j.radcr.2024.09.010","DOIUrl":"10.1016/j.radcr.2024.09.010","url":null,"abstract":"<div><div>Solitary pancreatic metastasis is a rare cause of pancreatic neoplasm. Pancreatic ductal adenocarcinoma is the primary differential consideration when a solitary pancreatic mass is diagnosed, as it is the most common solitary solid pancreatic neoplasm. A majority of pancreatic ductal adenocarcinomas arise in the region of the head of the pancreas; however, specific neoplastic and non-neoplastic lesions can occur at or adjacent to the pancreatic head, which can mimic a pancreatic ductal adenocarcinoma. Therefore, a histopathological diagnosis is essential for confirming pancreatic ductal adenocarcinoma. Isolated solitary metastasis from primary lung adenocarcinoma is a rare cause of a solitary pancreatic head mass. We report a case in which imaging and pathology were integral to the diagnosis of a solitary lung adenocarcinoma metastasis to the head of the pancreas, which ultimately guided appropriate patient management.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1930043324009658/pdfft?md5=cf382dddc9fc1ff65397177cc90b6c00&pid=1-s2.0-S1930043324009658-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.radcr.2024.09.060
Primary metastatic prostate cancer to the orbit is exceedingly rare. Benign lesions, including meningioma, have demonstrated PSMA expression and can be visualized using PSMA-based PET tracers. We report the findings of 18F-PSMA-1007 PET/CT in a 76-year-old man with progressive confusion and long-standing blindness of the left eye. PET/CT scan revealed increased uptake of PSMA in the orbital and temporal region, and other sites throughout the body. Histopathological examination after biopsy of the left orbit showed adenocarcinoma of the prostate. This case substantiates the diverse clinical and radiological presentations of metastatic prostate cancer and underscores the diagnostic significance of targeted biopsy.
{"title":"Exophthalmos as the initial presentation of metastatic prostate cancer","authors":"","doi":"10.1016/j.radcr.2024.09.060","DOIUrl":"10.1016/j.radcr.2024.09.060","url":null,"abstract":"<div><div>Primary metastatic prostate cancer to the orbit is exceedingly rare. Benign lesions, including meningioma, have demonstrated PSMA expression and can be visualized using PSMA-based PET tracers. We report the findings of <sup>18</sup>F-PSMA-1007 PET/CT in a 76-year-old man with progressive confusion and long-standing blindness of the left eye. PET/CT scan revealed increased uptake of PSMA in the orbital and temporal region, and other sites throughout the body. Histopathological examination after biopsy of the left orbit showed adenocarcinoma of the prostate. This case substantiates the diverse clinical and radiological presentations of metastatic prostate cancer and underscores the diagnostic significance of targeted biopsy.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1930043324010070/pdfft?md5=701d2016761d4848be309128453d8fde&pid=1-s2.0-S1930043324010070-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.radcr.2024.09.011
The transarterial approach is generally feasible for endovascular treatment of internal iliac artery aneurysms (IIAAs). However, this approach becomes difficult in patients who have undergone exclusion surgery (proximal ligation). We report our experience of performing transcatheter arterial embolization (TAE) using a retrograde approach from the deep femoral artery (DFA) for IIAAs that had enlarged after exclusion surgery. This case series includes 5 male patients (mean age, 57 years; range, 66-81 years) who underwent TAE of IIAAs between March 2015 and March 2024. The procedures were performed at a mean of 47 months (range, 33-108 months) after aortoiliac repair. Preoperative contrast-enhanced computed tomography (CT) or CT during aortography was performed before TAE in all cases to evaluate the development of collateral pathways. TAE was performed via the DFA using a retrograde approach with coils and cyanoacrylate glue in all cases. The procedure was technically successful in all 5 patients (100%). Intra-aneurysmal packing and embolization of the branched vessel was performed in all cases. The follow-up ranged from 6 to 66 months. All patients developed gluteal claudication but no major complications occurred during the follow-up period. No cases of aneurysm dilatation have been recorded to date. In conclusion, retrograde TAE of excluded IIAAs was a feasible and effective treatment in these 5 patients, after evaluating the development of collateral pathways on pretreatment contrast-enhanced CT.
{"title":"Retrograde embolization of internal iliac artery aneurysms that enlarged after proximal ligation: A report of 5 patients","authors":"","doi":"10.1016/j.radcr.2024.09.011","DOIUrl":"10.1016/j.radcr.2024.09.011","url":null,"abstract":"<div><div>The transarterial approach is generally feasible for endovascular treatment of internal iliac artery aneurysms (IIAAs). However, this approach becomes difficult in patients who have undergone exclusion surgery (proximal ligation). We report our experience of performing transcatheter arterial embolization (TAE) using a retrograde approach from the deep femoral artery (DFA) for IIAAs that had enlarged after exclusion surgery. This case series includes 5 male patients (mean age, 57 years; range, 66-81 years) who underwent TAE of IIAAs between March 2015 and March 2024. The procedures were performed at a mean of 47 months (range, 33-108 months) after aortoiliac repair. Preoperative contrast-enhanced computed tomography (CT) or CT during aortography was performed before TAE in all cases to evaluate the development of collateral pathways. TAE was performed via the DFA using a retrograde approach with coils and cyanoacrylate glue in all cases. The procedure was technically successful in all 5 patients (100%). Intra-aneurysmal packing and embolization of the branched vessel was performed in all cases. The follow-up ranged from 6 to 66 months. All patients developed gluteal claudication but no major complications occurred during the follow-up period. No cases of aneurysm dilatation have been recorded to date. In conclusion, retrograde TAE of excluded IIAAs was a feasible and effective treatment in these 5 patients, after evaluating the development of collateral pathways on pretreatment contrast-enhanced CT.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1930043324009580/pdfft?md5=bc4722f25e77992dc684380e1a63ef88&pid=1-s2.0-S1930043324009580-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.radcr.2024.08.131
Dual antiplatelet therapy is commonly used to treat or prevent thromboembolic events in patients with deep vein thrombosis, pulmonary embolism, atrial fibrillation, in patients after coronary artery stenting, cerebral artery stenting or artificial heart valves, etc. Although they significantly reduce the morbidity and mortality from thromboembolic events, dual antiplatelet therapy is associated with the risk of bleeding, which can be life-threatening. Gastrointestinal bleeding is one of the most common and dangerous events when using dual antiplatelet therapy for a long time. According to studies, nearly half of the major bleeding cases related to dual antiplatelet therapy arise from the gastrointestinal (GI) tract. We report the case of a 74-year-old female patient with lower gastrointestinal bleeding after using dual antiplatelet therapy that was successfully treated endovascularly with a coil.
{"title":"Endovascular interventional treatment of patients with gastrointestinal bleeding after dual antiplatelet therapy: A case report","authors":"","doi":"10.1016/j.radcr.2024.08.131","DOIUrl":"10.1016/j.radcr.2024.08.131","url":null,"abstract":"<div><div>Dual antiplatelet therapy is commonly used to treat or prevent thromboembolic events in patients with deep vein thrombosis, pulmonary embolism, atrial fibrillation, in patients after coronary artery stenting, cerebral artery stenting or artificial heart valves, etc. Although they significantly reduce the morbidity and mortality from thromboembolic events, dual antiplatelet therapy is associated with the risk of bleeding, which can be life-threatening. Gastrointestinal bleeding is one of the most common and dangerous events when using dual antiplatelet therapy for a long time. According to studies, nearly half of the major bleeding cases related to dual antiplatelet therapy arise from the gastrointestinal (GI) tract. We report the case of a 74-year-old female patient with lower gastrointestinal bleeding after using dual antiplatelet therapy that was successfully treated endovascularly with a coil.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1930043324009142/pdfft?md5=6f31676478fe072b84b3430c7ae2a2fa&pid=1-s2.0-S1930043324009142-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.radcr.2024.08.144
Pheochromocytoma is a rare neuroendocrine tumor arising from adrenal medulla. Patients usually show classic triad of headache, palpitations and diaphoresis along with persistent or paroxysmal hypertension. Majority of the tumors are solid or mixed solid and cystic. But purely cystic variant is extremely rare with few cases reports available in the published literature. We report a case of purely cystic pheochromocytoma in a male in 30s who presented to our hospital for unrelated symptom of recurrent burning micturition. He was evaluated for causes of recurrent UTI which revealed incidental right adrenal cyst. The patient's blood pressure was raised on clinical examination and imaging showed simple adrenal cyst without solid component or septations. Suspecting possibility of pheochromocytoma, biochemical analysis was done which revealed elevated 24-hour urinary metanephrine. The diagnosis of cystic pheochromocytoma was made. Adrenalectomy was performed showing cystic lesion in the right adrenal region. Histopathology and immunohistochemistry revealed pheochromocytoma with cystic degeneration. Patient's hypertension resolved during the follow up. In conclusion, purely cystic pheochromocytoma must be considered as differential for adrenal cystic lesions, especially when atypical features are present.
{"title":"Incidental detection of purely cystic pheochromocytoma in a young adult presenting with lower urinary tract infection","authors":"","doi":"10.1016/j.radcr.2024.08.144","DOIUrl":"10.1016/j.radcr.2024.08.144","url":null,"abstract":"<div><div>Pheochromocytoma is a rare neuroendocrine tumor arising from adrenal medulla. Patients usually show classic triad of headache, palpitations and diaphoresis along with persistent or paroxysmal hypertension. Majority of the tumors are solid or mixed solid and cystic. But purely cystic variant is extremely rare with few cases reports available in the published literature. We report a case of purely cystic pheochromocytoma in a male in 30s who presented to our hospital for unrelated symptom of recurrent burning micturition. He was evaluated for causes of recurrent UTI which revealed incidental right adrenal cyst. The patient's blood pressure was raised on clinical examination and imaging showed simple adrenal cyst without solid component or septations. Suspecting possibility of pheochromocytoma, biochemical analysis was done which revealed elevated 24-hour urinary metanephrine. The diagnosis of cystic pheochromocytoma was made. Adrenalectomy was performed showing cystic lesion in the right adrenal region. Histopathology and immunohistochemistry revealed pheochromocytoma with cystic degeneration. Patient's hypertension resolved during the follow up. In conclusion, purely cystic pheochromocytoma must be considered as differential for adrenal cystic lesions, especially when atypical features are present.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1930043324009282/pdfft?md5=5522018d2e32775ba2bc77d3e88e8d67&pid=1-s2.0-S1930043324009282-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.radcr.2024.09.083
Mucosa-associated lymphoid tissue (MALT) lymphoma commonly arises from chronic inflammation or autoimmune diseases, such as Sjögren syndrome (SjS). Although rare, amyloid deposition in MALT lymphoma has been reported. We present a rare case of parotid gland MALT lymphoma in a 49-year-old woman, in whom preoperative diagnosis was challenging due to atypical imaging findings resulting from amyloid deposits. MRI showed T2-hypointense and T1-iso- to slightly hyperintense masses in the left parotid gland and right sublingual gland, with predominant marginal contrast enhancement and no significant diffusion restriction. Additionally, atrophy and fatty replacement of the parenchyma were noted in bilateral parotid glands, suggesting SjS. Left superficial parotidectomy was performed and pathological findings confirmed MALT lymphoma with extensive amyloid deposition. Histopathological findings of the resected parotid gland parenchyma also suggested SjS. MALT lymphoma should be considered in the differential diagnosis of multiple salivary gland masses in patients with suspected SjS. If MRI reveals atypical imaging findings for malignant lymphoma, particularly T2-hypointensity with no significant diffusion restriction, the possibility of amyloid deposition in MALT lymphoma should be considered.
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