iRadiology最新文献

A 60-year-old woman presented to the emergency department, previously diagnosed in other hospital with acute subarachnoid hemorrhage (SAH) involving left proximal Sylvian and anterior interhemispheric sinuses. On presentation, her airway was patent, pulse rate was 86 beats per minute, blood pressure was 112/76 mmHg, respiratory rate was 18 beats per minute, SpO₂ was 99% on room air, Glasgow Coma Score was 11 (E3V3M5), and pupils were bilaterally (B/L) mid-dilated, reactive to light, and afebrile to touch. Neurological examination was limited due to altered sensorium: No neck rigidity; sensory functions, all cranial nerves, and cerebellar signs were not assessed; motor examination: power could not be assessed; B/L upper and lower limbs tone were decreased; B/L upper and lower limbs reflexes were normal; and B/L Plantar flexion were present. Her laboratory parameters were sodium 146.4 mmol/L, potassium 4.53 mmol/L, chloride 119.3 mmol/L, total bilirubin 55.23 μmol/L, creatinine 90.17 μmol/L, urea 8391.61 μmol/L, and INR 1.127.

A linear probe (frequency of 7–12 MHz) of Point-of-Care Ultrasound (POCUS) systems was utilized for pupillometry. There was anisocoria of 0.7 mm (the size of right and left pupils were 4.2 and 3.5 mm, respectively, Figure 1a,b). The bilateral pupil during direct light stimulation revealed briskly reactive pupils with rebound dilatation (Video 1a,b). However, the bilateral pupil during consensual light stimulation revealed a normal reactive pupil with no rebound dilatation (Video 1c,d). The patient was managed conservatively and referred to another hospital. She had decompression craniectomy on further deterioration of GCS. She died after 1 month due to infective complications of surgery.

Intracranial pressure can be raised due to any supratentorial mass lesion or head trauma. A common problem in the emergency department is how to decide when operative decompression is urgently required in them. Although computed tomography scans are standard tests for definitive diagnosis of brain stem compression, it is inconvenient to use to monitor for the requirement of surgical intervention. In addition, a more precise assessment of the pupil by manual examination is problematic due to large inter-examiner variability. Hence, there are no specific manual pupillary assessment findings for diagnosing brain stem compression. Some clinicians suggest that infrared pupillary scan findings, such as anisocoria of greater than 3 mm and reduced light reflexes, are predictive of an expanding mass lesion in the brain [1]. However, portable infrared pupillometers are not widely available. On the other hand, POCUS, a simple, objective, and quick imaging tool with an additional advantage of recording, is increasingly available for emergency imaging needs [2].

The raised intracranial pressure, sequelae of acute nontraumatic SAH, may cause compressive optic neuropathy and papilledema. Complication

Adrenal rest tumors are rare tumors at extra-adrenal sites that are derived from the heterotopic adrenocortical tissue. The frequency of hepatic adrenal rest tumors (HARTs) is exceedingly rare. Most reported HARTs are located under the capsule of segment VII and appear as a small well-circumscribed solid round mass with hypervascularity, a fatty component, and foci of calcification [1-7]. HARTs may be indistinguishable from hepatocellular carcinoma on imaging studies, which makes accurate preoperative diagnosis difficult.

A 56-year-old woman presented with an 8-month history of right upper abdomen distension and discomfort. She had no history of malignancy or chronic liver disease. Hepatitis viral markers were negative, and serum concentrations of alpha fetoprotein were within normal range. CT images showed a giant cystic lesion in the right lobe of the liver (Figure 1). A regular oval wall nodule had spotty calcifications along its anterior edge. The right adrenal gland was displaced and clearly demarcated from the tumor. The cyst wall and wall nodule demonstrated contrast enhancement. A right hemihepatectomy was performed. Immunohistochemical staining was positive for the adrenal cortical cell markers CD56, steroid growth factor-1, and inhibin-α; staining for chromogranin A was negative. The final histopathologic diagnosis was HART [1, 3, 8].

We report a rare atypical HART that differed from previously reported cases in terms of associated symptoms, size, and imaging characteristics [1-7]. Despite its rarity, this case highlights that HART should be considered in the differential diagnosis when a giant cystic liver lesion with regular wall nodule is encountered in the right lobe, especially in a patient with normal alpha-fetoprotein concentration.

Yu Liu: Writing - original draft (lead); resources (equal). Donghua Sun: Writing - original draft (equal). Heng Liu: Resources (equal); writing - review & editing (lead).

The authors declare no conflict of interest.

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Targeting receptors overexpressed on cancer cells with radiolabeled peptides has become a crucial aspect of molecular imaging in oncology. Small peptides offer favorable characteristics for tumor targeting with minimal side effects and toxicity owing to their small size and simple radiolabeling protocols. Among them, somatostatin analogs have received regulatory approval for the diagnosis and treatment of neuroendocrine tumors. Cyclic RGD (Arg-Gly-Asp) peptides, bombesin analogs, and glucagon-like peptide-1 analogs are currently under development and/or undergoing clinical trials. The most used radionuclides for tumor imaging include ^99mTc and ¹¹¹In for single-photon emission computed tomography, ⁶⁸Ga and ¹⁸F for positron emission tomography. This review highlights the clinical potential and future prospects of ^99mTc-labeled peptides for tumor imaging.

Aortoesophageal fistula is a rare, but life-threatening complication of several conditions [1, 2]. Computed tomography (CT) angiography is the diagnostic modality of choice [3, 4]. There is no consensus on therapeutic strategy [1].

A 73-year-old woman presented with severe chest pain and pressure, shortness of breath, and sweating. She also had a fever and low blood pressure. During observation, she began vomiting blood, lost consciousness, and became hemodynamically unstable. Chest X-ray showed mediastinal widening with a suspected aneurysm of the thoracic aorta and gas outlining the mediastinal structures, suggestive of pneumomediastinum (Figure 1).

CT angiography revealed mediastinal fat stranding, edema, fluid collections, and free gas inclusion. In the differential diagnosis, esophageal perforation with mediastinitis was assumed, but an infectious aneurysm was also considered due to the periaortic gas distribution (Figure 2). There were no previous data in the patient's history and anamnestic or imaging findings. Extensive gas locules around the esophagus were highly suggestive of esophageal perforation (Figure 2a). The esophagus was filled with hemorrhagic content, while the thoracic aorta was aneurysmally dilated, with irregular contours, overlayed by a thickened esophageal wall, with contrast extravasation into the lumen, clearly indicating an aortoesophageal fistula (Figure 2b,d).

Recurrent hematemesis and deterioration of the patient's condition unfortunately led to a fatal outcome, without surgery. Chest pain and progressive hematemesis are typical clinical signs of fistula [4]. Earlier indication of CT angiography could possibly increase the chances of survival [2]. Digital subtraction angiography could also clearly confirm the contrast extravasation [3]. Para-aortic fat stranding and fluid, as well as periaortic gas, may raise the suspicion of an infected aortic aneurysm [5]. Although we cannot determine the source of infection in this case with certainty, the presence of an aortoesophageal fistula was clearly demonstrated radiologically.

Aleksandar Pavlovic: Conceptualization (Equal); data curation (equal); methodology (equal); visualization (equal); writing—original draft (lead). Ljubica Sedlar: Conceptualization (equal); formal analysis (equal); investigation (equal); methodology (equal); validation (equal); visualization (equal); writing—review and editing (lead). Katarina Lazarevic: Conceptualization (equal); formal analysis (equal); methodology (equal). Jelica Vukmirovic: Conceptualization (equal); methodology (equal). Tarik Plojovic: Data curation (equal); formal analysis (equal); methodology (equal); writing—original draft (supporting). Ksenija Mijovic: Conceptualization (equal); investigation (equal); methodology (equal); writing—original draft (supporting). Dragan