Case Reports in Radiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Are Aortic Stent Grafts Safe in Pregnancy? Wed, 01 Jul 2015 12:32:02 +0000 http://www.hindawi.com/journals/crira/2015/190878/ Aortic stent grafts are increasingly used to treat aortic aneurysms and also other aortic pathologies. The safety of aortic stent grafts in pregnancy has never been studied or reported. We report on two cases of aortic stent grafts in pregnant women and discuss the effect of pregnancy on these aortic stent grafts. Nader Khandanpour, Tapan A. Mehta, M. Adiseshiah, and Felicity J. Meyer Copyright © 2015 Nader Khandanpour et al. All rights reserved. Noncirrhotic Extrahepatic Portosystemic Shunt Causing Adult-Onset Encephalopathy Treated with Endovascular Closure Thu, 25 Jun 2015 11:49:08 +0000 http://www.hindawi.com/journals/crira/2015/852853/ A 54-year-old woman presented with a six-month history of episodic confusion and progressive ataxia. A comprehensive metabolic panel was notable for elevated values of alkaline phosphatase (161 U/L), total bilirubin (1.5 mg/dL), and serum ammonia of 300 umol/L (normal range 9–47). Hepatitis panel, relevant serological tests, tumor markers (CA-19-9, CEA), and urea cycle enzyme studies were unrevealing. Lactulose and rifaximin therapy failed to normalize serum ammonia levels. Imaging revealed a structural vascular abnormality communicating between an enlarged inferior mesenteric vein and the left renal vein, measuring 16 mm in greatest diameter. The diagnosis of congenital extrahepatic portosystemic shunt was made and endovascular shunt closure was performed using a 22 mm Amplatzer II vascular plug. Within a day, serum ammonia levels normalized. Lactulose and rifaximin were discontinued, and confusion and ataxia resolved. Eldad Elnekave, Eugenia Belenky, and Lindsley Van der Veer Copyright © 2015 Eldad Elnekave et al. All rights reserved. Duodenocaval Fistula in a Patient with Inferior Vena Cava Leiomyosarcoma Treated by Surgical Resection and Caval Polytetrafluoroethylene Prosthesis Sun, 21 Jun 2015 08:45:04 +0000 http://www.hindawi.com/journals/crira/2015/575961/ Inferior vena cava (IVC) leiomyosarcoma represents an extremely rare disease that commonly involves the segment between the inflow of the renal veins and the inflow of the hepatic veins (46% of cases). We report the case of a patient affected by an IVC leiomyosarcoma, treated with surgical resection, caval reconstruction with polytetrafluoroethylene (PTFE), and right nephrectomy, followed by external beam radiotherapy. Oncological follow-up was negative for 17 years after this combined treatment, since the patient developed a duodenocaval fistula (DCF). Davide Ippolito, Giulia Querques, Silvia Girolama Drago, Pietro Andrea Bonaffini, and Sandro Sironi Copyright © 2015 Davide Ippolito et al. All rights reserved. Isolated Upper Extremity Posttransplant Lymphoproliferative Disorder in a Child Thu, 18 Jun 2015 07:16:48 +0000 http://www.hindawi.com/journals/crira/2015/813989/ Posttransplant lymphoproliferative disorder (PTLD) is a well-described complication of solid organ and bone marrow transplants. The most common presentation is intra-abdominal lymphadenopathy or single or multiple intraparenchymal masses involving the liver, spleen, or kidneys. Here we describe the imaging and pathology findings of an unusual case of PTLD appearing as an intramuscular forearm lesion in a pediatric male. The manifestation of PTLD as an isolated upper extremity mass in a pediatric patient has to our knowledge not been described. Sarah E. Halula, Daniel G. Leino, Manish N. Patel, John M. Racadio, and Matthew P. Lungren Copyright © 2015 Sarah E. Halula et al. All rights reserved. Transcolonic Migration of Retained Epicardial Pacing Wires Thu, 18 Jun 2015 07:04:16 +0000 http://www.hindawi.com/journals/crira/2015/416587/ Temporary epicardial pacing wires are associated with rare complications. Most of these occur in the chest. Even rarer are complications that occur within the abdomen. We report a case of migrating epicardial pacing wires entering the abdomen and penetrating the transverse colon found incidentally on colonoscopy in an asymptomatic patient. Sara Gonzales, Hugh White, and Juan Echavarria Copyright © 2015 Sara Gonzales et al. All rights reserved. Extranodal Rosai-Dorfman Disease Involving the Left Atrium: Cardiac MRI, CT, and PET Scan Findings Tue, 09 Jun 2015 17:12:14 +0000 http://www.hindawi.com/journals/crira/2015/753160/ Rosai-Dorfman disease (RDD) is a rare entity that usually involves the lymph nodes but extranodal involvements have been seen in numerous cases, although RDD with cardiovascular involvement is extremely rare. We describe a case of a young male who presented with intermittent palpitations and was found to have a left atrium mass. Our case not only emphasizes the rarity of the above lesion but also highlights the importance of modern-day imaging like computed tomography, Cardiac Magnetic Resonance Imaging (CMRI), and PET scan in characterizing such nonspecific lesions and directing appropriate line of treatment. RDD should be considered as one of the differentials even for isolated cardiac lesions. Vistasp J. Daruwalla, Keyur Parekh, Hassan Tahir, Jeremy D. Collins, and James Carr Copyright © 2015 Vistasp J. Daruwalla et al. All rights reserved. Visualizing Central Vessels of Hepatic Angiomyolipoma Devoid of Fat Using a 2D Multi-Breath-Hold Susceptibility-Weighted Imaging Sun, 31 May 2015 13:37:38 +0000 http://www.hindawi.com/journals/crira/2015/197431/ Epithelioid hepatic angiomyolipoma (Epi-HAML) is a rare benign mesenchymal tumor with malignant potential. Most of Epi-HAML contains no or only a minimal amount of adipose tissue and poses a diagnostic challenge. Central vessels are characteristic imaging finding of Epi-HAML, which usually were displayed by dynamic contrast imaging. In this paper, we displayed the central vessels of Epi-HAML invisible on conventional MR images using a new developed abdominal susceptibility-weighted imaging (SWI). To the best of our knowledge, this is the first description for the role of SWI in characterization of Epi-HAML. Ruo-Kun Li, Meng-Su Zeng, and Jin-Wei Qiang Copyright © 2015 Ruo-Kun Li et al. All rights reserved. Isolated Spontaneous Renal Artery Dissection Presented with Flank Pain Mon, 18 May 2015 07:54:10 +0000 http://www.hindawi.com/journals/crira/2015/896706/ Spontaneous renal artery dissection is a rare but important cause of flank pain. We report a case of isolated spontaneous renal artery dissection in 56-year-old man complicated by renal infarction presented with flank pain. Doppler study pointed towards vascular pathology. Computed tomography (CT) angiography was used to make final diagnosis which demonstrated intimal flap in main renal artery with renal infarction. Shruti P. Gandhi, Kajal Patel, and Bipin C. Pal Copyright © 2015 Shruti P. Gandhi et al. All rights reserved. Retrieval of a Dislodged Catheter Using Combined Fluoroscopy and Intracardiac Echocardiography Wed, 13 May 2015 12:14:35 +0000 http://www.hindawi.com/journals/crira/2015/610362/ This report details a method of percutaneous, transluminal retrieval of an intracardiac foreign body using fluoroscopy in combination with intracardiac echocardiography. During retrieval, intracardiac echocardiography (ICE) provided real-time anatomic localization of a constantly moving, almost radiolucent micropuncture coaxial dilator fragment with respect to the tricuspid and pulmonary valves. This method may serve as a crucial aid in retrieval of intracardiac foreign bodies that are difficult to see with fluoroscopy and which may be adjacent to cardiac valves. Gus Mitsopoulos, Robert F. Hanna, Sidney Z. Brejt, Greg E. Goldstein, Vladimir Sheynzon, Joshua L. Weintraub, and William A. Gray Copyright © 2015 Gus Mitsopoulos et al. All rights reserved. Spontaneous Retrobulbar Haematoma Sun, 10 May 2015 09:13:42 +0000 http://www.hindawi.com/journals/crira/2015/796834/ Background. Spontaneous orbital haemorrhage is a very rare condition and vision-threatening event. It may occur due to trauma, orbital surgery/injections, orbital vascular anomalies, and a variety of systemic predisposing factors. Signs of retrobulbar hemorrhage include proptosis, ophthalmoplegia, increased intraocular pressure, loss of pupillary reflexes, and optic disc or retinal pallor. Both Computed Tomography scan and Magnetic Resonance Imaging may be performed in the diagnosis. Case Report. A 31-year-old woman was referred to our hospital with a complaint of headache and blurred vision following a strong sneeze. Ophthalmological examination revealed mild Relative Afferent Pupillary Defect in left eye. Computed Tomography revealed left hyperdense retrobulbar mass and displaced optic nerve. T1 weighted hypointense, T2 weighted hyperintense and non-enhanced round shape, sharply demarcated lesion measuring 18 × 15 × 14 × mm in diameter compatible with haematoma was detected by MRI. Surgically Caldwell-Luc procedure was performed. Histological examination confirmed haematoma. Follow-up Magnetic Resonance Imaging revealed a small reduction in the size of lesion but not complete resolution. The patient’s complaint was regressed. She is now free of symptoms and is still under surveillance. To our knowledge, this is the first reported case of retrobulbar haematoma caused by sneeze. Mehmet Deveer, Nesat Cullu, Halil Beydilli, Hamdi Sozen, Onder Yeniceri, and Selcuk Parlak Copyright © 2015 Mehmet Deveer et al. All rights reserved. Bilateral Sclerosing Stromal Ovarian Tumor in an Adolescent Wed, 06 May 2015 08:42:38 +0000 http://www.hindawi.com/journals/crira/2015/271394/ Sclerosing stromal tumor of the ovary is a rare, benign, sex cord stromal tumor occurring predominantly in younger women in the 2nd and 3rd decades of life. It typically presents unilaterally with only 2 previously reported cases of bilateral presentation. Common clinical presentations include pelvic or abdominal pain, a mass, or menstrual changes. Although occasionally presenting with hormonal manifestations, virilization as a result of androgen production by the tumor is rare. Here we present an extremely rare case of a sclerosing stromal ovarian tumor in a 14-year-old patient with bilateral presentation and with clinical and biochemical evidence of hyperandrogenemia. Anjani Naidu, Betty Chung, Mitchell Simon, and Ian Marshall Copyright © 2015 Anjani Naidu et al. All rights reserved. Delayed Intraperitoneal Catheter Erosion into the Small Bowel Wed, 06 May 2015 07:49:39 +0000 http://www.hindawi.com/journals/crira/2015/697608/ Intraperitoneal chemotherapy can be provided in cases of metastatic ovarian carcinoma. Although most complications arise during or immediately after insertion of the catheter, there are complications that can arise several months later or during therapy administration. One of these delayed complications is catheter erosion into adjacent bowel. Lauren Kerwin and Sean Calhoun Copyright © 2015 Lauren Kerwin and Sean Calhoun. All rights reserved. Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI Thu, 23 Apr 2015 08:06:08 +0000 http://www.hindawi.com/journals/crira/2015/275623/ Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy. Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement. Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication. Linton T. Evans and S. Scott Lollis Copyright © 2015 Linton T. Evans and S. Scott Lollis. All rights reserved. Adult Langerhans Cell Histiocytosis with Hepatic and Pulmonary Involvement Tue, 21 Apr 2015 09:27:49 +0000 http://www.hindawi.com/journals/crira/2015/536328/ Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of Langerhans cells of unknown etiology. It can involve multiple organ systems with different clinical presentation, which complicates the diagnosis. It can range from isolated to multisystem disease with different prognosis. Although common among children, liver involvement is relatively rare in adults and frequently overlooked. Natural history of liver LCH fits into two stages: an early stage with infiltration by histiocytes and a late stage with sclerosis of the biliary tree. Pulmonary findings are more common and include multiple nodules in different stages of cavitation, predominantly in the upper lobes. We present a case of adult LCH with pulmonary and biopsy proven liver involvement with resolution of the hepatic findings after treatment. Bruno Araujo, Francisco Costa, Joanne Lopes, and Ricardo Castro Copyright © 2015 Bruno Araujo et al. All rights reserved. Simple Lymphangioma to Generalized Lymphatic Anomaly: Role of Imaging in Disclosure of a Rare and Morbid Disease Sun, 12 Apr 2015 13:14:58 +0000 http://www.hindawi.com/journals/crira/2015/603859/ Generalized lymphatic anomaly is a rare multisystem congenital disorder in which multiple organs are involved. Imaging features often overlap with other complex lymphatic anomalies and diagnosis is difficult. Treatment options are limited, not remedial and prognosis is poor. We report a 12-year-old male who presented with axillary and chest wall lymphangioma but was subsequently diagnosed as having diffuse lymphangiomatosis affecting lungs, liver, spleen, and bones on computerized tomography scan. We suggest complete radiological evaluation of susceptible adolescent children with lymphangioma to avoid diagnostic delay in this morbid condition. We also discuss radiological features of other similar complex lymphatic anomalies and crucial role of imaging in diagnosis. Manoj Joshi and Dilip S. Phansalkar Copyright © 2015 Manoj Joshi and Dilip S. Phansalkar. All rights reserved. Severe Headache with Eye Involvement from Herpes Zoster Ophthalmicus, Trigeminal Tract, and Brainstem Nuclei Thu, 02 Apr 2015 10:42:42 +0000 http://www.hindawi.com/journals/crira/2015/402015/ A 43-year-old female presented with severe sharp stabbing right-sided periorbital and retroorbital area headache, dull-aching unilateral jaw pain, eyelid swelling, ptosis, and tearing of the right eye but no rash. The pain episodes lasted five minutes to one hour and occurred 10–15 times per day with unremitting milder pain between the attacks. She later developed an erythematous maculopapular rash over the right forehead and therefore was treated with antivirals. MRI performed one month after the onset revealed small hypersignal-T2 in the right dorsolateral mid-pons and from the right dorsolateral aspect of the pontomedullary region to the right dorsolateral aspect of the upper cervical cord, along the course of the principal sensory nucleus and spinal nucleus of the right trigeminal nerve. No definite contrast enhancement of the right brain stem/upper cervical cord was seen. Orbital imaging showed no abnormality of bilateral optic nerves/chiasm, extraocular muscles, and globes. Slight enhancement of the right V1, V2, and the cisterna right trigeminal nerve was detected. Our findings support the hypothesis of direct involvement by virus theory, reflecting rostral viral transmission along the gasserian ganglion to the trigeminal nuclei at brainstem and caudal spreading along the descending tract of CN V. Sasitorn Siritho, Wadchara Pumpradit, Wiboon Suriyajakryuththana, and Krit Pongpirul Copyright © 2015 Sasitorn Siritho et al. All rights reserved. Transarterial Coil Embolization of a Symptomatic Posttraumatic Plantar Pseudoaneurysm Thu, 19 Mar 2015 11:39:47 +0000 http://www.hindawi.com/journals/crira/2015/453657/ Posttraumatic pseudoaneurysms of the lateral plantar artery are rare. We report the case of a 31-year-old woman with a painful pseudoaneurysm of the lateral plantar artery resulting from a deep plantar cut injury. The pseudoaneurysm was successfully treated by performing a transarterial “frontdoor-backdoor” coil embolization technique, which is a minimally invasive alternative to conventional ligature of the artery. Lukas Philipp Beyer, Walter A. Wohlgemuth, and René Müller-Wille Copyright © 2015 Lukas Philipp Beyer et al. All rights reserved. Kaposi’s Sarcoma Presenting as Acute Small Bowel Obstruction Diagnosed on Multidetector Computed Tomography with Histopathological Correlation Tue, 17 Mar 2015 14:20:37 +0000 http://www.hindawi.com/journals/crira/2015/581470/ Kaposi’s sarcoma was originally described by Moritz Kaposi in 1872 as a rare form of multiple hemorrhagic skin lesions. Today it is well documented as a systemic, multifocal, steadily progressive reticuloendothelial system tumor with a predilection for skin and visceral involvement. It occasionally presents as a visceral disease without skin manifestations. We report a case of Kaposi’s sarcoma of the small bowel in a seropositive patient who presented with acute right lower quadrant pain and was diagnosed with intestinal obstruction with perforation on contrast-enhanced multidetector computed tomography (MDCT). The diagnosis was confirmed as Kaposi’s sarcoma on postoperative histopathological analysis. Jaydeep Halankar, Elaine Martinovic, and Paul Hamilton Copyright © 2015 Jaydeep Halankar et al. All rights reserved. Rapid Pituitary Apoplexy Regression: What Is the Time Course of Clot Resolution? Sun, 15 Mar 2015 12:27:58 +0000 http://www.hindawi.com/journals/crira/2015/268974/ A 29-year-old male patient with a functioning pituitary macroadenoma is discussed. The pituitary mass was detected by MRI after the patient presented with sudden onset of headache, suggestive of an apoplectic event. The headache resolved with analgesic medications. Within a follow-up period of one week, the pituitary mass had spontaneously regressed to nearly half its original size without any therapy. The patient never reported any visual complaints and displayed no signs of hypopituitarism. Elevated prolactin levels were present. Seven weeks after the initial event, the pituitary mass showed continued regression on MRI. Prolactin levels remained elevated. This case provides a unique look at the rapid spontaneous regression of mass effect that may occur following apoplexy of a pituitary adenoma. Devon L. Jackson and Jamie J. Van Gompel Copyright © 2015 Devon L. Jackson and Jamie J. Van Gompel. All rights reserved. An Unusual Long-Term Survey of a Patient with Widespread Malignant Urachal Tumor, Not Given Chemotherapy or Radiotherapy Sun, 08 Mar 2015 12:51:45 +0000 http://www.hindawi.com/journals/crira/2015/183787/ The urachus establishes a connection between the dome of the bladder and the umbilicus throughout fetal life. If the urachus does not close completely, malignancy is a potential complication. The primary treatment for malignant urachal tumor is surgical excision. A 61-year-old male patient diagnosed with urachal carcinoma had undergone partial cystectomy 25 years previously. Twenty years later, local recurrence was treated with another partial cystectomy without umbilical remnant excision. Recurrence at the umbilical site was excised 2 years later, but intraperitoneal invasion had occurred, and the patient underwent a total colectomy at that time. Local disease and disseminated metastases in the thorax and intra- and extraperitoneal areas were noted upon admission to our hospital. Urachal carcinomas are usually aggressive tumors, and surgical treatment should include partial or radical cystectomy and excision of the urachus and umbilicus, to prevent local recurrence and distant metastasis. Tugrul Ormeci, Murat Can Kiremit, Bulent Erkurt, and Aslı Örmeci Copyright © 2015 Tugrul Ormeci et al. All rights reserved. Transcatheter Arterial Coil Embolization of Ruptured Common Hepatic Artery Aneurysm in a Patient with Behçet’s Disease Wed, 04 Mar 2015 09:55:27 +0000 http://www.hindawi.com/journals/crira/2015/790175/ Hepatic artery aneurysm is a rare and potentially life-threatening entity. We report a case of ruptured common hepatic artery aneurysm in a patient with Behçet’s disease. The ruptured aneurysm was treated successfully with transcatheter arterial coil embolization. Transcatheter arterial embolization is the preferred treatment modality in patients at high risk of surgical intervention. Akihiro Hotta, Ryohei Kuwatsuru, Kouichi Asahi, Shingo Okada, Daisuke Tsuge, Akihiko Shiraishi, and Yoshinari Takasaki Copyright © 2015 Akihiro Hotta et al. All rights reserved. Ischemic Cardiomyopathy and Cerebral Infarction in a Young Patient Associated with Khat Chewing Thu, 26 Feb 2015 07:10:37 +0000 http://www.hindawi.com/journals/crira/2015/893176/ Khat is a stimulating agent used by many people in the Horn of Africa and the Arabian peninsula. Khat chewing is a known cardiovascular risk factor and is thought to cause vasoconstriction, systemic hypertension, and thrombogenicity. A 33-year-old Somalian man initially presented with loss of neurological function of the left arm, hazy vision, and headache. He smokes tobacco and chews two bundles of khat a week for more than 10 years. His ECG on admission showed a Q wave in V1 and V2 and 2 mm ST-elevations in V1, V2, and V3 and a terminal negative T wave in I, aVL, V2, V3, and V4, consistent with a recent, evolving anterior infarction. A noncontrast enhanced CT of the brain showed ischemia in the right middle cerebral artery vascular territory. An MRI showed recent ischemia in the vascular territory of the posterior division of the right middle cerebral artery. Coronary angiography showed a 70% stenosis with haziness of the proximal left anterior descending artery. Diagnostic tests and imaging are consistent with recent myocardial infarction in the LAD vascular territory because of coronary spasm and cerebral infarction in the middle cerebral artery vascular territory probably related to khat chewing. T. J. Meulman, J. Bakker, and E. J. van den Bos Copyright © 2015 T. J. Meulman et al. All rights reserved. Assessing Biological Response to Bevacizumab Using 18F-Fluoromisonidazole PET/MR Imaging in a Patient with Recurrent Anaplastic Astrocytoma Sun, 22 Feb 2015 12:02:02 +0000 http://www.hindawi.com/journals/crira/2015/731361/ We present our initial experience in using single modality fluoromisonidazole (FMISO) PET/MR imaging to noninvasively evaluate the biological effects induced by bevacizumab therapy in a patient treated for recurrent high grade glioma. In this index patient, bevacizumab therapy resulted in the development of nonenhancing tumor characterized by reduced diffusion and markedly decreased FMISO uptake in the setting of maintained CBF and CBV. These observations suggest that the dynamic biological interplay between tissue hypoxia and vascular normalization occurring within treated recurrent high grade glioma can be captured utilizing FMISO PET/MR imaging. Ramon F. Barajas Jr., Miguel H. Pampaloni, Jennifer L. Clarke, Youngho Seo, Dragana Savic, Randall A. Hawkins, Spencer C. Behr, Susan M. Chang, Mitchel Berger, William P. Dillon, and Soonmee Cha Copyright © 2015 Ramon F. Barajas Jr. et al. All rights reserved. Ultrasonographic and Scintigraphic Findings of Thyroid Hemiagenesis in a Child: Report of a Rare Male Case Sun, 15 Feb 2015 13:59:49 +0000 http://www.hindawi.com/journals/crira/2015/917504/ Thyroid hemiagenesis is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. It is much rarer in males. There is a higher incidence of associated thyroid disorders in patients with thyroid hemiagenesis; therefore early and prompt diagnosis is important for children. We present the ultrasonographic and scintigraphic findings of thyroid hemiagenesis in an eight-year-old-boy. On ultrasonography (US), left lobe of the thyroid gland could not be demonstrated and the right lobe showed minimal hyperplasia. Its echogenicity was normal and no nodule was seen. On thyroid scintigraphy, left lobe of thyroid gland or any ectopic thyroid tissue could not be demonstrated, while the right lobe showed minimal hyperplasia. Without performing any invasive procedure, we enrolled the child in a follow-up program with the guidance of US and scintigraphy, which were effective both in making the final diagnosis of thyroid hemiagenesis and in evaluating the current status of the present thyroid tissue. In conclusion, if only one thyroid lobe is detected in a pediatric case initially with US or scintigraphy, the diagnosis of thyroid hemiagenesis should be suggested and, before any unnecessary or invasive attempt, the other complementary method (scintigraphy/US) should be performed. Ümit Yaşar Ayaz, Sevin Ayaz, Mehmet Ercüment Döğen, and Arman Api Copyright © 2015 Ümit Yaşar Ayaz et al. All rights reserved. Giant Pilomatrixoma Presenting in the Posterior Thorax, a Rare Location and the Largest Described Wed, 11 Feb 2015 11:10:35 +0000 http://www.hindawi.com/journals/crira/2015/590742/ Pilomatrixoma is a common benign soft tissue neoplasm arising from hair follicle cells, typically not exceeding 3 cm and located mainly within the head and neck regions. Lesions greater than 3 cm or those located elsewhere are rare and are often not thought of or high on a differential diagnosis. Moreover, the radiographic features of pilomatrixoma are very nonspecific making the diagnosis even more difficult and rarely described in the radiology literature. We present the largest reported case of pilomatrixoma measuring 24 cm arising from the posterior thorax. Our hope is to increase awareness of this diagnosis for slow-growing soft tissue masses not located in the classically described locations of head and neck, explore the radiographic features on various imaging modalities, and review the current radiology literature. P. Gongidi, J. Meshekow, T. Holdbrook, and P. Germaine Copyright © 2015 P. Gongidi et al. All rights reserved. Epidural Venous Plexus Engorgement: What Lies Beneath? Wed, 04 Feb 2015 06:20:09 +0000 http://www.hindawi.com/journals/crira/2015/965106/ Epidural venous plexus engorgement may occur due to several conditions that prevent the normal venous circulation. Inferior vena cava agenesis is a very rare cause of epidural venous enlargement. We present a case with a very thin inferior vena cava and left iliac vein agenesis who presented with back pain due to epidural vein engorgement and lacked other venous problems such as deep vein thrombosis. Fuldem Yildirim Donmez Copyright © 2015 Fuldem Yildirim Donmez. All rights reserved. Ultrasound Elastographic Findings of Mammary Fibromatosis Tue, 03 Feb 2015 06:58:39 +0000 http://www.hindawi.com/journals/crira/2015/829468/ Mammary fibromatosis is an uncommon, benign tumor of the breast. It is locally aggressive and has a high rate of recurrence. Its clinical presentation and imaging results always call for suspicion of malignancy. Here we describe a case of mammary fibromatosis with clinical manifestation, radiographic and pathologic results, and imaging findings from ultrasound elastography. Ping He, Li-Gang Cui, Yu-Tao Lei, Jian-Ying Liu, and Jin-Rui Wang Copyright © 2015 Ping He et al. All rights reserved. The Rare Cuboid-Navicular Coalition Presenting as Chronic Foot Pain Mon, 26 Jan 2015 07:31:56 +0000 http://www.hindawi.com/journals/crira/2015/625285/ Tarsal coalitions are relatively rare diagnoses affecting adolescent patients that typically present with progressive foot pain. Cuboid-navicular coalition, a type of tarsal coalition, is extremely rare with less than 10 reported cases to date. Most prevailing theories reported have described this specific type of coalition as asymptomatic except at specific moments of stress and exercise. The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient. We present a case of cuboid-navicular fibrocartilaginous coalition in an adolescent patient presenting with chronic foot pain. Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition. Instead, abnormal articulation between the cuboid and navicular must be sought. Omer Awan and James Allen Graham Copyright © 2015 Omer Awan and James Allen Graham. All rights reserved. Radiographic and MR Imaging Findings of the Spine after Bisphosphonate Treatment, in a Child with Idiopathic Juvenile Osteoporosis Tue, 20 Jan 2015 06:56:37 +0000 http://www.hindawi.com/journals/crira/2015/727510/ Bisphosphonates are employed with increasing frequency in various pediatric disorders, mainly associated with osteoporosis. After cessation of bisphosphonate treatment in children, skeletal radiologic changes have been documented including dense metaphyseal lines of the long bones and “bone in bone” appearance of the vertebrae. However, the evolution of these radiographic changes has not been fully explored. We describe the MR imaging appearance of the spine that, to our knowledge, has not been previously addressed in a child with idiopathic juvenile osteoporosis who had received bisphosphonates and emphasize the evolution of the radiographic findings of the spine and pelvis over a four-year period. Olympia Papakonstantinou, Maria Sakalidou, Erato Atsali, Vasiliki Bizimi, Maria Mendrinou, and Efthymia Alexopoulou Copyright © 2015 Olympia Papakonstantinou et al. All rights reserved. Atypical Intracranial Epidermoid Cysts: Rare Anomalies with Unique Radiological Features Thu, 15 Jan 2015 11:22:49 +0000 http://www.hindawi.com/journals/crira/2015/528632/ Epidermoid cysts are benign slow growing extra-axial tumours that insinuate between brain structures, while their occurrences in intra-axial or intradiploic locations are exceptionally rare. We present the clinical, imaging, and pathological findings in two patients with atypical epidermoid cysts. CT and MRI findings for the first case revealed an intraparenchymal epidermoid cyst that demonstrated no restricted diffusion. The second case demonstrated an aggressive epidermoid cyst that invaded into the intradiploic spaces, transverse sinus, and the calvarium. The timing of ectodermal tissue sequestration during fetal development may account for the occurrence of atypical epidermoid cysts. Eric K. C. Law, Ryan K. L. Lee, Alex W. H. Ng, Deyond Y. W. Siu, and Ho-Keung Ng Copyright © 2015 Eric K. C. Law et al. All rights reserved.