Case Reports in Radiology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Radiographic Thrombus within the External Jugular Vein: Report of a Rare Case and Review of the Literature Tue, 13 Oct 2015 11:45:44 +0000 We are reporting a case of a 91-year-old male with a primary malignancy of the right parotid gland with radiographic thrombus extension within the right external jugular vein. He was treated with palliative radiation therapy to the right parotid mass with a marked clinical response. The rarity of this occurrence as documented in the review of the literature provides for uncertainty with regard to proper management. Radiographic evidence of thrombus in the absence of clinical manifestations, the role of anticoagulation, and the proper radiation target delineation were all challenges encountered in the care of this patient. Our case represents a rare occurrence with unique radiologic findings that has implications for management. Sayyad Yaseen Zia, Richard L. Bakst, Qiusheng Si, Mike Yao, and Peter M. Som Copyright © 2015 Sayyad Yaseen Zia et al. All rights reserved. Retrograde Transpubic Approach for Percutaneous Radiofrequency Ablation and Cementoplasty of Acetabular Metastasis Tue, 29 Sep 2015 12:35:34 +0000 We report a case of painful and disabling anterior acetabular bone metastasis treated with bipolar radiofrequency ablation and cementoplasty. Due to the high risk of complications related to the proximity of the femoral neurovascular structures with a direct approach, we successfully performed a retrograde transpubic approach under combined CT and fluoroscopic guidance. In the present report, we describe this approach detailing its indications, advantages, and the technical tips to achieve a safe and satisfactory procedure. Salem Bauones, Veronique Freire, and Thomas P. Moser Copyright © 2015 Salem Bauones et al. All rights reserved. Severe Pulmonary Arterial Hypertension: Comprehensive Evaluation by Magnetic Resonance Imaging Tue, 08 Sep 2015 07:02:58 +0000 Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary artery (PA) pressure, which negatively affects the right ventricular (RV) function. This report shows a patient with severe PAH, on whom a comprehensive MRI exam was performed to evaluate both PA and RV. New imaging sequences were implemented for obtaining additional parameters about the patient’s condition. The results show the capabilities of the developed exam of providing complete picture of the cardiovascular system in PAH, which helps the physician optimize treatment. El-Sayed H. Ibrahim and Abubakr A. Bajwa Copyright © 2015 El-Sayed H. Ibrahim and Abubakr A. Bajwa. All rights reserved. Neuroimaging Features of San Luis Valley Syndrome Sun, 06 Sep 2015 13:10:21 +0000 A 14-month-old Hispanic female with a history of double-outlet right ventricle and developmental delay in the setting of recombinant chromosome 8 syndrome was referred for neurologic imaging. Brain MR revealed multiple abnormalities primarily affecting midline structures, including commissural dysgenesis, vermian and brainstem hypoplasia/dysplasia, an interhypothalamic adhesion, and an epidermoid between the frontal lobes that enlarged over time. Spine MR demonstrated hypoplastic C1 and C2 posterior elements, scoliosis, and a borderline low conus medullaris position. Presented herein is the first illustration of neuroimaging findings from a patient with San Luis Valley syndrome. Matthew T. Whitehead and Bonmyong Lee Copyright © 2015 Matthew T. Whitehead and Bonmyong Lee. All rights reserved. Caseous Necrosis of Mitral Annulus Tue, 18 Aug 2015 08:13:26 +0000 Masses or mass-like lesions located in proximity to mitral valve encompass a wide range of differential diagnoses including neoplasias, abscesses, thrombi, and rarely caseous calcification of mitral annulus. Due to asymptomatic presentation, its diagnosis is usually incidental. Echocardiography is the first choice of imaging in evaluation. Cardiac computed tomography (CT) is helpful in establishing diagnosis by showing dense calcifications while cardiac magnetic resonance imaging (MRI) is used primarily as a problem solving tool. Imaging in evaluation of mitral annulus caseous calcification is essential in order to prevent unnecessary operations. Sinan Balci, Selcuk Akkaya, Selin Ardali, and Tuncay Hazirolan Copyright © 2015 Sinan Balci et al. All rights reserved. Nonstenotic Culprit Plaque: The Utility of High-Resolution Vessel Wall MRI of Intracranial Vessels after Ischemic Stroke Thu, 06 Aug 2015 16:25:49 +0000 Intracranial atherosclerotic disease (ICAD) accounts for 9–15% of ischemic stroke in the United States. Although highly stenotic ICAD accounts for most of the strokes, it is assumed that nonstenotic ICAD (nICAD) can result in stroke, despite being missed on standard luminal imaging modalities. We describe a patient with nICAD who suffered recurrent thromboembolic stroke and TIA but had a negative conventional stroke workup. As a result, they were referred for high-resolution magnetic resonance imaging (HR-MRI) of the arterial vessel wall, which identified a nonstenotic plaque with multiple high-risk features, identifying it as the etiology of the patient’s thromboembolic events. The diagnosis resulted in a transition from anticoagulation to antiplatelet therapy, after which the patient’s clinical events resolved. HR-MRI is an imaging technique that has the potential to guide medical management for patients with ischemic stroke, particularly in cryptogenic stroke. Adam de Havenon, Chun Yuan, David Tirschwell, Thomas Hatsukami, Yoshimi Anzai, Kyra Becker, Ali Sultan-Qurraie, and Mahmud Mossa-Basha Copyright © 2015 Adam de Havenon et al. All rights reserved. Epithelioid Myofibroblastoma in an Old-Male Breast: A Case Report with MRI Findings Thu, 30 Jul 2015 12:50:38 +0000 Myofibroblastoma of the breast (MFB) is a very rare benign stromal tumor. In recent years, increase in mammographic screenings has resulted in increased diagnosis of MFB. Most cases are old males and postmenopausal women. MFB may be confused as malignant, clinically, morphologically, or by imaging. Immunohistochemistry is essential for final diagnosis in these cases. We report a case of a pathologically diagnosed MFB in an 80-year-old male patient who had coexisting prostate cancer and describe its imaging characteristics, especially magnetic resonance imaging (MRI). In this paper, histopathological and MRI findings of the MFB were discussed. Seyma Yildiz, Zuhal Gucin, and Ezgi Basak Erdogan Copyright © 2015 Seyma Yildiz et al. All rights reserved. Talcoma: A Diagnostic Challenge in Differential Diagnosis of Pleural Masses Sun, 26 Jul 2015 11:09:47 +0000 Talcoma is a pleural mass which may develop as a rare complication following talc pleurodesis. Talc pleurodesis is performed to obliterate the pleural space to prevent recurrent pleural effusions or persistent pneumothoraces. The present report describes a case of a patient who developed enlarging pleural mass (talcoma) following talc pleurodesis. Iclal Ocak and Rohit Dewan Copyright © 2015 Iclal Ocak and Rohit Dewan. All rights reserved. Are Aortic Stent Grafts Safe in Pregnancy? Wed, 01 Jul 2015 12:32:02 +0000 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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.