Case Reports in Radiology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. A Rare Presentation of Lymphoma of the Cervix with Cross-Sectional Imaging Correlation Thu, 17 Apr 2014 12:19:48 +0000 Non-Hodgkin’s lymphoma of the cervix is an extremely uncommon entity, with no standard established treatment protocol. A 43-year-old asymptomatic female with a history of dual hit blastic B-cell lymphoma/leukemia in complete remission presented with an incidental cervical mass, which was initially felt to represent a cervical fibroid on computed tomography (CT). It was further evaluated with ultrasound, biopsy, and positron emission tomography-computed tomography (PET-CT), which demonstrated a growing biopsy-proven lymphomatous mass and new humeral head lesion. The patient was started on chemotherapy to control the newly diagnosed humeral head lesion, which then regressed. She then underwent radiation to the cervix with significant improvement in the cervical lymphoma. A review of cross-sectional imaging findings of lymphoma of the cervix is provided, including how to differentiate it from other more common diseases of the cervix. Clinical awareness of rare cervical masses such as lymphoma is very important in order to achieve timely diagnosis and appropriate treatment. Brinda Rao Korivi, Corey T. Jensen, Madhavi Patnana, Keyur P. Patel, and Tharakeswara K. Bathala Copyright © 2014 Brinda Rao Korivi et al. All rights reserved. Congestive Heart Failure versus Inflammatory Carcinoma in Breast Mon, 07 Apr 2014 00:00:00 +0000 Inflammatory breast cancer is a rare highly malignant form of breast cancer. Clinical signs and symptoms with histologic examination usually confirm the diagnosis. There are rare reports of breast edema of congestive heart failure which were difficult to differentiate from inflammatory carcinoma. The differential becomes more difficult when congestive heart failure is associated with unilateral breast edema. We present a case of a 70-year-old woman with congestive heart failure associated with unilateral breast edema and skin thickening simulating inflammatory breast carcinoma on mammography. A. Alikhassi, R. Omranipour, and Z. Alikhassy Copyright © 2014 A. Alikhassi et al. All rights reserved. Mesenteric Lipoblastoma and Cervical Lipoblastomatosis: Ultrasound, Elastosonography, and Computed Tomography Findings in Two Children Thu, 27 Mar 2014 00:00:00 +0000 Lipoblastomas are benign tumors of the embryonic lipoid cells mainly occurring in infancy and early childhood. They are clinicopathologically distinguished in two forms: the well-circumscribed and localized type and the diffuse, irregularly confined type with infiltrative growth pattern, also called lipoblastomatosis. We report two pediatric cases of a mesentery localized and cervical diffuse lipoblastomas investigated both with ultrasound and computed tomography examinations. Raffaella Capasso, Eugenio Rossi, Luisa Castelli, Antonio Basilicata, Raffaele Zeccolini, Massimo Zeccolini, and Antonio Rotondo Copyright © 2014 Raffaella Capasso et al. All rights reserved. The Inguinal Herniation of the Ovary in the Newborn: Ultrasound and Color Doppler Ultrasound Findings Wed, 26 Mar 2014 11:18:12 +0000 Inguinal hernias in the newborn age group are seldom encountered. In the affected female patient, the ovaries, fallopian tubes, and the intestines may settle in the hernia sac. The early diagnosis of torsion in cases in which the ovary is herniated into the inguinal canal is of utmost importance in order to give surgery the chance of reduction and correction. In this paper, a case of an ovarian herniation into the inguinal canal without the presence of torsion is being presented, and the place of US and CDUS in the differential diagnosis of the situation is being discussed. Omer Kaya, Kaan Esen, Bozkurt Gulek, Cengiz Yilmaz, Gokhan Soker, and Onder Onem Copyright © 2014 Omer Kaya et al. All rights reserved. Diffuse Hepatic and Spleen Uptake of Tc-99m MDP on Bone Scintigraphy Resembling Liver-Spleen Scintigraphy in a Patient of Plasma Cell Tumor Tue, 25 Mar 2014 06:27:47 +0000 The present case demonstrates a diffuse intense hepatic and, to a lesser degree, spleen, Tc-99m MDP uptake on a routine bone scintigraphy resembling liver-spleen imaging. A 49-year-old female with a history of anaplastic plasma cell tumor and suffering from bone pain was referred for bone scintigraphy to evaluate possible bone metastases. The bone scintigraphy showed diffuse hepatic and spleen uptake of Tc-99m MDP resembling liver-spleen imaging. Furthermore, bone uptake of Tc-99m MDP was significantly diminished and there were no abnormal foci throughout the skeleton. The bone scintigraphy of the present case of an anaplastic plasma cell tumor suggests the possible presence of amyloidosis. Mohammad Reza Ravanbod, Reza Nemati, Hamid Javadi, Iraj Nabipour, and Majid Assadi Copyright © 2014 Mohammad Reza Ravanbod et al. All rights reserved. A Pilocytic Astrocytoma Mimicking a Clinoidal Meningioma Thu, 13 Mar 2014 07:07:00 +0000 Pilocytic astrocytomas and meningiomas are benign, primary brain tumors that may involve the optic tract. Classically, the presence of a dural “tail” sign may differentiate a meningioma from other intracranial lesions. In this report, we describe a mass with the typical appearance of a clinoidal meningioma on magnetic resonance imaging (MRI) but postoperatively diagnosed as a pilocytic astrocytoma. This case illustrates the rare occurrence of a pilocytic astrocytoma mimicking a meningioma on MRI. Christopher S. Hong, Norman L. Lehman, and Eric Sauvageau Copyright © 2014 Christopher S. Hong et al. All rights reserved. Erratum to “Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings” Wed, 12 Mar 2014 07:47:15 +0000 Vasileios Rafailidis, Anna Gavriilidou, Christos Liouliakis, Asimina Tsimitri, Sofia Paschaloudi, and Vasiliki Karadimou Copyright © 2014 Vasileios Rafailidis et al. All rights reserved. Delivery Induced Intraperitoneal Rupture of a Cystic Ovarian Teratoma and Associated Chronic Chemical Peritonitis Wed, 12 Mar 2014 06:26:22 +0000 Intraperitoneal rupture of cystic ovarian teratoma is a rare complication. We report a case in a 29-year-old female, with increased abdominal circumference 2 months after vaginal delivery. MRI/CT raised this diagnosis associated to chemical peritonitis. A malignant ovarian mass with peritoneal carcinomatosis was excluded. Laparoscopic oophorectomy was performed and histologic analysis confirmed imaging findings. This case demonstrates the interest of imaging before surgery in pelvic masses to avoid misdiagnosing and to provide adequate treatment. Reine Nader, Thibault Thubert, Xavier Deffieux, Jocelyne de Laveaucoupet, and Guillaume Ssi-Yan-Kai Copyright © 2014 Reine Nader et al. All rights reserved. Multimodality Imaging Evaluation of an Uncommon Entity: Esophageal Heterotopic Pancreas Tue, 11 Mar 2014 09:56:04 +0000 A 25-year-old male was referred to the Radiology Department with new onset of right upper quadrant and epigastric abdominal pain. He had no past medical or surgical history. Physical exam was unremarkable. The patient underwent computed tomography (CT), fluoroscopic upper gastrointestinal (GI) evaluation, endoscopic ultrasound (EUS), and positron emission tomography (PET) evaluation, revealing the presence of a heterogeneous esophageal mass. In light of imaging findings and clinical workup, the patient was ultimately referred for thorascopic surgery. Surgical findings and histology confirmed the diagnosis of esophageal heterotopic pancreas. Takman Mack, Debra Lowry, Peter Carbone, Brian Barbick, Joshua Kindelan, and Robert Marks Copyright © 2014 Takman Mack et al. All rights reserved. A Case of Neurosarcoidosis with Labyrinthine Involvement Thu, 06 Mar 2014 11:44:02 +0000 Sarcoidosis is a chronic granulomatous disease of unknown aetiology, which may involve any organ system. It most commonly occurs in adults with childhood involvement being rare. Central nervous system involvement is seen in up to 25% and typically involves meningeal disease resulting in multiple cranial neuropathies. Other common clinical findings include seizures, headache, dementia, and pituitary dysfunction. Imaging plays a central role in the diagnosis with typical findings including pachymeningeal and leptomeningeal enhancing lesions. Other imaging findings include lacunar and major territory infarcts, hypothalamic and infundibular thickening, hydrocephalus, and cranial nerve enhancement. We present a case of an eight-year-old male patient with progressive headache, visual disturbance, unilateral sensory hearing loss, and multiple cranial neuropathies. Imaging findings demonstrated the classic pachymeningeal and leptomeningeal enhancement along much of the skull base, as well as enhancement of the right and left second and eighth cranial nerves. Extensive inflammatory changes were noted in the temporal bones and paranasal sinuses. There was also enhancement of the right and left labyrinths. Sinus biopsy confirmed sarcoidosis. We present the first case to our knowledge of sarcoid labyrinthitis. Peter B. Johnson, Roxanne Melbourne-Chambers, Amit Manohar Saindane, Nilesh Desai, and Myrton Smith Copyright © 2014 Peter B. Johnson et al. All rights reserved. Vascular Plug-Assisted Retrograde Transvenous Obliteration of Portosystemic Shunts for Refractory Hepatic Encephalopathy: A Case Report Wed, 05 Mar 2014 13:42:41 +0000 While balloon-assisted retrograde transvenous obliteration (BRTO) has been used for two decades in Asia for the management of gastric variceal bleeding, it is still an emerging therapy elsewhere. Given the shunt closure brought about by the procedure, BRTO has also been used for the management of portosystemic encephalopathy with promising results. Modified versions of BRTO have been developed, including plug-assisted retrograde transvenous obliteration (PARTO), where a vascular plug is deployed within a portosystemic shunt. To our knowledge, we present the first North American case of PARTO in the setting of a large splenorenal shunt for the management of portosystemic encephalopathy. Jonathan K. Park, Sung-Ki Cho, Stephen Kee, and Edward W. Lee Copyright © 2014 Jonathan K. Park et al. All rights reserved. Two Congenital Anomalies in One: An Ectopic Gallbladder with Phrygian Cap Deformity Tue, 04 Mar 2014 12:19:00 +0000 The gallbladder is affected by a large number of congenital anomalies, which may affect its location, number, size, or form. Some of these malformations are very rare and may lead to misdiagnosis. An ectopic gallbladder can be misinterpreted as agenesis of the organ or as a cystic hepatic mass when intrahepatic. Given the frequency and the wide acceptance of the ultrasonographic examination of the biliary tract, radiologists should be aware of these malformations. In some cases, ultrasonographic diagnosis can be difficult. However, the use of Computed Tomography can elucidate such cases. We present the case of a patient whose gallbladder had two combined malformations but caused no symptoms. Namely, the patient had a transverse ectopic gallbladder combined with a “Phrygian cap” deformity. The incidence of ectopic locations of the gallbladder is 0.1–0.7%, whereas the “Phrygian cap” deformity can be found in 4% of patients. There is no other cases with combination of these two entities reported in the literature. Ultrasonographic and CT findings are presented and aspects of this malformation are discussed. The clinical significance of ectopic gallbladder is also emphasized because it may alter the clinical presentation of biliary tract diseases and pose technical problems during surgery. Vasileios Rafailidis, Sotirios Varelas, Naoum Kotsidis, and Dimitrios Rafailidis Copyright © 2014 Vasileios Rafailidis et al. All rights reserved. Lymphatic Filariasis Disseminating to the Upper Extremity Wed, 19 Feb 2014 12:29:05 +0000 Lymphatic filariasis is the most common cause of acquired lymphedema worldwide (Szuba and Rockson, 1998). It is endemic to tropical and subtropical regions, and its effects are devastating. With over 100 million infected persons, it ranks second only to leprosy as the leading cause of permanent and long-term disability. Wuchereria bancrofti is the etiologic agent in 90% of cases. There is a dearth of published MRI findings with pathologically proven active infections, making this entity even more of a diagnostic dilemma. Imaging may provide the first clue that one is dealing with a parasite and may facilitate proper treatment and containment of this disease. This is the first report of pathologic correlation with MRI findings in the extremity in active filariasis. The magnetic resonance images demonstrate an enhancing, infiltrative, mass-like appearance with partial encasement of vasculature that has not been previously described in filariasis. Low signal strands in T2-hyperintense dilated lymphatic channels are seen and may depict live adult worms. We hypothesize that the low signal strands correspond to the collagen rich acellular cuticle. This, in combination with the surrounding hyperintense T2 signal, corresponding to a dilated lymphatic channel, may provide more specific MRI findings for active nematodal infection, which can prompt early biopsy, pathological correlation, and diagnosis. Catherine Maldjian, Vineet Khanna, Bevan Tandon, Matthew Then, Mohamed Yassin, Richard Adam, and Michael J. Klein Copyright © 2014 Catherine Maldjian et al. All rights reserved. Magnetic Resonance Cholangiopancreatography with Secretin Stimulation in the Diagnosis of Intraductal Papillary Mucinous Neoplasm: A Paradigmatic Case Report Thu, 13 Feb 2014 00:00:00 +0000 Context. One of the characteristic findings of intraductal papillary mucinous neoplasms (IPMN) is the presence of a direct communication between the lesion and the ductal pancreatic system and when magnetic resonance cholangiopancreatography (MRCP) shows uncertain findings, it is useful to perform a MRCP after secretin stimulation (MRCP-S) which provides a better visualization of the ductal system. Case Report. We present a case of 51-year-old man in whom, during a CT follow-up for a renal tumour, was found a cystic lesion of the pancreas. To better evaluate the lesion and its suspected communication with the pancreatic system, MR with gadolinium and MRCP and MRCP-S were performed. With the MRCP and MRI it was not possible to identify a clear communication between the cystic lesion and the ductal system. MRCP-S showed an increase in signal intensity of the lesion and its communication with the ductal system, allowing us to classify the cystic lesion as a main duct in intraductal papillary mucinous neoplasm. The patient underwent a surgical duodenal pancreatectomy. The histological result of the specimen confirmed the diagnosis of adenocarcinoma IPMN. Conclusion. In this case MRCP-S has allowed a clearer identification of the cystic lesion allowing a correct diagnosis and treatment. Elsa Iannicelli, Francesco Carbonetti, Marco Di Pietropaolo, Giulia Francesca Federici, Gabriele Capurso, and Vincenzo David Copyright © 2014 Elsa Iannicelli et al. All rights reserved. Gradual Colonic Impaction of a Chicken Bone Associated with Inflammatory Pseudotumor Formation and Nonocclusive Colon Ischemia Tue, 11 Feb 2014 12:17:27 +0000 Foreign body (FB) ingestion is a common clinical problem and most FBs pass through the gastrointestinal tract without the need for intervention. A wide spectrum of clinical presentations may be possible and these can be either acute or chronic. We present a case of an 83-year-old woman featuring insidious abdominal discomfort who was hospitalized in our institution due to worsening symptoms. She underwent contrast-enhanced computed tomography (CT) evaluation which showed the presence of a significant parietal thickening of the transverse and descending colon, a mesenteric loose tissue imbibition, venous engorgement, and no filling defect of visceral arteries, suggesting a condition of nonocclusive colon ischemia. A hyperdense FB was identified in the sigma and was associated with a small pseudotumoral mass. The patient underwent surgical exploration which confirmed the hypoperfusional state of the colon, showing the presence of a chicken bone perforating the sigma and lying in the context of a pseudotumoral mass. Our experience shows how contrast-enhanced CT is feasible and can be strongly recommended as a first-line imaging tool on suspicion of colon ischemia and also how it can easily identify the underlying cause, in our case a FB sealed perforation of the sigma with pseudotumoral mass formation. Stefania Fosi, Simone Altobelli, Alessio Bindi, Massimo Villa, Flavio De Sanctis, Mauro Montuori, Edoardo Ricciardi, Piero Rossi, Giuseppe Petrella, and Giovanni Simonetti Copyright © 2014 Stefania Fosi et al. All rights reserved. Intracranial Rosai-Dorfman Disease Tue, 11 Feb 2014 09:41:20 +0000 Rosai-Dorfman disease (RDD) is a rare, benign pseudolymphomatous condition, predominantly involving lymph nodes. Rosai-Dorfman disease (RDD) (sinus histiocytes with massive lymphadenopathy) rarely affects the intracranial region without involvement of other sites. It is a rare and idiopathic histoproliferation disorder characterized by painless lymphadenopathy. We report a case of 43-year-old male who presented with unconsciousness; MRI was done and right temporofrontal mass was found. Excision was done, and on histopathology it confirmed RDD. Yadav Arun Kumar, Peng Yi Peng, and Xia Chen Chen Copyright © 2014 Yadav Arun Kumar et al. All rights reserved. An Unusual Fat-Containing Presacral Tumor in an Elderly Patient Thu, 06 Feb 2014 09:09:11 +0000 The authors present a case of a presacral myelolipoma diagnosed in an 84-year-old male patient with longstanding pelvic pain and past medical history of bladder cancer. Pelvic computed tomography (CT) revealed a well-encapsulated and lobulated presacral mass, with mixed fat and soft-tissue attenuation. Magnetic resonance (MR) imaging provided further confirmation of macroscopic intralesional fat and excluded either adjacent bone invasion or bladder cancer recurrence. A presacral myelolipoma was suspected based on imaging findings, with liposarcoma and teratoma having also been considered for the differential diagnosis. The histological confirmation of the tumor was only attained postoperatively. This case report alerts to the possible presacral location of myelolipomas, which should be considered for every fat-containing lesion detected in this region. The main clinical, imaging, and differential diagnoses of this entity are reviewed in this paper. Maria Inês Leite, Afonso Gonçalves, Ana Cristina Ferreira, Santiago Ortiz, Rui Esteves, and Isabel Távora Copyright © 2014 Maria Inês Leite et al. All rights reserved. Klippel-Trénaunay Syndrome with Intracranial Arteriovenous Malformation: A Rare Presentation Thu, 06 Feb 2014 06:16:32 +0000 Klippel-Trénaunay syndrome (KTS) is a rare vascular congenital anomaly affecting less than 200,000 people in the United States. Vascular malformations associated with KTS tend to affect slow flow systems: venous, capillary, and lymphatic systems. The nature of the syndrome leads to a higher risk for the development of arteriovenous malformations. Our case presentation describes a patient with KTS and an associated rare presentation of intraventricular arteriovenous malformation (AVM). Mahniya F. Sadiq, Waqas Shuaib, Muhammad H. Tiwana, Jamlik-Omari Johnson, and Faisal Khosa Copyright © 2014 Mahniya F. Sadiq et al. All rights reserved. Neurodegeneration with Brain Iron Accumulation in an Eleven-Year-Old Jamaican Male Tue, 28 Jan 2014 07:28:16 +0000 We present a case of an eleven-year-old boy presenting with progressive extrapyramidal signs and dementia. His imaging findings demonstrated the classic eye-of-the-tiger sign on T2W magnetic resonance imaging. He was diagnosed with pantothenate kinase-associated neurodegeneration (PKAN). This is a rare autosomal recessive inborn error of coenzyme A metabolism, caused by mutations in PANK2. This is the first reported case of PKAN from the Caribbean. Peter Johnson, Roxanne Melbourne-Chambers, Nilesh Desai, and Emma Greenaway Copyright © 2014 Peter Johnson et al. All rights reserved. Ultrasound of Primary Aneurysmal Bone Cyst Thu, 23 Jan 2014 08:47:08 +0000 Aneurysmal bone cysts (ABC) are rare, benign, expansile lesions of bone often found in the metaphyses of long bones in pediatric and young adult population. Multiple fluid levels are typically seen on imaging with magnetic resonance imaging (MRI) or computed tomography (CT). We describe a case of a primary ABC in the fibula of a 34-year-old man diagnosed on ultrasound with a mobile fluid level demonstrated sonographically. Katrina N. Glazebrook, Gary L. Keeney, and Michael G. Rock Copyright © 2014 Katrina N. Glazebrook et al. All rights reserved. Ewing Sarcoma of the Kidney: A Rare Entity Thu, 09 Jan 2014 10:06:12 +0000 Ewing sarcoma and primitive peripheral neuroectodermal tumor (PNET) are high-grade malignant tumors typically found in children and adolescents. These tumors belong to the family of small round cell tumors and are of neuroectodermal origin. Primary Ewing sarcoma of the kidney is rare and because of that is an infrequent differential diagnosis in urologic malignancies. Renal PNET mostly presents with nonspecific symptoms such as hematuria and abdominal pain. The imaging findings are uncharacteristic. The diagnosis is based on the histology, immunohistochemistry, and molecular pathologic findings. Once PNET has been diagnosed, multimodal treatment is indicated. Despite all treatment options, the prognosis of those with metastatic disease is poor. Maria Fernanda Arruda Almeida, Madhavi Patnana, Brinda Rao Korivi, Neda Kalhor, and Leonardo Marcal Copyright © 2014 Maria Fernanda Arruda Almeida et al. All rights reserved. A Rare Case of Near Complete Regression of a Large Cervical Disc Herniation without Any Intervention Demonstrated on MRI Mon, 06 Jan 2014 16:55:11 +0000 There are very few reported cases of regression of large cervical disc herniation without any intervention—the so-called spontaneous regression, demonstrated using MRI. We report a rare and interesting case of MRI that demonstrated near complete regression of a large herniated cervical intervertebral disc, without any surgical treatment. Parag Suresh Mahajan, Nawal M. Al Moosawi, and Islam Ali Hasan Copyright © 2014 Parag Suresh Mahajan et al. All rights reserved. Spontaneous Ureteral Rupture Diagnosis and Treatment Mon, 23 Dec 2013 18:52:41 +0000 Rupture of the urinary collecting system associated with perinephric or retroperitoneal extravasation of the urine is an unusual condition and it is commonly associated with renal obstructing disease. Perforation could occur at any level from the calix to the bladder but it is usually seen at the fornices and upper ureter. It may lead to several serious consequences including urinoma, abscess formation, urosepsis, infection, and subsequent irreversible renal impairment. We report a case of a 69-year-old woman who presented at the emergency department of our institution with severe abdominal pain. Due to symptomatology worsening, complete laboratory evaluation was performed and the patient underwent abdominal contrast enhanced computed tomography (CT) evaluation which showed contrast agent extravasation outside the excretory system without any evidence of renal calculi at basal acquisition. It was decided to perform a double-J stent placement which was followed by complete healing of the ureter and its removal was performed 8 weeks later. Diagnosis and therapeutic approaches are discussed. E. Pampana, S. Altobelli, M. Morini, A. Ricci, S. D'Onofrio, and G. Simonetti Copyright © 2013 E. Pampana et al. All rights reserved. Magnetic Resonance Cholangiopancreatography in the Diagnosis of Haemobilia Sun, 22 Dec 2013 13:29:28 +0000 Haemobilia is a rare cause of unrecognized gastrointestinal bleeding and is hard to diagnose. Through the present case report we aim to corroborate magnetic resonance relevance in the evaluation of biliary system and bile features, investigating on its role in patients with acute biliary diseases. We report a case of a Caucasian 48-year-old man who was admitted due to abdominal pain and fever. After an ultrasonography exam we detected multiple cysts in the hepatic left lobe: imaging features, laboratory findings, and patient past work experience (woodcutter) suggested a diagnosis of hepatic Echinococcosis. Once surgery decision was taken, patient underwent an intervention of cystopericystectomy. On the 8th postoperative day, the procedure was complicated by black stool, jaundice, and severe anaemia. Acomputed tomography revealed an inhomogeneous collection with some air bubbles in the area of previous surgical intervention, but it was not able to solve the diagnosis question. At this stage a magnetic resonance study was mandatory. On T2-weighted images we observed an expanse gallbladder with hypointense intraluminal material and a considerable intrahepatic biliary system dilatation due to bloody material. On the basis of these examination results, we supposed haemobilia arising from previous surgical intervention. A therapeutic endoscopic retrograde cholangiopancreatography procedure led to decompression of biliary system through a major papilla sphincterotomy with spillage of bile mixed with blood clots. Ines Casazza, Mara Angela Guglietta, and Giuseppe Argento Copyright © 2013 Ines Casazza et al. All rights reserved. An Asymptomatic Large Anterior Sacral Meningocele in a Patient with a History of Gestation: A Case Report with Radiological Findings Tue, 17 Dec 2013 14:39:28 +0000 Anterior sacral meningocele is characterized by herniation of the meningeal sac due to a developmental bone defect in the front of a sacrum bone. It was first described in 1837. The sacral meningocele may be congenital or acquired. It is usually discovered during a rectal or pelvic examination as a cystic lesion or discovered incidentally. Most of the symptoms are due to compression on the adjacent organs. In this paper, we present a case of an asymptomatic female patient who had a pelvic cyst detected during a routine obstetric ultrasound examination. We show radiological findings of the detailed postpartum evaluation of the cyst, which led to detection of sacral agenesis, huge anterior sacral meningocele, and significant arcuate uterus. Mehmet Beyazal Copyright © 2013 Mehmet Beyazal. All rights reserved. A Unique Case of Left Second Supernumerary and Left Third Bifid Intrathoracic Ribs with Block Vertebrae and Hypoplastic Left Lung Thu, 12 Dec 2013 11:33:06 +0000 Intrathoracic rib (IR) is a very rare anomaly in which a normal, an accessory, or a bifid rib lies within the chest cavity and may originate from a vertebra or a rib. It is more commonly present on the right side, and sometimes it may be associated with vertebral anomalies. Only 50 cases have been reported to date in the literature. In most cases, the IR is an isolated finding; it is incidentally detected and is asymptomatic. The IR can be easily missed on a chest radiograph and can be mistaken initially for a pleural lesion, lung consolidation, other peripheral lung parenchymal lesions, or a bony lesion. It is, therefore, essential for physicians and radiologists to know about this entity and consider it in the differential diagnosis, to avoid further evaluation and unnecessary investigations. We present a unique case of three intrathoracic ribs, a left second supernumerary rib, left third depressed normonumerary rib, and bifid arm of the left third rib, with block vertebrae and hypoplastic left lung. To our knowledge, this is the first such case presentation in the published literature. Parag Suresh Mahajan, Islam Ali Hasan, Nazeer Ahamad, and Nawal M. Al Moosawi Copyright © 2013 Parag Suresh Mahajan et al. All rights reserved. Inferior Vena Cava Torsion and Stenosis Complicated by Compressive Pericaval Regional Ascites following Orthotopic Liver Transplantation Tue, 10 Dec 2013 15:25:11 +0000 Inferior vena cava (IVC) stenosis and torsion are well-described rare complications following orthotopic liver transplantation (OLT). We present a case of inferior vena cava intermittent torsion and stenosis complicated by compressive regional ascites. To the best of our knowledge, this is the second case of post-OLT regional ascites related compressive IVC stenosis reported and the first reported case of torsion complicated by regional ascites compression. Adam Alli, Richard Gilroy, and Philip Johnson Copyright © 2013 Adam Alli et al. All rights reserved. Primary Extramedullary Plasmacytoma of the Heart: A Rare Manifestation of Plasmacellular Tumor Tue, 10 Dec 2013 13:19:27 +0000 Extramedullary plasmacytoma involving the heart is extremely rare. Primary extramedullary localizations are most commonly found in the head and neck region, with no radiologic evidence of additional skeletal lesions and normal bone marrow examination, but can occur in many other locations. They rarely occur in the heart and are commonly associated with multiple myeloma diagnosis. Here, we describe a case of primary extramedullary plasmacytoma of the heart in a 62-year-old man who presented with nocturnal dyspnea, arthralgia, and weakness. The symptoms can sometimes result from the mass effect on cardiac flow. The diagnosis and management require the same range of clinical and laboratory expertise as for patients with multiple myeloma. Their management is particularly challenging due to the lack of evidence or the presence of nonspecific symptoms. The case is presented as a learning point to remember to include plasmacytic tumors in the differential diagnosis of anaplastic tumors, even in unusual locations, such as the heart. Romagnoli Andrea, Coco Irene, Fusco Armando, Dominique De Vivo, and Giovanni Simonetti Copyright © 2013 Romagnoli Andrea et al. All rights reserved. Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings Mon, 09 Dec 2013 13:15:47 +0000 Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-old man with a history of pain at the lower left quadrant of the abdomen for 20 days and a visible mass in this site. Ultrasonography and computed tomography revealed this mass to be an abscess of the abdominal wall which had been formed by the spread of ruptured sigmoid diverticulitis by continuity of tissue through the lower left abdominal wall. Local drainage of the abscess was performed and the patient was discharged after alleviation of symptoms and an uneventful course. We also discuss causes of abdominal wall abscesses along with the possible pathways by which an intra-abdominal abscess could spread outside the abdominal cavity. Rafailidis Vasileios, Gavriilidou Anna, Liouliakis Christos, Tsimitri Asimina, Paschaloudi Sofia, and Karadimou Vasiliki Copyright © 2013 Rafailidis Vasileios et al. All rights reserved. Bilateral Adrenal Hemorrhage in a Patient with Myelodysplastic Syndrome: Value of MRI in the Differential Diagnosis Thu, 05 Dec 2013 15:35:17 +0000 Bilateral adrenal hemorrhage is a rare potentially life-threatening event that occurs either in traumatic or nontraumatic conditions. The diagnosis is often complicated by its nonspecific presentation and its tendency to intervene in stressful critical illnesses. Due to many disorders in platelet function, hemorrhage is a major cause of morbidity and mortality in patients affected by myeloproliferative diseases. We report here the computed tomography and magnetic resonance imaging findings of a rare case of bilateral adrenal hemorrhage in a patient with myelodysplastic syndrome, emphasizing the importance of MRI in the differential diagnosis. Lucia Manganaro, Najwa Al Ansari, Flavio Barchetti, Matteo Saldari, Claudia Vitturini, Marianna Glorioso, Valeria Buonocore, Giovanni Barchetti, and Francesca Maccioni Copyright © 2013 Lucia Manganaro et al. All rights reserved.