Case Reports in Radiology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Disseminated Alveolar Hydatid Disease Resembling a Metastatic Malignancy: A Diagnostic Challenge—A Report of Two Cases Wed, 08 Oct 2014 09:27:50 +0000 Alveolar hydatid disease or alveolar echinococcosis is a disease of the parasite Echinococcus multilocularis that is potentially fatal if left untreated. It primarily involves the liver but can be disseminated to other organs like the lungs and the brain by hematogenous route. Multiorgan involvement and the aggressive appearance of lesions make alveolar hydatid disease easy to confuse with a metastatic malignancy. For this reason, histopathological confirmation is essential for definite diagnosis. We present the imaging features of this disease in two patients in order to emphasize that these lesions can be easily misdiagnosed as malignancies. Mesut Bulakci, Erdem Yilmaz, Ferhat Cengel, Ahmet Gocmez, Merve Gulbiz Kartal, Emine Goknur Isik, Erhan Celenk, Gulcin Yegen, and Artur Salmaslioglu Copyright © 2014 Mesut Bulakci et al. All rights reserved. Concurrent Intracranial and Spinal Subdural Hematoma in a Teenage Athlete: A Case Report of This Rare Entity Mon, 29 Sep 2014 11:39:51 +0000 A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH). Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space. Daniel S. Treister, Sara E. Kingston, Gabriel Zada, Manu Singh, Jesse G. A. Jones, Jena N. Mills, Alexander Lerner, Orest B. Boyko, Meng Law, Anandh Rajamohan, and Mark S. Shiroishi Copyright © 2014 Daniel S. Treister et al. All rights reserved. Magnetic Resonance Imaging in Marchiafava-Bignami Syndrome: A Cornerstone in Diagnosis and Prognosis Tue, 23 Sep 2014 09:28:55 +0000 Marchiafava-Bignami syndrome is a rare condition. However, with the advent of MRI, more and more of these cases are being diagnosed. Thus, it becomes essential for a radiologist to be familiar with its imaging features as well as clinical presentation. A 50-year-old chronic alcoholic presented to the emergency room with history of 3 episodes of seizures 2 days earlier. The patient had gait disturbances for the last few days. On examination, the patient was in a state of stupor. No neck rigidity was elicited. On MRI, the corpus callosum appeared diffusely hypointense on T1 weighted images and hyperintense on T2 weighted sequences without any evident enhancement after intravenous administration of Gadolinium. On fluid attenuation and inversion recovery images, central hypointensity with surrounding hyperintense rim involving the genu, body, and splenium of corpus callosum was noted. Additionally, cortical-subcortical signal intensity changes were also noted predominantly involving the right frontal lobe. On diffusion weighted imaging, all the above mentioned lesions showed restriction of diffusion. I am presenting here a case of Marchiafava-Bignami syndrome highlighting the role of MR imaging in diagnosing, prognosticating as well as in understanding the underlying pathophysiology of this rare clinical entity. Kathyayini Paidipati Gopalkishna Murthy Copyright © 2014 Kathyayini Paidipati Gopalkishna Murthy. All rights reserved. Lump on Back: A Rare Case of Parosteal Lipoma of Scapula Mon, 22 Sep 2014 07:35:59 +0000 Lipomas are benign tumors of mature adipose tissue which can occur in subcutaneous, intramuscular, intermuscular, parosteal, and intraosseous compartments. Parosteal lipoma is a rare type of lipoma, accounting for less than 0.1% of primary bone neoplasms and 0.3% of all lipomas. Parosteal lipomas commonly arise in the femur and extremities. Around 150 cases have been reported in English literature with scapula being a rare site of involvement. They are known to be associated with underlying bony changes like focal cortical hyperostosis, pressure erosion of the underlying bone, and bowing deformity or with underlying osteochondroma. We report a rare case of a parosteal lipoma arising in the scapula with a bony excrescence in a 38-year-old male. Ankit Balani, Ashwini Sankhe, Tilak Dedhia, Maunil Bhuta, Narayan Lakhotia, and Jagir Yeshwante Copyright © 2014 Ankit Balani et al. All rights reserved. Hemorrhage in the Wall of Pyogenic Brain Abscess on Susceptibility Weighted MR Sequence: A Report of 3 Cases Tue, 16 Sep 2014 05:46:39 +0000 Background and Purpose. In pyogenic brain abscess, hemorrhage in the walls is considered exceptional. Recently, hemorrhagic changes in the walls of pyogenic abscess have been demonstrated on susceptibility weighted imaging with 3T MRI. Here, we report hemorrhagic changes in the walls of pyogenic brain abscess on susceptibility weighted imaging with 1.5T MRI. Method. MRI of brain was done using 1.5T MRI with diffusion weighted sequence, susceptibility weighted sequence, and other standard sequences in 3 consecutive cases of pyogenic brain abscess. Stereotactic biopsy and cultures were obtained in 2 cases. One case was treated empirically with antibiotics. Results. Susceptibility sequence demonstrated hemorrhage in the wall of brain abscess in all three cases. All three cases also demonstrated restricted diffusion on diffusion weighted imaging. Conclusion. Susceptibility weighted imaging can demonstrate hemorrhagic changes in the walls of pyogenic brain abscess on 1.5T MRI. Presence of hemorrhage in the walls of ring enhancing lesions should not automatically lead to a diagnosis of tumor. Krishnamoorthy Thamburaj, Amit K. Agarwal, Shyamsunder B. Sabat, and Dan T. Nguyen Copyright © 2014 Krishnamoorthy Thamburaj et al. All rights reserved. 63-Year-Old Male with Gastric Outlet Obstruction Mon, 15 Sep 2014 00:00:00 +0000 We describe a case of a 63-year-old male with complicated Bouveret’s syndrome, both in its presentation and in its management. Bouveret’s syndrome is a rare cause of gastric outlet obstruction resulting from mechanical obstruction from gallstones at the pyloroduodenal segment. As Bouveret’s syndrome can be a diagnostic and therapeutic challenge for clinicians, we aim to identify clinical and radiologic pearls that can lower the threshold for the diagnosis of Bouveret’s syndrome. Bhavraj Khalsa, Patrick Rudersdorf, Dattesh Dave, Brian R. Smith, and Chandana Lall Copyright © 2014 Bhavraj Khalsa et al. All rights reserved. Diagnostic Imaging of Primary Hepatic Neuroendocrine Tumors: A Case and Discussion of the Literature Tue, 02 Sep 2014 12:47:36 +0000 Neuroendocrine tumors (NETs) are derived from neuroendocrine cells that are capable of producing functional peptide hormones. These tumors occur most frequently in the GI tract and lungs. GI NETs frequently metastasize into the liver, though NETs of primary hepatic origin are extremely rare. Ultrasound, CT, and MRI are typically all employed for characterization of these lesions but their appearance on diagnostic imaging can be highly variable. Reported here is an interesting case of a primary hepatic neuroendocrine tumor (PHNET), along with a discussion of the imaging characteristics of these tumors. Additionally, the current standards for definitive diagnosis and treatment of PHNETs are discussed. Trenton Kellock, Betty Tuong, Alison C. Harris, and Eric Yoshida Copyright © 2014 Trenton Kellock et al. All rights reserved. Erratum to “Cystic Meningioma Simulating Arachnoid Cyst: Report of an Unusual Case” Tue, 02 Sep 2014 09:42:40 +0000 Jorge Docampo, Nadia Gonzalez, Claudio Vazquez, Carlos Morales, and Eduardo Gonzalez-Toledo Copyright © 2014 Jorge Docampo et al. All rights reserved. Imaging of Hidradenitis Suppurativa and Its Complications Thu, 21 Aug 2014 07:31:10 +0000 We present a 56-year-old man with known diabetes mellitus and a 10-year history of hidradenitis suppurativa (HS) and highlight, through MR imaging findings, the relentless natural progression of the disease, characterized by recurrent exacerbations of abscesses and fistulae and complications of perianal fistulae and sacral osteomyelitis. We also demonstrate the appearance of this condition on PET-CT with F-18 FDG, which was performed for staging after postexcision tissue specimen revealed well-differentiated squamous cell carcinoma. The association of arthritis and possible dactylitis was also manifested in our patient. Discussion of HS in the radiology literature is limited and, to our knowledge, there has been no case report describing these imaging findings in the same patient. Feng Poh and Siew Kune Wong Copyright © 2014 Feng Poh and Siew Kune Wong. All rights reserved. CT, MRI and DWI Features of a Solid Organizing Hepatic Abscess Wed, 13 Aug 2014 13:31:36 +0000 Solid organizing hepatic abscess is a rare form of focal infection, which needs differentiation from benign and malignant solid masses. We report a case of a 30-year-old man with a solid organizing hepatic abscess, diagnosed by imaging and ex juvantibus criteria. CT and MRI findings are presented and role of DWI is outlined. Noninvasive diagnosis of a solid organizing hepatic abscess is possible in the appropriate clinical setting; percutaneous or surgical biopsy may be indicated in equivocal cases. Sergio Savastano, Giampiero Pellizzer, Lorenzo Di Grazia, Dario Giacomini, and Mario Beghetto Copyright © 2014 Sergio Savastano et al. All rights reserved. Pleuroperitoneal Leak: An Unusual Cause of Acute Shortness of Breath in a Peritoneal Dialysis Patient Mon, 04 Aug 2014 13:24:18 +0000 Introduction. Pleuroperitoneal leak is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD), with an estimated incidence of 1.6%. It should be suspected in these patients when they present with recurrent unilateral pleural effusions and/or acute shortness of breath following dialysate infusion. Case Presentation. We present the case of a 25-year-old female patient who had acute hydrothorax as a result of pleuroperitoneal leak complicating continuous ambulatory peritoneal dialysis (CAPD), which was confirmed on peritoneal scintigraphy. Conclusion. Continuous ambulatory peritoneal dialysis patients presenting with acute shortness of breath and/or recurrent unilateral pleural effusion should be investigated with peritoneal scintigraphy to exclude pleuroperitoneal leak. D. P. Ramaema and P. Mpikashe Copyright © 2014 D. P. Ramaema and P. Mpikashe. All rights reserved. Peritoneal Inclusion Cysts in Female Children: Pathogenesis, Treatment, and Multimodality Imaging Review Mon, 21 Jul 2014 00:00:00 +0000 We report the multimodality imaging findings of peritoneal inclusion cysts in two adolescent females each with a prior history of abdominal surgery. The few reports of peritoneal inclusion cysts in the pediatric population have largely focused on the clinical and pathological features of this entity. We wish to emphasize the imaging findings of peritoneal inclusion cysts on multiple modalities, the advantage of MRI in confirming the diagnosis, and the need to keep considering this diagnosis in patients who present with a pelvic cystic mass, with a history of surgery, even if remote. Additionally, we review the pathology, pathophysiology, differential diagnosis, and treatment options of peritoneal inclusion cysts. Rachelle Goldfisher, Divya Awal, and John Amodio Copyright © 2014 Rachelle Goldfisher et al. All rights reserved. Isolated Asymptomatic Short Sternum in a Healthy Young Girl Sun, 20 Jul 2014 07:11:43 +0000 Congenital sternal defects are rare deformities frequently associated with other anomalies of the chest wall and other organ systems. Although pectus excavatum, pectus carinatum, and cleft sternum can present as isolated deformity, in most cases they are associated with heart and inner organs anomalies and described as symptoms of syndromes like Marfan syndrome, Noonan syndrome, Poland anomaly, and Cantrell pentalogy. In contrast, the etiology of an isolated defect is not well understood. We observed a short sternum (dysmorphic manubrium, hypoplastic body, and complete absence of the xiphoid process) in a completely asymptomatic 13-year-old woman. A comprehensive instrumental exams panel was performed to exclude associated anomalies of the heart and of the other organ systems. The patient was completely asymptomatic and she did not need any medical or surgical treatment. To our knowledge, this is the first case of isolated short sternum reported in literature. Francesco Turturro, Cosma Calderaro, Antonello Montanaro, Luca Labianca, Giuseppe Argento, and Andrea Ferretti Copyright © 2014 Francesco Turturro et al. All rights reserved. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis Thu, 17 Jul 2014 09:29:23 +0000 Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT) were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration. S. Fosi, V. Giuricin, V. Girardi, E. Di Caprera, E. Costanzo, R. Di Trapano, and G. Simonetti Copyright © 2014 S. Fosi et al. All rights reserved. MRI in Diagnosis of a Giant Prostatic Utricle Tue, 15 Jul 2014 12:13:12 +0000 A prostatic utricle cyst is an epithelial lined diverticulum arising from the prostatic urethra and usually asymptomatic when small. When enlarged, it may be symptomatic and is typically accompanied by hypospadias. We present a case of a markedly enlarged prostatic utricle in a neonate without hypospadias, demonstrated on voiding cystourethrography (VCUG), ultrasound, and 1.5 Tesla MRI. Dustin Johnson, Kushal Parikh, William Schey, and Winnie Mar Copyright © 2014 Dustin Johnson et al. All rights reserved. Isolated Nasopharyngeal Castleman Disease: An Uncommon Diagnosis in an Unusual Location Mon, 14 Jul 2014 09:59:45 +0000 Localised nasopharyngeal Castleman disease has rarely been reported. We present a case involving a 23-year-old female, describe the clinical, imaging, and histopathologic features of this challenging diagnosis, and review the literature. O. McDonnell, Melinda Morris, and Z. Khaleel Copyright © 2014 O. McDonnell et al. All rights reserved. Antenatal Diagnosis of Alobar Holoprosencephaly Mon, 14 Jul 2014 07:36:42 +0000 A twenty-year-old second gravida presented to the department of radiodiagnosis for routine obstetric ultrasound examination. Ultrasonography revealed a live fetus of 17 weeks with absent falx, fused thalami, monoventricle, proboscis, and cyclopia. Fetal MRI was performed and the findings were confirmed. Even though ultrasonography is diagnostic in the detection of fetal anomalies, MRI plays a vital role due to its multiplanar capability and excellent soft tissue resolution. The importance of presenting this classical case of alobar holoprosencephaly is to sensitize the clinicians and radiologists to the imaging manifestations of holoprosencephaly and to stress the importance of early diagnosis. If diagnosed in utero at an early stage of pregnancy, termination can be performed and maternal psychological trauma of bearing a deformed fetus can be avoided. Rajesh Raman and Geetha Mukunda Jagadesh Copyright © 2014 Rajesh Raman and Geetha Mukunda Jagadesh. All rights reserved. Tuber Cinereum Diverticula in a 28-Month-Old with Xq21 Deletion Syndrome Sun, 13 Jul 2014 12:01:59 +0000 A developmentally delayed 28-month-old male toddler was referred to us for brain MRI. Imaging revealed corpus callosum dysgenesis, forniceal hypoplasia, vermian hypoplasia, and hypothalamic dysmorphism characterized by tuber cinereum diverticula. Subsequent chromosomal microarray showed an Xq21 deletion. We present a case of Xq21 deletion syndrome with midline brain anomalies and a novel hypothalamic malformation. Matthew T. Whitehead and Gilbert Vezina Copyright © 2014 Matthew T. Whitehead and Gilbert Vezina. All rights reserved. An Important Clue in the Sonographic Diagnosis of Internal Carotid Artery Agenesis: Ipsilateral Common Carotid Artery Hypoplasia Wed, 02 Jul 2014 00:00:00 +0000 A 42-year-old female patient, who had been diagnosed with an occlusion of her left internal carotid artery (ICA) following Doppler ultrasonographic (US) and digitally-subtracted angiographic (DSA) examinations performed in an outer healthcare center in order to eliminate the underlying cause of her complaint of amorosis fugax, later applied to our hospital with the same complaint. At Doppler US performed in our hospital’s radiology department, her right common carotid artery (CCA) was normal, but her left CCA was hypoplastic. The right internal artery (ICA) was validated as normal. At the left side, however, the ICA was apparent only as a stump and it did not demonstrate a continuity. The diagnosis of ICA agenesis was confirmed by the utilization of Doppler US, CT, and DSA imaging, and it was concluded also that ipsilateral CCA hypoplasia could be evaluated as an important clue to the diagnosis of ICA agenesis. Omer Kaya, Cengiz Yilmaz, Bozkurt Gulek, Gokhan Soker, Gokalp Cikman, Ibrahim Inan, and Selahaddin Demirduzen Copyright © 2014 Omer Kaya et al. All rights reserved. Diffuse Large B-Cell Lymphoma in an Adolescent Male Presenting as Ureteral Stricture Sun, 29 Jun 2014 10:56:31 +0000 Lymphoma may affect the ureter in cases of retroperitoneal involvement. We present a case of an adolescent male found to have non-Hodgkin lymphoma initially presenting as ureteral stricture evident on imaging. He was treated and responded to multiagent chemotherapy with resolution of both the lymphoma and the ureteral stricture. Although rare, non-Hodgkin lymphoma should be included in the differential diagnosis of pediatric patients with noncalculous, idiopathic ureteral strictures. Christopher D. Jaeger, Kelly L. McAlvany, Shannon N. Zingula, Stephen A. Kramer, and Candace F. Granberg Copyright © 2014 Christopher D. Jaeger et al. All rights reserved. Cystic Meningioma Simulating Arachnoid Cyst: Report of an Unusual Case Thu, 26 Jun 2014 13:55:12 +0000 The purpose of this paper is to show an unusual case of meningioma simulating arachnoid cyst on CT scan and MRI, diagnosed in a 63-year-old woman evaluated for headache and vision disorders. The meningioma shown is predominantly cystic with a small mural nodule enhancing after gadolinium and exhibiting diffusion restriction. Cystic portion of the tumor is hypodense on CT, and evidences fluid signal intensity on T1- and T2-weighted MR imaging. Docampo Jorge, Gonzalez Nadia, Vazquez Claudio, Morales Carlos, and Gonzalez-Toledo Eduardo Copyright © 2014 Docampo Jorge et al. All rights reserved. A Rare Case of Hypertrophic Cardiomyopathy with Subendocardial Late Gadolinium Enhancement in an Apical Aneurysm with Thrombus Wed, 25 Jun 2014 08:02:35 +0000 The mechanisms responsible for the development of apical aneurysms in cases of hypertrophic cardiomyopathy (HCM) are currently unclear but likely involve multiple factors. Here, we present a case of HCM with marked subendocardial fibrosis involving the apical and proximal portions of the left ventricle. A 71-year-old man with left ventricular hypertrophy presented with signs and symptoms of heart failure. The presence of asymmetrical left ventricular hypertrophy and bilateral, thickened ventricular walls with an apical aneurysm on transthoracic echocardiography suggested a diagnosis of HCM with ventricular dysfunction. No intraventricular pressure gradients with obstruction were identified. Late gadolinium enhancement (LGE) with cardiac magnetic resonance imaging and endomyocardial biopsies showed subendocardial fibrosis involving the apical aneurysm and proximal portion. Whereas LGE in a transmural pattern is commonly observed in HCM apical aneurysms, subendocardial LGE, as noted in the present case, is a relatively rare occurrence. Thus, the present case may provide unique insights into the adverse remodeling process and formation of apical aneurysms in cases of HCM. Yusuke Morita, Takao Kato, Mitsumasa Okano, Kanae Su, Masahiro Kimura, Eri Minamino, Eisaku Nakane, Toshiaki Izumi, Shoichi Miyamoto, Tetsuya Haruna, and Moriaki Inoko Copyright © 2014 Yusuke Morita et al. All rights reserved. Adult Intramedullary Ewing Sarcoma of the Proximal Hip Thu, 12 Jun 2014 09:19:07 +0000 Ewing sarcoma of bone is classically a permeative lesion in the diaphysis of long bones in children. While they occur primarily in children and adolescents, they can be seen in young adults in their 20s, but these are typically seen in flat bones. The permeative nature of the lesion can elicit new bone formation creating a partially sclerotic appearance, cortical expansion presenting as a “Codman triangle,” or have an “onion-skin” type of aggressive periosteal reaction/periostitis. Ewing sarcoma is rarely seen without an associated soft-tissue mass and is even rarer to just have benign-appearing periostitis (e.g., thick, uniform, or wavy cortex). We present such a case of Ewing sarcoma in a young adult confined to just the medullary metadiaphysis without cortical erosion or soft-tissue mass. To the best of our knowledge, this is the first case to be reported in the radiology literature. Preetam Gongidi, Siva Jasti, William Rafferty, Veniamin Barshay, and Richard Lackman Copyright © 2014 Preetam Gongidi et al. All rights reserved. A Case of Emphysematous Osteomyelitis of the Midfoot: Imaging Findings and Review of the Literature Mon, 09 Jun 2014 09:20:23 +0000 Emphysematous osteomyelitis is a rare but potentially fatal condition that must be considered whenever intraosseous gas is identified on imaging. The organisms implicated in most cases of emphysematous osteomyelitis are anaerobes or members of the Enterobacteriaceae family. Significant comorbidities, such as malignancy and diabetes mellitus, frequently predispose to this condition, and high mortality rates have been reported. The radiologist must be aware of the implications of identifying intraosseous gas in order to facilitate early diagnosis and expedite management. We report a unique case of a 58-year-old male with diabetes mellitus who presented with emphysematous osteomyelitis of the midfoot and necrotising fasciitis of the ipsilateral distal lower limb. Specimen cultures in this case revealed a pure growth of Group G Streptococcus. Marcela Mautone, Jessica Gray, and Parm Naidoo Copyright © 2014 Marcela Mautone et al. All rights reserved. A Rare Anomaly of Biliary System: MRCP Evidence of a Cystic Duct Cyst Mon, 02 Jun 2014 09:06:19 +0000 Cystic duct cysts are a rare congenital anomaly. While the other bile duct cysts (choledochus and the intrahepatic bile ducts) are classified according to the classification described by Tadoni, there is no classification method described by the cystic duct cysts, although it is claimed that the cystic duct cysts may constitute a new “Type 6” category. Only a limited number of patients with cystic duct cysts have been reported in the literature. The diagnosis is usually made in the neonatal period or during childhood. The clinical symptoms are nonspecific and usually include pain in the right upper quadrant and jaundice. The condition may also present with biliary colic, cholangitis, cholelithiasis, or pancreatitis. In our case, the abdominal ultrasonography (US) performed on a 6-year-old female patient who presented with pain in the right upper quadrant pointed out an anechoic cyst at the neck of the gall bladder. Based on the magnetic resonance cholangiopancreatography (MRCP) results, a cystic dilatation was diagnosed in the cystic duct. The aim of this case-report presentation was to discuss the US and MRCP findings of the cystic dilatation of cystic duct, which is an extremely rare condition, in the light of the literature information. Cemil Goya, Mehmet Serif Arslan, Alpaslan Yavuz, Cihad Hamidi, Suzan Kuday, Mehmet Hanifi Okur, and Bahattin Aydogdu Copyright © 2014 Cemil Goya et al. All rights reserved. Imaging of a Renal Artery Aneurysm Detected Incidentally on Ultrasonography Thu, 22 May 2014 09:16:34 +0000 Renal artery aneurysms occur with a frequency of less than 1% of the general population. Even if they are usually asymptomatic and incidentally found, they can be complicated with life-threatening conditions like rupture, thrombosis, embolism, or hypertension. Thus, once diagnosed, they should be fully evaluated with further imaging and treated when indicated. We present the case of a patient who was referred for ultrasonography for an unrelated reason. The examination demonstrated a hyperechoic focus near the right kidney. Further imaging workup with MDCT established the diagnosis of a right renal artery aneurysm which was saccular in shape and peripherally calcified. This ring-like calcification was also visible in a KUB radiography which was also performed. After presenting the case, various aspects of this rare entity are discussed. Vasileios Rafailidis, Anna Gavriilidou, Christos Liouliakis, Maria Poultsaki, Triantafyllos Theodoridis, and Vasileios Charalampidis Copyright © 2014 Vasileios Rafailidis et al. All rights reserved. An Unusual Case of Ascending Pancreatitis with Mediastinal Involvement: A Case Report with CT and MRI Findings Wed, 14 May 2014 11:23:35 +0000 Fluid collections are common findings of pancreatitis and spread, more often, along preferential drainage pathways in the abdomen. In some rare cases, fluid collections may spread towards extra-abdominal sites like the mediastinum leading to the formation of mediastinal collections. We present the case of a 52-years-old man with pain in the right upper quadrant of the abdomen and mid-epigastrium lasting for some hours. Laboratory tests suggested a diagnosis of pancreatitis. CT and subsequent MRI revealed changes consistent with acute exacerbation on chronic pancreatitis spreading to the mediastinum and to the greater omentum. The patient received medical treatment and reported gradual improvement in his laboratory results and CT findings. Ernesto Di Cesare, Alessandra Di Sibio, Antonio Gennarelli, Valentina Felli, Valentina Vellucci, Ines Casazza, and Carlo Masciocchi Copyright © 2014 Ernesto Di Cesare et al. All rights reserved. Bihemispheric Posterior Inferior Cerebellar Artery Occurring with an Azygos Anterior Cerebral Artery: Case Study Tue, 13 May 2014 08:46:52 +0000 Variations in intracranial vasculature are well known. We report a rare anatomic variation in a patient who underwent cerebral angiography for suspected intracranial aneurysm. Digital subtraction angiography revealed a bihemispheric posterior inferior cerebellar artery (PICA) and an azygous anterior cerebral artery (ACA). There was no evidence of any aneurysm or vascular abnormality. To our knowledge, this is the first reported case of a patient with a common PICA supplying both the cerebellar hemispheres and a common ACA supplying ACA territory bilaterally. It is important for the physician to be aware of these anatomical variations in order to differentiate a normal variant from a pathological condition. Jamie Toms, Rishi Wadhwa, Sudheer Ambekar, and Hugo Cuellar Copyright © 2014 Jamie Toms et al. All rights reserved. A Rare and Unusual Case of Burkitt’s Lymphoma Presenting with a Prostate Mass in a 12-Year-Old Boy Tue, 13 May 2014 08:27:30 +0000 Burkitt’s lymphoma is the most frequent subtype of non-Hodgkin’s lymphoma in childhood. Radiographic findings are protean and can often overlap with other neoplastic and nonneoplastic processes. We present an unusual case of Burkitt’s lymphoma in a 12-year-old boy presenting with a one-week history of urinary retention, dysuria, and “tailbone pain,” as well as a 4-week history of jaw pain, initially treated as a dental abscess. On dental radiography, the patient was found to have resorption of alveolar bone adjacent to the lower first molars bilaterally, in keeping with “floating teeth,” classically associated with Langerhans cell histiocytosis. Additionally, a large, eccentric, prostatic mass was noted, prompting the inclusion of rhabdomyosarcoma on the differential diagnosis, with subsequent definitive diagnosis of Burkitt’s lymphoma on tissue and bone marrow biopsy. This case highlights the imaging overlap of these childhood neoplasms with an unusual lymphomatous prostate mass. It is important that the radiologists and pediatricians be aware of this potential overlap and the unusual presentation of Burkitt’s lymphoma. N. Sinclair, P. Babyn, M. Kinloch, and R. Sinha Copyright © 2014 N. Sinclair et al. All rights reserved. Regional Cerebral Blood-Flow with 99mTc-ECD Brain Perfusion SPECT in Landau-Kleffner Syndrome: Report of Two Cases Tue, 29 Apr 2014 12:38:30 +0000 Landau-Kleffner syndrome (LKS) is a rare childhood disorder characterized by acquired aphasia and epilepsy. 99mTc-ECD SPECT imaging was performed in two right-handed children with LKS. A relative decrease in perfusion was found in the left frontal-temporal cortices of both patients as well as in the left and right parietal cortices of one patient with aphasia, without clinical epilepsy. The degree of regional cerebral perfusion impairment did not correlate with the severity of the clinical and EEG abnormalities, but the area of hypoperfusion was compatible with the speech area of the brain. Overall, although asymmetrical temporoparietal perfusion appears as a common finding in LKS, SPECT findings in LKS alone cannot elucidate the pathogenic features of the disorder in the brain. Here, we present two cases of LKS in which we investigated SPECT perfusion scans. Reza Nemati, Iraj Nabipour, Hamid Javadi, Negar Chabi, and Majid Assadi Copyright © 2014 Reza Nemati et al. All rights reserved.