Case Reports in Radiology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Assessing Biological Response to Bevacizumab Using 18F-Fluoromisonidazole PET/MR Imaging in a Patient with Recurrent Anaplastic Astrocytoma Sun, 22 Feb 2015 12:02:02 +0000 We present our initial experience in using single modality fluoromisonidazole (FMISO) PET/MR imaging to noninvasively evaluate the biological effects induced by bevacizumab therapy in a patient treated for recurrent high grade glioma. In this index patient, bevacizumab therapy resulted in the development of nonenhancing tumor characterized by reduced diffusion and markedly decreased FMISO uptake in the setting of maintained CBF and CBV. These observations suggest that the dynamic biological interplay between tissue hypoxia and vascular normalization occurring within treated recurrent high grade glioma can be captured utilizing FMISO PET/MR imaging. Ramon F. Barajas Jr., Miguel H. Pampaloni, Jennifer L. Clarke, Youngho Seo, Dragana Savic, Randall A. Hawkins, Spencer C. Behr, Susan M. Chang, Mitchel Berger, William P. Dillon, and Soonmee Cha Copyright © 2015 Ramon F. Barajas Jr. et al. All rights reserved. Ultrasonographic and Scintigraphic Findings of Thyroid Hemiagenesis in a Child: Report of a Rare Male Case Sun, 15 Feb 2015 13:59:49 +0000 Thyroid hemiagenesis is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. It is much rarer in males. There is a higher incidence of associated thyroid disorders in patients with thyroid hemiagenesis; therefore early and prompt diagnosis is important for children. We present the ultrasonographic and scintigraphic findings of thyroid hemiagenesis in an eight-year-old-boy. On ultrasonography (US), left lobe of the thyroid gland could not be demonstrated and the right lobe showed minimal hyperplasia. Its echogenicity was normal and no nodule was seen. On thyroid scintigraphy, left lobe of thyroid gland or any ectopic thyroid tissue could not be demonstrated, while the right lobe showed minimal hyperplasia. Without performing any invasive procedure, we enrolled the child in a follow-up program with the guidance of US and scintigraphy, which were effective both in making the final diagnosis of thyroid hemiagenesis and in evaluating the current status of the present thyroid tissue. In conclusion, if only one thyroid lobe is detected in a pediatric case initially with US or scintigraphy, the diagnosis of thyroid hemiagenesis should be suggested and, before any unnecessary or invasive attempt, the other complementary method (scintigraphy/US) should be performed. Ümit Yaşar Ayaz, Sevin Ayaz, Mehmet Ercüment Döğen, and Arman Api Copyright © 2015 Ümit Yaşar Ayaz et al. All rights reserved. Giant Pilomatrixoma Presenting in the Posterior Thorax, a Rare Location and the Largest Described Wed, 11 Feb 2015 11:10:35 +0000 Pilomatrixoma is a common benign soft tissue neoplasm arising from hair follicle cells, typically not exceeding 3 cm and located mainly within the head and neck regions. Lesions greater than 3 cm or those located elsewhere are rare and are often not thought of or high on a differential diagnosis. Moreover, the radiographic features of pilomatrixoma are very nonspecific making the diagnosis even more difficult and rarely described in the radiology literature. We present the largest reported case of pilomatrixoma measuring 24 cm arising from the posterior thorax. Our hope is to increase awareness of this diagnosis for slow-growing soft tissue masses not located in the classically described locations of head and neck, explore the radiographic features on various imaging modalities, and review the current radiology literature. P. Gongidi, J. Meshekow, T. Holdbrook, and P. Germaine Copyright © 2015 P. Gongidi et al. All rights reserved. Epidural Venous Plexus Engorgement: What Lies Beneath? Wed, 04 Feb 2015 06:20:09 +0000 Epidural venous plexus engorgement may occur due to several conditions that prevent the normal venous circulation. Inferior vena cava agenesis is a very rare cause of epidural venous enlargement. We present a case with a very thin inferior vena cava and left iliac vein agenesis who presented with back pain due to epidural vein engorgement and lacked other venous problems such as deep vein thrombosis. Fuldem Yildirim Donmez Copyright © 2015 Fuldem Yildirim Donmez. All rights reserved. Ultrasound Elastographic Findings of Mammary Fibromatosis Tue, 03 Feb 2015 06:58:39 +0000 Mammary fibromatosis is an uncommon, benign tumor of the breast. It is locally aggressive and has a high rate of recurrence. Its clinical presentation and imaging results always call for suspicion of malignancy. Here we describe a case of mammary fibromatosis with clinical manifestation, radiographic and pathologic results, and imaging findings from ultrasound elastography. Ping He, Li-Gang Cui, Yu-Tao Lei, Jian-Ying Liu, and Jin-Rui Wang Copyright © 2015 Ping He et al. All rights reserved. The Rare Cuboid-Navicular Coalition Presenting as Chronic Foot Pain Mon, 26 Jan 2015 07:31:56 +0000 Tarsal coalitions are relatively rare diagnoses affecting adolescent patients that typically present with progressive foot pain. Cuboid-navicular coalition, a type of tarsal coalition, is extremely rare with less than 10 reported cases to date. Most prevailing theories reported have described this specific type of coalition as asymptomatic except at specific moments of stress and exercise. The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient. We present a case of cuboid-navicular fibrocartilaginous coalition in an adolescent patient presenting with chronic foot pain. Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition. Instead, abnormal articulation between the cuboid and navicular must be sought. Omer Awan and James Allen Graham Copyright © 2015 Omer Awan and James Allen Graham. All rights reserved. Radiographic and MR Imaging Findings of the Spine after Bisphosphonate Treatment, in a Child with Idiopathic Juvenile Osteoporosis Tue, 20 Jan 2015 06:56:37 +0000 Bisphosphonates are employed with increasing frequency in various pediatric disorders, mainly associated with osteoporosis. After cessation of bisphosphonate treatment in children, skeletal radiologic changes have been documented including dense metaphyseal lines of the long bones and “bone in bone” appearance of the vertebrae. However, the evolution of these radiographic changes has not been fully explored. We describe the MR imaging appearance of the spine that, to our knowledge, has not been previously addressed in a child with idiopathic juvenile osteoporosis who had received bisphosphonates and emphasize the evolution of the radiographic findings of the spine and pelvis over a four-year period. Olympia Papakonstantinou, Maria Sakalidou, Erato Atsali, Vasiliki Bizimi, Maria Mendrinou, and Efthymia Alexopoulou Copyright © 2015 Olympia Papakonstantinou et al. All rights reserved. Atypical Intracranial Epidermoid Cysts: Rare Anomalies with Unique Radiological Features Thu, 15 Jan 2015 11:22:49 +0000 Epidermoid cysts are benign slow growing extra-axial tumours that insinuate between brain structures, while their occurrences in intra-axial or intradiploic locations are exceptionally rare. We present the clinical, imaging, and pathological findings in two patients with atypical epidermoid cysts. CT and MRI findings for the first case revealed an intraparenchymal epidermoid cyst that demonstrated no restricted diffusion. The second case demonstrated an aggressive epidermoid cyst that invaded into the intradiploic spaces, transverse sinus, and the calvarium. The timing of ectodermal tissue sequestration during fetal development may account for the occurrence of atypical epidermoid cysts. Eric K. C. Law, Ryan K. L. Lee, Alex W. H. Ng, Deyond Y. W. Siu, and Ho-Keung Ng Copyright © 2015 Eric K. C. Law et al. All rights reserved. Granulocytic Sarcoma of the Uterus: A Rare Presentation of Extramedullary Relapse of AML and Importance of MRI Tue, 30 Dec 2014 13:52:52 +0000 Granulocytic sarcoma (GS) is a solid tumor that is the extramedullary presentation of acute myelogenous leukemia, other myeloproliferative disorders, or myelodysplastic syndromes. Less commonly, it also may arise as an isolated mass. In this report, we describe a 23-year-old female patient, with a GS in the uterus and we stress the value of diffusion weighted imaging for the evaluation of uterine neoplasms. To our knowledge, our case is the first in the literature to report diffusion weighted imaging (DWI) findings of GS. Murat Ucar and Melike Guryildirim Copyright © 2014 Murat Ucar and Melike Guryildirim. All rights reserved. Three-Dimensional CT Findings of Os Calcaneus Secundarius Mimicking a Fracture Sun, 21 Dec 2014 12:22:53 +0000 Os calcaneus secundarius is one of several accessory ossicles of the foot that have been identified as normal variants of skeletal development. It may cause ankle pain and may mimic an avulsion fracture of the anterior calcaneal process. A twenty-year-old male was admitted to our institution with right ankle pain following an inversion injury. An axial CT image of the patient’s right ankle revealed a shape with smooth and sharp margins, identified as a well-corticated bone fragment in the subtalar region. A diagnosis of an accessory ossicle, os calcaneus secundarius, was made based on radiographic findings. As a result of this case, it is recommended that potential locations of the accessory bones should be well understood in order to prevent misdiagnosis and inappropriate surgical procedures. Os calcaneus secundarius must be considered when an apparent bone fragment or a suspicious fracture line at the anterior region of os calcaneus is demonstrated. Mehmet Deniz Bulut, Alpaslan Yavuz, Aydın Bora, Mehmet Ata Gökalp, Sercan Özkaçmaz, and Abdussamet Batur Copyright © 2014 Mehmet Deniz Bulut et al. All rights reserved. A Rare Case of Pulmonary Atresia with Ventricular Septal Defect with a Right Sided Aortic Arch and a Calcified Pulmonary AVM Presenting in an Adult without Cyanosis Mon, 15 Dec 2014 00:10:28 +0000 Pulmonary atresia with ventricular septal defect (PA-VSD) with pulmonary arterial supply arising from the aorta representing large MAPCAs associated with a right sided aortic arch is an uncommon anomaly. Most of the patients succumb to severe respiratory compromise or congestive cardiac failure very early. We report the clinical details and imaging findings of a case of PA-VSD with a right sided aortic arch and a calcified pulmonary arteriovenous malformation (AVM) in a 21-year-old postpartum female with no previous episodes of cyanosis who was diagnosed as having a cardiac anomaly on echocardiography when she presented with breathlessness during the 8th month of the pregnancy. Devendra V. Kulkarni, Rahul G. Hegde, Ankit Balani, and Anagha R. Joshi Copyright © 2014 Devendra V. Kulkarni et al. All rights reserved. Evaluation of Suspected Aspirated Beverage Can Pull Tab: Radiographs May Not Be Enough Sun, 14 Dec 2014 11:28:13 +0000 A 67-year-old male presented to the emergency department with concern for accidental aspiration of an aluminum beverage can pull tab. Neck and chest radiographs did not reveal an aspirated foreign body. Despite ongoing complaint of dysgeusia and adamancy of aspiration by the patient, he was discharged to home without recommendation for further follow-up. Seven months later, a computed tomography (CT) scan of the chest performed as part of an unrelated lung cancer work up confirmed the presence of a left mainstem bronchus metallic foreign body compatible with a pull tab. This case report illustrates the poor negative predictive value of radiographs for a suspected aluminum foreign body and demonstrates the superiority of CT for this purpose. In such presentations it is imperative to have a low threshold for performing further diagnostic evaluation with CT due to the relatively high radiolucency of aluminum. Amy L. Kotsenas, Norbert G. Campeau, Richard A. Oeckler, and Ronald S. Kuzo Copyright © 2014 Amy L. Kotsenas et al. All rights reserved. Lobar Collapse and Obliteration of Air Bronchogram Allowing Early Diagnosis of Endobronchial Aspergillus Infection following Hematopoietic Stem Cell Transplantation Wed, 10 Dec 2014 12:21:00 +0000 Endobronchial fungal infection (EBFI) is notoriously difficult to diagnose early since it may present few systemic features and does not cause characteristic parenchymal lesions on lung CT scanning. We report a 9-year-old girl who suffered extended neutropenia following graft failure after haematopoietic stem cell transplantation (HSCT) for severe aplastic anaemia. CT scan prior to retransplantation was normal despite persistent cough but lobar collapse was shown on repeat scan 16 days later. The probable diagnosis of EBFI (later proven on bronchoscopy) was only suspected when subsequent chest X-ray (CXR) demonstrated lack of an air bronchogram in the partially collapsed lung. Early radiological suspicion resulted in multiagent antifungal therapy followed by delayed lobectomy, and led to this being the first reported case of Aspergillus EBFI not to result in respiratory failure. Elizabeth Thompson, Manigandan S. Thyagarajan, Elizabeth Johnson, David Weeden, Mary Morgan, Sarah J. Groves, and Colin G. Steward Copyright © 2014 Elizabeth Thompson et al. All rights reserved. Radiofrequency Ablation in the Management of Advanced Stage Thymomas: A Case Report on a Novel Multidisciplinary Therapeutic Approach Wed, 10 Dec 2014 00:10:43 +0000 We describe in this report a case of successful radiofrequency ablation of an unresectable stage III-type B3 thymoma, and we discuss the role of this novel approach in the management of patients with advanced stage thymoma. The patient, a 59-year-old Caucasian male underwent neoadjuvant chemotherapy with only a slight reduction of the mass. Subsequently, an explorative sternotomy and debulking were performed; before closing the thorax, radiofrequency ablation of the residual tumor was carried out and a partial necrosis of the mass was achieved. A further percutaneous radiofrequency ablation was performed subsequently, obtaining complete necrosis of the lesion. Successively, the patient underwent adjuvant radiotherapy. As a result of this multidisciplinary treatment, complete and stable response was obtained. It is hard to say which of the single treatments had the major impact on cure; nevertheless, the results obtained suggest that radiofrequency ablation must be taken into account for the treatment of advanced stage thymomas, and its effectiveness must be further assessed in future studies. Panagiotis Paliogiannis, Carlo Pala, Renato Versace, and Claudio Pusceddu Copyright © 2014 Panagiotis Paliogiannis et al. All rights reserved. Bilateral Maxillary Sinus Hypoplasia Mon, 08 Dec 2014 09:04:00 +0000 Maxillary sinus hypoplasia (MSH) is an uncommon abnormality of paranasal sinuses noted in clinical practice. Computed tomography (CT) scan helps in diagnosing the anomaly along with any anatomical variation that may be associated with it. MSH is usually associated with other anomalies like uncinate process hypoplasia. Three types of MSH have been described. Type 1 MSH shows mild maxillary sinus hypoplasia, type 2 shows significant sinus hypoplasia with narrowed infundibular passage and hypoplastic or absent uncinate process, and type 3 is cleft like maxillary sinus hypoplasia with absent uncinate process. CT and endoscopic examination usually complement each other in diagnosing MSH. Sachin Khanduri, Sumit Agrawal, Saakshi Chhabra, and Swati Goyal Copyright © 2014 Sachin Khanduri et al. All rights reserved. Myasthenia Gravis following Low-Osmolality Iodinated Contrast Media Wed, 03 Dec 2014 07:28:14 +0000 We describe the case of 79-year-old man admitted to our general hospital for a 6-week history of progressive dysphagia to solids and liquids associated with weight loss. To reach a diagnosis a total body CT scan with low-osmolality iodinate contrast agent was performed. Two hours later the patient developed an acute respiratory failure requiring orotracheal intubation and mechanical ventilation. The laboratory and neurological tests allow formulating the diagnosis of myasthenia gravis. In literature, other three case reports have associated myasthenic crisis with exposure to low-osmolality contrast media. This suggests being careful in administering low-osmolality contrast media in myasthenic patients. Luca Bonanni, Michele Dalla Vestra, Andrea Zancanaro, and Fabio Presotto Copyright © 2014 Luca Bonanni et al. All rights reserved. Atypical CT Findings in Plexiform Ameloblastoma Mon, 24 Nov 2014 10:15:42 +0000 Ameloblastoma is an uncommon epithelial odontogenic neoplasm that is nonmineralized, locally aggressive, and, in most cases, benign. Most ameloblastomas develop in the molar-ramus region of the mandible with 70% of them arising in the molar-ramus area. Radiologically they are unilocular or multilocular radiolucency with a honeycomb or soap bubble appearance. The radiographic appearance of ameloblastoma can vary according to the type of tumor. CT is usually helpful in determining the contours of the lesion, its contents, and its extension into soft and hard tissues. Through this case we would bring to light some of the unusual CT findings which include the destruction of the surrounding structures by the lesion which appeared to be normal routine lesion when viewed clinically. Karandeep Singh Arora, Nagesh Binjoo, Richa Modgil, Lalit Singh Negi, and Prabhpreet Kaur Copyright © 2014 Karandeep Singh Arora et al. All rights reserved. Renal Sinus Fat Invasion and Tumoral Thrombosis of the Inferior Vena Cava-Renal Vein: Only Confined to Renal Cell Carcinoma Tue, 18 Nov 2014 07:00:18 +0000 Epithelioid angiomyolipoma (E-AML), accounting for 8% of renal angiomyolipoma, is usually associated with tuberous sclerosis (TS) and demonstrates aggressive behavior. E-AML is macroscopically seen as a large infiltrative necrotic tumor with occasional extension into renal vein and/or inferior vena cava. However, without history of TS, renal sinus and venous invasion E-AML would be a challenging diagnosis, which may lead radiologists to misinterpret it as a renal cell carcinoma (RCC). In this case presentation, we aimed to report cross-sectional imaging findings of two cases diagnosed as E-AML and pathological correlation of these aforementioned masses mimicking RCC. Turker Acar, Mustafa Harman, Serkan Guneyli, Sait Sen, and Nevra Elmas Copyright © 2014 Turker Acar et al. All rights reserved. Left-Sided Patent Ductus Arteriosus in a Right-Sided Aortic Arch Mon, 17 Nov 2014 00:00:00 +0000 We present a 31-year-old female with repaired tetralogy of Fallot (TOF) and right-sided aortic arch (RAA) with left-sided patent ductus arteriosus (PDA) originating from the left brachiocephalic artery. This is a rare finding but most common site for a PDA in TOF and a RAA. To the best of our knowledge, this is the first demonstration of this rare finding on MRI in the literature. Ming-Yen Ng, Paaladinesh Thavendiranathan, Andrew Michael Crean, Qin Li, and Djeven Parameshvara Deva Copyright © 2014 Ming-Yen Ng et al. All rights reserved. Favourable Experience with M-Mode Sonography in the Diagnosis of Pneumothorax in Two Patients with Thoracic Subcutaneous Emphysema Thu, 13 Nov 2014 09:51:32 +0000 Introduction. Thoracic subcutaneous emphysema may be caused by various pathologies. In mechanically ventilated patients, timely diagnostic workup is particularly important, as the presence of subcutaneous surgical emphysema may indicate pneumothorax, representing a risk factor for the development of life threatening tension pneumothorax. Thoracic ultrasound is of proven value for the detection of pneumothorax but has so far been considered of little value in the context of subcutaeneous emphysema, due to poor visibility of anatomic structures. Case Presentation. We present the successful use of diagnostic M-mode sonography in two mechanically ventilated patients who developed thoracic subcutaneous emphysema. In both cases B-mode sonography was inconclusive. Conclusion. M-mode sonography may be more sensitive than B-mode sonography in the detection of lung sliding and could become a useful diagnostic tool when pneumothorax needs to be ruled in or ruled out and visibility of the pleura is limited. T. Berlet and R. Etter Copyright © 2014 T. Berlet and R. Etter. All rights reserved. A Rare Case of Right Retrocaval Ureter with Duplication of Infrarenal IVC Thu, 13 Nov 2014 00:00:00 +0000 Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly which commonly presents with loin pain in middle age group. Here, ureter passes between the inferior vena cava (IVC) and psoas muscle and gets compressed. Duplication of IVC is another rare congenital anomaly in the development of IVC. We present a case of a 49-year-old male who presented with loin pain and upon thorough investigation was found to have retrocaval ureter along with duplication of the infrarenal IVC. We bring forward this rare type of combination of two congenital malformations. Anees Dudekula and Sonali D. Prabhu Copyright © 2014 Anees Dudekula and Sonali D. Prabhu. All rights reserved. Spinal Nerve Root Haemangioblastoma Associated with Reactive Polycythemia Thu, 06 Nov 2014 09:22:13 +0000 Haemangioblastomas are uncommon tumours that usually occur in the cerebellum and, less commonly, in the intramedullary spinal cord. The extramedullary spinal canal is an uncommon location for these tumours. Also haemangioblastoma at this site is not known to be associated with polycythemia. We present the clinical, imaging, and histological findings of an adult patient with extramedullary spinal haemangioblastoma and reactive polycythemia. Radiography and computed tomography (CT) revealed a medium-sized tumour that most likely arose from an extramedullary spinal nerve root. This tumour appeared to be slow growing as evidenced by the accompanying well-defined bony resorption with a sclerotic rim and mild neural foraminal widening. Magnetic resonance imaging revealed prominent flow voids consistent with tumoural hypervascularity. CT-guided biopsy was performed. Although preoperative angiographic embolisation was technically successful, excessive intraoperative tumour bleeding necessitated tumour debulking rather than complete tumour resection. Histology of the resected specimen revealed haemangioblastoma. Seven months postoperatively, the patients back pain and polycythemia have resolved. Eric K. C. Law, Ryan K. L. Lee, James F. Griffith, Deyond Y. W. Siu, and Ho Keung Ng Copyright © 2014 Eric K. C. Law et al. All rights reserved.