Case Reports in Radiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Unique Presentation of Hematuria in a Patient with Arterioureteral Fistula Thu, 12 May 2016 17:30:45 +0000 http://www.hindawi.com/journals/crira/2016/8682040/ Active extravasation via an arterioureteral fistula (AUF) is a rare and life-threatening emergency that requires efficient algorithms to save a patient’s life. Unfortunately, physicians may not be aware of its presence until the patient is in extremis. An AUF typically develops in a patient with multiple pelvic and aortoiliac vascular surgeries, prior radiation therapy for pelvic tumors, and chronic indwelling ureteral stents. We present a patient with a left internal iliac arterial-ureteral fistula and describe the evolution of management and treatment algorithms based on review of the literature. Tomas Mujo, Erin Priddy, John J. Harris, Eric Poulos, and Mahmoud Samman Copyright © 2016 Tomas Mujo et al. All rights reserved. CT and MR Unilateral Brain Features Secondary to Nonketotic Hyperglycemia Presenting as Hemichorea-Hemiballism Mon, 09 May 2016 10:54:08 +0000 http://www.hindawi.com/journals/crira/2016/5727138/ Hemichorea-hemiballism is an unusual hyperkinetic movement disorder characterized by continuous involuntary movements of an entire limb or both limbs on one side of the body. The acute onset of this disorder occurs with an insult in contralateral basal ganglia. Ischemic events represent the most common cause. Nonketotic hyperglycemia comes in second place. Nonketotic hyperglycemic hemichorea-hemiballism (NHH) is a rare cause of unilateral brain abnormalities on imaging studies confined to basal ganglia (mainly putaminal region as well as caudate nucleus). Subtle hyperdensity in striatal region can be found on CT studies whereas brain MR imaging typically shows T1 hyperintensity and T2 hypointensity in the basal ganglia contralateral to the movements. Diagnosis is based on both glucose levels and neuroimaging findings. Elevated blood glucose and hemoglobin A1c levels occur with poorly controlled diabetes. In this case report, our aim is to present neuroimaging CT and MR unilateral findings in an elderly woman secondary to nonketotic hyperglycemia presenting as hemichorea-hemiballism. Víctor Manuel Suárez-Vega, Carlos Sánchez Almaraz, Ana Isabel Bernardo, Ricardo Rodríguez-Díaz, Ana Díez Barrio, and Leticia Martín Gil Copyright © 2016 Víctor Manuel Suárez-Vega et al. All rights reserved. Inferior Vena Cava Duplication: Incidental Case in a Young Woman Wed, 27 Apr 2016 07:18:49 +0000 http://www.hindawi.com/journals/crira/2016/3071873/ A case of a double inferior vena cava (IVC) with retroaortic left renal vein, azygos continuation of the IVC, and presence of the hepatic portion of the IVC drained into the right renal vein is reported and the embryologic, clinical, and radiological significance is discussed. The diagnosis is suggested by multidetector computed tomography (MDCT), which reveals the aberrant vascular structures. Awareness of different congenital anomalies of IVC is necessary for radiologists to avoid diagnostic pitfalls and they should be remembered because they can influence several surgical interventions and endovascular procedures. Danilo Coco, Sara Cecchini, Silvana Leanza, Massimo Viola, Stefano Ricci, and Roberto Campagnacci Copyright © 2016 Danilo Coco et al. All rights reserved. Isolation of Left Common Carotid Artery with Its Origin Proximal to Patent Ductus Arteriosus Presenting in Adult Age Tue, 26 Apr 2016 16:29:31 +0000 http://www.hindawi.com/journals/crira/2016/4149365/ Anomalies of aortic arch are a common occurrence. Such anomalies of right sided aortic arch with its various branching patterns are of clinical importance. Rarer anomalies include isolation (deficient connection) of either left subclavian artery or left common carotid artery; that is, they do not have their origin from aorta or its major branches. We present a case of an 18-year-old male who presented with gradual onset pulsatile swelling with bruit in neck on left side and was evaluated by CT brain and neck angiography. CT angiography revealed right sided aortic arch with aberrant left subclavian artery and isolated left common carotid artery. Very few cases of such an anomaly have been documented in the literature but none in an adult. Anagha R. Joshi, Saurabh Joshi, Kiran Kale, Rahul Jain, and Jernail Singh Bava Copyright © 2016 Anagha R. Joshi et al. All rights reserved. Unexpected Radiologic Findings for a Casting Type of Radiolucent Colorectal Foreign Body Composed of Polyurethane Foam Sun, 24 Apr 2016 09:26:52 +0000 http://www.hindawi.com/journals/crira/2016/4987105/ Radiologic diagnosis of colorectal foreign bodies is usually not very difficult, because inserted materials are often clearly visible on plain abdominal radiographs. However, when they are radiolucent, a plain abdominal radiograph has been reported to be useless. As radiolucent colorectal foreign bodies appear as radiolucent artificial contours or air-trapped materials in the pelvis, almost always the diagnosis itself can be made by careful evaluation of plain abdominal radiographs. We encountered a case of casting type of radiolucent colorectal foreign body formed from polyurethane foam. It presented us with unexpected radiologic findings and led to diagnostic difficulties. Emi Sanjo, Fumihiko Tamamoto, Shoichi Ogawa, Maiko Sano, Tetsunori Yoshimura, and Miwako Nozaki Copyright © 2016 Emi Sanjo et al. All rights reserved. Acute Abdominal Pain Caused by an Infected Mesenteric Cyst in a 24-Year-Old Female Tue, 12 Apr 2016 13:15:22 +0000 http://www.hindawi.com/journals/crira/2016/8437832/ A mesenteric cyst is a rare cause for abdominal pain. This umbrella term includes cystic entities which reside in the mesentery. We present a case of an infected false mesenteric cyst in a 24-year-old female patient without prior surgery or known trauma. Mainstay of treatment involves surgical resection, although less invasive treatments have been described. Prognosis depends on the origin of the cyst. Davy R. Sudiono, Joep B. Ponten, and Frank M. Zijta Copyright © 2016 Davy R. Sudiono et al. All rights reserved. Splenorenal Manifestations of Bartonella henselae Infection in a Pediatric Patient Tue, 05 Apr 2016 13:01:39 +0000 http://www.hindawi.com/journals/crira/2016/7803832/ Bartonella henselae is a bacterium which can cause a wide range of clinical manifestations, ranging from fever of unknown origin to a potentially fatal endocarditis. We report a case of Bartonella henselae infection in a pediatric-aged patient following a scratch from a kitten. The patient initially presented with a prolonged fever of unknown origin which was unresponsive to antibiotic treatment. The patient was hospitalized with worsening fevers and night sweat. Subsequent ultrasound imaging demonstrated multiple hypoechoic foci within the spleen. A contrast-enhanced CT of the abdomen and pelvis was also obtained which showed hypoattenuating lesions in the spleen and bilateral kidneys. Bartonella henselae IgG and IgM titers were positive, consistent with an acute Bartonella henselae infection. The patient was discharged with a course of oral rifampin and trimethoprim-sulfamethoxazole, and all symptoms had resolved following two weeks of therapy. Taylor Rising, Nicholas Fulton, and Pauravi Vasavada Copyright © 2016 Taylor Rising et al. All rights reserved. Hyperintense Acute Reperfusion Marker on FLAIR in a Patient with Transient Ischemic Attack Sun, 03 Apr 2016 09:24:49 +0000 http://www.hindawi.com/journals/crira/2016/9829823/ The hyperintense acute reperfusion marker (HARM) has initially been described in acute ischemic stroke. The phenomenon is caused by blood-brain barrier disruption following acute reperfusion and consecutive delayed gadolinium enhancement in the subarachnoid space on fluid attenuated inversion recovery (FLAIR) images. Here we report the case of an 80-year-old man who presented with transient paresis and sensory loss in the right arm. Initial routine stroke MRI including diffusion- and perfusion-weighted imaging demonstrated no acute pathology. Follow-up MRI after three hours demonstrated subarachnoid gadolinium enhancement in the left middle cerebral artery territory consistent with HARM that completely resolved on follow-up MRI three days later. This case illustrates that even in transient ischemic attack patients disturbances of the blood-brain barrier may be present which significantly exceed the extent of acute ischemic lesions on diffusion-weighted imaging. Inclusion of FLAIR images with delayed acquisition after intravenous contrast agent application in MRI stroke protocols might facilitate the diagnosis of a recent acute ischemic stroke. Alex Förster, Holger Wenz, and Christoph Groden Copyright © 2016 Alex Förster et al. All rights reserved. Retracted: Intramedullary Chondrosarcoma of Proximal Humerus Thu, 24 Mar 2016 07:19:18 +0000 http://www.hindawi.com/journals/crira/2016/1208982/ Case Reports in Radiology Copyright © 2016 Case Reports in Radiology. All rights reserved. Renal Allograft Torsion: US and CT Imaging Findings of a Rare Posttransplant Complication Sun, 20 Mar 2016 10:01:27 +0000 http://www.hindawi.com/journals/crira/2016/4273780/ Vascular torsion is a rare renal transplant complication which requires prompt diagnosis and surgery to salvage allograft function. We report here a case of renal allograft torsion with interesting imaging findings on unenhanced CT and color Doppler ultrasound. A 60-year-old woman with a history of pancreas and kidney transplant presented to the emergency room with nausea, vomiting, abdominal pain, and minimal urine output. Unenhanced CT of the abdomen demonstrated an enlarged and malrotated renal allograft with moderate hydronephrosis. Color Doppler ultrasound demonstrated lack of vascularity within the allograft. The patient was taken urgently to the operating room where the renal allograft was found twisted 360 degrees around the vascular pedicle. After the allograft was detorsed, the color of the kidney returned and the Doppler signals for arterial flow improved. Intraoperative biopsy showed no evidence of infarct or acute cellular rejection. The detorsed kidney was surgically fixed in position in its upper and lower poles. Follow-up ultrasound 1 day later demonstrated normal blood flow to the renal allograft and the serum level of creatinine returned to normal. Rohit Dewan, Anil K. Dasyam, Henke Tan, and Alessandro Furlan Copyright © 2016 Rohit Dewan et al. All rights reserved. Benign Cystic Peritoneal Mesothelioma Revealed by Small Bowel Obstruction Tue, 15 Mar 2016 12:03:10 +0000 http://www.hindawi.com/journals/crira/2016/6728160/ Benign cystic peritoneal mesothelioma is a rare tumor which frequently occurs in women of reproductive age. Abdominal pain associated with pelvic or abdominal mass is the common clinical presentation. We report the case of a 22-year-old woman with a pathological proved benign cystic mesothelioma of the peritoneum revealed by a small bowel obstruction and a painful left-sided pelvic mass with signs of psoitis. Contrast enhanced abdominal CT-scan demonstrated a large pelvic cystic mass with mass effect on rectosigmoid and pelvic organs. The patient underwent surgical removal of the tumor. Pathological examination revealed the diagnosis of benign cystic mesothelioma of the peritoneum. The outcome was excellent with a 12-month recoil. Kaimba Bray Madoué, Moifo Boniface, Edzimbi Annick Laure, and Herve Pierre Copyright © 2016 Kaimba Bray Madoué et al. All rights reserved. Multiple Brain Abscesses due to Streptococcus anginosus: Prediction of Mortality by an Imaging Severity Index Score Tue, 01 Mar 2016 10:11:13 +0000 http://www.hindawi.com/journals/crira/2016/7040352/ An elderly patient with altered mental status, brain abscesses, ventriculitis, and empyemas died of septic shock and brain abscesses secondary to Streptococcus anginosus despite aggressive treatment. An imaging severity index score with a better prognostic value than the Glasgow coma scale predicted mortality in this patient. K. O. Kragha Copyright © 2016 K. O. Kragha. All rights reserved. Hypoxemia and Right-to-Left-Shunt in Patient with Antiphospholipid Syndrome: A Case Report with Multimodality Imaging Findings and Literature Review Mon, 29 Feb 2016 16:45:29 +0000 http://www.hindawi.com/journals/crira/2016/2092084/ This is a case report of an extremely rare cause of superior vena cava syndrome with systemic-to-pulmonary venous shunts, illustrated using different imaging modalities with successful SVC and IVC dilatation and stenting. Mnahi Bin Saeedan, Mashael Alrujaib, and Ahmed L. Fathala Copyright © 2016 Mnahi Bin Saeedan et al. All rights reserved. US and CT of the Liver after Electric Shock Tue, 23 Feb 2016 10:04:17 +0000 http://www.hindawi.com/journals/crira/2016/9846357/ Liver injuries caused by high voltage electricity are rare and result in high mortality and morbidity. They are produced by the resistance to the passage of electrical current through the tissue, which creates heat that leads to coagulation necrosis and rupture of the cell membrane. We present a case of an electrical injury to the liver, diagnosed by ultrasound and CT in a 39-year-old man who presented with skin burns on his right hand and right hemiabdomen. Injuries occurred after the contact with 220 kV high voltage electricity. Amela Sofić, Nermina Bešlić, Alma Efendić, Aladin Čarovac, Jusuf Šabanović, Elma Jahić, Melika Bukvić, Fikreta Krakonja, and Jana Kupusović Copyright © 2016 Amela Sofić et al. All rights reserved. Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound Thu, 18 Feb 2016 14:13:56 +0000 http://www.hindawi.com/journals/crira/2016/1738521/ Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge, this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis. Sharad M. Malvadkar, Madhuri S. Malvadkar, Shilpa V. Domkundwar, and Shariq Mohd Copyright © 2016 Sharad M. Malvadkar et al. All rights reserved. Imaging Findings of Duodenal Duplication Cyst Complicated with Duodenal Intussusception and Biliary Dilatation Wed, 17 Feb 2016 11:38:43 +0000 http://www.hindawi.com/journals/crira/2016/3069576/ Duodenal duplication cyst is an extremely rare congenital anomaly usually diagnosed in childhood. However, it may remain asymptomatic for a long period. In adults it usually manifests with symptoms related to complications as pancreatitis, jaundice, or intussusception. We present the radiology findings of a patient with a duodenal intussusception secondary to a duplication cyst. The usefulness of the magnetic resonance (MR) in this case is highlighted. Eduardo Torres Diez, Raúl Pellón Dabén, Juan Crespo Del Pozo, and Francisco José González Sánchez Copyright © 2016 Eduardo Torres Diez et al. All rights reserved. Giant Cell Tumor within the Proximal Tibia after ACL Reconstruction Sun, 14 Feb 2016 14:11:22 +0000 http://www.hindawi.com/journals/crira/2016/2820381/ 26-year-old female with prior anterior cruciate ligament reconstruction developed an enlarging lytic bone lesion around the tibial screw with sequential imaging over the course of one year demonstrating progression of this finding, which was confirmed histologically to be a giant cell tumor of bone. The lesion originated around the postoperative bed, making the diagnosis challenging during the early course of the presentation. The case demonstrates giant cell tumor which originated in the metaphysis and subsequently grew to involve the epiphysis; therefore, early course of the disease not involving the epiphysis should not exclude this diagnosis. Takashi Takahashi, Lauren MacCormick, Jutta Ellermann, Denis Clohisy, and Shelly Marette Copyright © 2016 Takashi Takahashi et al. All rights reserved. Segmental Testicular Infarction, an Underdiagnosed Entity: Case Report with Histopathologic Correlation and Review of the Diagnostic Features Sun, 14 Feb 2016 12:20:09 +0000 http://www.hindawi.com/journals/crira/2016/8741632/ A 30-year-old male presented with a 1-day history of left scrotal pain and a tender left testicle and epididymis on physical exam. Scrotal ultrasound showed an avascular, heterogeneous, hypoechoic lesion in the superior left testis suggestive of infarction or neoplasm. The patient was managed conservatively; however, his pain continued and follow-up ultrasound 6 days later showed interval increase in the size of the mass. Left radical orchiectomy was done and pathology result showed segmental infarction of the left testis. Sahar Shiraj, Nisha Ramani, and Andrij R. Wojtowycz Copyright © 2016 Sahar Shiraj et al. All rights reserved. Aortic Pseudoaneurysm Secondary to Mediastinitis due to Esophageal Perforation Wed, 10 Feb 2016 12:06:57 +0000 http://www.hindawi.com/journals/crira/2016/7982641/ Esophageal perforation is a condition associated with high morbidity and mortality rates; it requires early diagnosis and treatment. The most common complication of esophageal rupture is mediastinitis. There are several case reports in the literature of mediastinitis secondary to esophageal perforation and development of aortic pseudoaneurysm as a complication. We report the case of a patient with an 8-day history of esophageal perforation due to foreign body (fishbone) with mediastinitis and aortic pseudoaneurysm. The diagnosis was made using Computed Tomography (CT) with intravenous and oral water-soluble contrast material. An esophagogastroduodenoscopy did not detect the perforation. Claudia Patricia Zuluaga, Felipe Aluja Jaramillo, Sergio Andrés Velásquez Castaño, Aura Lucía Rivera Bernal, Julio Cesar Granada, and Jorge Alberto Carrillo Bayona Copyright © 2016 Claudia Patricia Zuluaga et al. All rights reserved. Left Inferior Vena Cava and Right Retroaortic Renal Vein Wed, 03 Feb 2016 12:56:57 +0000 http://www.hindawi.com/journals/crira/2016/1270856/ Nowadays, incidental anatomical variants are frequent findings, due to the widespread diffusion of cross-sectional imaging. This case report illustrates a fairly uncommon anatomical variant, that is, the copresence of left inferior vena cava and retroaortic right renal vein reported in a 46-year-old lady, undergoing a staging CT for breast cancer. Although the patient was asymptomatic, the authors highlight potential risks related to the above-mentioned condition and the importance of correct identification and diagnosis of the findings. Alberto Nania, Fabio Capilli, and Eugenia Longo Copyright © 2016 Alberto Nania et al. All rights reserved. Fetal MRI Characteristics of Exencephaly: A Case Report and Literature Review Wed, 03 Feb 2016 11:59:41 +0000 http://www.hindawi.com/journals/crira/2016/9801267/ We present the fetal MRI characteristics of exencephaly, a rare malformation of the cranium. The fetus was initially misdiagnosed as anencephaly at 14 weeks of estimated gestational age (EGA) and later mislabeled as acrania at 20 weeks of EGA by ultrasound. A confirmatory magnetic resonance imaging (MRI) at 29 weeks of EGA demonstrated findings consistent with exencephaly, which was confirmed after birth. To our knowledge, no full fetal MRI characteristics have been described. We hope to use this case to review the key MRI findings in differentiating exencephaly from other cranial vault defects and to help early diagnosis of exencephaly as the appropriate use of correct nomenclature allows better research while giving parents the most accurate and appropriate counseling. Ali Sharif and Yihua Zhou Copyright © 2016 Ali Sharif and Yihua Zhou. All rights reserved. Imaging Manifestations of a Subependymal Giant Cell Astrocytoma in Tuberous Sclerosis Sun, 31 Jan 2016 12:19:52 +0000 http://www.hindawi.com/journals/crira/2016/3750450/ Tuberous sclerosis is a rare genetic disorder resulting in benign tumor growth in various organs including the brain, heart, skin, eyes, kidney, and lung as well as systemic manifestations including seizures, cognitive impairment, and dermatologic abnormalities. This report shows the radiological findings and differentiation between a subependymal nodule and subependymal giant cell astrocytoma in a patient with tuberous sclerosis presenting with new onset seizures. Joseph R. Stein and Daniel A. Reidman Copyright © 2016 Joseph R. Stein and Daniel A. Reidman. All rights reserved. Dual-Energy CT for Evaluation of Intra- and Extracapsular Silicone Implant Rupture Thu, 28 Jan 2016 13:44:49 +0000 http://www.hindawi.com/journals/crira/2016/6323709/ Silicone implants are commonly used for both breast augmentation and breast reconstruction. With aging of the implant, the silicone envelope may become weak or may rupture. The technique of choice for evaluation of implant integrity is breast MRI; however this may be contraindicated in some patients or the cost may be prohibitive. Dual-energy CT allows determination of density and atomic number of tissue and can provide material composition information. We present a case of extracapsular implant rupture with MRI and dual-energy CT imaging and surgical correlation. Katrina N. Glazebrook, Shuai Leng, Steven R. Jacobson, and Cynthia M. McCollough Copyright © 2016 Katrina N. Glazebrook et al. All rights reserved. Pulmonary Embolism Originating from a Hepatic Hydatid Cyst Ruptured into the Inferior Vena Cava: CT and MRI Findings Thu, 21 Jan 2016 13:45:01 +0000 http://www.hindawi.com/journals/crira/2016/3589812/ Pulmonary embolism due to hydatid cysts is a very rare clinical entity. Hydatid pulmonary embolism can be distinguished from other causes of pulmonary embolism with contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI). MRI especially displays the cystic nature of lesions better than CECT. Here we report a 45-year-old male patient with the pulmonary embolism due to ruptured hydatid liver cyst into the inferior vena cava. Necdet Poyraz, Soner Demirbaş, Celalettin Korkmaz, and Kürşat Uzun Copyright © 2016 Necdet Poyraz et al. All rights reserved. Bilateral Congenital Agenesis of the Long Head of the Biceps Tendon: The Beginning Thu, 21 Jan 2016 13:19:16 +0000 http://www.hindawi.com/journals/crira/2016/4309213/ The biceps brachii muscle is prone to variants but absence of the long head of the biceps (LHB) tendon is an exceptionally rare anomaly. This report concerns the fourth case of bilateral congenital absence of the LHB tendon and presents the ultrasonography (US) and magnetic resonance (MR) findings. Our case has the peculiarity of being the first in which bilateral LHB tendon agenesis is not associated with rotator cuff or labral tears. Francisco Rego Costa, Cátia Esteves, and Lina Melão Copyright © 2016 Francisco Rego Costa et al. All rights reserved. Detection of Myofascial Herniation on Dynamic Sonography and Magnetic Resonance Imaging Thu, 14 Jan 2016 07:53:28 +0000 http://www.hindawi.com/journals/crira/2016/4245189/ Muscle hernia is an uncommon cause of leg swelling. It can be detected in the early stages only if there is a high index of suspicion. It is common in lower extremity compared to the upper extremity. Tibialis anterior muscle in the leg is commonly involved. Dynamic sonography and magnetic resonance imaging (MRI) are the mainstay in their diagnosis, which demonstrate a facial defect with herniation of muscle fibers. We report a case of 23-year-old male patient who presented with a painless swelling in the anterolateral aspect of the left upper leg. Dynamic sonography done with high-resolution probe demonstrated a defect in fascia overlying tibialis anterior with herniation of outer muscle fibers which increased during dorsiflexion and reduced in the supine position at rest. MRI of the left leg confirmed the findings. Sanjay M. Khaladkar, Sushen Kumar Kondapavuluri, Anubhav Kamal, Raghav Kalra, and Vigyat Kamal Copyright © 2016 Sanjay M. Khaladkar et al. All rights reserved. Granulomatosis with Polyangiitis Presenting with Coronary Artery and Pericardial Involvement Tue, 22 Dec 2015 11:15:23 +0000 http://www.hindawi.com/journals/crira/2015/516437/ Granulomatosis with polyangiitis is a systemic disease resulting in necrotizing vasculitis of small- and medium-sized vessels. Cardiac involvement is rare and when present usually manifests with pericarditis and coronary artery vasculitis. We report here a case of granulomatosis with polyangiitis involving the native coronary arteries, bypass graft, and pericardium with interesting imaging findings on contrast-enhanced CT and MRI. A 57-year-old man with a history of chronic headaches presented to the emergency room with syncope. Contrast-enhanced CT demonstrated extensive soft tissue attenuation around the native coronary arteries and bypass graft. Contrast-enhanced MRI demonstrated enhancing nodular soft tissue surrounding the coronary arteries, bypass graft, and pericardium. Pericardial biopsy revealed a necrotizing granulomatous pericarditis with vasculitis concerning for granulomatosis with polyangiitis. The patient demonstrated MPO-positive and PR-3 negative serologies. After being discharged on rituximab and prednisone, follow-up CT 3 years later showed significant improvement of the soft tissue thickening surrounding the coronary arteries, bypass graft, and pericardium. Rohit Dewan, Humberto E. Trejo Bittar, Joan Lacomis, and Iclal Ocak Copyright © 2015 Rohit Dewan et al. All rights reserved. Late Type 3b Endoleak with an Endurant Endograft Sun, 20 Dec 2015 05:33:59 +0000 http://www.hindawi.com/journals/crira/2015/783468/ Endovascular stent grafting with different commercially available stent graft systems is widely applied for the treatment of abdominal aortic aneurysms with high success rates in the current era. Various types of endoleaks are potential complications of the procedure. They usually occur in the early period. In this report, we present type 3b endoleak occurring 14 months after a successful endovascular abdominal aortic aneurysm repair with a Medtronic Endurant stent graft. Mehmet Barburoglu, Bulent Acunas, Yilmaz Onal, Murat Ugurlucan, Omer Ali Sayin, and Ufuk Alpagut Copyright © 2015 Mehmet Barburoglu et al. All rights reserved. Cholangiocarcinoma Arising from a Type VI Biliary Cyst: A Case Report and Review of the Literature Tue, 15 Dec 2015 09:33:46 +0000 http://www.hindawi.com/journals/crira/2015/625715/ Cystic dilatations of the cystic duct which are suggested as type VI biliary cysts are very rare and many of them go unrecognized or are confused with other cysts until the operation although they are obvious on imaging studies. They can present with fusiform or saccular dilatations and can be accompanied by common bile duct dilatations. It is important to identify these cysts as they share the same characteristics as the other biliary cyst types and can be complicated with malignancy. We herein present a very unusual case of a cholangiocarcinoma arising from a type VI biliary cyst in a 58-year-old female patient and review the literature. The patient presented with jaundice, weight loss, and abdominal pain. On imaging, the cystic duct and common bile duct were fusiformly dilated and had a wide communication. There was a mass filling the distal parts of both ducts. The patient was urgently operated on after perforation following ERCP. Histopathology was compatible with a type VI biliary cyst and an associated cholangiocarcinoma. İlkay Çamlıdağ, Mehmet Selim Nural, Murat Danacı, İlhan Karabıçak, and Kağan Karabulut Copyright © 2015 İlkay Çamlıdağ et al. All rights reserved. Double Meniscal Ossicle, the First Description: CT and MRI Findings—Different Etiologies Tue, 15 Dec 2015 07:29:51 +0000 http://www.hindawi.com/journals/crira/2015/737506/ We present a case of 2 ossicles in the medial meniscus with emphasis on MRI and CT findings. Meniscal ossicle is a rare entity and is quite uncommon on the medial side. By showing the typical signal characteristics and intrameniscal location, MRI can be helpful in distinguishing this from other more clinically significant abnormalities. It should be kept as differential from synovial chondromatosis or sesamoid bones like fabella as management is different for all of these entities. Puneeth Kumar, Amit Kumar Dey, Kartik Mittal, Rajaram Sharma, and Priya Hira Copyright © 2015 Puneeth Kumar et al. All rights reserved.