Case Reports in Radiology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Isolated Spontaneous Renal Artery Dissection Presented with Flank Pain Mon, 18 May 2015 07:54:10 +0000 Spontaneous renal artery dissection is a rare but important cause of flank pain. We report a case of isolated spontaneous renal artery dissection in 56-year-old man complicated by renal infarction presented with flank pain. Doppler study pointed towards vascular pathology. Computed tomography (CT) angiography was used to make final diagnosis which demonstrated intimal flap in main renal artery with renal infarction. Shruti P. Gandhi, Kajal Patel, and Bipin C. Pal Copyright © 2015 Shruti P. Gandhi et al. All rights reserved. Retrieval of a Dislodged Catheter Using Combined Fluoroscopy and Intracardiac Echocardiography Wed, 13 May 2015 12:14:35 +0000 This report details a method of percutaneous, transluminal retrieval of an intracardiac foreign body using fluoroscopy in combination with intracardiac echocardiography. During retrieval, intracardiac echocardiography (ICE) provided real-time anatomic localization of a constantly moving, almost radiolucent micropuncture coaxial dilator fragment with respect to the tricuspid and pulmonary valves. This method may serve as a crucial aid in retrieval of intracardiac foreign bodies that are difficult to see with fluoroscopy and which may be adjacent to cardiac valves. Gus Mitsopoulos, Robert F. Hanna, Sidney Z. Brejt, Greg E. Goldstein, Vladimir Sheynzon, Joshua L. Weintraub, and William A. Gray Copyright © 2015 Gus Mitsopoulos et al. All rights reserved. Spontaneous Retrobulbar Haematoma Sun, 10 May 2015 09:13:42 +0000 Background. Spontaneous orbital haemorrhage is a very rare condition and vision-threatening event. It may occur due to trauma, orbital surgery/injections, orbital vascular anomalies, and a variety of systemic predisposing factors. Signs of retrobulbar hemorrhage include proptosis, ophthalmoplegia, increased intraocular pressure, loss of pupillary reflexes, and optic disc or retinal pallor. Both Computed Tomography scan and Magnetic Resonance Imaging may be performed in the diagnosis. Case Report. A 31-year-old woman was referred to our hospital with a complaint of headache and blurred vision following a strong sneeze. Ophthalmological examination revealed mild Relative Afferent Pupillary Defect in left eye. Computed Tomography revealed left hyperdense retrobulbar mass and displaced optic nerve. T1 weighted hypointense, T2 weighted hyperintense and non-enhanced round shape, sharply demarcated lesion measuring 18 × 15 × 14 × mm in diameter compatible with haematoma was detected by MRI. Surgically Caldwell-Luc procedure was performed. Histological examination confirmed haematoma. Follow-up Magnetic Resonance Imaging revealed a small reduction in the size of lesion but not complete resolution. The patient’s complaint was regressed. She is now free of symptoms and is still under surveillance. To our knowledge, this is the first reported case of retrobulbar haematoma caused by sneeze. Mehmet Deveer, Nesat Cullu, Halil Beydilli, Hamdi Sozen, Onder Yeniceri, and Selcuk Parlak Copyright © 2015 Mehmet Deveer et al. All rights reserved. Bilateral Sclerosing Stromal Ovarian Tumor in an Adolescent Wed, 06 May 2015 08:42:38 +0000 Sclerosing stromal tumor of the ovary is a rare, benign, sex cord stromal tumor occurring predominantly in younger women in the 2nd and 3rd decades of life. It typically presents unilaterally with only 2 previously reported cases of bilateral presentation. Common clinical presentations include pelvic or abdominal pain, a mass, or menstrual changes. Although occasionally presenting with hormonal manifestations, virilization as a result of androgen production by the tumor is rare. Here we present an extremely rare case of a sclerosing stromal ovarian tumor in a 14-year-old patient with bilateral presentation and with clinical and biochemical evidence of hyperandrogenemia. Anjani Naidu, Betty Chung, Mitchell Simon, and Ian Marshall Copyright © 2015 Anjani Naidu et al. All rights reserved. Delayed Intraperitoneal Catheter Erosion into the Small Bowel Wed, 06 May 2015 07:49:39 +0000 Intraperitoneal chemotherapy can be provided in cases of metastatic ovarian carcinoma. Although most complications arise during or immediately after insertion of the catheter, there are complications that can arise several months later or during therapy administration. One of these delayed complications is catheter erosion into adjacent bowel. Lauren Kerwin and Sean Calhoun Copyright © 2015 Lauren Kerwin and Sean Calhoun. All rights reserved. Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI Thu, 23 Apr 2015 08:06:08 +0000 Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy. Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement. Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication. Linton T. Evans and S. Scott Lollis Copyright © 2015 Linton T. Evans and S. Scott Lollis. All rights reserved. Adult Langerhans Cell Histiocytosis with Hepatic and Pulmonary Involvement Tue, 21 Apr 2015 09:27:49 +0000 Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of Langerhans cells of unknown etiology. It can involve multiple organ systems with different clinical presentation, which complicates the diagnosis. It can range from isolated to multisystem disease with different prognosis. Although common among children, liver involvement is relatively rare in adults and frequently overlooked. Natural history of liver LCH fits into two stages: an early stage with infiltration by histiocytes and a late stage with sclerosis of the biliary tree. Pulmonary findings are more common and include multiple nodules in different stages of cavitation, predominantly in the upper lobes. We present a case of adult LCH with pulmonary and biopsy proven liver involvement with resolution of the hepatic findings after treatment. Bruno Araujo, Francisco Costa, Joanne Lopes, and Ricardo Castro Copyright © 2015 Bruno Araujo et al. All rights reserved. Simple Lymphangioma to Generalized Lymphatic Anomaly: Role of Imaging in Disclosure of a Rare and Morbid Disease Sun, 12 Apr 2015 13:14:58 +0000 Generalized lymphatic anomaly is a rare multisystem congenital disorder in which multiple organs are involved. Imaging features often overlap with other complex lymphatic anomalies and diagnosis is difficult. Treatment options are limited, not remedial and prognosis is poor. We report a 12-year-old male who presented with axillary and chest wall lymphangioma but was subsequently diagnosed as having diffuse lymphangiomatosis affecting lungs, liver, spleen, and bones on computerized tomography scan. We suggest complete radiological evaluation of susceptible adolescent children with lymphangioma to avoid diagnostic delay in this morbid condition. We also discuss radiological features of other similar complex lymphatic anomalies and crucial role of imaging in diagnosis. Manoj Joshi and Dilip S. Phansalkar Copyright © 2015 Manoj Joshi and Dilip S. Phansalkar. All rights reserved. Severe Headache with Eye Involvement from Herpes Zoster Ophthalmicus, Trigeminal Tract, and Brainstem Nuclei Thu, 02 Apr 2015 10:42:42 +0000 A 43-year-old female presented with severe sharp stabbing right-sided periorbital and retroorbital area headache, dull-aching unilateral jaw pain, eyelid swelling, ptosis, and tearing of the right eye but no rash. The pain episodes lasted five minutes to one hour and occurred 10–15 times per day with unremitting milder pain between the attacks. She later developed an erythematous maculopapular rash over the right forehead and therefore was treated with antivirals. MRI performed one month after the onset revealed small hypersignal-T2 in the right dorsolateral mid-pons and from the right dorsolateral aspect of the pontomedullary region to the right dorsolateral aspect of the upper cervical cord, along the course of the principal sensory nucleus and spinal nucleus of the right trigeminal nerve. No definite contrast enhancement of the right brain stem/upper cervical cord was seen. Orbital imaging showed no abnormality of bilateral optic nerves/chiasm, extraocular muscles, and globes. Slight enhancement of the right V1, V2, and the cisterna right trigeminal nerve was detected. Our findings support the hypothesis of direct involvement by virus theory, reflecting rostral viral transmission along the gasserian ganglion to the trigeminal nuclei at brainstem and caudal spreading along the descending tract of CN V. Sasitorn Siritho, Wadchara Pumpradit, Wiboon Suriyajakryuththana, and Krit Pongpirul Copyright © 2015 Sasitorn Siritho et al. All rights reserved. Transarterial Coil Embolization of a Symptomatic Posttraumatic Plantar Pseudoaneurysm Thu, 19 Mar 2015 11:39:47 +0000 Posttraumatic pseudoaneurysms of the lateral plantar artery are rare. We report the case of a 31-year-old woman with a painful pseudoaneurysm of the lateral plantar artery resulting from a deep plantar cut injury. The pseudoaneurysm was successfully treated by performing a transarterial “frontdoor-backdoor” coil embolization technique, which is a minimally invasive alternative to conventional ligature of the artery. Lukas Philipp Beyer, Walter A. Wohlgemuth, and René Müller-Wille Copyright © 2015 Lukas Philipp Beyer et al. All rights reserved. Kaposi’s Sarcoma Presenting as Acute Small Bowel Obstruction Diagnosed on Multidetector Computed Tomography with Histopathological Correlation Tue, 17 Mar 2015 14:20:37 +0000 Kaposi’s sarcoma was originally described by Moritz Kaposi in 1872 as a rare form of multiple hemorrhagic skin lesions. Today it is well documented as a systemic, multifocal, steadily progressive reticuloendothelial system tumor with a predilection for skin and visceral involvement. It occasionally presents as a visceral disease without skin manifestations. We report a case of Kaposi’s sarcoma of the small bowel in a seropositive patient who presented with acute right lower quadrant pain and was diagnosed with intestinal obstruction with perforation on contrast-enhanced multidetector computed tomography (MDCT). The diagnosis was confirmed as Kaposi’s sarcoma on postoperative histopathological analysis. Jaydeep Halankar, Elaine Martinovic, and Paul Hamilton Copyright © 2015 Jaydeep Halankar et al. All rights reserved. Rapid Pituitary Apoplexy Regression: What Is the Time Course of Clot Resolution? Sun, 15 Mar 2015 12:27:58 +0000 A 29-year-old male patient with a functioning pituitary macroadenoma is discussed. The pituitary mass was detected by MRI after the patient presented with sudden onset of headache, suggestive of an apoplectic event. The headache resolved with analgesic medications. Within a follow-up period of one week, the pituitary mass had spontaneously regressed to nearly half its original size without any therapy. The patient never reported any visual complaints and displayed no signs of hypopituitarism. Elevated prolactin levels were present. Seven weeks after the initial event, the pituitary mass showed continued regression on MRI. Prolactin levels remained elevated. This case provides a unique look at the rapid spontaneous regression of mass effect that may occur following apoplexy of a pituitary adenoma. Devon L. Jackson and Jamie J. Van Gompel Copyright © 2015 Devon L. Jackson and Jamie J. Van Gompel. All rights reserved. An Unusual Long-Term Survey of a Patient with Widespread Malignant Urachal Tumor, Not Given Chemotherapy or Radiotherapy Sun, 08 Mar 2015 12:51:45 +0000 The urachus establishes a connection between the dome of the bladder and the umbilicus throughout fetal life. If the urachus does not close completely, malignancy is a potential complication. The primary treatment for malignant urachal tumor is surgical excision. A 61-year-old male patient diagnosed with urachal carcinoma had undergone partial cystectomy 25 years previously. Twenty years later, local recurrence was treated with another partial cystectomy without umbilical remnant excision. Recurrence at the umbilical site was excised 2 years later, but intraperitoneal invasion had occurred, and the patient underwent a total colectomy at that time. Local disease and disseminated metastases in the thorax and intra- and extraperitoneal areas were noted upon admission to our hospital. Urachal carcinomas are usually aggressive tumors, and surgical treatment should include partial or radical cystectomy and excision of the urachus and umbilicus, to prevent local recurrence and distant metastasis. Tugrul Ormeci, Murat Can Kiremit, Bulent Erkurt, and Aslı Örmeci Copyright © 2015 Tugrul Ormeci et al. All rights reserved. Transcatheter Arterial Coil Embolization of Ruptured Common Hepatic Artery Aneurysm in a Patient with Behçet’s Disease Wed, 04 Mar 2015 09:55:27 +0000 Hepatic artery aneurysm is a rare and potentially life-threatening entity. We report a case of ruptured common hepatic artery aneurysm in a patient with Behçet’s disease. The ruptured aneurysm was treated successfully with transcatheter arterial coil embolization. Transcatheter arterial embolization is the preferred treatment modality in patients at high risk of surgical intervention. Akihiro Hotta, Ryohei Kuwatsuru, Kouichi Asahi, Shingo Okada, Daisuke Tsuge, Akihiko Shiraishi, and Yoshinari Takasaki Copyright © 2015 Akihiro Hotta et al. All rights reserved. Ischemic Cardiomyopathy and Cerebral Infarction in a Young Patient Associated with Khat Chewing Thu, 26 Feb 2015 07:10:37 +0000 Khat is a stimulating agent used by many people in the Horn of Africa and the Arabian peninsula. Khat chewing is a known cardiovascular risk factor and is thought to cause vasoconstriction, systemic hypertension, and thrombogenicity. A 33-year-old Somalian man initially presented with loss of neurological function of the left arm, hazy vision, and headache. He smokes tobacco and chews two bundles of khat a week for more than 10 years. His ECG on admission showed a Q wave in V1 and V2 and 2 mm ST-elevations in V1, V2, and V3 and a terminal negative T wave in I, aVL, V2, V3, and V4, consistent with a recent, evolving anterior infarction. A noncontrast enhanced CT of the brain showed ischemia in the right middle cerebral artery vascular territory. An MRI showed recent ischemia in the vascular territory of the posterior division of the right middle cerebral artery. Coronary angiography showed a 70% stenosis with haziness of the proximal left anterior descending artery. Diagnostic tests and imaging are consistent with recent myocardial infarction in the LAD vascular territory because of coronary spasm and cerebral infarction in the middle cerebral artery vascular territory probably related to khat chewing. T. J. Meulman, J. Bakker, and E. J. van den Bos Copyright © 2015 T. J. Meulman et al. All rights reserved. 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.