We present an interesting case of focal amyloidosis of the left breast which was intermixed with ductal carcinoma in situ (DCIS). On subsequent staging bilateral breast magnetic resonance imaging (MRI), the patient was found to have an additional suspicious enhancing mass with spiculated borders within the left breast. This mass was biopsy proven to represent pleomorphic invasive lobular carcinoma. A pulmonary nodule within the lingula was also noted on the staging bilateral breast MRI and was biopsy proven to represent extranodal Castleman&#x2019;s disease. Therefore, it is believed that our patient had secondary amyloidosis due to Castleman&#x2019;s disease.

David Chiang

Michael Lee

Pauline Germaine

Lydia Liao

Amyloidosis of the Breast with Multicentric DCIS and Pleomorphic Invasive Lobular Carcinoma in a Patient with Underlying Extranodal Castleman&#x2019;s Disease

Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS. Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely. Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies.

Natanel Jourabchi

Justin Pryce McWilliams

Edward Wolfgang Lee

Steven Sauk

Stephen Thomas Kee

TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

Traumatic optic neuropathy is an uncommon, yet serious, result of facial trauma. The authors present a novel case of a 59-year-old gentleman who presented with an isolated blunt traumatic left optic nerve hematoma causing vision loss. There were no other injuries or fractures to report. This case highlights the importance of early recognition of this rare injury and reviews the current literature and management of traumatic optic neuropathy.

R. Parab

C. I. Fung

Gerrit Van Der Merwe

Blunt Facial Trauma Causing Isolated Optic Nerve Hematoma

This study focuses on CT and MR studies of adult patient with giant lesion of the posterior cranial fossa associated with micro- and macroaccumulations with density and signal like &#x201c;fat&#x201d; at the level of the cortical and cisternal cerebral spaces. This condition is compatible with previous asymptomatic ruptured dermoid cyst. Histological findings confirm the hypothesis formulated using the imaging. We also integrate elements of differential diagnosis by another giant lesion of the posterior cranial fossa.

Alessandro D'Amore

Alessandro Borderi

Rita Chiaramonte

Giorgio Conte

Ignazio Chiaramonte

Vincenzo Albanese

CT and MR Studies of Giant Dermoid Cyst Associated to Fat Dissemination at the Cortical and Cisternal Cerebral Spaces

We present a rare case of continuous, extensive aortic dissection (AD) involving the bilateral common carotid arteries, the ascending, thoracic, and abdominal aorta, and bifurcation of the right common iliac artery. A 61-year-old man with history of chronic hypertension presented with a one-day history of chest pain, vertigo, left facial drooping, and left hemiparesis. Despite the presence of bilateral carotid bruits, doppler ultrasound of the neck was postponed, and the patient was treated with thrombolytic therapy for a presumed ischemic stroke. The patient's symptoms began to resolve within an hour of treatment, at which time treatment was withheld. Ultrasound performed the following day showed dissection of bilateral common carotid arteries, and CT angiography demonstrated extensive AD as described earlier. The patient subsequently underwent cardiovascular surgery and has been doing clinically well since then. AD has a myriad of manifestations depending on the involvement of aortic branches. Our paper illustrates the importance of having a high index of suspicion for AD when a patient presents with a picture of ischemic stroke, since overlapping signs and symptoms exist between AD and stroke.  Differentiating between the two conditions is central to patient care as thrombolytic therapy can be helpful in stroke, but detrimental in AD.

E. W. Lee

N. Jourabchi

S. C. Sauk

D. Lanum

An Extensive Stanford Type A Aortic Dissection Involving Bilateral Carotid and Iliac Arteries

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Case Reports in Radiology publishes case reports and case series in all areas of radiology.

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Case Reports in Radiology - Table of contents 2013

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Case Reports in Radiology publishes case reports and case series in all areas of radiology.

Case Reports in Radiology