Case Reports in Radiology https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Malignant Tumours Mimicking Complicated Appendicitis and Discovered upon Follow-Up after Percutaneous Drainage: A Case of Two Patients Thu, 16 Nov 2017 08:45:39 +0000 http://www.hindawi.com/journals/crira/2017/3253928/ The conservative management of periappendiceal abscesses is gaining favour due to decreased morbidity and improved clinical outcomes for patients. Occasionally however an abscess can mask underlying sinister pathology. In this article, we highlight two cases of appendiceal adenocarcinoma that were initially diagnosed as periappendiceal abscesses and managed conservatively with percutaneous drainage. We also discuss clinical and imaging features that may assist with identifying a hidden malignancy when presented in these situations. Sharandran Chandra Mohan, Krishna Mohan Gummalla, and Martin Weng Chin H’ng Copyright © 2017 Sharandran Chandra Mohan et al. All rights reserved. Pyogenic Odontoid Osteomyelitis with Sinus Thrombosis Sun, 29 Oct 2017 07:00:16 +0000 http://www.hindawi.com/journals/crira/2017/2507645/ 71/F presented with left sided headaches and neck pain with nuchal rigidity progressively worsening over 3 weeks with no other neurologic symptoms. Odontoid osteomyelitis with epidural abscess was discovered on further workup with neuroimaging. Concurrent jugular vein and transverse sinus venous thrombosis was also found and suspected to be secondary to the pyogenic odontoid osteomyelitis. Patient was treated with intravenous antibiotics for the osteomyelitis as well as intravenous heparin for the venous thrombosis. To our knowledge, this is the first case reported in literature of transverse sinus venous thrombosis secondary to odontoid osteomyelitis. Rohit Aiyer, Janice Hwang, and Edward H. Yu Copyright © 2017 Rohit Aiyer et al. All rights reserved. Traumatic Haemorrhagic Cervical Lymphadenopathy with Underlying Infectious Mononucleosis Wed, 18 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/3097414/ A 16-year-old male presented to the Emergency Department with a painful 3 × 3 cm left-sided neck swelling six hours following blunt trauma to the neck from a heavy swinging door. A CT angiogram was performed which revealed a large haemorrhagic lymph node as well as generalised cervical lymphadenopathy. The patient was eventually diagnosed with infectious mononucleosis. This case report describes a rare case of traumatic haemorrhagic cervical lymphadenopathy with an underlying diagnosis of infectious mononucleosis. George Rahmani and Sarah Power Copyright © 2017 George Rahmani and Sarah Power. All rights reserved. Superinfection of a Dead Hepatic Echinococcal Cyst with a Cutaneous Fistulization Wed, 18 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/9393462/ Cystic echinococcosis (CE), also known as “hydatid disease” (HD), is a zoonotic infection caused by the larval stage of Echinococcus granulosus, which infects humans as intermediate hosts through the orofecal route. Carried by the intestinal venous blood, the embryos released by the eggs of the tapeworms can reach every organ, especially the liver, turning into a hydatid cyst. Usually asymptomatic, the cysts can be incidentally detected through radiological examinations performed for other reasons. We show an unusual case of superinfection of a hydatid cyst with typical radiological features of inactivity (WHO-type CE5) with an even rarer skin fistulization passing through a subcutaneous-abdominal abscess involving the right iliac muscle. Giuseppe Cicero, Alfredo Blandino, Giorgio Ascenti, Tommaso D’Angelo, Luciano Frosina, Carmela Visalli, Ignazio Salamone, Maria Adele Marino, Marco Cavallaro, and Silvio Mazziotti Copyright © 2017 Giuseppe Cicero et al. All rights reserved. Endovascular Repair with a Stent Graft in a Patient with Aortoduodenal Fistula after Radiation Therapy Tue, 17 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/2087142/ Primary aortoduodenal fistula (ADF) is a direct communication between the abdominal aorta and the gastrointestinal tract without any previous vascular intervention and represents a rare but critical cause of repeated and massive gastrointestinal bleeding. Primary ADF often occurs as a result of atherosclerotic aneurysm and infection, but ADF involving a normal-size aorta is rare; furthermore, ADF related to radiation therapy is extremely rare. We present the case of a 56-year-old man with a history of bowel obstruction due to radiation enteritis who was admitted with severe hematemesis and hemorrhagic shock. Gastroduodenal endoscopy and contrast-enhanced computed tomography findings were unremarkable. Aortoduodenal fistula was suspected based on the diffuse calcification of the abdominal aorta confined to the radiation field and the presence of an aortoduodenal communication on angiography. Endovascular repair with a stent graft seemed to be a safer option than open surgery and was suited to the rapid control of bleeding from ADF because of the patients’ unstable hemodynamic state and the presence of intestinal adhesions. The fistula was successfully sealed by endovascular stent graft placement. Hematemesis did not recur postoperatively and anemia gradually improved. The patient died from pneumonia 33 days later. Kazuhiko Morikawa, Hirokazu Ashida, Yosuke Nozawa, Kenji Motohashi, Takao Igarashi, Hiroya Ojiri, Yuji Kanaoka, and Takao Ohki Copyright © 2017 Kazuhiko Morikawa et al. All rights reserved. Carotidynia: A Rare Diagnosis for Unilateral Neck Pain Revealed by Cross-Sectional Imaging Sun, 24 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/7086854/ Idiopathic carotidynia (IC) is a rare and poorly understood syndrome consisting of unilateral neck pain, tenderness, and increased pulsations over the affected carotid bifurcation. A growing body of evidence supports the hypothesis that IC is a distinct clinicopathologic entity with characteristic imaging features. We report the case of a 34-year-old Caucasian male presenting with intense unilateral neck pain in the emergency setting. Computed tomography and ultrasonography revealed fusiform eccentric thickening of the ipsilateral carotid bifurcation without vessel narrowing. Contrast-enhanced magnetic resonance imaging depicted major perivascular enhancement without evidence of dissection. Further imaging and laboratory work-up excluded vasculitis. The diagnosis of IC was made. The patient was treated with nonsteroidal anti-inflammatory drugs and symptoms and imaging findings disappeared within a few weeks. Cross-sectional imaging allows not only ruling out IC mimickers but also making the correct diagnosis of this rare condition, in particular, as the clinical presentation of IC is often nonspecific. Corrado Santarosa, Salvatore Stefanelli, Roman Sztajzel, Pravin Mundada, and Minerva Becker Copyright © 2017 Corrado Santarosa et al. All rights reserved. A Case of Ruptured Pulmonary Hydatid Cyst of the Liver and Review of the Literature Sun, 24 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/7639056/ Background. Hydatid cyst is an endemic disease frequently localized to the liver. It is frequently observed in Southeast Europe, Middle East, and Turkey. Although the cyst rupture can occur spontaneously, it can also occur upon albendazole treatment. Its surgical treatment includes cystotomy, capitonnage, and wedge resection. Material-Method. A 56-year-old male immigrant was admitted with fever, pain, and cough. Albendazole treatment was initiated and elective surgery was planned. Upon his admission to emergency service, he was diagnosed with pneumonia, and a spontaneous cyst rupture was detected. Result. Thoracotomy and cystotomy were performed. Bile leakage aspiration and lung wedge resection were also performed. Conclusion. Different surgical methods are used in the treatment of hydatid cysts depending on the localization and complications. Follow-up with antihelminthic drugs such as albendazole and mebendazole is recommended in medical treatment. Nilufer Bulut and Sevinc Dagıstanlı Copyright © 2017 Nilufer Bulut and Sevinc Dagıstanlı. All rights reserved. Imaging, Histopathologic, and Treatment Nuances of Pulmonary Carcinosarcoma Sun, 17 Sep 2017 08:31:39 +0000 http://www.hindawi.com/journals/crira/2017/8135957/ A 76-year-old female with coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus type II, and 40 pack-year smoking history presented with a four-day history of cough, productive of green-yellow sputum. Chest X-ray revealed opacification of the left upper lung field, and computed tomography (CT) of the chest showed a large cavitary lesion invading the T2-T3 vertebral bodies, extending into the epidural space, giving rise to mild cord compression. Biopsy of the lesion revealed a poorly differentiated neoplasm composed of distinct epithelial and mesenchymal components, consistent with carcinosarcoma. A metastatic workup was negative. Primary lung carcinosarcoma is a rare tumour that can demonstrate an especially aggressive clinical course; diagnosis is often nuanced by limited sampling at initial presentation, especially in a setting of advanced disease and debility that precludes consideration for upfront resection or more extensive, invasive sampling. Tyler Gleason, Michael Haas, and Brian H. Le Copyright © 2017 Tyler Gleason et al. All rights reserved. Radiological Diagnosis of a Rare Premature Aging Genetic Disorder: Progeria (Hutchinson-Gilford Syndrome) Tue, 12 Sep 2017 09:36:00 +0000 http://www.hindawi.com/journals/crira/2017/1305360/ Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare disease with a combination of short stature, bone abnormalities, premature ageing, and skin changes. Though the physical appearance of these patients is characteristic, there is little emphasis on the characteristic radiological features. In this paper, we report a 16-year-old boy with clinical and radiological features of this rare genetic disorder. He had a characteristic facial appearance with a large head, large eyes, thin nose with beaked tip, small chin, protruding ears, prominent scalp veins, and absence of hair. Haji Mohammed Nazir, Akshiitha Ramesh Baabhu, Yuvaraj Muralidharan, and Seena Cheppala Rajan Copyright © 2017 Haji Mohammed Nazir et al. All rights reserved. Primary Neuroendocrine Breast Carcinoma in a 13-Year-Old Girl: Ultrasonography and Pathology Findings Sun, 10 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/7915806/ Neuroendocrine carcinoma (NEC) of the breast is a rare disease and has been scarcely reported by African authors. The authors report a case of breast NEC in a 13-year-old African girl initially diagnosed as an atypical adenofibroma by ultrasonography. Ultrasound-guided biopsy and conventional histological examination indicated two potential diagnoses: primary malignant non-Hodgkin’s lymphoma and undifferentiated carcinoma. According to immunohistochemistry performed on paraffin blocks in France, infiltrating ductal carcinoma with a strong neuroendocrine component was confirmed by CD56, CD57, and chromogranin A markers. Mazamaesso Tchaou, Tchin Darré, Koué Folligan, Akomola Sabi, Lantam Sonhaye, Azanledji Boumé, Akila Bassowa, Solange Adani-Ifé, and Gado Napo-Koura Copyright © 2017 Mazamaesso Tchaou et al. All rights reserved. Prenatal and Postnatal Sonographic Confirmation of Congenital Absence of the Ductus Venosus in a Child with Noonan Syndrome Wed, 06 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/3068178/ The ductus venosus serves as an important vascular pathway for intrauterine circulation. This case presents a description of an absent ductus venosus in a female patient with Noonan syndrome, including both prenatal and postnatal imaging of the anomaly. In the setting of the anomalous vascular connection, the umbilical vein courses inferiorly to the iliac vein in parallel configuration with the umbilical artery. This finding was suspected based on prenatal imaging and the case was brought to attention when placement of an umbilical catheter was thought to be malpositioned given its appearance on radiography. Ultrasound imaging confirmed the anomalous course. This is in keeping with prior descriptions in the literature of an association between Noonan syndrome and aberrant umbilical venous drainage. This case illustrates the need for awareness of this condition by the radiologist, allowing for identification on radiographs and the recommendation for further confirmatory imaging. Further, the case illustrates the value of paying particular attention to the fetal course of the umbilical vessels in patients with suspected Noonan syndrome, as this population is particularly at risk for anomalous vasculature. Christopher L. Newman, Matthew R. Wanner, and Brandon P. Brown Copyright © 2017 Christopher L. Newman et al. All rights reserved. The Monitoring of Preoperative External Detorsion with Diffusion-Weighted Imaging in a Patient with Acute Testicular Torsion Mon, 28 Aug 2017 07:47:17 +0000 http://www.hindawi.com/journals/crira/2017/3702873/ Testicular torsion is one of the main causes of acute scrotum and may result in permanent damage of the testicular tissue. Color Doppler imaging has been frequently used in the diagnosis of testicular torsion and posttreatment follow-up period of the disease. There are some studies reporting the value and usefulness of diffusion-weighted imaging in the diagnosis of testicular torsion. However, to the best of our knowledge, there is no report regarding the monitoring of preoperative external detorsion in testicular torsion with diffusion-weighted imaging examination. In this article, diffusion-weighted imaging findings in the management of preoperative external detorsion in a case with testicular torsion were presented. Mehmet Beyazal, Fatma Beyazal Çeliker, Mehmet Fatih İnecikli, Maksude Esra Kadioğlu, Hasan Rıza Aydın, and Tuğba Durakoğlugil Copyright © 2017 Mehmet Beyazal et al. All rights reserved. Breast Abscessed Cancer in Nonlactating Women in Tropical Environment: Radiological, Bacteriological, and Anatomopathological Features about 3 Cases Sun, 27 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/1639847/ The association of breast cancer and abscess is rare in daily practice. The authors report a short series of 3 cases of cancer of the breast in nonlactating women presented as breast abscess, reviewing aspects in radiology (ultrasound and mammography), correlating them with the histopathology findings and the bacteriological profile of the isolated germs. Mazamaesso Tchaou, Tchin Darre, Ayi Kossi Amavi, Kokou Kouliwa Kanassoua, Bidamin N’Timon, Lantam Sonhaye, Lama-Kegdigoma Agoda-Koussema, and Komlavi Adjenou Copyright © 2017 Mazamaesso Tchaou et al. All rights reserved. A Rare Cause of Obstructive Sleep Apnea Syndrome: Retropharyngeal Lipoma Mon, 21 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/2134362/ Lipoma is the most common benign mesenchymal neoplasm. About 16% of lipomas arise in the head and neck region, especially in the posterior neck. Large lipomas that originate from the retropharyngeal space may cause dyspnea, dysphagia, and snoring and occasionally may lead to obstructive sleep apnea syndrome (OSAS). Herein, we report a 45-year-old male patient with OSAS caused by a giant retropharyngeal lipoma with emphasis on CT findings. Okan Dilek, Omer Kaya, Cengiz Yilmaz, Gokhan Soker, Bozkurt Gulek, and Mehmet Ali Akin Copyright © 2017 Okan Dilek et al. All rights reserved. New Insights about Pulmonary Epithelioid Hemangioendothelioma: Review of the Literature and Two Case Reports Mon, 14 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/5972940/ Pulmonary epithelioid hemangioendothelioma (PEH) is a rare neoplasm of vascular origin. There are three different major imaging patterns identified in thoracic manifestation of epithelioid hemangioendothelioma: (1) multiple pulmonary nodules; (2) multiple pulmonary reticulonodular opacities; and (3) diffuse infiltrative pleural thickening. Radiographically, presence of bilateral multiple nodules is the most common pattern of presentation. The diagnosis is made on the basis of histopathological findings and confirmed by positive immunohistochemistry staining. Although the prognostic factors for PEH have not yet been well established, a better prognosis is usually associated with the multinodular pattern. We report two different imagological presentations of this rare disease, based on two institutional experiences, along with a review of the relevant literature. Romeu Duarte Mesquita, Marta Sousa, Carmen Trinidad, Eugénia Pinto, and Iosu Antón Badiola Copyright © 2017 Romeu Duarte Mesquita et al. All rights reserved. Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review Wed, 26 Jul 2017 08:21:12 +0000 http://www.hindawi.com/journals/crira/2017/6989673/ Pancreaticoduodenal artery aneurysms (PDA) are rare visceral aneurysms. Celiac trunk stenosis represents a common attributable aetiology for those aneurysms. Therefore, an alternative treatment approach, which differs from those isolated aneurysms, is recommended. We hereby present a 77-year-old male patient who was admitted with sudden onset of severe abdominal pain and significant drop in haemoglobin, occurring within a 24-hour interval. Contrast-enhanced computed tomography revealed a ruptured visceral aneurysm arising from the anterior branch of the inferior pancreaticoduodenal artery. A severe stenosis was also noted at the take-off of the celiac trunk. Selective catheterization of the supplying branch of the superior mesenteric artery, followed by coil embolization of the aneurysm, was performed, resulting in cessation of flow within the aneurysm, with preservation of the posterior branch, supplying the celiac territory. PDAs are usually asymptomatic and discovered incidentally at rupture. The risk of rupture is independent of the aneurysmal size and is associated with a 50% mortality rate. The consensus on coping with aneurysms is to treat them whenever they are discovered. Selective angiography followed by coil embolization represents a less invasive, and frequently definitive, approach than surgery. The risk for ischemia mandates that the celiac territory must not be compromised after embolization. Jad A. Degheili, Alissar El Chediak, Mohamad Yasser R. Dergham, Aghiad Al-Kutoubi, and Ali H. Hallal Copyright © 2017 Jad A. Degheili et al. All rights reserved. Osteoblastic Metastases Mimickers on Contrast Enhanced CT Wed, 26 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/7278016/ Secondary osseous involvement in lymphoma is more common compared to primary bone lymphoma. The finding of osseous lesion can be incidentally discovered during the course of the disease. However, osseous metastases are infrequently silent. Detection of osseous metastases is crucial for accurate staging and optimal treatment planning of lymphoma. The aim of imaging is to identify the presence and extent of osseous disease and to assess for possible complications such as pathological fracture of the load-bearing bones and cord compression if the lesion is spinal. We are presenting two patients with treated lymphoma who were in complete remission. On routine follow-up contrast enhanced CT, there were new osteoblastic lesions in the spine worrisome for metastases. Additional studies were performed for further evaluation of both of them which did not demonstrate any corresponding suspicious osseous lesion. The patients have a prior history of chronic venous occlusive thrombosis that resulted in collaterals formation. Contrast enhancement of the vertebral body marrow secondary to collaterals formation and venous flow through the vertebral venous plexus can mimic the appearance of spinal osteoblastic metastases. Fahad Al-Lhedan, Sam Samaan, and Wanzhen Zeng Copyright © 2017 Fahad Al-Lhedan et al. All rights reserved. Spontaneous Hematoma of the Rectus Sheath: Urgent Embolization with Squidperi Liquid Embolic Device Thu, 13 Jul 2017 09:14:25 +0000 http://www.hindawi.com/journals/crira/2017/3420313/ We treated a 78-year-old female affected by nontraumatic spontaneous rectus sheath hematoma. We decided to perform the embolization with the new liquid agent Squidperi. Complete exclusion of the bleeding vessel was obtained without complications. Its use should be considered for treatment of nontraumatic rectus sheath hematoma. Pierluca Torcia, Umberto G. Rossi, Silvia Squarza, and Maurizio Cariati Copyright © 2017 Pierluca Torcia et al. All rights reserved. Primary Osteosarcoma of the Breast Arising in an Intraductal Papilloma Wed, 21 Jun 2017 06:34:11 +0000 http://www.hindawi.com/journals/crira/2017/5787829/ Introduction. Primary osteosarcoma of the breast is extremely rare, and an osteosarcoma arising from an intraductal papilloma is exceptional. Case Presentation. A 72-year-old Saudi Arabian woman presented with a solid, bone-containing breast mass that was diagnosed as primary osteosarcoma of the breast on biopsy. She had a history of untreated intraductal papilloma. Treatment was completed with a modified mastectomy after excluding extramammary metastases. However, she subsequently developed multiple recurrent lesions at the same site. Conclusion. Primary osteogenic sarcomas of the breast are very rare. Although the main treatment is resection the optimal management remains uncertain and prognosis is poor. Khalefa Ali Alghofaily, Musab Hamoud Almushayqih, Muhannad Faleh Alanazi, Abdullah Abdulrahman Bin Salamah, and Halldor Benediktsson Copyright © 2017 Khalefa Ali Alghofaily et al. All rights reserved. Magnetic Resonance Enterography Findings of Intestinal Behçet Disease in a Child Wed, 24 May 2017 07:45:32 +0000 http://www.hindawi.com/journals/crira/2017/8061648/ Behçet’s disease (BD) is a multisystem disorder of unknown aetiology, characterized by recurrent oral ulcers, genital ulcers, uveitis, skin lesions, and pathergy. Gastrointestinal disease outside the oral cavity is well recognized and usually takes the form of small intestinal ulcers, with the most significant lesions frequently occurring in the ileocaecal region. Symptoms usually include nausea, vomiting, colicky abdominal pain, and change in bowel habit and it is not unusual that patients may present late, with life-threatening complications requiring surgery. Diagnosis has been hindered for many years by limitations in imaging the small bowel and it is usually achieved by means of endoscopy and CT of the abdomen. Magnetic resonance enterography (MRE) is a relatively new technique, which has a high diagnostic rate in patients with Crohn’s disease (CD). Although many similarities between CD and intestinal BD have already been described in literature, the role of MRE in the evaluation of intestinal BD has never been defined up to now. We report a case of a 12-year-old female patient with diagnosis of BD who presented at our institution for recurrent colicky abdominal pain and diarrhoea. The patient underwent MRE that demonstrated the gastrointestinal involvement. Tommaso D’Angelo, Romina Gallizzi, Claudio Romano, Giuseppe Cicero, and Silvio Mazziotti Copyright © 2017 Tommaso D’Angelo et al. All rights reserved. Chronic Dialysis Dependent Renal Failure Resulting from a Massive Bladder Containing Inguinal Hernia Sun, 07 May 2017 07:43:24 +0000 http://www.hindawi.com/journals/crira/2017/2368237/ Bladder involvement in inguinal hernia is relatively rare, 1–4%, although the incidence is increased to 10% with advancing age or obesity. There are several previously reported cases presenting with obstructive uropathy and renal failure, but all reversed with urinary diversion and hernia repair. We believe this to be the first reported case of bladder hernia leading to dialysis dependent chronic renal failure. Michael M. Herskowitz, Jamel Reid, and Robert F. Leonardo Copyright © 2017 Michael M. Herskowitz et al. All rights reserved. Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids Wed, 03 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/2520989/ Uterine fibroids, the most common benign tumor in women of childbearing age, may cause symptoms including pelvic pain, menorrhagia, dysmenorrhea, pressure, urinary symptoms, and infertility. Various approaches are available to treat symptomatic uterine fibroids. Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) represents a recently introduced noninvasive safe and effective technique that can be performed without general anesthesia, in an outpatient setting. We review the principles of MRgFUS, describing patient selection criteria for the treatments performed at our center and we present a series of five selected patients with symptomatic uterine fibroids treated with this not yet widely known technique, showing its efficacy in symptom improvement and fibroid volume reduction. Laura Geraci, Alessandro Napoli, Carlo Catalano, Massimo Midiri, and Cesare Gagliardo Copyright © 2017 Laura Geraci et al. All rights reserved. Skeletal Muscle Involvement in B-Cell Lymphoma: Two Cases Illustrating the Contribution of Imaging to a Clinically Unsuspected Diagnosis Sun, 30 Apr 2017 08:31:30 +0000 http://www.hindawi.com/journals/crira/2017/2068957/ Skeletal muscle lymphoma is rare, comprising only a very small subset of lymphoma cases. There are characteristic imaging features which, if recognized, can prevent delay in diagnosis and treatment, particularly when not suspected clinically. Herein, we report two cases of skeletal muscle lymphoma with nearly identical imaging features; the first is an example of primary muscle lymphoma in a 17-year-old boy with back and thigh pain, and the second represents lymphoma recurrence in a 55-year-old man with HIV. Characteristic features seen on MRI were key in raising suspicion for the disease and helped prevent a delay in pathologic diagnosis. Elijah Burton, Kristian Schafernak, Elaine Morgan, and Jonathan Samet Copyright © 2017 Elijah Burton et al. All rights reserved. Port Placement via the Anterior Jugular Venous System: Case Report, Anatomic Considerations, and Literature Review Mon, 10 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/2790290/ We report on a patient who was referred for port implantation with a two-chamber pacemaker aggregate on the right and total occlusion of the central veins on the left side. Venous access for port implantation was performed via left side puncture of the horizontal segment of the anterior jugular vein system (AJVS) and insertion of the port catheter using a crossover technique from the left to the right venous system via the jugular venous arch (JVA). The clinical significance of the AJVS and the JVA for central venous access and port implantation is emphasised and the corresponding literature is reviewed. Gernot Rott and Frieder Boecker Copyright © 2017 Gernot Rott and Frieder Boecker. All rights reserved. Brain Herniation into Giant Arachnoid Granulation: An Unusual Case Tue, 14 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/8532074/ Arachnoid granulations are structures filled with cerebrospinal fluid (CSF) that extend into the venous sinuses through openings in the dura mater and allow the drainage of CSF from subarachnoid space into venous system. Usually they are asymptomatic but can be symptomatic when large enough to cause sinus occlusion. We report a rare case of a brain herniation into a giant arachnoid granulation in an asymptomatic elderly male patient, which was discovered incidentally. Joana Ruivo Rodrigues and Gonçalo Roque Santos Copyright © 2017 Joana Ruivo Rodrigues and Gonçalo Roque Santos. All rights reserved. Giant Splenorenal Shunt in a Young Patient with Autoimmune Hepatitis/Primary Biliary Cholangitis Overlap Syndrome and Portal Vein Thrombosis Mon, 20 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/crira/2017/2167364/ We present a case of giant Splenorenal Shunt (SRS) associated with portal vein thrombosis in a 37-year-old woman with a twelve-year history of autoimmune hepatitis/primary biliary cholangitis overlap syndrome. At the moment of the CT examination laboratory tests showed creatinine 1.5 mg/dl, bilirubin 1.5 mg/dl, INR 3, and Na 145 mmol/l and the Model End-Stage Liver Disease score was 24. Extensive calcified thrombosis causing complete occlusion of the portal vein lumen and partially occluding the origin of the superior mesenteric vein was present and a small calcified thrombus in the Splenic Vein lumen was also evident. SRS was located among the spleen hilum and the left kidney with a maximum diameter of 3.25 cm and was associated with dilatation of left renal vein and inferior vena cava. After a multidisciplinary evaluation the patient was put on the Regional Liver Transplant waiting list and liver transplantation was performed successfully. Although portal vein thrombosis and SRS are common occurrences in cirrhotic patients, the impact in the natural history of the disease is still unclear. Careful management and accurate imaging protocols are essential in the evaluation of those patients. F. Chegai, A. U. Cavallo, M. Forcina, V. Giuricin, F. Castellani, L. Greco, M. Manuelli, T. M. Manzia, and G. Sergiacomi Copyright © 2017 F. Chegai et al. All rights reserved. Thrombosis of the Azygos Anterior Cerebral Artery Sun, 12 Feb 2017 12:39:32 +0000 http://www.hindawi.com/journals/crira/2017/5409430/ The azygos anterior cerebral artery is a rare variant, characterized by the absence of the anterior communicating artery and the union of two proximal segments of the anterior cerebral artery, forming a single trunk and ascending through the interhemispheric fissure. The incidence in the population varies from 0.3 to 2%. The presence of occlusion for this vessel causes bifrontal infarcts, with potentially devastating functional consequences, hence the importance of recognizing this anatomical variation in imaging exams. Camila Soares Moreira de Sousa, Carla Lorena Vasques Mendes de Miranda, Marcelo Coelho Avelino, Breno Braga Bastos, Rafael Soares Moreira de Sousa, and Carla Valéria Vasques Mendes de Miranda Copyright © 2017 Camila Soares Moreira de Sousa et al. All rights reserved. CT and MRI Features of Pediatric-Aged Colloid Cysts: Report of Two Cases Tue, 31 Jan 2017 07:13:41 +0000 http://www.hindawi.com/journals/crira/2017/2467085/ A 10-year-old boy with the history of headache, anorexia, and vomiting was referred to our department to undergo a brain CT scan. CT images demonstrated a well-defined, rounded, hyperdense lesion at the level of the foramen of Monro causing moderate dilatation of the lateral ventricles. An 11-year-old girl with a long history of a headache was also referred to undergoing a brain MRI. MR images demonstrated a well-defined round abnormal signal intensity lesion at the level of the foramen of Monro causing moderate dilatation of lateral ventricles. The findings from imaging perspective were consistent with the colloid cyst of the third ventricle. Therefore, the diagnosis of the colloid cyst was made. Hidayatullah Hamidi, Fazel Rahman Faizi, Najibullah Rasouly, and Mer Mahmood Shah Hoshang Copyright © 2017 Hidayatullah Hamidi et al. All rights reserved. Ectopic Thyroid Tissue in the Mediastinum Characterized by Histology and Functional Imaging with I-123 SPECT/CT Mon, 30 Jan 2017 09:31:21 +0000 http://www.hindawi.com/journals/crira/2017/9084207/ Ectopic thyroid tissue is a rare entity and when discovered it is typically along the pathway of embryologic migration of the thyroid. We present a case of incidental finding of ectopic thyroid tissue within mediastinum in a 61-year-old female patient with a history of total thyroidectomy for thyroiditis and nodules. The patient presented to emergency room with cough and right chest pain and underwent a chest computed tomographic angiogram (CTA) to exclude pulmonary embolism as part of chest pain workup. One right paratracheal mediastinal soft tissue nodule was visualized on the images of CTA. This right paratracheal soft tissue mass was found to be ectopic benign thyroid tissue by histological analysis of the biopsied tissue samples. The function of this ectopic thyroid tissue was characterized by I-123 radioiodine uptake and single photon emission computed tomography/computed tomography (SPECT/CT) imaging. This case illustrates that ectopic thyroid tissue should be included for differential diagnosis of a hyperdense soft tissue mass located within mediastinum. I-123 SPECT/CT is useful for guiding tissue biopsy of ectopic thyroid tissue distant from orthotopic thyroid gland and functional and anatomic characterization of mediastinal ectopic thyroid tissue for surgical resection when it is medically necessary. Jed Hummel, Jason Wachsmann, Kelley Carrick, Orhan K. Oz, Dana Mathews, and Fangyu Peng Copyright © 2017 Jed Hummel et al. All rights reserved. Testicular Vasculitis: A Sonographic and Pathologic Diagnosis Thu, 26 Jan 2017 09:38:22 +0000 http://www.hindawi.com/journals/crira/2017/8923621/ Very little has been published about single-organ vasculitis of the testicle in the radiological literature. Consequently, it is a diagnosis that is unfamiliar to most radiologists. This case report describes the sonographic, pathologic, and laboratory findings of testicular vasculitis and reviews the available literature with regard to this subject. Anuj Dixit, Cameron Hague, and Simon Bicknell Copyright © 2017 Anuj Dixit et al. All rights reserved.