Case Reports in Radiology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Left-Sided Upper Partial Anomalous Pulmonary Venous Return through a Curved Vein Joining the Left Brachiocephalic Vein Sun, 09 Oct 2016 12:24:22 +0000 The evaluation of pulmonary veins during cross-sectional imaging of the chest and the knowledge of their embryology and anatomy are useful for detecting congenital conditions that may be clinically significant. Moreover, with the spread of cross-sectional imaging it is very frequent to find anatomical variants; therefore the radiologist should easily recognize their appearances. This case report shows a left-side upper partial anomalous pulmonary venous return (PAPVR) through a “curved” vein that joins the left brachiocephalic vein, in a female patient who underwent whole-body computed tomography (CT) for staging endometrial cancer. This was an incidental finding, not related to any symptoms; however, we explain the anatomical aspects of this abnormality within the congenital condition of PAPVR and its possible clinical relevance. Eleonora Tricarico, Francesco Tricarico, and Carlo Florio Copyright © 2016 Eleonora Tricarico et al. All rights reserved. Diagnosis and Management of Spontaneous Lumbar Venous Retroperitoneal Hematoma in Setting of Deep Venous Thrombosis: A Case Report and Algorithm Mon, 03 Oct 2016 14:18:30 +0000 Retroperitoneal hematoma is rare and benefits from a systematic approach to prevent morbidity and mortality. Management of such bleeds is based upon patient stability, the cause (spontaneous or posttraumatic), and source (arterial or venous). Herein, the authors describe a diagnostic and management algorithm for retroperitoneal hemorrhage with an example of a rare lumbar venous bleed under the complicated clinical setting of deep venous thrombosis. Joseph Tseng, Michael Leshen, Todd Chapman, Ryan Scott, and Olga Kalinkin Copyright © 2016 Joseph Tseng et al. All rights reserved. Atypical Growth Pattern of an Intraparenchymal Meningioma Mon, 26 Sep 2016 12:49:46 +0000 Meningiomas are the most common primary nonneuroglial extra-axial neoplasms, which commonly present as spherical or oval masses with a dural attachment. Meningiomas without dural attachment are rare and, according to their locations, are classified into 5 varieties, including intraventricular, deep Sylvain fissure, pineal region, intraparenchymal, or subcortical meningiomas. To the best of our knowledge, intraparenchymal meningioma with cerebriform pattern has never been reported. In this paper, we report a 34-year-old Chinese male patient who presented with paroxysmal headaches and progressive loss of vision for 10 months and blindness for 2 weeks. A thorough physical examination revealed loss of bilateral direct and indirect light reflex. No other relevant medical history and neurologic deficits were noted. Computed tomography and magnetic resonance imaging scans showed an irregular mass with a unique cerebriform pattern and extensive peritumoral edema in the parietal-occipital-temporal region of the right cerebral hemisphere. The initial diagnosis was lymphoma. Intraoperatively, the tumor was completely buried in a sulcus in the parietal-occipital-temporal region without connecting to the dura. The histological diagnosis was intracranial meningioma based on pathological examination. Therefore, when an unusual cerebriform growth pattern of a tumor is encountered, an intraparenchymal meningioma should be considered as a differential diagnosis. Zhen Zeng, Tijiang Zhang, Yihua Zhou, and Xiaoxi Chen Copyright © 2016 Zhen Zeng et al. All rights reserved. Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male Thu, 22 Sep 2016 16:15:36 +0000 Intracranial capillary hemangioma (ICH) is a rare entity, with approximately 24 reported cases in the literature. There are only three reported cases of ICH in an adult male. In this case report, we describe the fourth documented case of ICH in an adult male and, to the best of our knowledge, the first ever documented case of ICH in the posterior fossa of an adult male. We also discuss its imaging appearance and differential diagnosis. Jordan Nepute, Jinping Lai, and Yihua Zhou Copyright © 2016 Jordan Nepute et al. All rights reserved. Mediastinal Hibernoma: A Rare Case with Radiologic-Pathologic Correlation Mon, 29 Aug 2016 12:35:07 +0000 Hibernomas, especially located in the mediastinum, are extremely rare benign tumors, which are important to consider in the differential diagnosis of a heterogeneously enhancing mass with areas of fat attenuation on imaging of an often incidentally discovered mass. Other common possibilities in the differential include malignant tumors, such as liposarcoma, hence histopathology is usually required to confirm the diagnosis. Hibernomas often follow the distribution of sites of persistence of brown fat in adults, and intrathoracic locations are unusual. We present a very rare case of a mediastinal hibernoma in a 53-year-old woman. She presented to the emergency department with severe, progressive right neck and shoulder pain with radiation down her arm and was found to have a right apical posterior mediastinal mass on imaging. Initial radiographs of the shoulder showed a soft tissue mass within the apical right hemithorax. Further imaging with CT revealed a well circumscribed, heterogeneously enhancing mass with areas of fat attenuation. Pathology confirmed the diagnosis of mediastinal hibernoma, and the mass was completely excised. Fourteen months after surgery, the patient had a normal chest radiograph, and thirty-two months after surgery, she remains asymptomatic. Maxine Darke, Anil Dasyam, Matthew Then, Kavita Varma, Amir A. Borhani, and Rakesh Varma Copyright © 2016 Maxine Darke et al. All rights reserved. Tailgut Cyst and Perineal Hydatid Cyst: A Case Report with Multimodality Imaging Findings Wed, 17 Aug 2016 11:25:18 +0000 A tailgut cyst is a rare developmental lesion and usually is located in the retrorectal or presacral space. Extrahepatic hydatid disease has been reported in several locations including the pelvis and it often poses a diagnostic challenge. There are very few reported cases of primary perineal hydatid cysts. We present the multimodality imaging findings of a tailgut cyst and concurrent perineal hydatid disease in a 32-year-old male patient. Ibtisam Musallam Aljohani, Khalefa Ali Alghofaily, Sebastian R. McWilliams, and Mnahi Bin Saeedan Copyright © 2016 Ibtisam Musallam Aljohani et al. All rights reserved. Giant Cell Tumor of Bone: Documented Progression over 4 Years from Its Origin at the Metaphysis to the Articular Surface Wed, 17 Aug 2016 09:41:17 +0000 The exact location of origin for giant cell tumors of bone (GCTB) remains controversial, as lesions are not routinely imaged early but rather late when the tumor is large and clinically symptomatic. At the time of diagnosis, GCTB are classically described as lucent, eccentric lesions with nonsclerotic margins, located within the epiphysis to a greater extent than the metaphysis. Here we present a case of a biopsy proven GCTB initially incidentally seen on MRI as a small strictly metaphyseal lesion, which over the course of several years expanded across a closed physis to involve the epiphysis and abut the articular surface/subchondral bone plate. Colin Burke, Thomas Link, Richard J. O’Donnell, Soo-Jin Cho, and Daria Motamedi Copyright © 2016 Colin Burke et al. All rights reserved. Fatal Meningitis in a 14-Month-Old with Currarino Triad Thu, 11 Aug 2016 10:49:29 +0000 We report a case of a 14-month-old girl with undiagnosed Currarino triad presenting acutely with meningitis caused by enteric commensals. Head CT demonstrated a large pneumocephalus. A fistulous neurenteric tract through a presacral mass was present on spine MRI and abdominal CT. The patient had a history of constipation for the last three months. However, an underlying diagnosis of Currarino triad had not been suspected. In retrospect, a sickle-shaped sacral anomaly was present on a previous abdominal radiograph. The patient succumbed to complications of meningitis. The purpose of the case report is to highlight the potentially fatal complication of Currarino triad and sensitize radiologists to look actively for sacral anomalies on abdominal radiographs, especially of children with chronic constipation. Hanan Mohammed Al Qahtani, Khalid Suliman Aljoqiman, Hisham Arabi, Hesham Al Shaalan, and Sumit Singh Copyright © 2016 Hanan Mohammed Al Qahtani et al. All rights reserved. MRI Findings of Syndrome of Acute Bilateral Symmetrical Basal Ganglia Lesions in Diabetic Uremia: A Case Report and Literature Review Sun, 17 Jul 2016 12:32:45 +0000 The syndrome of acute bilateral basal ganglia lesions is an uncommon clinical occurrence exhibiting acute onset of movement abnormalities, which can be seen almost exclusively among patients with chronic renal failure, especially in the setting of concurrent diabetes mellitus. Symmetrical lesions located in basal ganglia demonstrated in MRI are typical manifestation of this syndrome. Our study includes routine MRI examination, MRS, 3D-ASL, and SWI findings, which have been rarely reported and will contribute to diagnosing more cases about this syndrome. Xin Cao, Qiang Fang, and Hao Shi Copyright © 2016 Xin Cao et al. All rights reserved. Painful Os Peroneum Syndrome: Underdiagnosed Condition in the Lateral Midfoot Pain Tue, 05 Jul 2016 09:53:00 +0000 Os peroneum is an accessory ossicle located within the peroneus longus tendon. The painful os peroneum syndrome (POPS) results from a wide spectrum of conditions, including fractures, diastases, and other causes. POPS can result in tenosynovitis or discontinuity of the peroneus longus tendon with a clinical presentation of pain in the lateral aspect of the midfoot. Authors report a typical case of POPS, illustrating this entity through different imaging methods (radiographs, ultrasound, and magnetic resonance imaging). We emphasize the prevalence of this ossicle and discuss painful complications. Francisco Abaete Chagas-Neto, Barbara Nogueira Caracas de Souza, and Marcello Henrique Nogueira-Barbosa Copyright © 2016 Francisco Abaete Chagas-Neto et al. All rights reserved. Müllerian Remnant Cyst as a Cause of Acute Abdomen in a Female Patient with Müllerian Agenesis: Radiologic and Pathologic Findings Thu, 30 Jun 2016 14:17:50 +0000 We report a case of a 17-year-old female with Müllerian agenesis who presented with right sided abdominal pain clinically suspicious for acute appendicitis. Multimodality imaging workup revealed a heterogeneous cystic right upper quadrant mass with surrounding fluid and inflammatory changes. Surgical resection of this mass was performed and a histopathologic diagnosis of a hemorrhagic Müllerian remnant cyst was made, which to the best of our knowledge has never been described in a patient with Müllerian agenesis. Mujtaba Mohammed, Mary Allen-Proctor, and Andrij Wojtowycz Copyright © 2016 Mujtaba Mohammed et al. All rights reserved. Variant PTA Terminating in Cerebellar Artery, Associated with Multiple Aneurysms Thu, 30 Jun 2016 09:36:36 +0000 Persistent trigeminal artery (PTA) is one of the remnant fetal anastomoses between the carotid artery and basilar artery. PTAs are classified according to angiographic appearance and various connection. Among them, those directly terminating in the cerebellar arteries are rare subtype. In addition, aneurysms of the PTA are unusual in the literature and have not previously accompanied this subtype of PTA connecting cerebellar artery. We present the first case of an aneurysm of the PTA which is directly terminating in the cerebellar arteries and combined with multiple aneurysms. Yeong Uk Hwang and Jin Woo Kim Copyright © 2016 Yeong Uk Hwang and Jin Woo Kim. All rights reserved. Fractured Ribs and the CT Funky Fat Sign of Diaphragmatic Rupture Sun, 26 Jun 2016 10:55:40 +0000 Traumatic diaphragmatic rupture remains a diagnostic challenge for both radiologists and surgeons. In recent years, multidetector CT has markedly improved the diagnosis of diaphragmatic injury in polytrauma patients. Herein, we describe two cases of subacute presentation of traumatic diaphragmatic rupture from a penetrating rib fracture and subsequent intrathoracic herniation of omental fat, representing the CT “funky fat” sign. Iclal Ocak and Diane C. Strollo Copyright © 2016 Iclal Ocak and Diane C. Strollo. All rights reserved. Solitary Spinal Epidural Metastasis from Prostatic Small Cell Carcinoma Thu, 16 Jun 2016 11:56:23 +0000 Solitary, spinal epidural metastasis (SEM) that is not related to vertebral metastasis is very rare. And solitary SEM from prostatic cancer is rarely found in previously published reports. However, it is clinically significant due to the possibility of neurologic dysfunction, and it can be assessed by MRI. In this report, we show a case of solitary SEM arising from prostatic small cell carcinoma detected by MRI. Kyung Ryeol Lee and Young Hee Maeng Copyright © 2016 Kyung Ryeol Lee and Young Hee Maeng. All rights reserved. Bilateral Morgagni Hernia: A Unique Presentation of a Rare Pathology Tue, 14 Jun 2016 11:22:50 +0000 Morgagni hernia is an unusual congenital herniation of abdominal content through the triangular parasternal gaps of the anterior diaphragm. They are commonly asymptomatic and right-sided. We present a case of a bilateral Morgagni hernia resulting in delayed growth in a 10-month-old boy. The presentation was unique due to its bilateral nature and its symptomatic compression of the mediastinum. Diagnosis was made by 3D reconstructed CT angiogram. The patient underwent medical optimization until he was safely able to tolerate laparoscopic surgical repair of his hernia. Upon laparoscopy, the CT findings were confirmed and the hernia was repaired. Michael Leshen and Randy Richardson Copyright © 2016 Michael Leshen and Randy Richardson. All rights reserved. Traumatic Cardiac Injury: Ventricular Perforation Caught on CT Sun, 12 Jun 2016 11:33:44 +0000 Myocardial rupture is a rare imaging diagnosis given its clinical severity and high mortality. Early findings should be promptly communicated to the trauma service to ensure immediate intervention. We present a rare case of blowout perforation of the right ventricle which was prospectively diagnosed on computed tomography (CT) leading to emergent operative repair. The patient subsequently survived and was discharged after a lengthy hospital course. Behrad Golshani, Paul Dong, and Scott Evans Copyright © 2016 Behrad Golshani et al. All rights reserved. Multifocal Head and Neck Neurofibromas with Osseous Abnormalities and Muscular Hypoplasia in a Child with Neurofibromatosis: Type I Sun, 12 Jun 2016 06:04:53 +0000 Neurofibromatosis type 1 (NF1) is a clinically and genetically distinct disease involving both neuroectodermal and mesenchymal derivatives. Orofacial manifestations in NF1 have been documented before but occurrence of multifocal intraosseous (IO) and extraosseous (EO) neurofibromas is rare. The present case highlights the importance of imaging findings in the diagnosis and management of multifocal jaw, infratemporal, and parotid neurofibromas with muscular hypoplasia in an eight-year-old girl with NF1. Apart from orthopantomograms (OPG), three-dimensional computed tomography (3D CT) and cross-sectional reformations were valuable in delineating the extent of the lytic lesion and identifying additional bony deformities of the mandible. Magnetic resonance imaging (MRI) helped to identify the solid nature of the lesion and true extent of the soft tissue mass. Rachna Rath, Sheetal Kaur, Shadab Ali Baig, Punyashlok Pati, and Sonalisa Sahoo Copyright © 2016 Rachna Rath et al. All rights reserved. CT Findings of Axillary Tuberculosis Lymphadenitis: A Case Detected by Breast Cancer Screening Examination Thu, 09 Jun 2016 06:21:32 +0000 We report the first description of CT findings of axillary tuberculous lymphadenitis confirmed by the pathological specimen. The breast cancer screening examination is one of the prime methods of detection of axillary tuberculous lymphadenitis. The most common site of axillary tuberculous lymphadenitis is the deep axilla. Screening mammography often fails to cover the whole axilla. The presence on the contrast-enhanced CT of unilateral multiple circumscribed dense nodes, some of which have large and dotted calcifications, might suggest tuberculous lymphadenitis in axillary region. Hiroko Shojaku, Kyo Noguchi, Tetsuya Kamei, Yasuko Tanada, Kouichi Yoshida, Yasuko Adachi, and Kazuhiro Matsui Copyright © 2016 Hiroko Shojaku et al. All rights reserved. Endovascular Embolization of an Aberrant Bronchial Artery Originating from the Internal Mammary Artery in a Patient with Hemoptysis Tue, 07 Jun 2016 06:19:13 +0000 Massive hemoptysis is a life threatening respiratory emergency with high mortality and the bronchial artery (BA) is its most frequent source. Herein, we report a case of a 76-year-old man with recurrent hemoptysis due to an aberrant right BA arising from the right internal mammary artery (IMA), an extremely rare origin, that was clearly depicted on pretreatment computed tomography angiography (CTA). The patient was treated successfully by transcatheter bronchial artery embolization (BAE) of the aberrant BA and the hemoptysis has since been controlled for 9 months. Knowledge of the detailed BA anatomy is essential for performing BAE, especially in cases of aberrant BA. CTA is a promising tool for pretreatment planning of emergency BAE in patients with hemoptysis. Hiroyuki Fujii, Akifumi Fujita, Hiroyasu Nakamura, Takahiro Sasaki, and Hideharu Sugimoto Copyright © 2016 Hiroyuki Fujii et al. All rights reserved. Macroscopic Hematuria and a Bladder Mass: Eosinophilic Cystitis in a 7-Year-Old Boy Tue, 31 May 2016 13:45:16 +0000 We report a case of eosinophilic cystitis in a 7-year-old boy with a history of atopic symptoms, with focus on the radiological findings. He presented with hematuria and dysuria and ultrasonography (US) showed irregular bladder wall thickening resembling a bladder mass. CT urography did not characterize the lesion any further and showed no local or distant spread. Biopsies revealed eosinophilic cystitis, a benign inflammatory condition. We found that US characterized the lesion at least as well as CT and should be the first choice of imaging. When staging is considered before biopsy, MRI should be preferred to CT. There are no specific radiological signs of eosinophilic cystitis. On follow-up, US was a safe, cost-effective imaging modality, but findings should be interpreted in a clinical context. In a child with hematuria and a bladder mass, eosinophilic cystitis is a relevant but rare differential diagnosis, especially when there is a known atopic history. Stine Bjerrum Runge, Søren Høyer, and Louise Winding Copyright © 2016 Stine Bjerrum Runge et al. All rights reserved. New Method of Parent Catheter Advancement in the Balloon Anchor Technique during Balloon-Occluded Transarterial Chemoembolization for Hepatic Tumors Tue, 31 May 2016 08:50:13 +0000 Balloon-occluded transarterial chemoembolization (B-TACE) using a microballoon catheter is a promising method for improvement of lipiodol emulsion accumulation and local control relative to conventional transarterial chemoembolization. This method has been referred to as the balloon anchor technique in previous reports. We report a new technique for successful parent catheter advancement for achievement of stable backup for the selective insertion of a microballoon catheter during B-TACE using the microballoon as an anchor, even in patients with tortuous anatomy of the hepatic and celiac arteries. Deep cannulation of parent catheters was accomplished in all three cases and complications such as vascular injury were not observed in the postprocedure angiograms. Kei Shibuya, Hiroki Tahara, Suguru Takeuchi, Yoshinori Koyama, and Yoshito Tsushima Copyright © 2016 Kei Shibuya et al. All rights reserved. Multisystem Radiologic Manifestations of Erdheim-Chester Disease Tue, 31 May 2016 08:44:36 +0000 Erdheim-Chester Disease is a rare form of multiorgan non-Langerhans’ cell histiocytosis that affects individuals between the ages of 50 and 70 with an equal distribution among males and females. It is associated with significant morbidity and mortality that is mostly due to infiltration of critical organs. Some of the sites that Erdheim-Chester Disease affects include the skeletal system, central nervous system, cardiovascular system, lungs, kidneys (retroperitoneum), and skin. The most common presenting symptom of Erdheim-Chester Disease is bone pain although a large majority of patients are diagnosed incidentally during a workup for a different disease process. Diagnosing Erdheim-Chester Disease is challenging due its rarity and mimicry to other infiltrative processes. Therefore, a multimodality diagnostic approach is employed with imaging being at the forefront. As of date, a comprehensive radiologic review of the manifestations of Erdheim-Chester Disease has rarely been reported. Here we present radiologic findings of an individual suffering from Erdheim-Chester Disease. Umairullah Lodhi, Uzair Sarmast, Saadullah Khan, and Kavitha Yaddanapudi Copyright © 2016 Umairullah Lodhi et al. All rights reserved. Unique Presentation of Hematuria in a Patient with Arterioureteral Fistula Thu, 12 May 2016 17:30:45 +0000 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 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 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 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 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 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 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 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.