Case Reports in Radiology The latest articles from Hindawi Publishing Corporation © 2017 , Hindawi Publishing Corporation . All rights reserved. Cystic Echinococcosis: A Case of Extrahepatic Intra-Abdominal Involvement Tue, 17 Jan 2017 08:27:13 +0000 Hydatid disease, or echinococcal disease, is a parasitic infestation caused by the larval stage of the Echinococcus tapeworm and it primarily affects the liver and lung but involvement of other organs is also possible secondary to peritoneal seeding or hematogeneous dissemination. We describe a rare case of extensive abdominal disease, with lesions affecting the liver, peritoneum, and lesser omentum, requiring aggressive surgical intervention. Complementary diagnostic exams were crucial to reach the diagnosis and evaluate the extension of the disease. Patrícia Leitão, André Carvalho, Teresa Fernandes, and José Gonçalves Copyright © 2017 Patrícia Leitão et al. All rights reserved. A Rare Case of Diffuse Hemangiomatosis of the Spleen with Splenic Rupture following Aortic Valve Replacement Thu, 12 Jan 2017 08:08:41 +0000 In this paper we present a rare case of splenic rupture that occurred after an open aortic valve replacement in a male patient with hemangiomatosis of the spleen and the liver. The patient was treated with an emergency splenectomy. He showed no other sings of associated systemic disorder, such as Klippel-trénaunay syndrome or Proteus syndrome. F. Capilli, M. Weinbeck, M. Czerny, M. Siepe, and T. Krauss Copyright © 2017 F. Capilli et al. All rights reserved. Tubular Carcinoma of the Breast: Advantages and Limitations of Breast Tomosynthesis Mon, 26 Dec 2016 11:32:51 +0000 Tubular carcinoma of the breast is a rare variant of invasive ductal carcinoma. We report a case of 42-year-old asymptomatic female with a histopathological proven multifocal tubular carcinoma, studied by mammography, Tomosynthesis, Ultrasound, and Magnetic Resonance. Herein, we discuss the advantages and limitations of Tomosynthesis, an emerging imaging technique, in this particular case. Filipa Vilaverde, Ana Rocha, and Alcinda Reis Copyright © 2016 Filipa Vilaverde et al. All rights reserved. Diffuse Gallium-67 Accumulation in the Left Atrial Wall Detected Using SPECT/CT Fusion Images Tue, 20 Dec 2016 14:36:18 +0000 Gallium-67 scintigraphy is useful for detecting active inflammation. We show a 66-year-old female patient with atrial fibrillation and diffuse thickening of the left atrial wall due to acute myocarditis, who presented diffuse abnormal accumulation of gallium-67 in the left atrium on single photon emission computed tomography/computed tomography (SPECT/CT) fusion images. In the second gallium-67 scan 2 months after the first scintigraphy, the abnormal accumulation in the heart was no longer visible. Gallium-67 SPECT/CT images helped understanding the disease condition that temporary inflammation in the left atrium caused atrial fibrillation. Kohei Kotani, Joji Kawabe, Shigeaki Higashiyama, Atsushi Yoshida, and Susumu Shiomi Copyright © 2016 Kohei Kotani et al. All rights reserved. A Retroperitoneal Isolated Enteric Duplication Cyst Mimicking a Teratoma: A Case Report and Literature Review Mon, 19 Dec 2016 13:50:38 +0000 Enteric duplication cysts lacking anatomic association with the gastrointestinal tract are called isolated enteric duplication cysts (IEDCs). We present an atypical case of a retroperitoneal IEDC with a tortuous tubular complex shape that enfolded the surrounding retroperitoneal fat and mimicked a retroperitoneal teratoma. Multiplanar reconstruction images should be used to evaluate such a lesion correctly. A tortuous tubular complex shape could be a key finding to differentiate from other retroperitoneal cysts. Daichi Momosaka, Yasuhiro Ushijima, Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Tetsuo Ikeda, Keiichiro Uchida, Masaaki Sugimoto, Kenichi Kohashi, and Hiroshi Honda Copyright © 2016 Daichi Momosaka et al. All rights reserved. Gliosarcoma with Primary Skull Base Invasion Thu, 08 Dec 2016 08:36:52 +0000 Gliosarcoma is an uncommon variant of glioblastoma, which commonly demonstrates dural attachment. However, skull base invasion is rarely seen with this entity. Herein, we report a 44-year-old female patient diagnosed with primary intracranial gliosarcoma extensively invading the skull base and muscles of mastication. She presented to our institution with a three-month history of difficult right jaw opening and retro-orbital pressure and one week of severe right-sided postauricular headache. Head CT demonstrated a 6 cm mass with marked bony erosion. Brain MRI at a one-week interval more clearly characterized tumor extension through the right orbit and muscles of mastication, with overall growth to 7 cm and worsening midline shift. The patient underwent a right frontotemporal craniotomy for gross total resection. Pathology confirmed the diagnosis of gliosarcoma, IDH-wildtype (WHO grade IV). Her postoperative course was uneventful and she was discharged at preoperative neurologic baseline. To our knowledge, this is the third reported case of a primary intracranial gliosarcoma with direct invasion of skull base, brain parenchyma, and extracranial compartment. However, this is the first report case of primary GS invading the surrounding musculature and orbit. This case report highlights the rapid aggressiveness of gliosarcomas and further a prior undescribed radiographic and anatomic finding of skull base invasion with this entity. Quoc-Bao D. Nguyen, Avital Perry, Christopher S. Graffeo, Cody L. Nesvick, Aditya Raghunathan, Mark E. Jentoft, Brian P. O’Neill, Padraig P. Morris, Jonathan M. Morris, and Jamie J. Van Gompel Copyright © 2016 Quoc-Bao D. Nguyen et al. All rights reserved. Untreated Superior Vena Cava Aneurysm: Radiological Significance and Review of the Literature Mon, 05 Dec 2016 09:38:47 +0000 Superior vena cava (SVC) aneurysms are a rare entity. The majority of the literature is in the form of case reports. SVC aneurysms are often an incidental finding with iatrogenic, congenital, or idiopathic etiologies. Treatment goals focus on preventing theoretical rupture or thrombus formation. Management options include observation, conservative medical management, surgical excision, and thrombin injection. We present a 73-year-old female with an incidental SVC aneurysm discovered on computed tomography (CT) of the thorax. The patient was observed without intervention for greater than 6 years. No complications were attributable to the SVC aneurysm during follow-up or over the course of the patient’s life. Abhinav Patel, Ryan Cobb, Victor Rivera, and Scott Simpson Copyright © 2016 Abhinav Patel et al. All rights reserved. Thymic Epidermoid Cyst: Clinical and Imaging Manifestations of This Rare Anterior Mediastinal Mass Thu, 24 Nov 2016 12:17:33 +0000 Thymic epidermoid cysts are an extremely rare entity. These arise from epidermal cells that migrate to the thymus. The radiologic diagnosis of this rare lesion is challenging. We describe a case of an otherwise healthy 35-year-old woman who presented with an acute onset of chest pain and shortness of breath. She was found to have an anterior mediastinal mass. The imaging findings were, however, not characteristic for any single diagnostic entity. Since the imaging was inconclusive, surgical resection was performed for definitive diagnosis. The mass was found to be a thymic epidermoid cyst. This case underlines the significance for radiologists to be aware that epidermoid cysts can occur in the thymus and should be considered in the differential diagnosis for a heterogeneous anterior mediastinal mass. Jawad M. Qureshi, Brian Pagano, Jeffrey Mueller, Lana Schumacher, Claudia Velosa, and Matthew S. Hartman Copyright © 2016 Jawad M. Qureshi et al. All rights reserved. Occipital Hypometabolism on FDG PET/CT Scan in a Child with Hodgkin’s Lymphoma Mon, 14 Nov 2016 12:06:07 +0000 It is known that Fluorodeoxyglucose (FDG) Positron Emission/Computed Tomography (PET/CT) images may be helpful for evaluation of brain function in newborns. Here we described the fluorine-18 [18-F] FDG PET/CT imaging findings of encephalomalacia due to perinatal asphyxia in a child with refractory Hodgkin’s Lymphoma (HL) who underwent PET/CT scan to stage the primary disease. Prominent hypometabolism was incidentally detected in the occipital regions bilaterally apart from the FDG uptakes in the malign lymphatic infiltrations. This case highlights the potential coexistence of a malignancy and a functional brain disorder. Inci Uslu Biner, Ebru Tatci, Ozlem Ozmen, Atila Gokcek, Haci Ahmet Demir, and Nadide Basak Gulleroglu Copyright © 2016 Inci Uslu Biner et al. All rights reserved. Rare Case of Posterior Reversible Leukoencephalopathy Syndrome Secondary to Acute Chest Syndrome Thu, 10 Nov 2016 08:41:00 +0000 We present a case of 29/m with a history of sickle cell disease who presented to the emergency department with sudden onset of chest, trunk, extremity, and back pain, consistent in quality and severity with the patient’s usual pain crises. Soon after admission to the medical unit for acute chest syndrome (ACS), the patient developed sudden onset of hypertension associated with left sided hemiplegia, lethargy, dysarthria, aphasia, and left sided facial droop. Neuroimaging revealed that on MRI Brain there was multifocal extensive signal abnormality and a small focal areas of hemorrhage compatible with posterior reversible leukoencephalopathy syndrome (PRES). Patient was treated with levetiracetam and phenytoin and improved soon afterwards, with resolution seen on follow-up MRI two months later. Rohit Aiyer, Daniel Klein, and Yasir El-Sherif Copyright © 2016 Rohit Aiyer et al. All rights reserved. Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy Wed, 09 Nov 2016 13:11:21 +0000 Tuberculosis is a common infectious disease with a high prevalence in developing countries and presents a major public health issue. Internal jugular vein (IJV) thrombosis is a rare complication in tuberculous cervical lymphadenopathy. We report a case of 26-year male patient with a history of low-grade evening rise in fever, dry cough, loss of appetite, and loss of weight with swelling in lower neck on right side. Ultrasonography (USG) neck showed well-defined hypoechoic lymph nodes posterior to right IJV and common carotid artery in the lower neck at level IV and in the right supraclavicular region showing central necrotic areas with adjoining IJV thrombosis. The association between tuberculosis and deep vein thrombosis is rare. Awareness of IJV thrombosis in isolated cervical lymphadenopathy needs high diagnostic suspicion and prompt treatment to avoid fatal complication. Our case is rare as there was isolated tuberculous cervical lymphadenopathy with adjoining IJV thrombosis. Both USG and computed tomography (CT) are accurate and reliable radiological investigations for detecting IJV thrombosis along with cervical lymph nodes. They are useful in assessing surrounding soft tissue and fat planes and knowing the size and extent of cervical lymphadenopathy. USG is inexpensive and readily available for monitoring response to treatment. Sanjay Khaladkar, Avadhesh Chauhan, Arijit Ghosh, Kunaal Jain, and Surbhi Chauhan Copyright © 2016 Sanjay Khaladkar et al. All rights reserved. Cardiac Magnetic Resonance for Evaluating Catheter Related FDG Avidity Thu, 27 Oct 2016 12:54:45 +0000 A 53-year-old female with a history of metastatic left arm melanoma presented for F(18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) which showed a moderately FDG avid focus at her port catheter tip near the cavoatrial junction. Although catheter tip related FDG avidity has previously been suggested to be bland thrombus or infection, melanoma can metastasize to unusual locations including the superior vena cava. In addition, the patient had an elevated risk of anticoagulation due to a history of hemorrhagic brain metastases. Therefore, confirmatory cardiac magnetic resonance (CMR) was obtained and findings were consistent with bland catheter-related thrombus. Daniel Jeong, Kenneth L. Gage, Claudia G. Berman, and Jaime L. Montilla-Soler Copyright © 2016 Daniel Jeong et al. All rights reserved. Bilateral Simultaneous Pseudoangiomatous Stromal Hyperplasia of the Breasts and Axillae: Imaging Findings with Pathological and Clinical Correlation Thu, 27 Oct 2016 11:23:34 +0000 Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a pathology that is usually diagnosed by accident during pathological examination of other breast lesions. PASH is an uncommon and benign tumoral lesion of the mammary stroma that can be pathologically mistaken for other tumours, such as phyllodes, fibroadenoma, and sometimes even angiosarcoma. We report the case of a 45-year-old woman with complaints of huge bilateral breast enlargement. This is a rare case of PASH presenting with gigantomastia and involving bilateral breasts and axillae simultaneously. Mammography, ultrasonography, and MRI features are illustrated with histopathological correlation. Afsaneh Alikhassi, Fereshteh Ensani, Ramesh Omranipour, and Alireza Abdollahi Copyright © 2016 Afsaneh Alikhassi et al. All rights reserved. Congenital Vitelline Band Causing Intestinal Obstruction in an Adult with a Double Inferior Vena Cava Sun, 23 Oct 2016 08:09:17 +0000 Introduction. Vitelline artery remnants are rare causes of intra-abdominal bands leading to bowel obstruction. These bands may be associated with Meckel’s diverticulum. Double inferior vena cava (IVC) is a rare presentation and is usually identified incidentally. Case Presentation. A sixty-year-old male presented with progressive vomiting for five days and he was clinically diagnosed with intestinal obstruction. Plain X-ray abdomen showed evidence of small bowel obstruction. CT scan of the abdomen revealed dilated small bowel loops with a small outpouching in the distal ileum with a band like structure attached to it. In the CT, left sided patent IVC draining into the left renal vein was identified. Left external iliac vein was in continuity with the left IVC. Left internal iliac vein was draining into the right IVC. Exploratory laparotomy revealed a Meckel’s diverticulum with a band identified as the vitelline remnant attached to its apex and inserting at the anterior abdominal wall near the umbilicus. Discussion. Meckel’s diverticulum with vitelline bands, although rare, should be borne in mind in adult patients with intestinal obstruction. Identification of this anomaly can be difficult in imaging studies. Presence of double IVC should be mentioned in the imaging findings to prevent possible catastrophic complications during surgery. Mihiri Wettasinghe, Kumari Pussepitiya, Bandula Samarasinghe, and Nuwan Wickramasinghe Copyright © 2016 Mihiri Wettasinghe et al. 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.