A benign laryngeal tumor such as lipoma can sometimes develop airway stenosis. A 56-year-old woman with symptoms of pharyngeal discomfort and dyspnea in the supine position visited an ENT clinic and was diagnosed as having a laryngeal tumor. Endoscopic examination revealed that a space-occupying lesion between the base of the tongue and the epiglottis extended to the laryngeal cavity. Surgical resection was successfully completed without tracheostomy. General anesthesia was induced by nasal intubation assisted by nasal fiberscopy and transoral tumor retraction. Observation under a distending videolaryngoscope confirmed the tumor was raised from the epiglottis. Dissection of the tumor was achieved by fractional excision, and the tumor was diagnosed histologically as lipoma.
A benign laryngeal tumor such as lipoma can sometimes develop airway stenosis. A 56-year-old woman with symptoms of pharyngeal discomfort and dyspnea in the supine position visited an ENT clinic and was diagnosed as having a laryngeal tumor. Endoscopic examination revealed that a space-occupying lesion between the base of the tongue and the epiglottis extended to the laryngeal cavity. Surgical resection was successfully completed without tracheostomy. General anesthesia was induced by nasal intubation assisted by nasal fiberscopy and transoral tumor retraction. Observation under a distending videolaryngoscope confirmed the tumor was raised from the epiglottis. Dissection of the tumor was achieved by fractional excision, and the tumor was diagnosed histologically as lipoma.
neurological disorder with a prevalence of less than 1/1,000,000 [1]. Recently, a number of genes have been identified, known to be associated with familial primary brain calcification (PFBC), causing Fahr’s disease or syndrome [1]. These genes are SCL20A2, PDGFB, PDGFRB and XPR1, and a significant correlation was found between the presence of headache in PDGFB mutations, and parkinsonism with SLC20A2 [2]. We present the case of a 49-year-old woman with Greenlandic Inuit origin and an otherwise unremarkable medical history. She initially presented with symptoms of headache and diplopia. She was referred to a CT scan of the cerebrum, which showed bilateral calcifications of the thalamus and corpus striatum (Figures 1 and 2) compatible with Fahr’s syndrome [1]. Shortly after, the patient developed tremor of the right hand, fatigability especially of her right side, dizziness, and minor cognitive decline. Laboratory studies showed no metabolic disorders such as hypopituitarism, parathyroid disturbances or significant changes in the calcium-phosphate metabolism, besides a minimal hypocalcaemia (free calcium: 1.12 mmol/L, reference 1.17–1.34 mmol/L), which was interpreted as secondary to D-vitamin deficiency (13 nmol/L), very common in the arctic region. No other primary cause for brain calcification was detected, and the patient has a younger sister, who is also diagnosed with Fahr’s syndrome, suggestive of an inherited type. The present case shows that symptoms of Fahr’s syndrome may be few. Furthermore, this exemplifies that neurological manifestations may be confined to one side of the body, despite the presence of bilateral calcifications [1]. This case illustrates the importance of neuroimaging for establishing the diagnosis. Competing Interests The authors have no competing interests to declare.
Case Report A 47-year-old woman was referred to the imaging department for Computed Tomography Angiography (CTA) of the supra-aortic arteries in order to investigate the cause for systemic blood pressure asymmetry. Prior Doppler ultrasonography of the cervical arteries had failed to demonstrate the vertebral arteries. CTA (Figure 1) confirmed major hypoplasia of the vertebral arteries (red and white arrowheads on a) especially on the left side (red arrowhead). These hypoplastic vertebral arteries were not connected to the basilar artery (blue arrowhead on a) which was only fed by a large ascending artery (white arrows on Figures 1 and 2) emerging from a large left internal carotid artery (green circle). 3D volume rendering views without bone removal (Figure 2a and b) showed that this atypical artery was penetrating the skull through the hypoglossus canal (red circle on Figures 1 and 2). The artery was clearly identified as a persistent hypoglossal artery. The finding was considered as fortuitous.
A 14-year-old girl presented to the emergency department. She complained of chronic back pain that recently started to irradiate towards the abdomen. The pain was persistent and progressive. The blood analysis showed a slight increase in white blood cell count and C-reactive protein (CRP). Subsequently abdominal ultrasound (US) was requested. A large well-circumscribed hypogastric mass was seen. The mass had a hyporeflective content and a small amount of hyperreflective material posteriorly, compatible with debris in a midline cyst (Figure 1). The day after, magnetic resonance imaging (MRI) was performed. The mass appeared to be a dilatation of the vagina, in continuity with the uterine cavity (Figure 2A, sagittal image: arrow = uterine cervix). The content was T2 hyperto iso-intense and T1 hyperintense (Figure 2B, axial image). The hyperreflective material seen on ultrasound, showed susceptibility artifacts on T2*-weighted images, which corresponds to hemosiderin (Figure 2C, axial image). There was no pathologic diffusion restriction. After MRI, the patient was seen by a gynecologist. He found out that the abdominal pain had a cyclic pattern on a monthly base, and that the patient never had menses. On clinical examination, a mass was felt and the hymen was bombed and painful. Based on these findings, the diagnosis of a hematometrocolpos, due to an imperforate hymen, was made. The patient underwent hymenotomy to remove the large amount of blood. Figure 1: Sagittal US-image showing a large hypogastric mass with hyporeflective content and a small amount of hyperreflective material posteriorly.
Case History A 41-year-old male with a history of acute myeloid leukemia (AML) presenting with a pneumonia and neutropenic fever was admitted to the intensive care unit with symptoms of shock. An urgent contrast-enhanced computed tomography (CT) was performed to exclude active bleeding (Figure 1, arterial phase; Figures 2 and 3, venous phase). The CT showed enhancement of the renal medulla (Figure 1, arrowhead), hypoattenuation of the renal cortex and a small rim of cortical enhancement in the arterial and venous phase (Figures 1 and 3, white arrow). These findings were compatible with acute cortical necrosis. A fine caliber of the renal arteries and the hypoattenuating liver and spleen due to shock were also noted (Figure 1, black arrow). Also note the splenomegaly due to AML (Figure 3, asterisk). No signs of active bleeding were found. At the time of the CT scan, the most recent renal function was not yet known. Lab results shortly after the scan showed acute renal failure.
This thesis has received funding by General Electrics Healthcare. The funding has been used to cover the costs of the adenosine perfusion CMR, the contrast medium and adenosine of all included patients. Funding for the statistical analysis was received by Limburg Clinical Research Program (LRCP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Hospital Oost-Limburg and Jessa Hospital.
Saba senegalensis (SS) is a well-known and commonly eaten fruit in Western Africa, especially in the rainy season when it is abundant. The ingestion of its seeds may cause abdominal pain and bowel obstruction. This cause might not be recognized by radiologists who are not aware of SS CT features. We thus present the characteristic CT features of SS as found in patients presenting with abdominal pain and incidentally in others. We also discuss the differential diagnosis with the cowries (ornament) and other similar fruits as imaged on CT.
Objective: Dynamic contrast-enhanced MRI (DCE-MRI) can measure the changes in tumor blood flow, vascular permeability and interstitial and intravascular volume. The objective was to evaluate the efficacy of DCE-MRI in prediction of Barcelona Clinic Liver Cancer (BCLC) staging B or C hepatocellular carcinoma (HCC) response after treatment with transcatheter arterial chemoembolization (TACE) followed by sorafenib therapy. Methods: Sorafenib was administered four days after TACE of BCLC staging B or C HCC in 11 patients (21 lesions). DCE-MRI was performed with Gd-EOB-DTPA contrast before TACE and three and 10 days after TACE. DCE-MRI acquisitions were taken pre-contrast, hepatic arterial-dominant phase and 60, 120, 180, 240, 330, 420, 510 and 600 seconds post-contrast. Distribution volume of contrast agent (DV) and transfer constant Ktrans were calculated. Patients were grouped by mRECIST after one month or more post-TACE into responders (complete response, partial response) and non-responders (stable disease, progressive disease). Results: DV was reduced in responders at three and 10 days post-TACE (p = 0.008 and p = 0.008 respectively). DV fell in non-responders at three days (p = 0.025) but was not significantly changed from pre-TACE values after sorafenib. Sensitivity and specificity for DV 10 days post-TACE were 88% and 77% respectively. Conclusion: DV may be a useful biomarker for early prediction of therapeutic outcome in intermediate HCC.
The mission of our person-centered and value-based health care system is to provide high-quality and safe care, being payable and accessible. In this care, the goal of health information technology (HIT) is to improve the well-being of individuals and communities through the use of new technologies and deploying a resilient health information system (HIS), infrastructure and architecture.
Knowledge of the normal and pathological three-dimensional (3D) gleno-humeral relationship is imperative when planning and performing a total shoulder arthroplasty. Currently, two-dimensional (2D) parameters are used to describe this anatomy and despite the fact that these 2D measurements have a wide distribution in the normal population, they are commonly accepted. This broad distribution can be explained on one hand by anatomical factors and on the other hand, by positional errors. A 3D CT-scan reconstruction and evaluation can overcome this shortcoming and can be used to determine more accurately the surgical planes on the normal and pathological shoulder joint. There is, however, no consensus on which references should be used when studying this 3D relationship. This thesis describes the normal 3D gleno-humeral relationship and the best glenoid plane to use in surgery, based on 3D CT-scan. Furthermore, a glenoid aiming device that can be of surgical help in the reconstruction of the normal glenoid anatomy was developed based on these measurements.
Anatomical differences between adults and adolescents and between left and right varicoceles were shown in this work. We designed a standardized and reproducible method for pressure measurement in the inguinal internal spermatic vein (ISV). We demonstrated that the mean absolute pressure in the ISV in the upright position is higher than the veno-capillary pressure in the testicle, and hence could impair spermatogenesis prompting the need for treatment in varicoceles. Histoacryl transparent and Glubran2, the current commercially available adhesives for the treatment of varicoceles, do not differ with regard to efficiency, safety and tolerance during and after embolization. Both adhesives cause a mild pain in 30% of the patients in the week after embolization. The radiation exposure is low during embolizations of varicoceles with highly viscous liquid products. Therefore, the endovascular treatment with glue is an efficient, safe and tolerable method of treatment for varicoceles when applicable.
