Intramedullary spinal cord abscesses are uncommon, with only a few documented cases. They typically present with lower-limb neurological symptoms and signs of sepsis, often leading to misdiagnosis, particularly in children, where symptoms may be atypical. The present case report details the distinctive presentation of a 4-year-old boy with recurrent urinary tract infections who subsequently developed lower-limb weakness. Initially, his symptoms were attributed to recurrent urinary tract infections, delaying neurological evaluation. However, magnetic resonance imaging revealed a diffuse intramedullary spinal cord abscess extending from the cervical to lumbar regions, linked to an S2-S3 congenital dermal sinus tract. These uncommon congenital dermal sinus tracts promote infections, often leading to overlooked abscess formation in children. Magnetic resonance imaging confirmed whole-spine involvement and follow-up imaging revealed significant resolution with residual fibrotic changes.
Background: Obturator hernia is rare and accounts for less than 1% of all abdominal wall hernias. It represents a diagnostic challenge due to its non-specific signs and symptoms. Case Report: We describe a 93-year-old woman presenting with 12 hours of lower abdominal pain. Computed tomography demonstrated a right strangulated obturator hernia causing small-bowel obstruction. Laparoscopic transabdominal preperitoneal repair was performed with mesh placement. The patient recovered uneventfully and was discharged on postoperative day 4. Conclusion: Early CT diagnosis followed by laparoscopic repair allows rapid recovery and reduces morbidity in strangulated obturator hernia.
Background: Articular cartilage is an essential component of our joints, and cartilage degeneration or injury may impede quality of life. With the advent of cartilage repair techniques first described in 1994, magnetic resonance imaging (MRI) has been the gold standard in evaluating cartilage repairs post-operatively. In particular, compositional MRI techniques such as T2RV (T2 Relaxation Values) mapping are useful in qualitative and quantitative evaluation, due to its sensitivity for water and collagen content. Case Report: A 58-year-old male presented with left knee pain from a patella chondral defect at our tertiary institution and underwent a cartilage graft repair (HyaloFast; Anika Therapeutics, Italy). However, almost ayear later, his left knee pain was noted to have recurred on follow-up. MRI cartilage studies showed features normally associated with graft viability, despite the patient's persistent symptoms of knee pain on clinical examination. He subsequently underwent a diagnostic arthroscopy, and the orthopedic surgeon noted that the surface of the previous cartilage graft was filled with fibrocartilage rather than hyaline cartilage, and that there was no viable cartilaginous tissue at the site. The patient then had a revision cartilage patch repair surgery performed (ProChondrix CR; Stryker, USA). His left knee pain significantly improved after. Notably, MRI cartilage T2RV mapping studies before and after the revision surgery were similar in appearance and showed features suggestive of graft viability, despite the clinical examination and history from the patient. Conclusion: This case report serves to demonstrate how MRI T2RV mapping should not be solely utilized to assess technical success after cartilage repair surgery though it remains as a suitable non-invasive surveillance option. In addition to repeat MRI cartilage studies, a thorough history-taking to assess symptoms as well as physical examinations are critical in the post-operative follow-up.
Background: Optic nerve sheath meningioma is an uncommon tumour arising from the meningothelial cells of the optic nerve sheath. Diagnostic challenges can arise when differentiating optic nerve sheath meningioma and optic neuritis and perineuritis due to similar clinical presentation and magnetic resonance imaging findings. A delay in diagnosis can lead to a delay in appropriate therapy thereby increasing the risk of irreversible vision loss. Case: A 19-year-old male presented with painless visual loss in the left eye, with optic atrophy noted on clinical examination. Initial Magnetic Resonance Imaging of brain and orbits with gadolinium demonstrated increased T2 signal in and enhancement of the left optic nerve with the diagnostic impression being left optic neuritis. Initial laboratory testing excluded infectious and inflammatory aetiologies. Repeat Magnetic Resonance Imaging three months later demonstrated persistent enhancement of the left optic nerve. The possibility of optic nerve sheath meningioma was raised and therefore, a Gallium-68 DOTA-octreotate Positron Emission Tomography/Computed Tomography was arranged. This demonstrated linear fusiform uptake (Standardised uptake value maximum 6.4) along the left optic nerve extending to the orbital apex, consistent with a somatostatin receptor expressing lesion such as an optic nerve sheath meningioma. Conclusion: This case highlights the diagnostic value of Gallium-68 DOTA-octreotide Positron Emission Tomography/Computed Tomography in confirming optic nerve sheath meningioma and avoiding invasive biopsy in young patients with atypical or equivocal Magnetic Resonance Imaging findings and negative inflammatory markers.
Mesenchymal chondrosarcoma (MCS) is a rare, aggressive malignancy that can arise in either bone or soft tissue, typically affecting young adults in the second to third decades of life. Because clinical symptoms and radiographic features are often nonspecific, accurate diagnosis requires careful integration of imaging, histopathologic, and immunohistochemical findings. We report the case of a healthy 26-year-old woman with a large juxtacortical mass arising from the left superior pubic ramus causing compression of the iliofemoral vein. Imaging revealed a lobulated, mineralized lesion with cortical origin and matrix calcification. Pathologic diagnosis was made based on the presence of biphasic histology-comprising undifferentiated small round cells interspersed with islands of cartilaginous differentiation and detection of a specific genetic fusion on molecular testing. This case emphasizes the importance of imaging-pathology correlation in establishing an accurate diagnosis and guiding multidisciplinary management for mesenchymal chondrosarcoma.
Pulmonary arteriovenous malformations are rare vascular anomalies characterized by abnormal connections between a pulmonary artery and vein, bypassing the capillary bed. Most patients remain asymptomatic, but right-to-left shunts allow septic or non-septic emboli to enter systemic circulation, leading to serious central nervous system complications. We report a case of a middle-aged woman with brain abscess of initially unknown origin, in whom a solitary pulmonary arteriovenous malformation was incidentally detected on thoracic computed tomography. Although brain abscesses secondary to pulmonary arteriovenous malformation are very uncommon, this case underlines the importance of considering pulmonary arteriovenous malformation in patients with cryptogenic brain abscess.
Pulmonary Arteriovenous Malformations (PAVMs) are an important cause of right-to-left shunting and paradoxical embolic events, particularly in patients with Hereditary Hemorrhagic Telangiectasia (HHT). Endovascular embolization is the treatment of choice, but prior unsuccessful attempts may complicate subsequent management. We report a 48-year-old woman with genetically confirmed HHT and progressive hypoxemia, in whom two earlier embolization procedures were aborted due to ventricular ectopy and transient tachyarrhythmia. Under general anesthesia, atraumatic pulmonary valve crossing was achieved using a 4 Fr angled pigtail catheter, enabling successful embolization of five PAVMs in a single session with microvascular plugs and detachable coils. No arrhythmias occurred, and oxygen saturation improved from 92% to 98%. This case highlights the value of tailored procedural planning-including catheter selection and anesthesia-in preventing arrhythmia-related complications and achieving complete treatment in technically challenging or previously failed PAVM interventions.
While appendicitis is the most common emergent indication for abdominal surgery worldwide and abdominal hernia repair is also one of the most common abdominal surgeries, the scenario in which the appendix becomes entrapped or entangled with the hardware associated with a hernia repair has rarely been documented. The patient in this case underwent a bilateral inguinal hernia repair procedure approximately 20 years ago. Years later, the patient developed appendiceal perforation with imaging and surgical findings indicating involvement of the inguinal hernia repair hardware.
Scapulothoracic bursitis is an uncommon condition characterized by inflammation of the bursa located between the scapula and the thoracic wall. This disorder is frequently associated with repetitive shoulder movements or systemic inflammatory diseases. This report describes a 56-year-old woman with rheumatoid arthritis who presented with painless swelling in the left upper back. Imaging studies identified a well-defined, fluid-filled lesion beneath the latissimus dorsi and serratus anterior muscles. Ultrasound demonstrated an anechoic lesion without vascularity, and magnetic resonance imaging (MRI) confirmed a T1 hypointense and T2 hyperintense lesion with fine septations. The lesion resolved spontaneously without surgical intervention, possibly facilitated by ongoing anti-inflammatory therapy. This case emphasizes the need to consider scapulothoracic bursitis in the differential diagnosis of posterior chest wall masses and demonstrates the critical role of imaging in preventing unnecessary invasive procedures.
A 40-year-old man was involved in a motorcycle accident in Thailand, where limited diagnostic capabilities led to the oversight of severe wrist injuries. Due to the mistaken assumption that the patient was a tourist, detailed imaging of the wrist was not carried out, resulting in a delay of treatment for many months. It was only upon return to Poland that CT scans were performed, revealing multiple fractures and dislocations of the wrist bones, requiring urgent surgical intervention. This case highlights the importance of accurate post-traumatic injury diagnosis, the consequences of its neglect and 5-month follow up of surgical treatment.
A 21-year-old male presented with sudden-onset left upper quadrant abdominal pain radiating to the chest, associated with shortness of breath. He had a history of intermittent abdominal bloating and fullness for 3-4 years. Contrast-enhanced computed tomography revealed a large left-sided posterolateral diaphragmatic defect (Bochdalek hernia) containing the stomach, spleen, and left kidney. The stomach was distended and twisted (organoaxial gastric volvulus) with surrounding inflammatory changes. Emergency surgery was performed, involving reduction of herniated contents, detorsion of the stomach, and mesh repair of the diaphragmatic defect. The intrathoracic kidney was left in situ due to normal perfusion. The patient recovered fully. This case highlights the importance of prompt imaging and surgical intervention in adult Bochdalek hernias presenting with acute complications.
A young adult male with background chronic granulomatous disease presented with a subacute history of fatigue, dyspnoea, abdominal pain, fevers and intermittent neck pain. The right thyroid lobe was enlarged with a heterogeneous fluid collection on ultrasound, with microbiological analysis demonstrating anAspergillus felis abscess. Combined with other abscesses in the liver and spleen, the clinical picture was consistent with angioinvasive aspergillosis.
Cerebral amyloid angiopathy related inflammation is a rare condition that can present with rapid cognitive impairment, seizures, headaches. Imaging typically shows the underlying microbleeds and signs of inflammation; however, a brain biopsy is needed for definitive diagnosis. Once diagnosed, treatment tends to be immunosuppression. Here, we present a severe case confirmed with brain biopsy with classic imaging of this infrequently seen condition.
