Human dirofilariasis is caused by infection with a parasite relatively common in dogs. Occasional transmission of larvae to humans occurs via an insect bite and development of an immature worm at the bite site. The disease, once confined to southern Europe, is becoming increasingly widespread, particularly due to global warming. Clinical signs are nonspecific and laboratory findings usually normal. Imaging shows pseudotumor features also nonspecific on computed tomography (CT) and magnetic resonance imaging (MRI) scans. Ultrasound may suggest the diagnosis by the presence of double echogenic ‘rail’ images. However, only spontaneous motility of the parasite observation can confirm the diagnosis.
Teaching point: Gastrosplenic fistula, a rare complication of splenic lymphoma, can be diagnosed early with computed tomography (CT), which also delineates diaphragmatic or thoracic extension, facilitating timely management and preventing further thoracoabdominal involvement.
Pulmonary calcifications are a frequent phenomenon with a wide range of etiology. They are divided into two categories: metastatic and dystrophic pulmonary calcification, with different underlying pathology and CT features. Teaching point: Metastatic pulmonary calcifications appear when there is a metabolic imbalance with some typical radiographic features for characterization.
Teaching point: Segmental testicular infarction is a rare entity that remains poorly documented in the literature. Awareness of its imaging evolution is essential to avoid unnecessary surgical intervention.
A case is reported of a woman presenting with a firm, tender right frontal lump. Ultrasound showed a small, irregular subgaleal mass with tiny bone surface perforations. Color Doppler ultrasound demonstrated compression-decompression induced alternating flow signals, indicating flow and reflux through the bone lesion. CT revealed an expansile osteolytic frontal lesion with a honeycomb pattern, consistent with an intraosseous venous malformation, which was confirmed histologically. The added value of compression-decompression color Doppler ultrasound in low‑flow calvarial vascular malformations is illustrated. Teaching point: Compression-decompression color Doppler ultrasound can reveal flow-reflux in low‑flow intraosseous venous malformations, contributing to the diagnosis.
Objectives: To assess the safety, efficacy, and mid‑term clinical and radiological outcomes of computerized tomography (CT)‑guided cryoablation of malignant T1 renal lesions. Methods: Consecutive patients who underwent percutaneous cryoablation (PCA) under CT guidance between January 2018 and January 2024 for one or multiple renal masses were included. Technical success and primary and secondary treatment efficacy were calculated. Complications were categorized according to the Clavien-Dindo classification system. Overall survival (OS) and local progression‑free survival (LPFS) were assessed based on Kaplan-Meier analysis. Results: A total of 72 renal lesions, with a mean size of 23.4 mm (SD: 9.8, range 7-45), were treated in 59 patients (41 males and 18 females, mean age: 69 years [range 45-88]). A total of 25 patients (42.4%) had a history of radical and/or partial nephrectomy. Primary treatment efficacy was 91.0% and increased to 95.6% with the re‑ablation of two lesions. The overall complication rate was 10.8%, with a major complication (Clavien-Dindo grade ≥ III) rate of 3.1%. The estimated LPFS at 15 months was 92.9%. Local progression occurred in four lesions, of which two had already been ablated. The estimated OS at 1 year was 95.9% (standard error [SE] of 2.8%) and 91.6% (SE: 5.0%) at 3 years. Conclusion: Percutaneous CT‑guided cryoablation is a safe and effective treatment for small renal cell carcinoma.
Gymnast’s wrist is an uncommon stress‑related injury of the distal radial physis caused by repetitive axial loading in skeletally immature athletes. We report the case of a 16‑year‑old elite gymnast presenting with progressive wrist pain without acute trauma. Magnetic resonance imaging demonstrated focal widening of the volar distal radial physis with adjacent metaphyseal and epiphyseal bone marrow edema, consistent with a stress‑related physeal injury. Conservative management with activity modification and physical therapy resulted in symptom resolution. Teaching point: In young athletes with wrist pain, stress‑related physeal injury should be considered, and MRI allows early diagnosis and appropriate management.
Teaching point: The possibility of a radiation‑induced osteosarcoma should be considered in any painful, ossifying mass occurring within a previously irradiated area, even years after the initial treatment.
Teaching point: Detection of intraosseous gas with a bubbly or irregular pattern on imaging should raise a strong suspicion for emphysematous osteomyelitis and prompt urgent antimicrobial treatment, particularly in immunocompromised patients without a history of trauma or surgery.
Teaching point: The case highlights the importance of identifying gastric complications after RFCA and the need for prompt diagnosis and treatment of gastroparesis with gastrokinetic medication, such as mosapride citrate.
Photon-counting computed tomography is the newest technological advancement in CT imaging allowing for an improved spatial resolution, inherent spectral information, and significant radiation dose reduction. These benefits may enhance diagnostic confidence and accuracy for radiologists and clinicians. Multiple clinical applications in musculoskeletal radiology benefit from this technology, including the reduction of metal artifacts, improved visualization of bone marrow edema, and better assessment of crystal arthropathies. This narrative review presents a comprehensive summary of the current advancements and applications of this emerging technology within musculoskeletal radiology using several illustrative cases.
Assessment of cortical bone and mineralized tissue in athletes traditionally relied on radiographs and CT, as conventional MRI provides limited/no signal from cortical bone. Recent advances, particularly zero echo time (ZTE) MRI, enable CT-like visualization of osseous structures within routine MRI protocols. This pictorial essay highlights the added value of ZTE in sports imaging, illustrating its role in the evaluation of stress injuries, occult fractures, osteoid osteoma, osteochondral lesions, calcified tendon pathology, hip and groin pathologies, and relevant differential diagnosis. ZTE complements conventional MRI by improving the depiction of cortical and mineralized abnormalities relevant to athletic populations.
Teaching point: Typical imaging features of perianal mucinous adenocarcinoma are multilocular cystic mass around the anus, with peripheral irregular enhancement, calcification, and slightly higher signal intensity than muscle on T1-weighted imaging.
Congenital pulmonary artery anomalies may remain undetected until adulthood, and radiologists must recognize these anomalies to avoid misdiagnosis and guide clinical decisions. This pictorial essay reviews several congenital pulmonary artery anomalies and illustrates their representative imaging findings.
Carcinoid heart disease (CHD) is a serious and potentially life‑limiting complication of neuroendocrine tumors (NETs), resulting from prolonged systemic exposure to serotonin and other vasoactive substances, leading to fibrotic valvular degeneration. We report the case of a 71‑year‑old woman with metastatic small‑intestinal NET and associated carcinoid syndrome presenting with progressive exertional intolerance. Transthoracic echocardiography revealed severe tricuspid and moderate pulmonary regurgitation with right‑sided ventricular dilation. Cardiac MRI confirmed regurgitation and right‑heart remodeling consistent with CHD. Teaching point: This case highlights the diagnostic value of multimodal imaging, particularly cardiac MRI, in confirming and characterizing CHD in patients with metastatic NETs.
Teaching point: Transient, topographically delineated, intense arterial enhancement in liver segment 4, associated with early filling of the dilated veins of Sappey, is a pathognomonic abdominal CT sign of superior vena cava (SVC) syndrome.
Ewing sarcoma (ES) is a high-grade osseous malignancy that typically occurs between 10 and 20 years of age. Prognosis is poor with a 30% five-year survival in the case of metastatic disease. This case describes a 20-year-old female patient with known lumbar vertebral ES developing a splenic metastasis years after primary treatment. To the best of our knowledge, metastatic spread to the spleen in ES has not been reported before. Teaching point: In patients with a history of Ewing sarcoma, new parenchymal lesions should always prompt consideration of rare metastatic disease, given its profound prognostic impact.
Teaching point: Adrenal vein thrombosis should be considered in pregnant patients presenting with unexplained unilateral adrenal enlargement, even when the thrombus itself is not visualized, as early diagnosis allows effective anticoagulant management and prevention of adrenal insufficiency.
Fracture of the polyethylene tibial post is a rare complication of posterior-stabilized total knee arthroplasty and is frequently missed on conventional radiography due to the radiolucent nature of polyethylene. We report a case of post-traumatic instability in which computed tomography demonstrated a displaced polyethylene fragment with characteristic low attenuation values. The diagnosis was confirmed intraoperatively, and isolated polyethylene exchange resulted in a good clinical outcome. Teaching point: CT attenuation measurements can aid in identifying displaced polyethylene fragments and facilitate the diagnosis of tibial post fracture in posterior-stabilized knee arthroplasty.
