Intracranial germ cell tumors (GCT) are extremely rare brain neoplasms, with imaging characteristics being often non-specific. Considering such imaging limitation in establishing their exact histology, the aim of this paper is to integrate conventional, physiologic and metabolic magnetic resonance imaging (MRI) with histology of these tumors, with the goal of proposing some new insights that could aid in their diagnosis. We have retrospectively analyzed preoperative imaging findings in 9 patients with histology proven intracranial germ cell tumors. In all patients conventional magnetic resonance imaging in conjunction with diffusion-weighted imaging (DWI) and proton magnetic resonance spectroscopy (MRS) was performed. Based on imaging characteristics on conventional sequences germinoma cannot be differentiated from nongerminoma. DWI offered the potential for differentiation of germinomas from non-germinomas since solid part of germinomas demonstrated restricted diffusion with ADC values under 1.0 × 10−3 mm2/s, whereas nongerminoma showed elevated diffusion with ADC values above 1.3 × 10−3 mm2/s. Short echo MRS demonstrated characteristic spectra in germinomas: increased Cho, decreased NAA and prominent broad lipid resonances. DWI and MRS imaging findings provide additional information that can facilitate evaluation of intracranial germ cell tumors.
A case of a 75-year-old gentleman with an unusual presentation of metallosis 3 years after a left hip resurfacing arthroplasty is presented. This report illustrates the atypical appearances of metallosis using CT and other imaging modalities, which has been only sparsely described in the literature.
Traumatic pseudoaneurysms of the superficial temporal artery (STA) are uncommon. The appearance of a pulsatile preauricular mass after a traumatism is highly suggestive of the diagnosis. Diagnostic techniques are echo-doppler, CT-scan and arteriography. The most common treatment is surgical. Embolization may prove to be an alternative to surgery in some cases. We report a rare case of pseudoaneurysm arising from STA caused by blunt injury.
We report an unusual association between Ebstein anomaly of the tricuspid valve and a stenotic double orifice mitral valve diagnosed later in life.
We report a case of a 68-year-old Chinese man who presented with Fatigue, anorexia more than half month, the body clear yellow dye for a week, liver function tests with alkaline phosphatase, alanine transferase increased, etc. Abdominal ultrasound showed extrahepatic duct dilatation. Enhanced computed tomography revealed signs of hepatic duct obstruction. Magnetic resonance imaging showed about the confluence of hepatic duct and upper common bile duct wall thickening; cholestasis common bile duct, multiple small stones in the lower; cholecystitis, elevation of the tumor markers CA19-9. At laparotomy, gallbladder, common bile duct, extrahepatic bile duct is clearly dissected out, no tumor, tumor eliminated by histologic examination.
Intradural extramedullary tuberculoma in the spinal cord is a rare disease, which follows tuberculous meningitis with negative human immunodeficiency virus. We present a case of 31-year-old man with intradural extramedullary tuberculoma at the cervical and thoracic spine following tuberculous meningitis.
A 31-year-old woman presented with anterior neck mass which had been first noticed 2 months ago. She underwent neck CT which revealed solid and cystic lesion adjacent to hyoid bone. After surgery, she was diagnosed with thyroglossal duct cyst (TGDC) combined with papillary cancer. This is a rare form of TGDC, so we report a case with CT images.
Stab wounds resulting spinal cord injury (SCI) are relatively rare and typically associated with immediate neurological damage. We report MDCT and MRI findings of spinal injury findings following an unusual penetrating stab wound of the neck. A 31-year-old man had a stab wound in the cervical region. CT showed linear fracture in the corpus and left lamina of fourth cervical vertebra. MRI revealed left side oriented posteroanterior penetrating linear spinal cord lesion and broad T2W hyperintensity changes representing spinal cord contusion. CT and MRI allow bony injuries, foreign bodies, spinal instability and the classification of different types of lesions, ranging from spinal cord edema to complete spinal cord transection. MR imaging should be performed after acquiring negative CT imaging findings in the case of high suspicion of spinal cord trauma as seen in our present case.
Primary epiphyseal lesions in children are rare and usually benign, with chondroblastoma being the most typical for this location and age. Very occasionally, malignant bone tumors may occur primary within long bones epiphyses during growth; few reports are given on such single cases in orthopedic and radiological scientific literature. This paper presents a case report on a malignant primitive neuroectodermal tumor affecting primary distal femoral epiphysis in a child, having a benign-looking lytic appearance. Short literature review and discussion on possible differential diagnosis of such lesion is also included.
Neurothekeomas are extremely rare benign tumors of nerve sheath origin. We describe MR and CT Myelogram findings of an intraspinal neurothekeoma occurring in a 49-year-old white female who presented with back pain. MR imaging showed a well-circumscribed avidly enhancing intrathecal mass at L1–L2 lumbar spine level while CT Myelogram imaging showed an intradural soft tissue density mass filling the thecal sac at L1–L2 level. Neurothekeomas mimic ependymoma, schwanoma, and paragangliomas in radiologic appearance and may be included in the differential diagnosis of soft-tissue masses of cauda equina in an adult female patient. Additionally, neurosurgeons and neuroradiologists should be familiar with the benign nature of these masses.
Spinal vascular malformations are rare but complex entities. Non-invasive assessment and screening can be effectively performed with MRI/MRA. More recently, use of spinal CTA for characterization of these lesions is being reported. We describe, to our knowledge, the first report of dynamic assessment of a spinal vascular malformation with CT angiography of the spine using 320 detector imaging technique.
A rare case of mobile thrombus in the ascending aorta causing peripheral embolization is reported. Transesophageal echocardiography (TEE) could not clearly delineate this lesion, as portions of ascending aorta are not well visualized by TEE due the interposition of right main stem bronchus and the trachea. We performed dynamic cardiac CT angiography, which clearly visualized the lesion allowing detailed preoperative planning and successful surgical excision.
Left ventricular non-compaction, which is characterized by left ventricular hypertrabeculation, is a rare congenital cardiomyopathy. The changing and progressing morphology, with different clinical manifestations, made the diagnosis difficult. Here is a case report of a middle-age woman, who had exercise intolerance for many years. Traditional echocardiography showed findings of dilated cardiomyopathy but obscure trabeculations, which was clearly seen by three-dimensional echocardiography. Subsequent cardiac magnetic resonance imaging well demonstrated the myocardial non-compaction and delayed enhancement. LVNC could be found early in a child, and also in a mid-age adult. When a patient with LVNC had progressing heart failure, the hypertrabeculation may become less prominent. The utilization of three-dimensional echocardiography and MRI would help identify such landmark findings.
The authors present a case of giant pelvic tumor in a 29-year-old previously healthy female. The tumor was an incidental finding during cesarean procedure after an unremarkably pregnancy. Both CT and MRI prior to surgery demonstrated a heterogeneous tumor measuring 30cm×16cm×5cm occupying the entire pelvis and involving bilaterally both iliac and inguinal vessels. CT revealed little contrast enhancement and on MRI showed slight hypointensity signal on T1-weighted sequences and hyperintensity on T2-weighted sequences. Surgical excision was performed 2 weeks later.
Cobb syndrome is a rare illness that combines vascular skin nevus and spinal vascular malformation at the same metamere.
Systemic air embolism (SAE) frequently has a fatal outcome, actually for 80% in blunt trauma and 48% in penetrating ones. Several diagnosis tools can detect intracardiac and cerebral air, but should not be necessary to confirm SAE. Our observation underlines that computed-tomography is an interesting and sensitive exam enough, and can be performed also in post-mortem in case of unexplained fatal outcome of chest trauma.
We report an unusual case of an artery running alongside a common hepatic artery aneurysm. The artery running alongside the aneurysm was thought to be either an anatomical variation or dissection (true lumen) with reentry, both of which are atypical. Here, we document our experiences working with this unusual case of aneurysm formation in a common hepatic artery, in which we performed coil embolization.
Pneumocephalus is expected after any craniotomy and usually resolves without any sequelae. However if the air entering the cranial cavity gets entrapped, it can lead to tension pneumocephalus and can have disastrous consequences. It is of utmost clinical importance to differentiate a tension pneumocephalus from a non-tension pneumocephalus as the latter does not usually require decompressive surgery. CT scan is considered the gold standard and diagnostic modality of choice for the diagnosis of pneumocephalus in the post-operative period. The Peaking sign and Mount Fuji sign are proposed as fairly specific for tension pneumocephalus, the latter being the most specific and an important sign to differentiate it from non-tension pneumocephalus. We present a case of a 20 year old male whose post-operative CT brain showed the typical Mount Fuji sign suggestive of tension pneumocephalus but was managed conservatively without any decompressive surgery.
Amyloidosis is a heterogeneous group of diseases characterized by the presence of extracellular deposition of amyloid. We present a case of localized amyloidosis of the middle mediastinum, that was diagnosed by trans-esophageal endoscopic ultrasound (EUS)-guided biopsy, focusing on imaging features of contrast-enhanced CT, MRI including dynamic contrast-enhanced study and DWI, and integrated fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT.
It is presented an impressive image of a cholangio-Magnetic Resonance Imaging in a bilateral Caroli disease. The innovative technique of 3D imaging elaboration allowed to perfectly build up the anomalies of the biliary tract.
