Purpose:To evaluate the efficacy and safety of intra-arterial chemotherapy (IAC) delivered via the internal carotid artery (ICA) and external carotid artery (ECA) anastomoses at a single Indonesian center. Materials and Methods:A retrospective chart review was conducted of consecutive retinoblastoma cases treated with IAC between June 2022 and September 2025. Procedures were performed under general anesthesia via ultrasound-guided femoral arterial access. ICA catheterization using a diagnostic catheter was followed by ophthalmic artery (OA) cannulation with a microcatheter. Alternative access routes included the vertebrobasilar circulation and ECA branches (middle meningeal, internal maxillary, and zygomatico-orbital arteries). Melphalan (4-5 mg) was the primary agent for International Classification of Retinoblastoma Groups B-C, whereas topotecan and carboplatin were added for recurrent or advanced disease (Groups D-E). Recorded outcomes included the number of sessions, access route, procedure-related complications, globe salvage, and enucleation. Ocular survival was analyzed using Kaplan-Meier methods, and predictors of enucleation were assessed using multivariable Cox proportional hazards modeling. Results:Twenty-four eyes of 24 patients (median age, 13.7 months) underwent 65 IAC sessions (45 via ICA and 20 via ECA). Globe salvage was achieved in 19 of 24 eyes (79.2%) at 6 months, and 14 of 24 eyes (58.3%) remained enucleation-free at 39 months. Ocular survival was lower for ECA compared with ICA access (p = 0.01). On multivariable analysis, the ECA route independently predicted enucleation (hazard ratio, 6.24; 95% confidence interval, 1.09-35.76; p = 0.04). No severe ischemic perioperative complications were observed. Conclusion:In this cohort, IAC provided favorable globe salvage with an acceptable safety profile. However, ECA access was associated with an increased risk of enucleation; therefore, direct OA access via the ICA is preferable when feasible. Larger prospective studies are warranted.
This review summarizes skeletal chest wall injuries and diaphragmatic injuries that may occur in patients with chest trauma. In Korea, most chest trauma results from blunt mechanisms and is closely associated with high-energy injuries, such as traffic accidents and falls. Skeletal chest wall and diaphragmatic injuries have a substantial impact on patient prognosis. This review describes the principal radiologic findings of rib fractures, sternal fractures, and diaphragmatic injuries and emphasizes that these findings are directly incorporated into injury severity scoring systems, thereby influencing treatment strategies and risk stratification. Radiologists should provide clear, detailed descriptions of injury patterns to support accurate severity assessment and guide therapeutic decision-making. Such reporting also facilitates consistent and clear communication across clinical care, administrative, and reimbursement processes.
A 54-year-old man presented with a two-year history of bilateral proptosis, bilateral lacrimal gland enlargement, and eyelid swelling. MRI demonstrated diffuse sinonasal mucosal thickening in a pansinusitis pattern (Fig. 1A), together with symmetric bilateral enhancing thickening of the infraorbital nerves (Fig. 1B, C, arrows). Additional findings included bilateral lacrimal gland enlargement (Fig. 1A, arrowheads) and extraocular muscle thickening (Fig. 1B, asterisks). Lacrimal gland excision confirmed immunoglobulin G4 (IgG4)-related disease, with more than 200 IgG4-positive plasma cells per high-power field and an IgG4:IgG ratio exceeding 90%. Although infraorbital nerve involvement is uncommon, it represents a characteristic imaging feature of IgG4-related disease, particularly when bilateral and symmetric. While not entirely specific, this finding has been reported to exhibit high specificity compared with other causes of orbital disease, including lymphoma (1-3). Recognition of this pattern—bilateral infraorbital nerve thickening in conjunction with lacrimal gland enlargement, extraocular muscle involvement, and pansinusitis—should raise strong suspicion of IgG4-related disease.
Traumatic thoracic aortic injury and hemopericardium are among the most life-threatening conditions encountered in acute thoracic trauma care. CT angiography (CTA) is the cornerstone of evaluation in such cases, providing essential information for diagnosis, triage, and treatment planning. In traumatic aortic injury, key CTA findings, including the presence of an intimal flap, intramural hematoma, pseudoaneurysm, and contrast extravasation, form the basis of the Society for Vascular Surgery grading system and guide management. In patients with traumatic hemopericardium, CT attenuation characteristics, imaging features of cardiac tamponade, and associated cardiac injuries help determine the urgency and approach to intervention. Familiarity with common pitfalls and mimickers, including ductus diverticulum, mediastinal hematoma without aortic injury, and motion-related artifacts, is essential to avoid diagnostic errors. Structured reporting can facilitate communication of managementrelevant findings and support timely decision-making. This review summarizes the imaging findings, grading systems, management implications, pitfalls, and structured reporting considerations for traumatic aortic injury and hemopericardium.
Thoracic trauma, particularly pneumothorax and hemothorax, requires rapid and accurate radiologic assessment to reduce morbidity and mortality. Although supine chest radiography remains the initial screening tool, its diagnostic sensitivity is limited in evaluating patients with trauma, necessitating the use of alternative diagnostic tools such as chest ultrasonography. CT serves as the reference standard examination, providing definitive evaluation of the whole thorax and identifying pseudoaneurysms or active contrast extravasation in patients with suspected bleeding. Recently, AI has been developed and integrated into clinical workflows to reduce diagnostic errors. This review discusses standardized radiologic approaches for pneumothorax and hemothorax, focusing on distinctive imaging features, common interpretive pitfalls, structured reporting formats, and the evolving roles of advanced imaging modalities and AI in emergency trauma settings.
Lung parenchymal and airway injuries are common and potentially life-threatening complications of thoracic trauma, requiring rapid and accurate radiological evaluation for optimal patient management. Chest CT remains an important diagnostic tool, because imaging findings-such as the extent of pulmonary injury and precise localization of tracheobronchial tears, often directly guide critical management decisions. This review provides a comprehensive overview of the key imaging features of pulmonary contusion, laceration, and tracheobronchial injury, with emphasis on clinically relevant findings that guide treatment. We also propose a clinical checklist and structured report to facilitate timely communication between radiologists and clinicians.
Myopericytoma is a rare pericytic (perivascular) soft tissue tumor. Its occurrence in the knee is exceptionally uncommon, with only 14 cases reported to date. Although it is generally benign, malignant transformation has been reported. As it has only recently been recognized as a distinct pathological entity, it may be overlooked in the differential diagnosis of soft tissue tumors. This case report describes the medial knee, highlights its clinical and imaging findings. Awareness of this rare tumor in atypical locations is essential for timely diagnosis, appropriate treatment, and structured follow-up.
When diagnosing cardiac tumors, it is important to consider factors such as the patient’s age, tumor location, radiologic features, differentiation between benign and malignant tumors and to provide the surgeon with appropriate information. In this report, we present a case of two cardiac masses originating in the left atrium that were diagnosed as undifferentiated pleomorphic sarcomas through surgical resection. Imaging studies showed two masses attached to the posterior wall of the left atrium and mitral valve; hemorrhagic changes were suspected in these masses. Irregular thickening of the mitral valve suggests tumor invasion; however, the possibility of a mural thrombus should be excluded. Multiplicity, large size, and irregular mitral valve thickening suggest a malignancy. However, given the much higher incidence of myxomas, well-defined margins, and the fact that hemorrhagic changes can occur in large myxomas, the possibility of a benign tumor cannot be ruled out.
Extraosseous Ewing sarcoma (ES) is a rare malignant tumor with poor prognosis. ES of pancreatic origin is exceedingly rare, with only a few dozen cases documented in the literature. It is a poorly differentiated, aggressive tumor characterized by multiple recurrences and a relatively poor prognosis. Owing to nonspecific imaging findings, it can easily be misdiagnosed as other tumors. Here, we report a case of primary pancreatic ES with direct gastric invasion in a 63-year-old male who presented with melena and summarize previously reported cases of primary pancreatic ES. Radiologists should be aware of the imaging findings of primary pancreatic ES and understand that it may be clinically confused with other tumors because of overlapping imaging features.
This case report describes a patient with rapidly progressive organizing pneumonia accompanied by cavitary lesions, in whom concomitant nontuberculous mycobacterial (NTM) infection caused significant diagnostic difficulty. Initial imaging showed rapidly worsening pulmonary consolidation and nodules with cavitation, raising concerns for pneumonia, tuberculosis, fungal infection, or vasculitis. However, surgical wedge resection confirmed the diagnosis of organizing pneumonia, and bronchoalveolar lavage cultures subsequently yielded NTM. This case highlights that NTM-associated organizing pneumonia with cavitary lesions can closely mimic other infectious diseases as well as vasculitic disorders presenting with an organizing pneumonia pattern on imaging, leading to substantial diagnostic challenges.
Emphysematous osteomyelitis is a particularly rare disease diagnosed by the presence of intraosseous gas and positive bone culture results. Radiologically, this disease is characterized by irregular intraosseous air density patterns. In particular, emphysematous osteomyelitis caused by Clostridium septicum has been reported in only two cases worldwide, one of which occurred in a patient with colon cancer. However, concurrently occurring emphysematous osteomyelitis with bone metastasis has not been described yet. Here, we report a case of emphysematous osteomyelitis accompanied by bone metastasis, focusing on the radiologic findings.
Purpose To assess the utility of tumor sphericity on CT as a quantitative shape parameter for distinguishing fat-poor angiomyolipoma (AML) from renal cell carcinoma (RCC) in small renal masses (SRMs, maximum diameter ≤4 cm). Materials and Methods We retrospectively evaluated 238 solitary sporadic SRMs that were pathologically confirmed as either AML or RCC and showed no visible fat on unenhanced CT. Tumor volume and sphericity were obtained through volumetric analysis using dedicated software. To distinguish fat-poor AML from RCC, clinical and imaging findings were compared, and receiver operating characteristic (ROC) curve analysis was performed. Binary logistic regression analysis was conducted to identify variables independently associated with fat-poor AML. Results Among the 238 SRMs, 22 were diagnosed as AMLs and 216 as RCCs, comprising 173 clear cell, 25 papillary, and 18 chromophobe subtypes. Fat-poor AMLs were significantly more prevalent in female and had lower tumor volumes than RCCs (both p < 0.001). The tumor sphericity was significantly lower in fat-poor AMLs than in RCCs (0.755 ± 0.042 vs. 0.824 ± 0.026, p < 0.001). For distinguishing fat-poor AML from RCC, the area under the ROC curve (AUC) for sphericity was 0.909 (optimal cutoff, 0.801; sensitivity, 86.4%; specificity, 84.7%). Female sex, lower tumor volume, and lower sphericity were independent predictors of fat-poor AML (all p < 0.005). The AUC for the multivariate model was 0.965 (sensitivity, 90.9%; specificity, 92.6%). Conclusion Tumor sphericity serves as a quantitative shape parameter for distinguishing fat-poor AML from RCC in SRMs.
A 45-year-old man presented to the emergency department with massive hemoptysis. His medical history included chronic renal failure, ischemic heart failure, and permanent catheter exchange 2 months prior to presentation. CT revealed elongated filling defects in the left lower lobe pulmonary artery, characterized by central low attenuation and peripheral rim-like calcifications, with wedge-shaped consolidation suggestive of pulmonary infarction. The differential diagnosis based on CT findings was a calcified pulmonary embolus or a fractured and embolized perm catheter tip, either of which could have caused the pulmonary infarction. The patient underwent an emergency left lower lobectomy and pulmonary thromboendarterectomy. The pathological diagnosis was a retained fibrin sheath embolism. Although rare, an embolized retained fibrin sheath should be suspected in patients with a central venous catheter when a calcified pulmonary embolus is observed on CT.
ZTE MRI provides CT-like images; however, its relatively low signal-to-noise ratio makes it challenging to detect subtle structural lesions in the SI joints of patients with SpA (2). This study tested the hypothesis that recently developed DLR could improve the quality of ZTE MRI, potentially enabling its inclusion in standard MRI protocols as an alternative to CT. The results indicate that a higher percentage of DLR significantly improves structural conspicuity. Of particular interest is the differential diagnostic performance for specific osseous lesions, namely bone sclerosis and bone erosion. Given this difference, it may be beneficial to optimize the DLR denoising level based on the type of targeted osseous lesion. Furthermore, these results suggest that varying denoising levels may be necessary when applying ZTE DLR to different anatomic regions in the future.
Wolffian tumors are rare neoplasms that arise from remnants of the Wolffian duct, also known as female adnexal tumors of probable Wolffian origin. Owing to their rarity, they are frequently misdiagnosed as malignant adnexal tumors. We present the case of a 61-year-old woman with a Wolffian tumor initially misdiagnosed as malignant tubal cancer based on atypical imaging findings. Diagnostic evaluations included ultrasonography, CT, and MRI.
Purpose:This study aimed to identify the appropriate clinical indications for core needle biopsy (CNB) in low-suspicion nodules (Korean Thyroid Imaging Reporting and Data System category 3) by assessing the US features associated with CNB-based diagnoses of malignancy and surgically relevant disease. Materials and Methods:Between January 2018 and December 2019, 910 thyroid nodules from 903 patients underwent US-guided CNB. Among these, 271 patients with low-suspicion thyroid nodules on US who later underwent surgery were included in this study. The nodules were dichotomized into two categories: malignancy (including low-suspicion neoplasms) and surgical disease (categorized as follicular neoplasm, suspicious for malignancy, or malignancy on CNB). Hypervascularity was defined as types 3 or 4. Results:The malignancy rate of resected low-suspicion nodules was found to be 36.5%. In low-suspicion nodules, a well-defined halo and hypervascularity were independent risk factors associated with malignancy (odds ratio = 2.06, 95% confidence interval [CI] = 1.11-3.83, p = 0.02 for well-defined halo; odds ratio = 3.54, 95% CI = 1.96-6.38, p < 0.01 for hypervascularity) and surgical disease (odds ratio = 4.96, 95% CI = 2.66-9.24, p < 0.01 for well-defined halo; odds ratio = 2.98, 95% CI = 1.96-6.38, p < 0.01 for hypervascularity). When the two features were combined, the diagnostic area under the receiver operating characteristic curve was 0.660 for malignancy and 0.709 for surgical disease. Conclusion:Targeting low-suspicion thyroid nodules with a well-defined halo and hypervascularity observed on US may provide supplementary diagnostic value in identifying nodules associated with malignancy and surgical disease using CNB.
