Chondromas are rare benign cartilaginous tumours, typically arising in the small bones of the hands and feet. Laryngeal chondromas are exceptionally uncommon and account for a very small proportion of head and neck neoplasms. We present a case of a 72-year-old male referred with a painless, slowly enlarging right-sided neck mass. Multimodal imaging, including ultrasound, CT, and MRI, revealed a well-circumscribed lesion with internal calcification arising from the thyroid cartilage. Differential diagnoses included chondroma and low-grade chondrosarcoma. Initial cytological assessment was inconclusive, prompting expert histopathological review, which confirmed a well-differentiated benign chondroid lesion consistent with a chondroma. The patient underwent successful surgical excision, and follow-up imaging over a 4-year period has shown no evidence of recurrence. This case highlights the diagnostic challenges in distinguishing chondromas from malignant cartilaginous tumours in atypical locations, and emphasises the importance of a multidisciplinary approach, combining imaging, histology, and specialist input to guide management.
Cerebral arterial gas embolism is a rare complication of percutaneous CT-guided lung biopsy, associated with seizures and neurological deficits such as stroke. Failure to promptly recognize and urgently treat can lead to a very poor prognosis. This case describes an 80-year-old woman undergoing a CT-guided lung biopsy for histological assessment of a suspected malignant cavitating lung lesion. Shortly after the procedure, the patient developed complete left-sided hemiparesis. A CT scan of the head demonstrated air in the right middle cerebral artery territory. Urgent transfer to a specialist centre for gold standard hyperbaric oxygen therapy was critical to optimize patient recovery. To prevent further air migration, the patient was placed in the Trendelenburg and left lateral decubitus position and high flow oxygen was administered, while awaiting transfer. Following hyperbaric oxygen therapy, the patient was stepped down to a stroke unit for rehabilitation. Full neurological recovery was made. This case highlights that radiologists should be well-versed in recognizing the signs and immediate management of air embolism and anticipate it as a rare but severe complication of lung biopsy.
Acute superior mesenteric artery (SMA) embolism is potentially fatal if intestinal necrosis develops, and prompt revascularization is essential. Although thrombolytic therapy and aspiration thrombectomy are commonly employed, thrombolysis is contraindicated in patients with hemorrhagic lesions. We report the application of the continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE) technique in an elderly woman with acute SMA embolism complicated by hemorrhagic stroke. Mechanical thrombectomy using a React 71 aspiration catheter and Solitaire stent retriever was performed under proximal balloon flow control. Staged thrombectomy of the jejunal and ileal branches achieved wide recanalization with a limited number of passes, avoiding intestinal necrosis. This case highlights the feasibility of adapting an established neuroendovascular technique to visceral arterial occlusion. The CAPTIVE technique may represent a minimally invasive alternative in selected patients in whom thrombolytic therapy is not indicated.
Carotid web is an underdiagnosed cause of ischemic stroke, particularly in young and middle-aged patients without major atherosclerotic risk factors. It is characterized by a shelf-like intraluminal filling defect arising from the posterior wall of the carotid bulb, promoting thrombus formation through local hemodynamic disturbances. We report the case of a 45-year-old woman with a history of well-controlled hypertension who presented with acute right upper limb weakness. Brain imaging confirmed an acute ischemic stroke. CT angiography of the supra-aortic vessels demonstrated a carotid web at the left carotid bulb associated with a floating thrombus. No alternative embolic etiology was identified after a comprehensive cardiovascular and systemic evaluation. This case highlights the importance of considering a carotid web in cases of otherwise cryptogenic stroke, even in patients with well-controlled comorbidities. Early diagnosis is essential due to the high risk of recurrence, requiring timely and appropriate interventional management.
Decidual changes in deep pelvic endometriosis (DPE) are extremely rare. During pregnancy, endometriotic activity and symptoms diminish due to hormonal changes, whereas the endometrial lining undergoes decidualization in response to progesterone. In some cases, a significant hormonal boost can promote the decidualization of endometriotic implants, with endometriomas being the most common sites for such changes. Decidualized endometriosis at sites outside the ovaries is a rarer phenomenon, and the associated imaging features have been studied less. We present a case of non-pregnancy-related decidualization involving multiple sites of DPE. A 33-year-old woman exposed to ovarian stimulation before in vitro fertilization (IVF) presented with chronic pelvic pain and vaginal bleeding. Emergency CT demonstrated irregular solid tissue in the pouch of Douglas and along the bowel loops, raising concern for a neoplastic process. Tumor markers were negative. Transvaginal ultrasound showed a hypoechoic, irregular, hypervascular lesion, and ultrasound-guided biopsy demonstrated decidualized stromal endometriosis. MRI confirmed a solid mass centered in the posterior cul-de-sac with intermediate T2-weighted (W) signal intensity, hemorrhagic foci on fat-suppressed T1W images, marked diffusion restriction, and avid post-contrast enhancement. Similar solid components were also present at multiple pelvic sites, adjacent to DPE implants. Short-interval MRI follow-up showed size reduction; however, due to persistent pain, fertility-sparing surgery was performed, and histology confirmed decidualization of DPE at all sites. This rare case emphasizes that decidualization can also occur on DPE and outside pregnancy, potentially mimicking malignant transformation, highlighting the role of MRI in aiding diagnosis and guiding proper management for these patients.
Soft-tissue sarcomas of the abdomen and abdominal wall are rare, and their imaging appearances can overlap with those of benign inflammatory conditions. Foreign body-related phlegmon caused by a migrated fish bone from the bowel represents an uncommon but important diagnostic mimic, often indistinguishable from malignancy on cross-sectional imaging. Although several single case reports describe this entity, no radiology-focused multi-case series has been previously published. We present 3 patients referred to a regional sarcoma service with abdominal wall masses initially suspected to represent soft-tissue sarcoma. All 3 underwent multimodality imaging, which demonstrated heterogeneous, enhancing abdominal-wall lesions with associated inflammatory change. In each case, thin-slice CT ultimately identified a subtle linear hyperdense structure, corresponding to a migrated fish bone traversing or lying adjacent to bowel, establishing the correct diagnosis of foreign-body-induced phlegmon. MRI appearances were non-specific and mimicked neoplastic processes. Management varied from conservative antibiotic therapy to incision and drainage, with all patients making a full recovery and no recurrence. This case series highlights a rare but significant radiologic pitfall in the assessment of abdominal wall masses. Key learning points include scrutinizing CT in thin slices and bone windows for linear calcified foreign bodies, recognizing that MRI and PET-CT may mislead toward malignancy, and maintaining foreign-body phlegmon within the differential diagnosis for atypical abdominal wall "tumours." Awareness of this entity can prevent unnecessary biopsies, oncologic referrals, and radical surgeries.
Abstract Introduction Intussusception is a common cause of acute abdominal emergency in infants and is usually managed successfully with image-guided enema reduction. Failure of nonoperative reduction should prompt consideration of underlying anatomic abnormalities, including congenital intestinal rotational anomalies. Case Presentation We report a 6-month-old infant who presented with symptoms of intussusception. Abdominal ultrasonography demonstrated a classic target sign consistent with intussusception, without additional specific findings. Contrast enema reduction was unsuccessful and revealed an unexpected bowel configuration. Surgical intervention was subsequently performed. Postoperative imaging demonstrated abnormal bowel positioning consistent with a congenital rotational abnormality, characterized by an atypical, mirror-image distribution of the small bowel and colon that did not conform to classical definitions of malrotation or nonrotation. Conclusion Recognition of atypical intestinal rotational patterns is clinically relevant in the evaluation of intussusception, particularly when nonoperative management fails. Awareness of these uncommon configurations may aid in accurate interpretation of imaging findings, timely surgical management, and improved characterization of congenital bowel anomalies.
Inferior Vena Cava (IVC) filters are an established treatment option to prevent morbidity and mortality in patients who are at high risk for pulmonary embolus and unable to receive pharmacological anticoagulation. As their use increases, we are now seeing an increasing incidence of associated complications; IVC thrombosis is one of them and can be challenging to treat. Our report describes a rare case of a 55-year-old male patient with active metastatic lung cancer presenting with concurrent inferior vena cava syndrome and spontaneous retroperitoneal hemorrhage due to an occlusive IVC filter-associated thrombus. The case demonstrates successful treatment with large bore mechanical thrombectomy. Our case aims to provide insight into a rare yet complex complication that can occur due to IVC filter use. Our hope is that this case increases awareness of how to successfully manage concurrent IVC filter thrombosis and resultant retroperitoneal hemorrhage with large bore mechanical thrombectomy.
Epididymo-orchitis usually responds to antibiotics, yet a small subset of patients progress to testicular infarction, a rare but serious complication. We describe a 73-year-old man with epididymo-orchitis and a pyocele whose initial ultrasound demonstrated reversal of diastolic intratesticular flow, in keeping with impending infarction. Despite transient improvement with antibiotics, he re-presented on day 8 with recurrent pain and near-complete infarction on repeat ultrasound, with persistent reversed diastolic flow in regions of preserved vascularity. This case highlights reversal of diastolic flow as a radiological red flag in epididymo-orchitis and suggests practical recommendations for Doppler assessment, early repeat imaging, and urgent urological review.
Uterine polypoid adenomyoma (UPA) is a rare focal form of adenomyosis that can present as an intracavitary lesion and pose a significant diagnostic challenge, often mimicking more common or concerning entities, such as endometrial polyps or uterine adenosarcoma. We describe the case of a 53-year-old woman who presented with profound anemia (hemoglobin 3.9 g/dL) secondary to acute on chronic heavy vaginal bleeding. Multimodal imaging, including ultrasound and MRI, prompted the initial diagnosis of UPA, later supported by surgical pathology. Ultrasound demonstrated diffusely heterogeneous myometrial echotexture and multifocal "venetian blind" artifact consistent with adenomyosis. MRI revealed an ovoid lesion within the endometrial cavity containing numerous T2 hyperintense cystic foci and imaging characteristics similar to the junctional zone, consistent with a submucosal UPA. Management included blood transfusions, hormone therapy, and ultimately hysterectomy. This case serves to underscore the importance of a combined approach, including both multimodal imaging and histopathology, in guiding the accurate diagnosis and optimal management of UPA. It is also intended to increase awareness of this rare lesion and encourage its consideration in the differential diagnosis of intracavitary uterine masses, as it may have implications for treatment planning.
Sarcoidosis is a multisystem granulomatous disease that most commonly involves the lungs and intrathoracic lymph nodes. Osseous involvement is uncommon, reported in approximately 1%-14% of cases, and is frequently subclinical or discovered incidentally on imaging. Symptomatic bone involvement as the presenting manifestation of sarcoidosis is rare. In the largest single-center series, only 1 of 20 patients (5%) had osseous disease as the sole manifestation. We describe a 48-year-old man who presented with progressive atraumatic right shoulder pain and was initially suspected to have rotator cuff pathology. MRI instead revealed supraspinatus and infraspinatus tendinitis, multifocal destructive osseous lesions involving the humerus and scapula, and a pathologic scapular fracture. Subsequent FDG PET-CT demonstrated pulmonary and multifocal skeletal hypermetabolic lesions, and CT-guided biopsy of the left iliac crest showed non-caseating granulomas, establishing the diagnosis of sarcoidosis. This case highlights the diagnostic challenge of osseous sarcoidosis when it presents before a known systemic diagnosis and mimics both common shoulder pathology and metastatic disease. It also illustrates the value of advanced imaging and tissue diagnosis in clarifying destructive bone lesions in patients without classic systemic symptoms.
Emphysematous pyelonephritis (EPN) is a severe necrotizing infection characterized by gas formation within the renal parenchyma and surrounding tissues. Although perinephric extension is well recognized, fistulous communication with the adjacent bowel is exceedingly rare. We report a case of a 58-year-old woman presenting with fever, left flank pain, uncontrolled diabetes mellitus, and acute kidney injury. Initial non-contrast CT KUB showed left EPN with a large perinephric air-containing collection and loss of fat planes with the adjacent descending colon, raising suspicion of a reno-colic fistula. Following DJ stenting, a repeat CT scan with administration of rectal contrast demonstrated direct contrast leakage into the perinephric collection, confirming fistulous communication. Subsequent colonoscopy corroborated the imaging findings. This case highlights the importance of sequential CT imaging and the role of rectal contrast in confirming rare fistulous complications of EPN.
Hepatic pseudolymphoma (HPL) is a rare benign lymphoproliferative disorder that can mimic malignant hepatic tumors on imaging. Hepatic pseudolymphoma is usually small and solitary; however, multiple lesions can develop in some cases. Herein, we report multiple HPLs with an unusual hepatobiliary finding on gadoxetic acid-enhanced MRI. A woman in her 50 s with non-alcoholic fatty liver disease was incidentally found to have 2 hepatic tumors: a 3-cm lesion in segment 5 (S5) and a 1-cm lesion in segment 8 (S8) during pre-operative cholelithiasis evaluation. The laboratory tests, including liver function and tumor marker levels, were unremarkable. The 2 lesions were hyperintense on fat-suppressed T2-weighted images and showed restricted diffusion. On dynamic gadoxetic acid-enhanced MRI, both lesions demonstrated faint arterial enhancement and hepatobiliary-phase hypointensity, with peritumoral arterial-phase hyperenhancement. Additionally, the S5 lesion showed faint linear hyperintensity adjacent to the lesion on diffusion-weighted imaging and contained an internal ring-like area that was hypointense on T2-weighted images but hyperintense within an otherwise hypointense lesion in the hepatobiliary phase. As malignancy could not be excluded, laparoscopic anterior sectionectomy was performed. Histopathological examination confirmed reactive lymphoid hyperplasia in both lesions. In the S5 lesion, the intratumoral fibrotic tissues formed a ring-like structure corresponding to the hepatobiliary-phase hyperintensity. Hepatobiliary-phase ring-like hyperintensity attributable to intratumoral fibrosis in HPL has not been previously reported. Awareness of this imaging-pathology correlation may improve interpretation of HPL imaging and help differentiate it from malignant hepatic tumors that can show hepatobiliary-phase hyperintensity, including hepatocellular carcinoma, cholangiocarcinoma, and metastases.
Congenital hernia of the umbilical cord (CHUC) is a rare and often under-recognized anterior abdominal wall defect that is frequently misdiagnosed as an omphalocele. It represents a distinct embryological entity with a benign course and favorable prognosis. Prenatal ultrasonography is crucial for accurate diagnosis, appropriate parental counseling, and safe perinatal management, particularly to prevent bowel injury during umbilical cord clamping. We report a case of isolated fetal umbilical hernia detected on a routine mid-trimester anomaly scan and highlight key sonographic features that aid differentiation from other abdominal wall defects.
Cerebral fat embolism (CFE) is a rare complication of orthopaedic, cardiac and plastic surgery and major trauma. Mechanical embolectomy has been used as a treatment option for this condition. Here, we described a case report of an elderly woman who developed CFE after a total hip replacement which was treated with mechanical embolectomy with aspiration alone. The patient developed left-sided hemiparesis and abnormal posturing after surgery and a CT angiogram 45 minutes later showed a right M1 embolus with fat attenuation. Mechanical embolectomy with aspiration was conducted to produce a TICI score of 3. No patent foramen ovale (PFO) was found to explain the paradoxical embolism. Subsequently, a systematic literature review on the use of mechanical embolectomy for CFE was conducted, with the databases Medline, Web of Science, Embase, Cinahl, and Scopus being searched. The review found 20 cases, 13 of which were treated with aspiration and a stent retriever, and 5 of which were treated with aspiration only. A reduced mortality was observed in the aspiration only cohort compared to the aspiration plus stent retriever cohort, despite both groups having similar age and gender. Among patients treated with stenting, 3 out of 13 (23%) died, compared to 0 out of 5 (0%) patients treated with aspiration alone. Although this difference was not statistically significant, it may reflect a trend worth further exploration, potentially limited by the small sample size. Further registry-based studies and preclinical models are required to elucidate the effectiveness and superior technique of mechanical embolectomy for CFE.
Complex perianal fistulas can harbor extensive secondary extensions and pelvic sepsis despite minimal systemic symptoms and normal inflammatory markers, creating a high risk of incomplete surgery when anatomy is underestimated. We report a case of a complex transsphincteric fistula (Parks classification) with suspected supralevator involvement in which preoperative MRI provided decisive anatomic mapping for operative planning. Multiplanar T2-weighted imaging delineated the primary tract, its relationship to the sphincter complex and levator plate, and extension into the ischioanal/ischiorectal fossae, while also demonstrating features consistent with secondary tracts and occult abscesses-findings that commonly explain postoperative persistence or recurrence if missed. Notably, gadolinium-enhanced fat-suppressed T1-weighted sequences increased conspicuity of subtle distal rectal communications that were poorly visualized on T2-weighted images, supporting the utility of contrast in selected scenarios to distinguish enhancing active tracts/abscess walls from surrounding inflammatory edema or fibrosis. Given concomitant distal rectal ulceration on endoscopy, an inflammatory bowel disease work-up was considered to exclude fistulizing Crohn's disease, for which careful staging of perianal sepsis and combined medical-surgical management are recommended. This case highlights the value of MRI (including contrast-enhanced protocols when indicated) as a preoperative adjunct to examination under anesthesia, enabling tailored, sphincter-preserving strategies and comprehensive sepsis control in complex fistulizing disease.
Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition that can closely mimic malignancy on imaging. IgG4-related retroperitoneal fibrosis (RPF) most commonly involves the para-aortic or peri-iliac regions, while focal perinephric involvement is uncommon. Accurate differentiation from true perinephric tumour extension is critical, as misinterpretation may substantially alter renal cell carcinoma (RCC) staging and management. A 41-year-old man undergoing contrast-enhanced CT for transient rectal bleeding was incidentally found to have a heterogeneously enhancing left renal mass suspicious for RCC, with adjacent unilateral irregular perinephric soft tissue extending beyond Gerota's fascia. On CT, these findings were interpreted as locally advanced cT4 RCC. Radical nephrectomy was performed. Histopathology demonstrated clear cell RCC, grade 2, confined to the kidney (pT1b), with intact renal capsule and no perinephric or lymphovascular invasion. The adjacent perinephric tissue instead showed storiform fibrosis, dense IgG4-positive plasma cell infiltrates, and obliterative phlebitis, consistent with IgG4-related RPF. Serum IgG4 was mildly elevated. Postoperative FDG PET/CT demonstrated a focal hypermetabolic perinephric lesion without systemic involvement, and both imaging and serologic findings improved following corticosteroid therapy. This case highlights a rare but important radiologic pitfall in which focal perinephric IgG4-related RPF was radiologically indistinguishable from perinephric RCC extension, resulting in initial overstaging. IgG4-RD should be considered in the differential diagnosis when perinephric soft tissue appears inseparable from a renal mass, and multimodal evaluation integrating imaging, pathology, and serology is essential to avoid overstaging and inappropriate management.
Pancreatic lipomas are exceptionally rare benign mesenchymal tumors that may closely resemble well-differentiated liposarcomas on imaging, particularly when large or atypical. We report the case of a 60-year-old man who presented with abdominal pain, nausea, and vomiting, and was found to have a large fat-containing mass in the pancreatic head on computed tomography. Imaging characteristics-including size, mild heterogeneity, and a cystic component-raised strong suspicion for a well-differentiated liposarcoma. Due to diagnostic uncertainty and potential oncologic risk, the patient underwent a pancreaticoduodenectomy (Whipple procedure). Histopathological evaluation revealed a benign pancreatic lipoma composed of mature adipocytes without atypia or lipoblasts. This case highlights the diagnostic limitations of imaging in differentiating benign from malignant fat-containing pancreatic lesions and underscores the essential role of histopathology for definitive diagnosis. Surgical resection remains crucial when imaging is inconclusive or when malignancy cannot be confidently excluded.
Congenital anomalies of the inferior vena cava (IVC) are often encountered incidentally in cross sectional imaging modalities. The most frequently described anomalies include retroaortic left renal vein, left IVC, double IVC, circumaortic left renal vein, interruption of IVC with azygos and hemiazygos continuation, absence of the infrarenal IVC, and circumcaval ureter. This report shows an unusual case of congenital inferior vena cava anomaly, characterized by an intrapulmonary course of the inferior vena cava.
The optimal treatment strategy for intracranial aneurysms (IA) in pregnancy is unclear, particularly in the third trimester of pregnancy and during the intrapartum period. We discuss a case of a ruptured IA at 39 + 3 weeks of gestation, during prelabour and review literature focusing on the order of treatment and delivery. A 4 × 6 × 3 mm aneurysm arising from the left posterior communicating segment of the internal carotid artery was embolised with multiple detachable coils, followed by a caesarean section (CS) with good maternal and foetal outcomes. Our review of the literature identified 29 reported cases of ruptured intracranial aneurysms in pregnancy. After 22 weeks of gestation, mortality was higher amongst patients who delivered first (3/9) compared to those who were coiled first (1/11). Our case and the published literature support the approach of securing the aneurysm before delivery to improve maternal outcomes.
