Abstract In this case report, we present a 76-year-old woman who presented with an adnexal mass, ascites, and peritoneal lesions, all features highly suspicious for ovarian cancer. The patient was enrolled in a clinical trial evaluating the diagnostic performance and clinical value of [68Ga]Ga-fibroblast activation protein inhibitor-46 ([68Ga]Ga-FAPI-46) PET/CT, a novel PET tracer that has demonstrated promising results in ovarian cancer. The preoperative [18F]Fluorodeoxyglucose ([18F]FDG) PET/CT and [68Ga]Ga-FAPI-46 PET/CT showed up to moderate tracer uptake in the ovarian tumor and peritoneal lesions; however, final histopathology revealed a benign teratoma and peritoneal reactive changes. Furthermore, the patient had a history of Polymyalgia Rheumatica (PMR), and [18F]FDG PET/CT showed classic findings of PMR. [68Ga]Ga-FAPI-46 PET/CT revealed similar results, but with even higher tracer accumulation in affected locations. This case is the first to demonstrate the potential of [68Ga]Ga-FAPI-46 PET/CT in PMR.
Abstract Renal cortical hemosiderosis is the accumulation of iron in the renal cortex. On MRI, this can be inferred by marked cortical T2 hypointensity and loss of signal on in-phase imaging relative to opposed-phase imaging. Although classically associated with paroxysmal nocturnal hemoglobinuria, renal hemosiderosis can be seen in a variety of pathologic conditions associated with acute or chronic renal injury. We present a case of a 59-year-old female that developed acute kidney injury while hospitalized for management of hydronephrosis and hepatic abscess with imaging features on MR angiography and renal parenchymal biopsy consistent with renal cortical hemosiderosis. Combined with other laboratory results, this finding supports the diagnosis of atypical hemolytic uremic syndrome, a condition with poor prognosis for which timely treatment is essential. Thus, recognition of renal cortical hemosiderosis on imaging may facilitate appropriate clinical workup and timely management.
Abstract Background Cystic echinococcosis rarely involves the pancreas and may mimic common cystic neoplasms. Recognition of characteristic imaging signs is central to diagnosis; the “water-lily” sign (floating detached endocyst) is a rare and highly characteristic finding in favor of transitional-stage hydatid cyst and, when recognized, can prevent inappropriate cyst puncture and guide stage- and anatomy-based management. Case A 34-year-old woman from Iran, an endemic region for cystic echinococcosis, presented with intermittent epigastric/right upper quadrant pain. At an outside institution, endoscopic ultrasound-guided fine-needle aspiration had been performed before referral; cyst-fluid amylase was 20 U/L and carcinoembryonic antigen was not detected, arguing against pseudocyst and mucinous neoplasm. Ultrasound and MRI/MRCP performed after EUS showed a unilocular pancreatic head cyst with a floating internal membrane (“water-lily”/“serpent” appearance) and mild upstream pancreatic duct dilatation. Our multidisciplinary team favored pancreatic cystic echinococcosis. The patient underwent surgical cyst excision with avoidance of scolicidal instillation into the biliary tree. Albendazole (400 mg twice daily, ∼ 10-15 mg/kg/day) was given perioperatively and continued for 6 months. Pathology confirmed laminated membranes and protoscolices. She remains asymptomatic on surveillance MRI without recurrence. Conclusion In an endemic region, a pancreatic cyst with a floating membrane and low cyst-fluid amylase should raise suspicion for cystic echinococcosis. Anchoring the diagnosis to WHO staging and resisting routine EUS-FNA can avert spillage and caustic cholangiopathy from scolicidal agents. Radiologists play the key role in making this distinction.
Abstract We report a case of refractory chylous ascites following nephroureterectomy and para-aortic lymphadenectomy for renal pelvic carcinoma, which was successfully treated with percutaneous lymphatic embolization. An 83-year-old man underwent nephroureterectomy with para-aortic lymph node dissection for renal pelvic carcinoma. Postoperatively, >1000 mL/day of chylous ascites was continuously drained. Despite conservative management, high-output ascites persisted. Transnodal lymphangiography via the inguinal lymph nodes and post-lymphangiographic CT revealed lymphatic leakage at the nephroureterectomy site. Percutaneous lymphatic embolization was planned as a minimally invasive procedure. Under CT guidance, embolization of a lymphopseudoaneurysm and para-aortic lymph nodes near the leakage site was successfully performed using N-butyl cyanoacrylate. Ascitic fluid output decreased significantly postoperatively, and the drainage tube was removed the following day. This case highlights the importance of post-lymphangiographic CT in identifying actionable lymphatic targets and demonstrates that an anatomically tailored dual-target embolization strategy can achieve effective sealing when central duct access is not feasible.
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.
