Primary intraventricular abscesses are very rare and may be mistaken for intraventricular tumors or other lesions with very few cases reported in literature. Although organisms from the oral cavity are recognized pathogens for brain abscess formation, reports of abscesses caused by Schaalia odontolytica previously known as Actinomyces odontolyticus remain uncommon.This is a case report of a 6-year-old boy with a congenital heart disease (ventricular septal defect and pulmonary atresia) who presented with headaches, fever, neck stiffness and vomiting. Magnetic resonance imaging of the brain showed central T1W hypointense, T2/FLAIR hyperintense collection in the dilated left lateral ventricle with associated periventricular vasogenic oedema indicating a primary intraventricular abscess. The main abscess was drained via a burr hole with persistent small abscesses in the occipital and temporal horns. A second burr hole attempt at draining the occipital and temporal lobe abscesses failed. Cultures of the pus yielded Schaalia odontolytica a known flora of the mouth. No oral lesions were observed in the patient. The patient was managed on 61 days of amoxicillin-clavulanic acid, with erythrocyte sedimentation rate falling from 6 mm/h to 1 mm/h after 2 months of therapy.Primary intraventricular abscess is a rare but potentially life-threatening condition that can present with nonspecific neurological symptoms. In children with cyanotic congenital heart disease, an intracranial abscess should be considered when compatible clinical and neuroimaging findings are present. This case highlights the importance of MRI for diagnosis and microbiological examination of drained material for identification of unusual pathogens such as Schaalia odontolytica.
Papillary thyroid carcinoma (PTC) generally has an excellent prognosis and an indolent clinical course. However, major vascular invasion with tumor thrombus formation is exceedingly rare. We report the case of a 63-year-old woman with recurrent PTC presenting five years after total thyroidectomy and radioactive iodine therapy.Contrast-enhanced CT demonstrated recurrent disease within the thyroidectomy bed, extensive cervical nodal metastases, retrosternal extension, pulmonary nodules, and tumor thrombus involving the left brachiocephalic vein near the SVC junction.The patient underwent extensive surgical management, including left modified neck dissection, median sternotomy, en bloc resection of recurrent disease, thrombectomy, and primary repair of the brachiocephalic vein. Histopathological examination confirmed recurrent papillary thyroid carcinoma with vascular tumor thrombosis. Postoperatively, the patient received adjuvant radioactive iodine therapy.At 12-month follow-up, serum thyroglobulin levels were undetectable, and imaging studies demonstrated no evidence of locoregional recurrence. This case highlights a rare and aggressive presentation of recurrent PTC with major venous involvement and demonstrates that satisfactory short-term disease control can be achieved through aggressive multidisciplinary management.
Hirayama disease is an uncommon, self-limiting myelopathy of the lower cervical cord that predominantly affects young males. The condition arises from a length mismatch between the vertebral column and the posterior dura, leading to anterior dural displacement and cord compression during neck flexion. We present the case of a 19-year-old male with a two-year history of progressive right-hand weakness and forearm wasting. Clinical examination showed the oblique amyotrophy sign, cold paresis, and intact sensory function without pyramidal findings. We performed a single-session dynamic cervical MRI covering three neck positions: neutral with intravenous gadolinium, flexion at approximately 48 degrees, and gentle hyperextension. In the neutral position, T2-weighted sequences revealed loss of cervical lordosis with asymmetric right hemicord atrophy at C6–C7, and post-contrast images demonstrated a crescentic enhancing structure in the posterior epidural space from C3 to C6, consistent with an engorged posterior internal vertebral venous plexus. Flexion images showed posterior dural detachment spanning C3 to T1, marked enlargement of this epidural crescent, anterior displacement of the cord, and near-total effacement of the posterior subarachnoid space. On extension imaging, all of these compressive changes reversed almost completely, with the dural wall returning to laminar apposition and the subarachnoid space restored to its normal caliber. This three-position approach yielded a complete mechanistic picture of the flexion-dependent pathology and allowed a confident diagnosis without recourse to electrophysiological testing.
Silicone breast implant rupture is a recognized long-term complication that may result in extracapsular silicone deposition and foreign-body granulomatous inflammation, potentially mimicking breast malignancy. We report a 74-year-old woman with breast augmentation approximately 30 years earlier who presented with failure to thrive and progressive left breast erythema despite multiple courses of antibiotics. Mammography demonstrated findings suggesting implant rupture with extensive free silicone in the left breast. Given associated skin thickening and persistent inflammation, the findings were interpreted as BI-RADS 4 and inflammatory breast cancer could not be excluded. Punch biopsy revealed dermal inflammation, foreign-body giant-cell reaction, and material consistent with silicone, without malignancy, confirming silicone-associated granulomatous inflammation. The patient’s condition continued to decline requiring intensive care unit admission and subsequently expired 2 months after index presentation and admission. We report this case to highlight extracapsular silicone rupture as an important mimic of inflammatory breast cancer and emphasizes the role of multimodality imaging and tissue sampling in establishing the diagnosis while distinguishing localized siliconosis from systemic breast implant-related syndromes.
En plaque meningioma is an uncommon variant of meningioma (2–9% of cases), defined by a thin carpet-like sheet of tumor spreading along the dura together with bone hyperostosis that is disproportionate to the intradural component. The spheno-orbital region is the site of election, and because the dominant abnormality on imaging is a sclerotic bone lesion rather than a mass, the diagnosis is frequently delayed or mistaken for fibrous dysplasia. We report the case of a 75-year-old woman with no history of malignancy, cranio-orbital trauma, or infection, who presented with slowly progressive left orbital swelling, unilateral exophthalmos, and ipsilateral visual loss. Magnetic resonance imaging showed a left spheno-orbital lesion with broad-based dural thickening, isointense to cortex on T1-weighted images, iso- to slightly hyperintense on T2/FLAIR, with intense and relatively homogeneous enhancement after gadolinium, exerting mass effect on the orbital contents without adjacent parenchymal signal abnormality. Computed tomography demonstrated marked hyperostosis along the left greater sphenoid wing with mild narrowing of the ipsilateral optic canal. The association of a broad-based enhancing dural sheet with disproportionate hyperostosis was highly suggestive of an en plaque meningioma of dural origin. Histopathologic examination of the resected specimen confirmed a meningothelial meningioma, CNS WHO grade 1, with bone invasion. This case illustrates a compartment-based reading of spheno-orbital hyperostosis (orbital, osseous, or meningeal) and the value of imaging–pathology correlation: bone invasion was histologically confirmed in this patient, although meningioma-associated hyperostosis does not necessarily reflect direct neoplastic invasion in every case.
