Case-based Review Research Articles

Mycobacterium marinum: A Case-Based Narrative Review of Diagnosis and Management.

Skin and soft tissue infections caused by non-tuberculous mycobacteria are occurring more frequently in recent years. However, chronic skin and soft tissue lesions present a challenge for clinicians, as the diagnostic work-up and definitive diagnosis require knowledge and available laboratory resources. We present here the case of a 66-year-old male patient who presented with painful abscess-like nodules on his right hand and forearm, which worsened after treatment with an anti-TNF-a agent. The fluid specimen taken from the lesion was positive for mycobacteria according to the acid-fast stain. Mycobacterium marinum was identified, first by next-generation sequencing and finally grown on culture, after eight weeks. Acknowledging the complexity of diagnosing and managing infections by non-tuberculous mycobacteria, and especially Mycobacterium marinum, we provide a review of the current epidemiology, clinical characteristics, diagnosis and management of Mycobacterium marinum infection.

A Case-Based Review of Free-living Amebic Human Infections and Diagnosis

Naegleria fowleri, Balamuthia mandrillaris, and Acanthamoeba species are free-living amebae that are ubiquitously found in soil and water and can opportunistically cause invasive, deadly infections in humans. In this review, we present four patient cases due to free-living amebae and review the epidemiology and clinical significance of the diseases they cause. Specifically, primary amebic encephalitis due to N. fowleri, granulomatous amebic encephalitis due to B. mandrillaris and Acanthamoeba spp., keratitis due to Acanthamoeba spp., and non-central nervous system systemic infections (due to B. mandrillaris and Acanthamoeba spp.) are reviewed, and the clinical utility of microbiologic and histopathologic methods for diagnosing infections due to free-living amebae are compared.

A Rare Presentation of AKI Due to Retroperitoneal Fibross as A Result of Gastric Linitis Plastica: A Case-Based Review

Short bowel syndrome (SBS) refers to a condition resulting from loss of bowel or loss of small bowel absorptive surface area due to surgical resection or bypass leading to maldigestion, malabsorption and malnutrition.

Valentino's Syndrome: from History to Images. A Case-Based Literature Review

In the emergency setting, right lower quadrant pain is a common clinical scenario. While acute appendicitis is the most relevant cause, there is a wide differential diagnosis. Valentino syndrome is a rare entity in which gastric or duodenal perforation, usually secondary to peptic ulcer disease, presents clinically with right lower quadrant pain mimicking acute appendicitis. It has its origins in Rudolph Valentino, a famous American actor who died of sepsis following an undiagnosed perforated ulcer after an appendectomy. Nowadays, radiological images play a crucial role in this pathology, historically diagnosed using exploratory laparotomy. Through a clinical case and a review of the literature, we aim to describe the historical evolution of Valentino’s syndrome, illustrate its clinical and radiological characteristics and highlight the increasing role of imaging, particularly computed tomography, in its early prospective diagnosis and in guiding targeted treatment. Finally, it is important to consider this pathology when assessing acute abdominal patients with coexisting pneumoperitoneum and appendicitis.

Improvement in Intestinal-Failure-Associated Liver Disease by Using Parenteral Fish Oil as Monotherapy: Case-Based Review of the Literature

Intestinal-failure-associated liver disease (IFALD) is a common complication of prolonged parenteral nutrition (PN). Risk factors for IFALD include clinical features, as well as medical interventions, and its management was initially based on the decrease or interruption of parenteral nutrition while increasing enteral nutrition. However, the tolerance of full enteral nutrition in children with intestinal failure may require prolonged intestinal rehabilitation over a period of years. As a consequence, infants unable to wean from PN are prone to develop end-stage liver disease. We describe the case of an infant receiving long-term PN who was diagnosed with IFALD wherein we were able to reverse IFALD by switching lipid emulsions to fish oil monotherapy. A systemic review of case reports and case series on reversing IFALD using fish oil lipid emulsion follows the case description.

Fulminant myocarditis with adult-onset Still's disease: case-based review.

Myocarditis has been reported as a life-threatening complication of adult-onset Still's disease (AOSD), but fulminant myocarditis with AOSD is very rare. We hereby report a case of a 43-year-old female with fulminant myocarditis with AOSD. She had a refractory AOSD and cardiogenic shock with markedly elevated ferritin level up to 67,370 ng/mL. She was successfully treated with canakinumab and mechanical circulatory support (MCS) such as venoarterial extracorporeal membrane oxygenation and Impella CP. We also reviewed the previous cases of fulminant myocarditis with AOSD published from 1976 to December 2022, and only 8 cases of fulminant myocarditis with AOSD have been reported. The characteristics of these cases showed that the average age at presentation was 37.6 years (range 24-47 years). The time to myocarditis from the onset of AOSD ranged from 2 weeks to 2 years; however, most cases developed myocarditis within 1 year. Initial presenting symptoms included fever, dyspnea, chest pain, myalgia, rash, and sore throat. The median peak ferritin was 13,000 ng/mL. Left ventricular ejection fractions were not greater than 35%. Our case was the first reported case successfully treated with canakinumab and MCS. This review suggests that myocarditis may be an early phase of the complication in patients with AOSD, and the severity of AOSD may correlate with the severity of myocarditis. Canakinumab for AOSD and MCS for fulminant myocarditis may be one of the choices for overcoming the comorbidities.

Newly-onset Autoimmune Diabetes Mellitus Triggered by COVID 19 Infection: A Case-based Review.

The devastating global pandemic Coronavirus disease 2019 (COVID 19) isolated in China in January 2020 is responsible for an outbreak of pneumonia and other multisystemic complications. The clinical picture of the infection has extreme variability: it goes from asymptomatic patients or mild forms with fever, cough, fatigue and loss of smell and taste to severe cases ending up in the intensive care unit (ICU). This is due to a possible cytokine storm that may lead to multiorgan failure, septic shock, or thrombosis. Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV -2), which is the virus that causes COVID 19, binds to angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in key metabolic organs and tissues, including pancreatic beta cells, adipose tissue, the small intestine and the kidneys. Therefore it is possible to state that newly-onset diabetes is triggered by COVID 19 infection. Although many hypotheses have clarified the potential diabetogenic effect of COVID 19, a few observations were reported during this pandemic. Two male patients admitted to us with devastating hyperglycemia symptoms were diagnosed with type 1/autoimmune diabetes mellitus within 3 months following COVID 19 infection. Autoantibodies and decreased C peptide levels were detected in these patients. We speculated that several mechanisms might trigger autoimmune insulitis and pancreatic beta-cell destruction by COVID 19 infection. We aim to raise awareness of the possible link between SARS-CoV-2 and newly onset type 1 diabetes mellitus. Further studies are needed to determine a more definitive link between the two clinical entities.

Leukocytoclastic vasculitis induced by adalimumab biosimilar in an elderly female with rheumatoid arthritis: A case-based review

Leukocytoclastic vasculitis induced by adalimumab biosimilar in an elderly female with rheumatoid arthritis: A case-based review

Juvenile clinically amyopathic dermatomyositis (CADM): Case-based review

Juvenile clinically amyopathic dermatomyositis (CADM): Case-based review

Cardiothoracic Conditions with Female Preponderance: Case-based Imaging Review

HomeRadioGraphicsVol. 43, No. 6 Next Chest ImagingRadioGraphics FundamentalsCardiothoracic Conditions with Female Preponderance: Case-based Imaging ReviewKatharina F. Feister*, Katerina S. Konstantinoff* , Clinton E. Jokerst, Pamela K. Woodard, Kathryn J. Lindley, Tonya D. Russell, Sanjeev BhallaKatharina F. Feister*, Katerina S. Konstantinoff* , Clinton E. Jokerst, Pamela K. Woodard, Kathryn J. Lindley, Tonya D. Russell, Sanjeev BhallaAuthor AffiliationsFrom the Mallinckrodt Institute of Radiology (K.F.F., K.S.K., P.K.W., S.B.), and Department of Pulmonology (T.D.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; Department of Radiology, Mayo Clinic, Phoenix, Ariz (C.E.J.), and Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tenn (K.J.L.).Address correspondence to K.S.K. (email: [email protected]).Katharina F. Feister*Katerina S. Konstantinoff* Clinton E. JokerstPamela K. WoodardKathryn J. LindleyTonya D. RussellSanjeev BhallaPublished Online:May 11 2023https://doi.org/10.1148/rg.220115MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In * K.F.F. and K.S.K. contributed equally to this work.AbstractUsing a case-based approach, this slide presentation promotes awareness and recognition of cardiothoracic conditions that are unique to or disproportionately affect women to help radiologists formulate a differential diagnosis and avoid diagnostic pitfalls.Suggested ReadingsAbramson S, Gilkeson RC, Goldstein JD, Woodard PK, Eisenberg R, Abramson N. Benign metastasizing leiomyoma: clinical, imaging, and pathologic correlation. AJR Am J Roentgenol 2001;176(6):1409–1413. Crossref, Medline, Google ScholarBroncano J, Vargas D, Bhalla S, Cummings KW, Raptis CA, Luna A. CT and MR Imaging of Cardiothoracic Vasculitis. RadioGraphics 2018;38(4):997–1021. Link, Google ScholarCapobianco J, Grimberg A, Thompson BM, Antunes VB, Jasinowodolinski D, Meirelles GSP. Thoracic manifestations of collagen vascular diseases. RadioGraphics 2012;32(1):33–50. Link, Google ScholarChamié LP, Ribeiro DMFR, Tiferes DA, Macedo Neto AC, Serafini PC. Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings. RadioGraphics 2018;38(1):309–328. Link, Google ScholarJeung MY, Gangi A, Gasser B, et al. Imaging of chest wall disorders. RadioGraphics 1999;19(3):617–637. Link, Google ScholarKhashper A, Gruber JM, Fraser RS, Discepola F, Semionov A. Review of Thoracic Imaging Findings Unique to Women. Can Assoc Radiol J 2015;66(3):223–230. Crossref, Medline, Google ScholarPrince JS, Duhamel DR, Levin DL, Harrell JH, Friedman PJ. Nonneoplastic lesions of the tracheobronchial wall: radiologic findings with bronchoscopic correlation. RadioGraphics 2002;22(Spec No):S215–S230. Link, Google ScholarSeaman DM, Meyer CA, Gilman MD, McCormack FX. Diffuse cystic lung disease at high-resolution CT. AJR Am J Roentgenol 2011;196(6):1305–1311. Crossref, Medline, Google ScholarTailor TD, Kicska GA, Jacobs JE, Pampaloni MH, Litmanovich DE, Reddy GP. Imaging of Heart Disease in Women. Radiology 2017;282(1):34–53. Link, Google ScholarArticle HistoryReceived: May 8 2022Revision requested: June 16 2022Revision received: July 7 2022Accepted: July 11 2022Published online: May 11 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleCardiothoracic Conditions with Female Preponderance: Case-based Imaging ReviewMay 11 2023Default Digital Object SeriesRecommended Articles Practical Imaging Interpretation in Patients Suspected of Having Idiopathic Pulmonary Fibrosis: Official Recommendations from the Radiology Working Group of the Pulmonary Fibrosis FoundationRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 1Thoracic Manifestations of Rheumatoid ArthritisRadioGraphics2021Volume: 41Issue: 1pp. 32-55Chronic Lung Allograft Dysfunction: Review of CT and Pathologic FindingsRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 1Imaging Features of Primary Immunodeficiency DisordersRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 2Interstitial Lung Disease in Children Made Easier…Well, AlmostRadioGraphics2017Volume: 37Issue: 6pp. 1679-1703See More RSNA Education Exhibits The Female Thorax - A Case Based Review Of Thoracic Pathology In The Female PatientDigital Posters2021An Image is Worth a Thousand Words: Important Considerations about Connective Tissue Disease-Associated Interstitial Lung DiseaseDigital Posters2022Uncommon Causes of Interlobular Septal Thickening: How to Tell Them Apart?Digital Posters2022 RSNA Case Collection LymphangioleiomyomatosisRSNA Case Collection2021Organizing pneumonia associated with ulcerative colitisRSNA Case Collection2020Organizing pneumonia associated with ulcerative colitisRSNA Case Collection2020 Vol. 43, No. 6 Slide PresentationMetrics Altmetric Score PDF download

Venous Thromboembolism Management in Pregnant Patients

Pulmonary embolism (PE) in pregnancy accounts for 10% of maternal deaths in the United States. As maternal morbidity and mortality continue to increase, it is imperative for all specialties interfacing with pregnant patients to understand the current research and guidelines surrounding risk stratification, diagnosis, and treatments of PE in pregnancy. Given the complexity of high-risk pregnancy-associated PE (PA-PE), that is, which is associated with hemodynamic instability or collapse, and the rising popularity of new technologies to treat high-risk PA-PE in the nonpregnant population, this review aims to emphasize the differences in diagnosis, risk stratification, and management of the pregnant and nonpregnant PE patients. Furthermore, this review will cover treatment paradigms that include anticoagulation versus advanced therapies such as systemic thrombolysis, surgical embolectomy, extracorporeal membrane oxygenation, and inferior vena cava disruption as well as the more novel therapies which fall under the umbrella term of catheter-based treatments. Finally, this review will include a case-based review of 2 patients with PA-PE requiring catheter-based therapies and their ultimate clinical outcomes.

Developmental milestones as ACNS turns one year old

Developmental milestones as ACNS turns one year old

Refractory alopecia in lupus treated with tofacitinib - a case-based review.

One of the common cutaneous symptoms of systemic lupus erythematosus (SLE) that may have major psychosocial effects in a female is diffuse alopecia. Although Janus kinase inhibitors have shown encouraging results in the treatment of SLE and of alopecia areata in recent studies, tofacitinib in treating refractory alopecia caused by SLE has been rarely documented. The Janus kinases (JAKs) are intracellular tyrosine kinases that play a significant role in the pathophysiology of SLE by participating in a wide range of inflammatory cascades. Here, we reported a 33-year-old SLE patient with long standing (3years) refractory alopecia who took tofacitinib and observed a substantial increase in hair growth. This was sustained at 2-years follow-up even after tapering off glucocorticoids completely. In addition, we reviewed the literature to look for further evidence to support the use of JAK inhibitors for alopecia in SLE.

Cogan’s syndrome is more than just keratitis: a case-based literature review

BackgroundCogan's syndrome (CS) is a rare autoimmune disorder characterized by non-syphilitic interstitial keratitis (IK) and Menière-like cochlear vestibular symptoms, which may also have systemic effects. Corticosteroids are first-line treatment. DMARDs and biologics have been used to treat ocular and systemic symptoms of CS.Case presentationThis is a case of a 35-year-old female who reported hearing loss, eye redness and photophobia. Her condition progressed to a sudden sensorineural hearing loss, tinnitus, and constant vertigo accompanied by cephalea. CS was diagnosed after excluding other diseases. The patient still developed bilateral sensorineural hearing loss after receiving hormone, methotrexate, cyclophosphamide, and a variety of biological agents. Joint symptoms were relieved after treatment with a JAK inhibitor (tofacitinib), and hearing did not deteriorate further.ConclusionsCS should be involved in the differential diagnosis of keratitis. Early identification and intervention of this autoimmune disease can minimize disability and irreversible damage.

Pediatric Extra-Renal Nephroblastoma (Wilms' Tumor): A Systematic Case-Based Review.

Wilms Tumor (WT) is one of the most common renal tumors in the pediatric population. Occasionally, WT can primarily develop outside the kidneys (Extra-Renal Wilms Tumor, ERWT). Most pediatric ERWTs develop in the abdominal cavity and pelvis, whereas the occurrence of this tumor in other extra-renal sites represents a minor part of ERWT cases. In addition to describing a case of spinal ERWT (associated with spinal dysraphism) in a 4-year boy (to add a further clinical experience on this very rare pediatric tumor), we performed a case-based systematic literature review on pediatric ERWT. We retrieved 72 papers providing enough information on the diagnosis, treatment, and outcomes of 98 ERWT pediatric patients. Our research highlighted that a multimodal approach involving both chemotherapy and radiotherapy, after partial or complete tumor resection in most cases, was typically used, but there is no standardized therapeutic approach for this pediatric malignancy. However, this tumor may be potentially treated with a better success rate if the diagnostic confirmation is not delayed, the mass can be totally resected, and an appropriate and, possibly, tailored multimodal treatment can be promptly established. In this regard, an international agreement on a unique staging system for (pediatric) ERWT is definitely needed, as well as the development of international research, which may be able to gather several children diagnosed with ERWT and, possibly, lead to clinical trials which should also include developing countries.

Mowat-Wilson Syndrome; 3 Cases with Characteristic EEG Findings (P3-1.008)

<h3>Objective:</h3> This is a case-based review of clinical manifestations and electroencephalogram findings of Mowat-Wilson Syndrome (MWS) <h3>Background:</h3> MWS is a rare multi system disorder due to ZEB2 gene defects. The main feature of MWS is epilepsy; 75–80% prevalence was noted in prior case series. <h3>Design/Methods:</h3> Children with known diagnoses of MWS were identified in the Pediatric Epilepsy Clinic attached to a tertiary-care pediatric hospital through retrospective chart review. Literature was searched with keywords ‘Mowat-Wilson Syndrome’ and ‘EEG features’ <h3>Results:</h3> Three children with MWS were identified. All cases were heterozygous for ZEB2 gene mutations and had brain imaging and electroencephalograms available for review. <h3>Patient A (11 year-old):</h3> Semiology was generalized and focal (oral automatisms and left-hand flapping). On electroencephalogram there was continuous 2–3 Hz spike-and-wave activity during sleep with left predominance (left frontal at first, but then involving the entire left hemisphere over the years), and intermittent 2.5–3 Hz high-voltage generalized spike-and-wave bursts during wakefulness <h3>Patient B (7 year-old):</h3> Semiology was generalized and focal (right-sided hypotonia and leftwards gaze). On electroencephalogram there were frequent 2–3 Hz poly-spike-and-wave discharges with left frontal-central predominance during sleep, and seizures stemming from right temporal and parieto-occipital areas during status epilepticus <h3>Patient C (4 year-old):</h3> Semiology was generalized. On electroencephalogram there were frequent bi-occipital sharp-and-slow-wave discharges as well as infrequent bursts of high-amplitude generalized 1–2 Hz spike-and-waves <h3>Conclusions:</h3> Electroencephalograms of 2 of 3 patients had continuous spike-waves in sleep (CSWS), even as seizure burden and semiology differed. While there was no CSWS in Patient C, there were sharp-and-slow-wave discharges during wakefulness. It is possible that due to Patient C’s younger age, the EEG has not progressed to develop full CSWS. Indeed, in Patient A, there was a clear progression of EEG abnormalities as the child grew older. This leads these authors to believe that CSWS seems to be distinctly common among Mowat-Wilson. <b>Disclosure:</b> Dr. Shahab has nothing to disclose. Dr. Anilkumar has received publishing royalties from a publication relating to health care.

The Radiologist at the Center of Breast Conservation in the Management of Breast Cancer: A Case-Based Narrative Review of the Literature

The management of breast cancer involves a multidisciplinary team approach involving the surgeon, radiologist, pathologist, radiotherapist, and clinical oncologist. Radiology in the management of breast cancer patients allows for lesion detection and characterization, confirmation of diagnosis with image-guided biopsy, post-biopsy placement of clip marker, confirmation of patients’ eligibility for breast conservation surgery, image-guided localization, staging, evaluation of response to therapy before surgery, and follow-up after treatment for breast cancer. This narrative review is based on a case of a 35-year-old woman offered breast-conserving therapy for stage IIB breast cancer in a tertiary hospital in Southwest Nigeria. This case-based review highlights the radiologist’s vital role in breast conservation in the management of breast cancer, elaborating on the radiological management of this patient.

Withdrawal from Hemodialysis in a Patient with IgD Type Multiple Myeloma: A Case-based Review.

Several previous case reports have shown that patients with immunoglobulin D (IgD) multiple myeloma (MM) can be withdrawn from hemodialysis, however, the characteristics that can predict withdrawal in these patients have not yet been elucidated. A 57-year-old Japanese woman required hemodialysis because of renal dysfunction due to IgD-λ and Bence Jones protein-λ MM. Bortezomib-based chemotherapy nine days after admission led to her withdrawal from hemodialysis on Day 50. In our case-based review, younger age and early initiation of bortezomib-based chemotherapy emerged as possible predictors of successful hemodialysis withdrawal.

Mucopolysaccharidosis Type I in Mexico: Case-Based Review

Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disease present in 1:100,000 newborns. Variants in the IDUA (alpha-L-iduronidase) gene decrease the enzyme activity for glycosaminoglycans metabolism. MPS I patients exhibit clinical manifestations that fall on the Hurler, Hurler-Scheie, and Scheie syndrome spectrum. We present a male Mexican patient with respiratory exacerbations requiring recurrent hospitalizations. He showed macrocephaly, coarse facies, hepatomegaly, umbilical hernia, and dorsal kyphosis. The sequencing of the IDUA gene revealed the following genotype: c.46_57del12/c.1205G>A. He received combined therapy with hematopoietic stem cell transplantation and enzyme replacement. Mexican case reports were analyzed to estimate the prevalence of the associated genetic variants. Despite the challenges of managing this rare disease in Mexico, our patient benefited from the combined therapy. The discrete clinical manifestations and prompt evaluation by a geneticist were crucial in establishing a diagnosis, enabling an early intervention by a multidisciplinary team. The combination of ERT before and after HSCT provided health benefits to our patient.

Idiopathic axillary web syndrome: a case-based review of an unusual disorder

Axillary web syndrome (AWS), which frequently develops following axillary lymph node dissection, can also be caused by several other conditions, such as infection or strenuous exercise. In recent years, idiopathic cases have also been reported. We report the case of a 27-year-old female who presented with pain, tension and a taut rope-like structure in the left armpit area. She also had a limited shoulder range of motion in abduction and forward flexion. We diagnosed the patient with idiopathic AWS based on a detailed clinical history and manifestations. The patient completely recovered without any sequelae by therapeutic interventions, including nonsteroidal anti-inflammatory drugs and physical therapy. Through a systematic review of the literature, four additional cases of idiopathic AWS were identified. This study aimed to investigate the similarities and differences between idiopathic and typical AWS cases.