Characteristic Radiological Findings Research Articles

Clinical analysis of infectious mononucleosis complicated with acute acalculous cholecystitis.

This study aimed to investigate specific clinical diagnostic methods for children with infectious mononucleosis (IM) complicated by acute acalculous cholecystitis (AAC). We conducted a retrospective analysis of 171 cases of IM diagnosed in the infectious disease ward of Children's Hospital of Nanjing Medical University between January 2020 and December 2020. All IM patients underwent abdominal ultrasound examinations to assess the liver, gallbladder, and spleen. Fourteen patients with symptoms of AAC underwent a follow-up assessment one week later. The estimated incidence of AAC in hospitalized IM children was 8.2%. Both groups of patients presented with fever, abdominal pain, and eyelid edema upon admission. Characteristic radiological findings of AAC were observed, including gallbladder (GB) distention, increased GB wall thickness and increased common bile duct diameter. Analysis of laboratory results revealed no statistically significant differences in leukocyte, absolute lymphocyte count, CD3+, CD3 + CD4+, CD3+ CD8+, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), or Gamma-Glutamyl Transferase (GGT) levels between the AAC(+) and AAC(-) groups on admission. However, these parameters were not significant risk factors for AAC. After discharge, relevant indicators in non-AAC patients gradually decreased to normal levels, while those in AAC(+) patients did not show a significant decrease. While cases of IM complicated by AAC are relatively uncommon, the utilization of abdominal ultrasound offers a reliable tool for confirming this diagnosis. Routine abdominal ultrasound examinations are recommended for IM patients to improve early detection and treatment of associated conditions.

A Case of Pulmonary and Central Nervous System Invasive Aspergillosis with Characteristic Radiological Findings

A Case of Pulmonary and Central Nervous System Invasive Aspergillosis with Characteristic Radiological Findings

A Case of Multiple Sclerosis Presenting with Tumefactive Lesions

Inflammatory demyelinating diseases including multiple sclerosis (MS) are usually diagnosed based on characteristic clinical and radiological findings. However, some demyelinating diseases have presented with growing large mass-like lesions, and it is difficult to differentiate those demyelinating lesions from brain tumors. We report a case of biopsy-proven MS mimicking brain tumor. This case suggests that inflammatory demyelinating diseases including MS have a wide spectrum and can present with the same radiological features as brain tumors such as lymphoma or high-grade glioma.

A Scarce Case of Sarcomatoid Bladder Carcinoma and Bladder Stone in a 58-Year-Old Man: A Case Report

BACKGROUND: Sarcomatoid bladder carcinoma is scarcely found, with most cases of bladder carcinoma due to bladder stone as a risk factor consisting of squamous cell carcinoma. Only 221 cases were reported between 1973 and 2004 of sarcomatoid bladder cancer. Therefore, this case report brings out sarcomatoid bladder carcinoma and its clinical relevance. CASE DESCRIPTION: A 58 years old Indonesian man experienced gross hematuria for 3 months, and thus finally brought to the Emergency Room (ER) where he was initiated urinary catheter and given intravenous (IV) fluid along with analgesic parenterally. Emergency abdominal radiograph assessment and blood test were made. Abdominal radiograph assessment suggests a 6 x 6 cm opacity in the bladder and several urolithiasis in the pelvic cavity. Ureum and creatinine increased in the blood test procedure. Based on the characteristic appearance and radiological findings, a diagnosis of vesicolithiasis was made. Following the diagnosis, the patient was urgently operated on (Open vesicolithotomy), and during the stone removal, there was a tangled polyp-like mass found buried underneath the stone. Histological findings of mass and surrounding lymph nodes were made and histopathologically stated the mass was sarcomatoid carcinoma of the bladder and it had metastated to lymph node and pelvic region. CONCLUSION: Considering hematuria in urolithiasis is frequent, the clinician should be aware of any tumor findings especially when the hematuria is massive thus emergency urolithotomy should be considered immediately.

A Case of Multiple Sclerosis Presenting with Tumefactive Lesions

Inflammatory demyelinating diseases including multiple sclerosis (MS) are usually diagnosed based on characteristic clinical and radiological findings. However, some demyelinating diseases have presented with growing large mass-like lesions, and it is difficult to differentiate those demyelinating lesions from brain tumors. We report a case of biopsy-proven MS mimicking brain tumor. This case suggests that inflammatory demyelinating diseases including MS have a wide spectrum and can present with the same radiological features as brain tumors such as lymphoma or high-grade glioma.

Esophageal tumors: The keys to diagnosis by pneumo-computed tomography

ObjectiveTo review and describe the most characteristic radiological findings of the most frequent esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique. ConclusionMalignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly leiomyoma being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.

Posterior Reversible Encephalopathy Syndrome in a Patient with Septic Shock: A Case Report.

Posterior reversible encephalopathy syndrome (PRES) is a reversible condition with nonspecific neurologic and characteristic radiologic findings. Clinical presentation may include headache, nausea, vomiting, altered mental status, seizures, and vision changes. Diagnosis is confirmed through T2-weighted brain magnetic resonance imaging (MRI) showing bilateral hyperintensities in the white matter of posterior circulatory regions. We report a case of PRES in a patient suffering from complicated diverticulitis. Following medical management in the emergency department, the patient deteriorated, becoming hypotensive and altered. Bowel resection under general anesthesia was performed. Postoperative brain MRI demonstrated bilateral and symmetric T2 signal hyperintensities suggestive of PRES. Following supportive treatment, the patient was discharged from the surgical intensive care unit on postoperative day 21 with no residual deficits. It is important to recognize the nonspecific neurologic symptoms associated with PRES. Emergency physicians should suspect acute PRES when managing patients with prolonged or unexplained encephalopathy, while recognizing that hypertension need not be present.

Evaluation of paediatric hip pain.

Hip pain in a child can pose a diagnostic conundrum. In most cases, the cause of a painful hip is often attributed to trauma, but a number of these cases will be atraumatic. The main entities to consider are inflammatory, infective and neoplastic causes. Pathologies such as avascular necrosis and slipped upper femoral epiphysis can also present in a similar manner. A detailed history and clinical examination are crucial in narrowing down the differential diagnosis. In addition, understanding the most appropriate imaging modalities and the characteristic radiological findings is key in ensuring timely treatment and management. This article reviews the various disease processes in children who present with hip pain and outlines the most appropriate assessment and imaging modalities that will aid diagnosis.

Pictorial spectrum of fibrodysplasia ossificans progressiva – Report of a rare case

Fibrodysplasia ossificans progressiva (FOP) is a rare debilitating inherited disorder which is characterized by great toe malformation and progressive heterotopic ossification of connective tissue in which tendons and ligaments are gradually replaced by bone. The extraskeletal heterotopic bone limits the patient’s mobility. The average age of onset is the first 2 decades of life with the current prevalence rate of 1 in 2 million cases worldwide. Thorough clinical examination, characteristic radiological findings, and genetic analysis pave a way in making an early diagnosis for better care and management of the patient with FOP.

Patología tumoral esofágica: claves diagnósticas mediante neumo-tomografía computarizada (Neumo-TC)

ObjectiveTo review and describe the most characteristic radiological findings of the most frequent esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique. ConclusionMalignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly leiomyoma being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.

Identification of the audiological and temporal bone radiology manifestations of SOFT syndrome: a case report

BackgroundSOFT syndrome is characterized by prenatal onset growth retardation, brachydactyly, onychodysplasia, postpubertal onset hypotrichosis, normal psychomotor development, and facial dysmorphism including dolichocephaly, elongated triangular face, prominent forehead and nose, and abnormal ear structure. This syndrome has been described in 31 patients worldwide.Case presentationIn this case report, the audiological and temporal bone radiological results of a 4-year- and 5-month-old patient with SOFT syndrome are presented. Bilateral internal acoustic canals (IAC) are dilated with lobulated contour.ConclusionsThis case report is the first in the literature as it reports audiological and temporal bone radiology observations in SOFT syndrome. It is thought that regular and detailed audiological and temporal bone radiology evaluations performed in patients with different SOFT syndrome will be a reference for determining the characteristic audiological and temporal bone radiological findings related to this syndrome.

A rare case of sclerosing angiomatoid nodular transformation of the spleen – a case report

Sclerosing angiomatoid nodular transformation (SANT) is a benign vascular lesion arising in the spleen. Although this lesion has characteristic radiological findings on both computerised tomography (CT) and magnetic resonance imaging (MRI) scans, it may pose a difficulty in distinguishing this rare benign entity from other lesions of the spleen both clinically and radiologically. We report a case of 46-year-old man with a splenic soft tissue lesion found incidentally on ultrasonography of the abdomen.

A case of thanatophoric dysplasia with characteristic radiological, histological and molecular findings

Thanatophoric dysplasia (TD) is one the most common lethal skeletal dysplasia with an incidence of one in 20,000. It is caused by de novo mutation of fibroblast growth factor receptor 3 (FGFR3) which in turn leads to reduced proliferation and maturation of growth plate chondrocytes. Two subtypes have been described. Type I typically features short long bones with bowed femurs, while type II manifests with straighter femurs and cloverleaf skull due to craniosynostosis.1 Our case is a 21 week gestation female baby with skeletal dysplasia diagnosed on the 20 week ultrasound.

A pictorial review of the radiographic skeletal findings in Morquio syndrome (mucopolysaccharidosis type IV).

Morquio syndrome, also known as Morquio-Brailsford syndrome or mucopolysaccharidosis type IV (MPS IV), is a subgroup of mucopolysaccharidosis. It is an autosomal recessive lysosomal storage disorder. Two subtypes of Morquio syndrome have been identified. In MPS IVA, a deficiency in N-acetylgalactosamine-6-sulfate sulfatase interrupts the normal metabolic pathway of degrading glycosaminoglycans. Accumulated undigested glycosaminoglycans in the tissue and bones result in complications leading to severe skeletal deformity. In MPS IVB, a deficiency in beta-galactosidase results in a milder phenotype than in MPS IVA. Morquio syndrome presents a variety of clinical manifestations in a spectrum of mild to severe. It classically has been considered a skeletal dysplasia with significant skeletal involvement. However, the extraskeletal features can also provide valuable information to guide further work-up to assess the possibility of the disorder. Although the disease involves almost all parts of the body, it most commonly affects the axial skeleton, specifically the vertebrae. The characteristic radiologic findings in MPS IV, such as paddle-shaped ribs, odontoid hypoplasia, vertebral deformity, metaphyseal and epiphyseal bone dysplasia, and steep acetabula, are encompassed in the term "dysostosis multiplex," which is a common feature among other types of MPS and storage disorders. Myelopathy due to spinal cord compression and respiratory airway obstruction are the most critical complications related to mortality and morbidity. The variety of clinical features, as well as overlapping of radiological findings with other disorders, make diagnosis challenging, and delays in diagnosis and treatment may lead to critical complications. Timely imaging and radiologic expertise are important components for diagnosis. Gene therapies may provide robust treatment, particularly if genetic variations can be screened in utero.

Case report on chronic non-bacterial osteomyelitis (CNO) and review of literature

Introduction: Chronic Non-Bacterial Osteomyelitis (CNO) is a rare inflammatory disorder not related to any infectious disease characterized by focal aseptic inflammation with a self-limiting, relapsing course of disease with female predominance and usually observed in paediatric age groups diagnosed by clinical, radiological and histopathological findings after ruling out all other differentials.Case Report: A case of 6 year old female which presented with non-specific bone pain in the metadiaphyseal region of proximal humerus. X-rays had osteolytic lesions in the metadiaphyseal region and with a history of trivial trauma and no positive history of autoimmunity. Conclusion: CNO is difficult to identify and no consensus exist on diagnosis and treatment modality. Multifocal bone lesions with characteristic radiological findings are very suggestive of CNO. But dilemma with unifocal lesion with no corroborative findings. In such cases diagnosis is achieved with exclusion. No data exist on best treatment option after Non-Steroidal Anti-Inflammatory Drugs failure. But excision biopsy with complete curettage in unifocal lesions gives immediate symptom relief and long term good outcome without a background of identifiable auto-immune disease.

Neuroimaging in the diagnosis and treatment of intracranial pressure disorders.

To review the clinical features, proposed pathophysiology, and the role of medical imaging in the diagnosis and treatment of idiopathic intracranial hypertension and spontaneous intracranial hypotension. The authors conducted a narrative review of the current literature on intracranial hypertension and hypotension syndromes, with a focus on imaging findings and role of neurointerventional radiology as a therapeutic option for these pathologies. Idiopathic intracranial hypertension commonly presents in obese women of childbearing age, being headache and papilledema the main clinical manifestations. Characteristic radiological findings consist of increased cerebrospinal fluid around the optic nerve, partially empty sella turcica and stenosis of the transverse sinuses. Transverse sinus stenting is a treatment alternative that has proven valuable utility in the recent years. Spontaneous intracranial hypotension in most of cases presents with orthostatic headache and has predilection for female population. The typical radiological features in the brain consist of subdural fluid collections, enhancement of the dura, engorgement of the venous structures, pituitary enlargement, and sagging of the brain. In this pathology, a cerebrospinal fluid leak in the spine associated with a defect in the dura, meningeal diverticulum, or a cerebrospinal fluid-venous leak must be actively ruled out. Neurologic complaints secondary to changes in intracranial pressure exhibit certain clinical features that in combination with fairly specific radiological patterns allow a highly accurate diagnosis. The diverse specialists in neurosciences should be aware of the multiple image modalities in the study of these syndromes as well as the treatment alternatives by neurointerventional radiology.

Leigh Syndrome in a Filipino Child: A Case Report

Introduction: Leigh disease and Leigh-like syndrome are a heterogenous group of neurodegenerative disorders involving any level of the neuraxis and may present with a variety of clinical presentations, prominent among them is psychomotor regression. Despite the remarkable number of established disease genes and novel mutations being discovered, many cases of Leigh syndrome remain without a genetic diagnosis, indicating that there are still more disease genes to be identified. Case: Here we present a case of a two and a half-year-old girl who presented with delayed acquisition of developmental milestones with subsequent regression, ataxia, and dyskinesia. Her work-up showed raised blood lactate levels and lactate peak in MR spectroscopy. Mitochondria genome showed absence of mitochondrial DNA mutation, while whole exome sequence analysis revealed a novel dynein gene variant, p.A1577S. Her parents underwent genetic testing as well, and her father also had the same dynein mutation, however, is non-symptomatic. She had an older brother who initially presented with ophthalmoplegia and eventually developed psychomotor regression. He subsequently expired from respiratory failure after almost 2 years from initial presentation. Both siblings were diagnosed with Leigh syndrome. Conclusion: The diagnosis of Leigh syndrome remains based on characteristic clinical and radiologic findings. However, a specific defect must be identified if reliable genetic counseling is to be provided.

Protocolo diagnóstico y terapéutico de las micosis pulmonares

Fungal infections are less common than bacterial or viral infections and are associated with a high rate of morbidity and mortality. This text will discuss infections by Aspergillus in their different clinical symptoms, histoplasmosis, and coccidioidomycosis. The diagnosis is determined by compatible symptoms, characteristic risk factors, radiological findings, and microbiological isolation. There are a wide variety of prophylaxis and antifungal treatment strategies. Antifungal treatment in aspergillosis and other types of pulmonary mycoses are based on the use of liposomal amphotericin B, echinocandins, and azoles, all based on the isolation of the described species and resistances. This type of treatment has different profiles of effectiveness, safety, pharmacological interactions, and important side effects to take into account.

Jaundice on Presentation Is Associated with Higher In-Patient Mortality and Complications in Patients Admitted for Acute Pancreatitis: A Retrospective Study Based on National Inpatient Sample Database.

Pancreatitis usually presents with characteristic abdominal pain, radiological findings, and elevated lipase. The presence of jaundice may hint at a biliary etiology; however, it is not always present. We hypothesized that the presence of jaundice is associated with worse outcomes in patients admitted with pancreatitis. We conducted a retrospective analysis using the National Inpatient Sample, inquiring about patients admitted with pancreatitis with and without jaundice between October 2015 and December 2017. The primary outcome was in-hospital mortality in patients admitted for pancreatitis with and without jaundice. Secondary outcomes were the median length of stay, hospitalization cost, the incidence of ventilator-dependent respiratory failure (VDRF), acute respiratory distress syndrome (ARDS), sepsis, septic shock, dehydration and electrolyte disturbances, and ascites. A total of 1,267,744 patients were admitted with pancreatitis from October 2015 to December 2017. Among them, 8855 (0.7%) had concomitant jaundice on presentation. In-hospital mortality in this group was 4.3%. The patients with pancreatitis and jaundice had higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 1.51, 99% CI 1.35–1.68, p < 0.0001) as compared to those without jaundice. Patients with jaundice showed a significantly higher incidence of sepsis (15.2% vs. 9.6%, p < 0.0001), septic shock (4.1% vs. 2.9%, p < 0.0001), ascites (6.5% vs. 3.1%, p < 0.0001), and dehydration and electrolyte disorders (47.6% vs. 43.8%, p < 0.0001). Patients with jaundice also had higher total hospital costs ($11,412 vs. $7893, p < 0.0001). There was no statistical difference in ARDS, VDRF, and median length of stay. In conclusion, patients admitted for pancreatitis with jaundice had worse outcomes, including in-hospital mortality and complications, compared to those without jaundice.

DYSKERATOSIS CONGENITA: A RARE CAUSE OF USUAL INTERSTITIAL PNEUMONIA

DYSKERATOSIS CONGENITA: A RARE CAUSE OF USUAL INTERSTITIAL PNEUMONIA