Imaging Differential Diagnosis Research Articles

Oropharyngeal Hairy Polyp: A Case of Respiratory Failure in a Newborn

Hairy polyps, also known as dermoid polyps (DPs), are rare benign cystic lesions of bigerminal origin that may occur in several head and neck regions, including the oropharynx. Despite their benign histopathological nature, DPs may be life threatening, due to their upper airway location, and DPs represent one of the most unusual causes of respiratory distress during the neonatal period. In this paper, we describe a case of respiratory failure in a newborn with an oropharyngeal mass that was accidentally found during difficult intubation. Magnetic resonance imaging (MRI) detected a well-defined soft tissue pedunculated mass, arising from the left oropharynx wall, consistent with an oropharyngeal DP. The newborn had a prompt recovery after trans-oral mass removal. Our case underlines the importance of imaging in differential diagnosis of children’s respiratory distress, secondary to a variety of lesions within the region of the skull base or oropharynx. It allowed us to assess the origin of the lesion, as well as its relationship with the adjacent soft tissues, and to exclude intracranial extension, thus providing essential information for the surgical planning.

Investigating cystic lung disease: a respiratory detective approach.

The cystic lung diseases are rare orphan lung disorders that most physicians will see infrequently in their everyday practice. Diagnostic and treatment options have improved over recent decades, with opportunities for slowing rate of progression and improving outcome for patients. This review provides a summary of the clinical approach to these lung disorders, including how to differentiate between different imaging patterns, clinical features, differential diagnosis and characteristics of the commonest presenting disorders.Educational aimsTo understand the clinical, pathological and radiological features of cystic lung disordersTo explore the differential diagnosis of cystic lung diseaseTo be familiar with the key features (clinical, radiological, physiological and pathological) of the commoner cystic lung diseases, which assist in differentiating between these

The Role of Optical Coherence Tomography in Differential Diagnosis of Multiple Sclerosis and Autoimmune Connective Tissue Diseases with CNS Involvement.

The purpose of this study was to examine whether application of optical coherence tomography (OCT) measurements can provide a useful biomarker for distinguishing central nervous system (CNS) involvement in autoimmune connective tissue diseases (CTD) from multiple sclerosis (MS). An observational study included non-optic neuritis eyes of 121 individuals: 59 patients with MS, 30 patients with CNS involvement in CTD, and 32 healthy controls. OCT examination was performed in all subjects to measure retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, ganglion cell layer-inner plexiform layer (GCIPL) thickness, and volume of the macula. There was a significant group effect with regard to superior optic disc RNFL, macular RNFL, GCC, and GCIPL thickness, and macular volume. Post-hoc analysis revealed that MS patients have significantly smaller macular volume and thinner superior optic disc RNFL, macular RNFL, GCC, and GCIPL compared to healthy controls. CTD patients have significantly smaller superior optic disc RNFL, GCIPL, and GCC thickness compared to healthy controls. However, no significant group differences were observed between the patient groups (MS vs. CTD) on any outcome. Although a prominent retinal thinning may be a useful biomarker in MS patients, in a general population of individuals with a confirmed CNS involvement the use of OCT is not specific enough to discriminate between MS and autoimmune CTD.

Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas.

The aim of the study is to describe the imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas (ACLs). ACLs are benign lymphatic malformations that mainly arise in the subperitoneal space and the retroperitoneum. The typical presentation of an ACL is a multilocular lesion with homogenous serous content, presenting a thin wall and septa, usually free from adjacent organ compression. Atypical findings, including fat or hemorrhagic content, septal calcifications and unilocular presentation, are not uncommon. Rarely, ACLs can be revealed by acute complications, such as infection, hemorrhage, intussusception, complications with a twisting mechanism (including torsion around its own pedicle) or spontaneous rupture, which can be diagnosed by imaging. Ultrasonography and CT are the most useful modalities in emergency situations. MRI performs best in the noninvasive characterization of cystic lesions. ACLs should be differentiated from normal anatomic structures (e.g., cisterna chyli) or pitfalls (e.g., ascites, extrapancreatic necrosis, lymphocele) that can simulate ACLs. Among other primary peritoneal cystic lesions, benign cystic mesothelioma can be difficult to differentiate from ACL. Some neoplastic peritoneal lesions may have cystic components or content that looks like fluid on imaging (such as mucinous or myxoid content) and be misdiagnosed as ACL. Nodular or thick enhancement of the wall or septa should then be considered worrisome features and should not suggest ACL. ACLs mostly require a simple follow-up. If treatment is necessary, percutaneous sclerotherapy is a safe and effective alternative to surgery. Imaging, especially MRI, allows the noninvasive diagnosis of ACL and helps to exclude potential malignant differential diagnoses.

The Atypical “Diving” Lesion: Congenital Dilated Imperforate Submandibular Duct

A congenital dilated imperforate submandibular duct is a rare condition that presents early in neonates. Treatment can vary considerably from other lesions more commonly found in the floor of the mouth. Here we describe the case of a 1-week-old neonate with a fluctuant lesion in the floor of the mouth, ultimately diagnosed as a congenital dilated imperforate submandibular duct. We then discuss the imaging characteristics, differential diagnosis, and treatment of the condition.

The role of HRCT in the diagnosis of COVID-19

Objective The outbreak of COVID-19 in China has spread rapidly across the country since December 2019, the population is generally susceptible, and human-to-human transmission has gradually spread out. This article explores the value of HRCT in the diagnosis of COVID-19. Methods This article explores the typical CT imaging findings, imaging staging, imaging diagnosis process and differential diagnosis of the COVID-19. Results With the emergence of the classification of diagnostic in Hubei Province, imaging examinations, especially HRCT, play important roles in the diagnosis of COVID-19. HRCT is helpful for early screening of suspected cases and monitoring the dynamic changes of the disease. Conclusions HRCT will make up for missed diagnosis caused by the false negative of the viral nucleic acid detection, and empower the clinical diagnosis and treatment of Novel Coronavirus Pneumonia with more scientificity and effectivity. Key words: HRCT; COVID-19; Imaging diagnostic cases; Clinical diagnostic cases

Imaging diagnosis and differential diagnosis of neuromyelitis optica spectrum disorders

视神经脊髓炎谱系疾病的诊断标准提出了6大核心临床特征，包括视神经炎、急性脊髓炎、极后区综合征、急性脑干综合征、症状性睡眠发作或急性间脑综合征伴典型的间脑MRI病灶、症状性大脑综合征伴典型大脑MRI病变，其中影像学具有重要的作用。本文拟通过对其6大核心临床特征所对应影像学改变的探讨以及常见疾病鉴别诊断的分析，使影像科和神经科医师更好地认识视神经脊髓炎谱系疾病，同时更好地理解并掌握其诊断标准。

Vascular Ischemic Myelopathy in Adolescents and Young Adults: What Should One Know?

We present 3 cases of adolescents and young adult with vascular ischemic myelopathy, 2 of which were associated with sports (surfing and water polo), and a third of a patient with a fibrocartilaginous embolism related to a trivial fall from a forklift. These are rare clinical presentations in adolescents and with poor prognosis in most cases. This article describes their clinical presentations in detail and offers a review of the literature with emphasis on the imaging findings and differential diagnosis.

Pediatric multiple sclerosis: from clinical basis to imaging spectrum and differential diagnosis.

Pediatric multiple sclerosis (MS) deserves special attention because of its impact on cognitive function and development. Although knowledge regarding pediatric MS has rapidly increased, understanding the peculiarities of this population remains crucial for disease management. There is limited expertise about the efficacy and safety of current disease-modifying agents. Although pathophysiology is not entirely understood, some risk factors and immunological features have been described and are discussed herein. While the revised International Pediatric MS Study Group diagnostic criteria have improved the accuracy of diagnosis, the recently revised McDonald criteria also offer some new insights into the pediatric population. It is fundamental that radiologists have strong knowledge about the vast spectrum of demyelinating disorders that can occur in childhood to ensure appropriate diagnosis and provide early treatment.

Comparison of gadoxetic acid and gadobenate dimeglumine, liver-specific contrast agents used in magnetic resonance imaging in differential diagnosis of liver masses

To compare Gadoxetic acid and Gadobenate dimeglumine in the detection and characterization of liver masses. In this study, 59 lesions in 28 patients are included in which were dynamic MRI that had been used Gadoxetic acid (Gd-EOB-DTPA) and Gadobenate dimeglumine (Gd-BOPTA). Observers recorded the liver lesions and adjacent parenchymal signal intensities (SI) in precontrast, arterial and hepatocyte phase by using the ROIs for the quantitative analysis. All statistical analyzes were performed with SPSS 22 software. p

Anterior chest wall non-traumatic diseases: a road map for the radiologist.

The anterior chest wall (AWC) non-traumatic pathologies are largely underestimated, and early detection through imaging is becoming increasingly important. This paper aims to review the major non-traumatic ACW pathologies, with a particular interest in imaging features and differential diagnosis. (www.actabiomedica.it)

A case report on how not to miss Kaposiform hemangioendothelioma in neonates

Background: Kaposiform hemangioendothelioma (KH) is an uncommon tumor in infants and children. The typical clinical presentations include ill-demarcated, red to purple, indurated plaque and are frequently complicated by the Kasabach-Merritt phenomenon (KMP), a condition of severe thrombocytopenia and consumptive coagulopathy. It might be misdiagnosed as infantile hemangioma at birth, leading to a delay in delivering optimal treatment. Therefore, imaging differential diagnosis of KH should be included in pediatric patients presented with atypical vascular lesion for timely management. Case Presentation: We present a case of a 2-month-old male child, born with right lower limb hypertrophy and bluish discoloration, initially diagnosed as a hemangioma. Magnetic resonance imaging diagnosis was suggestive of KH complicated with KMP in correlating with clinical history. Therefore, optimal treatment is possible at a time if correct diagnosis is made early. Conclusion: KH should be retained as one of the differential diagnoses in pediatric patients presenting with vascular tumor. Imaging could help in reaching the diagnosis without invasive surgical interventions in order to initiate proper treatment.

Imaging of Nontraumatic Orbital and Neuro-ophthalmological Emergencies

Emergency department (ED) visits for eye and vision-related concerns are common. In most cases, accurate diagnosis is made using clinical history and physical exam findings without the need for emergent imaging. When orbital imaging is performed in the ED, it is often in patients with orbital trauma where CT is used to assess for orbital fractures and associated injuries. However, CT or MR imaging can also be critical to appropriately diagnose and manage certain ED patients with nontraumatic eye and vision-related conditions. The purpose of this article is to review the imaging findings and differential diagnoses for nontraumatic orbital and neuro-ophthalmological emergencies from a practical, clinical perspective, based on a patient's typical presenting symptoms. The more commonly imaged clinical indications will be discussed including periorbital swelling, proptosis, eye pain, diplopia, and visual disturbances. In addition, rare but easily overlooked and clinically important diagnoses for the emergency radiologist to recognize will be highlighted.

Multiple Hereditary Exostoses: Genetics, Multimodality Imaging Features, Complications, Differential Diagnosis, and Treatment

Osteochondromas are a common type of benign bone tumor that occur during childhood. Osteochondromas can be solitary or multifocal as a part of a syndrome, known as multiple hereditary exostoses (MHE). This differentiation was first discovered in 1786 by John Hunter, a famous Scottish surgeon. In 1814, MHE was found to have a familial association. Later, in the 1900s, MHE was differentiated from other disorders, such as Ollier disease (multiple enchondromatosis) and Trevor disease (dysplasia epiphysealis hemimelica). MHE is known by other names including hereditary multiple osteochondromas, diaphyseal aclasis, hereditary deforming chondrodysplasia, and Ehrenfried disease. MHE occurs more frequently in males than in females (1.5–2:1) and whites. Males also tend to be more severely affected. In patients with MHE, the mean number of osteochondromas is typically 15 to 18. Osteochondromas typically occur within the first decade of life (80%) and continue to increase in size until physeal closure. Osteochondromas are most commonly asymptomatic, although they can present with various symptoms including pain and limb length discrepancies. Osteochondromas have key imaging characteristics that help to differentiate them from other types of skeletal lesions and to characterize malignant potential.1

Multiple Hereditary Exostoses: Genetics, Multimodality Imaging Features, Complications, Differential Diagnosis, and Treatment

Contemporary Diagnostic Radiology 42(23):p 8, November 15, 2019. | DOI: 10.1097/01.CDR.0000604032.11274.73

PATH-60. PRIMARY CNS LYMPHOMA PRECEDED BY ACUTE DEMYELINATION

Abstract Primary CNS lymphoma commonly presents with nonspecific encephalopathy or focal neurologic deficits. Magnetic resonance imaging typically shows a homogeneously enhancing mass with surrounding edema. The imaging differential diagnosis is broad, and includes high grade glioma and neuroinflammatory conditions. Definitive diagnosis therefore requires biopsy. Here we present a case of primary CNS lymphoma that was diagnosed as an acute demyelinating process on initial biopsy. A 68 year old female presented with gait instability and vertigo. MRI showed right cerebellar and right trigonal enhancing lesions. Biopsy revealed an acute demyelinating inflammatory process and she was diagnosed with acute disseminated encephalomyelitis. She was treated with intravenous methylprednisolone followed by oral prednisone with resulting clinical and radiographic improvement. She was re-admitted to hospital 4 months later with encephalopathy. Imaging showed a new enhancing mass in the pericallosal frontal lobes. Repeat brain biopsy showed diffuse large B-cell lymphoma. This case illustrates a highly unusual situation of biopsy-proven central demyelination preceding a primary CNS lymphoma diagnosis. It raises a number of etiopathological questions concerning the coexistence and potential causal relationships between demyelination and lymphoma. Additionally, it highlights the need for repeat biopsy if clinical and radiographic suspicion for lymphoma persists despite an alternative initial biopsy result.

Magnetic resonance imaging characteristics and differential diagnosis of common sellar cystic lesions

Objective: To investigate magnetic resonance imaging (MRI) characteristic and differential diagnostic keypoints of common sellar regional cystic lesions with the purpose of improving differential diagnostic accuracy. Methods: In total, 174 cases of the pathologically diagnosed cystic lesions in sellar region between March 2016 and June 2019 were included in the current retrospective analysis. These cases included Rathke's cleft cyst (n=68), craniopharyngioma (n=48), pituitary adenoma (n=56) and arachnoid cyst (n=2) in the sellar region. The position, texture and morphology of leisions, signal of cystic and solid part, invasion of surrounding tissues and maximum diameter of cysts on the MRI images were evaluated and compared between different groups. SPSS 25.0 software was used for statistical analysis. Results: There were several specific changes on several MRI sequences in Rathke's cleft cysts, craniopharyngioma and pituitary adenoma groups. For Rathke's cleft cysts, round shape, rare polycystic structure, lack of solid part and maximum diameter of cysts which was significantly less than that of craniopharyngioma and pituitary adenoma groups ((17.37±6.12) mm vs (30.29±13.51) mm vs (28.18±11.13) mm, t value was 6.680, 5.838, respectively, all P<0.05), were favorable diagnostic criteria. While, the intracystic nodules were mostly found in craniopharyngioma. There was no high signal intensity in cystic wall on T1WI and T2WI of pituitary adenoma. MRI signal of arachnoid cyst in sellar region was basically the same as CSF signal, with low signal intensity on T1WI and DWI, high signal intensity on T2WI, without enhanced signal. Conclusions: Common sellar regional cystic lesions showed characteristic manifestations on different MRI sequences. Valuable information in the morphology, MRI signal intensity, maximum diameter measurements may improve accuracy of differential diagnosis for sellar regional cystic lesions.

MRI image features and differential diagnoses of Herlyn–Werner–Wunderlich syndrome

This study aims to explore how Herlyn–Werner–Wunderlich Syndrome (HWWS) manifests in diagnostic images and analyze the imaging specifications and differential diagnoses thus improving the understanding of the disease. The preoperative magnetic resonance imaging (MRI) findings and clinical data of 19 patients with HWWS were retrospectively analyzed, taking the intraoperative findings and postoperative pathological results of laparoscopic or hysteroscopy surgery as the diagnostic criteria. In this study, all the 19 patients underwent laparoscopic or hysteroscopic excision of vaginal oblique septum, and the preoperative MRI diagnosis of HWSS was consistent with the clinical postoperative diagnosis, with a diagnosis coincidence rate of 19/19 (100%). According to the classification of vaginal oblique septum syndrome, 16 cases were vaginal oblique septum type I and 3 cases were vaginal oblique septum type II. MRI showed a double uterus and double cervix, blood accumulation and dilatation of the vagina connected with the cervix of the affected side, T1WI showed high signal intensity and T2WI showed low or mixed signal intensity. MRI coronal view of 19 patients clearly showed ipsilateral renal absence with obstruction, including 5 cases on the left and 14 cases on the right. Other pelvic complications included: 1 patient with cervical dysplasia and the absence of right kidney and ureter, 3 patients with right ovarian endometriosis cyst, 1 patient with complicated with adenomyosis, 1 patient with right ovarian follicular cyst, 1 patient with right ovarian fallopian tube and pelvic abscess, and 1 patient with right ovarian hematoma. The MRI image of HWWS has its own features and MRI can more accurately evaluate type and related complications of HWWS, therefore it can be used as the best and effective examination method for preoperative imaging evaluation, thus better providing help for clinical comprehensive preoperative evaluation and guidance of surgery.

METASTATIC CAVITARY ADENOCARCINOMA OF THE LUNG IN A PATIENT WITH RECENT AGGRESSIVE SQUAMOUS CELL CARCINOMA OF THE CHEST WALL

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Simultaneous existence of two histologically different primary malignancies, although rare, has been reported in literature1. This represents a diagnostic dilemma especially when the first detected primary malignancy is aggressive, therefore, the second primary is often deemed to be a metastatic lesion, until proven otherwise on biopsy. We present a case of a 62 year old male, with a recent aggressive squamous cell carcinoma (SCC) of the chest wall, who developed metastatic cavitary adenocarcinoma of the lungs. CASE PRESENTATION: A 62-year old gentleman, with past medical history significant for basal cell carcinoma of the nose and a recent aggressive SCC of the chest wall, status post Mohs surgery, was referred to the outpatient pulmonology clinic after a CT scan of the chest showed persistent dense consolidation of the left upper lobe, multiple bilateral lung nodules with central necrosis and cavitation, and left sided hilar and mediastinal lymphadenopathy. He presented with low-grade fever and a productive cough, unresponsive to antibiotics, for the past three weeks prompting the CT scan of the chest. Diagnostic work-up, for infection (including fungal studies), vasculitis or any other autoimmune disorder, was started and urgent bronchoscopy was arranged. PET/CT scan showed a hyper-metabolic left upper lung mass, multiple hypermetabolic cavitary lung lesions. Bronchoscopy with endobronchial ultrasound revealed a reversible external compression of the right middle lobe bronchus with mediastinal lymphadenopathy. Bronchoalveolar lavage from the left upper lobe showed atypical cells, suspicious for malignancy while negative for fungal organisms. Fine needle aspiration of lymph nodes, station 7 and 4L, revealed non-small cell carcinoma with tumor cells being positive for CK-7 and TTF-1 and negative for CK20, CDX-2 and NKX3.1. With the recent aggressive SCC history and multiple cavitary lung lesions, biopsy of one of the cavitary lesions was recommended by the tumor board, to determine if they were SCC vs adenocarcinoma. Results of the biopsy were consistent with an invasive lung adenocarcinoma. DISCUSSION: Cavitary lesions shown on chest imaging can have several etiologies. Although various radiological features of these cavitations, including wall thickness, have been studied to differentiate benign from non-benign etiologies2, the final diagnosis in many instances is made on serological investigations or biopsy. 22% of primary lung cancers can cause cavitation with squamous cell carcinoma being the most common type of lung cancer associated with cavitary lesions followed by adenocarcinoma and large cell carcinoma3. CONCLUSIONS: Our case emphasizes that cavitary lesions on imaging, in patients with a prior history of malignancy, should prompt investigation for possible malignancy. Early biopsy, in such cases, becomes crucial for a timely and accurate diagnosis, and appropriate management. Reference #1: Jena A, Patnayak R, Lakshmi AY, Manilal B, Reddy MK. Multiple primary cancers: An enigma. South Asian J Cancer. 2016;5(1):29-32. Reference #2: Parkar AP, Kandiah P. Differential Diagnosis of Cavitary Lung Lesions. Journal of the Belgian Society of Radiology. 2016;100(1):100. DOI: http://doi.org/10.5334/jbr-btr.1202. Reference #3: Gill, R. R., Matsusoka, S. & Hatabu, H. Cavities in the lung in oncology patients: imaging overview and differential diagnoses. Applied Radiology 39, 10 (2010). DISCLOSURES: No relevant relationships by Huthayfa Ateeli, source=Web Response No relevant relationships by Mahum Shahid, source=Web Response

MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review

ObjectivesThe use of magnetic resonance (MR) imaging in differentiation between benign and malignant adnexal masses in children and adolescents might be of great value in the diagnostic workup of sonographically indeterminate masses, since preserving fertility is of particular importance in this population. This systematic review evaluates the diagnostic value of MR imaging in children with an ovarian mass.MethodsThe review was made according to the PRISMA Statement. PubMed and EMBASE were systematically searched for studies on the use of MR imaging in differential diagnosis of ovarian masses in both adult women and children from 2008 to 2018.ResultsSixteen paediatric and 18 adult studies were included. In the included studies, MR imaging has shown good diagnostic performance in differentiating between benign and malignant ovarian masses. MR imaging techniques including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to further improve the diagnostic performance.ConclusionThe addition of DWI with apparent diffusion coefficient (ADC) values measured in enhancing components of solid lesions and DCE imaging may further increase the good diagnostic performance of MR imaging in the pre-operative differentiation between benign and malignant ovarian masses by increasing specificity. Prospective age-specific studies are needed to confirm the high diagnostic performance of MR imaging in children and adolescents with a sonographically indeterminate ovarian mass.Key Points• MR imaging, based on several morphological features, is of good diagnostic performance in differentiating between benign and malignant ovarian masses. Sensitivity and specificity varied between 84.8 to 100% and 20.0 to 98.4%, respectively.• MR imaging techniques like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to improve the diagnostic performance.• Specific studies in children and adolescents with ovarian masses are required to confirm the suggested increased diagnostic performance of DWI and DCE in this population.