Immobile Mass Research Articles

Abstract 17356: Recurrent Hemorrhagic Pericardial Effusion Requiring a Multimodality Imaging Approach: A Case Report

Background: A 24-year-old female with no medical history presented to the ED with chest pain and dyspnea. Vitals were notable for tachycardia to 120s. Physical examination was unremarkable. Clinical Course: Initial evaluation was notable for thrombocytopenia, NT-proBNP of 151 and high sensitivity troponin T of 18. Transthoracic echocardiogram (TTE) revealed a small pericardial effusion with tamponade physiology prompting urgent pericardiocentesis. Bloody pericardial fluid was drained and fluid studies were consistent with hemorrhagic effusion with no evidence of infection or malignancy on cytology. Surveillance TTEs showed rapid reaccumulation of pericardial fluid within 72 hours of the initial intervention. Urgent pericardial window with drain placement was performed and intraoperative transesophageal echocardiogram (TEE) revealed a right atrial (RA) mass not detected on prior TTE. Cardiac MRI confirmed the presence of a large (50 mm x 31 mm) immobile and heterogeneous mass in the superior aspect of the RA suggestive of a malignant etiology with invasion to the adjacent pericardium. Positron Emission Tomography (PET) scan demonstrated hypermetabolic activity concerning for malignancy with no evidence of mediastinal, hilar adenopathy, or distant disease. She underwent mini-sternotomy and biopsy with pathology suggestive of primary cardiac angiosarcoma. Due to the high-risk nature and location of the tumor, she was unable to undergo primary surgical resection. Neoadjuvant chemotherapy was initiated with plan for subsequent surgical reassessment. Conclusion: Workup of recurrent hemorrhagic pericardial effusions require a multimodal imaging approach.

A LITHOPEDION – AN UNUSUAL CALCIFIED ABDOMINAL PREGNANCY: A CASE REPORT

Introduction: Lithopedion is an ectopic pregnancy that progresses to fetal mortality and calcification, as described in the introduction. It is uncommon, with a reported incidence of 1.5% to 2% of all ectopic pregnancies. The fetus expires and is not absorbed by the mother's body, but it evades maternal immunity by surrounding itself with a calcified shell. Lithopedion can be diagnosed through abdominal X-rays, ultrasonography, and CT imaging. Case presentation: A 73-year-old female complaining of abdominal mass for over three decades and radiating pain to the right hip for a month. The patient is multipara with a history of habitual abortion. There was an immobile abdominopelvic mass in palpation. The ultrasound showed a large calcified mass in the pelvic cavity. Abdominal and pelvic CT revealed a mummified fetus, depicting great detail of the fetal anatomy surrounded by a calcified membrane. The uterus was normal. Our case is suitable with lithokelyphopedion. Conclusion: Lithopedion is a seroius condition associated with high maternal and perinatal mortality rates. The condition was not identified during prenatal visits. A thorough history and physical examination are as important as imaging investigations in this setting. Keywords: lithopedion, lithokelyphopedion, calcified abdominal mass

Rare Intraosseous Cavernous Hemangioma of the Orbit

A healthy 52-year-old man presented with a painless, enlarging, right lateral orbital nodule of 1-year duration (A, arrow). Clinical examination revealed a 2.3-cm firm immobile lateral orbital rim mass. Computed tomography displayed an expansile and osteolytic neoplasm of the zygoma with orbital and extraorbital extension (B). Lateral orbitotomy exposed a porous neoplasm of the anterior zygomatic face (C). The exophytic component was resected, and histopathological examination demonstrated multiple, dilated, blood-filled cavities between bony trabeculae, consistent with a benign intraosseous cavernous hemangioma (D). Orbital intraosseous cavernous hemangiomas are rare, and malignancy should be ruled out in the setting of a progressive osteolytic neoplasm (Magnified version of Figure A-D is available online at www.aaojournal.org/).

Transient dispersion regimes in heterogeneous porous media: On the impact of spatial heterogeneity in permeability and exchange kinetics in mobile–immobile transport

Transport processes in the subsurface are coupled with the heterogeneity of the porous structure. Obtaining an accurate description of mass transport in such media at all time scales remains a crucial task, as the subsurface is strongly impacted by human activity. Spreading of pollutants in the transient but also in the asymptotic regime, as well as the time to reach a critical location (e.g. aquifer, well) significantly depend on the underlying heterogeneity of the permeability field. Moreover, in the case of solute retention, transport is also characterized by local exchange kinetics that depend on the local aquifer properties. Consequently, exchange (retention) times are expected to be spatially heterogeneous. In this work we focus on the influence of spatially heterogeneous permeability and exchange times on the transient and asymptotic transport regimes and provide a parametric study. To this goal, we simulate in a first part the transport in a two-dimensional heterogeneous medium under spatially varying permeability and mobile–immobile mass transfer parameters. Equations are solved using a Lattice-Boltzmann two-relaxation-time (TRT) algorithm. We assume the following relation between the local permeability K and the local exchange time: τ∝Kγ. Taking into account this relation, we investigate the impact of the Damköhler number (Da, ratio of the advection and exchange time scales), the disorder of the permeability field and the value of the exponent of the coupling function (γ) on the spatial evolution of the concentration field and breakthrough curve. We show that, depending on the parameters (Da, γ, etc.), we can observe transient, non-Fickian dispersion, which is characterized by non-exponential tails of the solute breakthrough curves and a non-linear evolution of the spatial variance of the solute distribution.In a second part, we present a new continuous time random walk (CTRW) model to upscale these transport behaviors. The model is based on a spatial Markov model for particle velocities that couples advective–dispersive transport and heterogeneous mass transfer through a compound Poisson process. The upscaled model can be fully parameterized by the statistics of permeability and the hydraulic gradient (with no fitting parameter), that is, in terms of medium and flow characteristics. The results of the CTRW model fully capture the non-Fickian transient transport regimes both for the breakthrough curves and spatial concentration variance. In the longtime limit, as expected from the central limit theorem, the CTRW model predicts normal, Fickian behavior. Finally we show, that the time to reach the asymptotic regimes in heterogeneous media (e.g. heterogeneous exchange times) is parameter dependent and in average is two orders of magnitude larger than for the respective homogeneous case. To summarize, the coupling between the heterogeneous permeability field and the local mass transfer properties can strongly influence transient and asymptotic transport regimes and potentially explain experimentally observed non-Gaussian behaviors.

The Elastic Nature of the Mass and of the Gravitation

We generalize the Schwarzschild horizon radius by considering a spherical immobile mass m0 of radius R0  of center located at a fixed ether point O , and consider a particle of mass m1 , of velocity V1  due to the interaction of the fields created by m0  and by m1 . We prove how a mass is related to a field and what is the constitution of this field. The great lines of this proof is that even when it is immobile, a mass m is related to a frequency νm  by the relation m=hνmc2 . This shows that a mass m  creates a field of frequency νm  propagated in the ether. The nature of such a field is that it is an ensemble of ether points only rotating on themselves, such that axes of these rotations are situated on any line passing through the center of this mass. We proves that on the axis joining two masses m1  and m2  then, between them the fields of the rotation of the ether points due to m1  and m2  are of inverse senses that is, they partially destroys themselves, that is, there, the fields are smaller than the those that are not between m1  and m2  and situated on this axis. It follows that m1  and m2  have the tendency to get closer, that is, are submitted to a force that tends to make them closer and finally to form only one mass. This force is the gravitational attraction.

Athena: Specialty Certificate Examination case for skin surgery and cosmetic dermatology.

A 62-year-old woman presented with a mass over the dorsal aspect of her left index finger distal interphalangeal joint that she reported had been present for at least 6 months. A 62-year-old woman presents with a mass over the dorsal aspect of her left index finger distal interphalangeal joint (DIPJ), which she reports has been present for at least 6 months and is slowly growing in size and causing pain and changes to the nail. On examination, there is a smooth, firm and relatively immobile dome-shaped mass overlying the DIPJ that is mildly tender on palpation (Figure 1).

A case of fungal conjunctivitis manifested by a conjunctival mass

A 71-year-old man presented with a history of persistent redness and swelling in the left eye accompanied by an enlarging mass in the conjunctiva. He denied any history of trauma. Local anti-inflammatory treatment was ineffective. Slit lamp examination demonstrated a tough and immobile grayish broad basal mass at the corneal limbus and bulbar conjunctiva and a local bulge of 3 mm × 2 mm at the medial and lateral side of the upper palpebral conjunctiva near the eyelid margin. The excisional biopsy showed granulomatous inflammation with irregular and atypical squamous epithelial hyperplasia. Histopathology and immunohistochemical staining revealed a fungal infection. The secretion smear examination was performed to clarify the pathogen as Candida albicans, and chronic fungal maxillary sinusitis was found through imaging tests. Thus a diagnosis of conjunctival candidiasis was made. The conjunctival mass subsided after systemic and local antifungal therapy.

Multiple cerebral infarctions due to calcified amorphous tumor growing rapidly from an antecedent infection and decreasing rapidly by detachment of fibrin and antithrombotic drugs: a case report

BackgroundCalcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracardiac mass, a calcium deposition surrounded by amorphous fibrous tissue, and possibly causes cerebral embolism. Even rarer is CAT associated with infection, and no CAT with antecedent infection has been reported to our knowledge. In addition, although some CAT in patients on hemodialysis has been reported to grow rapidly, no case has been reported on CAT that grew and diminished rapidly in a short period of time. Here, we report the case of an 82-year-old Japanese woman with normal renal function who developed multiple cerebral infarctions due to CAT that grew rapidly, associated with inflammation from an antecedent infection, and diminished rapidly by detachment of fibrin on the mass surface and antithrombotic drugs.Case presentationThe patient developed fever after dental treatment and found musical hallucination on the left ear worsened in degree and frequency. In a nearby clinic, she was treated with antibiotics, and her body temperature turned to normal in approximately 1 month. She presented to our hospital for workup on the worsened musical hallucination. Magnetic resonance imaging (MRI) showed multiple cerebral infarctions, and transthoracic echocardiography (TTE) revealed an immobile hyperechoic mass with an acoustic shadow arising from a posterior cusp of the mitral valve. CAT was suspected and treated with apixaban and aspirin. Follow-up MRI and TTE showed newly developed multiple cerebral infarctions and rapidly diminished CAT. Cardiac surgery was performed to resect the CAT. The pathological findings showed calcifications surrounded by amorphous fibrous tissue including fibrin, indicating CAT. The patient’s symptoms improved and no cerebral infarctions recurred in 4 months follow-up.ConclusionInflammation from an antecedent infection can cause CAT to grow rapidly. Fibrous tissue including fibrin may attach to the surface of CAT, resulting in multiple cerebral infarctions. Fibrous tissue may detach and disappear by antithrombotic drugs, leading to a rapid diminishment of CAT in size.

A swollen, discoloured thumb.

A woman aged in her 40s presented to Shanxi Provincial People's Hospital (Taiyuan, Shanxi, China) in January, 2020, with a 1-year history of a slowly swollen, discoloured, painful left distal thumb. No history of trauma or potentially systemic symptoms (eg, fever, cough, weight loss, or night sweats) was elicited. Physical examination showed a bulging thumbnail, clubbed fingertip, and a round, firm, immobile mass on palpation. There was abnormal 3 × 4 mm blue-black pigmentation at the lateral nail folds (figure, A). Joint mobilisation, skin temperature, and laboratory tests were normal. Radiograph showed a slightly expansile, ill-defined osteolytic lesion on the distal phalanx with cortical destruction and without matrix calcification or bony septae (figure, B).

Alteration of basaltic glass within the Surtsey hydrothermal system, Iceland – Implication to oceanic crust seawater interaction

Low-temperature hydrothermal alteration of basaltic glass on the seafloor has important implications on the chemical evolution of the oceanic crust and seawater composition. However, mass fluxes resulting from seawater-glass interaction in this type of environment remain poorly understood. This study presents new results on element mobilities for the palagonitization of basaltic glass and bulk rock hydrothermal alteration at Surtsey volcano, Iceland over a time period of ~50-years. Assessments of element mobilities were based on 1) immobile trace element isocon mass balance for palagonitization, 2) the assumption of large scale TiO2 immobility during bulk rock alteration and 3) chemical analyses of pore fluids and authigenic minerals.Element mobilities of glass alteration vary between initial palagonitization and subsequent palagonite maturation: Initially, palagonitization of sideromelane leaches SiO2, Al2O3, MgO, CaO, Na2O, K2O from the glass. Following this, the maturation of the palagonitized glass causes re-uptake of all of the abovementioned elements except for CaO, which shows either no change or slight uptake, and Na2O, which continues to be lost from the palagonitized glass. Among major elements TiO2 and FeO can be considered immobile during palagonitization, but not during the subsequent aging process of palagonitized glass. Among trace elements Hf, Ta, Zr, Nb, Y and REE were found to be immobile at all stages of the alteration. On the bulk rock scale, comprising both glass alteration and the formation of authigenic phases, early-stage alteration at Surtsey releases SiO2, Al, Mg and Ca to the fluid, whereas late-stage alteration poses a sink of SiO2, Al, Mg, Ca and Na. Net element budgets during early- and late-stage alteration indicate that chemical exchange between basaltic tuffs and seawater derived fluids at Surtsey acts as a long-term source of dissolved Ca, Al and SiO2 for seawater as well as a long-term sink for seawater Mg and Na.

Giant Left Atrial Thrombus in a Heart Transplant Recipient - Risk Factors and Diagnostic Approach

<h3>Introduction</h3> The left atrium (LA) in heart transplant (HT) recipients is a surgically created chamber from different portions of donor and recipient atria and is thus frequently enlarged. It was hypothesized that remaining sutures and LA enlargement may precipitate LA thrombus (LAT) formation, but LAT following bi-caval anastomosis has seldom been described. We report a case of a giant LAT diagnosed upon routine transthoracic echocardiography in an asymptomatic HT recipient. <h3>Case Report</h3> A 58 y/o man with non-ischemic cardiomyopathy underwent orthotopic HT (bi-caval technique) from a 30 y/o donor with head trauma. Perioperative course and long-term follow up were uneventful, except for an early single self-resolving episode of atrial fibrillation (AF). Chronic aspirin therapy was administered per institutional protocol. The immunosuppression protocol included tacrolimus, mTORi and prednisone. Five years after HT, routine follow up TTE revealed, within a known enlarged LA (AP diameter 56mm, area 30mm²), a new large fixed mass (29*39mm) that had not been evident on previous TTEs done every 3 months. Blood count, electrolytes, and CRP were unremarkable; no arrhythmia was documented. Transesophageal echocardiography revealed a large immobile echogenic mass attached to the interatrial septum (Fig. 1A), and ECG-gated CT revealed a non-contrast enhancing filling defect (36*31*39mm) adjacent to the interatrial septum (Fig. 1B). Cardiac MRI showed a homogenous non-gadolinium enhancing mass adherent to the interatrial septum at the upper pole of the LA. Collectively, these findings were consistent with a diagnosis of LAT. Anticoagulation therapy was initiated, and mTORi was withdrawn; no further embolic events were recorded. <h3>Summary</h3> Remaining sutures, enlarged LA, history of AF and immunosuppressive therapies may play a role in thrombus formation. Systematic echocardiographic surveillance post-HT should be considered for early diagnosis and treatment of this potentially devastating complication.

Osteochondroma of rib.

Osteochondroma is also known as exostosis and is a benign bone tumour. It commonly presents in the first 3 decades of life with a male preponderance. The most common site for the development of these tumours is the metaphysis of long bones, with almost 30% of cases originating from the distal metaphysis of the femur. Origin from flat bones like ilium and scapula is rare, while origin from vertebrae and ribs is unheard of. A 21-year-old female presented with a history of swelling over the left upper back since 2 years, pain in the left upper back and shoulder with tingling since 4 months. On examination, a 3 cm by 3 cm, hard, immobile mass was palpable in the left paravertebral region of the 4th Intercostal space. X-ray and CT scan of the thorax revealed two irregular lesions arising from the neck of the 5th rib posteriorly and an FNAC revealed the lesion to be of chondroid matrix origin, consisting of normal chondrocytes. Through a posterior approach, two pedunculated tumours of size 3.5 x 2 x 1Â cm and 2 x 2 x 1Â cm, along with the costovertebral junction of the 5th rib were resected. Histopathological examination confirmed the mass to be an Osteochondroma of the rib. On 6 months follow up, the patient is stable, has no pain or tingling and there is no evidence of recurrence of the tumour.

Infected Branchial Cleft Cyst Due to Neisseria Meningitidis: An Unusual Presentation in a Pediatric Case

Meningococcal disease, which is caused by Neisseria meningitidis (N. meningitidis), may present clinically as meningococcemia, as meningitis, or with a mixed picture. A 3-year-old girl was admitted to our hospital with a tender, immobile, hard, hot and erythematous mass measuring 3x4 cm on the left anterior part of the neck. The patient was diagnosed with branchial cleft cyst in the left side of the neck and regularly followed by an otolaryngologist since 6-month-old. The abscess culture grew N. meningitidis. Serogroup determination identified nongroupable Neisseria meningitidis. Infected branchial cleft cyst associated with N. meningitidis has rarely been reported, and to our knowledge, this is the second case in the literature. This demonstrates the importance of microbiologic identification, which plays a major role in the management of the patient. It should be noted that N.meningitidis can present with unusual clinical manifestations affecting all systems of the body; which indicates the importance of vaccination in vaccine-preventable diseases.

Oral leiomyosarcoma in a dog

Leiomyosarcoma is malignant mesenchymal tumor of smooth muscle and commonly encountered in the gastrointestinal tract of dogs. However, primary canine leiomyosarcoma in oral cavity is rare due to lack of smooth muscle in the oral tissue. A 13-year-old, neutered male Poodle presented a hard and immobile mass on the left maxilla. Imprinting cytology from the mass as well as fine-needle aspirated cytology from the left scapular lymph node revealed predominant spindle cells met malignancy criteria of the tumors, including coarse chromatin, high N/C ratio, nuclear molding, macro/multi-nucleoli with cigar-shaped nucleus. Radiography of the skull showed lysis of the nasopalatine bone, and mineral radiopacity in the mass. Computed tomography showed soft tissue attenuating mass from the left incisor teeth to the left retrobulbar space with loss of nasopalatine bone and medial wall of orbit. The histopathological examination showed irregularly arranged malignant spindle-shaped cells with oval or elongated nuclei. The nucleolus is distinct and moderate cellular polymorphism is observed. Mitotic figures are occasionally observed. The tumor cells are positive to vimentin, desmin, α-smooth muscle actin when immunohistochemistry was performed, and in Masson’s trichrome stain, tumor cells are stained as red. Overall, histopathologic exam and immunohistochemistry confirmed canine oral leiomyosarcoma. Because of the poor prognosis, the owner did not consent further treatment.

S2787 A Rare Hepatic Malignancy Disguised by Unalarming Symptoms

Introduction: Primary liver sarcomas are extremely rare, representing 0.1% to 0.2% of all hepatic tumors in adults. Most cases have been described in pediatric populations, with few occurring in adults. Prognosis is dismal, leading to death in the majority cases. Due to the tumor’s rapid growth and mortality, it is usually misdiagnosed resulting in an inappropriate treatment plan. Case Description/Methods: A 59-year-old Hispanic male with past medical history of hypertension and alcohol abuse who presented to the ER due to right upper quadrant pain and nausea. The patient had visited the ER a few weeks prior and was discharged on Omeprazole given diagnostic impression of GERD, however returned due to partial relief. Denied fever, chills, weight loss, diarrhea, or constipation. Labs showed an elevated alkaline phosphatase at 189 U/L, CEA and alpha-fetoprotein were normal. Physical examination revealed tenderness to palpation at the epigastric area and right upper quadrant, along with a new palpable, immobile mass. Abd-pelvic CT showed a large right hepatic lobe subcapsular complex, cystic mass with solid components displaying extracapsular extension. Interventional radiology service was consulted for biopsy prior to discharge. While awaiting results, patient’s abdominal pain increased significantly accompanied by early satiety, poor appetite, increased abdominal girth, and bilateral lower extremity edema. Imaging studies were repeated, revealing significant increase in previously described liver lesion, now measuring 24 x 16 cm compared to 20.8 x 13.9 cm less than three weeks prior. Biopsy confirmed the diagnosis of malignant spindle cell neoplasm with extensive necrosis and pleomorphism. Negative immunostains included pankeratin, CK7, CK20, desmin, arginase 1, S-100, c-kit, CD34, triple melanoma stain, HMB-45 and Melan-A consistent with Undifferentiated Sarcoma. PET CT disclosed only a severe hypermetabolic lesion confirming primary liver involvement. Therapy was started promptly with Doxorubicin and Ifosfamide. Discussion: Rapidly evolving pathologies are easily confused for other etiologies, such as infection. This sheds light on the importance of a holistic approach that brings together patient’s clinical presentation, labs and physical exam. This case highlights the fact that most common is not synonymous with accuracy. As a result, undifferentiated sarcomas should form part of the differential diagnoses when a patient simply presents with nausea, vomiting, and abdominal pain, as time is of the essence.

"WHAT AN IMPOSTER!" LIPOMATOUS HYPERTROPHY OF THE ATRIAL SEPTUM: A DIAGNOSTIC CHALLENGE IN CARDIAC IMAGING

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Lipomatous hypertrophy of the atrial septum (LHAS) is a rare, non-neoplastic fatty infiltration of the inter-atrial septum that spares the fossa ovalis. It is best differentiated from other cardiac tumors with transesophageal echocardiogram (TEE) and cardiac computed tomographic (CT) or magnetic resonance (MR) imaging. CASE PRESENTATION: A 52-year-old woman with diabetes, hypertension and a chronic tobacco smoker, presented with complaints of shortness of breath. An electrocardiogram showed non-specific ST-T wave changes. A TTE revealed an ejection fraction of 60% and a well-encapsulated mass in the right atrium; the differential diagnosis of the mass included entities such as atrial myxoma. Further evaluation with a TEE demonstrated a large, sessile, immobile mass in the right atrium with a characteristic dumbbell shaped thickening of the atrial septum, thus raising the possibility of lipomatous hypertrophy of the atrial septum (LHAS). Cardiac MRI confirmed the distinctive hour-glass shaped mass in the intra-atrial septum, with characteristic sparing of the fossa ovalis. There was no contrast enhancement and lacked signal on fat suppression sequences confirming benign LHAS. DISCUSSION: LHAS is a rare, non-neoplastic abnormality of the heart. Unlike other cardiac tumors such as myxomas and papillary fibroelastomas which require surgical intervention, LHAS is a benign finding. It is thought to be an infiltration of brown adipose tissue into the myocytes of the interatrial septum. Most cases remain clinically silent and are detected incidentally during echocardiography, surgery or autopsy. Echocardiography, where a TEE is more sensitive than a TTE, and cardiac MRIs demonstrate a characteristic dumbbell or hour-glass shaped appearance. Tailored MRI sequences with lack of gadolinium enhancement and fat suppression imaging, differentiate it from other intracardiac neoplasms, including myxomas. Moreover, positron emission tomography (PET) scans will show high fluorodeoxyglucose (FDG) uptake by the brown adipose tissue that may further aid in diagnosis. Rare complications of LHAS include SVC syndrome, sick-sinus syndrome and other life-threatening arrhythmias that may warrant surgical intervention. CONCLUSIONS: LHAS is an uncommon cardiac anomaly. The utility of TEE and cardiac MRI, in this case, aids in defining the benign nature of LHAS. REFERENCE #1: Nadra I. Lipomatous hypertrophy of the ineratrial septum; a commonly misdiagnosed mass often leading to unnecessary cardiac surgery. Heart. 2004;90(12):66. REFERENCE #2: Heyer C, Kagel T, Lemburg S, Bauer T, Nicolas V. Lipomatous hypertrophy of the interatrial septum. Chest. 2003;124(6):2068–2073. doi: 10.1378/chest.124.6.2068. DISCLOSURES: No relevant relationships by Adhiraj Bhattacharya, source=Web Response No relevant relationships by Rizwan Khan, source=Web Response No relevant relationships by Michael Maysky, source=Web Response

Canine Synovial Sarcoma of the Stifle Joint with Pulmonary and Liver Metastases

A seven-year-old female mongrel dog was presented at the Sokoine University of Agriculture Teaching Animal Hospital for second opinion regarding a progressive swelling of the right hind limb of two months duration. Clinical examination revealed a loss of body condition, tachypnea and tachycardia, a painful immobile solid mass of 20 cm x 14 cm x 10 cm located on the right stifle joint, leucocytosis, and anaemia. Radiographic examination of the joint revealed marked soft tissue swelling with amorphous areas of mineralization and complete destruction of the proximal tibia. Smooth and solid periosteal reaction was seen around the tibia and fibula with a Codman’s triangle. Multiple nodules and a mass with soft tissue opacity were seen in the lung fields. Post-mortem examination revealed separation of tibia and fibula, softening of the proximal parts of the tibia, and complete integration of the proximal region of the two bones and articular tissues into the surrounding muscular tissues. Multifocal nodular lesions of variable sizes were mostly found in the lungs and partly in the liver. Histologically, predominantly oval and round cells with variable nuclear sizes and moderate mitoses were observed in tissue samples from the joint, lungs and the liver although some parts of the lung metastases showed both round and spindle shaped tumor cells. Clinical profile is suggestive of aggressive biphasic (spindle and epithelial) type of synovial cell sarcoma with lung and liver metastasis. Early radiographic and biopsy examination of persistent musculoskeletal nodules is recommended for early diagnosis and interventions.

A New Optimization Algorithm Based on the Fungi Kingdom Expansion Behavior for Antenna Applications

This paper presents a new optimization algorithm based on the behavior of the fungi kingdom expansion (FKE) to optimize the radiation pattern of the array antenna. The immobile mass expansion of the fungi is mimicked in this work as a chaotic behavior with a sinusoidal map function, while the mobile mass expansion is realized by a linear function. In addition, the random germination of the spores is utilized for randomly distributing the variables that are far away from the best solution. The proposed FKE algorithm is applied to optimize the radiation pattern of the antenna array, and then its performance is compared with that of some well-known algorithms. The MATLAB simulation results verify the superiority of the proposed algorithm in solving 20-element antenna array problems such as sidelobe reduction with sidelobe ratio (SLR = 25.6 dB), flat-top pattern with SLR = 23.5 dB, rectangular pattern with SLR = 19 dB, and anti-jamming systems. The algorithm also results in a 100% success rate for all of the mentioned antenna array problems.

Cardiac Metastasis From Anaplastic Thyroid Carcinoma

Background: Anaplastic thyroid carcinoma represents 2% of all thyroid carcinomas. The most common metastatic sites are lung and neck lymph nodes. Cardiac metastasis is extremely rare. Autopsy studies of patients with thyroid cancer have documented a frequency of metastatic cardiac involvement of 0%–2%. Clinical Case: A 57- year- old woman was admitted to the emergency room with a rapidly expanding neck mass of 3 months duration. She complained of pain in the anterior neck, dysphagia, dyspnea, palpitations and hemoptoic sputum. She further reported history of weight loss. She denied medical history of cancer in the family. Prior medical history was described as non- significant. On clinical examination, vital signs were normal. General swelling around the thyroid region was noted. A hard, tender, immobile mass was palpated. A superficial lymph node of about 5 cm in diameter was palpated in level II A and IIB. The patient was admitted to the hospital for further workup. Laboratory work up revealed, hemoglobin 7.6 g/dL, hematocrit 22.5%, white blood cells 15,000/mm3, fasting plasma glucose 135 mg/dL and urea 59 mg/dL. Thyroid function tests revealed TSH 2.46 mUI/ml (normal range: 0.38-5.33 mUI/ ml), fT3 1.69 pg/ml (normal range: 2.39-6.79 pg/ml), fT4 0.57 ng/dl (normal range: 0.58-1.64 ng/dl). A fine needle aspiration cytology from the thyroid lesion described a poorly differentiated thyroid carcinoma. CT scan of the neck and chest revealed a large heterogeneous mass with hypointense areas involving the thyroid gland of 9 x 8 x 7 cm that surrounded the vertebral bodies and displaced and infiltrated the neck vessels, trachea and esophagus. In the right atrium and right ventricle three well- circumscribed ovoid masses were observed, the largest one measured approximately 21 x 17 mm, suggestive of cardiac metastases. Bilateral adrenal masses were also observed the largest one measuring 69 x 51 mm. Diagnosis of anaplastic thyroid cancer stage IVC was established with a large thyroid mass, widespread metastasis and poorly differentiated metastatic carcinoma on fine needle aspiration biopsy. During her hospitalization she presented both atrial tachycardia and atrial fibrillation and was started on amiodarone. A week later, the patient′s condition deteriorated and she died of respiratory arrest without having any further treatment for the tumor. Conclusion: In patients with established thyroid malignancy who develop cardiac arrhythmias, cardiac metastasis should be considered.

A rare case of spontaneous internal jugular vein thrombosis: A case report

Internal jugular vein thrombosis (IJVT) is uncommon and an unidentifiable vascular disease which showed fatal complications mainly sepsis and pulmonary embolism. It is usually subsidiary to intravenous drug abuse, prolonged central venous catheterization or deep head-neck infections or trauma. Associated malignancies are not common and not well documented in the etiology of IJVT. Spontaneous IJVT is considered when no evident predisposing cause of thrombosis is present. A previously healthy, 37-year-old woman doctor by profession presented to the radiology department due to the mild painful swelling in the left anterior side of her neck. Physical examination revealed a painful, soft and immobile mass in the left anterior side of the neck beneath the sternocleidomastoid muscle, without hyperemia or local heat. On ultrasonographic examination, an echogenic thrombus with absent colour flow noted in left internal jugular vein s/o complete thrombosis. The patient was administered subcutaneous Fondared 7.5 mg (fondaparinux sodium inj) as anticoagulant therapy for 14 days (2 weeks). Her complaints were relieved within 14 days and later she was put on Ecosprin 150 mg once daily for 6 months. Partial recanulization was seen after 3 months. This case report describes a patient with IJVT. Venous thrombosis in general results from impaired blood flow locally or systemically that leads to activation of coagulation. Physicians should uphold a high index of suspicion in patients who present with undiagnosed swelling in the neck, or other signs and symptoms attributed to IJVT.