Radiological Findings Research Articles

Multinodular Vacuolating Neuronal Tumors: Symptomatic Presentation Versus Incidental Finding: Case Series and Literature Review

Background: Multinodular Vacuolating Neuronal Tumors (MVNTs) are mixed glial–neuronal brain lesions classified as World Health Organization (WHO) CNS grade 1 tumors, often associated with long-term epilepsy. First described by Huse et al. in 2013 and included in the WHO CNS classification in 2016, MVNTs present a range of clinical manifestations, from symptomatic to asymptomatic. They typically affect young to middle-aged adults and exhibit diverse presentations. Radiologically, MVNTs are usually supratentorial, frequently located in the temporal lobe but also observed in the frontal and parietal lobes. MRI is essential for diagnosis, revealing multiple coalescing subcortical or cortical nodules with hyperintense signals on T2-weighted/FLAIR sequences, often without peripheral edema or mass effects. Case Reports: This paper presents two cases: one symptomatic MVNT with significant clinical manifestations, and the other documenting an incidental finding of MVNT in an asymptomatic patient. One case shows typical temporal lobe localization, while the other highlights a rare frontal lobe localization, with clear radiological findings on T2/FLAIR sequences. Conclusions: These cases illustrate the varied clinical presentations of MVNTs and emphasize MRI’s critical role in diagnosis and management. Asymptomatic cases often require conservative management, stressing the avoidance of unnecessary invasive procedures and the importance of regular monitoring.

Primary central nervous system lymphoma: a series report and literature review

ObjectiveThis study aims to analyze the clinical features, Radiological findings and diagnostic characteristics (tissue biopsy, flow cytometry and cerebrospinal fluid cytology) of primary central nervous system lymphoma (PCNSL). To improve the diagnosis of the disease.MethodsA total of 19 patients with primary central nervous system lymphoma admitted to the Second Hospital of Hebei Medical University from 2014 to 2023 were selected. The clinical data of the patients were retrospectively analyzed. Combined with the relevant literature, the clinical characteristics of PCNSL patients were analyzed to assist the diagnosis.ResultMost of the patients were middle-aged and elderly patients (65 years old), and the main clinical manifestations showed no obvious specificity, including headache, dizziness and limb weakness. Radiological findings showed that common site of currence were located in the brain parenchyma. The PCNSL subtype of 19 patients was all diffuse large B cell subtype by cytology, flow cytometry or histopathology. Six cases were diagnosed by biopsy pathology and 11 cases were diagnosed by flow cytometry of cerebrospinal fluid. In all patients diagnosed with PCNSL by clinical cytology (CSF cytology and flow cytometry), abnormal cells were found on CSF examination.ConclusionThe pathological type of primary central nervous system lymphoma was diffuse large B-cell subtype, with diverse clinical manifestations and multiple. Both tissue directed biopsy and flow cytometry could effectively assist clinical diagnosis. Early and timely diagnosis and intervention are of great significance for delaying the disease process and reducing the economic burden of patients and families.

Assessing Chat Generative Pre-training Transformer’s Proficiency in Identifying, Diagnosing, and Managing Orthopedic Fractures

Abstract Background: The exploration of Chat generative pre-training transformer’s (GPT’s) applications in medicine is gaining momentum, with artificial intelligence, particularly ChatGPT, showing promise in enhancing orthopedic care. ChatGPT can assist clinicians by providing relevant information based on patient symptoms, medical history, and radiological findings, aiding in differential diagnosis, and suggesting appropriate imaging modalities. This study focuses on evaluating the effectiveness of ChatGPT-4 in diagnosing and managing common orthopedic fractures. Methods: This study involved inputting a diverse set of fracture images into the ChatGPT-4 model. The process commenced by prompting ChatGPT with four questions: “What does the radiograph show?” The second prompt instructed ChatGPT with the actual diagnosis, followed by inquiries on how a clinician should manage the condition and potential complications. All generated responses underwent grading by two authors (musculoskeletal radiologist and orthopedic trainee), utilizing a 5-point Likert scale. Intraclass correlation coefficient (ICC) analysis measurements were performed to assess inter-rater reliability. Descriptive statistical analysis was then employed to provide a comprehensive summary of the study’s findings. Results: ChatGPT demonstrated limitations in identifying diagnoses based on inputted X-ray images. However, it excelled in providing comprehensive information about fracture management and potential complications. There was excellent interobserver reliability with a kappa of 0.9. Conclusion: Our study underscores the utility of ChatGPT as a valuable tool for aiding in the management of common fractures, offering a comprehensive overview of diagnosis, management, and potential complications. The findings highlight its potential role as a supplementary resource in orthopedic practice.

Predictive value of coronary artery calcium score on radiological and autoptic findings in cases of sudden death

Calcium Artery Coronary Score (CACS) is a noninvasive examination of the coronary arteries in which the amount of calcium is calculated using cardiac Computed Tomography. The role of postmortem imaging in sudden death has been the subject of increasing interest in recent years, and previous studies have proposed a possible correlation between CACS and autopsy findings.The present study aims to establish a correlation between CACS, the presence of coronary artery opacification defects on Multi-Phase Post-Mortem Computed Tomography Angiography (MPMCTA), and the presence of coronary stenosis at autopsy, in order to verify whether CACS confirms its predictive value in terms of cardiac risk and can guide the decision to perform or not to perform MPMCTA.A cohort of 24 subjects who died suddenly was examined. Firstly, MPMCTA was performed, then autopsy was carried out. CACS was calculated, the detection of opacification defects on MPMCTA was investigated and the presence of coronary stenoses on autopsy was described.24 deceased individuals (53 years ± 11.7; 20 men) were evaluated. CACS has a positive predictive value of 0.78 and a negative predictive value of 0.73 in assessing the presence of radiological coronary artery opacification defects. The positive predictive value on stenosis relief is 0.88, while the negative predictive value on the same relief is 0.73.CACS is an appropriate additional tool in the evaluation of sudden death cases. Our results provided an encouraging contribution to the systematic application of CACS in cases of sudden death.

Ruptured Very Small Cerebral Aneurysms and the Usefulness of Coil Embolization

Objective: Cerebral aneurysms larger than 7 mm are considered at risk for rupture. The International Study of Unruptured Intracranial Aneurysms (ISUIA)-1 (1998) and ISUIA-2 (2003) suggested that there is a negligible risk of subarachnoid hemorrhage (SAH) in aneurysms larger than 7 mm. However, smaller cerebral aneurysms are also at risk for rupture. We analyzed patients with spontaneous SAH due to the rupture of cerebral aneurysms smaller than 3 mm.Methods: From January 2019 to June 2022, seven patients were diagnosed with spontaneous SAHs with ruptured saccular aneurysms smaller than 3 mm and treated with coil embolization. Age, sex, location, hypertension, and smoking were analyzed as possible risk factors, and complications based on radiological findings and clinical outcomes after coil embolization were assessed to evaluate treatment. Results: The seven patients analyzed during this 3-year period ranged in age from 43 to 80 years (five women and two men). The saccular aneurysms were located in the anterior and posterior circulation. Four patients were diagnosed with hypertension, and three patients were smokers. Successful coil embolization involving subtotal occlusion with a remnant neck was done in all seven patients, and there were no complications.Conclusion: Ruptured aneurysms smaller than 3 mm can be successfully treated with coil embolization.

Clinical characteristics and predictors of complications and mortality in hospitalized octogenarian patients with COVID-19: an ambispective study.

This study aimed to describe the clinical presentation of COVID-19 in hospitalized patients aged 80 or above and to identify predictors for death and complications throughout the epidemic waves of the disease. This was an observational, multicenter, ambispective study conducted between March 2020 and August 2021 using data collected in five centers from southern metropolitan area of Barcelona (COVID-MetroSud cohort). Patients were grouped based on the pandemic waves of inclusion in the registry. We conducted a descriptive analysis, followed by bivariate and multivariate analyses (binary logistic regression) to identify predictors of risk for death or complications. A total of 1192 patients (mean [SD] age 85.7 [4.22] years and 46.8% female) were included. The most frequently reported symptoms in all waves were fever (63.1%), cough (56.5%), dyspnea (48.2%), and asthenia (27.5%). Laboratory and radiological findings consistently showed abnormal bilateral chest X-ray results (72.5% of patients) and elevated inflammatory markers such as lactate dehydrogenase (mean [SD] 335 [188] U/L), C-reactive protein (CRP) (mean [SD] 110 [88.4] U/L), and ferritin (mean [SD] 842 [1561] U/L). Acute respiratory distress syndrome (43.7%), renal failure (19.2%), and delirium (17.5%) were the most frequent complications. The overall mortality rate was 41.4% and declined across the epidemic waves. Age, diabetes mellitus, heart failure, dyspnea, and higher baseline levels of creatinine were identified as risk factors for complications, while a higher Barthel index and presence of cough were found to be protective. Age, dyspnea, abnormal bilateral chest X-ray, CRP, and sodium were identified as risk factors for death. This study demonstrates the clinical presentation of COVID-19 (fever, cough, dyspnea, and asthenia) and the different risk factors for mortality and complications in octogenarian hospitalized patients throughout the pandemic. These findings could be highly valuable for managing future virus pandemics.

SYMPTOMATIC MIGRATION OF SILICONE OIL TO THE VENTRICULAR SYSTEM.

The objective of this article is to report a case of silicone oil migration into intraocular packing in cases of retinal detachment, while reviewing the existing literature on the various mechanisms and locations of this migration. However, it is important to highlight that the use of this material is not free from complications. This article is a case report with a literature review. The information was obtained through a review of the medical record, interview and photographic record of the patient's diagnostic methods. PubMed was used as a database to perform the search for selected articles and literature review, selecting articles published from the year 2016. The exact mechanism of migration of intraocular silicone oil to the central nervous system is still unclear, being a rare complication that may be related to several factors. We report a case in which the patient underwent vitrectomy surgery and, after several years, presented a complication related to the migration of intraocular silicone oil to the right frontal horn and third ventricle, causing headache. Conclusion: Knowledge about migration of intraocular silicone oil into the central nervous system (CNS) is extremely important, since it manifests itself in several clinical and radiological findings, which can lead to incorrect diagnoses. Thus, it is suggested the follow- up of the patient after introduction of silicone oil to avoid complications that threaten results.

Failure Modes in Orthopedic Oncologic Reconstructive Surgery: A Review of Imaging Findings and Failure Rates.

Limb salvage surgeries utilizing endoprostheses and allografts are performed for a variety of oncologic conditions. These reconstructions can fail and require revision for many reasons, which are outlined and classified into mechanical failures (soft tissue failures, aseptic loosening, structural failure), non-mechanical failures (infection, tumor progression), and pediatric failures (physeal arrest, growth dysplasia). Distinct radiologic and clinical findings define specific failure subtypes but are sparsely illustrated in the radiology literature. Specifically, an understanding of the organizational structure of the failure modes can direct radiologists' search for post-reconstruction complications, enhance an appreciation of their prognostic significance, and facilitate research by standardizing the language and conceptual framework around outcomes. The purpose of this review is to highlight the key radiologic findings and imaging studies of each failure mode in orthopedic oncologic reconstructive surgery in the context of risk factors, failure rates, prognosis and survival statistics, and clinical decision-making regarding chemotherapy, radiation, and revision surgery.

Futile recanalization after endovascular treatment in acute ischemic stroke with large ischemic core

BackgroundEndovascular therapy (EVT) is the treatment of choice for acute ischemic stroke (AIS) with large vessel occlusion. However, in many patients, successful EVT recanalization does not correspond to a clinical improvement, called futile recanalization (FR). We aimed to identify stroke risk factors and patient characteristics associated with FR in AIS with large core infarct (LCI).MethodsA total of 137 patients with AIS with LCI treated by EVT at a single stroke center were retrospectively included from January 2016 to June 2023. LCI was defined by Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECT) < 6. Patient age, sex, modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), time to treatment, risk factors, and radiologic findings were collected, and potential associations with FR were analyzed. FR was defined as successful reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b but without functional independence at 90 days (mRS ≥ 3). A multivariate logistic regression analysis was conducted on the clinical characteristics of patients, based on the presence or absence of FR, and the factors influencing FR.ResultsOf 137 patients, 120 showed successful recanalization (mTICI ≥ 2b). All patients were divided into FR (n = 80) and no FR (n = 40) groups. Older age (odds ratio [OR] 1.052, 95% confidence interval [CI] 1.002–1.105; p = 0.041), the higher the initial NIHSS score (OR 1.181, 95% CI 1.037–1.344; p = 0.012), and prior intravenous plasminogen activator (OR 0.310, 95% CI 0.118–0.813, p = 0.017) were independent influencing factors of FR.ConclusionsThe older age, the higher the initial NIHSS, and not receiving intravenous plasminogen activator were independently associated with FR in AIS with LCI. These factors could identify poor responders to EVT recanalization.

Abbreviated Breast MRI as a Supplement to Mammography in Family Risk History of Breast Cancer within the Croatian National Breast Screening Program.

To evaluate the diagnostic performance of abbreviated breast MRI compared with mammography in women with a family history of breast cancer included in the Croatian National Breast Screening Program. 178 women with a family history of breast cancer aged 50 to 69 underwent abbreviated breast MRI and mammography. Radiological findings for each method were categorized according to the BI-RADS classification. The gold standard for assessing the diagnostic accuracy of breast MRI and mammography, in terms of suspicious BI-RADS 4 and BI-RADS 5 findings, was the histopathological diagnosis. Performance measures, including cancer detection rates, specificity, sensitivity, and positive and negative predictive values, were calculated for both imaging methods. Twelve new cases of breast cancer were detected, with seven (58.3%) identified only by abbreviated breast MRI, four (33.3%) detected by both mammography and breast MRI, and one (8.3%) diagnosed only by mammography. Diagnostic accuracy parameters for abbreviated breast MRI were 91.67% sensitivity, 94.58% specificity, 55.0% positive predictive value (PPV), and 99.37% negative predictive value (NPV), while for mammography, the corresponding values were 41.67%, 96.39%, 45.46%, and 95.81%, respectively. Abbreviated breast MRI is a useful supplement to screening mammography in women with a family history of breast cancer. Considering the results of the conducted research, it is recommended to assess whether women with a family history of breast cancer have an increased risk and subsequently provide annual abbreviated breast MRI in addition to mammography for early detection of breast cancer.

Fibrotic outcomes from SARS-CoV-2 virus interstitial pneumonia.

Following the onset of the new COVID-19 pandemic, particular attention is paid to the long-term outcomes, especially concerning patients affected by the SARS-CoV-2 virus leading to interstitial pneumonia. The aim of this research is to evaluate the possible evolution over time of interstitial pneumonia into post-inflammatory fibrosing interstitial disease. This research included 42 patients admitted to the COVID ward for SARS-CoV-2 interstitial pneumonia, 10 patients with mild pneumonia and respiratory failure who were treated with O2 only, 32 patients with severe pneumonia in which O2 and non-invasive ventilation were used for respiratory assistance, and 4 patients treated with invasive mechanical ventilation. At 70±30 days, 6, 12, 24, and 36 months after discharge, the cohort of patients carried out the evaluation of inflammation indices, high-resolution computed tomography (CT) chest scans, and functional respiratory tests. The comparative analysis showed that 83.3% of patients had residual parenchymal lung disease at 36-month follow-up, with a significantly higher rate in those with severe pneumonia and more extensive disease on initial CT. Regarding the pulmonary involvement model, patients presented ground-glass opacity or peripheral parenchymal bands, or a combination of them, peri- and intralobular interstitial thickening, which may be representative of fibrotic interstitial lung disease. There is a correlation between the severity of pneumonia, the inflammatory state, the need to increase respiratory support, and the quantity and persistence of CT-related lesions. Reductions in respiratory functions and exercise capacity were observed, the latter more pronounced in patients (24%) who had contracted severe pneumonia and required ventilatory support.Pulmonary outcomes from SARS-CoV-2 respiratory infections show a wide range of radiological findings, from complete recovery to stable outcomes of thickening and distortion of the interstitial architecture. From a functional point of view, there is an impairment of the alveolar-capillary diffusion capacity and, in cases who had contracted severe pneumonia, desaturation and reduced exercise tolerance in 24% of cases at a 36-month follow-up.

Clinical, radiological, and serological assessment of the efficacy and safety of nintedanib compared to pirfenidone in a sample of Iraqi patients with idiopathic pulmonary fibrosis: A retrospective cohort study

This study compares the treatment effects after six months of therapy with nintedanib and pirfenidone in patients with idiopathic pulmonary fibrosis (IPF) by comprehensively analyzing key parameters and establishing the diagnostic performance of two biomarkers, Krebs von den Lungen-6(KL-6) and CC chemokine Ligand-18 (CCL-18), to predict treatment outcomes. In a hospital-based retrospective cohort study, 75 patients diagnosed with IPF were divided into three groups based on their treatment: the newly diagnosed group, which included newly diagnosed IPF patients without receiving any antifibrotic treatment (25 patients), IPF patients on pirfenidone treatment (26 patients), and IPF patients on nintedanib treatment (24 patients). After adjustment for age, sex, body mass index, and baseline values of predicted forced vital capacity (FVCp), there was no significant difference in the rate of changes after 24 weeks of follow-up for FVCp (-0.2 ± 0.6, 0.0 ± 2.3, and 0.8 ± 3.5 ml change after 4, 12, and 24 weeks for pirfenidone) and (-1.7 ± 5.9, 1.0 ± 8.9, and 1.4 ± 9.5 ml change after 4, 12, and 24 weeks for nintedanib). CCL-18 offers a better ability to predict radiological findings than KL-6. Most side effects were minor and included diarrhea, stomach pain, skin rash, and hyperpigmentation. In conclusion, both drugs have demonstrated the capacity to postpone the beginning stages of FVCp decrease and lung function decline. There was little difference between the efficacy of nintedanib and pirfenidone. Both drugs were safe and well tolerated for the treatment of IPF.

Unusual Presentation of Tuberculosis in the Lungs and Lymph Nodes

Abstract Introduction/Objective Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis mainly affecting the lungs. Despite treatment advancements, TB remains a major cause of morbidity. This report presents a patient with active pulmonary and lymph node TB. Methods/Case Report The patient is a 41-year-old male from Bangladesh admitted for worsening cough and shortness of breath. Earlier, he had a cough and right cervical lymphadenopathy with lymph node biopsy demonstrating noncaseating granuloma and a positive Quantiferon-Gold. Outpatient workup included negative sputum TB PCR with negative cultures. The patient was febrile, tachycardic, and oxygenating normally. D-dimer was 1484. CT angiography was negative for emboli and showed mediastinal and right hilar lymphadenopathy. Imaging was otherwise non-indicative of active TB. We started rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy with bronchoalveolar lavage for additional sputum sampling and excisional lymph node biopsy to rule out malignancy. Workup for autoimmune disease and sarcoidosis was negative. An acid-fast bacilli stain of the biopsy was positive, indicating active TB. The patient was discharged on RIPE with outpatient follow-up. Results (if a Case Study enter NA) NA Conclusion Histological findings of TB demonstrate caseating granulomatous lesions. Sarcoidosis can be considered in patients with hilar or mediastinal lymphadenopathy with noncaseating granulomatous lesions. However, both active and inactive TB should be considered in the differential diagnosis with biopsy results indicating noncaseating granuloma, as infected tissues can lack the central necrosis to produce caseation. Common chest radiographic findings in TB include pulmonary consolidation, hilar and mediastinal lymphadenopathy, disseminated miliary disease, and a normal chest radiograph. Our patient had just hilar and mediastinal lymphadenopathy. While a common finding in tuberculosis, this is also present in other inflammatory pathologies, emphasizing the importance of keeping a broad differential even in settings where initial biopsy and imaging results may indicate latent infection or other diagnoses. We utilized the expertise of pathologists to identify lymph nodes with active TB infection in a patient who previously had inconsistent pathological and radiological findings. Without the help of the pathologists in this case, diagnosing and treating this patient would not have been possible, showing the necessity of histopathological correlation with clinical and radiologic findings.

Prevalence, Radiological, and Pathological Findings of Ossification and Calcification of the Lumbar Spinal Ligamentum Flavum: A Comparative Study with Thoracic Lesions.

This study aimed to determine the prevalence of lumbar ligamentum flavum lesions and identify correlations between radiological and pathological findings. We conducted an observational cross-sectional study of 349 patients (lumbar: n = 296, thoracic: n = 39, lumbar and thoracic: n = 14, mean age: 69 ± 12 years, male: 74%) who underwent posterior surgery for thoracolumbar spinal canal stenosis between January 2008 and April 2023 at our hospital.Computed tomography (CT) revealed that the prevalence of ligamentum flavum lesions defined as a high-density area with a CT value of 200 Hounsfield Unit or higher in the lumbar and thoracic spine was 47% (147/310) and 85% (45/53), respectively. CT showed that most patients had radiologically suspected ossification in the lumbar (90%) and thoracic spine (98%) than radiologically suspected calcification. Lumbar lesions were thinner than the thoracic lesions (2.5 vs 3.7 mm, p < 0.01). Pathological examinations were performed in specimens collected from 34 cases (lumbar: n = 13, thoracic: n = 21), and ossification was found in 62% (8/13) and 95% (20/21) of lumbar and thoracic lesions (p = 0.02), respectively. Lastly, ossification was confirmed pathologically in 72% (8/11) and 95% (19/20) of lumbar and thoracic lesions that showed ossification on imaging (p = 0.13), respectively. The literature review revealed that the prevalence of the lumbar ligamentum flavum lesions varied from 1.5 to 35% and the patient population was mostly asymptomatic.Collectively, we found that the prevalence of lumbar ligamentum flavum lesions in symptomatic patients was greater than previously reported. Histologically confirmed ossification was less common in lumbar lesions than in thoracic lesions.

Unexpected Presentations of Histiocytic Disorders as Mass Lesions in the Central Nervous System and Spine

Abstract Introduction/Objective A number of neoplastic and non-neoplastic hematolymphoid lesions can involve the CNS and spine. The majority are lymphomas, but some are rare lesions that mimic primary neoplasms clinically, radiologically, and even pathologically. Here, we present our experience of such cases. Methods/Case Report Pathology archives were searched, and five cases representing different challenges were identified to review clinical, radiological, and pathologic features. Case 1. 31-year-old female presented with vision changes and hearing loss and numerous supratentorial extra-axial masses, suspicious for meningiomatosis. Extensive lymphoplasmacytic infiltrate was seen at Intraoperative consult (IOC). Final diagnosis was Rosai-Dorfman disease with features of IgG4 related disease. Case 2. 31-year-old female with Chronic myeloid leukemia (CML), which progressed to AML presented with a right frontal brain mass. IOC displayed atypical hematolymphoid infiltrate. Final diagnosis was myeloid sarcoma. Case 3. 29-year-old male presented with a T10 vertebral lesion. IOC showed hypercellular tissue with atypia and was deferred. Subsequently, histiocytic sarcoma was diagnosed. Case 4. 22-year- old male presented with a T3-T4 intradural, extramedullary mass radiologically thought to be a meningioma. No IOC was requested. Final diagnosis was juvenile xanthogranuloma. Case 5. 36-year-old male presented with a C7-T1 dura-based mass. IOC revealed granulomatous inflammation, eventually resulting in a diagnosis of non-necrotizing granulomatous inflammation, suggesting sarcoidosis. Results (if a Case Study enter NA) NA Conclusion These cases highlight the importance of incorporating all clinical and radiological findings into pathologic evaluation, while being alert for mimickers and pitfalls. Both practicing general surgical pathologists and neuropathologists should remain alert to such unexpected and unusual cases especially at the time of IOC and initiate appropriate work-up with expedited diagnostic protocols such as intraoperative cultures, flow cytometry, and cytogenetics, as the differential diagnosis is broad with inflammatory, infectious, and neoplastic possibilities, presenting a variety of challenges.

Prevalence of Asymptomatic Changes in the Groin Region Among Adult Professional Soccer Players and Their Association With Limb Dominance.

To investigate the prevalence of asymptomatic radiologic groin region findings in adult professional soccer players using magnetic resonance imaging (MRI) and examine the influence of age and limb dominance on their occurrences. Cross-sectional trial. Soccer club medical service, private practice. Forty-seven male professional soccer players. Players underwent a groin presigning MRI scan with a magnetic field induction of 1.5 Tesla. Image analysis of their pubic bones was performed according to The Copenhagen Standardized MRI protocol to assess the pubic symphysis and adductor regions of players. The prevalence of various changes in the symphysis, pubic bone, and adjacent areas. Fifty images of pubic bones and adjacent regions (53.2%) highlighted 1 to 4 changes, while another 44 images (46.8%) demonstrated 5 or more changes. The most frequent changes observed in the pubic bone were joint surface irregularities (100%), symphyseal sclerosis (93.6%), pubic bone swelling (56.3%), parasymphyseal high-intensity line (55.3%), fatty infiltration in bone marrow (38.3%), and adductor tendinopathy (34%). When comparing the prevalence of different changes in the dominant and nondominant limbs, no statistically significant differences were found. In adult professional soccer players with no prior groin pain complaints in recent history (12 months), asymptomatic changes are extremely common in the pubic joint and adjacent areas, including those that are very likely to be considered the main cause of pain when investigated in soccer players with groin pain. None of these changes were associated with limb dominance.

Hypophysitis in COVID-19: a systematic review.

This systematic review aims to collect and examine recent research findings regarding hypophysitis in COVID-19 patients. We conducted a comprehensive literature review in English on the topic "Hypophysitis in COVID-19," using the MEDLINE (PubMed) database in July 2024. The selected articles were systematically tabulated and we have assessed in this review patient demographics, symptom presentation, imaging results, diagnosis, clinical management, and outcomes. Seven reported cases of post-COVID-19 hypophysitis were identified, comprising 4 (57%) females and 3 (43%)males, with a median age of 37 years. The interval between COVID-19 infection symptoms and the onset of hypophysitis ranged from 2 to 3 weeks. Initial symptoms included frontal headache in 4 (57%) cases and polyuria and polydipsia in 3 (43%)cases. Anterior or posterior hypopituitarism was observed in 6 (85%)patients. Radiological findings varied: 2 (28.5%) cases showed panhypophysitis, 3 (43%) cases exhibited gland enlargement with homogeneous contrast enhancement on magnetic resonance imaging (MRI), 1 case involved the loss of the posterior pituitary bright spot, and 1 case involved pituitary apoplexy/enlargement of the gland and infundibulum. No pituitary biopsies were performed. Four (57%) patients received glucocorticoid (GC) treatment. Long-term follow-up was documented in only one case, a 16-year-old female followed for 2 years reporting complete clinical and radiological resolution. Although rare, hypophysitis related to COVID-19 is documented in the literature exhibiting distinct characteristics such as a homogeneous gender prevalence, an average age of onset around 35 years, and primary symptoms of headache, polyuria, and polydipsia which are indicative of angiotensin-vasopressin deficiency. This is in contrast with primary autoimmune hypophysitis characterized by a female prevalence and typical symptoms with headache and visual impairment. Longer-term follow-up of these patients is needed to better understand the potential lasting impact on pituitary function and radiological improvement. Future research should also explore the presence of anti-pituitary antibodies and the other possible pathophysiological mechanisms potentially involved in these cases.

Hiding in Plain Sight: Radiologic and Pathologic Findings Can Identify Beckwith-Wiedemann Syndrome in Patients With Wilms Tumor.

Most pediatric specialists, including hematologists/oncologists, surgeons, radiologists, and pathologists, are familiar with the diagnosis and management of Wilms tumor (WT). However, it may be challenging to identify the underlying conditions causing cancer predisposition, which can change the management for the patient and potentially their entire family. In this paper, we present 3 cases of clinically suspected WT associated with Beckwith-Wiedemann syndrome (BWS). We review the radiologic and histologic findings to diagnose BWS. We also discuss the implications of a BWS diagnosis on the clinical management of WT and follow-up guidelines for BWS patients.

A unique case of mesothelial cyst removal during peritoneal dialysis.

A peritoneal mesothelial cyst is a rare entity, commonly asymptomatic, which is usually detected as an incidental radiological finding and needs surgical intervention for complete removal. We present a unique case of a peritoneal simple mesothelial cyst that was removed accidentally during peritoneal dialysis in a pediatric patient.

Etiology, Clinical Profiles, and Outcomes of Acute Encephalitis Syndrome Cases Admitted to a Tertiary Care Center in Myanmar in 2023.

The diagnosis of encephalitis is a challenging problem due to the heterogeneity of clinical presentations. The objective was to determine the etiology, clinical features, laboratory parameters, radiological findings, and in-hospital outcome of acute encephalitis syndrome (AES) cases in Myanmar. A prospective descriptive study was conducted at the Neuromedical Ward of Yangon General Hospital from March to August 2023. Eighty-one AES cases were enrolled, and cerebrospinal fluid (CSF) samples were collected. A Qiastat ME Panel was used to detect viral, bacterial, and fungal pathogens. Seventeen out of eighty-one (21%) cases were non-encephalitis with alternative definite diagnosis. Among the remaining 64 encephalitis cases, the exact infectious and immune etiologies were identified in 31 of 64 cases (48.4%); 26 of these (83.9%) were due to infectious causes and 5 (16.1%) were immune encephalitis. Among the infectious causes, six Herpes Simplex Virus-1-, one bacteriologically confirmed and seven probable Mycobacterium tuberculosis-, three Haemophilus influenzae-, two Streptococcus pneumoniae-, one Streptococcus pyogenes-, one Varicella-Zoster Virus (Ramsay Hunt Syndrome with meningoencephalitis)-, and two Cryptococcus neoformans-infected patients and rare causes such as Listeria monocytogenes, Burkholdelria cepacia, Sphingomonas paucimobilis, and Aspergillus were identified. One case was a dual infection with Haemophilus influenzae and Cryptococcus neformans. Abnormal protein levels and CSF pleocytosis were significantly higher among bacterial causes (p < 0.05). In total, 6.45% (2/31) of encephalitis patients with identified causes and 12.12% (4/33) of those without an identified organism had poor outcome. Herpes encephalitis and tuberculous meningoencepalitis were the commonest. This study highlighted that molecular testing with a multidisciplinary approach is required to ensure the right treatment on time.