Radiological Syndrome Research Articles

The frequency of the bony parameters of femoroacetabular impingement syndrome in young asymptomatic individuals: a computed tomography study

Objectives: Femoroacetabular impingement syndrome is a painful disorder of the hip formed by movements in the hip joint between the femoral head-neck junction and the acetabular edge. The aim of this study was to determine the prevalence of radiological femoroacetabular impingement syndrome findings in a young, asymptomatic Turkish population. Methods: A total of 1000 abdominal pelvic CT images were collected from patients aged between 18–40 years. Measurements were taken on the CT images of the alpha angle and femoral head offset as signs of cam-type deformity, and of the acetabular version angle and center-edge angle as signs of pincer-type deformity. Results: Femoroacetabular impingement syndrome was determined in 2.3% of the individuals. Pincer type deformity was determined in 56.5%, being 83.3% in females and 47.1% in males. The cam-type deformity was present in 43.5% of all cases, being in 16.7% of the females and in 52.9% of the males. No difference was determined between the genders in respect of alpha angle which is >55°. A head-neck offset which is <8 mm was at a higher rate in females (13.3%) than males. An acetabular anteversion angle which is <15° and centre-edge angle which is >40° was more in males than females at a rate of 11% and 25.2% respectively. Conclusion: The results of this study showed that the incidence of cam-type deformity in the adult males and the incidence of pincer-type deformity in the adult females were lower in the asymptomatic Turkish population than previously reported in literature.

Pulmonary Melioidosis Masquerading as Tuberculosis: A Case Report

Tuberculosis is most common chronic lung infection in India and it will present radiologically from nodules with branching lines called as ‘tree in bud’ to consolidations. Radiological presentations in various chronic lung diseases are overlapping and microbiological confirmation is must rather than giving empirical ant-tuberculosis treatment. Melioidosis is bacteriological infection causing similar clinical and radiological syndrome mimicking tuberculosis. In this case report, 70-year female presented with chronic respiratory illness with constitutional symptoms like cough, low grade fever, weight loss and anorexia and HRCT thorax imaging showing progressive pathologies as tree in bud to consolidations over 3 months duration. She had received anti-tuberculosis treatment empirically for 3 months and was having clinical and radiological deterioration. Bronchoscopy guided broncho-alveolar lavage (BAL) analysis for Gene Xpert MTB/RIF and Bacterial culture suggestive of Melioidosis as cause for her chronic respiratory illness. She was treated as per antibiotic protocol for Melioidosis and shown complete clinical and radiological response.

Reversible Cerebral Vasoconstriction Syndrome(RCVS)and Posterior Reversible Encephalopathy Syndrome(PRES)

Reversible cerebral vasoconstriction syndrome(RCVS)is a clinical and radiological syndrome that is characterized by recurrent severe thunderclap headaches with or without other neurological symptoms and diffuse segmental constriction of cerebral arteries that usually resolves spontaneously within three months. Posterior reversible encephalopathy syndrome(PRES)is also a clinical and radiological syndrome characterized by headache, seizures, altered consciousness, cortical blindness, other focal neurological signs, and a diagnostic imaging picture of brain vasogenic edema. Both syndromes can occur in similar clinical contexts such as hypertension, pre-eclampsia/eclampsia, drug neurotoxicity, uremia, and some autoimmune diseases, and are frequently associated. Although the syndromes are usually fully reversible with early diagnosis and prompt treatment, some cases can develop hemorrhagic or ischemic brain lesions, often resulting in permanent disability. We need to be aware of the typical and atypical imaging manifestations of the syndromes to make an accurate diagnosis.

Akut Lenfoblastik Lösemi Tedavisi Sırasında Posterior Reversible Ensefalopati Sendromu Gelişen Olgularımız

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome, characterized by acute onset of headache, altered mental status, visual impairment, nausea, vomiting, seizure, and hypertension. PRES is a reversible condition if it is recognized early, but neurological damage or even death may occur. Herein, we present two cases of ALL who developed PRES during their induction therapy and a literature review of PRES.

A 23-Year-Old Man with SARS-CoV-2 Infection Who Presented with Auditory Hallucinations and Imaging Findings of Cytotoxic Lesions of the Corpus Callosum (CLOCC)

Patient: Male, 23-year-oldFinal Diagnosis: Cytokine release syndrome • disseminated intravascular coagulation • multiple organ failureSymptoms: Auditory hallucinations • fever • headache • restlessness • suicidal thoughtsMedication: —Clinical Procedure: —Specialty: Infectious Diseases • NeurologyObjective:Unusual clinical courseBackground:Cytotoxic lesions of the corpus callosum (CLOCC) is a rare clinical and radiological syndrome that has been associated with various infectious etiologies. CLOCC are among the recently described neurological associations with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with coronavirus disease 2019 (COVID-19). We report a case of CLOCC in a man with SARS-CoV-2 infection who presented with auditory hallucinations and rapidly developed systemic inflammatory response syndrome (SIRS).Case Report:A 23-year-old man with no past medical and psychiatric history presented with auditory hallucinations, restlessness, and suicidal ideations. A nasopharyngeal swab specimen tested using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay was positive for SARS-CoV-2. A brain MRI revealed an isolated oval-shaped lesion in the splenium of the corpus callosum, with hyperintense signal on diffusion-weighted imaging (DWI) and hypointense on apparent diffusion coefficient (ADC) maps, suggestive of CLOCC. After a dramatic hospital course associated with multiple organ dysfunction syndrome (MODS) and severe intra-abdominal and cerebral bleeding, he developed cardiac arrest and died on hospital day 15.Conclusions:This case highlights the need for increased vigilance for the atypical manifestations of SARS-CoV-2 infection. In addition, it suggests that CLOCC can be considered as a differential diagnosis by clinicians in patients with SARS-CoV-2 infection who present with unexplained neurological and neuropsychiatric symptoms, leading to poor outcome.

Immunological skin tests in differential diagnostics disseminated processes in the lungs

Diseases that manifest as Х-ray syndrome of pulmonary dissemination are one of the most complex differential diagnostic problems in pulmonology and Phthisiology. Literature data on the effectiveness of using a new intradermal test with tuberculosis recombinant allergen (ATR, Diaskintest®) for disseminated processes in the lungs are single and contradictory.The aim. Тo study the diagnostic capabilities of intradermal test with tuberculosis recombinant allergen in disseminated lung processes of various etiologies.Methods. The analysis of archival materials of 204 patients with disseminated lung processes of various etiologies who were admitted to diagnostic departments of the N.S.Pokhvisneva Voronezh regional anti-tuberculosis dispensary in 2011 – 2019 was carried out. There were 85 (41.67%) women and 119 (58.33%) men aged 19 to 87 years. The data of im mu no - logical examination of patients using intradermal Mantoux samples with 2 TE PPD-L and with ATR were studied, and their comparative analysis was performed.Results. In disseminated pulmonary processes in tuberculosis, the proportion of individuals who respond positively to the Mantoux test was greater only in comparison with the group of people with sarcoidosis (p < 0.01) and did not significantly differ from the results in other groups of patients (p > 0.05). At the same time, the proportion of people who respond positively to a test with ATR in tuberculosis was greater than in patients with pneumonia, sarcoidosis (p < 0.01) and, to some extent, with a tumor. In healthy individuals, a lower proportion of positive reactions to ATR was established compared to the Mantoux test (p < 0.01). With active disseminated pulmonary tuberculosis, a hyperergic reaction (11.9%) was observed in the sample with ATR, which was not observed with the Mantoux test. In non-specific processes in the lungs, less often than negative reactions (p < 0.05) were detected on the sample with ATR less often than on the Mantoux test with 2 TE.Conclusion. The ATR sample compared to the Mantoux test indicates that it is appropriate to use it in the differential diagnosis of tuberculosis and non-specific lung diseases in adult patients with radiological dissemination syndrome.

Reversible Cerebral Vasoconstriction Syndrome Associated with Infundibular Dilation.

Reversible cerebral vasoconstriction syndrome (RCVS) is defined as a clinical and radiological syndrome that comprises a group of disorders characterized by sudden-onset severe headache and segmental vasoconstriction of the cerebral arteries with resolution within 3 months. A 51-year-old female patient with a 2-week history of sudden-onset severe headache, visual disturbances and cerebellum; no relevant imaging findings, except for an infundibular dilation at the origin of the posterior communicating artery, and so, angiography was performed. When symptoms persisted, a new imaging study was carried out with findings of RCVS as the cause of the symptoms from the beginning. Findings of RCVS can be obtained in various vasculopathies of the nervous system and vasculitis, being misdiagnosed, and so, clinical suspicion is essential; if vasoconstriction is not demonstrated on the initial image and other diagnoses have been excluded, the patient should be managed as having possible or probable RCVS. RCVS is a clinical and radiological syndrome that comprises a group of disorders characterized by sudden-onset severe headache and segmental vasoconstriction of the cerebral arteries.It can occur spontaneously or can be triggered by a specific "trigger" in 25 to 60% of cases.It commonly affects women between 20 and 50 years of age, but children and adolescents may also be affected.

Vessel wall imaging for diagnosis and follow-up of basilar artery reversible cerebral vasoconstriction syndrome (RCVS)

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a clinical and radiological syndrome that is primarily defined by thunderclap headache, with or without further neurological deficits, and segmental intracranial vasoconstriction that resolves within three months. The current nomenclature was only established in 2007, but it has been known with diferent names for over fifty years. The pathophysiology, while still not completely understood, seems to point towards a disease based on abnormalities of vascular tonus without structural inflammation. It is clear, however, that patients with RCVS often have triggers, especially drugs or other vasoactive substances. Distinguishing this entity from others, especially subarachnoid hemorrhage and arterialdissection, is extremely important, given the particular prognosis and need of immediate treatment of each disease. The preferred imaging method has long been the angiography; however, new magnetic resonance imaging (MRI) such as vessel wall imaging have allowed for non-invasivediagnosis and follow-up. The authors report a case in which MRI was used in a patient with basilar artery RCVS and present a literature review.

Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) in twin sisters with two CD36 frameshift mutations.

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinical radiological syndrome with good prognosis that affects mainly children or young adults. We describe two cases of MERS, associated with echovirus 6 and influenza A infection, in two twin sisters, at the age of 4years. Genetic analysis was performed; next exome sequencing was performed on twins to disclose the eventual causative gene. Two different frameshift mutations in the CD36 gene [NM_000072] were found in both twins and confirmed by Sanger sequencing. To best of our knowledge, we report an association between CD36 mutation and MERS. We think that this relation between CD36 and inflammation has had a crucial role in the same callosal alteration during viral disease in the twin sister with the same gene mutation.

A rare presentation of posterior reversible encephalopathy syndrome in recovery phase of guillain–Barré syndrome

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome, in which a patient presents with neurological symptoms, including headache, seizures, altered sensorium, and loss of vision, and accompanied with characteristic magnetic resonance imaging findings which are likely to be reversible. Guillain–Barré syndrome (GBS) is an acute demyelinating polyneuropathy presumably related to immunological mechanisms. Here, we describe a patient who had PRES in recovery phase of GBS while he was neither on any immunomodulator nor was having hypertension. He recovered completely clinically as well as radiologically.

Posterior reversible encephalopathy syndrome as an underlying cause for encephalopathy in a sepsis patient in the intensive care unit: case report

Posterior reversible encephalopathy (PRES) is a clinical and radiological syndrome characterized by neurological findings and vasogenic edema in the posterior regions of the cerebral hemispheres. Sepsis and septic shock have recently been recognized as an etiological factor in PRES. In this case report, we are presenting a patient with intraabdominal sepsis and PRES followed in the intensive care unit with an unfavorable neurological outcome. Wider recognition of PRES as a cause of encephalopathy in sepsis patients is necessary.

Posterior reversible encephalopathy syndrome after massive transfusion in a patient with postpartum vaginal hematoma

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome characterized by headache, potentially reversible neurological deficits. PRES has been described in various clinical settings, such as severe hypertension, eclampsia, and chemotherapy. Transfusion related PRES are rare. We report a patient with postpartum vaginal hematoma who manifested PRES after massive packed red blood cell transfusion confirmed by brain MRI and clinical features. A 34-year-old woman gravida 1, para 1 admitted for surgery of postpartum vaginal hematoma, rectum repair, sphincter repair. Twelve hours ago, she was delivered. After delivery her uterine contraction was poor and vaginal bleeding was persistent. On admission, her hematocrit was at 27.2%, and her hemoglobin was at 9.0 g/dl. She received 18 packed red blood cell transfusion and 10 packed fresh frozen plasma. Her hematocrit and hemoglobin increased 41.1% and 13.9 g/dl, and platelet increased up to 78,000/ul. After 2 days of the transfusion, she had a left eye ball deviation and 5 min prolonged confusion. Her blood pressure was normal, and no other contributing factors for PRES were found. Brain MRI showed regional T2 signal change in right occipital lobe including cortex, and small signal change in left occipital lobe. In this case, some relation may have existed between late postpartum eclampsia and PRES, but the pathogenesis remains unclear. Although blood transfusion is a common procedure with rare neurological complications, great caution should be taken with anemic patients because a rapid elevation in hemoglobin may precipitate PRES.

Results of morphological diagnosis of the aetiology of the diffuse lung disease syndrome.

Background. Diffuse Pulmonary diseases (DZL) is a heterogeneous group of diseases united on the basis of the characteristic radiological syndrome of pulmonary dissemination, which is manifested by widespread changes in both lungs of nodular, reticulate or mixed character with nonspecific clinical and altered pathological changes. Objective. To present the results of morphological diagnostics of the pathological process in the syndrome of pulmonary dissemination and to compare them with the final clinical diagnoses when applying different methods of biopsy sampling. Methods. 216 lung biopsies were selected for morphological diagnosis, followed by histological examination in 210 patients. Patients were divided into 4 groups depending on the method of obtaining biopsy material for histological examination (video assisted, open and transbronchial lung biopsy). Results. Most patients were with sarcoidosis 81 (37.5 ± 3.3)%metastatic lung damage was diagnosed for 36 (16.7 ± 2.5)% cases. Other diseases (various forms of fibrotic alveolitis, alveolar proteinosis, histiocytosis, diffuse pulmonary ossification, etc.) 25 (11.6 ± 2.2)% and pulmonary tuberculosis – 24 (11.1 ± 2.1) % cases. Conclusion. Prevalent patients were diagnosed with "disseminated process in lungs of unknown etiology" – 121 (57,6 ± 3,4)% of patients and "diffuse process in lungs in combination with syndrome of intrathoracic lymphadenopathy" – 41 (19,5 ± 2,7)% patient. According to the histological examination, sarcoidosis was the most common in 81 (37.5 ± 3.3)% of cases and metastatic lung injury was 36 (16.7 ± 2.5)%; Morphological examination of the pulmonary tissue in the case of pulmonary dissemination syndrome reveals numerous diseases of different etiology; or "narrows" the spectrum of pathology in the differential diagnosis of a particular disease.

Clinical and experimental studies of bone tissue in fl uorosis

Introduction. Despite the signifi cant reduction in the production of electrolytic aluminum, the frequency of fl uorosis is a leader in this industry. In this pathology, fi rst of all, bone tissue actively reacts to the impact of factors of the working environment. The aim of the study was to study the eff ect of chronic fl uoride intoxication on the morphofunctional state of bone tissue. Materials and methods. Th e analysis of bone mineral density, structural rearrangement of skeletal bones was evaluated by x-ray method using photon densitometry. Biochemical status of blood of workers with fl uorosis included determination of parameters of mineral homeostasis (level of calcium, phosphorus) and genetic markers (COL1A1, IL1β, IL6, VEGF). Histological analysis of bone tissue was carried out in an experiment on white rats.Results. A comprehensive clinical and experimental study of bone tissue under chronic fl uoride intoxication is presented. A signifi cant correlation of GG COL1A1, TT IL1β, GC IL6, GC VEGF genotypes with the development of osteosclerosis was revealed. Th e study showed the relationship of combined signs of fl uorosis, confi rmed by experimental data on persistent bone destruction.Conclusions. Th e leading clinical and radiological syndrome of industrial fl uorosis is the defeat of the musculoskeletal system against the background of gross violations of the morphological and functional structure of the bones of the skeleton, due to the osteotropic mechanism of action of fl uorides and the genetic status of the body.

Localized Marked Elongation of the Distal Internal Carotid Artery with or without PHACE Syndrome: Segmental Dolichoectasia of the Distal Internal Carotid Artery.

Segmental intracranial dolichoectasia of the distal ICA is a feature of PHACE syndrome or a sporadic phenomenon. We evaluated the relationship between intracranial dolichoectasia of the distal ICA and PHACE syndrome and illustrated the characteristic radiologic findings of the lesions. Intracranial dolichoectasia of the distal ICA was identified in 20 patients at our institution from 2005 to 2016 through a review of diagnostic cerebral angiography results. All radiologic images were reviewed to determine the vascular morphologic dispositions around the distal ICA, including dysplasia, mural calcification, vessel wall enhancement, lumen narrowing, and aneurysm formation. Medical records were reviewed to determine the symptoms of PHACE syndrome. Subsequently, the correlation between radiologic findings and PHACE syndrome was assessed. In this cohort, which had a strong female predominance (male/female ratio= 2:18), intracranial dolichoectasia had a more ipsilateral vascular morphologic disposition. Mural calcification was detected more frequently in elderly patients, whereas vessel wall enhancement was detected more frequently in younger patients. Follow-up images showed a slow progression of the lesions. However, no significant differences in the vascular morphologic disposition and brain structural changes were observed between patients with (n = 11) and without (n = 9) PHACE syndrome. The striking elongation and tortuosity of the distal ICA generally appeared to be a type of congenital lesion occurring early in embryogenesis as either a sporadic phenomenon or an arterial change associated with PHACE syndrome. Imaging findings revealed various mural abnormalities with a benign clinical course.

Posterior Reversible Encephalopathy Syndrome Secondary to Cyclophosphamide in the Treatment of Pulmonary Renal Syndrome

SESSION TITLE: Nervous System Disorders in the ICU 2 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is a clinical radiological syndrome, carrying a 15% mortality risk. It can lead to permanent neurological deficits and death if not identified and treated early. CASE PRESENTATION: A 22-year-old female with a history of Sjogren’s syndrome was admitted to the intensive care unit for acute respiratory failure. She was diagnosed with diffuse alveolar hemorrhage after bronchoalveolar lavage, along with concurrent acute glomerulonephritis. Labs were significant for creatinine of 1.47 mg/dL, as well as protein >500, large blood, and 54 RBCs/hpf on urinalysis. Urine protein to creatinine ratio was 8.3. Glomerulonephritis workup was significant for ANA 1:5120, positive anti-MPO IgG, but negative anti-dsDNA, negative anti-GBM, negative HIV and hepatitis serologies, as well as a negative syphilis screen. The patient was initially diagnosed with pulmonary renal syndrome due to MPO-associated vasculitis. She was treated with high dose pulse steroids, cyclophosphamide induction on day 2 of ICU, and 5 days of plasmapheresis with improvements in respiratory status, but not in renal function. On day 5 the patient developed acute nausea, vomiting, and tonic-clonic seizures. Her vital signs were significant for a blood pressure of 170/110 mmHg. Neurological exam was evident for lethargic appearance, and a right pronator drift. Based on documentation, a progressive increase in her blood pressure was observed since the start of cyclophosphamide. Non-contrast MRI of the brain confirmed posterior reversible encephalopathy syndrome (PRES), with evidence of vasogenic edema in the bilateral parietal, occipital lobes, and cerebellum. DISCUSSION: The most common signs and symptoms of PRES are acute hypertension, seizure, nausea and vomiting, and altered consciousness. The incidence of PRES is unknown but is reported in ages 2-90, and occurs more frequently in women. Reported risk factors associated with PRES are hypertension, renal disease, immunosuppressive therapy, eclampsia/preeclampsia, and autoimmune diseases. The pathogenesis is not fully understood, however current hypotheses suggest disruption of vascular autoregulation in the brain, leading to vascular leakage, vasogenic edema, and hemorrhage. Diagnosis involves a high degree of clinical suspicion, as there are no current guidelines available. Aggressive blood pressure control with rapid lowering of the diastolic pressure below 100 mmHg within 2-6 hours is the mainstay of therapy, along with removal of the inciting agent. CONCLUSIONS: It is important to recognize PRES early and initiate the appropriate management. Unlike its name, PRES is not always posterior, and may not always be reversible. If not treated, it can lead to permanant neurological disability and death. Reference #1: Pedraza, R. Posterior Reversible Encephalopathy Syndrome: A Review, Crit Care & Shock (2009) 12:135-143 DISCLOSURE: The following authors have nothing to disclose: Di Pan, Basera Sabharwal, Franco Vallejo No Product/Research Disclosure Information

A case of posterior reversible encephalopathy syndrome

Discussion of a rare case of posterior reversible encephalopathy syndrome (PRES), a clinical radiological syndrome characterised by headache, confusion, visual disturbance and seizures associated with typical neuroimaging findings of posterior cerebral white matter oedema. We report a case of a 74-

Iatrogenic Coagulopathy and the Development of Posterior Reversible Encephalopathy Syndrome after L-asparaginase Chemotherapy

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome mostly related to hypertension, eclampsia, renal failure, or to chemotherapy and/or immunosuppressive drugs. Although the PRES pathophysiology is multifactorial, hypertension and endothelial dysfunction are hypothesized to be the pivotal factors. Here we report a case of PRES in an adult patient after chemotherapy (Escherichia coli L-asparaginase [L-ASP], daunorubicin, vincristine, and intrathecal methotrexate) for acute lymphoblastic leukemia. The development of the PRES was strictly associated with an iatrogenic coagulopathy induced by L-ASP, which inhibits the biosynthesis of hepatic coagulation factors. The nadir of platelet count, antithrombin III (ATIII) and fibrinogen curve was coincident with the onset of the PRES neurological picture; subsequently, the normalization of the ATIII and fibrinogen levels seemed to parallel the good clinical evolution. This case seems to provide new insights into the PRES pathophysiological mechanisms.

JC virus granule cell neuronopathy: A cause of infectious cerebellar degeneration

JC virus (JCV) infection of glial cells can lead to progressive multifocal leukoencephalopathy (PML) in immunocompromised patients. A newly described phenotype of the infection is infection of neurons. This distinct clinical and radiological syndrome is named JCV granule cell neuronopathy, characterized by exclusive or predominant cerebellar atrophy. We report the clinical and radiological longitudinal findings of 5 HIV-infected patients referred to us between September 2004 and November 2011 who exhibited JCV granule cell neuronopathy (4 probable cases and 1 possible). The association of immunocompromised status, progressive cerebellar syndrome, MRI abnormalities with cortical cerebellar atrophy and cerebrospinal fluid positive for JCV on PCR allowed for a highly probable diagnosis. The reversal of the immunocompromised status is the only way to stop the disease evolution. Motor functioning can remain impaired, but the illness itself, unlike progressive multifocal leukoencephalopathy, does not seem to threaten life.

Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course.

Reversible cerebral vasoconstriction syndrome is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. The syndrome is characterized by thunderclap headache and reversible vasoconstriction of cerebral arteries, which can either be spontaneous or related to an exogenous trigger. The pathophysiology of reversible cerebral vasoconstriction syndrome is unknown, though alterations in cerebral vascular tone are thought to be a key underlying mechanism. The syndrome typically follows a benign course; however, reversible cerebral vasoconstriction syndrome may result in permanent disability or death in a small minority of patients secondary to complications such as ischemic stroke or intracranial hemorrhage.