Subsequent Magnetic Resonance Imaging Research Articles

Paracetamol overdose associated with cortical blindness-complicated acute leukoencephalopathy: a case report

Abstract Background Paracetamol is one of the most used antipyretics and analgesics among pediatrics, and its overdose is highly encountered among pediatrics especially in the pre-school age. While it is well-known that paracetamol overdose may lead to toxicities including severe hepatic toxicity, some recent reports have highlighted its “in situ” toxicity on brain tissue at high doses, even in the absence of hepatotoxicity. This can result in acute leukoencephalopathy (AL), coma, or even death. This report describes a case of a child who developed cortical blindness-complicated AL, following a paracetamol overdose. Case presentation An 18-month-old previously healthy girl accidentally ingested 300 mg/kg of paracetamol suspension. After ingestion, the child was in an initial bad condition that has gradually improved. Several days after ingestion, the patient lost her vision, and she remained blind since then despite a newer appreciation to light. The initial brain magnetic resonance imaging (MRI) suggested AL demonstrated as a faint high T2/fluid-attenuated inversion recovery (FLAIR) signal intensity in the cortical and subcortical regions of both parieto-occipital lobes with sulcal effacement and restricted diffusion. After around 3 months, the subsequent brain MRI showed involutional changes that were manifested as a brain volume loss in the same areas with evidence of gyri-form laminar necrosis in both parieto-occipital regions without restricted diffusion. Other brain MRI findings include right cerebral convexity hyperacute subdural hematoma with prominent subarachnoid spaces. Conclusions The child developed cortical blindness-complicated AL following a paracetamol overdose. It is well- known that AL may result from several toxins by their direct and/or indirect effect on the cerebral white matter. However, there is still no enough data in the literature clearly explaining the relation of paracetamol overdose to AL. The generally proposed effect of paracetamol on the brain is mainly justified by the excessive oxidative stress. Further studies at the cellular and genetic levels are still needed to investigate the exact association between paracetamol overdose and AL, as well as the underlying mechanisms involved.

Invasive Aspergillosis with Cavernous Sinus Thrombosis Following High-Dose Corticosteroid Therapy: A Challenging Case of Rhino-Orbital-Cerebral Mycosis

Invasive aspergillosis is a rare but severe fungal infection primarily affecting immunocompromised individuals. The Coronavirus Disease-2019 (COVID-19) pandemic has introduced new complexities in managing aspergillosis due to the widespread use of corticosteroids for treating COVID-19-related respiratory distress, which can increase susceptibility to fungal infections. Here, we present a challenging case of progressive cerebral aspergillosis complicated by cavernous sinus thrombosis (CST) in a 67-year-old male with a history of COVID-19. The patient, initially misdiagnosed with temporal arteritis, received pulse corticosteroid therapy twice before presenting with persistent left-sided headaches and vision loss. Cranial imaging revealed findings consistent with fungal sinusitis, Tolosa–Hunt syndrome, and orbital pseudotumor, which progressed despite initial antifungal therapy. Subsequent magnetic resonance imaging indicated an invasive mass extending into the left cavernous sinus and other intracranial structures, raising suspicion of aspergillosis. A transsphenoidal biopsy confirmed Aspergillus infection, leading to voriconazole therapy. Despite aggressive treatment, follow-up imaging revealed significant progression, with extension to the right frontal region and left cavernous sinus. The patient then developed visual impairment in the right eye and was diagnosed with CST secondary to fungal sinusitis. Management included a combination of systemic antifungals and antibiotics; however, the patient declined surgical intervention. This case underscores the diagnostic challenges and rapid progression associated with cerebral aspergillosis in post-COVID-19 patients treated with corticosteroids. This report highlights the need for heightened clinical suspicion and prompt, targeted interventions in similar cases to improve patient outcomes. Further research is required to understand the optimal management of invasive fungal infections.

Prevalence of Clinically Relevant Findings on Magnetic Resonance Imaging in Middle-Aged Adults With Knee Pain and Suspected Meniscal Tear: A Follow-Up.

Radiographs are frequently obtained for patients with knee osteoarthritis (KOA), with magnetic resonance imaging (MRI) reserved for those with complex KOA. There are few data on how often subsequent MRI reveals clinically actionable but unanticipated findings. The purpose of this study is to estimate the prevalence of these findings on MRI for patients managed nonoperatively for suspected meniscal tears. The Treatment of Meniscal Problems and Osteoarthritis (TeMPO) study enrolled patients aged 45 to 85 years with knee pain, osteoarthritis (Kellgren-Lawrence [KL] grades 0-3), and suspected meniscal tear. We reviewed baseline MRI and recorded notable findings, including subchondral insufficiency fractures of the knee (SIFKs), avascular necrosis (AVN), tumors, and nonsubchondral fractures. Other baseline data included demographic characteristics, Knee Injury and Osteoarthritis Outcome Score, duration of knee symptoms, and KL grade. Study-ordered MRI was performed on 760 patients, with 61 concerning findings identified (8.03%, 95% confidence interval 6.09%-9.96%). A total of 25 participants had SIFKs, 10 had nonsubchondral fractures, 4 had AVN, 8 had benign tumors, and 14 had other clinically relevant findings. We estimated the prevalence of clinically relevant incidental findings on MRI to be 8.03% in middle-aged adults with mild to moderate KOA and suspected meniscal tear. These data may prompt clinicians to be more aware of the range of findings that can underlie knee symptoms, some of which could change management but may require different modalities of imaging to detect. Future research is needed to pinpoint factors associated with these concerning findings so that patients who are at risk can be identified and referred for advanced imaging.

Chronic management and recurrent challenges: a case of multifocal spinal hemangiopericytoma over 7 years. Illustrative case.

Spinal hemangiopericytoma (sHPC) is a rare vascular tumor that presents significant challenges in diagnosis and management due to its potential for recurrence and metastasis. This report documents the 7-year clinical course of a 68-year-old female diagnosed with multifocal sHPC. The patient initially presented with myelopathy due to a spinal mass, which was managed with resection, followed by several years of stability. Subsequent magnetic resonance imaging (MRI) revealed new growths, necessitating further interventions, including stereotactic radiosurgery. Despite the recurrence and progression of the disease, the strategic use of surgical and radiosurgical interventions demonstrated significant efficacy in managing tumor growth and alleviating symptoms. This case emphasizes the critical importance of continual surveillance and a multidisciplinary approach in the treatment of sHPC. Continuous monitoring through regular MRI is essential for early detection of recurrences. Adaptable treatment strategies, including resection and radiosurgery, are necessary to manage the complex dynamics of tumor behavior. This report also highlights the need for patient-centered care and flexible, individualized treatment plans to ensure optimal patient outcomes in the face of recurrent and multifocal disease manifestations. https://thejns.org/doi/10.3171/CASE24368.

Isolated vertebral bone infarction following lumbar artery embolization- a case report.

To report a rare case of isolated lumbar vertebral body infarction following lumbar artery embolization for suspected retroperitoneal haemorrhage. We present the case of a 75-year-old male who underwent lumbar artery embolization due to a suspected retroperitoneal haemorrhage post-surgery. Magnetic resonance imaging (MRI) was performed to monitor post-embolization severe lumbar pain. Initial MRI two days post-embolization showed no osseous signal changes or epidural abscess. A subsequent MRI 26 days post-embolization was performed because of increasing lumbar back pain and it revealed a new bone infarction at the L3 vertebral body. CT showed embolization deposits within the vertebral body, not present before the procedure. This unique case underscores the importance of considering vertebral body infarction as a potential complication following lumbar artery embolization. MRI was critical in early detection of the bone infarction, while CT confirmed the presence of embolization material. Awareness of this rare complication is crucial for prompt diagnosis and management.

A Novel TEK::GAB2 Gene Fusion in Pediatric Angiosarcoma of Pelvic soft Tissue: A Case Report and Literature Review.

Pediatric angiosarcoma of soft tissue, an extremely rare entity, remains poorly understood from a genetic standpoint. Herein, we present the case of a previously healthy 17-year-old girl with acute left hip pain. Subsequent magnetic resonance imaging revealed a 21.8 cm left pelvic sidewall mass with heterogeneous enhancement and multiple lung nodules. Biopsy of the tumor showed an infiltrative, hemorrhagic neoplasm composed primarily of atypical spindle to epithelioid cells. Focal vasoformative architecture was appreciated. Immunohistochemically, the tumor cells were strongly positive for CD31, ERG, and FLI-1, supporting the diagnosis of angiosarcoma. Genetic analysis identified a novel TEK::GAB2 gene fusion. TEK belongs to the angiopoietin receptor family, and its fusion with GAB2 is predicted to mediate tumorigenesis. This report expands the current knowledge on the spectrum of gene rearrangements of angiosarcoma.

Impact of Covert Brain Infarction Following Coronary Angiography on Coronary Artery Bypass Surgery Outcomes

ObjectiveTo determine the association between preoperative covert brain infarction following coronary angiography (CAG) and major adverse cardiac and cerebrovascular events (MACCE) after CABG. DesignCohort study between January 2006 and December 2019 with the follow-up period concluding at either 5 years after surgery, the date of death, or April 27th, 2023. SettingAt a single tertiary center in Korea. ParticipantsPatients who underwent pre-operative CAG and subsequent brain magnetic resonance imaging (MRI) before elective CABG. InterventionsNone. Measurements and Main ResultsThe primary outcome was the incidence of MACCE within 30 days of CABG. MACCE included operative death (all-cause death within 30 days of surgery or before discharge), myocardial infarction, mechanical circulatory support, circulatory arrest, and stroke. The secondary outcomes included each component of MACCE and all-cause mortality at 5 years after surgery. Out of the 2,476 study patients (median [IQR] age, 65 [58 to 71] years; 24.7% were female), 212 (8.6%) had covert cerebral infarction on brain MRI after CAG but before CABG, and 353 (14.3%) patients experienced MACCE after CABG. After performing 1:4 propensity-score matching, a total of 1,057 patients were included in the final outcome analysis (212 with covert brain infarction and 845 without). The incidence of MACCE within 30 days was not significantly different between patients with a covert brain infarction and those without (15.1% [32/212] vs. 15.6% [132/845]; risk difference, -0.5, 95% confidence interval [CI]: -5.6 to 4.4; risk ratio: 0.97, 95% CI, 0.66 to 1.32; P=.85). There were also no significant differences in each component of MACCE within 30 days. There was no significant difference between the two groups in terms of all-cause mortality at 5 years (18.7% vs. 17.0%, respectively, P for stratified log-rank test=.33). ConclusionsAmong patients undergoing elective CABG, there was no significant association between covert brain infarction following CAG and the occurrence of MACCE within 30 days and long-term mortality after CABG.

The predicting value of post neoadjuvant treatment magnetic resonance imaging: a meta-analysis.

Neoadjuvant therapy has become standard of care for locally advanced rectal cancer patients. It is correlated with improved clinical and pathological outcomes, including significant tumor downstaging and organ preservation in certain patients. Magnetic resonance imaging (MRI), which has become the standard for pre-operative staging, is also used for clinical and pre-operative restaging following pre-operative treatment. In this meta-analysis, we aimed to evaluate the concordance between restaging MRI (following the completion of neoadjuvant therapy) and postoperative pathology result. We conducted a meta-analysis following the PRISMA 2020 guidelines. Two independent reviewers searched PubMed and Google Scholar for studies reporting restaging MRI results compared to pathological outcomes. Outcomes included tumor and nodal staging, circumferential resection margin (CRM) and pathological complete response (pCR). Out of 25,000 studies found on the initial search; 33 studies were included. The studies were published between 2005 and 2023 and included 4100 patients (57.14% males). The median age was 62.45 years. The median interval between the conclusion of neoadjuvant treatment and the subsequent restaging MRI was 6 weeks (range 4.14-8.8 weeks). The pooled concordance rates between the restaging MRI and the pathological outcomes for ypT stage and ypN stage were 63.9% (54.5%-73.3%, I2 = 96.02%) and 60.9% (42.9%-78.9%, I2 = 98.96%), respectively. The pooled concordance for predicting pathological complete response was 70.4% (53.6%-87.1%, I2 = 98.21%). As for the circumferential resection margin (CRM), the pooled concordance was 78.2.% (71.6%-84.8%, I2 = 83.76%). Our findings suggest that the concordance rates between restaging MRI and pathological outcomes in rectal cancer patients following neoadjuvant therapy are limited. Caregivers should take these results into consideration when making clinical decisions about these patients. More data should be gathered about the predictive value of MRI after total neoadjuvant therapy as well as immunotherapy in rectal cancer patients.

Case of the Season: Hemorrhagic Renal Cyst Mimicking a Cystic Renal Neoplasm

An 81-year-old male with a history of chronic kidney disease, prostatic adenocarcinoma, metastatic melanoma, and Waldenström macroglobulinemia presented with acute kidney injury and dysuria. Initial renal ultrasound revealed a complex left renal cystic lesion, which was subsequently followed up on magnetic resonance imaging (MRI). Its complex appearance coupled with apparent nodularity suggested a cystic renal cell carcinoma; however, subsequent MRI revealed that active hemorrhage explained the complex appearance. A hemorrhagic renal cyst can be a diagnostic conundrum in such a scenario and should be considered in the differential diagnosis.

Heterotopic Splenic Tissue Mimicking Metastases on Magnetic Resonance Imaging.

Heterotopic splenic tissue can occur following splenectomy and is typically asymptomatic, often discovered incidentally during imaging for other conditions. This benign condition may mimic malignant processes, posing diagnostic challenges especially in patients with a history of cancer or concurrent malignancy. We report the case of a 60-year-old male with a history of well-controlled hypertension and a splenectomy following a traumatic injury at age 7. The patient underwent routine screening which revealed elevated prostate-specific antigen (PSA) levels. Subsequent magnetic resonance imaging (MRI) identified suspicious lesions in the prostate and a left lower quadrant mass. Prostate biopsy confirmed an adenocarcinoma with a Gleason score of 6, while biopsy of the abdominal mass revealed heterotopic splenic tissue. The management strategy included active surveillance for prostate cancer, considering the tumour's low aggressiveness and the benign nature of the splenic tissue. This case highlights the importance of considering heterotopic splenic tissue in differential diagnosis when evaluating abdominal masses in patients with a history of splenectomy. Accurate diagnosis through careful imaging and biopsy is crucial to avoid misdiagnosis and unnecessary treatments, particularly in patients with concurrent malignancies. In patients who have had a prior splenectomy for trauma, heterotopic splenic tissue may be mistaken for metastases on MRI.

The hidden value of MRI: modifying treatment decisions in C-spine injuries

Background dataComputed Tomography (CT) is the gold standard for cervical spine (c-spine) evaluation. Magnetic resonance imaging (MRI) emerges due to its increasing availability and the lack of radiation exposure. However, MRI is costly and time-consuming, questioning its role in the emergency department (ED). This study investigates the added the value of an additional MRI for patients presenting with a c-spine injury in the ED.MethodsWe conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into “c-spine injured” and “c-spine uninjured”. Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers.ResultsWe identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p < 0.001) the duration of the patients’ stay in the ED. Of this cohort, 25% had a change in treatment strategy and among the patients with neurological symptoms (AON ≥ 1), 45.8% experienced a change in treatment. Patients that were N-positive, had a 12.4 (95% CI 2.7–90.7, p < 0.01) times higher odds of a treatment change after an additional MRI than neurologically intact patients.Conclusion and relevanceOur study suggests that patients with a c-spine injury and neurological symptoms benefit from an additional MRI. In neurologically intact patients, an additional MRI retains value only when carefully evaluated on a case-by-case basis.

Pediatric Case of Autoimmune Cerebellitis with Positive Anti-GAD Antibodies and Accidental Finding of Roth Spots

Abstract We present a pediatric case of autoimmune cerebellitis, which was distinguished by the presence of positive anti-glutamic acid decarboxylase (anti-GAD) antibodies. The patient, a young child, presented with a four-day history of progressively worsening headaches, coupled with persistent vomiting. These symptoms prompted immediate medical evaluation. Initial computed tomography (CT) imaging revealed a hypodense area in the left cerebellum and mild hydrocephalus, indicating fluid accumulation in the brain. Subsequent magnetic resonance imaging (MRI) provided more detailed visualization, confirming the diagnosis of acute cerebellitis, which was characterized by bilateral enlargement of the cerebellum and an associated mass effect that exerted pressure on the adjacent brain structures. The medical team initiated a comprehensive treatment regimen that included antibiotics to address any potential bacterial infection, antivirals to counter possible viral etiologies, immunoglobulin therapy to modulate the immune response, and corticosteroids to reduce inflammation. The patient responded well to this treatment protocol, with follow-up imaging showing a significant reduction in cerebellar swelling and overall improvement in clinical symptoms. The detection of elevated anti-GAD antibodies, along with anti-thyroglobulin antibodies, indicated an autoimmune origin of the cerebellitis. This autoimmune response can lead to the body’s immune system mistakenly attacking healthy brain tissue. Moreover, the incidental finding of a Roth spot, a retinal hemorrhage with a white center, during a routine eye examination suggested potential systemic involvement, possibly indicating a broader immune-mediated condition.

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

BackgroundMalassezia restricta, a lipophilic and lipodependent yeast belonging to the basidiomycetes group, is an opportunistic fungal pathogen associated with various skin diseases, including seborrheic dermatitis and dandruff. Typically, Malassezia infection in neonates manifests as fungemia or hematogenous dissemination to the bone or lungs. However, vertebral osteomyelitis caused by these fungi is rarely reported owing to non-specific clinical presentations and laboratory/imaging findings. The Pathogen Metagenomics Sequencing (PMseq) technique enables direct high-throughput sequencing of infected specimens, facilitating the rapid and accurate detection of all microorganisms in clinical samples through comprehensive reports.Case presentationA 52-year-old male was admitted to our hospital on July 20, 2022 with a 3-month history of ambulatory difficulties and localized low back pain. Magnetic Resonance Imaging (MRI) examination of the spinal column revealed irregular bone destruction affecting the L2, L3, and L5 vertebral bodies. Additionally, low T1 and high T2 intensity lesions were observed at the intervertebral discs between L3 and L5. The presumptive diagnosis of tuberculous spondylitis was made based on the imaging findings, despite negative results in all mycobacterium tests. However, the patient exhibited no improvement after receiving regular anti-tuberculosis treatment for 3 months. Subsequent MRI revealed an expansive abnormal signal within the vertebral body, leading to progressive bone destruction. The absence of spinal tuberculosis or other infective microorganisms was confirmed through culture from blood and pathological tissue from the L4 vertebral body. Subsequently, PMseq was performed on the specimens, revealing M. restricta as the predominant pathogen with the highest relative abundance value. The pathological examination revealed the presence of fungal mycelium in the L4 vertebral body, with positive findings on periodic Schiff-methenamine and periodic acid-Schiff staining. The anti-tuberculosis treatment was discontinued, and an antifungal combination of fluconazole and voriconazole was administered. All symptoms were resolved after 7 consecutive months of treatment, and the patient was able to ambulate autonomously. Vertebral lesions were reduced on MRI during the 13-month follow-up.ConclusionsM. restricta is not a commonly recognized pathogen associated with infectious vertebral osteomyelitis. However, PMseq can aid in diagnosis, timely treatment, and decision making for some non-specific infectious diseases.

Neurosarcoidosis-Induced Winging Scapula: Efficacy of Infliximab Treatment in Addressing Multifaceted Challenges.

Sarcoidosis, a systemic granulomatous disease primarily affecting the respiratory and lymphatic systems, can rarely manifest as neurosarcoidosis either in isolation or alongside other systemic symptoms. Here, we describe the case of a 45-year-old male with a history of recurrent sinusitis refractory to antibiotics, who presented to the emergency department with sinus congestion and dysphagia. Clinical examination revealed left lower motor neuron facial palsy and enlarged submandibular salivary glands. Despite obtaining negative results from various antibody panels, the patient exhibited elevated Angiotensin Converting Enzyme levels of 83 nmol/kg/min. Additionally, computed tomography chest scans revealed bilateral hilar and mediastinal lymph node enlargement, findings consistent with sarcoidosis. Otorhinolaryngology evaluation for dysphagia confirmed left vocal cord palsy. Following a negative infectious disease workup, submandibular salivary gland biopsy confirmed sarcoidosis. Treatment with mycophenolate mofetil and oral steroids led to gradual improvement in salivary gland swelling, dysphagia, and facial palsy. However, worsening left shoulder pain prompted further investigation, revealing winging of the left scapula on repeat examination. Magnetic resonance imaging (MRI) of the cervical spine revealed a six mm hyperintensity in the left dorsal cord at the C5 level, suggesting possible neurosarcoidosis vs. demyelinating disease. Subsequently, the patient was prescribed anti-tumor necrosis factor alpha inhibitor infliximab. Subsequent MRI of the cervical spine, conducted six months after initiating Infliximab therapy, indicated resolution of the lesions. This positive outcome was supported by the patient's report of symptom improvement, notably reduced shoulder pain and improvement in left scapular winging. This case underscores the unusual co-occurrence of Bell's palsy and vocal cord palsy in the same patient, along with the potential contribution of neurosarcoidosis to the winged scapula. Additionally, it sheds light on the positive response of neurosarcoidosis to Infliximab therapy.

AN OUT OF HOSPITAL CARDIAC ARREST SURVIVOR WITH PRESUMED EMBOLIC MYOCARDIAL INFARCTION: ROLE OF MULTI–MODALITY IMAGING

Abstract Background Myocardial infarction with non–obstructive coronary arteries (MINOCA) refers to a puzzling clinical entity that is characterized by symptoms suggestive of acute coronary syndrome, demonstrates troponin elevation with inconclusive coronary angiogram. The underlying pathophysiologic mechanisms include atherosclerotic cause or non–atherosclerotic causes, such as coronary dissection or coronary embolus. A standardized approach that includes multimodality imaging is necessary to determine underlying aetiology and direct appropriate treatment. Case Summary A 57–year–old male was admitted to our hospital after experiencing cardiac arrest after physical exercise (swimming) treated immediately with cardiac pulmonary resuscitation and two defibrillator–delivered electrical shocks for shockable rhythm before return of spontaneous circulation. Relevant abnormal bloods included a hs–Troponin I elevation. Invasive coronary angiography demonstrated non–obstructed coronary arteries. Subsequent cardiac magnetic resonance imaging (MRI) demonstrated akinesia and an area of subendocardic late gadolinium enhancement in the inferior–lateral wall. This pattern was in keeping with an ischaemic cause, as a recent embolic myocardial infarction. Further investigations, including contrast bubble echocardiogram, were performed in order to identify a cause and source of the embolic infarction and led to the diagnosis of tunnel–like patent foramen ovale with right to left shunting, then confirmed on trans–oesophageal echocardiogram. The patient was treated as myocardial infarction most likely due to embolic phenomena in the presence of a PFO. Therefore, a transvenous ICD was implanted for secondary prevention and the patient underwent percutaneous closure of the PFO. Discussion and Conclusion MINOCA can occur in 5–15% of all acute coronary syndromes and represents a working diagnosis. It is important to identify the underlying aetiology of their presentation to appropriately manage them. In particular, where cardiac MRI demonstraded LGE areas ichaemic patterns, myocardial infarction due to secondary embolism should be considered and the next step in clinical management is to identify potential sources of emboli performing further assessments. Multi–modality imaging with cardiac MRI and echocardiogram (transthoracic, contrast bubble and trans–oesophageal) is important in correctly identifying any source of emboli and the diagnosis of any intra–cardiac shunt.

Pancreatic cancer with multiple liver metastasis complicating multi organ infarcts from Marantic endocarditis and Trousseau&amp;apos;s syndrome

Background: Marantic endocarditis and Trousseau&amp;apos;s syndrome are historically linked with pancreatic cancer. The patient had catastrophic embolic events which caused multi organ infarct due to underlying advanced pancreatic cancer. Doctors should be aware of early signs and symptoms of pancreatic cancer and conduct necessary clinical assessments and investigations that can prevent any severe complications. Case Presentation: A middle-aged healthy gentleman who presented with left-sided weakness, slurred speech, left-sided sensory neglect, mild headache, and fever. CT head showed acute right-sided temporal ischemic changes with subsequent magnetic resonance imaging (MRI) head showed multiple infarcts in the brain. A transesophageal echocardiogram reported possible MV vegetation. MRI of the liver was done due to deranged LFTs which showed multiple liver metastasis with a primary mass in the tail of the pancreas. Left leg ultrasound Doppler showed a large left leg deep vein thrombosis involving the femoral vein as he complained of left leg pain for 2 months and went to GP with right leg pain 3 months ago which was treated as a right ankle sprain. The clinical events explained that most likely he developed Trousseau&amp;apos;s syndrome 3 months ago and the embolic phenomena were due to rare Marantic endocarditis (Non-bacterial thrombotic endocarditis) secondary to pancreatic cancer. Ultrasound-guided biopsy of liver metastasis was planned, but sadly the patient passed away the next day. Conclusion: The diagnosis of early pancreatic cancer with imaging poses a challenge sometimes, therefore the pancreatic protocol of CT or MRI is the first line of investigation. Moreover, the cause of unprovoked thrombo-embolism should be investigated to rule out any underlying malignancy.

Intracerebral hemorrhagic developing in a patient with posterior reversible encephalopathy syndrome; a case report

We describe a case of hemorrhagic posterior reversible encephalopathy syndrome (PRES) in a 19-year-old woman, who had undergone a cesarean section for epilepsy and lupus-related chronic renal failure 2 months ago, and presented to the emergency department with complaints of blurred vision. The neurological and ophthalmological examinations were normal. Despite the initial imaging being normal, subsequent magnetic resonance images showed hyperintensity in bilateral occipital lobes and cerebellum (indicative of PRES) and watershed ischemia in addition to intracerebral hemorrhage. Brain surgery was performed, external ventricular drainage was placed and she was monitored postoperatively with routine care in the intensive care unit where she remained intubated for a month, after which she died of the consequences of her condition.

Extensor tendon rupture and preoperative mri confirmations of suture anchor prolapse: a case report and literature review

BackgroundWhile suture anchors are widely used in medical procedures for their advantages, they can sometimes lead to complications, including anchor prolapse. This article presents a unique case of suture anchor prolapse at the base of the distal phalanx of the little finger after extensor tendon rupture reconstruction surgery.Case presentationA 35-year-old male, underwent extensor tendon rupture reconstruction using a non-absorbable suture anchor. After seven years the patient visited our outpatients complaining of stiffness, pain, and protrusion at the surgical site. Initial X-ray imaging suggested suggesting either a fracture of the distal phalanx or tendon adhesion but lacked a definitive diagnosis. Subsequent magnetic resonance imaging (MRI) revealed bone connectivity between the middle and distal phalanges with irregular signal shadow and unclear boundaries while maintaining a regular finger shape. MRI proved superior in diagnosing prolapsed suture anchors, marking the first reported case of its kind. Surgical intervention confirmed MRI findings.ConclusionsSuture anchor complications, such as prolapse, are a concern in medical practice. This case underscores the significance of MRI for accurate diagnosis and the importance of tailored surgical management in addressing this uncommon complication.

Ultrasound Versus Magnetic Resonance Imaging as First-Line Imaging Strategies for Rotator Cuff Pathologies: A Comprehensive Analysis of Clinical Practices, Economic Efficiency, and Future Perspectives.

Rotator cuff injuries are a prevalent cause of atraumatic chronic shoulder pain, imposing a significant healthcare burden. This articlereviews the clinical presentation, diagnostic imaging modalities, practice variations, and economic efficiency considerations in the evaluation of rotator cuff pathologies. Ultrasound (US) and magnetic resonance imaging (MRI) are the primary imaging methods for diagnosing rotator cuff injuries. US provides real-time visualization but has limited tissue penetration, while MRI offers detailed anatomical information but is not a dynamic process. Studies show that MRI is superior to US with higher sensitivity and specificity. MRI is the gold standard, particularly for surgical planning, but US remains relevant when MRI is not feasible. Both require standardized protocols for evaluating tear dimensions and muscle atrophy. With the operator-dependent nature of US, MRI offers a more comprehensive assessment of rotator cuff tears and predictive insights for clinical outcomes. Practice variations exist in the management of rotator cuff pathologies, with some countries favoring US as the primary imaging modality and others relying more on MRI. These variations are influenced by factors like resource availability and healthcare system nuances. In Australia, current guidelines lean towardconservative management, potentially leading to delayed diagnoses and increased costs. The United States often favors MRI, while Canada advocates for US as the initial choice. Economic considerations play a significant role in selecting imaging modalities. While US is cost-effective, it may necessitate subsequent MRI examinations, contributing to inefficiencies in the diagnostic process. Studies suggest that a combined approach of US and MRI is less efficient and cost-effective than MRI alone. However, the use of both modalities rather than MRI aloneis common in clinical practice, adding to healthcare expenses. In conclusion, the choice of imaging modality for rotator cuff pathologies should consider factors such as diagnostic efficacy, cost-effectiveness, and resource availability. Radiologists play a pivotal role in guiding this selection and ensuring comprehensive evaluations. Future considerations should include the revision of management guidelines and the potential inclusion of shoulder pathologies in healthcare coverage to optimize patient care and healthcare expenditure.

Nontraumatic orbital hematoma secondary to labor and childbirth: a case report and review of the literature.

Non-traumatic orbital hemorrhage without underlying vascular malformations or predisposing conditions is uncommon, and particularly rare in the context of maternal labor. This study combines a novel case report and retrospective review to analyze reported cases and propose insights. This study is both a unique case report and literature review examining PubMed publications with articles traced back to original sources through citations for inclusion. Analysis included clinical presentation, visual examination, hematoma characteristics, neuroimaging, management strategies, and outcomes. We present a 37-year-old multigravida woman at 40weeks gestation who developed acute right-sided proptosis, diplopia, retrobulbar pain, and periorbital edema during the second stage of labor. Computed tomography (CT) revealed a subperiosteal hemorrhage, with subsequent magnetic resonance imaging (MRI) excluding vascular anomalies. Symptoms resolved within two months. Only 14 cases of maternal orbital hematoma associated with labor have been reported. The average age was 28 with 42% (6/14) being primigravid. Including our case, forty percent (6/15) developed symptoms during the second stage of labor, 40% (6/15) immediately postpartum, and 20% (3/15) over 24hours postpartum. Overall, 33% (5/15) had potentially contributing conditions including coagulopathies, delivery complications, or vascular malformations. Unilateral orbital hemorrhage occurred in 87% (13/15). Surgical intervention was necessary in 13% (2/15). Most (87%, 13/15) underwent observation or medical management with full recovery of symptoms. Non-traumatic orbital hematomas associated with maternal labor are rare and likely related to increased valsalva during delivery and heightened blood volume in pregnancy. Neuro-imaging and systemic workup are recommended to assess for vascular anomalies or underlying coagulopathies. The overall prognosis is favorable with most having full recovery.