Unusual Imaging Features Research Articles

Poorly differentiating squmous cell carcinoma in lung with unusual imaging features

Poorly differentiating squmous cell carcinoma in lung with unusual imaging features

Primary Angiitis of the Central Nervous System with Unusual Imaging Characteristics (P1.346)

Primary Angiitis of the Central Nervous System with Unusual Imaging Characteristics (P1.346)

Radiographic findings of hemolymphangioma in four patients: A case report.

Due to the rarity of hemolymphangioma, a limited number of cases of the disease have been reported in the literature thus far. The present case report describes the cases of 4 patients with hemolymphangioma that were diagnosed and treated at the Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China). All patients were female, with a mean age of 44.7 years and a mean duration of symptoms prior to diagnosis of 2.7 years. The diagnosis of hemolymphangioma was determined by postoperative histopathology in all patients. A total of 2 patients were diagnosed with tumors that exhibited cystic characteristics (one in the mediastinum and the other in the neck), which was determined by computed tomography and magnetic resonance imaging. Another of the patients' tumors was located in the left forearm, and 1 patient had multifocal hemolymphangioma in the mediastinum and spleen. All patients underwent surgery and were asymptomatic during the follow-up periods (range, 8–15 months). In the present case report, the radiographic findings of the 4 cases are presented, including the unusual imaging characteristics that were observed, and relevant reports in the literature are discussed.

Intramedullary Spinal Ganglioglioma involving the Conus with Unusual Magnetic Resonance Imaging Features

Intramedullary Spinal Ganglioglioma involving the Conus with Unusual Magnetic Resonance Imaging Features

P74 – 2429: A review of a series of patients with type 1 glutaric aciduria at Inkosi Albert Luthuli Central Hospital, Durban, South Africa

Objective To describe the clinical profile, diagnosis and treatment of patients with Type 1 Glutaric Aciduria. Methods A retrospective review of children with a confirmed diagnosis at Inkosi Albert Luthuli Hospital, South Africa. Results We identified 5 children (3 females, 2 Males) during the period 2007–2014. The mean age at diagnosis was 11 months (range 7–22 months). Three patients presented in acute encephalopathic crises. Two patients had an insidious presentation-developmental delay (n=1) and hemiparesis (n=1). The clinical findings on presentation were hyptonia (n=4), hemiparesis (n=1) and macrocephaly (n=5). Two children had a history of pre-morbid developmental delay. Four children had neuro-regression on presentation. Other complications included seizures (n=3), dystonia (n=2). Urine organic acid screens showed elevated glutaric acid in all patients. Of the 4 patients tested, all were positive for the common A293 mutation on the GCDH gene. All patients had MRI brain scans. The basal ganglia were hyperintense on the T2/FLAIR sequences in all patients (enlarged n=3, atrophic n=2); those with enlarged basal ganglia showed restricted diffusion. This was seen in the 3 children who presented in crises. Delayed myelination was seen in 1 child. Other abnormalities included: abnormal signal in the cerebral peduncles/central tegmental tract n=4, enlarged temporal fossa n=5, cortical atrophy n=3. All patients were treated with L-carnitine and dietary modification. Three patients required anti-epileptics and 2 required L-dopa for dystonia. Two patients had a static clinical course, 1 has gained milestones and 2 have shown progression. Conclusion Key clinical features in our patients include a child presenting in acute encephalopathic crises follow, neuro-regression, and macrocephaly. We identified unusual imaging features – abnormal signal in the central tegmental tract/cerebral peduncles. South Africa does not have a neonatal screening programme for Glutaric Aciduria. It is crucial to have a high index of suspicion as early diagnosis/intervention improves outcome. To describe the clinical profile, diagnosis and treatment of patients with Type 1 Glutaric Aciduria. A retrospective review of children with a confirmed diagnosis at Inkosi Albert Luthuli Hospital, South Africa. We identified 5 children (3 females, 2 Males) during the period 2007–2014. The mean age at diagnosis was 11 months (range 7–22 months). Three patients presented in acute encephalopathic crises. Two patients had an insidious presentation-developmental delay (n=1) and hemiparesis (n=1). The clinical findings on presentation were hyptonia (n=4), hemiparesis (n=1) and macrocephaly (n=5). Two children had a history of pre-morbid developmental delay. Four children had neuro-regression on presentation. Other complications included seizures (n=3), dystonia (n=2). Urine organic acid screens showed elevated glutaric acid in all patients. Of the 4 patients tested, all were positive for the common A293 mutation on the GCDH gene. All patients had MRI brain scans. The basal ganglia were hyperintense on the T2/FLAIR sequences in all patients (enlarged n=3, atrophic n=2); those with enlarged basal ganglia showed restricted diffusion. This was seen in the 3 children who presented in crises. Delayed myelination was seen in 1 child. Other abnormalities included: abnormal signal in the cerebral peduncles/central tegmental tract n=4, enlarged temporal fossa n=5, cortical atrophy n=3. All patients were treated with L-carnitine and dietary modification. Three patients required anti-epileptics and 2 required L-dopa for dystonia. Two patients had a static clinical course, 1 has gained milestones and 2 have shown progression. Key clinical features in our patients include a child presenting in acute encephalopathic crises follow, neuro-regression, and macrocephaly. We identified unusual imaging features – abnormal signal in the central tegmental tract/cerebral peduncles. South Africa does not have a neonatal screening programme for Glutaric Aciduria. It is crucial to have a high index of suspicion as early diagnosis/intervention improves outcome.

Primary Hepatic Diffuse Large B-Cell Lymphoma: Unusual Presentation and Imaging Features

Primary hepatic lymphoma is an uncommon malignancy affecting the liver, with limited reports and series in the literature. Imaging appearance is not well described, with no definite features suggesting a diagnosis, and it may mimic other focal hepatic lesions. However, biopsy is needed in most of the cases for confirmation. We report a case of 22-year-old pregnant woman who on ultrasonography showed a large heteroechoic solitary liver mass mimicking focal nodular hyperplasia. Further evaluation after parturition with contrast-enhanced magnetic resonance imaging showed a large mass with central scar and peripheral diffusion restriction and contrast enhancement, which was atypical. Biopsy confirmed it as lymphoma. The case illustrates unusual presentation and magnetic resonance imaging features, including diffusion-weighted imaging, of primary hepatic lymphoma in a young female.

Atypical proliferative myositis: original MR description with pathologic correlation: Case report

Proliferative myositis (PM) along with proliferative fasciitis and nodular fasciitis are a group of pseudosarcomatous myofibroblastic proliferations. Although the histologic presentation of each is almost identical, the magnetic resonance imaging (MRI) appearance of proliferative myositis is closer to that of inflammatory myopathies. We report a case of PM in which the imaging and histologic features combine typical findings of PM with unusual imaging features, suggesting of reactive (or nodular) fasciitis.

Features of the hypointense solid lesions in the female pelvis on T2‐weighted MRI

Most solid lesions in the female pelvis appearing hyperintense on T2-weighted images should be interpreted as malignant. In contrast, if the solid lesions in the female pelvis appear hypointense on T2-weighted images they may be benign. The characteristic imaging features of hyperintense solid lesions in the female pelvis on T2-weighted images are well known, but various unusual causes and imaging features of hypointense solid lesions in the female pelvis on T2-weighted images can be particularly misleading. Therefore, careful assessment of hypointense solid lesions in the female pelvis on T2-weighted images is warranted. In this article, we demonstrate a variety of hypointense solid lesions in the female pelvis on T2-weighted images. Familiarity with the clinical setting and imaging features of hypointense solid lesions in the female pelvis on T2-weighted images will facilitate prompt, accurate diagnosis and treatment.

Unique MR Findings in a Case Series of Two Symptomatic Patients with Peliosis Hepatis

Purpose: The aim of this report is to describe the unusual MR imaging characteristics observed in two patients with biopsy-proven peliosis hepatis. Imaging findings using gadoxetate disodium (Eovist) as the contrast agent in a patient with peliosis hepatis are presented for the first time. Methods: This is a retrospective review of the MRI findings in two patients reviewed independently by two specialized abdominal imaging radiologists. The radiological findings were correlated with clinical history and histopathology. Results: Peliosis hepatis is a rare clinical and radiological entity that is often a diagnostic dilemma due to its non-specific clinical characteristics. Unusual imaging characteristics in this rare entity make diagnosis even more challenging. Conclusions: Improved understanding of the imaging characteristics of peliosis hepatis may prevent unnecessary and potentially dangerous biopsies in select patients with peliosis hepatis. This requires a high index of suspicion for practicing radiologists due to the rarity of this disease.

Metachronous appearance of second malignancies in medullary thyroid carcinoma (MTC) patients: a diagnostic challenge and brief review of the literature

Medullary thyroid carcinoma (MTC) is a rare tumour which frequently occurs in the context of the multiple endocrine neoplasia syndromes, where it coexists with other usually benign tumours. The clinical picture varies and distant metastases are frequently present at diagnosis. Calcitonin levels are elevated in the presence of metastatic disease. Two MTC cases are presented, which had elevated postoperative calcitonin levels. Imaging revealed lung lesions which were originally attributed to metastatic disease from the MTC. However, at follow-up, these cases presented unusual features. The rapid increase in the lung lesions and the development of hypercalcaemia in the first patient suggested a second unrelated tumour. Biopsy of the lung lesion was compatible with lung adenocarcinoma. In the second patient, the appearance of a liver mass, although calcitonin levels remained stable, led to biopsy of the lesion: this was negative for calcitonin and compatible with metastatic lung adenocarcinoma. These MTC cases show that further malignancies may coexist with MTC and may obscure the clinical picture and influence the therapeutic decisions, especially in the case of metastatic disease. Features such as unusual imaging characteristics and the development of hypercalcemia, never encountered in MTC outside the MEN2 syndromes, as well as 'disproportionately' low calcitonin levels, incompatible with extensive metastatic disease, were the factors that led to further work-up. Both the cases subsequently proved to carry an unsuspected second malignancy. It is crucial to discriminate the metastatic lesion attributed to MTC from another coexisting primary malignancy, because different therapeutic strategies are needed for each setting.

Solitary necrotic nodule of the liver: radiologic–pathologic correlation in a case with unusual imaging features

Solitary necrotic nodule of the liver (SNNL) is rare. Generally thought to be nonmalignant, it is often mistaken for malignancy based on imaging findings alone. We present a case of a hepatitis B carrier who was found to have a new sonographically detected hepatic lesion. The lesion was further evaluated with CT and MRI, and as appearances were suggestive of a hypovascular hepatoma, the lesion was surgically resected. This case is unique in that while it demonstrates several characteristic features of SNNL, several other imaging and histological features have not been previously described.

Isolated Extra hepatic Hydatid Cyst of Para spinal Muscle - Unusual Presentation - a Case Report

Hydatid disease (echinococcosis) commonly involves liver while other known extrahepatic sites of involvement are lung, heart, brain, kidney, bones, spleen, pancreas, adrenal and muscles.1-3 Ultrasonography (US) and computed tomography (CT) features are characteristic especially in hepatic disease and hence diagnosed easily, while isolated extrahepatic diseases are sometimes difficult to diagnose. Here, we present an interesting case of hydatid cyst in paraspinal muscle with unusual clinical and imaging features, but treated successfully inspite, initial diagnostic dilemma. Imaging features and follow up result are discussed. NJR I VOL 2 I ISSUE 1 31-34 Jan-June, 2012 DOI: http://dx.doi.org/10.3126/njr.v2i1.6977

Unusual imaging features of completely isolated enteric duplication in a child

We report a case of completely isolated enteric duplication in an 18-month-old boy in whom US revealed a reniform abdominal mass with a pseudokidney sign that had no connection to adjacent organs. Distinctive histopathological changes of the duplication account for these unusual imaging features. Our case represents a diagnostic challenge in this rare entity. To our knowledge, this is a unique case.

Ventriculus Terminalis in Adults: Unusual Magnetic Resonance Imaging Features and Review of the Literature

ObjectiveThe ventriculus terminalis (VT) in adults is a rare pathology. We report various MR imaging features of the adult VT.Materials and MethodsTen patients were included in this retrospective review.. All patients had undergone magnetic resonance (MR imaging with a surface coil that used two different 1.5T MR systems. All patients had undergone initial and follow-up MR imaging with contrast enhancement using gadopentate dimeglumine. Three patients underwent additional MR imaging using the echocardiogram-gated spatial modulation of magnetization (SPAMM) technique. If a shift in tagging band during the systolic phase was less than half of the band space, it was defined as a "non-pulsatile fluid". Two neuroradiologists independently reviewed these images, while clinical symptoms and outcomes were statistically analyzed between the treated and non-treated group.ResultsAll cases presented an intramedullary cystic lesion in the conus medullaris and showed the same signal intensity as CSF. Three VTs had intracystic septation and cord edema, which were pathologically confirmed after surgery; two of these were associated with kyphotic deformity and spinal arteriovenous malformation. SPAMM-MRI of 3 patients demonstrated non-pulsatile fluid motion within the VT. In the treated group, clinical symptoms improved better than the non-treated group.ConclusionThe adult VT shows some unusual imaging features, including septation, cord edema, and coexistence of a spinal AVM, as well as the typical findings. Surgical maneuvers may be considered as a treatment option in adult VT with progressive neurological symptoms.

Imaging features of benign solid testicular and paratesticular lesions

The presence of an intratesticular solid lesion is usually highly suspicious for malignancy. Conversely, most extratesticular solid lesions including paratesticular lesions are benign. The characteristic imaging features of malignant solid testicular lesions are well known, but various unusual causes and imaging features of benign solid testicular lesions can be particularly misleading. Therefore, a careful assessment of solid testicular and paratesticular lesions is warranted. The purpose of this article is to present the clinical and imaging features of the spectrum of benign solid testicular and paratesticular lesions. We demonstrate a variety of benign solid testicular and paratesticular lesions and correlate them with pathologic results. Specific the clinical and imaging features of the spectrum of benign solid testicular and paratesticular lesions have been described. Familiarity with the clinical setting and imaging features of benign solid testicular and paratesticular lesions should facilitate prompt, accurate diagnosis and treatment.

Urothelial Cancer of the Renal Pelvicaliceal System: Unusual Imaging Manifestations

Unusual imaging features of urothelial cancer of the renal pelvicaliceal system can be challenging for any radiologist. These manifestations include noncalcified and calcified focal infiltrative parenchymal masses, incidentally detected tumors in a hydronephrotic kidney due to ureteropelvic junction obstruction, transpelvic infiltrating solid masses extending through the retroperitoneum, and tumors primarily invading the perirenal fat. Less common manifestations include massive papillary frond-like projections within a large hydronephrotic sac, large multiloculated cystic masses with thick and irregular septa, tumors invading the renal vein, and paraaortic lymph node metastases as the only sign of an undetectable primary tumor of the renal collecting system. Radiologists should be aware that an eccentric, focal, infiltrative pelvicaliceal carcinoma that causes distortion of the renal contour may simulate renal cell carcinoma; when calcified, such a pelvicaliceal carcinoma may simulate chronic inflammatory renal disease. The radiologist should also be aware of the importance of a meticulous sonographic evaluation of a hydronephrotic kidney, particularly in older patients, to avoid missing a urothelial cancer. When a nonfunctioning and enlarged kidney is present, radiologists should always consider infiltrative hydronephrotic urothelial carcinoma as a diagnostic possibility. Familiarity with unusual imaging features of urothelial cancer of the renal pelvicaliceal system may facilitate making the correct diagnosis, thus enabling adequate therapeutic management.

Infections rachidiennes : aspects typiques et atypiques

While the imaging features of established spondylodiscitis are well known, other presentations may be misleading. The purpose of this article is to review the typical imaging features of spondylodiscitis as well as some more atypical and unusual imaging features (early spondylodiscitis, sceptic spondylitis, septic arthritis of facet joints, primary epidural abscess, unusual germs, neonate).

Diffuse cerebellar MR imaging changes in anti-Yo positive paraneoplastic cerebellar degeneration

A 48 year old lady presented with a month’s history of vertigo, nausea, and vomiting. Examination revealed nystagmus, mild limb-clumsiness (predominantly left sided) and mild gait ataxia. MR imaging demonstrated diffuse signal change within the cerebellar hemispheres (most prominent on the left), predominantly affecting the white matter but also the cerebellar cortex (Fig. 1). CSF examination revealed 52 lymphocytes (‘‘bland’’ on cytology), oligoclonal bands were not detected. The cerebellar findings progressed rapidly and she developed dysarthric speech and marked limb/truncal ataxia. Her symptoms plateaued within 3 months, by which time she was bedbound. An Anti-Yo antibody was detected in the serum. CT imaging demonstrated an area of abnormal tissue in the left breast; biopsy confirmed breast adenocarcinoma with axillary lymph node spread. She declined repeat cerebral imaging. While our patient’s clinical course is typical for an anti-Yo positive paraneoplastic cerebellar degeneration (PCD), the imaging findings are most unusual. Despite profound ataxia, brain imaging in PCD is usually ‘‘remarkably unremarkable’’, although cerebellar atrophy may be observed eventually [5, 6]. Very rarely PCD has been reported with imaging abnormalities, early in the course of the disease, in the context of anti-Tr [1] and anti-CRMP5 (anti-CV2) antibodies [2]. McHugh et al. [4] reported a case of anti-Yo positive PCD (secondary to ovarian adenocarcinoma) associated with signal abnormality in the right mesial temporal lobe on MRI. Interval imaging, following tumour resection, showed resolution of the temporal abnormality but a new focal cerebellar hyperintensity. To our knowledge, our case is the first to demonstrate diffuse cerebellar signal change on MRI in the context of anti-Yo positive PCD, expanding the radiological features recognised in this condition. The sensitivity of MRI for detecting such changes may be increased by imaging at high field strengths, as in this case (3.0 Telsa Philips Achieva; Best, The Netherlands). The pathological substrate of these imaging changes is unclear. Peterson et al. [5] examined three cases of anti-Yo positive PCD at postmortem, observing a diffuse loss of Purkinje cells but a notable absence of inflammatory infiltrates in the cerebellar cortex. However, inflammatory changes may be seen much earlier in the disease course. Giometto et al. [3] reported the post-mortem findings in a patient who died of a myocardial infarct 4 months after developing an anti-Yo positive PCD, observing CD8? lymphocyte infiltration in the cerebellum and cerebral cortex, and diffuse microglial upregulation of MHC-II throughout the brain. In conclusion, we describe a case of PCD with very unusual imaging features, characterised by diffuse signal abnormality within the cerebellar hemispheres. In order to C. P. Gilmore (&) P. Maddison Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK e-mail: chris.gilmore@nottingham.ac.uk

Unusual radiological characteristics of teratoid/rhabdoid brain tumor in children.

We report a case of atypical teratoid rhabdoid brain tumor for 4 months old male child, who presented with unusual radiological findings, that can be confused with other brain tumors ,so we high light these unusual imaging features to aid in making correct diagnosis.Keywords: atypical teratoid–rhabdoid tumor, brain tumor, children, medulloblastoma.

MRI appearance of mesenchymal tumors of the uterus

Purpose Uterine leiomyomas are the most common uterine neoplasms. Statistically, a uterine mass with unusual imaging features is more likely to represent a leiomyoma than other uncommon uterine mesenchymal neoplasms such as leiomyosarcoma or endometrial stromal tumors. Several prior studies have attempted to identify objective imaging characteristics that differentiate these entities. The purpose of this study was to test these criteria on our patient population. Methods and materials This retrospective study was approved by the institutional Human Investigations Committee and was performed in compliance with HIPAA regulations. Four patients with uterine leiomyosarcoma, two with stromal tumors of uncertain malignant potential (STUMP), one with endometrial stromal sarcoma, and two with mixed endometrial stromal and smooth muscle tumors were included in the study. Seventeen additional control cases of leiomyomas were selected as controls. Cases were blindly evaluated by two experienced readers. Objective criteria included T1 and T2 signal characteristics, enhancement pattern, the presence of cystic changes, and ill defined margins. Subjective criteria included individual reader gestalt. All cases had pathologic correlation. Results None of the objective criteria were associated with the presence or absence of uterine mesenchymal neoplasm. Ill defined margins came closest to having statistical significance ( p = 0.06). Reader gestalt was statistically associated with the presence of mesenchymal neoplasm for one of our readers ( p = 0.02) but not for the other ( p = 0.07). Conclusion We found poor accuracy for objective imaging criteria in distinguishing leiomyomas with atypical imaging features from more clinically significant uterine mesenchymal neoplasms.