Unusual Radiological Presentation Research Articles

An Unusual Radiological Presentation of a Common Disorder: Cervical Spinal Cord Enhancement in Spondylotic Myelopathy, Mimicking Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease

An Unusual Radiological Presentation of a Common Disorder: Cervical Spinal Cord Enhancement in Spondylotic Myelopathy, Mimicking Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease

An Unusual Clinical and Radiological Presentation of Ovotesticular Disorders of Sex Development with Male and Female External Genitalia: A Case Report

Background: Ovotesticular disorders of sex development (ODSD), previously known as true hermaphroditism, is a rare disorder of sexual differentiation that causes ambiguity in external genitalia and the presence of both ovarian and testicular elements in the gonads. The condition is characterised by the existence of testicular tissue with distinctive tubules and ovarian tissue in the same gonad (ovotestis), or separately in an individual. The most common cytogenetic karyotype is 46,XX. The age and presentation of symptoms vary, but typically include hypospadias, urogenital sinus, inguinal hernia, cryptorchidism, and gynaecomastia during the peripubertal age, as well as lower abdominal mass. Case Presentation: A 15-year-old female exhibited typical male genitalia, including a normal penile shaft, scrotal sac, palpable testes, and a urethral opening, with a separate vaginal opening located between the penile shaft and scrotum. Pelvic MRI confirmed the presence of both testes within the scrotal sac and an infantile-sized uterus with a central endometrium, as well as a left-sided ovary in the pelvic region. The right ovary was not seen. Correlative ultrasound confirmed these findings and indicated that the testes had a normal echo texture and vascularity. The patient was diagnosed with ODSD, and further hormonal testing was recommended. Conclusions: ODSD is a rare cause of genital ambiguity. Typically, both paramesonephric and mesonephric duct derivatives are seen, and most of the affected individuals present as neonates or infants with ambiguous external genitalia. At peripubertal age, the symptoms typically include hypospadias, urogenital sinus, inguinal hernia, unilateral or bilateral cryptorchidism, and gynaecomastia. Fertility is not uncommon and has been reported in female-reared patients. The ovotestis is the commonest gonad in people with ODSD and are known to be predisposed to germ cell tumours. Over 500 cases of ODSD have been reported in the literature. Ultrasound is the first line of investigation used to see the pelvic organs. The non-invasive test of choice for detecting paramesonephric and mesonephric duct derivatives is an MRI pelvis. The purpose of this paper is to describe various clinical and radiological features associated with ODSD.

Giant Sternal Pilomatricoma: An Unusual Tumor at an Uncommon Site

AbstractPilomatricoma, pilomatrixoma, or calcified epithelioma of Malherbe is an uncommon, benign, isolated tumor of hair matrix primarily seen in children and young adults. The most common location is the head and neck region. It usually manifests as a small nodular mass. Here we report a rare case of giant pilomatricoma over the sternum in a 60-year-old male patient with an unusual clinical and radiological presentation mimicking a calcified sebaceous cyst.

Pulmonary parenchymal involvement by Classic Hodgkin Lymphoma – An unusual presentation

Pulmonary involvement of Hodgkin’s disease is often encountered. However, presentation in the form of “pneumonia-like” consolidation is rare. A case is being described where a 31-year-old male patient presented with respiratory distress, intermittent fever, cough, and cervical lymphadenopathy for the past 2–3 months. Contrast-enhanced computed tomographic scan of thorax revealed a consolidation at anterior segment of the right upper lobe with atelectasis and mediastinal lymphadenopathy. CT-guided biopsy from the right lung lesion revealed infiltration by inflammatory cells mainly lymphocytes and eosinophils with presence of a few scattered atypical mononuclear and occasional binucleated cells. These atypical cells were immunopositive for CD 15 and CD 30 and negative for CD 45, CD 20, Epstein Barr Virus Latent Membrane Protein (EBV LMP 1), and multiple myeloma 1 (MUM 1). The final diagnosis was pulmonary involvement by Classic Hodgkin’s lymphoma. The present case is being depicted for its unusual clinical and radiological presentation.

MENAGERIE OF BREAST LESIONS ON TRUCUT BIOPSIES AND THEIR CORRELATION WITH BIRADS SCORE-3 YEARS INSTITUTIONAL STUDY

Breast ultrasound is a primary diagnostic modality for evaluating suspected breast lesions. Histopathological examination of trucut biopsies helps in accurate typing and grading the tumor. In the present study we compared histopathological ndings of trucut breast biopsies with BIRADS score. It was a retrospective, 3 years study with 183 cases that had under gone ultrasound examination and trucut biopsy for histopathological examination. Among 183 cases, 8 were inconclusive, 93 were benign and 82 were malignant. In 183 cases, 62 cases were classied as BIRADS-II, 24 cases as BIRADS-III, 66 cases as BIRADS IV and 31 cases as BIRADS V. Sensitivity calculated was 98.78%, specicity was 86.02%, positive predictive value was 86.17% and negative predictive value was 98.77%. The disease prevalence was 46.86% and accuracy was 92%. P value was statistically signicant. Therefore, we conclude that BIRADS score is non-invasive and a useful test for evaluating breast lesions preoperatively. However, we cannot rely on BIRADS score in cases of sampling error, nature of the lesion or unusual radiological presentation that may lead to interpretation error and thus histopathology will be considered as gold standard in diagnosis of breast lumps.

Miliary distribution of MRI ring-enhancing brain lesions: An atypical presentation of multiple sclerosis

Ring-enhancing lesions are one of the most frequently encountered abnormalities on neuroimaging and can be expression of infectious, neoplastic, vascular or inflammatory disease. In particular, they are currently considered a possible radiological pattern of Multiple Sclerosis (MS) [1]. We report a case of Multiple Sclerosis with atypical ring-enhancing lesions: clinicians should be aware of the possible unusual radiological presentation of this very common inflammatory disease.

Covid-19 pneumonia: An unusual radiological presentation

A 26 year old female presented with complaints of high grade fever and cough for 10 days. Nasopharyngeal swab tested for COVID-19 RT-PCR at admission was negative. Clinical examination suggested a patch of bronchial breathing in left infrascapular region and bilateral diffuse rhonchi. Chest X-ray was suggestive of left lower zone consolidation. HRCT showed a large patch of consolidation with GGO along with a cavitary lesion involving left lower lobe. Sputum for RT-PCR COVID 19 was positive. Patient was managed as per covid-19 protocol, subsequently showing clinical and radiological improvement.

Unusual presentation of tuberculous osteitis distal fibula

We present the case of a 10-year-old boy presenting with pain and swelling on the lateral aspect of the left ankle associated with occasional fever of 1-month duration. Before he presented to us, he was treated with antibiotics and anti-inflammatory agents on two occasions in a local hospital for the same complaints. The swelling disappeared and mild pain persisted. The inflammatory markers were high, and the X-ray was not typical of either pyogenic infection or Ewing's sarcoma. Hence, a biopsy was done and the material was sent for histopathological and bacteriological studies. The histopathology report was typical of tuberculosis. The child became asymptomatic after antituberculous treatment. The case is presented because of the unusual clinical and radiological presentation of tuberculosis in one of the rarest sites reported in the literature.

Unusual radiological and histological presentation of a diffuse leptomeningeal glioneuronal tumor (DLGNT) in a 13-year-old girl

Diffuse leptomeningeal glioneuronal tumors (DLGNTs) are newly recognized as an entity in the 2016 revision of the WHO Classification of tumors of the central nervous system. They typically present as diffuse leptomeningeal infiltrates along the neuraxis with focal and superficial involvement of the parenchyma. Here, we report a DLGNT with unusual radiological and histological features. A 13-year-old girl presented with scoliosis and back pain. Magnetic resonance imaging demonstrated a syrinx from C2 to T11 and an intramedullary mass from T6 to T9-10. No leptomeningeal involvement was recognized. Histological examination of the gross total resection specimen revealed a low-grade neuroepithelial neoplasm predominantly infiltrating the spinal cord and only focally involving the leptomeninges. Chromosome microarray identified co-deletion of the short arm of chromosome 1 and the long arm of chromosome 19 as well as fusion of the KIAA1549 and BRAF genes. Next-generation sequencing demonstrated wild-type alleles at the mutational hotspots of IDH1 (R132) and IDH2 (R140 and R172). In contrast to most reported DLGNTs, the tumor described in this manuscript was characterized by a predominant parenchymal component and only minor leptomeningeal involvement both radiographically and histologically. Our case, therefore, expands the spectrum of radiological and histopathological features of this new entity. It also highlights the critical role of molecular genetic testing in establishing the diagnosis of DLGNT in unusual cases.

Radiologic diagnosis of pulmonary metastases of uterine choriocarcinoma

The article describes a rare case of metastatic pulmonary choriocarcinoma manifested with hemoptysis. Obstacles and pitfalls of the diagnosis of uterine choriocarcinoma with atypical manifestation were discussed. The patterns of pulmonary metastases of uterine choriocarcinoma and contribution of cross-sectional imaging modalities to diagnostic work-up were described. For the first time diffusion weighted magnetic resonance imaging of the chest was used for the follow-up examination and diagnosis of the recurrence of the disease.This case is of interest due to unusual clinical and radiological presentation of uterine choriocarcinoma. The article is aimed to radiologists to be familiar with this disease to provide its early diagnosis and timely treatment.

Myriad of MR imaging phenotypes of primary central nervous system lymphoma in a cohort of immunocompetent Indian patient population.

PCNSL (primary central nervous system lymphoma) is a chemosensitive and radiosensitive tumor, and early diagnosis has a significant impact on management. Unlike many other brain tumors, radical surgical excision of PCNSLs is not indicated because these lesions are highly infiltrative and even partial resection leads to a bad prognosis. The goal of this study is to highlight the unusual radiological presentation of PCNSLs and increase the awareness, familiarity, and global database of our observations that pose a challenge on management.

Aspergilloma mimicking olfactory groove meningioma

Central nervous system aspergillosis is rare with reported mortality rate of 13–50% involving foci in paranasal sinuses and even higher mortality rates (80–100%) in patients of immune-compromised status. Modern day imaging offers an opportunity for early diagnosis, but findings are minimal. A typical finding is that of a space occupying mass lesion with iso-hypointense signal on T1-weighted sequences and extreme hypointense appearance on T2-weighted. This results from the concentration of ferromagnetic substances (iron/zinc/magnesium/manganese) within the lesion. Gadolinium enhancement pattern varies from homogeneous to peripheral ring enhancement. The immune-competent hosts present with homogeneous enhancement while those with immune compromise bear more variable radiological appearance. Due to such radiological appearance, meningioma or tuberculoma is considered in differential earlier than fungal granuloma, if not for the hypointense appearance on T2-weighted sequences which strongly points to fungal granuloma. Through this case report, we attempt to highlight the unusual radiological presentation of the entity.

An unusual presentation of pulmonary lymphoma: When diffuse ground glass opacities can mean anything.

Primary lung lymphoma (PLL) is a rare type of lymphoma confined to the lung at the time of diagnosis. Pulmonary diffuse large B cells lymphoma (P-DLBCL) is the second most common type of PLL and it usually appears radiologically as solitary or multiple nodules or areas of consolidation. We present the case of a 63-year-old Caucasian male who developed severe acute respiratory failure and diffuse ground glass opacities (GGO) on chest computerized tomography. Diffuse GGO may be the radiological expression of very different diseases, ranging from infectious processes to interstitial lung diseases (ILDs) and neoplastic diseases. In our case, pneumonia and de novo ILD were initially considered given the symptoms and past medical history. However, bronchoscopy with trans-bronchial biopsies demonstrated the presence of P-DLBCL, despite an unusual radiological presentation and negative cytological analyses on bronchoalveolar lavage. In conclusion, P-DLBCL should be considered among the many differential diagnoses of diffuse GGO.

Immunohistochemical features of giant cell ependymoma of the filum terminale with unusual clinical and radiological presentation

BackgroundGiant cell ependymoma of the filum terminale is a rare variant, generally manifested as a well-circunscribed intradural mass with an indolent biological behavior.Case presentationWe describe the case of a 48-year-old Mexican female who non-relevant past medical history, that developed a GCE of the filum terminale. Magnetic resonance imaging and computed tomography revealed the presence of an intra-axial tumor extending from L3 to L5 with extra-medullary invasion. Therefore the tumor was considered unresectable and only incisional biopsy was obtained, establishing the tentative diagnosis of a poorly differentiated neoplasia. A second evaluation of the case revealed the presence of numerous non-cohesive pleomorphic giant cells with intranuclear inclusions and broad eosinophilic cytoplasm, alternating with intermediate size cells with round, hyperchromatic nuclei and forming a perivascular pseudo-rosettes pattern. The ependymal phenotype was supported by light microscopy and corroborated by immunohistochemistry analysis. The patient was subsequently treated with radiotherapy 54Gy. She is alive after a 27-month follow-up, with residual disease, difficulty ambulating and pain.ConclusionsGCE of filum terminale may have an atypical clinical and radiological presentation, albeit with invasive characteristics and anaplasia on histologic analysis. However, its biological behavior is indolent and associated to longer survival. Due to the presence of giant cells, the differential diagnosis of other primary neoplasias at that site were considered, including paraganglioma, malignant peripheral nerve sheath tumors as well as metastatic malignant melanoma, adrenal carcinoma, thyroid gland carcinoma and urothelial carcinoma, that may all harbor giant cells.

Unusual Radiological Sign in Bronchial Atresia.

Bronchial atresia is usually diagnosed by incidentally detecting opacitiy at hilar ragion and hyperinflation around this opacity on chest X-ray. It may rarely be detected as air sac like atresic bronchus. The breath sounds in the right hemithorax were heard less when compared to the left hemithorax in the auscultation of a 16-year-old male patient with allergic rhinitis. The patient had no pulmonary complaints, and this finding was not recorded in his previous follow-up. In order to determine the etiology of hyperinflation seen on chest X-ray, computed tomography was performed. Hyperinflation was identified in the lower lobe superior segment of the right lung, which could be secondary to bronchial atresia. It was confirmed that in the evaluation of computed tomography with three-dimensional reconstruction, lower lobe superior segment bronchus of the right lung was atresic and contrary to expected mucus opacity in the distal of atresia, dilated bronchus was filled with air. This case was especially presented to lay emphasis on careful auscultation and share its unusual radiological presentation which had been reported twice before.

An unusual radiological presentation of mucinous adenocarcinoma of the colon

We report a case of an elderly patient presenting with the left iliac fossa mass. The provisional diagnosis included an inflammatory diverticular mass or sigmoid colon cancer. Interestingly, computed tomography (CT) of the abdomen and pelvis demonstrated the left incarcerated Spigelian hernia containing an inflamed loop of the colon with signs of an early strangulation. However, at operation, a mucinous tumor was found involving the descending and upper sigmoid colon. The tumor eroded through the anterior abdominal wall, which was excised "en bloc." In the presented case, CT findings suggestive of a benign etiology were misleading. This potentially could have had significant consequences if the patient was treated conservatively. This case highlights that clinical history and examination remain the core components of a safe surgical practice. Clinical judgment cannot be substituted even by the best quality imaging. Therefore, we feel that it is important to share our experience of the successful management of the presented case.

An unusual radiological presentation of optic nerve sheath meningioma

Our report describes an unusual radiological presentation of optic nerve sheath meningioma. The classic radiological appearance of optic nerve thickening with enhancement and calcification within the tumor was not seen; instead, an elongating gadolinium enhancing band-like area adjacent to the superomedial aspect of the left optic nerve sheath was identified. The diagnosis was confirmed on histopathology. Our report adds to the spectrum of presentations of this relatively common clinical entity.

Fever and multilobular mass of the right lung in a young adult with asthma

We report a case of a 37-year-old mild asthmatic male presenting with fever, productive cough and chest pain. The chest x-ray showed a multilobular perihilar shadow of the right lung with a mass-like appearance, confirmed by the CT-scan. He was diagnosed with allergic bronchopulmonary aspergillosis (ABPA). ABPA usually manifests as chronic asthma, recurrent pulmonary infiltrates and bronchiectasis. However, it can rarely be seen in patients with mild asthma and with an unusual radiological presentation of a solid mass.

A Case of Langerhans Cell Histiocytosis with Atypical Radiological Presentation.

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial lung disease characterized by the accumulation of histiocytes within the airspaces or parenchyma of the lung. It almost always occurs in smokers between the ages of 20 and 40. Bronchoscopic interventions, such as transbronchial biopsy (TBB) and bronchoalveolar lavage (BAL), should be performed before other more invasive procedures, but their diagnostic yield is lower. TBB is frequently non-diagnostic due to inadequate sampling. BAL cellular analysis may show alveolar macrophage predominance, and the detection of >5% of CD1a-positive cells in BAL fluid is highly suggestive and specific for the disease; however, this increase is not observed frequently. Surgical lung biopsy is the most definite modality for diagnosis. Smoking cessation must be recommended for all patients. The prognosis for most patients is relatively good, particularly if longitudinal lung function testing shows stability. Here, we presented a 48-year-old smoker with an unusual and unexpected radiological presentation.

Castleman’s Disease with an Unusual Radiological Presentation: A Case Report

Castleman’s Disease with an Unusual Radiological Presentation: A Case Report