Unusual Radiological Presentation Research Articles

Unusual Presentation of a Gangrenous Cholecystitis that Mimics a Bowel Perforation

We report the case of a diabetic 49-year-old man affected by phlegmonous cholecystitis with an unusual radiological presentation mimicking a bowel perforation. Actually, abdomen X-ray showed free intraperitoneal air spots (dark crescent beneath the diaphragm) in the upright positions. We have not found any similar cases in the published literature, except for a case report about an unusual presentation of an emphysematous cholecystitis. The clinical practitioner has to pay attention not to fall into a fixation error during diagnosis.

Primary extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type in the central nervous system (MZL CNS) presented as traumatic subdural hematoma and subarachnoid bleeding – case report

The study describes a very rare case of primary extranodal marginal zone Bcell lymphoma of the central nervous system (MZL CNS) with an unusual clinical and radiological presentation mimicking subarachnoid bleeding and subdural hematoma (SDH) after head injury. The patient presented symptoms which had commenced 3 weeks earlier: a gradually-progressing headache associated with periodic right-sided cramp of the face muscles and numbness of the right upper limb. During urgent craniotomy for drainage of the presumed SDH, a tumor mass histopathologically and immunohistochemically matching marginal zone B-cell lymphoma was found. Molecular analysis confirmed monoclonal immunoglobulin heavy chain gene (IgH) rearrangement; the patient had previously suspected nodal lymphoma because of cervical lymphadenopathy, but histopathological, immunohistochemical and molecular examination excluded malignant lymphoma. The patient underwent successful radiotherapy, and achieved complete response. At present, no evidence of either systemic disease or lymph node enlargement has been found. The recognition of an indolent type of lymphoma in a rare anatomical localization is very important due to the proper management of the patient.

An Unusual Radiological Presentation of a Pulmonary Hydatid Cyst in a Child

Giant pulmonary hydatid cyst is usually encountered in adolescents and children who are older than 10 years. A relatively higher elasticity of the lung tissue allows rapid growth of cysts. We present a case of a 15-year-old male who was admitted with complaint of frequent and persistent dry cough for over a month. Computed tomographic scan revealed a giant cyst with thick enhancing rim and an “air bubble” sign. Diagnosis of giant hydatid cyst was confirmed by surgery and histopathological examination.

Multifocal skeletal tuberculosis involving the lumbar spine and iliac bone, mimicking a malignant bone tumour: a case report.

Multifocal osteoarticular tuberculosis is uncommon and accounts for approximately10% of all cases of osteoarticular tuberculosis. Concomitant vertebral and iliac bone tuberculosis has not been reported in the literature to date. We report one such case for its unusual clinical and radiological presentation, which had presentation more similar to a malignant bone tumour than an infection. Skeletal tuberculosis, multifocal osteoarticular tuberculosis.

An initial MRI picture of limbic encephalitis in subacute sclerosing panencephalitis

Background Subacute sclerosing panencephalitis (SSPE) is a rare and severe long-term complication of measles. Hallmarks of this entity include progressive cognitive decline, myoclonia, a generalized periodic pattern on EEG and deep white matter abnormalities on MRI. However, imaging can be normal in early stages. Aim We report herein the case of a previously healthy 13-years-old girl with an unusual radiological presentation. Results She presented with unilateral myoclonia, cognitive decline with memory impairment and a first brain MRI with swelling of both hippocampi mimicking limbic encephalitis. Measles antibodies were positive in CSF and the EEG showed slow periodic complexes. Conclusion This unusual radiological presentation has never been described in SSPE. Relationship between virus and limbic system are discussed.

Case of an unusual clinical and radiological presentation of pulmonary metastasis from a costal chondrosarcoma after wide surgical resection: A transbronchial biopsy is recommended

Chondrosarcomas are the most frequently occurring primary malignant chest wall tumors. Furthermore, the lungs serve as the most frequent sites for metastases. Pulmonary metastases from sarcomas usually appear as round nodules of varying sizes on roentgenograms. Here, we report an unusual clinical and radiographic presentation of pulmonary metastasis from a costal chondrosarcoma. Bilateral pulmonary metastases developed soon after wide surgical resection. Thoracic computed tomography revealed unusual radiological findings: consolidation accompanied with ground-glass opacity. To confirm the metastasis, we recommend a transbronchial biopsy in cases where unusual pulmonary findings are detected.

Pulmonary Nocardiosis in a Kidney Transplant Recipient: A Case Report and Review of the Literature

Nocardiosis is a life threatening disease in solid organ transplant recipients. It is an uncommon but important infection for these patients. We report a case of 37- year-old kidney recipient who developed pulmonary nocardiosis that was successfully treated with intravenous imipenem and tetracyclines in conjunction with a reduction in immunosuppressive therapy. Four years later, graft function remains stable with complete regression of radiological abnormalities and absence of relapses. This case emphasizes the role of new potent immunosuppressants and diabetes in the occurrence of opportunistic infections. Nocardiosis should be suspected in the presence of pulmonary symptoms with unusual radiological presentation.

Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy: Response to the Letter

Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy: Response to the Letter

Fine-needle aspiration cytology of extra mammary metastatic lesions in the breast: A retrospective study of 36 cases diagnosed during 18 years

Background:Metastatic tumors in the breast require treatment according to origin and type of tumor. It is important to recognize these lesions in fine-needle aspiration cytology (FNAC) in order to avoid unnecessary mastectomy or non-relevant chemotherapy. The aim of this study was to evaluate the cytological features of metastatic tumors and possible criteria that could alert us as to the possibility of a metastasis from an extra mammary malignancy.Methods:The material included 36 confirmed or suspected metastases in the breast registered in the pathology files at Oslo University Hospital, Ulleval, during 1990–2007. There were a total of 6,325 cases of malignant breast FNAC, representing 30 men and 6,295 women. Smears were evaluated for the amount of material, presence or absence of myoepithelial cells, microcalcifications, mitoses and necrotic material. All carcinomas were graded.Results:There were seven men (7/30 = 23.3%) and 29 women (29/6,295 = 0.46%). The primary tumor was known in 22 cases (22/36 = 61.1%). No other primary tumor was known and metastatic lesion was not initially suspected in 14 cases (14/36 = 38.9%). The most common origin was lung (15/36 = 41.7%). In five cases (5/36 = 13.9%), the origin remained uncertain.Conclusions:Metastases from extra mammary sites are (relatively) common in males (23.3%). In women, metastatic lesions are rare (0.46%). A large proportion of them (88%) are high-grade adenocarcinomas and poorly differentiated carcinomas that may resemble grade 3 ductal carcinomas. Unusual clinical and/or radiological presentation in combination with high-grade malignant cells should alert us to consider the possibility of a metastasis.

Large Cell Lung Carcinoma with Unusual Imaging Feature, Immunophenotype and Genetic Finding

We present a case of large cell lung carcinoma in sixty-one year old male with typical lung cancer symptoms but unusual radiological presentation and immunophenotype. Tumor morphological finding related to its radiological finding was suggestive for large cell lymphoma or carcinoma, but its immunophenotype made confusion for pathological diagnosis. No p53 mutations were detected in genetic investigation. Multidisciplinary diagnostic approach to some tumors is useful for their final diagnosis.

Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy

Choriocarcinoma is the most malignant tumor of gestational trophoblast origin. Metastasis to brain is considered a poor prognostic indicator. Recent advances in adjuvant radiotherapy and chemotherapy have led to an excellent outcome of these patients. Craniotomy is indicated in selected cases with cerebral metastases. The authors report an interesting case of an aggressive choriocarcinoma with multiple metastases to the brain and viscera. The patient had radiological evidence of new lesions occurring almost every week while on the initial treatment and yet had a complete long-term remission with EMA-CO therapy. The interesting presentation, radiology and adjuvant therapies are discussed.

Autosomal recessive familial neurohypophyseal diabetes insipidus: onset in early infancy

Familial neurohypophyseal diabetes insipidus (FNDI), usually an autosomal dominant disorder, is caused by mutations in the arginine vasopressin (AVP)-neurophysin II preprohormone leading to aberrant preprohormone processing and gradual destruction of AVP-secreting cells. Patients typically present between 1 and 6 years of age with polyuria and polydipsia. Clinical, biochemical, and genetic studies of three new cases of autosomal recessive FNDI presenting in early infancy. Three Palestinian cousins presented with failure to thrive, vomiting, irritability, and fever. The parents were asymptomatic. Patients developed hypernatremia (154-163 mmol/l) and serum hyperosmolality (>320 mOsm/kg), while urine osmolality remained between 73 and 229 mOsm/kg. Plasma AVP levels were low, and the posterior pituitary bright spot was absent on magnetic resonance imaging (MRI). All patients responded to desmopressin. Patients were homozygous and parents were heterozygous for microsatellite markers flanking the AVP gene. All patients were homozygous for the P26L (proline to leucine) substitution affecting mature AVP. A founder effect with the single original kindred carrying the P26L mutation was confirmed by microsatellite analysis, but patients in that family presented only at 2 years of age. In microsatellite analysis, the new kindred patients were not homozygous and did not share a single allele at the aquaporin 2 and vasopressin receptor-2 genes locuses. This is the first description of autosomal recessive FNDI presenting in the neonatal period. The unusual early clinical and radiological (MRI) presentation argues against gradual destruction of AVP-secreting neurons as the pathophysiological mechanism. Factors beside allelism of AVP-related genes must influence the age of FNDI presentation given the founder effect demonstrated for the P26L mutation.

Unusual Radiological Presentation of Tuberous Sclerosis Complex With Leptomeningeal Angiomatosis Associated With a Hypomorphic Mutation in the TSC2 Gene

Tuberous sclerosis complex is an autosomal dominant disorder affecting primarily the central nervous system, skin, and kidney caused by mutations in the TSC1 and TSC2 genes. Diagnosis is established with the identification of various neurocutaneous symptoms and multiple organ system hamartomas. The authors report on a 9-year-old patient with episodes of vertigo and headache followed by full spontaneous recovery. There was no history of seizures, mental retardation, or other neurologic sequelae, and psychomotor development was normal. Magnetic resonance imaging revealed pial angiomatosis of the left cerebellum and calcifications in the left parieto-occipital lobe consistent with the diagnosis of Sturge-Weber syndrome. At the age of 13, multiple renal angiomyolipomas and a single hypomelanotic macule were found, and subsequent imaging revealed several cortical tuberi. The diagnosis was confirmed by sequence analysis, which identified a novel missense mutation p.Ala460Thr in exon 13 of the TSC2 gene. Thus, mild tuberous sclerosis due to a hypomorphic mutation in TSC2 may present with isolated leptomeningeal angiomatosis.

Germinoma with synchronous involvement of midline and off-midline structures associated with progressive hemiparesis and hemiatrophy in a young adult

Cerebral germinomas, the most common and least malignant intracranial germ cell tumors, usually arise in the pineal or suprasellar region and have characteristic clinical and radiological features. Germinomas more rarely occur in the thalamus, basal ganglia, and internal capsule, causing sometimes cerebral hemiatrophy and hemiparesis. More rarely, other clinical features can be fever of unknown origin, visual disturbance, and neuropsychiatric symptoms. Cerebral hemiatrophy can precede the imaging depiction of the off-midline mass. The authors present the first case of cerebral germinoma with synchronous involvement of the midline and off-midline structures, with unusual clinical and radiological presentation. The literature is reviewed, and the pathogenesis, the clinical findings, the imaging, and the therapy are discussed.

Unusual Radiological Presentation of PCNSL

Unusual Radiological Presentation of PCNSL

Sclérose en plaques rémittente ou encéphalomyélite multiphasique disséminée ?

The imaging presentation of some forms of multiple sclerosis may be misleading. In patients with a history of recent infection or vaccination, especially for adolescents or young adults, the differential diagnosis with acute disseminated encephalomyelitis can be difficult. We report an unusual clinical and radiological presentation of multiple sclerosis, mimicking acute disseminated encephalomyelitis. We discuss clinical and radiological differential diagnosis, and the outcome after immunosuppressive treatment. Distinguishing between acute disseminated encephalomyelitis and the first relapse of multiple sclerosis can be difficult. Brain imaging is a precious tool for differentiating between the two diseases.

Unilateral ossification of the ligamentum flavum in the cervical spine with atypical radiological appearance

We report a case of symptomatic unilateral ossification of the ligamentum flavum with unusual radiological presentation in the cervical spine. The patient was a 64 year old man with numbness and weakness of the left upper extremity who was admitted to our hospital. Computerized tomography revealed a triangular-shaped high density mass severely compressing the spinal cord at C6. Concomitant small ossification of the posterior longitudinal ligament was noted from C3 to C6. The ossified mass was completely removed via a unilateral osteoplastic laminectomy of the left C6 and C7.

Radiological Tumor-Like Image in Multiple Sclerosis

Tumefactive tumor-like radiological image in multiple sclerosis (MS) is not a common finding in magnetic resonance imaging. This presentation poses an extra challenge to the already difficult diagnosis of MS. We report on a clinical MS case with this unusual radiological presentation and the diagnostic difficulties in this patient. We also discuss our case in comparison to the world literature, and we comment on the relative lack of Brazilian papers on the subject.

Unusual radiological features in Paget's disease of bone

The radiological diagnosis of Paget's disease of bone is usually straightforward because most cases conform to well-established classic descriptions. Diagnosis becomes more difficult, however, when radiological appearances are not typical or other disease processes mask or alter the behavior of Paget's disease. Examples are presented to illustrate four categories of unusual radiological presentation of Paget's disease: (1) unusual disease progression, (2) massive post-immobilization lysis, (3) metastatic spread to pagetic bone, and (4) vertebral end-plate destruction that mimics infection.

Unusual radiological presentation of a primary CNS lymphoma

Unusual radiological presentation of a primary CNS lymphoma