Diagnostics

2024

Jump to: 2023, 2022, 2021, 2020

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Spontaneous Transvaginal Small Bowel Evisceration After Laparoscopic Hysterectomy

by Ismini Kountouri, Amyntas Giotas, Christos Gkogkos, Ioannis Katsarelas, Panagiotis Nachopoulos, Afroditi Faseki, Dimitrios Chatzinas, Alexandra Panagiotou, Athanasios Polychronidis, Mohammad Husamieh, Periklis Dimasis, Nikolaos Gkiatas, Dimitra Manolakaki and Miltiadis Chandolias

Diagnostics 2024, 14(22), 2498; https://doi.org/10.3390/diagnostics14222498 - 8 Nov 2024

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Abstract

Vaginal cuff dehiscence can be a rare complication of total hysterectomy, with an estimated prevalence of 0.032% to 1.25% and a high mortality rate of 6 to 10%. Dehiscence is also reported in cases following total laparoscopic hysterectomy, with a prevalence of 0.87%. [...] Read more.

Vaginal cuff dehiscence can be a rare complication of total hysterectomy, with an estimated prevalence of 0.032% to 1.25% and a high mortality rate of 6 to 10%. Dehiscence is also reported in cases following total laparoscopic hysterectomy, with a prevalence of 0.87%. This case report details the emergency management of a 59-year-old female who complained of abdominal and pelvic pain and the feeling of a foreign body in her vagina. The patient reported a history of laparoscopic total hysterectomy 6 months prior to presenting at the Emergency Department. A clinical examination revealed small bowel loops protruding through the vagina. The patient underwent exploratory laparotomy through a Pfannenstiel incision, and the terminal ileum was found prolapsing through the vaginal cuff. The bowel loops were identified as viable and the vagina was sutured. The patient had an unremarked post operative course. This case report showcases that in patients with transvaginal evisceration, immediate surgical management is crucial in order to avoid serious life threatening complications, and both surgeons and gynecologists should remain vigilant regarding this pathology. Full article

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6 pages, 9823 KiB

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Central Nervous System Involvement and Neuroradiological Imaging Insights of Neurocutaneous Melanocytosis in Congenital Melanocytic Nevi

by Christer Ruff, Georg Gohla, Thomas Nägele and Marion Batra

Diagnostics 2024, 14(21), 2345; https://doi.org/10.3390/diagnostics14212345 - 22 Oct 2024

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Abstract

Congenital melanocytic nevi (CMN) are pigmented lesions present at birth, varying widely in size and clinical impact. In rare instances, these nevi become visible during the first months of life, a phenomenon known as tardive melanocytic nevi (tardive CMN). Giant congenital melanocytic nevi [...] Read more.

Congenital melanocytic nevi (CMN) are pigmented lesions present at birth, varying widely in size and clinical impact. In rare instances, these nevi become visible during the first months of life, a phenomenon known as tardive melanocytic nevi (tardive CMN). Giant congenital melanocytic nevi (GCMN) are defined as nevi larger than 40 cm in projected adult size (PAS). Their association with the central nervous system (CNS) poses significant risks, including melanoma and neurocutaneous melanocytosis (NCM), where melanocytes infiltrate the CNS, potentially causing seizures, hydrocephalus, and, rarely, CNS melanoma. MRI is recommended for GCMN patients, particularly those with numerous satellite nevi or neurological symptoms, to detect CNS involvement. The Nevosurgery Network recommends MRI examinations in cases of GCMN (>40 cm PAS), the presence of over 20 concomitant nevi, and neurological symptoms requiring clarification. CMN can be associated with melanocyte accumulations and melanin deposits in the brain, spinal cord, and leptomeninges. Full article

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5 pages, 2320 KiB

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Secondary Angle Closure Glaucoma in Weill–Marchesani Syndrome

by Valeria Coviltir, Miruna Gabriela Burcel, Maria Cristina Marinescu, Bianca Maria Urse and Ciprian Danielescu

Diagnostics 2024, 14(20), 2303; https://doi.org/10.3390/diagnostics14202303 - 16 Oct 2024

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Abstract

We report a case of a 16-year-old girl presenting to our clinic with decreased visual acuity and increased intraocular pressure in both eyes. The ophthalmological examination revealed best-corrected visual acuity (BCVA) of 0.3 in the right eye (R.E.) and 0.4 in the left [...] Read more.

We report a case of a 16-year-old girl presenting to our clinic with decreased visual acuity and increased intraocular pressure in both eyes. The ophthalmological examination revealed best-corrected visual acuity (BCVA) of 0.3 in the right eye (R.E.) and 0.4 in the left eye (L.E.) and intraocular pressure (IOP) of 46 mmHg in the R.E. and 42 mmHg in the L.E., with a 360° closed angle on gonioscopy, pupillary block due to bulging, a hyper-spherical lens and high corneal thickness, without ectopia lentis or cataract. The eyes responded poorly to pharmacological mydriasis; therefore, the lens equator could not be visualised. The patient had a history of pulmonary stenosis, short stature and no significant cognitive deficits. These elements point to the diagnosis of Weill–Marchesani syndrome, and the ophthalmological management was surgical, including lens extraction and the installation of a capsular tension ring, an intraocular lens and a Shunt ExPress implantation. Evolution was favourable, with improved BCVA of 0.7 in the R.E. and 0.63 in the L.E. and IOP of 14 mmHg in the R.E. and 13 mmHg in the L.E., without topical or systemic treatment at the 6-month follow-up. Weill–Marchesani syndrome has a complex presentation, with ophthalmological, musculoskeletal, cardiac and psychiatric manifestations. Usually, this leads to a need for a multidisciplinary approach. The ophthalmologic symptoms are often the cause of presentation to a specialist, and glaucoma is the most threatening of the ocular pathologies, with possible evolution into irreversible blindness; therefore, prompt surgery and careful follow-up become key components of the treatment plan. As a take-home message, we encourage a high degree of suspicion of Weill–Marchesani syndrome in such cases. Full article

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6 pages, 9533 KiB

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A Unique Case of Unilateral Pseudogynecomastia

by Ismini Kountouri, Ioannis Katsarelas, Eftychia Kokkali, Amyntas Giotas, Christos Gkogkos, Dimitrios Chatzinas, Panagiotis Nachopoulos, Afroditi Faseki, Alexandra Panagiotou, Athanasios Polychronidis, Miltiadis Chandolias, Nikolaos Gkiatas, Dimitra Manolakaki and Periklis Dimasis

Diagnostics 2024, 14(18), 2058; https://doi.org/10.3390/diagnostics14182058 - 17 Sep 2024

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Abstract

Background/Objectives: Gynecomastia is a common condition characterized by the benign enlargement of male breast tissue, often resulting from hormonal imbalances. A rare variant, unilateral pseudogynecomastia, involves enlargement due to adipose tissue accumulation without glandular proliferation and can be associated with occupational factors. Methods: [...] Read more.

Background/Objectives: Gynecomastia is a common condition characterized by the benign enlargement of male breast tissue, often resulting from hormonal imbalances. A rare variant, unilateral pseudogynecomastia, involves enlargement due to adipose tissue accumulation without glandular proliferation and can be associated with occupational factors. Methods: We report the case of a 45-year-old male mechanic presenting with unilateral enlargement of the left breast. The patient reported daily microtrauma on his left axilla and chest wall. The clinical evaluation and imaging revealed lipomatosis with pronounced fibrous tissue and no glandular tissue involvement. The hormonal assays were within the normal limits. The patient underwent surgical excision of excess adipose tissue using the Kornstein technique, preserving the nipple–areola complex. Results: The histopathological examination confirmed the absence of malignancy. The postoperative recovery was uneventful, and the follow-up examination at 12 months demonstrated a symmetrical breast appearance with no recurrence. This case underscores the importance of differentiating pseudogynecomastia from true gynecomastia and recognizing potential occupational risks. Surgical management using techniques that preserve the nipple–areola complex can achieve excellent cosmetic outcomes. Full article

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6 pages, 3556 KiB

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Small Bowel Obstruction Masking a Perforated Dermoid Ovarian Cyst

by Ismini Kountouri, Christos Gkogkos, Ioannis Katsarelas, Periklis Dimasis, Amyntas Giotas, Eftychia Kokkali, Miltiadis Chandolias, Nikolaos Gkiatas and Dimitra Manolakaki

Diagnostics 2024, 14(17), 1975; https://doi.org/10.3390/diagnostics14171975 - 6 Sep 2024

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Abstract

A 58-year-old female presented with abdominal pain, vomiting and constipation. Laboratory tests indicated elevated white blood cell count and C-reactive protein levels. Imaging via CT scan revealed a large cystic mass in the right ovary, abscesses and generalized small bowel distension, which initially [...] Read more.

A 58-year-old female presented with abdominal pain, vomiting and constipation. Laboratory tests indicated elevated white blood cell count and C-reactive protein levels. Imaging via CT scan revealed a large cystic mass in the right ovary, abscesses and generalized small bowel distension, which initially raised suspicion of the existence of ovarian cancer with peritoneal carcinomatosis. Despite conservative management, the patient’s condition did not improve, prompting a laparotomy. Intraoperative findings included generalized peritonitis, significant small bowel dilation due to inflammatory adhesions and a perforated dermoid ovarian cyst. The cyst was resected and a prophylactic ileostomy was installed. Histopathological examination confirmed the diagnosis of a benign dermoid ovarian cyst. This case illustrates the rare presentation of a perforated dermoid cyst mimicking peritoneal carcinomatosis and emphasizes the importance of considering such complications in the differential diagnosis of bowel obstruction and peritoneal disease. Early recognition and appropriate surgical intervention are crucial for optimal outcomes. Full article

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4 pages, 765 KiB

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Spontaneous Splenic Rupture Secondary to Infectious Mononucleosis

by Ismini Kountouri, Evangelos N. Vitkos, Periklis Dimasis, Miltiadis Chandolias, Maria Martha Galani Manolakou, Nikolaos Gkiatas and Dimitra Manolakaki

Diagnostics 2024, 14(14), 1536; https://doi.org/10.3390/diagnostics14141536 - 16 Jul 2024

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Abstract

Spontaneous splenic rupture (SSR) is a relatively rare but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically [...] Read more.

Spontaneous splenic rupture (SSR) is a relatively rare but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically or with abdominal pain and hemodynamic instability. As adolescents and young adults are the most affected population group, with this case report, we intend to raise the vigilance of any doctor treating those patients in the emergency department. We present the case of a 16-year-old patient with an atraumatic splenic rupture and hemoperitoneum secondary to an Epstein–Barr virus (EBV) infection. The patient underwent an exploratory laparotomy, and a splenectomy was performed. This case demonstrates that, even if SSR in patients with IM is extremely rare, it should always be considered in a patient with a relevant clinical presentation. Full article

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7 pages, 7287 KiB

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Analysis of Tomographic Images of a Catastrophic Gas Embolism during Endoscopic Retrograde Cholangiopancreatography

by Marta Frydrych, Marceli Łukaszewski, Kamil Nelke, Maciej Janeczek, Agata Małyszek, Jan Nienartowicz, Grzegorz Gogolewski and Maciej Dobrzyński

Diagnostics 2024, 14(13), 1425; https://doi.org/10.3390/diagnostics14131425 - 3 Jul 2024

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Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed minimally invasive procedure. Air embolism in a patient undergoing ERCP is relatively rare, accounting for approximately 2–3% of procedures performed, and a catastrophic air embolism is even rarer. Symptoms of air embolism can come from [...] Read more.

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed minimally invasive procedure. Air embolism in a patient undergoing ERCP is relatively rare, accounting for approximately 2–3% of procedures performed, and a catastrophic air embolism is even rarer. Symptoms of air embolism can come from the cardiopulmonary and nervous system. It is important to remember this in the differential diagnosis of complications of ERCP, as early detection is crucial. In the case presented here, the diagnostic CT scan performed immediately after the incident brings awareness of how massive an air embolism can be. The CT results showed gas bubbles entering both the superior and inferior vena cava. The presence of air has been captured in the bile ducts, duodenum wall, heart, femoral veins and intracranially. Risk factors for this complication include previous biliary surgeries, the presence of prostheses and stents, cholangitis, liver tumors and anatomical anomalies such as hepatobiliary fistulas, as well as intrahepatic and extrahepatic anatomical leaks. As gas embolism is associated with serious health consequences, knowledge of the problem and adequate preparation may reduce the occurrence of the problem. Attention should be paid to basic and easily obtainable precautions when performing the procedure, such as the patient’s hemodynamic status, adequate hydration and positioning during the procedure. Full article

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7 pages, 2097 KiB

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Late Outcomes of Undiagnosed Unilateral Condylar Hyperplasia and Reoccurrence of Mandibular Asymmetry

by Kamil Nelke, Wojciech Pawlak, Klaudiusz Łuczak, Maciej Janeczek, Edyta Pasicka, Jan Nienartowicz, Grzegorz Gogolewski and Maciej Dobrzyński

Diagnostics 2024, 14(10), 1014; https://doi.org/10.3390/diagnostics14101014 - 15 May 2024

Cited by 2 | Viewed by 955

Abstract

Unilateral condylar hyperplasia (UCH) is a rare cause of asymmetrical mandibular overgrowth because of the presence of an atypical growth in the affected condyle. SPECT (single-photon emission computed tomography) can easily establish the presence of an atypical, prolonged growth exceeding far beyond normal [...] Read more.

Unilateral condylar hyperplasia (UCH) is a rare cause of asymmetrical mandibular overgrowth because of the presence of an atypical growth in the affected condyle. SPECT (single-photon emission computed tomography) can easily establish the presence of an atypical, prolonged growth exceeding far beyond normal condylar growth and activity. A CT, CBCT, or LDCT (computed tomography, cone-beam computed tomography, or low-dose computed tomography) can confirm the diagnosis by evaluating the scope of bone overgrowth, mandibular basis/ramus asymmetry, tendency to condylar head enlargement, changes in bone density, and occurrence of differences in condylar head shapes, size, and bone structure. In most cases, a condylectomy is the procedure of choice in growing cases of UCH to remove the pathological condyle and reduce asymmetry levels. Sometimes, the growth is very slow and progressive over time, causing slowly growing asymmetry with similar symptoms to any other mandibular asymmetry, and this causes some troublesome procedures in UCH diagnostics, resulting in patients being underdiagnosed; it can even lead to some relapses in mandibular asymmetry and skeletal malocclusion after previously performed orthodontic and surgical treatment of such discrepancies. When the source of asymmetry is not identified in time, possible inadequate treatment protocols can be used. If any relapse of facial and mandibular asymmetry re-occur, SPECT and CT evaluation are necessary to evaluate if condylar hyperplasia is present and to establish what kind of surgical intervention should be used in each case. Full article

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3 pages, 1792 KiB

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Evolution of a Meningothelial Meningioma: From WHO Grade 1 to Anaplastic Grade 3 with Extracranial Metastasis Including Extensive Liver Metastasis

by Christer Ruff, Paula Bombach, Georg Gohla, Till-Karsten Hauser, Frank Paulsen, Nick Farhang, Hans Boesmueller, Rudi Beschorner and Malte Bongers

Diagnostics 2024, 14(7), 676; https://doi.org/10.3390/diagnostics14070676 - 22 Mar 2024

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Abstract

A 61-year-old patient was diagnosed with a left-sided falx meningioma. Histopathological analysis following extirpation showed a meningothelial meningioma ZNS WHO grade 1 with sparse mitoses. Over the course of 12 years, the patient received irradiation (54.0 Gy), peptide radio-receptor therapy (¹⁷⁷Lu-DOMITATE) [...] Read more.

A 61-year-old patient was diagnosed with a left-sided falx meningioma. Histopathological analysis following extirpation showed a meningothelial meningioma ZNS WHO grade 1 with sparse mitoses. Over the course of 12 years, the patient received irradiation (54.0 Gy), peptide radio-receptor therapy (¹⁷⁷Lu-DOMITATE) and targeted therapy (mTOR inhibitor). Follow-up imaging revealed an increased size of the residual tumor. Due to increased liver function parameters, imaging of the liver was performed, showing widespread space-occupying lesions with atypical appearance. Biopsy revealed metastasis of the meningioma, now with 2.7 mitoses/mm², necrosis and homozygous CDKN2A/B deletion, corresponding to an anaplastic CNS meningioma WHO grade 3. A second small meningioma on the left petroclival side has been consistent in size over 12 years. Metastatic meningiomas pose a pertinent clinical challenge due to poor prognosis. The lung, bone, liver and cervical lymph nodes are the most common sites of extracranial metastasis. According to the World Health Organization criteria, the most important predictive factor for recurrence and metastasis is the tumor grade. Full article

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4 pages, 1299 KiB

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Bilateral Renal Ectopia—Prenatal Diagnosis

by Nicolae Gică, Livia Mihaela Apostol, Iulia Huluță, Corina Gică, Ana Maria Vayna, Anca Maria Panaitescu and Nicoleta Gana

Diagnostics 2024, 14(5), 539; https://doi.org/10.3390/diagnostics14050539 - 3 Mar 2024

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Abstract

This report explores the diverse spectrum of congenital anomalies of the kidney and urinary tract (CAKUT), ranging from asymptomatic presentations to the most severe form characterized by bilateral renal agenesis. Genitourinary anomalies, a prevalent subset within this domain, account for a significant proportion, [...] Read more.

This report explores the diverse spectrum of congenital anomalies of the kidney and urinary tract (CAKUT), ranging from asymptomatic presentations to the most severe form characterized by bilateral renal agenesis. Genitourinary anomalies, a prevalent subset within this domain, account for a significant proportion, constituting 15–20% of anomalies identified during prenatal screening. An ectopic kidney is defined by the presence of an empty renal fossa and the displacement of the kidney from the lumbar region to alternative locations, with the pelvic region emerging as the most prevalent site. The reported case involves bilateral renal ectopia with unilateral duplex kidney. Initial suspicions of a renal anomaly arose during the first trimester, leading to a definitive diagnosis in the second trimester. The patient underwent regular monitoring every four weeks, ultimately delivering a healthy baby at term. This case underscores the frequency of renal anomalies, emphasizing that a considerable proportion remains asymptomatic. These findings contribute to a broader understanding of congenital renal anomalies, their varied manifestations, and the importance of vigilant prenatal screening for early detection and management. Full article

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2 pages, 950 KiB

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Over-Inflating a Tracheostomy Tube Cuff for Tracheo-Innominate Artery Fistula

by Yi-Chia Hsieh, Wen-Ruei Tang and Ying-Yuan Chen

Diagnostics 2024, 14(2), 223; https://doi.org/10.3390/diagnostics14020223 - 20 Jan 2024

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Abstract

We report an angiographic image of a 58-year-old woman with profuse bleeding from a tracheo-innominate artery fistula. It may not have been possible to obtain this valuable image if adequate initial resuscitation and an over-inflated tracheostomy tube cuff had not been administered to [...] Read more.

We report an angiographic image of a 58-year-old woman with profuse bleeding from a tracheo-innominate artery fistula. It may not have been possible to obtain this valuable image if adequate initial resuscitation and an over-inflated tracheostomy tube cuff had not been administered to stop bleeding during an emergency. Full article

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6 pages, 4584 KiB

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Fatal Subarachnoid Hemorrhage in a Deep Brain Stimulation Patient: Displacement of Stimulation Leads for Deep Brain Stimulation Indicate Subarachnoid Hemorrhage on X-ray

by Gregor Bara, Valeri Borger and Jaroslaw Maciaczyk

Diagnostics 2024, 14(2), 222; https://doi.org/10.3390/diagnostics14020222 - 19 Jan 2024

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Abstract

We depict the rare case of a patient with aneurysmatic subarachnoid hemorrhage previously treated with deep brain stimulation for Parkinson’s disease. Initial CT scans showed a Fisher grade 4 subarachnoid hemorrhage with lead displacement due to midline-shift. CT angiogram revealed a supra-ophthalmic aneurysm [...] Read more.

We depict the rare case of a patient with aneurysmatic subarachnoid hemorrhage previously treated with deep brain stimulation for Parkinson’s disease. Initial CT scans showed a Fisher grade 4 subarachnoid hemorrhage with lead displacement due to midline-shift. CT angiogram revealed a supra-ophthalmic aneurysm of the internal carotid artery. The patient subsequently underwent clipping of the aneurysm and decompressive hemicraniecomy. Full article

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4 pages, 3376 KiB

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Congenital Infiltrating Lipomatosis of the Face: Multimodality Assessment through CT-Scan and Magnetic Resonance Imaging

by Giuseppe Cicero, Francesco Marcello Arico and Silvio Mazziotti

Diagnostics 2024, 14(2), 176; https://doi.org/10.3390/diagnostics14020176 - 12 Jan 2024

Cited by 1 | Viewed by 1022

Abstract

Congenital infiltrating lipomatosis of the face is a rare and benign condition involving a hamartomatous proliferation of mature adipose cells. The final diagnosis derives from a combination of clinical data, histology, and imaging features and affects the treatment decision. This report describes the [...] Read more.

Congenital infiltrating lipomatosis of the face is a rare and benign condition involving a hamartomatous proliferation of mature adipose cells. The final diagnosis derives from a combination of clinical data, histology, and imaging features and affects the treatment decision. This report describes the clinical case of a young patient suffering from facial lipomatosis with particular emphasis on radiological findings detected at CT-scan and magnetic resonance imaging. Full article

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2023

Jump to: 2024, 2022, 2021, 2020

7 pages, 14762 KiB

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Diaphragmatic Liver Herniation after Radiofrequency Ablation of a Secondary Liver Tumor

by David Hoskovec, Josef Hořejš, Zdeněk Krška, Soňa Argalácsová and Pavol Klobušický

Diagnostics 2024, 14(1), 26; https://doi.org/10.3390/diagnostics14010026 - 22 Dec 2023

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Abstract

Radiofrequency thermal ablation (RFA) is widely used and has been accepted for the treatment of unresectable tumors. The leading technique that is used is percutaneous RFA under CT or US guidance. Multicenter surveys report acceptable morbidity and mortality rates for RFA. The mortality [...] Read more.

Radiofrequency thermal ablation (RFA) is widely used and has been accepted for the treatment of unresectable tumors. The leading technique that is used is percutaneous RFA under CT or US guidance. Multicenter surveys report acceptable morbidity and mortality rates for RFA. The mortality rate ranges from 0.1% to 0.5%, the major complication rate ranges from 2% to 3%. Diaphragmatic injury is a rare complication and it is described after RFA of subdiaphragmatic tumors. Most of them are without clinical importance. There are some case reports about diaphragmatic herniation of the intestine into the pleural cavity. We present a case of diaphragmatic perforation resulting in the herniation of the liver into the pleural cavity. A thoracotomy was performed, the liver was lowered back into the peritoneal cavity and the perforation was closed with mesh. Full article

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6 pages, 3265 KiB

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Hepatic Portal Venous Gas (HPVG) after Ingestion of Chlorine Bleach: A Transient Phenomenon

by Francesco M. Arico, Francesco Buemi, Pietro Pitrone, Claudio Giardina, Renato Trimarchi, Flavia Borruto, Sarah Doria, Cristina Turiaco and Simona Caloggero

Diagnostics 2023, 13(24), 3615; https://doi.org/10.3390/diagnostics13243615 - 7 Dec 2023

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Abstract

We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association [...] Read more.

We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association between chlorine bleach ingestion and the development of hepatic portal venous gas (HPVG), a radiological finding traditionally thought to carry poor prognoses. The HPVG in this case resolved spontaneously within 24 h with conservative management, indicating its transient nature. The exact pathophysiological mechanisms responsible for HPVG after the ingestion of toxic substances .remain only partially understood. One hypothesis suggests that extensive damage to the gastrointestinal wall caused by caustic agent may allow enteric gas to enter the portal system. While HPVG after toxic ingestion is often transient, its consequences and potential risks should be carefully considered. Hyperbaric oxygen therapy is suggested in cases with neurological symptoms. In conclusion, HPVG is not a specific disease but rather a manifestation of various underlying factors, and its development in the context of chlorine bleach ingestion represents an additional insight to its understanding. It can be associated with severe medical conditions, but it is also found in less severe cases that can be managed conservatively. Full article

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6 pages, 3067 KiB

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Coexistence of Ehlers–Danlos Syndrome with Coronary–Pulmonary Arterial Fistula and Other Multiple Coronary Artery Anomalies

by Paweł Gać, Arkadiusz Jaworski, Jakub Karwacki, Michał Jarocki, Artur Ams and Rafał Poręba

Diagnostics 2023, 13(23), 3555; https://doi.org/10.3390/diagnostics13233555 - 28 Nov 2023

Cited by 1 | Viewed by 1470

Abstract

This case report presents a 34-year-old male with Ehlers–Danlos syndrome, type 2 diabetes mellitus, aortic valve regurgitation, and aortic bulb aneurysm. Following spine surgery for thoracic–lumbar stabilization, the patient underwent assessment for aortic bulb aneurysm and aortic valve replacement surgeries. Five months post [...] Read more.

This case report presents a 34-year-old male with Ehlers–Danlos syndrome, type 2 diabetes mellitus, aortic valve regurgitation, and aortic bulb aneurysm. Following spine surgery for thoracic–lumbar stabilization, the patient underwent assessment for aortic bulb aneurysm and aortic valve replacement surgeries. Five months post spinal surgery, a coronary computed tomography angiography was performed. The coronary computed tomography angiography revealed unique findings, including the absence of the left main coronary artery, right coronary artery dominance, ectopic origin of the left circumflex artery from the right sinus of the valsalva, a coronary–pulmonary arterial fistula originating from the right sinus of the valsalva, and an additional right pulmonary vein. The patient was qualified for surgical treatment for an aortic bulb aneurysm, was informed about the high surgical risk, and is awaiting surgery. This case underscores the rarity of Ehlers–Danlos syndrome coexisting with multiple coronary artery anomalies. The presence of a coronary–pulmonary arterial fistula further emphasizes the need for specialized patient monitoring when Ehlers–Danlos syndrome and coronary anomalies converge. Full article

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3 pages, 537 KiB

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Two Birds with One Stone: Hepatocellular Carcinoma and Small Cell Lung Cancer Imaged with [¹⁸F]Fluorocholine Positron Emission Tomography/Computed Tomography

by Marco Cuzzocrea, Gaetano Paone and Giorgio Treglia

Diagnostics 2023, 13(16), 2639; https://doi.org/10.3390/diagnostics13162639 - 10 Aug 2023

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Abstract

We describe the case of a 67-year-old male patient with a moderately differentiated hepatocellular carcinoma (HCC) of the right liver lobe who underwent [¹⁸F]fluorocholine positron emission tomography/computed tomography (PET/CT) for staging due to a suspicious lung lesion at previous CT scan. [...] Read more.

We describe the case of a 67-year-old male patient with a moderately differentiated hepatocellular carcinoma (HCC) of the right liver lobe who underwent [¹⁸F]fluorocholine positron emission tomography/computed tomography (PET/CT) for staging due to a suspicious lung lesion at previous CT scan. [¹⁸F]fluorocholine PET/CT showed increased radiopharmaceutical uptake in a liver lesion corresponding to the known HCC. Furthermore, a right pulmonary hilar lesion suspicious for metastatic spread of HCC showed increased radiopharmaceutical uptake. Surprisingly, the histological assessment of the thoracic lesion demonstrated the presence of small cell lung cancer (SCLC). The patient underwent treatment with radiation therapy and chemotherapy for the SCLC and selective internal radiation therapy (SIRT) for the HCC. The patient died after one year due to progressive SCLC. This case demonstrates that coexisting tumors showing increased cell membrane turnover, including SCLC, can be detected by [¹⁸F]fluorocholine PET/CT. In our case, [¹⁸F]fluorocholine PET/CT findings influenced the patient management in terms of histological verification and different treatment of the detected lesions. Full article

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4 pages, 1550 KiB

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Failed Dental Implant: When Titanium Fractures

by João Paulo Mendes Tribst, Arie Werner and Erik J. Blom

Diagnostics 2023, 13(12), 2123; https://doi.org/10.3390/diagnostics13122123 - 20 Jun 2023

Cited by 6 | Viewed by 1849

Abstract

Despite the widespread use of titanium implants in orthopedic and dental surgeries, concerns have recently emerged regarding potential deformations and fractures after osseointegration. In a recent clinical case, a titanium implant fractured after successful osseointegration. This fracture occurred despite the absence of any [...] Read more.

Despite the widespread use of titanium implants in orthopedic and dental surgeries, concerns have recently emerged regarding potential deformations and fractures after osseointegration. In a recent clinical case, a titanium implant fractured after successful osseointegration. This fracture occurred despite the absence of any significant trauma or excessive external force applied to the area. The fracture was attributed to a combination of factors, including abutment design flaws, material fatigue, and biomechanical stress imposed on the implant during functional loading. This raises concerns about the long-term durability and reliability of titanium implants, particularly in high-stress areas such as the posterior region or weight-bearing bones. An image was made with scanning electron microscopy showing the fracture region near the prosthetic platform and highlighting the knowledge that despite their ductility, titanium implants can fracture. Full article

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9 pages, 5019 KiB

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Imaging Criteria for the Diagnosis of Progressive Supranuclear Palsy: Supportive or Mandatory?

by Nicoleta Lupascu, Ioan Cristian Lupescu, Ionuț Caloianu, Florin Naftanaila, Remus Relu Glogojeanu, Carmen Adella Sirbu and Marian Mitrica

Diagnostics 2023, 13(11), 1967; https://doi.org/10.3390/diagnostics13111967 - 5 Jun 2023

Cited by 3 | Viewed by 13539

Abstract

We present the case of a 54-year-old male, without any significant medical history, who insidiously developed speech disturbances and walking difficulties, accompanied by backward falls. The symptoms progressively worsened over time. The patient was initially diagnosed with Parkinson’s disease; however, he failed to [...] Read more.

We present the case of a 54-year-old male, without any significant medical history, who insidiously developed speech disturbances and walking difficulties, accompanied by backward falls. The symptoms progressively worsened over time. The patient was initially diagnosed with Parkinson’s disease; however, he failed to respond to standard therapy with Levodopa. He came to our attention for worsening postural instability and binocular diplopia. A neurological exam was highly suggestive of a Parkinson-plus disease, most likely progressive supranuclear gaze palsy. Brain MRI was performed and revealed moderate midbrain atrophy with the characteristic “hummingbird” and “Mickey mouse” signs. An increased MR parkinsonism index was also noted. Based on all clinical and paraclinical data, a diagnosis of probable progressive supranuclear palsy was established. We review the main imaging features of this disease and their current role in diagnosis. Full article

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6 pages, 3732 KiB

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Minimal Fat Content in Papillary Renal Cell Carcinoma Diagnosed with Dual-Layer Dual-Energy CT

by Velio Ascenti, Francesco M. Arico, Renato Trimarchi, Giuseppe Cicero, Antonio Ieni, Marta Rossanese and Giorgio Ascenti

Diagnostics 2023, 13(10), 1742; https://doi.org/10.3390/diagnostics13101742 - 15 May 2023

Cited by 1 | Viewed by 1864

Abstract

A 56-year-old man with a previous right nephrectomy for multiple papillary renal cell carcinomas (pRCC) underwent a follow-up CT scan. Using a dual-layer dual-energy CT (dlDECT), we demonstrated the presence of a small amount of fat in a 2.5 cm pRCC that mimicked [...] Read more.

A 56-year-old man with a previous right nephrectomy for multiple papillary renal cell carcinomas (pRCC) underwent a follow-up CT scan. Using a dual-layer dual-energy CT (dlDECT), we demonstrated the presence of a small amount of fat in a 2.5 cm pRCC that mimicked the diagnosis of angiomyolipoma (AML). Histological examination demonstrated the absence of macroscopic intratumoral adipose tissue, showing a fair amount of enlarged foam macrophages loaded with intracytoplasmic lipids. The presence of fat density in an RCC is an extremely rare occurrence in the literature. To our knowledge, this is the first description using dlDECT of a minimal amount of fat tissue in a small RCC due to the presence of tumor-associated foam macrophages. Radiologists should be aware of this possibility when characterizing a renal mass with DECT. The option of RCCs must be considered, especially in the case of masses with an aggressive character or a positive history of RCC. Full article

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3 pages, 794 KiB

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In Vivo Fibroblast Activation of Systemic Sarcoidosis: A ⁶⁸Ga-FAPI-04 PET/CT Imaging Study

by Jingnan Wang, Li Huo, Lu Lin, Na Niu and Xiang Li

Diagnostics 2023, 13(8), 1450; https://doi.org/10.3390/diagnostics13081450 - 17 Apr 2023

Cited by 4 | Viewed by 1578

Abstract

A 47-year-old female with cardiac dysfunction and lymphadenopathy underwent ¹⁸FDG PET/CT and ⁶⁸Ga-FAPI-04 imaging for tumor screening. Mild uptake in the left ventricular wall was detected on the oncology ¹⁸FDG PET/CT. True myocardiac-involvement could not be distinguished with physiological uptake. [...] Read more.

A 47-year-old female with cardiac dysfunction and lymphadenopathy underwent ¹⁸FDG PET/CT and ⁶⁸Ga-FAPI-04 imaging for tumor screening. Mild uptake in the left ventricular wall was detected on the oncology ¹⁸FDG PET/CT. True myocardiac-involvement could not be distinguished with physiological uptake. The following ⁶⁸Ga-FAPI-04 showed intense heterogeneous uptake in the left ventricular wall, particularly in the septum and apex area, corresponding with the late gadolinium enhancement regions shown by cardiac MR. Intense uptake was also noted in the mediastinal and bilateral hilar lymph nodes. Endomyocardial biopsy demonstrated sarcoidosis. Full article

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6 pages, 1165 KiB

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Transarterial Embolization of Ruptured Pancreaticoduodenal Artery Pseudoaneurysm Related to Chronic Pancreatitis

by Lucian Mărginean, Adrian Vasile Mureșan, Emil Marian Arbănași, Cătălin Mircea Coșarcă, Eliza Mihaela Arbănași, Eliza Russu, Rares Cristian Filep and Réka Kaller

Diagnostics 2023, 13(6), 1090; https://doi.org/10.3390/diagnostics13061090 - 14 Mar 2023

Cited by 2 | Viewed by 1642

Abstract

We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × [...] Read more.

We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × 4 cm² in size) located intra-abdominally, adjacent to the duodenojejunal area, with hyperdensity around the duodenum, positioned inferior to the pancreas (30–59 HU). Moreover, the CT scan also revealed an enhancing lesion as a pseudoaneurysm of the inferior pancreaticoduodenal artery, measuring 5 × 8 × 8 mm³ with active bleeding and associated hematoma. Following these investigations of the abdominal area, a decision was made to proceed with an endovascular intervention within the interventional radiology department. With the patient under conscious sedation, via a right common femoral artery approach, the superior mesenteric artery was catheterized. While injecting the contrast agent to obtain a better working projection, the pseudoaneurysm ruptured, and acute extravasation of the contrast agent was noted, followed by injection of a mixture of 1 mL Glubran 2 with 2 mL Lipiodol until complete obliteration of the pseudoaneurysm was obtained. The patient was hemodynamically stable at the end of the procedure and was discharged 6 days later in a good condition without active bleeding signs. Full article

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6 pages, 3932 KiB

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Orbital Metastases of Breast Cancer in Males

by Cosmin Adrian Teodoru, Mihai Dan Roman, Horațiu Dura and Maria-Emilia Cerghedean-Florea

Diagnostics 2023, 13(4), 780; https://doi.org/10.3390/diagnostics13040780 - 18 Feb 2023

Cited by 3 | Viewed by 1956

Abstract

We report a case of orbital metastasis of infiltrative breast carcinoma in a 65-year-old man. The patient was diagnosed with stage four breast cancer one year before, for which a mastectomy was performed. He refused postoperative radiotherapy and chemotherapy at that time. He [...] Read more.

We report a case of orbital metastasis of infiltrative breast carcinoma in a 65-year-old man. The patient was diagnosed with stage four breast cancer one year before, for which a mastectomy was performed. He refused postoperative radiotherapy and chemotherapy at that time. He had a history of lung, liver, and mediastinal metastases. At admission, he presented with blurred vision, diplopia, ocular pain, and mild swelling of the upper lid of the left eye (LE). Computed tomography (CT) of the brain and orbit revealed a front-ethmoidal tissue mass with left orbital and frontal intracranial extension. Ophthalmologic examination revealed exophthalmos on the LE with a downward and outward deviation of the eyeball, proptosis, and intraocular pressure (IOP) of 40 mmHg. The patient’s treatment started with topical maximal anti-glaucomatous drops and radiotherapy sessions. After three weeks of follow-up, there was a gradual improvement of local symptoms and signs and a normal IOP. Full article

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2022

Jump to: 2024, 2023, 2021, 2020

5 pages, 1683 KiB

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Cor Triatriatum Sinister Presenting as Cardioembolic Stroke in a Young Woman

by Timea Magdolna Szabo, Erhard Heidenhoffer, Ádám Kirchmaier, Benedek Pelok and Attila Frigy

Diagnostics 2023, 13(1), 97; https://doi.org/10.3390/diagnostics13010097 - 29 Dec 2022

Cited by 6 | Viewed by 1704

Abstract

Cor triatriatum sinister is a rare congenital heart disease characterized by an additional fibromuscular membrane in the left atrium. Cardioembolic stroke is a rare complication of cor triatriatum sinister, especially among women. We hereby describe the case of an 18-year-old female patient, without [...] Read more.

Cor triatriatum sinister is a rare congenital heart disease characterized by an additional fibromuscular membrane in the left atrium. Cardioembolic stroke is a rare complication of cor triatriatum sinister, especially among women. We hereby describe the case of an 18-year-old female patient, without a past medical history, presenting with cardioembolic stroke in the territory of the right posterior cerebral artery. During extensive diagnostic work-up, nonrestrictive cor triatriatum sinister and patent foramen ovale were diagnosed using transthoracic and transesophageal echocardiography. In clinical practice, it is important to identify congenital cardiac defects as potential substrates for cardioembolism in young patients. In our case, cor triatriatum sinister presenting as ischemic stroke was diagnosed, which is an uncommon finding, especially in young females. Determining the optimal management strategy for patients with cor triatriatum sinister complicated by cardioembolic stroke requires a multidisciplinary approach. Full article

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7 pages, 1468 KiB

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New Imaging Features of Multinodular and Vacuolating Neuronal Tumor Revealed by Alcohol and Illicit Drugs Consumption

by Carmen Adella Sirbu, Constantin Ștefani, Sorin Tuță, Aida Mihaela Manole, Octavian Mihai Sirbu, Raluca Ivan, Gabriela Simona Toma, Alexandra Giorgiana Calu and Dragos Catalin Jianu

Diagnostics 2022, 12(11), 2779; https://doi.org/10.3390/diagnostics12112779 - 14 Nov 2022

Cited by 3 | Viewed by 2892

Abstract

It has been almost a decade since the multinodular and vacuolating neuronal tumor (MVNT) was first described. In 2021, WHO classified it as a defined entity, and it is considered one of the glioneuronal and neuronal tumors. Due to its similarities with dysembryoplastic [...] Read more.

It has been almost a decade since the multinodular and vacuolating neuronal tumor (MVNT) was first described. In 2021, WHO classified it as a defined entity, and it is considered one of the glioneuronal and neuronal tumors. Due to its similarities with dysembryoplastic neuroepithelial tumors (DNET), some authors consider it a variant of these, ranking in the category of malformations, but genetic alterations favor a neoplastic origin. We present a 29-year-old male with a generalized onset tonic-clonic seizure after a nightclub party. Imaging studies revealed a right temporal multinodular and vacuolating neuronal tumor confirmed by biopsy. It is considered a nonaggressive, “leave me alone” brain lesion, which does not require biopsy because of well-defined MRI characteristics. Surgery is indicated only in symptomatic cases. We consider that this lesion was revealed by his seizure, most probably provoked (with normal video EEG recording) by the consumption of a lot of alcohol, illicit drugs, and sleep loss after a club party. We recommended close monitoring, but our patient preferred the surgery. Our case added more imaging details corroborated with the histopathology features of MVNT. FLAIR images revealed hypointense nodules surrounded by hyperintense peripheral rings and areas of high signal intensity between the nodules, which correspond to the histopathological architecture. To our knowledge, this is the first case of MVNT with diffusion tensor imaging and fiber tractography imaging studies. Full article

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11 pages, 4692 KiB

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Incidental Vascular Findings in Computed Tomography Performed in the Qualification for the TAVI Procedure

by Paweł Gać, Aleksandra Grochulska and Rafał Poręba

Diagnostics 2022, 12(11), 2773; https://doi.org/10.3390/diagnostics12112773 - 13 Nov 2022

Viewed by 1682

Abstract

Transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) is now a very widespread treatment method for symptomatic and severe aortic stenosis as an alternative for patients at intermediate or high risk of surgery or contraindications to surgery. The key role [...] Read more.

Transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) is now a very widespread treatment method for symptomatic and severe aortic stenosis as an alternative for patients at intermediate or high risk of surgery or contraindications to surgery. The key role of imaging examinations before TAVI is to assess the morphology of the aortic valve, the routes of surgical access, and non-cardiac and extravascular structures. The objective of this article is to present and discuss the importance of selected accidental vascular findings in computed tomography examinations of the heart and large vessels performed in the TAVI qualification procedure: persistent left superior vena cava (SVC) with absent right SVC, right aortic arch, ectopic right coronary artery ostium, and left superior pulmonary vein draining into left brachiocephalic vein. Full article

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4 pages, 967 KiB

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Different Uptake of ⁶⁸Ga-FAPI and ¹⁸F-FDG in Lymphadenopathy Caused by Angioimmunoblastic T-Cell Lymphoma in a Patient with Colon Cancer

by Meiqi Wu, Qingqing Pan and Yaping Luo

Diagnostics 2022, 12(9), 2211; https://doi.org/10.3390/diagnostics12092211 - 13 Sep 2022

Cited by 1 | Viewed by 1955

Abstract

An 82-year-old man with a history of colon cancer was found with multiple lymphadenopathies and a pulmonary mass. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) detected generalized hypermetabolic lymph nodes and an FDG-avid pulmonary mass. PET/CT with ⁶⁸Ga-labeled fibroblast [...] Read more.

An 82-year-old man with a history of colon cancer was found with multiple lymphadenopathies and a pulmonary mass. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) detected generalized hypermetabolic lymph nodes and an FDG-avid pulmonary mass. PET/CT with ⁶⁸Ga-labeled fibroblast activation protein inhibitor (FAPI) revealed intense uptake in the lung mass, consistent with metastatic disease from colon cancer. However, the lymphadenopathies were not avid for ⁶⁸Ga-FAPI, suggesting a different etiology. The biopsy of a cervical node confirmed angioimmunoblastic T-cell lymphoma. The case showcased the potential of ⁶⁸Ga-FAPI in differentiation of solid tumor and hematological disease due to different histopathologic nature of stromal fibrosis. Full article

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4 pages, 1929 KiB

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Multiple Clay Shoveler’s Fractures of the Thoracic Spine

by Wilbur Teng Jun Hoong and Arun-Kumar Kaliya-Perumal

Diagnostics 2022, 12(9), 2190; https://doi.org/10.3390/diagnostics12092190 - 9 Sep 2022

Cited by 1 | Viewed by 2084

Abstract

Typically, a clay shoveler’s fracture is a stress-type avulsion fracture involving the spinous processes of the lower cervical or upper thoracic vertebrae. Even though C7 and T1 are the most commonly involved spinal levels, these avulsion fractures can occur at any lower cervical [...] Read more.

Typically, a clay shoveler’s fracture is a stress-type avulsion fracture involving the spinous processes of the lower cervical or upper thoracic vertebrae. Even though C7 and T1 are the most commonly involved spinal levels, these avulsion fractures can occur at any lower cervical or upper thoracic level, either as solitary or multiple fractures. This fracture used to be common in workers who shovel heavy loads of clay for long periods, hence its name. It does not cause any structural, functional, or neurological impairments and is therefore considered a stable fracture. Management is mostly conservative, involving rest, analgesics, and activity modification for a period of 4–6 weeks. Here, we present a 35-year-old male who sustained a motor vehicle accident. Except for midline tenderness in the back, there were no other positive findings. Plain radiographs showed a T11 vertebral compression fracture and absent or deviated spinous process shadows for most of the upper thoracic vertebrae. Computed tomography (CT) imaging clearly revealed multiple spinous process fractures extending from T2 to T8 levels. Considering the stability of these fractures, the patient was managed conservatively with rest, bracing, and analgesics. The recovery was quick, and he was back to his full functional status by six weeks. Full article

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8 pages, 2077 KiB

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MRI Evolution of a Patient with Viral Tick-Borne Encephalitis and Polymorphic Seizures

by Carmen Adella Sirbu, Constantin Stefani, Marian Mitrică, Gabriela Simona Toma, Aurelian Emil Ranetti, Any Docu-Axelerad, Aida Mihaela Manole and Ion Stefan

Diagnostics 2022, 12(8), 1888; https://doi.org/10.3390/diagnostics12081888 - 4 Aug 2022

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Abstract

Some neurotropic viruses induce specific lesions in the deep structures, such as basal ganglia and thalamus. These anatomical structures play an important role in initiating and maintaining different types of epileptic seizures. We present the case of a 25-year-old male, transferred to our [...] Read more.

Some neurotropic viruses induce specific lesions in the deep structures, such as basal ganglia and thalamus. These anatomical structures play an important role in initiating and maintaining different types of epileptic seizures. We present the case of a 25-year-old male, transferred to our clinic one week after the onset of the symptomatology, with a recent history of traveling to Turkey and Egypt. At the moment of his hospital admission, his symptoms included altered consciousness, agitation, and seizures. Shortly after, his state worsened, requiring intubation. Viral tick-borne encephalitis diagnoses were favored by the CSF (cerebrospinal fluid) analysis, EEG (Electroencephalography), MRI (magnetic resonance imaging) images presenting symmetric hyper signal in the basal ganglia, and IgM antibodies for anti-tick-borne encephalitis. These lesions persisted for several weeks, and the patient’s seizures were polymorphic, originally generalized onset motor, generalized onset non-motor, and focal myoclonic. The patient achieved his independence, seizures decreasing both in intensity and frequency; the MRI images became almost normal. The reduction in antiepileptic doses was not followed by seizure recurrence. Full article

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4 pages, 2295 KiB

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A Case Report of a Gluteus Hematoma Detected on ^99mTc-MDP Bone Scan

by Miju Cheon and Jang Yoo

Diagnostics 2022, 12(6), 1383; https://doi.org/10.3390/diagnostics12061383 - 3 Jun 2022

Cited by 1 | Viewed by 2026

Abstract

This is a case report of a gluteal hematoma detected on ^99mTc-methylene diphosphonate (MDP) whole-body bone scan in a 77-year-old male who had experienced a road traffic accident. Full article

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5 pages, 1965 KiB

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Border-Zone Infarction Due to Cerebrovascular Fibromuscular Dysplasia

by Yu-Ming Chen

Diagnostics 2022, 12(6), 1337; https://doi.org/10.3390/diagnostics12061337 - 27 May 2022

Cited by 1 | Viewed by 2498

Abstract

A 45-year-old male presented with acute-onset left-sided weakness and slurred speech. Non-contrast-enhanced brain magnetic resonance imaging revealed cortical and internal border-zone infarcts compatible with stroke. A survey of ischemic stroke risk factors in young adults excluded coagulopathy, vasculitis, and cardiac disease. Nevertheless, neck-computed [...] Read more.

A 45-year-old male presented with acute-onset left-sided weakness and slurred speech. Non-contrast-enhanced brain magnetic resonance imaging revealed cortical and internal border-zone infarcts compatible with stroke. A survey of ischemic stroke risk factors in young adults excluded coagulopathy, vasculitis, and cardiac disease. Nevertheless, neck-computed tomography angiography revealed a long-segmental narrowing of the right internal carotid artery with wall thickening and a “string-of-beads” appearance suspicious for fibromuscular dysplasia, which was confirmed on further angiography. His clinical condition stabilized after intensive medical therapy. This case demonstrates cerebrovascular fibromuscular dysplasia as a possible cause of ischemic stroke in young adults. Full article

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4 pages, 799 KiB

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Neuroimaging Findings in a Patient with Anti-IgLON5 Disease: Cerebrospinal Fluid Dynamics Abnormalities

by Daniele Urso, Roberto De Blasi, Antonio Anastasia, Valentina Gnoni, Valentina Rizzo, Salvatore Nigro, Benedetta Tafuri, Carlo Maria Iacolucci, Chiara Zecca, Maria Teresa Dell’Abate, Francesca Andreetta and Giancarlo Logroscino

Diagnostics 2022, 12(4), 849; https://doi.org/10.3390/diagnostics12040849 - 30 Mar 2022

Cited by 8 | Viewed by 3333

Abstract

Anti-IgLON5 disease is a recently described autoimmune neurodegenerative disorder characterized by insidious onset, slow progression and a variety of neurological features. Neuroimaging in most patients with anti-IgLON5 disease is normal or shows nonspecific findings. Here, we report a case of anti-IgLON5 disease presenting [...] Read more.

Anti-IgLON5 disease is a recently described autoimmune neurodegenerative disorder characterized by insidious onset, slow progression and a variety of neurological features. Neuroimaging in most patients with anti-IgLON5 disease is normal or shows nonspecific findings. Here, we report a case of anti-IgLON5 disease presenting with parkinsonism, falls, sleep problems with severe nocturnal dyspnea attacks, dysphagia, and dysautonomia. Imaging findings were initially suggestive of progressive supranuclear palsy. An altered cerebrospinal fluid dynamic was found on an MRI as well as high-convexity hyperperfusion on a brain SPECT. Further case descriptions with neuroimaging are required to characterize cerebral and cerebrospinal fluid dynamics abnormalities in this rare condition. Full article

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7 pages, 2620 KiB

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Magnetic Resonance Imaging of Multiple Cerebral and Spinal Cavernous Malformations of a Patient with Dementia and Tetraparesis

by Florian Antonescu, Ioana Butnariu, Florentina Melania Cojocaru, Daniela Nicoleta Anghel, Dana Antonescu-Ghelmez and Sorin Tuță

Diagnostics 2022, 12(3), 677; https://doi.org/10.3390/diagnostics12030677 - 10 Mar 2022

Cited by 1 | Viewed by 3337

Abstract

Cavernomas are rare cerebrovascular malformations that usually occur in sporadic forms with solitary lesions located most often in the hemispheric white matter, but also in the infratentorial or spinal region. Multiple lesions at different CNS levels are considered a hallmark for the familial [...] Read more.

Cavernomas are rare cerebrovascular malformations that usually occur in sporadic forms with solitary lesions located most often in the hemispheric white matter, but also in the infratentorial or spinal region. Multiple lesions at different CNS levels are considered a hallmark for the familial form of the disease. The diagnostic modality of choice for cerebral cavernous malformations (CCMs) is magnetic resonance imaging (MRI). We present an intriguing case of a 65-year-old male admitted to our hospital with tetraparesis and cognitive impairment where highly sensitive MRI sequences identified many cerebral cavernous lesions at the supra-, infratentorial and cervical–thoracic spine levels, some of them with recent signs of bleeding in a patient with oral anticoagulant therapy due to atrial fibrillation. The mechanism of cognitive impairment in this patient is most probably the interruption of strategic white matter tracts, as it is known to happen in other subcortical vascular pathologies. MRI can be helpful not only in mapping the anatomical distribution of lesions, but also in weighing the risks and making decisions regarding whether or not to continue oral anticoagulant therapy. Full article

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2 pages, 1199 KiB

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Specifically Regional Cerebral Hypoperfusion in a Case of Highly Suspected Sporadic Creutzfeldt-Jakob Disease on ^99mTc-ECD SPECT/CT with Easy Z-Score Imaging System Analysis

by Shun-Chieh Chen, Daniel Hueng-Yuan Shen, Hung-Yen Chan, Ming-Hui Yang and Hung-Pin Chan

Diagnostics 2022, 12(2), 437; https://doi.org/10.3390/diagnostics12020437 - 8 Feb 2022

Cited by 1 | Viewed by 1764

Abstract

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly-progressive dementing illness, the challenge of diagnosis during life. We presented a 78-year-old woman reported stupor, right facial palsy, and fluctuations in consciousness. ^99mTc-ECD brain SPECT/CT with eZIS analysis revealed significant decreased regional cerebral blood flow [...] Read more.

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly-progressive dementing illness, the challenge of diagnosis during life. We presented a 78-year-old woman reported stupor, right facial palsy, and fluctuations in consciousness. ^99mTc-ECD brain SPECT/CT with eZIS analysis revealed significant decreased regional cerebral blood flow mainly in specific regions of Alzheimer’s disease as the published article reported with involving frontal region. Brain DWI MRI increased signal intensities corresponding to similar location of ^99mTc-ECD brain SPECT/CT. In this case, we reported the pattern of decreased rCBF may correlate to rapidly progressive dementia and associated neurodegenerative symptoms of the highly suspected sCJD patient. Full article

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5 pages, 1427 KiB

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Significant Stenosis of the Brachiocephalic Trunk and Moderate Stenosis of the Left Circumflex Artery in Computed Tomography Angiography Images

by Paweł Gać and Rafał Poręba

Diagnostics 2022, 12(1), 200; https://doi.org/10.3390/diagnostics12010200 - 14 Jan 2022

Viewed by 2555

Abstract

Atherosclerosis, as a civilization disease, is a serious epidemiological problem. Significant carotid disease and significant coronary artery disease result in acute consequences, such as ischemic stroke and myocardial infarction, which are the major causes of cardiovascular mortality. Typically, atherosclerosis of the aortic arch [...] Read more.

Atherosclerosis, as a civilization disease, is a serious epidemiological problem. Significant carotid disease and significant coronary artery disease result in acute consequences, such as ischemic stroke and myocardial infarction, which are the major causes of cardiovascular mortality. Typically, atherosclerosis of the aortic arch branches involves the bulbs of the common carotid arteries and the proximal segments of the internal carotid arteries, and can be effectively assessed by ultrasonography. Computed tomography angiography enables the identification of patients with less typical clinical manifestations of atherosclerosis, e.g., brachiocephalic trunk stenosis with symptoms of the steal syndrome and moderate stenosis in the coronary arteries. We present examples of computed tomography angiography images of this type of changes. Full article

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2021

Jump to: 2024, 2023, 2022, 2020

2 pages, 428 KiB

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Fractional Flow Reserve in the Diagnosis of Ischemic Heart Disease in a Patient with Coronary Artery Ectasia

by Malgorzata Zalewska-Adamiec, Lukasz Kuzma, Hanna Bachorzewska-Gajewska and Slawomir Dobrzycki

Diagnostics 2022, 12(1), 17; https://doi.org/10.3390/diagnostics12010017 - 23 Dec 2021

Cited by 2 | Viewed by 2582

Abstract

Coronary artery ectasias (CAE) are diffuse dilatations of coronary artery segments with a diameter 1.5 times greater than the largest adjacent normal segment of the vessel. They are found in 0.3–5.0% of coronary angiography. Risk factors for CAE include atherosclerosis, previous percutaneous coronary [...] Read more.

Coronary artery ectasias (CAE) are diffuse dilatations of coronary artery segments with a diameter 1.5 times greater than the largest adjacent normal segment of the vessel. They are found in 0.3–5.0% of coronary angiography. Risk factors for CAE include atherosclerosis, previous percutaneous coronary interventions, arterial inflammation and connective tissue diseases. The diagnosis of CEA in a patient is a considerable diagnostic and therapeutic problem due to the unfavorable prognosis and the lack of guidelines. We present a case of a 69-year-old male patient with a history of retrosternal pain admitted to the clinic for the diagnosis of coronary artery disease. In coronary angiography, numerous ectases of the main coronary arteries and atherosclerotic lesions causing border stenosis of the left anterior descending (LAD), diagonal (2D) and marginal branch (OM). The heart team decided to assess the significance of the changes with the fractional flow reserve (FFR). The FFR was performed and haemodynamically insignificant stenoses of the ectatically dilated coronary arteries were found. The patient was qualified for conservative treatment. Full article

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2 pages, 542 KiB

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Breast Carcinomatous Lymphangitis as an Unusual Presentation of Ovarian Cancer

by Barbara Muoio, Giorgio Treglia, Paola Migliora and Maria Del Grande

Diagnostics 2021, 11(11), 2106; https://doi.org/10.3390/diagnostics11112106 - 14 Nov 2021

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Abstract

We describe the case of a 45-year-old woman with an unusual presentation of metastatic ovarian cancer. The patient presented to the oncological clinic with a three-week history of skin rash on the right breast. She underwent a chest and abdomen CT scan, which [...] Read more.

We describe the case of a 45-year-old woman with an unusual presentation of metastatic ovarian cancer. The patient presented to the oncological clinic with a three-week history of skin rash on the right breast. She underwent a chest and abdomen CT scan, which showed skin thickening of the right breast, right pleural effusion and bilateral cystic ovarian masses. Biopsy of a left ovarian lesion by diagnostic laparoscopy revealed the presence of ovarian serous carcinoma. Biopsy of the breast skin lesion revealed the presence of carcinomatous lymphangitis and immunohistochemistry documented the ovarian origin. Full article

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4 pages, 2652 KiB

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[⁶⁸Ga]Ga-NODAGA-E[(cRGDyK)]₂ Angiogenesis PET/MR in a Porcine Model of Chronic Myocardial Infarction

by Simon Bentsen, Andreas Clemmensen, Mathias Loft, Mette Flethøj, Karina Poulsdóttir Debes, Trine Pagh Ludvigsen, Cecilie Bjørstrup Larsen, Jeppe Kirchhoff, Lisbeth Høier Olsen, Jacob Eifer Møller, Thomas Lund Andersen, Helle Hjorth Johannesen, Thomas Jespersen and Andreas Kjaer

Diagnostics 2021, 11(10), 1807; https://doi.org/10.3390/diagnostics11101807 - 30 Sep 2021

Cited by 5 | Viewed by 2458

Abstract

Angiogenesis is crucial in tissue repair and prevents scar tissue formation following an ischemic event such as myocardial infarction. The ischemia induces formation of new capillaries, which have high expression of integrin α_vβ₃. [⁶⁸Ga]Ga-NODAGA-E[(cRGDyK)]₂ ([⁶⁸ [...] Read more.

Angiogenesis is crucial in tissue repair and prevents scar tissue formation following an ischemic event such as myocardial infarction. The ischemia induces formation of new capillaries, which have high expression of integrin α_vβ₃. [⁶⁸Ga]Ga-NODAGA-E[(cRGDyK)]₂ ([⁶⁸Ga]Ga-RGD) is a promising PET-radiotracer reflecting angiogenesis by binding to integrin α_vβ₃. A Göttingen mini-pig underwent transient catheter-induced left anterior descending artery (LAD) occlusion for 120 min, and after 8 weeks was imaged on a Siemens mMR 3T PET/MR system. A large antero-septal infarction was evident by late gadolinium enhancement (LGE) on the short axis and 2–4 chamber views. The infarcted area corresponded to the area with high [⁶⁸Ga]Ga-RGD uptake on the fused PET/MR images, with no uptake in the healthy myocardium. To support the hypothesis that [⁶⁸Ga]Ga-RGD uptake reflects angiogenesis, biopsies were sampled from the infarct border and healthy myocardium. Expression of α_vβ₃ was evaluated using immunohistochemistry. The staining showed higher α_vβ₃ expression in the capillaries of the infarct border compared to those in the healthy myocardium. These initial data confirm in vivo detection of angiogenesis using [⁶⁸Ga]Ga-RGD PET in a translational model, which overall support the method applicability when evaluating novel cardio-protective therapies. Full article

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4 pages, 978 KiB

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Two Birds with One Stone: Skull Base Meningioma and Jugulotympanic Paragangliomas with Somatostatin Receptor Positron Emission Tomography

by Giorgio Treglia, Mariana Raditchkova, Luca Giovanella, Jean-Jacques Stelmes, Davide G. Bosetti and Francesco Martucci

Diagnostics 2021, 11(9), 1669; https://doi.org/10.3390/diagnostics11091669 - 13 Sep 2021

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Abstract

We describe the case of a 74-year-old female patient previously treated with radiation therapy for a meningioma of the skull base and with surgery for a right tympanic paraganglioma. After the morphological progression of the meningioma demonstrated by magnetic resonance imaging (MRI), the [...] Read more.

We describe the case of a 74-year-old female patient previously treated with radiation therapy for a meningioma of the skull base and with surgery for a right tympanic paraganglioma. After the morphological progression of the meningioma demonstrated by magnetic resonance imaging (MRI), the patient underwent somatostatin receptor positron emission tomography/computed tomography (SR-PET/CT) with Gallium-68 DOTATATE for restaging. This examination showed increased somatostatin receptor expression by the meningioma and confirmed its extension as already assessed by MRI (endocranial extension, skull base involvement and invasion of the right orbit). Furthermore, SR-PET/CT detected two small right jugulotympanic pararagangliomas with high somatostatin receptor expression. Lastly, SR-PET/CT demonstrated that this patient would be an ideal candidate for peptide receptor radionuclide therapy (PRRT) that can be used for the treatment of progressive/treatment-refractory meningiomas and relapsed paragangliomas with high somatostatin receptors expression, both conditions coexisting in this case. Full article

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5 pages, 3449 KiB

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Cell Proliferation PET Imaging with 4DST PET/CT in Colorectal Adenocarcinoma and Adenoma

by Ryogo Minamimoto and Hisako Endo

Diagnostics 2021, 11(9), 1658; https://doi.org/10.3390/diagnostics11091658 - 10 Sep 2021

Viewed by 1870

Abstract

An age of 70-year-old man was incidentally found two focal high 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) uptake in the descending colon and in the sigmoid colon. We observed the feature of these two areas in the preplanned 4′-[methyl-11C]-thiothymidine (4DST) positron emission tomography (PET)/computed Tomography (CT)providing cell [...] Read more.

An age of 70-year-old man was incidentally found two focal high 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) uptake in the descending colon and in the sigmoid colon. We observed the feature of these two areas in the preplanned 4′-[methyl-11C]-thiothymidine (4DST) positron emission tomography (PET)/computed Tomography (CT)providing cell proliferation imaging. A mass forming high 4DST uptake in the descending colon and focal moderate 4DST uptake in the sigmoid colon was confirmed, and that were proven pathologically as adenocarcinoma and moderate to severe type tubular adenoma, respectively. This is the first report to present that colorectal adenoma can be visualized by proliferation PET imaging and the degree of uptake may enable discrimination of colorectal adenoma from adenocarcinoma, based on pathological considerations. Full article

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3 pages, 716 KiB

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An Incidental Pancreatic Finding at 18F-Choline PET/CT: Chronic Mass-Forming Pancreatitis

by Laura Evangelista, Alessandro De Pellegrin, Rossano Girometti, Gianluca Cassarino, Francesco Giacomuzzi and Marco Rensi

Diagnostics 2021, 11(8), 1490; https://doi.org/10.3390/diagnostics11081490 - 17 Aug 2021

Viewed by 2427

Abstract

We present a case of a chronic mass-forming pancreatitis (CMFP) detected by 18F-choline (FCH) PET/CT in a male affected by prostate cancer. FCH PET/CT scan showed a focal uptake in the uncinate process of the pancreas, later diagnosed as a CMFP at biopsy. [...] Read more.

We present a case of a chronic mass-forming pancreatitis (CMFP) detected by 18F-choline (FCH) PET/CT in a male affected by prostate cancer. FCH PET/CT scan showed a focal uptake in the uncinate process of the pancreas, later diagnosed as a CMFP at biopsy. Although the physiological distribution of FCH in the pancreas, a careful interpretation of the images in this area is warranted. Full article

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by Paweł Cichocki, Zbigniew Adamczewski, Jacek Kuśmierek and Anna Płachcińska

Diagnostics 2021, 11(8), 1426; https://doi.org/10.3390/diagnostics11081426 - 6 Aug 2021

Cited by 2 | Viewed by 2400

Abstract

A 61-year-old man was referred for myocardial perfusion scintigraphy (MPS) by an occupational physician to exclude coronary artery disease (CAD). The patient had a complete left bundle branch block (LBBB) that rendered the routine exercise stress test non-diagnostic, but otherwise had no history [...] Read more.

A 61-year-old man was referred for myocardial perfusion scintigraphy (MPS) by an occupational physician to exclude coronary artery disease (CAD). The patient had a complete left bundle branch block (LBBB) that rendered the routine exercise stress test non-diagnostic, but otherwise had no history of heart diseases, good stress tolerance with no symptoms of angina, and no abnormalities in transthoracic echocardiogram, apart from contraction patterns typical for LBBB. Initial MPS, performed using technetium-labeled Sestamibi on a Discovery NM 530c camera equipped with solid-state semiconductor detectors, revealed a significant stress-induced ischemia that did not match the good overall condition of the patient. A motion detection procedure revealed significant heart motion in Z-axis during the stress study. Upon inquiry, the patient reported breathing difficulties caused by the mandatory mask, which slipped into an uncomfortable position during the study. Repeated acquisition, without motion artifacts, revealed no features of ischemia. Full article

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5 pages, 1326 KiB

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Evolution of ¹⁸F-FDG Uptake as a Pitfall of Image Diagnosis for Systemic Anaplastic Large Cell Lymphoma

by Hung Chang and Wen-Yu Chuang

Diagnostics 2021, 11(8), 1387; https://doi.org/10.3390/diagnostics11081387 - 31 Jul 2021

Viewed by 1629

Abstract

In most patients, systemic anaplastic large cell lymphoma (sALCL) is an ¹⁸F-FDG-avid tumor. Both ALK-positive and ALK-negative tumors can be evaluated by PET scans as both tumor types uptake ¹⁸F-FDG in PET. The PET scan is also valuable in predicting prognosis [...] Read more.

In most patients, systemic anaplastic large cell lymphoma (sALCL) is an ¹⁸F-FDG-avid tumor. Both ALK-positive and ALK-negative tumors can be evaluated by PET scans as both tumor types uptake ¹⁸F-FDG in PET. The PET scan is also valuable in predicting prognosis during and after the treatment course. The evolution of ¹⁸F-FDG uptake in patients with sALCL has not been reported. For tumors lacking ¹⁸F-FDG uptake, there is a diagnostic pitfall of underestimating the cancer stage and misjudgment of metastases. In the present case, the PET scan results were negative at diagnosis but disseminated ¹⁸F-FDG avid lesions were found at relapse. Biopsy of bone marrow and lymph nodes revealed the pathological features were identical to the original tumor at the time of diagnosis. In the wake of such evolutional change, physicians dealing with sALCL should be cautious in interpretation of PET/CT scans. Full article

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4 pages, 1674 KiB

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A Rare Case of Primary Breast Osteosarcoma Evaluated with Multiple Modalities

by Tomoyuki Fujioka, Mio Mori, Iichiroh Onishi, Yuka Yashima, Emi Yamaga, Jun Oyama, Kota Yokoyama, Kazunori Kubota, Goshi Oda, Tsuyoshi Nakagawa and Ukihide Tateishi

Diagnostics 2021, 11(7), 1170; https://doi.org/10.3390/diagnostics11071170 - 28 Jun 2021

Viewed by 2189

Abstract

Primary breast osteosarcoma (PBO) is very rare. This report presents a case of POB that was evaluated by multiple modalities. A woman in her 70s presented with a mass of increasing size in her right breast. A mammogram and an ultrasound visualized a [...] Read more.

Primary breast osteosarcoma (PBO) is very rare. This report presents a case of POB that was evaluated by multiple modalities. A woman in her 70s presented with a mass of increasing size in her right breast. A mammogram and an ultrasound visualized a lobulated mass containing coarse calcification in the right breast. Magnetic resonance imaging showed a strong enhancement effect and high signal on diffusion-weighted imaging. Further imaging on 18F-fluorodeoxyglucose positron-emission tomography and computed tomography exhibited a high uptake. A right total mastectomy was performed. Histologic examination revealed abundant periosteal formation, areas of calcification and moderately pleomorphic oval to spindle-shaped stromal cells, leading to the diagnosis of PBO. The presence of calcified breast tumors exhibiting aggressive growth indicates that PBO should be added to the differential diagnosis. Full article

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Active Herpes Zoster Mimicking Worsening of Axillary Lymph Node Metastases of Breast Cancer after Chemotherapy on 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography

by Tomoyuki Fujioka, Kota Yokoyama, Mio Mori, Yuka Yashima, Emi Yamaga, Kazunori Kubota, Jun Oyama, Goshi Oda, Tsuyoshi Nakagawa and Ukihide Tateishi

Diagnostics 2021, 11(6), 1085; https://doi.org/10.3390/diagnostics11061085 - 14 Jun 2021

Cited by 2 | Viewed by 3569

Abstract

A woman in her 60s presented to our hospital with a left breast mass that was diagnosed as breast cancer. 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) revealed intense, hot uptake in the cancerous mass and left axillary lymph node metastasis. After chemotherapy, another [...] Read more.

A woman in her 60s presented to our hospital with a left breast mass that was diagnosed as breast cancer. 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) revealed intense, hot uptake in the cancerous mass and left axillary lymph node metastasis. After chemotherapy, another PET/CT scan was performed. Although the mass and left axillary lymph nodes shrank and FDG uptake decreased, enlarged lymph nodes with high FDG uptake appeared in the right axilla. The patient had a painful vesicular eruption on the front to the back of the right upper hemithorax, which was diagnosed as active herpes zoster. Active herpes zoster mimics a worsening axillary lymph node metastasis on the PET/CT scan. Full article

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Clinical Application of Dynamic SPECT/CT in a Patient with Prior Myocardial Infarction Underwent Percutaneous Coronary Intervention Twice

by Hung-Pin Chan, Chin Hu, Ming-Hui Yang, Hung-Yen Chan and Nan-Jing Peng

Diagnostics 2021, 11(6), 1028; https://doi.org/10.3390/diagnostics11061028 - 3 Jun 2021

Viewed by 2087

Abstract

We present a case of CAD with anteroseptal MI after stent insertion for revascularization due to symptoms presented. MPI with dynamic SPECT/CT provided useful information in terms of flow parameters and matched territories of stenting results as well as providing coronary artery flow [...] Read more.

We present a case of CAD with anteroseptal MI after stent insertion for revascularization due to symptoms presented. MPI with dynamic SPECT/CT provided useful information in terms of flow parameters and matched territories of stenting results as well as providing coronary artery flow phenomenon underwent PCI. In this case, dynamic SPECT/CT may minimize errors with proper stents treatment, especially for controversial MPI results. Full article

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3 pages, 661 KiB

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Sarcoid-Like Reaction in Non-Hodgkin’s Lymphoma—A Diagnostic Challenge for Deauville Scoring on ¹⁸F-FDG PET/CT Imaging

by Michael Winkelmann, Kai Rejeski, Marion Subklewe, Jens Ricke, Marcus Unterrainer, Martina Rudelius and Wolfgang G. Kunz

Diagnostics 2021, 11(6), 1009; https://doi.org/10.3390/diagnostics11061009 - 31 May 2021

Cited by 3 | Viewed by 2699

Abstract

The sarcoid-like reaction represents an autoinflammatory cause of mediastinal and hilar lymphadenopathy but may also involve other lymph node regions and organs. This rare phenomenon has mainly been reported in patients with Hodgkin’s lymphoma (HL) or solid tumors (particularly melanoma) undergoing immunotherapy and [...] Read more.

The sarcoid-like reaction represents an autoinflammatory cause of mediastinal and hilar lymphadenopathy but may also involve other lymph node regions and organs. This rare phenomenon has mainly been reported in patients with Hodgkin’s lymphoma (HL) or solid tumors (particularly melanoma) undergoing immunotherapy and chemotherapy. Cases in non-Hodgkin’s lymphoma (NHL) are very uncommon. We present an uncommon case of a patient with primarily mediastinal diffuse large B-cell lymphoma (DLBCL) who showed a CT-based partial response in interim staging, whereas at end-of-treatment multiple newly enlarged and hypermetabolic mediastinal and bilateral hilar lymph nodes were detected by ¹⁸F-FDG PET/CT imaging. A subsequent histological workup determined a sarcoid-like reaction without any lymphomatous tissue. Therefore, sarcoid-like reactions should be considered as a potential pitfall in Deauville staging with ¹⁸F-FDG PET/CT imaging for patients with NHL. Full article

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4 pages, 1950 KiB

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Imaging of Fibrous Dysplasia Protuberans, an Extremely Rare Exophytic Variant of Fibrous Dysplasia

by Amin Haghighat Jahromi, William F. James, Michael D. Starsiak and Eugene D. Silverman

Diagnostics 2021, 11(6), 1006; https://doi.org/10.3390/diagnostics11061006 - 31 May 2021

Cited by 1 | Viewed by 2833

Abstract

This paper details the case report of a 26-year-old man who presented with a growing right-sided skull mass evaluated with ultrasound, non-contrast CT, contrast-enhanced MRI and ^99mTc-MDP whole body bone scan with SPECT/CT. These studies suggested a broad differential diagnosis favoring benign [...] Read more.

This paper details the case report of a 26-year-old man who presented with a growing right-sided skull mass evaluated with ultrasound, non-contrast CT, contrast-enhanced MRI and ^99mTc-MDP whole body bone scan with SPECT/CT. These studies suggested a broad differential diagnosis favoring benign osseous lesions. Given a more recent increase in the rate of growth, headache and large size, the lesion was excised via craniotomy followed by cranioplasty. Pathology confirmed fibrous dysplasia (FD) as the diagnosis. Interestingly, this report is the imaging evaluation of the exophytic subtype of FD, the so-called FD protuberance, an extremely rare variant of FD, of which only two case reports are found in the literature. Full article

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4 pages, 1677 KiB

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A “Galactic” Chest X-ray

by Cristiano Carbonelli, Angela de Matthaeis, Antonio Mirijello, Concetta Di Micco, Evaristo Maiello, Salvatore De Cosmo and Paolo Graziano

Diagnostics 2021, 11(5), 899; https://doi.org/10.3390/diagnostics11050899 - 18 May 2021

Viewed by 2906

Abstract

Clinical manifestations accompanying respiratory failure with insidious and rapidly progressive onset are often non-specific. Symptoms such as a cough, dyspnea, and fever are common to a large number of inflammatory, infectious, or neoplastic diseases. During the COVID-19 pandemic it is essential to limit [...] Read more.

Clinical manifestations accompanying respiratory failure with insidious and rapidly progressive onset are often non-specific. Symptoms such as a cough, dyspnea, and fever are common to a large number of inflammatory, infectious, or neoplastic diseases. During the COVID-19 pandemic it is essential to limit the use of hospital services and inappropriate diagnostic techniques. A particular radiological pattern can orient the clinical and laboratory scenario and guide the diagnostic workup. A 58-year-old woman was admitted to our COVID-19 unit for suspected coronavirus infection. She was complaining of worsening dyspnea, tachycardia, and low grade fever. A chest X-ray showed diffuse, alveolar, and interstitial lung involvement with micronodules tending to coalescence. This radiographic pattern known as “galaxy sign”, consistent with diffuse, coalescing nodular miliary pulmonary involvement, simulating a non-specific alveolar opacification of the lungs is typical of a few pneumological differential diagnoses, represented by sarcoidosis, tuberculosis, pneumoconiosis, and metastatic lesions, and virtually excludes an interstitial viral pneumonitis. The use of endoscopic techniques can, in such cases, confirm the clinical suspicion for initiating appropriate targeted therapies. Full article

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3 pages, 15183 KiB

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Role of ¹¹C-Methionine PET/CT in ^99mTc-Sestamibi-Negative Parathyroid Adenoma: A Case Report

by Jang Yoo and Miju Cheon

Diagnostics 2021, 11(5), 831; https://doi.org/10.3390/diagnostics11050831 - 4 May 2021

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Abstract

We report a case of 16-year-old female primary hyperparathyroidism patient who underwent cervical ultrasonography and ^99mTc-sestamibi single photon emission computed tomography/computed tomography, both of which were negative for parathyroid adenoma. Subsequent ¹¹C-methionine positron emission tomography/CT showed positive focal uptake suggesting parathyroid [...] Read more.

We report a case of 16-year-old female primary hyperparathyroidism patient who underwent cervical ultrasonography and ^99mTc-sestamibi single photon emission computed tomography/computed tomography, both of which were negative for parathyroid adenoma. Subsequent ¹¹C-methionine positron emission tomography/CT showed positive focal uptake suggesting parathyroid adenoma, which then was confirmed pathologically. Full article

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4 pages, 1446 KiB

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Pilomatrixcarcinoma of the Foot: A New Localization of an Extremely Rare Adnexal Tumour

by Gerardo Cazzato, Anna Colagrande, Paolo Romita, Caterina Foti, Leonardo Resta and Giuseppe Ingravallo

Diagnostics 2021, 11(5), 793; https://doi.org/10.3390/diagnostics11050793 - 28 Apr 2021

Cited by 1 | Viewed by 2040

Abstract

Pilomatrixcarcinoma is a very rare follicular neoplasm that shows matrical differentiation. The majority of these lesions originate de novo, while only a few cases of transformation of pilomatricoma (calcifying epithelioma of Malherbe) have been described in the literature. The neoplasm affects mostly middle-aged [...] Read more.

Pilomatrixcarcinoma is a very rare follicular neoplasm that shows matrical differentiation. The majority of these lesions originate de novo, while only a few cases of transformation of pilomatricoma (calcifying epithelioma of Malherbe) have been described in the literature. The neoplasm affects mostly middle-aged males with a male-to-female ratio of 3–4:1. The most common localizations are the face, head, trunk and extremites, though there are a few reports of pilomatrixcarcinoma of the eyelid, eyebrow, axilla and clitorid. Here, we describe the first case of a pilomatrixcarcinoma on the anterolateral surface of the first toe of the left foot of an 83-year-old patient, which developed in less than six months and led to amputation of the distal phalanx. We report a brief review of the current literature with particular emphasis on histopathological features useful for diagnosis. Full article

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4 pages, 2154 KiB

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Eosinophilic Cystitis Presenting as Possible Pediatric Rhabdomyosarcoma in Conventional Imaging Including ¹⁸F-FDG-PET/CT/MRI—A Rare Case

by Naja Enevold Olsen, Marie Øbro Fosbøl, Jorgen Thorup, Helle Hjorth Johannesen and Lise Borgwardt

Diagnostics 2021, 11(4), 672; https://doi.org/10.3390/diagnostics11040672 - 8 Apr 2021

Cited by 3 | Viewed by 3393

Abstract

Eosinophilic cystitis (EC) is a relatively rare, but benign inflammatory bladder disease compared to that of the malignant pediatric rhabdomyosarcoma (RMS), in which it can be mimicking on initial suspicion. The origin, symptoms and findings of both EC and RMS are still discussed [...] Read more.

Eosinophilic cystitis (EC) is a relatively rare, but benign inflammatory bladder disease compared to that of the malignant pediatric rhabdomyosarcoma (RMS), in which it can be mimicking on initial suspicion. The origin, symptoms and findings of both EC and RMS are still discussed and hence, lead to the challenge in distinguishing them by cystoscopy and several image modalities. We present a case in which cross-sectional imaging modalities including fluorine-18-fluro-2-deoxy-D-glucose (¹⁸F-FDG)-positron emission tomography (PET) / computed tomography (CT) / magnetic resonance imaging (MRI) (¹⁸F-FDG-PET/CT/MRI (The imaging modality ¹⁸F-FDG-PET/CT/MRI referring to two continuous scans scanned on the same ¹⁸F-FDG-tracer dose for both the whole-body ¹⁸F-FDG-PET/CT and the regional ¹⁸F-FDG-PET/MRI of the pelvis.)) raised suspicion of RMS. Hence, the final diagnosis of EC was established by repeated histopathology. It is important to have EC in mind when seeking differential diagnosis of malignant diseases like RMS in order to provide the correct treatment for the patient and highly homogenously increased ¹⁸F-FDG-uptake should raise the suspicion of EC as a differential diagnosis. Furthermore, ¹⁸F-FDG-uptake rate is suggested as a future potential biomarker for monitoring of therapeutic response in eosinophilic inflammatory diseases, thus more research on this topic is needed. Full article

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2 pages, 434 KiB

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A Case of Chronic Neutrophilic Leukemia Incidentally Detected by ¹⁸F-FDG PET/CT

by Miju Cheon, Jang Yoo, Hae Su Kim and Eunsin Bae

Diagnostics 2021, 11(4), 654; https://doi.org/10.3390/diagnostics11040654 - 5 Apr 2021

Viewed by 2404

Abstract

Chronic neutrophilic leukemia (CNL) is a rare, potentially aggressive, myeloproliferative neoplasm. To the best of our knowledge, there are no previous reports dealing with ¹⁸F-FDG PET findings in CNL. We describe a case of CNL in a 69-year-old male, imaged with ¹⁸ [...] Read more.

Chronic neutrophilic leukemia (CNL) is a rare, potentially aggressive, myeloproliferative neoplasm. To the best of our knowledge, there are no previous reports dealing with ¹⁸F-FDG PET findings in CNL. We describe a case of CNL in a 69-year-old male, imaged with ¹⁸F-FDG PET/CT at diagnosis and during treatment. Full article

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3 pages, 522 KiB

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Acute Necrotizing Encephalopathy in a Four-Year-Old Boy

by Cheng-Hsien Tsai and Wei-Sheng Lin

Diagnostics 2021, 11(3), 568; https://doi.org/10.3390/diagnostics11030568 - 22 Mar 2021

Cited by 1 | Viewed by 3049

Abstract

Acute necrotizing encephalopathy is a devastating clinico-radiological syndrome characterized by fulminant neurological deterioration after an antecedent febrile illness, as well as the imaging hallmark of bilateral thalamic involvement. Herein, we describe a 4-year-old boy with typical clinical and neuroimaging features of acute necrotizing [...] Read more.

Acute necrotizing encephalopathy is a devastating clinico-radiological syndrome characterized by fulminant neurological deterioration after an antecedent febrile illness, as well as the imaging hallmark of bilateral thalamic involvement. Herein, we describe a 4-year-old boy with typical clinical and neuroimaging features of acute necrotizing encephalopathy. The bithalamic swelling led to a block of cerebrospinal fluid circulation at the foramen of Monro, thereby causing the mild dilatation of lateral ventricles. The periventricular areas could, therefore, have been potentially affected by the acute necrotizing encephalopathy per se and/or transependymal edema secondary to obstructive hydrocephalus. The information from diffusion imaging allows for differentiation between these two pathophysiological processes. Full article

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Left Ventricular Rupture as a Complication of Anterior Wall Myocardial Infarction on Computed Tomography Angiography and Ventriculography

by Paweł Gać, Piotr Macek, Andrzej Szczepański and Rafał Poręba

Diagnostics 2021, 11(3), 525; https://doi.org/10.3390/diagnostics11030525 - 16 Mar 2021

Cited by 1 | Viewed by 2408

Abstract

Rupture of the free wall of the left ventricle, rupture of the interventricular septum and acute mitral regurgitation are mechanical complications of myocardial infarction. They are rare; left ventricular rupture occurs in about 2–4% of patients with myocardial infarction. We present the case [...] Read more.

Rupture of the free wall of the left ventricle, rupture of the interventricular septum and acute mitral regurgitation are mechanical complications of myocardial infarction. They are rare; left ventricular rupture occurs in about 2–4% of patients with myocardial infarction. We present the case of an 85-year-old woman with an anterior wall infarction complicated by left ventricular rupture. We present diagnostic images of pathology visualized by computed tomography angiography, performed in order to exclude aortic dissection as the cause of the presence of fluid in the pericardial sac. Images from ventriculography are also presented. Summing up, during the diagnostic and therapeutic process of acute coronary syndrome, it is important to bear in mind the risk of possible complications, such as left ventricular rupture. Full article

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Acute Labyrinthitis Revealing COVID-19

by Marie Perret, Angélique Bernard, Alan Rahmani, Patrick Manckoundia and Alain Putot

Diagnostics 2021, 11(3), 482; https://doi.org/10.3390/diagnostics11030482 - 9 Mar 2021

Cited by 24 | Viewed by 5195

Abstract

An 84-year-old man presented to the emergency department for acute vomiting associated with rotational vertigo and a sudden right sensorineural hearing loss. A left peripheral vestibular nystagmus was highlighted. The patient was afebrile, without respiratory signs or symptoms. Blood sampling at admission showed [...] Read more.

An 84-year-old man presented to the emergency department for acute vomiting associated with rotational vertigo and a sudden right sensorineural hearing loss. A left peripheral vestibular nystagmus was highlighted. The patient was afebrile, without respiratory signs or symptoms. Blood sampling at admission showed lymphopenia, thrombopenia and neutrophil polynucleosis, without elevation of C reactive protein. Cerebral magnetic resonance imaging eliminated a neurovascular origin. Vestibule, right semicircular canals and cochlear FLAIR hypersignals were highlighted, leading to the diagnosis of right labyrinthitis. A nasopharyngeal swab sampled at admission returned positive for SARS CoV2 by polymerase chain reaction. The etiologic investigation, including syphilitic and viral research, was otherwise negative. An oral corticotherapy (prednisone 70 mg daily) was introduced, followed by a progressive clinical recovery. Although acute otitis media have already been highlighted as an unusual presentation of COVID-19, radiology-proven labyrinthitis had to our knowledge, never been described to date. Full article

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4 pages, 957 KiB

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Neuroendocrine Differentiation of Prostate Cancer Is Not Systematically Associated with Increased 18F-FDG Uptake

by Matteo Bauckneht, Silvia Morbelli, Alberto Miceli, Sara Elena Rebuzzi and Giuseppe Fornarini

Diagnostics 2021, 11(3), 468; https://doi.org/10.3390/diagnostics11030468 - 8 Mar 2021

Cited by 7 | Viewed by 2204

Abstract

Neuroendocrine differentiation (NED) of prostate cancer represents an acknowledged predictor of resistant and more aggressive disease. NED can be functionally exploited in vivo using PET/CT imaging with somatostatin analogs radiolabeled with 68Ga. Many previous reports have shown that 18F-FDG PET/CT should also be [...] Read more.

Neuroendocrine differentiation (NED) of prostate cancer represents an acknowledged predictor of resistant and more aggressive disease. NED can be functionally exploited in vivo using PET/CT imaging with somatostatin analogs radiolabeled with 68Ga. Many previous reports have shown that 18F-FDG PET/CT should also be used in cases such as guiding management, as NED is systematically associated with increased glycolysis. We hereby discuss the case of a metastatic prostate cancer patient in which 68Ga-Dotatoc PET/CT revealed the occurrence of NED with low FDG-avidity. Full article

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Unraveling an Unusual Phenocopy of Hypertrophic Cardiomyopathy: MELAS Syndrome

by Anna B. Reid, Luigi Venetucci, Matthias Schmitt and Gaetano Nucifora

Diagnostics 2021, 11(2), 295; https://doi.org/10.3390/diagnostics11020295 - 12 Feb 2021

Cited by 3 | Viewed by 2346

Abstract

The mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is an uncommon cause of cardiac hypertrophy, fibrosis, and dysfunction. It shares similar features to numerous other causes of left ventricular hypertrophy, and therefore, because of its rarity, may not be immediately [...] Read more.

The mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is an uncommon cause of cardiac hypertrophy, fibrosis, and dysfunction. It shares similar features to numerous other causes of left ventricular hypertrophy, and therefore, because of its rarity, may not be immediately considered as a diagnosis. Prompt recognition of clinical and cardiac imaging features may expedite diagnosis and management. We report the case of a 38-year-old man admitted with neurological symptoms and in whom the diagnostic workup led to the diagnosis of MELAS syndrome with cardiac involvement. Full article

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Systemic Mastocytosis Associated with “Smoldering” Multiple Myeloma

by Magda Zanelli, Stefano Ricci, Maurizio Zizzo, Francesca Sanguedolce, Federica De Giorgi, Andrea Palicelli, Giovanni Martino and Stefano Ascani

Diagnostics 2021, 11(1), 88; https://doi.org/10.3390/diagnostics11010088 - 7 Jan 2021

Cited by 11 | Viewed by 2977

Abstract

A 79-year-old woman presented with a long history of peripheral eosinophilia. Previous right hemicolectomy for colonic polyposis was reported. Laboratory tests were notable for mild macrocitic anaemia and eosinophilia. β2 microglobulin and serum tryptase levels were elevated. Serum immunofixation revealed IgA/kappa monoclonal protein. [...] Read more.

A 79-year-old woman presented with a long history of peripheral eosinophilia. Previous right hemicolectomy for colonic polyposis was reported. Laboratory tests were notable for mild macrocitic anaemia and eosinophilia. β2 microglobulin and serum tryptase levels were elevated. Serum immunofixation revealed IgA/kappa monoclonal protein. Bence-Jones protein was positive. Bone marrow (BM) biopsy revealed the coexistence of two neoplastic components. Cohesive clusters of bland-looking, spindle-shaped mast cells, representing 20% of marrow cellularity, were close to aggregates of mature plasma cells occupying 40% of marrow cellularity. Molecular analysis on marrow aspirate demonstrated KIT D816V mutation, TET2 mutation, monoallelic deletion of TP53/17p13 and trisomy of ATM/11q23. A bone density study revealed mild osteoporosis. Full skeletal X-rays and magnetic resonance imaging (MRI) of spine and hips showed multiple, small rarefaction areas and an old L1-L2 fracture, both ascribed to osteoporosis. The association of systemic mastocytosis (SM) and multiple myeloma (MM) is very uncommon. The coexistence of SM with MM placed our patient in the SM with associated clonal haematological non-mast-cell lineage disease (SM-AHN) subtype. Midostaurin therapy was started. Full article

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2020

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4 pages, 596 KiB

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Magnetic Resonance Imaging of Intramyocardial Fat Deposition in Tuberous Sclerosis

by Zoi Tsoumani, Melanie Greaves, Matthias Schmitt and Gaetano Nucifora

Diagnostics 2020, 10(12), 1031; https://doi.org/10.3390/diagnostics10121031 - 1 Dec 2020

Viewed by 2267

Abstract

Tuberous sclerosis complex (TSC) is a rare autosomal dominant neurocutaneous syndrome. The phenotype is highly variable and may affect several organ systems, the hallmark of the disease being widespread hamartomas or abnormal growth of normal tissues. Although cardiac rhabdomyomas are the most common [...] Read more.

Tuberous sclerosis complex (TSC) is a rare autosomal dominant neurocutaneous syndrome. The phenotype is highly variable and may affect several organ systems, the hallmark of the disease being widespread hamartomas or abnormal growth of normal tissues. Although cardiac rhabdomyomas are the most common cardiac manifestation of TSC, being developed quite early, even during the second semester of the gestation, they tend to regress spontaneously over a period of months or years. On the other hand, the presence of intramyocardial fat deposition has been significantly associated with brain involvement and other extracardiac manifestations. We report the case of a 37-year-old man with TSC who presented to hospital with loss of consciousness, head injury and amnesia and in whom cardiac magnetic resonance imaging revealed the presence of multiple areas intramyocardial fat deposition. Full article

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4 pages, 5974 KiB

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¹⁸F-FDG PET/CT for Response Assessment in Pediatric Sebaceous Carcinoma of the Parotid Gland

by Adrien Holzgreve, Thomas Pfluger, Irene Schmid, Orlando Guntinas-Lichius, Wolfgang G. Kunz, Jens Ricke, Peter Bartenstein, Nathalie L. Albert and Marcus Unterrainer

Diagnostics 2020, 10(11), 908; https://doi.org/10.3390/diagnostics10110908 - 6 Nov 2020

Cited by 2 | Viewed by 2693

Abstract

A 16-year-old male patient underwent ¹⁸F-FDG PET/CT staging after multiple surgical resections and radiotherapy of an uncommon metastatic pediatric sebaceous carcinoma of the parotid gland. Initial PET/CT imaging exhibited a recurrent paravertebral metastasis (C4) as well as a metabolically active tumor tissue [...] Read more.

A 16-year-old male patient underwent ¹⁸F-FDG PET/CT staging after multiple surgical resections and radiotherapy of an uncommon metastatic pediatric sebaceous carcinoma of the parotid gland. Initial PET/CT imaging exhibited a recurrent paravertebral metastasis (C4) as well as a metabolically active tumor tissue at the primary site. Follow-up PET/CT after radiotherapy of the cervical spine (C4) and four cycles of chemotherapy with cisplatin and palbociclib revealed complete functional remission in the cervical spine and partial remission at the primary site. This case illustrates the ¹⁸F-FDG-uptake behavior and the disease course of a very rare malignant epithelial tumor of the salivary glands. Full article

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4 pages, 7067 KiB

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Massive Relief: Papillary Adenoma of the Lung in Asymptomatic Former Smoker Patient

by Jelena Stojšić, Marko Popović, Federica Pezzuto and Jelena Marković

Diagnostics 2020, 10(11), 906; https://doi.org/10.3390/diagnostics10110906 - 6 Nov 2020

Cited by 3 | Viewed by 3070

Abstract

Benign epithelial tumors of the lung are uncommon and can represent a diagnostic challenge. Herein, we describe one such emblematic case. A 59-year-old former smoker male was admitted to the hospital complaining of cough for a long time. A radiological examination showed a [...] Read more.

Benign epithelial tumors of the lung are uncommon and can represent a diagnostic challenge. Herein, we describe one such emblematic case. A 59-year-old former smoker male was admitted to the hospital complaining of cough for a long time. A radiological examination showed a centrally excavated mass strictly connected to the visceral pleura. The patient underwent tumorectomy. At gross examination, the tumor was composed of solid and cystic areas containing clear liquid. Histological examination highlighted a sub-pleural encapsulated tumor, with foci of capsular invasion, characterized by a single layer of columnar and cuboidal epithelial cells lining moderately cellular fibro-vascular cores. A wide spectrum of immunohistochemical markers was performed. The final diagnosis was suggestive of a peripheral pulmonary papillary tumor of undetermined malignant potential. At the last follow-up, six years after surgery, no recurrence or metastases were described. Reporting this case, we would like to point out the existence of these rare entities that should be taken into account in the diagnostic process, thus avoiding potential misdiagnosis. Moreover, the presence of capsular invasion should be better investigated in order to reconsider the exact terminology of the tumor and the classification of its malignant potential. Full article

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4 pages, 1757 KiB

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CT Findings in Negative Pressure Pulmonary Edema

by Adrien Holzgreve, Matthias P. Fabritius and Philippe Conter

Diagnostics 2020, 10(10), 749; https://doi.org/10.3390/diagnostics10100749 - 25 Sep 2020

Cited by 6 | Viewed by 3470

Abstract

Negative pressure pulmonary edema (NPPE) is a rare, potentially life-threatening, and yet diagnostically challenging perioperative complication. Most cases of NPPE occur in the context of anesthetic procedures, mainly caused by upper airway obstruction, and are diagnosed during the recovery period. We present a [...] Read more.

Negative pressure pulmonary edema (NPPE) is a rare, potentially life-threatening, and yet diagnostically challenging perioperative complication. Most cases of NPPE occur in the context of anesthetic procedures, mainly caused by upper airway obstruction, and are diagnosed during the recovery period. We present a case of fulminant NPPE in a patient during general anesthesia which illustrates the eye-catching CT findings that can occur in NPPE and eventually support diagnosis. With regard to the current pandemic, we include a discussion of the typical imaging patterns of COVID-19 as a radiological differential diagnosis of NPPE. A 42-year old male patient presented with sudden respiratory insufficiency during arthroscopic knee lavage and subsequently required highly invasive ventilation therapy and catecholamine administration. Postoperative CT imaging of the thorax exhibited extensive, centrally accentuated consolidations with surrounding ground-glass opacity in all lung lobes, suggestive of pulmonary edema. In view of the clinical course and the imaging findings, a negative pressure pulmonary edema (NPPE) was diagnosed. Full article

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3 pages, 1411 KiB

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Mesonephric Adenocarcinoma of the Uterine Fundus Exhibiting High ¹⁸F-FDG Uptake

by Hyung Kyung Kim, Kyu Yeoun Won and Chanwoo Kim

Diagnostics 2020, 10(9), 729; https://doi.org/10.3390/diagnostics10090729 - 21 Sep 2020

Cited by 1 | Viewed by 2621

Abstract

Mesonephric adenocarcinoma is a rare tumor that is considered to develop from mesonephric remnants of the female genital tract. This tumor usually occurs in the lateral wall of the uterine cervix. Herein, we present an exceptionally rare case of mesonephric adenocarcinoma located in [...] Read more.

Mesonephric adenocarcinoma is a rare tumor that is considered to develop from mesonephric remnants of the female genital tract. This tumor usually occurs in the lateral wall of the uterine cervix. Herein, we present an exceptionally rare case of mesonephric adenocarcinoma located in the uterine fundus. The tumor exhibited intense hypermetabolism on ¹⁸F-FDG PET/CT. Based on the characteristic histologic features and immunohistochemical phenotypes, the diagnosis of mesonephric adenocarcinoma was confirmed. The patient underwent hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection, and no lymph node or distant metastasis was identified. After 20 months of surveillance without adjuvant therapy, she remains free of relapse. Full article

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5 pages, 2252 KiB

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Primary Cardiac Intimal Sarcoma Visualized on 2-[¹⁸F]FDG PET/CT

by Kim Francis Andersen, Nahid Sharghi Someh, Annika Loft and Jane Maestri Brittain

Diagnostics 2020, 10(9), 718; https://doi.org/10.3390/diagnostics10090718 - 18 Sep 2020

Cited by 5 | Viewed by 2754

Abstract

Primary cardiac tumors are extremely rare, with an incidence of 0.001–0.03%. Twenty-five percent of these tumors are malignant, with sarcomas accounting for approximately 95%. Cardiac intimal sarcoma is the least reported subtype of primary cardiac sarcoma. These endocardial mesenchymal tumors most often arise [...] Read more.

Primary cardiac tumors are extremely rare, with an incidence of 0.001–0.03%. Twenty-five percent of these tumors are malignant, with sarcomas accounting for approximately 95%. Cardiac intimal sarcoma is the least reported subtype of primary cardiac sarcoma. These endocardial mesenchymal tumors most often arise from great arterial vessels, and are rarely located in the heart. They often present with an aggressive clinical course and have a poor prognosis, with surgical resection with achievement of free margins being the mainstay of treatment. This emphasizes the importance of an early, correct diagnosis and timely intervention. We report a 60-year-old Caucasian male with several former cardiac surgical procedures due to congenital aortic stenosis, presenting with functional mitral stenosis/insufficiency and left ventricular outflow tract obstruction (LVOTO) due to massive masses in the left ventricle and atrium of the heart. Hybrid imaging with 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission tomography/computed tomography (2-[¹⁸F]FDG PET/CT) was performed prior to surgery to characterize the intracardiac masses and estimate tumor burden, as well as to identify a potential extracardiac primary malignancy. Full article

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2 pages, 471 KiB

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Monostotic Fibrous Dysplasia Mimicking Metastasis in the Femoral Neck on Bone Scintigraphy and ¹⁸F-FDG PET/CT

by Wei-Liang Hung, Hung-Yen Chan, Ni-Chun Kuo and Hung-Pin Chan

Diagnostics 2020, 10(9), 682; https://doi.org/10.3390/diagnostics10090682 - 10 Sep 2020

Cited by 3 | Viewed by 3685

Abstract

A 51-year-old woman who had lung adenocarcinoma was found to have a high uptake area over the right femoral neck by means of bone scintigraphy, suggesting a suspicious bony metastasis. ¹⁸F-FDG PET/CT was arranged, and showed an FDG-avid lesion in the same [...] Read more.

A 51-year-old woman who had lung adenocarcinoma was found to have a high uptake area over the right femoral neck by means of bone scintigraphy, suggesting a suspicious bony metastasis. ¹⁸F-FDG PET/CT was arranged, and showed an FDG-avid lesion in the same region. However, after augmented CT, a well-defined ground-glass lesion with circular calcification was found, which is the favored benign lesion of fibrous dysplasia. The following imaging of bone scintigraphy and ¹⁸F-FDG PET/CT presented no apparent change. This case demonstrates that the treatment scheme should not be solely guided by abnormalities in scintigraphy. Additional imaging is recommended for accurate staging or development of an appropriate treatment plan. Full article

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5 pages, 2044 KiB

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Brain Metastases Unresponsive to Immunotherapy Detected by 18F-FDG-PET/CT in a Patient with Melanoma

by Rosa Fonti, Sara Pellegrino, Ciro Gabriele Mainolfi, Elide Matano and Silvana Del Vecchio

Diagnostics 2020, 10(6), 410; https://doi.org/10.3390/diagnostics10060410 - 17 Jun 2020

Cited by 4 | Viewed by 4246

Abstract

Recently, newer therapies such as immunotherapy have been increasingly used in the treatment of several tumors, including advanced melanoma. In particular, several studies showed that the combination of ipilimumab, an anti-Cytotoxic T-lymphocyte Associated Protein 4 (CTLA-4) monoclonal antibody and nivolumab, an anti-Programmed Death [...] Read more.

Recently, newer therapies such as immunotherapy have been increasingly used in the treatment of several tumors, including advanced melanoma. In particular, several studies showed that the combination of ipilimumab, an anti-Cytotoxic T-lymphocyte Associated Protein 4 (CTLA-4) monoclonal antibody and nivolumab, an anti-Programmed Death 1 (PD-1) monoclonal antibody, leads to improved survival in patients with metastatic melanoma. Despite that, immunotherapeutic agents may not reach therapeutic concentration in the brain due to the blood–brain barrier. We report the case of a 50-year-old man with advanced melanoma who underwent whole-body 18F-FDG-PET/CT before and after treatment with immunotherapy showing resistant brain metastases confirmed by subsequent MRI of the brain. Moreover, 18F-FDG-PET/CT was able to detect an immune-related adverse event such as enterocolitis that contributed to the worsening of patient conditions. This case shows how a whole-body methodology such as 18F-FDG-PET/CT can be useful in identifying melanoma cancer patients unresponsive to immunotherapy that may benefit from traditional palliative therapy in the effort to improve their quality of life. Full article

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4 pages, 607 KiB

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Dural Metastases of Advanced Prostate Cancer Detected by ¹⁸F-Fluorocholine

by Mauro Morassi, Mattia Bonacina, Claudio Bnà, Alberto Zaniboni and Giordano Savelli

Diagnostics 2020, 10(6), 385; https://doi.org/10.3390/diagnostics10060385 - 8 Jun 2020

Viewed by 3856

Abstract

Prostate cancer with extensive dural metastases is very rare, with only few cases described in the literature. We report one such case of a 74-year-old man with advanced prostate cancer, and in relatively good clinical condition. The patient returned with complaints of headache [...] Read more.

Prostate cancer with extensive dural metastases is very rare, with only few cases described in the literature. We report one such case of a 74-year-old man with advanced prostate cancer, and in relatively good clinical condition. The patient returned with complaints of headache and diplopia. Fluorocholine (¹⁸F) chloride (¹⁸F-FCH) is an analog of choline in which a hydrogen atom has been replaced by fluorine (¹⁸F). After crossing the cell membrane by a carrier-mediated mechanism, choline is phosphorylated by choline kinase to produce phosphorylcholine. ¹⁸F-FCH positron emission tomography–computed tomography (PET/CT) is widely used to stage and restage patients affected by prostate cancer with good sensitivity. ¹⁸F-FCH PET/CT showed disease progression with the onset of multiple skull lesions. Numerous suspicious dural hypermetabolic lesions indicating neoplastic involvement were detected along the fronto-parietal convexities, in the left fronto-orbital region and right lateral wall of the orbit, concerning for metastases in these regions. A contrast-enhanced computed tomography (CECT) scan was performed which showed corresponding enhancing tissue which correlated with the PET findings. The final imaging diagnosis was osteo-dural metastases from prostate cancer associated with poor outcome. Awareness of this pattern of metastases may be of clinical relevance in order to avoid unnecessary invasive diagnostic procedures in groups of patients with a dismal prognosis. Full article

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4 pages, 1082 KiB

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Diagnosis of Dizziness Due to a Core Vestibular Projection Injury in a Patient with Intracerebral Hemorrhage

by Hyeok Gyu Kwon, Chul Hoon Chang and Sung Ho Jang

Diagnostics 2020, 10(4), 220; https://doi.org/10.3390/diagnostics10040220 - 15 Apr 2020

Cited by 5 | Viewed by 3354

Abstract

Herein, we present a patient diagnosed with dizziness due to a core vestibular projection injury following intracerebral hemorrhage (ICH). A 51-year-old female patient underwent conservative management for a spontaneous ICH in the left hemisphere (mainly affecting the basal ganglia and insular cortex). When [...] Read more.

Herein, we present a patient diagnosed with dizziness due to a core vestibular projection injury following intracerebral hemorrhage (ICH). A 51-year-old female patient underwent conservative management for a spontaneous ICH in the left hemisphere (mainly affecting the basal ganglia and insular cortex). When she visited the rehabilitation department of the university hospital at two years after the ICH onset, she advised of the presence of moderate dizziness (mainly, light-headedness) that started after ICH onset. She mentioned that her dizziness had decreased slightly over time. No abnormality was observed in the vestibular system of either ear on physical examination by an otorhinolaryngologist. However, diffusion tensor tractography results showed that the core vestibular projection in the left hemisphere was discontinued at the basal ganglia level compared with the patient’s right core vestibular projection and that of a normal subject. Therefore, it appears that the dizziness in this patient can be ascribed to a left core vestibular projection injury. Full article

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3 pages, 587 KiB

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“Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation

by Wonho Lee, Mathieu Boudier-Revéret, Du Hwan Kim and Min Cheol Chang

Diagnostics 2020, 10(4), 185; https://doi.org/10.3390/diagnostics10040185 - 27 Mar 2020

Cited by 3 | Viewed by 2835

Abstract

A 77-year-old woman having back pain due to an L2 vertebral body compression fracture took a lumbar spine magnetic resonance imaging (MRI). In MRI, in addition to the L2 vertebral body fracture, invagination of the small intestine into the intervertebral disc space at [...] Read more.

A 77-year-old woman having back pain due to an L2 vertebral body compression fracture took a lumbar spine magnetic resonance imaging (MRI). In MRI, in addition to the L2 vertebral body fracture, invagination of the small intestine into the intervertebral disc space at L5-S1 was found by chance. On a lateral lumbar spinal X-ray, the lordotic angle was markedly increased at the L5-S1 level. Additionally, the L5-S1 disc space had widened. These X-ray findings indicate the segmental instability at L5-S1. The spinal fusion operation on L3-4-5 seems to have resulted in overt mechanical loading on the inferior spinal segment (L5-S1). We think the instability damaged the anterior longitudinal ligament and caused a tear in the anterior portion of the annulus fibrosus. The defect in the L5-S1 intervertebral disc after the tear would have caused the vacuum, which is presumed to have pulled the patient’s small intestine into the empty space within the L5-S1 intervertebral disc. Although intervertebral invagination of intra-abdominal structures is not common, clinicians should be aware of the possibility of this complication in patients who have spinal segmental instability. Full article

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