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Rituximab-Related Interstitial Pneumonitis: A Case Report, the CT Images, and a Literature Review

Rituximab has been proved effective in B-cell lymphomas as a single agent or in combination with chemotherapy. In rare cases, it may cause interstitial lung disease due to potentially fatal pulmonary toxicity. We report a patient who developed severe interstitial pneumonitis after combination of rituximab with cyclophosphamide, vincristine and prednisolone (COP).

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Serial Imaging Follow-Up of a Case with Neurocutaneous Melanosis

We herein report a 19-month-old boy with neurocutaneous melanosis (NCM) without neurologic symptoms. He was born with large cutaneous melanocytic nevi mainly on the back and multiple ＂satellite nevi＂ over the other part of body. First Magnetic resonance imaging (MRI) of the brain at the age of 4 days revealed melanocytic deposits in the brain parenchyma and leptomeninges. During the 19-month follow-up with serial MRI of the brain, there was no evidence of progression while two distinct patterns of age related regression of melanocytic deposits were observed. This case reminds us both images and clinical characteristics of the NCM.

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Multiple Ectopic Thyroid with Goiter: A Rare Case

The presence of multiple thyroid ectopias with a normally located thyroid gland is a very rare condition. We present a 38-year-old Taiwanese man who had palpable neck masses for a few months. He was clinically euthyroid and results of the thyroid function tests were normal. Neck ultrasonography revealed left thyroid goiter and a left lateral neck mass. Computed tomography (CT) scan of the neck showed a multicystic lesion in the left thyroid gland plus several nodular lesions with similar appearances at the bilateral submandibular regions, bilateral level II and left level IV of the neck. He underwent left hemithyroidectomy and complete excision of the left lateral neck mass. The histopathological diagnosis of the left thyroid lesion was goiter with cystic degeneration, and the lateral neck mass was ectopic thyroid goiter.

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Tracheal Schwannoma: Making a Prompt Evaluation with Chest Radiograph

Tracheal schwannomas are rare entities, accounting for 2% of all benign tracheal tumors. Clinical manifestations of tracheal schwannomas are nonspecific, often leading to delayed diagnosis. Although chest radiographs are quite limited by superimposition of anatomical structures, tracheal tumors can be easily visible; rapid diagnosis of such tumors potentially prevents serious complications. Here, we present two cases of tracheal schwannomas detected on chest radiographs.

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Improving Patient Safety in Radiological Examinations Using Collaboration and Transparency with Industry

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Hepatoid Adenocarcinoma of the Lung: An Unusual Subtype of Lung Cancer

Hepatoid adenocarcinoma of the lung (HAL) is a rare lung cancer typically defined as an alpha-fetoprotein (AFP)- producing primary cancer with mimic histopathologic features of hepatocellular carcinoma. We present a case of HAL in a 48-year-old male patient with a history of smoking and alcohol consumption. He complained of chronic productive cough with blood-tinged sputum, right upper chest wall pain, and weight loss. Chest CT showed a large, necrotic tumor in right upper lung with amorphous calcification and mass effect on mediastinal structures. His serum AFP levels were highly elevated (34,700 mg/mL). After CT-guided biopsy, the diagnosis of HAL was confirmed by the histopathologic identification of hepatoid cells with positive expression of AFP.

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Does Slice Thickness Matter on Measuring Tumor Volume of Acoustic Neuromas? Comparison between Ellipsoid Formulas and Planimetry

PURPOSE. To examine the influence of slice thickness on measurement time and accuracy on ellipsoid formulas and planimetry. MATERIALS AND METHODS. This study enrolled 30 patients with acoustic neuroma and receiving MR images. Tumor volume was measured by planimetry and ellipsoid formulas (ABC/2 and ABC'/2) on thin-sliced and thick-sliced images. Measurement time was recorded. Intraobserver and interobserver agreement of measurements were examined. Estimation accuracy and bias represented by absolute percentage error (APE) and percentage error (PE) were calculated. One way analysis of variance (ANOVA) with post-hoc analysis was applied. p ＜ 0.05 was considered statistically significant. RESULTS. The tumor volume was 6.67 ± 9.60 ml based on the thin-sliced planimetry. Excellent intra- and interoberver agreements were achieved (all intraclass correlation coefficients [ICCs] ＞ 0.990). The thin-sliced planimetry required longer measurement time (551 ± 330 sec) significantly than thick-sliced planimetry (74 ± 43 sec) and all ellipsoid formulas (31 ± 7 sec to 48 ± 9 sec). The APE was 11.9 ± 10.8%, 14.3 ± 7.6%, 19.6 ± 12.2%, 23.1 ± 13.7%, and 33.1 ± 25.9% for thick-sliced ABC/2 formula, thick-sliced planimetry, thin-sliced ABC'/2 formula, thin-sliced ABC/2 formula, and thick-sliced ABC'/2 formula, respectively. The corresponding PE was 2.6 ± 16.0%, -8.1 ± 14.2%, 16.6 ± 16.2%, 21.3 ± 16.4%, and -32.1 ± 27.2%, respectively. CONCLUSION. Slice thickness plays a role in measurement time and accuracy of the planimetry and the ellipsoid formulas. There is a trade-off between measuring accurately using thin-sliced planimetry and measuring quickly using thick-sliced planimetry and ellipsoid formulas.

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Longitudinal MR Follow-up of Pallister-Hall Syndrome: From Fetus to Childhood

Pallister-Hall syndrome (PHS) is a disorder that affects multiple organs. Among the multiple anomalies, presence of a hypothalamic hamartoma is the most characteristic of PHS. We report on a PHS case with longitudinal clinical and magnetic resonance imaging (MRI) studies from her fetus to childhood. At the estimated gestational age (EGA) of 29 weeks, her fetal MRI showed a 40 mm hypothalamic hamartoma. Periodic generalized tonic-clonic seizures attacked since seven days of age. The seizures are clinically manageable by anti-epileptic drugs, the endocrine functions are within normal limits, the daily activities are normal as compared with the peers, while the tumor grows to 77 mm in maximum diameter at her age of 5, when the report is made.

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A Rare Complication: Right Ventricular Perforation by Temporary Pacemaker Lead

The incidence of cardiac perforation after temporary pacemaker (TP) implantation is very low. Severe consequences including cardiac tamponade and death may occurred when cardiac perforation. We present a case of an 89-year-old man patient with progressive chest tightness and dyspnea soon after TP implantation. Chest radiography revealed right ventricular (RV) lead migration and emergent unenhanced chest computed tomography (CT) demonstrated the RV lead perforated the right ventricular wall into the pericardium. Emergent open-heart surgery confirmed RV perforation.

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Transarterial Embolization of Pulmonary Arteriovenous Malformations with Amplatzer Vascular Plugs

Pulmonary arteriovenous malformations (PAVMs) are rare but can cause life-threatening complications. Advances in endovascular treatment have made it a primary consideration for treating PAVMs. We report the case of an elderly woman with hereditary hemorrhagic telangiectasia (HHT) who experienced hemothorax, was diagnosed with PAVMs, and was successfully treated with transarterial embolization (TAE) with vascular plugs.