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Orbital Solitary Fibrous Tumor: A Case Report and Review of the Literatures

Solitary fibrous tumors (SFTs) are uncommon, benign, and slowly progressing spindle-cell tumors. First reported in 1931, SFT accounts for 1% of all orbital tumors and can affect any orbital space. Proptosis and palpable mass are common clinical manifestations. SFTs should be included in the first line of differential diagnosis when the mass shows markedly enhancing pattern similar to the internal carotid artery on postcontrast computed tomography (CT) or magnetic resonance (MR) images. Cluster of differentiation 34 (CD34) is the most important diagnostic marker for SFT. Herein, we report a case of orbital SFT and demonstrate its image characteristics, with review of the literatures.

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A Rare Cerebellum Venous-Predominant Parenchymal Arteriovenous Malformation: A Case Report and Review of the Literature

We describe a rare case of venous-predominant parenchymal arteriovenous malformation (AVM). The patient was initially treated by embolization, but progression with intracerebral hemorrhage (ICH) occurred 12 years later. According to our experience with this patient and a review of the literature, embolization is an alternative treatment of choice, but long-term follow up for possible progression and hemorrhage is necessary.

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Abdominal CT Depicted ＂Fat Halo Sign＂ of Stomach in a Young, Underweighted Man With Chronic Gastritis

Inflammation of gastrointestinal (GI) tract remained a challenge for radiologist. Image findings are usually nonspecific and subtle in much modality. Since the diagnosis of inflammatory bowel disease (IBD) is not simply made, clinical presentation, endoscopic findings, image features, and pathology can be complimentary. In the literature, computed tomography (CT) depicted ＂fat halo sign＂ of GI tract was once regarded as specific findings for IBD. However, some authors found this sign can be a normal variant in obese patient with non-distended GI tract. In this article, we report a young, underweighted man, who had pathologically proved chronic gastritis and ＂fat halo sign＂ on CT, and successfully treated as Crohn's disease.

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Desmoplastic Small Round Cell Tumor in a Young Female

Desmoplastic small round cell tumor (DSRCT) is a rare, but highly aggressive primary peritoneal malignancy, and predominantly affects the male adolescent. It has a very poor prognosis despite multimodal therapy. We report an uncommon case of a 12-year-old female patient who presented with progressive abdominal distension associated with poor appetite and weight loss, and was subsequently diagnosed as DSRCT based on imaging and histological analysis with positive immunohistochemical staining for Wilms' tumor 1 protein.

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Super-Dominant Left Anterior Descending Coronary Artery With Posterior Descending Artery From Septal Perforator Artery: A Rare Case

The posterior descending artery (PDA) usually arise from the right coronary artery or the left circumflex artery. It is extremely rare for the PDA originate from the left anterior descending artery. A 64 years old man presented with angina, palpitation, and cold sweating. Coronary computed tomography angiography revealed a large branch of septal perforator artery coursing through the ventricular septum to gain the posterior interventricular groove, where it continued as the PDA.

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Sonoelastographic Findings of De Quervain's Disease

PURPOSE. Use of sonoelastography to diagnose De Quervain's disease may increase diagnostic accuracy and provide a quantitative index for disease severity. We aimed to apply sonoelastography to detect changes in the physical properties of target tendons. MATERIALS AND METHODS. This is a prospective comparative study conducted between January and March 2018. All patients were diagnosed by physical examination and then underwent gray-scale sonography, Doppler sonography, and ultrasound elastography over bilateral wrists. Abnormal findings and the elasticity of affected tendons were compared with those of the asymptomatic side. RESULTS. In total, 24 patients ranging in age from 26 to 74 (mean = 43.67 ± 15.45) years were enrolled in the study. There was a significantly higher rate of effusion and intratendinous hypoechoic lesions for affected tendons. The strain ratio of tendons was also significantly lower for the De Quervain's disease group as compared with asymptomatic group (0.80 ± 0.52 vs. 1.73 ± 0.50, p ＜ 0.001). CONCLUSION. Sonoelastography can help diagnose De Quervain's disease as an inexpensive, rapid, and clinic-based tool.

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Hepatic Arterial Infusion Chemotherapy via Reconstituted Proper Hepatic Artery From the Left Gastric Artery for Intrahepatic Cholangiocarcinoma, Complicated by the Formation of Arterio-Enteric Fistula: A Case Report

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary cancer in the liver. Hepatic arterial infusion chemotherapy (HAIC) is one of the several choices available in liver-directed therapy for inoperable patients. However, HAIC carries several potential complications, such as occlusion of the hepatic artery, gastric or duodenal mucosal lesions, catheter dislodgement, infection of the port-catheter system, and bleeding around the port system. We hereby report a case of a patient who had undergone repeated HAIC sessions for ICC by a rare pathway via a reconstituted proper hepatic artery (PHA) from the left gastric artery. The treatment course was complicated by the development of an arterio-enteric fistula between the PHA and the duodenal bulb. Subsequently, the tip of the catheter migrated into the duodenal lumen.

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Analysis of Predictors of Operative Time During Percutaneous Nephrolithotomy

PURPOSE. Prolonged operative time is associated with prolonged anesthesia and presumably postoperative complications. Few studies had evaluated the impact of percutaneous nephrolithotomy (PCNL) on the operative time. The purpose of this study was to investigate the associations of duration of surgery with more variables including patient characteristics, stone burden, access tract, and perioperative complications. In our study, factors that influence operative time were analyzed. MATERIALS AND METHODS. This retrospective study contained 76 patients who received PCNL between December 2010 and February 2018 at a single institution. In this study, PCNL was carried out in two steps: percutaneous renal access and percutaneous nephrostomy (PCN) catheter placement, which were performed respectively by a radiologist under ultrasonographic and fluoroscopic guidance in the angiography-interventional room, then lithotomy, which was performed by a urologist in the operation room. Univariate and multivariate analyses were used to investigate the effects of variables on the duration for PCN catheter placement, operative time, and perioperative morbidity, including patient-, stone-, and procedure-related factors including age, sex, body mass index, skin-to-kidney distance, renal parenchymal thickness, stone size and location, and the access tract. Complications were identified and classified according to the Clavien-Dindo classification system. RESULTS. The average age was 55.74 ± 9.58 (32-76) years old and male-to-female ratio was 50:26. The mean stone size was 3.58 ± 2.26 (0.70-13.30) cm, the skin-to-kidney distance was 7.70 ± 1.76 (4.80-14.40) cm, and the mean renal parenchymal thickness was 16.0 ± 4.8 (3.0-28.0) mm. The mean PCN duration for catheter placement was 59.1 ± 35.1 (14.0-138.0) min, and the operation time was 183 ± 70 (50-453) min. Longer operative time was statistically associated with thin renal parenchyma (p = 0.010) but not skin-to-kidney distance (p = 0.070). Complications were classified as Clavien-Dindo grades I in 71 patients (93.4%), grade II in 3 patients (3.9%), and grade III in 2 patients (2.6%). CONCLUSION. Patients with thin renal parenchyma have longer operative time. The skin-to-kidney distance does not contribute to the longer operative time.

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Preoperative CT Diagnosis of Spontaneous Hemoperitoneum Due to Rupture of a Subserosal Uterine Leiomyoma: A Case Report

A 49-year-old woman experienced diffuse abdominal pain for 2 hours. Increased bowel sounds and diffuse abdominal tenderness were noted. The laboratory examination was normal. Ultrasonography showed a mass connected to the uterus and anechoic ascites. Non-contrast-enhanced computed tomography (CT) showed a 7-cm, round, hypodense mass in the pelvic cavity abutting the anterosuperior aspect of the uterus, with a hyperdense component inside the mass, and contiguous hyperdense intraperitoneal fluid. Contrast-enhanced CT revealed contrast enhancement of the hypodense mass. A ruptured uterine leiomyoma of the subserosal type causing hemoperitoneum was diagnosed with CT. Emergency exploratory laparotomy confirmed a subserosal uterine leiomyoma with rupture, and 400 cc intraperitoneal blood. Myomectomy was performed. Pathological examination revealed a 4 × 5 × 6 cm^3, well-encapsulated cellular leiomyoma, and a bleeding site with hemorrhage. The patient had an uneventful postoperative course and was discharged on the 5th postoperative day.

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Spontaneous Pneumoperitoneum in Systemic Sclerosis: A Case Report

Scleroderma or systemic sclerosis is a chronic, multisystem autoimmune disorder manifested by fibrosis of the skin, blood vessels, muscles, and internal organs. Herein, we present a case of a 51-year-old woman with past history of rheumatoid arthritis and systemic sclerosis for many years. She presented to emergency department with nausea, vomiting, and painless abdominal fullness for 5 days. Computed tomography revealed spontaneous pneumoperitoneum by depicting triangle sign, Rigler sign and dilated bowel loops, but without ascites or pneumatosis intestinalis. Then conservative management was initiated. Follow-up imaging studies showed intra-abdominal free air decreased in volume gradually.