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Isolated Retroaortic Left Brachiocephalic Vein: An Incidental CT Finding in an Adult Patient

A 50-year-old man experienced right chest pain for 6 days. The laboratory examination showed elevated blood white blood cell counts (13,290/μL), and an elevated C-reactive protein (8.18 mg/dL). Chest radiograph showed an air space pattern in right lower lung and obliteration of right costophrenic angle compatible with pneumonia and right pleural effusion. Contrast-enhanced computed tomography (CT) of the chest demonstrated pneumonia in right lower lobe and right pleural effusion. Retroaortic left brachiocephalic vein was incidentally found on CT imaging. Echocardiography showed no congenital heart disease. Antibiotics were administered. Thoracentesis and percutaneous closed drainage using a 10F pigtail catheter for the right pyothorax were also performed. The symptom of the patient improved. He was discharged after the 13 hospitalization days with regular outpatient department follow-up.

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Omental Abscesses Caused by Migrating Fish Bones: Two Case Reports

Accidental ingestion of the foreign body is a common clinical presentation in the general population. Gastrointestinal (GI) perforation caused by an ingested foreign body is rare and occurs in less than 1% of patients. Fish bone is the most common ingested foreign body and causes perforation most frequently. Migration of a fish bone into the adjacent or even distant organs after perforating the GI tract is even rarer. We report two cases of fish bone perforation from the ileum, migrating to the adjacent omentum, and causing omental abscesses. The diagnoses were made preoperatively by using a multi-detector computed tomography, in which the lengths of the fish bones were demonstrated by using a thin collimation (1 mm) and image reconstruction in a plane parallel to the longitudinal axis of the fish bones, which are in good correlation with the surgical findings.

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Differential Diagnosis of Calcified Nodules Arising from Tracheal Wall

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Late Onset of Kidney and Inferior Vena Cava Anomaly with Leg Thrombosis (KILT) Syndrome: A Case Report

A 69-year-old male patient had suffered from left calf swelling for 1 month. The pain was aggravated during walking and relieved after leg elevation or body lying. The laboratory examination revealed mildly elevated blood creatinine (1.29 mg/dL; normal, 0.6-1.2 mg/dL). Contrast-enhanced computed tomography (CT) of the abdomen showed atrophy of right kidney, agenesis of infrarenal segment of inferior vena cava (IVC), thrombosis of left external iliac vein and left superficial femoral vein, dilatation of abdominal wall veins, lumbar veins, left retroperitoneal veins, azygos and hemiazygos veins. Therefore, CT diagnosis of KILT syndrome (eponym for kidney and IVC anomaly with leg thrombosis) was made. The patient then received low-molecular-weight heparin for 5 days, and then shifted to Endoxaban 60 mg once daily. The symptom improved. He was discharged on the 5th hospitalization day with regular outpatient department follow-up.

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A Rare Complication of Chronic Pancreatitis: Fistula Between an Infectious Pancreatic Pseudocyst and Psoas Abscess, Treated with Percutaneous Drainage, and a Review of the Literature

We present a 47-year-old male with chronic pancreatitis complicated by a pancreatico-psoas fistula, and review the relevant published papers. The psoas abscess was drained by percutaneous multiple side-hole drainage catheter with antibiotics treatment, and the fistula was regressed 1 month later.

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Pulmonary and Intraabdominal Tuberculosis Mimicking Lung Malignancy with Intraabdominal Metastasis on CT: A Case Report

A 60-year-old male patient suffered from fever off and on for 1 month. The laboratory examination revealed leukocytosis and elevated C-reactive protein. The sputum showed positive acid-fast stain. The chest radiograph demonstrated a cavitated consolidation in right upper lung. Computed tomography (CT) showed a cavitated consolidation in right upper lobe of lung involving the mediastinum and encasing the superior vena cava and the ascending branch of right pulmonary artery. Enlarged mediastinal lymph nodes, bilateral adrenal gland enlargement, peritoneal thickening, omental cake appearance, ascites and bilateral pleural effusion were also found. Therefore, CT diagnosis of lung carcinoma with invasion to the mediastinum, metastasis to bilateral adrenal glands, and peritoneal carcinomatosis was made. Ultrasound (US)-guided paracentesis was carried out; the cytological findings showed predominant multinuclear cells. Percutaneous biopsy under US-guidance was performed for the right lung mass; the pathological result demonstrated caseating granulomas. Acid-fast bacilli were found after special staining for tuberculosis (TB) bacilli. The final diagnosis was pulmonary and intraabdominal TB.

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A Case of Magnetic Resonance Imaging-induced Thermal Injury

We report an unusual case of magnetic resonance imaging (MRI) induced thermal injury. A 45-year-old man without systemic disease came for MRI study due to a left thigh tumor. During the MRI examination, the patient mentioned a prickling sensation in his lower legs, but this did not draw any attention from the staff. After the exam, a pair of symmetrical burn wounds were found at the medial sides of his bilateral calves. They were usually caused by an unexpected electrical loop formation inside the body. This is the first case of MR thermal burn injury in the 20-year operation history of our MR scanner. We report this case to remind the potential causes of MRI thermal injury, and what should we do to avoid the unnecessary thermal injury to patients.

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Sacral Epidural Rhabdoid Meningioma: A Case Report and Review of the Literature

Spinal meningiomas are usually intradural extramedullary spinal tumors, and the majority of them are located in the thoracic region. We present an extremely rare case of spinal epidural rhabdoid meningioma located at the sacral spine in a 38-year-old man with low back pain and right foot numbness. Computed tomography and magnetic resonance imaging revealed a lesion occupying the right sacral spinal canal at the level of S1-S2 and with extension of tumor into the right S1-2 and S2-3 neural foramens. Sacral epidural rhabdoid meningioma, although a relatively uncommon entity, should be considered in the differential diagnosis of tumors occurring in the sacral spinal canal.

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Clinical and Radiological Manifestations of Dyke-Davidoff-Masson Syndrome

PURPOSE. This study aims to determine the clinical-radiological features of Dyke-Davidoff-Masson syndrome (DDMS) in children and adults. MATERIALS AND METHODS. A total of 11 patients (7 males, 4 females) aged 2-46 years with a diagnosis of cerebral hemiatrophy at our institution between 2012 and 2018 were retrospectively reviewed. The 11 patients were classified into two groups: children (n = 4) and adults (n = 7). Clinical symptoms, etiologies, and imaging characteristics found in computed tomography and magnetic resonance imaging were compared and analyzed. RESULTS. Among the 11 patients, left hemisphere involvement was observed in 5 patients, and right hemisphere involvement was noted in 6 patients. Etiologic investigation found a congenital cause in 1 patient and acquired causes in 9 patients; the etiology for 1 patient was not identified. Seizure was observed in all patients, contralateral hemiparesis was found in 9 patients (3 children and 6 adults), and mental retardation was noted in 10 patients (4 children and 6 adults). Imaging characteristics including ipsilateral sulcal enlargement, lateral ventricular dilatation, and ipsilateral calvarial thickening were observed in all patients. Porencephalic cyst and Wallerian degeneration of ipsilateral midbrain and pons were found in 7 patients (2 children and 5 adults). Midline structural shift, elevation of orbital roof, and petrous ridge were seen in 8 patients (2 children and 6 adults). Hyperpneumatization of a paranasal sinus and mastoid were found in 6 patients (5 adults and 1 child). All differences in imaging characteristics between these two groups did not reach statistical significance. CONCLUSION. Clinical presentations of seizure, contralateral hemiparesis, and mental retardation might appear in a patient with DDMS regardless of age group. Subtle differences between children and adults were identified in radiological manifestations of DDMS. Identifications of porencephalic cyst, Wallerian degeneration of ipsilateral midbrains and pons, midline structural shift, paranasal sinus, and mastoid hyperpneumatization were more likely among adults. Nonetheless, larger samples are required to establish distinct features of the different age groups.

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Biliary Ascites Caused by a Spontaneously Ruptured Choledochal Cyst in a Child: A Case Report with Literature Review

Choledochal cysts are a congenital anomaly of the biliary duct. The classic triad for the diagnosis of a choledochal cyst includes the presence of abdominal pain, jaundice, and a palpable mass, as well as exclusion of other causes that could result in biliary duct dilatation. Common complications of choledochal cysts include stone formation, malignant transformation, and inflammatory conditions (e.g., cholangitis and pancreatitis). We report a case of ruptured choledochal cyst, which is a rare manifestation and complication. The complication was initially managed with external drainage, followed by interval surgical excision.