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Predictors of Variceal Bleeding on Contrast-Enhanced Computed Tomography in Patients With Hepatocellular Carcinoma

PURPOSE. The purpose of this cross-sectional study was to identify patients with hepatocellular carcinoma (HCC) requiring endoscopic intervention for esophageal varix (EV) bleeding. MATERIALS AND METHODS. Patients who received both emergency endoscopy and abdominal computed tomography (CT) for HCC in the 3 months preceding the study were enrolled. Laboratory data, including platelet count, serum albumin, liver function parameters, and international normalized ratio, were collected. In addition, submucosal EV diameter, portal collateral system diameter, and spleen width were measured using CT. Red signs detected during endoscopic surveillance and subsequent intervention were considered to indicate active EV bleeding. RESULTS. Among 86 patients, 67 men (77.9%) and 19 women (22.1%), whose mean age (standard deviation) was 64 (11.7) years, increased submucosal EV diameter (odds ratio [OR] = 3.263, 95% confidence interval [CI] = 1.930-5.515, p ＜ 0.001) and portal vein thrombosis (OR = 6.314, 95% CI = 1.147-34.762, p = 0.034) were significant predictors of EV bleeding. The area under the receiver operating characteristic curve for predicting EV bleeding from a submucosal EV diameter cutoff of 5.6 mm was 0.954 (95% CI = 0.886-0.987; sensitivity: 94.83%, specificity: 96.43%). CONCLUSION. Patients with HCC and large submucosal EVs measured on CT require endoscopic intervention for variceal bleeding. CT may be employed to screen for high-risk patients before endoscopy.

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A Rare Imaging Manifestation of Thoracic Sarcoidosis: A Case Report and Literature Review

Sarcoidosis is a granulomatous inflammatory disorder that implicates multiple systems, including the thoracic spine, the orbit, the skin, the central nervous system, the cardiovascular system, and the musculoskeletal system. Hypercalcemia and suspicious chronic inflammatory process of pleura may be indicators of sarcoidosis.

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Imaging Features of Chronic Adrenal Hematoma: Case Reports

Nontraumatic adrenal gland hemorrhage is associated with several conditions including stress, hemorrhagic diathesis or coagulopathy, iatrogenic cause or underlying tumor. The imaging features of adrenal gland hemorrhage vary with the age of blood cells. Chronic hematomas are usually large and round in shape with a well-defined margin. On magnetic resonance imaging, the internal signal intensity appears heterogeneous. Contrast enhancement studies may show the linear peripheral enhancement with a gradually increasing pattern, causing difficulty in the differentiation of these hematomas from other adrenal neoplasms. A study of the imaging features and etiologies of adrenal hemorrhage/hematoma may enable accurate diagnosis and thus prompt management. Herein, we report two cases of adrenal hematoma to summarize its characteristic imaging features.

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A Contrast-Dependent Sign in the Descending Aorta During Coronary Computed Tomography Angiography

A 67-year-old male patient received coronary computed tomography angiography for atypical chest pain. Images revealed a contrast-dependent sign in the descending aorta and no enhancement of the coronary artery. The reason for the unusual imaging finding is due to inadvertent intra-arterial contrast injection through the left brachial artery.

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Cuboid Pulley Lesion May Be A Presentation of Spondyloarthritis: A Case Report

Cuboid pulley lesions are a rare finding in imaging, with a distinct location and presentation. The lesion indicates functional enthesitis between the cuboid bone and peroneus longus tendon. The pathogenesis of enthesitis includes overuse, traumatic causes, and inflammatory arthritis, especially spondyloarthritis. We report a case of cuboid pulley lesion associated with enthesitis-related arthritis. Because of considerable differences in treatment methods, we suggest careful evaluation of the patient's history and relevant laboratory data to identify the underlying cause of the cuboid pulley lesion.

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Reversible Cerebral Dural Sinus Ectasia Mimicking Vein of Galen Malformation in a Neonate With Patent Ductus Arteriosus: A Case Report

Diffuse dilatation of cerebral dural sinuses is a classic finding on the images of vein of Galen (VOG) malformation, which is a rare but severe neonatal vascular anomaly. However, if there is no evidence for abnormal intracranial shunts, impaired cardiac function should be considered a possible cause. In this report, a newborn with a large patent ductus arteriosus (PDA) and heart failure was found to have a suspicious vascular malformation on cranial ultrasound. Other than the marked engorgement of the VOG and major dural sinuses, no shunting was detected on time-of-flight or contrast-enhanced magnetic resonance (MR) angiography. A follow-up brain MR imaging (MRI) conducted 1 week after receiving PDA ligation showed the complete resolution of the previously detected engorged dural sinuses. In neonates with diffuse dural venous sinus dilatation without abnormal intracranial shunts, heart failure should be considered in differential diagnoses in addition to congenital brain vascular malformation.

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Prevalence of Septal and Extra-septal Bulging in Resistant Hypertension Determined Through Cardiac Magnetic Resonance Imaging and Comparison With Different Echocardiography-Based Diagnostic Criteria

PURPOSE. Few studies have analyzed focal myocardial bulging in resistant hypertension. This study investigated the prevalence and distribution of focal myocardial bulging in patients with resistant hypertension through geometric analyses. MATERIALS AND METHODS. Using two standard deviations above the mean wall thickness as the cutoff value and based on a 16-segment left ventricle model, geometric analyses were performed on 1,008 myocardial segments obtained from 63 patients with newly diagnosed resistant hypertension. The results were compared with different existing echocardiography-based diagnostic criteria. RESULTS. The results indicated that focal myocardial bulging was prevalent in 60.3% (38/63) of the patients. Of them, 34 patients (89.5%) exhibited focal bulging of the septal segments; 4 patients (10.5%) presented with extra-septal bulging segments. The prevalence of bulging was the highest (16/63, 25.4%) for the basal anteroseptal wall (Segment 2), followed by the middle inferoseptal wall (Segment 9) (15/63, 23.8%). Existing echocardiography-based diagnostic criteria are heterogeneous and do not include criteria for the entire left ventricle. CONCLUSION. Septal or extra-septal focal myocardial bulging is frequently observed on magnetic resonance images in patients with newly diagnosed resistant hypertension. Novel echocardiographic criteria are necessary for identifying bulging in hypertensive heart disease.

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Pancreatic Schwannoma With Multiple Benign Peripheral Nerve Sheath Tumors: A Case Report

Pancreatic schwannomas are rare pancreatic tumors. We describe an extremely rare case of a patient having a large pancreatic schwannoma and multiple benign peripheral nerve sheath tumors (BPNSTs). A 37-year-old woman presented to our hospital complaining of right chest pain. Thoracic spine magnetic resonance imaging revealed an intradural mass at T4-T5. Additionally, we incidentally identified a right paratracheal mass and a large pancreatic cyst. The final pathology report confirmed a thoracic spine meningioma, a mediastinal schwannoma, and a pancreatic schwannoma. Three and 10 years after presentation, the patient was diagnosed as having benign nerve sheath tumors in the lumbar spine and left buttock region. Pancreatic schwannomas are rare but should be included in differential diagnoses of cystic pancreas tumors. This case report details the first recorded case of a pancreatic schwannoma with multifocal BPNSTs involving the mediastinum, the spinal canal, the pelvic cavity, and the lower extremities.

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Case Presentation of Rare Intrathoracic Tumor: Primary Pulmonary Synovial Sarcoma

Primary pulmonary synovial sarcomas are extremely rare and account for less than 0.5% of all pulmonary malignancies. We present a case of a 45-year-old man with primary pulmonary synovial sarcomas in the right lower lobe of the lung. Contrast-enhanced computed tomography indicated 〞triple attenuation〞 (a soft-tissue attenuation with a well-enhanced solid portion and a cystic or necrotic portion). We confirmed the diagnosis of primary pulmonary synovial sarcoma by the histopathology and specific immunochemistry.

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IgG4-Related Disease Presenting as Paravertebral Mass With Chylothorax: A Case Report

Immunoglobulin G4-related disease (IgG4-RD) is a rare but increasingly recognized fibroinflammatory disorder involving multiple organs. The various manifestations of IgG4-RD often lead to diagnostic challenges. Herein, we report the case of a 50-year-old woman who initially presented with chylothorax. Chest computed tomography (CT) revealed a paravertebral mass at the T5-11 vertebrae. CT-guided biopsy revealed diffuse lymphoplasmacytic infiltrations with IgG4-related plasma cells and storiform fibrosis. Oral administration of prednisone was prescribed. Follow-up CT revealed complete resolution of the paravertebral mass.