Notes

Clozapine re-challenge and introduction following neutropenia: a review and case number of 15 individuals inside a high-secure forensic healthcare facility.
This is the first known case of incidentally detected serous cystadenoma with splenic invasion, reported with detailed imaging findings of dynamic CT and MRI.Bilateral Adult Idiopathic Oclussion of Foramen of Monro is a rare entity, with less than 22 cases published in the literature so far, all of them symptomatic.1 When the symptoms require it, the current first-line treatment is endoscopic foraminoplasty, sometimes associated with septum pellucidum fenestration, although some authors consider that a more conservative treatment in paucisymptomatic patients.2 We report the case of an idiopathic biventricular hydrocephalus found incidentally in an asymptomatic 42-year-old female with temporomandibular joint disfunction. The fact that some patients with Monro foraminal stenosis may be asymptomatic increases the possibility of underdiagnosis, so we consider it a condition that radiologists should be aware of, mainly taking into account the fact that the diagnosis of this entity is usually radiologic3 and the potential complications associated with treatment.A 56-year-old female presented with intermittent hemoptysis and was diagnosed with lung cancer. 18F-fluorodeoxyglucose positron emission tomography/CT for staging revealed hypermetabolic liver (hot liver), uptake in the mediastinal lymph nodes and reduced uptake in the kidneys. Unexpectedly, liver biopsy findings were consistent with tuberculous infection. Following the intensive phase of antituberculous treatment, repeat CT revealed significant resolution of the mediastinal lymph nodes making the lung cancer Stage 1 (T1 lesion). She underwent left lower lobectomy as a definitive surgical treatment. Positron emissiontomography/CT scan in this patient was considered to be a hepatic superscan since it revealed a hot liver.Vertebral hemangiomas are relatively frequent among tumors of the spine. Most of them are asymptomatic and the diagnosis is usually made based solely on imaging. However, although rare, some hemangiomas with atypical imaging features (aggressive hemangiomas) can pose a diagnostic challenge. Clinically, these patients present with neurological symptoms. In imaging, aggressive hemangiomas appear as lesions with significant osseous expansion or extraosseous extension, mimicking the appearance of other tumors, such as metastasis or plasmacytoma. In such cases, a biopsy is often required to obtain a histopathological diagnosis in order to rule out the differential diagnoses mentioned above. We report on two cases of aggressive hemangiomas whose diagnosis remained uncertain until the pathology analysis. On CT-scan control immediately after biopsy, we have been surprised to observe the formation of gas bubbles inside the biopsied lesion, spreading over almost the whole vertebra. This gas web sign may support its liquid-filled spaces composition and its benign nature. Our goal was to highlight this finding and its usefulness.Systemic arterial supply to a segment of normal lung is rare.1 Usually the anomalous systemic artery arises from the descending aorta, although it can arise from other sites including the coeliac axis.1-3 Case reports documenting an anomalous artery to normal lung from the coeliac axis are few. However, in these cases the patients were being investigated for respiratory symptoms and all were under the age of 50. In our case, we describe a rare case of anomalous systemic arterial supply arising from the coeliac axis to the right lower lobe, in the absence of abnormal bronchial connection or parenchymal disease in an asymptomatic patient. The anomalous arterial supply was an incidental finding on CT. The literature suggests surgical treatment to prevent symptoms of haemoptysis or congestive cardiac failure, but it is unclear from current evidence whether this is indicated in an asymptomatic patient.Retroperitoneal fibrosis (RPF) is a rare systemic disease. Two-third of the cases are idiopathic but assumed to have autoimmune process related to IgG-4. It is often a diagnosis of exclusion due to its non-specific clinical presentation. Sunitinib concentration Early manifestation commonly causes back pain, raised erythrocyte sedimentation rate level and renal impairment. Investigations of choice are MRI and contrast-enhanced CT but biopsy should be performed for diagnostic confirmation. This case report describes a delay in diagnosing RPF in a 57-year-old female who initially presented to primary care with back pain, mild anaemia, raised erythrocyte sedimentation rate and progressive renal function decline. She was seen urgently in haematology clinic who arranged bone scan to rule out osteoblastic metastases, finding demonstrated possible pelviureteric junction dysfunction. The investigation was followed by a MAG3 renogram 4 weeks later instead of an abdominal CT leading to diagnostic delay. She then presented acutely 1 day after renogram with life-threatening hyperkalaemia and AKI 3. RPF was then suspected. Renal ultrasound scan and CT scan consecutively showed bilateral gross hydronephrosis and retroperitoneal mass around the aorta. The pelviureteric junction dysfunction was due to ureters getting embedded into the dense retroperitoneal fibrous tissue. She subsequently underwent bilateral ureteric stent placement and was commenced on steroid therapy, with satisfactory outcome on follow-up. Laparoscopic retroperitoneal biopsy later confirmed the diagnosis. This case not only highlighted important learning points on the presenting features and radiographic findings of RPF, but also the clinician's cognitive biases leading to diagnostic delay of a rare but life-threatening disease.Primary intracranial tumours rarely metastasise outside of the central nervous system (CNS). This report describes a rare case of recurrent meningeal haemangiopericytoma with extensive systemic metastases, which eventually resulted in a fatal outcome. We discuss some prevailing theories as to the rarity of extracranial metastases from primary CNS haemangiopericytoma, and elucidate the epidemiology, imaging features, differential diagnosis, treatment, and prognosis of this unusual but surprisingly aggressive meningeal tumour. Besides aggressive treatment for local tumour control, patients with primary CNS haemangiopericytoma require long-term post-treatment surveillance to detect systemic metastases.Iliopsoas primary tuberculous abscess is a rare clinical and imaging entity. Most reported imaging literature cases are secondary to tuberculous spondylodiscitis. Iliopsoas tuberculous inflammation and abscess constitutes a diagnostic challenge owing to its insidious onset and subtle non-specific symptoms. Here, in a case of right iliopsoas and thigh primary tuberculosis abscess complicated with right iliac bone osteomyelitis extended to the right hip joint. The conventional radiography, thigh and pelvic ultrasonography, MRI and CT examinations showed the whole right iliopsoas and thigh abscess compartments and right iliac bone osteomyelitis. No defined other pulmonary or abdominal tuberculous lesions. Percutaneous drainage of the thigh compartment under ultrasound guidance and microbiologic culture of the drained fluid elicited mycobacterium tuberculosis.CT scanning techniques used in head and facial bones examination in the clinical environment can also be transferable to the imaging of post-mortem cases as a novel non-destructive and non-invasive investigation in forensic cases. We describe a study of the head and facial bones of a 2700-year-old Egyptian mummy. Cross-sectional investigation can lead to discovering unknown information of skeletal and soft tissue structures and anatomy to contribute to the knowledge of preserved mummified remains and the practice of palaeoradiology.Myopericytomas are exceedingly rare soft-tissue tumors with less than 10 cases including radiological depictions. We report three new cases of benign myopericytomas located in the soft-tissues of the hand in adult patients. A pre-treatment MRI was available for all patients and systematically evidenced well-defined, lobulated tumors closely related to the superficial palmar vascular arch and/or digital vessels with a perivascular pushing growth pattern that correlated with pathological findings. Though rare, this small case series show that myopericytomas display recurrent imaging features that could support their radiological diagnosis.A 44-year-old male initially presented with a right thalamic brain tumor that was confirmed with stereotactic biopsy to be glioblastoma (GBM). The patient was treated with radiotherapy and temozolomide for 6 weeks. At 1 month after completing chemoradiation therapy, the patient underwent follow-up imaging that revealed the primary lesion had mildly responded to chemoradiation, but a secondary lesion had developed along the biopsy needle tract. This secondary lesion was outside of the field of radiation therapy for the primary tumor and concluded to be intracranial spread of GBM along the biopsy tract. The patient's final imaging 4 months after initial diagnosis revealed the primary and secondary lesions had enlarged. Subsequently, the patient clinically deteriorated and died 7 months after initial diagnosis.The onset of an autoimmune, sarcoidosis-like reaction during or after treatment with immunomodulatory drugs as Ipilimumab is an atypical but renowned eventuality. Awareness of this scenario and its radiological features helps the Radiologist to avoid misdiagnosis of disease progression. In this case report, we present a patient operated for advanced cutaneous melanoma of the left forearm who developed hilar adenopathies with lung and splenic nodules during therapy with Ipilimumab in adjuvant setting. These findings were at first referred to as disease recurrences. Based on discrepancies between imaging, clinic and blood test findings we decided to put the patient on strict follow-up which showed a spontaneous complete regression on the visceral lesions few months after Ipilimumab withheld.Transdiaphragmatic intercostal herniation can occur following blunt or penetrating trauma and is usually associated with rib fractures. It is uncommon and only sporadically reported in literature. We report a case of cough-induced intercostal herniation containing large bowel, on a background of sustaining a blunt chest trauma 25 years prior to presentation. The patient was treated by reducing the hernia followed by surgical repair of the diaphragm and intercostal muscles defect. He was discharged without further complications and remained well at follow-up.With the increasing number of laparoscopic nephrectomies, trauma to lymphatic channels has become an increasingly recognised complication. Early diagnosis and prompt management are key to avoid highly morbid sequelae including severe malnutrition and immunodeficiency. This case reviews the important complication of a retroperitoneal chylous collection following laparoscopic radical nephrectomy.Vertebral artery pseudoaneurysm usually occurs after major trauma, but it can arise spontaneously after trivial injury. Clinical manifestations are often related to alterations in the posterior brain circulation. CT and angiography are usually the diagnostic methods of choice. We present a case of a pseudoaneurysm of the left vertebral artery caused by a lesion during a cervical spine surgery and treated with endovascular approach with a covered stent.
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