Articles : Journal of Clinical Imaging Science as on May 8, 2012)

Avoiding Unnecessary Fine-Needle Aspiration Cytology by Accuractely Predicting the Benign Nature of Thyroid Nodules Using Ultrasound

Sudhir Vinayak — Sat,28 Apr 2012

Sudhir Vinayak, Joyce A Sande

Journal of Clinical Imaging Science 2012 2(1):23-23

Objective: The objective of this study was to describe a reliable ultrasound based index scoring system based on ultraound characteristics to identify benign thyroid nodules and avoid unnecessary fine needle aspiration cytology. Materials and Methods: Patients undergoing ultrasound-guided fine-needle aspiration cytology (FNAC) for thyroid nodules were evaluated prospectively. A total of 284 patients were evaluated from November 2005 to November 2011. There were 284 nodules. Any solid or partly solid focal nodule in the thyroid gland was included in the study. Cysts with no solid component were excluded. We used LOGIQ 9 (GE Healthcare) scanner equipped with a 10--14 MHz linear matrix transducer with color and power Doppler capability. Four US characteristics were evaluated, i.e., nodule margins, echo texture, vascularity, and calcification. Fine needle aspiration (FNA) was performed on all nodules. The nodules were labeled benign or suspicious using an ultrasound index score and the results compared with FNAC. Follicular neoplasms on fine-needle aspiration cytology were further assessed by excision biopsy and histology. Cytology/histology was used as the final diagnosis. Results: In total 284 nodules were analyzed. All the 234 nodules in US labeled benign category were proven to be benign on cytology/histology. Therefore the specificity of ultrasound in labeling a nodule benign was 100%. Twenty of the 50 nodules that were suspicious on US were malignant. The most significant US differentiating characteristics were nodule margins, vascularity, and microcalcification. Conclusion: Our results show that US can accurately characterize benign thyroid nodules using an index scoring system and therefore preclude FNAC in these patients.

Prenatal Diagnosis of Amniotic Band Syndrome in the Third Trimester of Pregnancy using 3D Ultrasound

Luciano Marcondes Machado Nardozza — Sat,28 Apr 2012

Luciano Marcondes Machado Nardozza, Edward Araujo, Ana Carolina Rabachini Caetano, Antonio Fernandes Moron

Journal of Clinical Imaging Science 2012 2(1):22-22

Amniotic band syndrome is characterized by a build-up of bands and strings of fibrous tissue that adhere to the fetus and can compress parts of the fetus, thus causing malformations and even limb amputation while the fetus is still in the uterus. The clinical manifestations are extremely variable and their extent may range from a single abnormality, like a constriction ring, to multiple abnormalities. Such abnormalities are generally diagnosed at the end of the first or the beginning of the second trimester using two-dimensional ultrasonography (2DUS). Three-dimensional ultrasonography (3DUS) in rendering mode allows spatial analysis of the fetus and amniotic band, thus enabling better comprehension of this pathological condition and better counseling for the parents. There has not previously been any evidence to show that 3DUS would be useful in cases of late diagnosis (third trimester) of amniotic band syndrome. In the present case, a primigravid woman underwent her second obstetric ultrasound scan in the 34 th week, from which we observed two bands in contact with the right forearm, but with normal movement of this limb and its fingers. 3DUS made it possible to see the spatial relationship of these bands to the fetal body, thereby confirming their adherence to the limb. After the birth, the prenatal diagnosis of amniotic band syndrome without limb constriction was confirmed. A surgical procedure was carried out on the third day after birth to excise the bands, and the newborn was then discharged in a good general condition.

Review of Metaplastic Carcinoma of the Breast: Imaging Findings and Pathologic Features

Rebecca Leddy — Sat,28 Apr 2012

Rebecca Leddy, Abid Irshad, Tihana Rumboldt, Abbie Cluver, Amy Campbell, Susan Ackerman

Journal of Clinical Imaging Science 2012 2(1):21-21

Metaplastic carcinoma (MPC), an uncommon but often aggressive breast cancer, can be challenging to differentiate from other types of breast cancer and even benign lesions based on the imaging appearance. It has a variable pathology classification system. These types of tumors are generally rapidly growing palpable masses. MPCs on imaging can present with imaging features similar to invasive ductal carcinoma and probably even benign lesions. The purpose of this article is to review MPC of the breast including the pathology subtypes, imaging features, and imaging pathology correlations. By understanding the clinical picture, pathology, and overlap in imaging characteristics of MPC with invasive ductal carcinoma and probably benign lesions can assist in diagnosing these difficult malignancies.

Idiopathic Thrombus in the Common Carotid Artery on Digital Subtraction Angiography

Anand Alurkar — Sat,28 Apr 2012

Anand Alurkar, Lakshmi Sudha Prasanna Karanam, Suresh Nayak, Sagar Oak

Journal of Clinical Imaging Science 2012 2(1):20-20

In the present study, we discuss the accuracy of digital subtraction angiography (DSA) in diagnosis of thrombus in the common carotid artery and its role in the medical management of this disorder. Between 2006 and 2011, four patients (age group ranging from 26 to 48 years) presented to our institution with symptoms of stroke. DSA in all these patients showed cigar-shaped filling defect in the common carotid artery. All the patients were managed successfully with anticoagulation treatment. Follow-up Duplex scan was done in all the patients. DSA is the gold standard to diagnose free floating thrombus in the common carotid artery. Medical management can be effective in these patients but a multidisciplinary team approach is needed for appropriate management.

Rupture of Plantaris Muscle - A Mimic: MRI Findings

TN Gopinath — Sat,28 Apr 2012

TN Gopinath, J Jagdish, K Krishnakiran, PC Shaji

Journal of Clinical Imaging Science 2012 2(1):19-19

Calf muscle trauma commonly involves the gastrocnemius and soleus muscles. Plantaris muscle is a vestigial muscle coursing through the calf. Similar clinical features may be seen with injury to the plantaris muscle. It can also mimic other conditions like deep vein thrombosis, rupture of Baker's cyst, and tumors. MRI is helpful in identifying and characterizing it. We report two cases of ruptured plantaris muscle seen on MRI.

Report of Two Siblings with Overlapping Features of Ellis-van Creveld and Weyers Acrodental Dysostosis

Devi C Shetty — Sat,28 Apr 2012

Devi C Shetty, Harkanwal P Singh, Prince Kumar, Chanchal Verma

Journal of Clinical Imaging Science 2012 2(1):18-18

Skeletal dysplasias are a heterogenous group of disorders combining abnormalities in the skull and other skeletal bones. Weyers acrofacial dysostosis also known as Weyers acrodental dysostosis was first described in 1952, by Weyers, as a postaxial polydactyly, which had features distinct from, yet some in common with the Ellis-van Creveld Syndrome (EvC). Both the syndromes have been mapped to the same chromosome, 4p16. The cases reported here highlight the overlapping features of both syndromes, which are dissimilar in mode of inheritance and phenotypic severity, emphasizing the need for genetic analysis, to categorize these conditions.

Agenesis of the Gallbladder with the Presence of a Small Dysmorphic Cyst: Role of Magnetic Resonance Cholangiopancreatography

Antonio Pierro — Sat,28 Apr 2012

Antonio Pierro, Matia Martucci, Giuseppina Maselli, Alessandra Farchione

Journal of Clinical Imaging Science 2012 2(1):17-17

We report a case of agenesis of the gallbladder with the presence of a small dysmorphic cyst, along the bed of the gallbladder and cystic duct. The patient presented to us with a suspected diagnosis of atrophic and sclerotic gallbladder that was not seen on ultrasound examination, indicating the need for cholecystectomy. The patient's medical history report mentioned agenesis of the left kidney. The existence of a congenital abnormality led us to suspect the inability to visualize the gallbladder was probably due to a possible agenesis of the gallbladder. The patient was investigated with magnetic resonance cholangiopancreatography (MRCP), that confirmed the suspected diagnosis and avoided unnecessary surgery. The hypothesis of anomalous development or agenesis of the gallbladder should always be suspected when the gallbladder is not visible on ultrasound imaging, especially in patients with other congenital anomalies. We believe that in all these patients, MRCP must always be performed to help make decisions on the treatment protocol.

An Unusual Case of Gallium Scan Mimicking a Bone Scan

Ameya Puranik — Sat,28 Apr 2012

Ameya Puranik, Karuna Luthra, RD Lele

Journal of Clinical Imaging Science 2012 2(1):16-16

Gallium-67 localization is based on the fact that it binds to plasma proteins like transferrin and lactoferrin, which have iron-binding sites. Abnormal biodistribution of gallium-67 citrate can occur in iron-overload states. We report one such case of gallium scan mimicking a bone scan due to skeletal uptake of gallium.

Post-traumatic Cavernosal Artery Pseudoaneurysm Presenting as Right Hip Pain: An Imaging Evaluation

Aarthi Govindarajan — Thu,22 Mar 2012

Aarthi Govindarajan, PM Venkata Sai, C Anupama, S Santhosh Joseph

Journal of Clinical Imaging Science 2012 2(1):15-15

Pseudoaneurysm of the cavernosal artery is quite rare. Herein, we describe color Doppler findings of post-traumatic pseudoaneurysm of the right cavernosal artery in a 19-year-old adolescent boy who presented with right hip pain. Doppler showed turbulence of flow with arterial inflow and outflow from the Pseudoaneurysm of the cavernosal artery is quite rare. Herein, we describe color Doppler findings of post-traumatic pseudoaneurysm of the right cavernosal artery in a 19-year-old adolescent boy who presented with right hip pain. Doppler showed turbulence of flow with arterial inflow and outflow from the aneurysm. Selective transarterial catheterization of the internal iliac and internal pudental artery with microcatheter and embolization of pseudoaneurysm using histocryl resulted in alleviation of symptoms.aneurysm. Selective transarterial catheterization of the internal iliac and internal pudental artery with microcatheter and embolization of pseudoaneurysm using histocryl resulted in alleviation of symptoms.

Focal Lipoatrophy of Face: A Rare Esthetic Complaint

K Anbarasi — Thu,22 Mar 2012

K Anbarasi, S Sathasivasubramanian, CL Krithika, PM VenkataSai

Journal of Clinical Imaging Science 2012 2(1):14-14

A well-proportioned face combines features that are balanced and symmetrical. Any structural alteration that leads to facial asymmetry causes esthetical and psychological disturbances. Lipoatrophy is one such condition, which results in loss of subcutaneous fat layer and manifests as a depression. Although many subtypes with varying clinical and etiological backgrounds exist, the idiopathic form is rare and facial involvement is the rarest. Computed tomography is one of the accepted diagnostic tools to determine the atrophic layer of facial anatomy. This report presents the clinical types, diagnosis, and management of a case of facial lipoatrophy.

Imaging Techniques in Endodontics: An Overview

BS Deepak — Thu,22 Mar 2012

BS Deepak, TS Subash, VJ Narmatha, T Anamika, TK Snehil, DB Nandini

Journal of Clinical Imaging Science 2012 2(1):13-13

This review provides an overview of the relevance of imaging techniques such as, computed tomography, cone beam computed tomography, and ultrasound, to endodontic practice. Many limitations of the conventional radiographic techniques have been overcome by the newer methods. Advantages and disadvantages of various imaging techniques in endodontic practice are also discussed.

Assessing the Performance of Imaging Health Systems in Five Selected Hospitals in Uganda

Michael G Kawooya — Thu,22 Mar 2012

Michael G Kawooya, George Pariyo, Elsie Kiguli Malwadde, Rosemary Byanyima, Harriet Kisembo

Journal of Clinical Imaging Science 2012 2(1):12-12

Objectives : The first objective of the study was to develop an index termed as the 'Imaging Coverage' (IC), for measuring the performance of the imaging health systems. This index together with the Hospital-Based Utilization (HBU) would then be calculated for five Ugandan hospitals. Second, was to relate the financial resources and existing health policy to the performance of the imaging systems. Materials and Methods: This was a cross-sectional survey employing the triangulation methodology, conducted in Mulago National Referral Hospital. The qualitative study used cluster sampling, in-depth interviews, focus group discussions, and self-administered questionnaires to explore the non-measurable aspects of the imaging systems' performances. Results: The IC developed and tested as an index for the imaging system's performance was 36%. General X-rays had the best IC followed by ultrasound. The Hospital-Based Utilization for the five selected hospitals was 186 per thousand and was the highest for general radiography followed by ultrasound. Conclusion: The IC for the five selected hospitals was 36% and the HBU was 186 per thousand, reflecting low performance levels, largely attributable to inadequate funding. There were shortfalls in imaging requisitions and inefficiencies in the imaging systems, financing, and health policy. Although the proportion of inappropriate imaging was small, reducing this inappropriateness even further would lead to a significant total saving, which could be channeled into investigating more patients. Financial resources stood out as the major limitation in attaining the desired performance and there is a need to increase budget funding so as to improve the performance of the imaging health systems.

Asymptomatic Thymic Cyst Appearing in the Neck on Valsalva: Unusual Presentation of a Rare Disease

Kishor V Hegde — Mon,19 Mar 2012

Kishor V Hegde, P Suneetha, PV Pradeep, Panil Kumar

Journal of Clinical Imaging Science 2012 2(1):11-11

Thymic cysts are usually diagnosed accidentally during radiological evaluation of the chest for unrelated conditions. Symptoms appear late when the mass compresses on adjoining tissues. We report an unusual case of asymptomatic mediastinal thymic cyst which was seen in the neck whenever the patient was asked to perform Valsalva maneuver. This case is being reported for the unusual clinical presentation of a rare disease. The role of imaging in the diagnosis and common differential diagnoses are also discussed.

Deep Circumflex Iliac Artery Pseudoaneurysm as a Complication of Paracentesis

Bhawna Satija — Mon,19 Mar 2012

Bhawna Satija, Sanyal Kumar, Ramnik K Duggal, Supreethi Kohli

Journal of Clinical Imaging Science 2012 2(1):10-10

We report a case of a pseudoaneurysm arising from the deep circumflex iliac artery, in an end-stage renal disease patient with gross ascitis, presenting with an anterior abdominal wall hematoma following paracentesis. Duplex Doppler sonography confirmed the presence of the pseudoaneurysm and multidetector computed tomography angiography delineated the detailed arterial anatomy.

Asymptomatic Incidental Ductal Carcinoma in situ in a Male Breast Presenting with Contralateral Gynecomastia

Laura M Isley — Mon,19 Mar 2012

Laura M Isley, Rebecca J Leddy, Tihana Rumboldt, Jacqueline M Bernard

Journal of Clinical Imaging Science 2012 2(1):9-9

Ductal carcinoma in situ (DCIS) in males is rare and usually presents with symptoms on the affected side, such as, palpable mass or bloody nipple discharge. Even as DCIS has been reported in conjunction with gynecomastia in the same breast, we report an unusual case of a 62-year-old Caucasian male, with no family history of breast cancer, who presented with symptomatic side gynecomastia, and was incidentally found to have DCIS in a completely asymptomatic left breast. To the best of our knowledge, this case is the first report in literature of asymptomatic, incidentally discovered DCIS in a male patient.

Aggressive Form of Cherubism

GV Reddy — Sat,25 Feb 2012

GV Reddy, G Siva Prasad Reddy, NVS Sekhar Reddy, Raj Kumar Badam

Journal of Clinical Imaging Science 2012 2(1):8-8

Cherubism is a rare non-neoplastic hereditary disease related to genetic mutations characterized by symmetrically swollen cheeks, particularly over the angles of the mandible, and an upward turning of the eyes. The affected mandible and maxilla begin to swell in early childhood, and gradually increase until the age of puberty. Apparently, surgical intervention is unnecessary unless significant functional, esthetic, or emotional disturbances develop. In the present paper, we report a case of cherubism, with classic features that was classified as grade 3, managed with surgery and followed up for 2-years after treatment.

Dedicated Cone-beam Breast Computed Tomography and Diagnostic Mammography: Comparison of Radiation Dose, Patient Comfort, And Qualitative Review of Imaging Findings in BI-RADS 4 and 5 Lesions

Avice M O'Connell — Sat,25 Feb 2012

Avice M O'Connell, Daniel Kawakyu-O'Connor

Journal of Clinical Imaging Science 2012 2(1):7-7

Objective: This pilot study was undertaken to compare radiation dose, relative visibility/conspicuity of biopsy-proven lesions, and relative patient comfort in diagnostic mammography and dedicated cone-beam breast computed tomography (CBBCT) in Breast Imaging-Reporting and Data System (BI-RADS)® 4 or 5 lesions. Materials and Methods: Thirty-six consecutive patients (37 breasts) with abnormal mammographic and/or ultrasound categorized as BI-RADS® 4 or 5 lesions were evaluated with CBBCT prior to biopsy. Administered radiation dose was calculated for each modality. Mammograms and CBBCT images were compared side-by-side and lesion visibility/conspicuity was qualitatively scored. Histopathology of lesions was reviewed. Patients were administered a survey for qualitative evaluation of comfort between the two modalities. Results: CBBCT dose was similar to or less than diagnostic mammography, with a mean dose of 9.4 mGy (±3.1 SD) for CBBCT vs. 16.9 mGy (±6.9 SD) for diagnostic mammography in a total of 37 imaged breasts (P<0.001). Thirty-three of 34 mammographic lesions were scored as equally or better visualized in CBBCT relative to diagnostic mammography. Characterization of high-risk lesions was excellent. Patients reported greater comfort in CBBCT imaging relative to mammography. Conclusion: Our experience of side-by-side comparison of CBBCT and diagnostic mammography in BI-RADS® 4 and 5 breast lesions demonstrated a high degree of correlation between the two modalities across a variety of lesion types. Owing to favorable radiation dose profile, excellent visualization of lesions, and qualitative benefits including improved patient comfort, excellent field-of-view, and more anatomical evaluation of lesion margins, CBBCT offers a promising modality for diagnostic evaluation of breast lesions.

Krukenberg Tumor: A Rare Cause of Ovarian Torsion

Sameer Sandhu — Sat,18 Feb 2012

Sameer Sandhu, Omar Arafat, Harshad Patel, Chandana Lall

Journal of Clinical Imaging Science 2012 2(1):6-6

Ovarian torsion is the fifth most common gynecological surgical emergency. Ovarian torsion is usually associated with a cyst or a tumor, which is typically benign. The most common is mature cystic teratoma. We report the case of a 43-year-old woman who came to the Emergency Department with rare acute presentation of bilateral Krukenberg tumors, due to unilateral ovarian torsion. In this case report, we highlight the specific computed tomography (CT) features of ovarian torsion and demonstrate the unique radiological findings on CT imaging. Metastasis to the ovary is not rare and 5 to 10% of all ovarian malignancies are metastatic. The stomach is the common primary site in most Krukenberg tumors (70%); an acute presentation of metastatic Krukenberg tumors with ovarian torsion is rare and not previously reported in radiology literature.

Fibrochondrogenesis, an Antenatal and Postnatal Correlation

Nischal G Kundaragi — Sat,18 Feb 2012

Nischal G Kundaragi, Kishor Taori, Chetan Jathar, Amit Disawal

Journal of Clinical Imaging Science 2012 2(1):5-5

Fibrochondrogenesis is a rare, neonatally lethal osteochondrodysplasia, with autosomal recessive inheritance. It differs from other lethal dwarfisms in that it leads to broad, long-bone metaphyses (dumb-bell shaped) and pear-shaped vertebral bodies. We report a case of fibrochondrogenesis with severe pear-shaped platyspondyly, suspected antenatally, and give a comprehensive pictorial review of the antenatal ultrasound and postnatal radiographic findings. Only few cases of fibrochondrogenesis are diagnosed before the termination of pregnancy.

An unusual case of extraosseous accumulation of bone scan tracer in a renal calculus - demonstration by SPECT-CT

Prathamesh Vijay Joshi — Sat,18 Feb 2012

Prathamesh Vijay Joshi, Vikram Lele, Rozil Gandhi

Journal of Clinical Imaging Science 2012 2(1):4-4

Extraosseous localization of radioisotope, used in bone scan, in a variety of physiological and pathological conditions is a well-known phenomenon. The causes of extraosseous accumulation of bone-seeking radiotracers should be kept in mind when bone-imaging studies are reviewed to avoid incorrect interpretations. We report an extremely rare occurrence of extraosseous accumulation of bone scintigraphy tracer in a renal calculus, in a patient with adenocarcinoma of prostate, that was demonstrated by Single Photon Emission Computed Tomography and Computed Tomography (SPECT-CT) fusion imaging.

Acute Concomitant Anterior Cruciate Ligament and Patellar Tendon Tears in a Non-dislocated Knee

Robert D Wissman — Sat,18 Feb 2012

Robert D Wissman, Nathaniel Vonfischer, Kari Kempf

Journal of Clinical Imaging Science 2012 2(1):3-3

Anterior cruciate ligament (ACL) tears are common and may occur in isolation or with other internal derangements of the joint. Tears of the patellar tendon (PT) occur less frequently and are rarely associated with intra-articular pathology. Acute combined tears of both the ACL and PT are known complications of high-energy traumatic knee dislocations. We present a case of an acute concomitant ACL and PT tears in a low-energy non-dislocated knee. To our knowledge, this injury has only been described in a limited number of case reports in the orthopedic literature. We present the imaging findings of this combined injury and discuss the importance of magnetic resonance (MR) in diagnosis.

Radiological Imaging Features of Fasciola hepatica Infection − A Pictorial Review

Abdurrahim Dusak — Fri,27 Jan 2012

Abdurrahim Dusak, Mehmet R Onur, Mutalip Cicek, Ugur Firat, Tianbo Ren, Vikram S Dogra

Journal of Clinical Imaging Science 2012 2(1):2-2

Fascioliasis refers to a zoonosis caused by Fasciola hepatica, a trematode infecting herbivores, but also occurs in humans who ingest the metacercaria found in fresh water plants. Infection in humans is common in developing countries and is also not uncommon in Europe. Diagnosis of this infection is difficult, as the history and symptoms are nonspecific and stool analysis for eggs is negative until the disease is in an advanced state by when the parasite has reached the biliary system. The clinical course consists of two phases; first a hepatic parenchymal phase in which immature larvae invade the liver parenchyma, followed by a ductal phase characterized by the excretion of larvae into the bile ducts. Parenchymal Phase: Ultrasonography (US) findings are nonspecific in this early phase. Computerized tomography (CT) may demonstrate subcapsular low attenuation regions in the liver. Magnetic Resonance imaging (MRI) can also be utilized to establish liver parenchymal involvement, and is better than CT in characterizing hemorrhagic lesions, as well as identifying more lesions relative to CT. Ductal Phase: US examination is most useful at this stage, with its ability to demonstrate the live movement of the worms within the dilated ducts. A CT demonstrates dilated central biliary ducts with periportal tracking, whereas, mild ductal dilatation is poorly appreciated under MRI. Therefore, familiarity with the multimodality imaging features of fascioliasis, in combination with an available confirmatory enzyme-linked immunoassay, would be most helpful for early diagnosis.

Arachnoid Pit and Extensive Sinus Pnematization as the Cause of Spontaneous Lateral Intrasphenoidal Encephalocele

Ali AlMontasheri — Fri,27 Jan 2012

Ali AlMontasheri, Bandar Al-Qahtani, Nader Aldajani

Journal of Clinical Imaging Science 2012 2(1):1-1

Lateral sphenoid encephalocele, especially within the lateral aspect of the sphenoid sinus, when the sphenoid sinus has pneumatized extensively into the pterygoid recess, are considered exceedingly rare. We report a rare case of lateral intrasphenoidal encephalocele with spontaneous cerebral spinal fluid (CSF) rhinorrhea. Computed tomography demonstrated bilateral arachnoid pit, extensive sphenoid sinus pneumatization, and a defect in the superior wall of the left lateral recess of the sphenoid sinus. Magnetic resonance imaging demonstrated anteromedial temporal lobe herniating through the bony defect.

Gardner's Syndrome

Sapna Panjwani — Sat,31 Dec 2011

Sapna Panjwani, Anjana Bagewadi, Vaishali Keluskar, Saurabh Arora

Journal of Clinical Imaging Science 2011 1(1):65-65

Gardner's syndrome is an autosomal dominant disease and is a subtype of familial adenomatous polyposis. It is characterized by adenomatous intestinal polyps, multiple osteomas in the skull, maxillae, mandible, and multiple cutaneous and subcutaneous masses (epidermoids and desmoid). Intestinal polyps, if not treated, have 100% chance of becoming malignant. We report a case of a 25-year-old female patient with Gardner's syndrome, with clinical manifestations including impacted supernumerary teeth, odontomes, sebaceous cyst on the scalp, and osteomas. It is important for the general dental practitioners to be aware of the clinical and radiological characteristics of Gardner's syndrome.

Adenomatoid Odontogenic Tumor − A Report of Two Cases with Histopathology Correlation

Pavitra Baskaran — Sat,31 Dec 2011

Pavitra Baskaran, Satyaranjan Misra, M Sathya Kumar, R Mithra

Journal of Clinical Imaging Science 2011 1(1):64-64

Adenomatoid odontogenic tumor (AOT) is an uncommon, hamartomatous, benign, epithelial lesion of odontogenic origin that was first described by Driebaldt in 1907, as a pseudo-adenoameloblastoma. The current World Health Organisation (WHO) classification of odontogenic tumors defines AOT as being composed of the odontogenic epithelium in a variety of histoarchitectural patterns, embedded in mature connective tissue stroma, and characterized by slow, but progressive growth. The current article reports two cases with different presentations; first in a young female patient and the second in a middle-aged male patient. The importance of biopsy, which is the gold standard for diagnosis, and its use in planning of the treatment is discussed.

New Aspirations

Vikram Dogra — Sat,24 Dec 2011

Vikram Dogra

Journal of Clinical Imaging Science 2011 1(1):63-63

Bronchial Artery Arising from the Left Vertebral Artery: Case Report and Review of the Literature

Timothy J Amrhein — Sat,24 Dec 2011

Timothy J Amrhein, Charles Kim, Tony P Smith, L Washington

Journal of Clinical Imaging Science 2011 1(1):62-62

Knowledge of bronchial artery anatomy, including the possible locations of anomalous origin, is essential for complete catheter directed embolization for massive hemoptysis. Undetected anomalous bronchial arteries can be a source of failed bronchial artery embolization. We report a case of a common trunk bronchial artery arising from the left vertebral artery and review standard and variant bronchial artery anatomy.

Plexiform Ameloblastoma of the Mandible

Dinesh Singh Chauhan — Sat,24 Dec 2011

Dinesh Singh Chauhan, Yadavalli Guruprasad

Journal of Clinical Imaging Science 2011 1(1):61-61

Ameloblastoma is a common and aggressive odontogenic epithelial tumor. It has an aggressive behavior and recurrent course, and is rarely metastatic. Ameloblastoma represents 1% of all tumors and cysts that involve the maxillomandibular area and about 10% of the odontogenic tumors. It is primarily seen in adults in the third to fifth decade of life, with equal sex predilection. Radiographically, it appears as an expansile radiolucent, with thinned and perforated cortices, and is known to cause root resorption. As it shares common radiographic features with other lesions such as the giant cell tumor, aneurismal bone cyst, and renal cell carcinoma metastasis, a definitive diagnosis can only be made with histopathology. We present an extensive case of plexiform ameloblastoma of the mandible in a 42-year-old female patient.

Left Internal Carotid Artery Agenesis Associated with Basilar and Left Vertebral Artery Aneurysm

Lale Pasaoglu — Sat,24 Dec 2011

Lale Pasaoglu, Murat Vural, Ipek Ziraman, Sadik Ahmet Uyanik

Journal of Clinical Imaging Science 2011 1(1):60-60

Agenesis of the internal carotid artery (ICA) is a rare congenital anomaly. Most of the patients are asymptomatic and it is usually discovered incidentally by computed tomography (CT) or magnetic resonance imaging (MRI). There is close association of the cranial aneurysms and subarachnoid hemorrhage with ICA agenesis. We present a case of a 61-year-old male with left ICA agenesis associated with basilar artery and left vertebral artery aneurysms. The patient complained of headaches and numbness on the right-side of the face. Physical examination showed high blood pressure (210/90 mmHg). Neurological examination revealed nystagmus and decreased sensation on the right-side of the face. Agenesis of left ICA, left carotid canal with basilar and left vertebral artery aneurysms were demonstrated incidentally using CT, MRI, and digital subtraction angiography, as a part of an evaluation for suspected cerebrovascular accident.

Ellis Van Creveld Syndrome with Synpolydactyly, an Antenatal Diagnosis with Postnatal Correlation

Nischal G Kundaragi — Sat,24 Dec 2011

Nischal G Kundaragi, Kishor Taori, Ritesh Kumawat, Jawahar Rathod, Atul E Sawant

Journal of Clinical Imaging Science 2011 1(1):59-59

Ellis Van Creveld syndrome (EVC), also known as chondroectodermal dysplasia, presents at birth with short limbs accompanied by postaxial polydactyly, nail dysplasia, and dental anomalies. Other manifestations of EVC include atrial septum defects and other congenital heart diseases. We report a case of the EVC syndrome with postaxial polydactyly (Synpolydactyly with seven fingers on the right side and hexadactyly on the left side) and a partial atrioventricular canal defect diagnosed antenatally. This variation of EVS has not been reported in English literature till date.

F-18 Fluorodeoxy Glucose Positron Emission Tomography/Computed Tomography Findings in a Rare Case of Penile Leiomyosarcoma

Kuruva Manohar — Sat,17 Dec 2011

Kuruva Manohar, Bhagwant Rai Mittal, Raghava Kashyap, Anish Bhattacharya, Nandita Kakkar, Uttam Kumar Mete

Journal of Clinical Imaging Science 2011 1(1):58-58

Penile cancer is a rare entity accounting for only 0.4% all male malignancies. Penile leiomyosarcomas are even rarer with only around 35 cases reported in literature. We report a rare case of penile leiomyosarcoma illustrating F-18 Fluorodeoxy glucose (FDG) positron emission tomography/computed tomography (PET/CT) features and histopathology correlation.

Paratesticular Liposarcoma: A Radiologic Pathologic Correlation

Ahmet Pergel — Sat,17 Dec 2011

Ahmet Pergel, Ahmet Fikret Yucel, Ibrahim Aydin, Dursun Ali Sahin, Hasan Gucer, Ahmet Kocakusak

Journal of Clinical Imaging Science 2011 1(1):57-57

Spermatic cord liposarcoma is an uncommon paratesticular tumor. Patients usually present with a painless scrotal or inguinal mass, mimicking inguinal hernia. Clinical examination suggested an inguinal hernia. Computed tomography demonstrated a fat-containing mass in the right inguinal region. The mass was surgically removed, along with the right testis and spermatic cord. Histopathological examination revealed a well-differentiated liposarcoma. No evidence of recurrence or metastases has been noted during the two-year follow-up with postoperative adjuvant therapy.

Peripheral Osteoma of the Mandible

Hemant Shakya — Fri,2 Dec 2011

Hemant Shakya

Journal of Clinical Imaging Science 2011 1(1):56-56

Osteomas of the facial bones are a rare entity and very few cases have been reported in the literature. Osteomas are benign neoplasms, often asymptomatic and consist of well-differentiated matured bone. There are three varieties of osteomas- the central type arising from the endosteum, the peripheral type arising from the periosteum, and the extra-skeletal soft tissue osteomas which usually develops within the muscle. In the facial bones, both central and peripheral osteomas have been described. Peripheral osteomas have been described to occur in the frontal, ethmoid, and maxillary sinuses, but are not common in jawbones. We describe a rare case of symptomatic peripheral osteoma of mandible in a middle-aged female patient.

Dermatofibrosarcoma Protuberans of the Scalp with Fibrosarcomatous Degeneration and Pulmonary Metastasis

Joseph L Gatlin — Fri,2 Dec 2011

Joseph L Gatlin, Richard Hosch, Majid Khan

Journal of Clinical Imaging Science 2011 1(1):55-55

Dermatofibrosarcoma protuberans is a rare locally aggressive cutaneous tumor of intermediate malignancy. It is a slow-growing neoplasm with a marked propensity to recur after resection. Head and neck involvement is unusual and distant metastases are quite rare but tend to be more frequent in tumors that undergo fibrosarcomatous degeneration. We present the imaging and corresponding histopathology in a case of dermatofibrosarcoma protuberans of the scalp demonstrating fibrosarcomatous degeneration and lung metastasis.

Glandular Odontogenic Cyst of Maxilla

Yadavalli Guruprasad — Mon,21 Nov 2011

Yadavalli Guruprasad, Dinesh Singh Chauhan

Journal of Clinical Imaging Science 2011 1(1):54-54

Glandular odontogenic cyst (GOC) is a rare developmental lesion that is considered a distinct entity because of its uncommon histopathological characteristics. It has morphological similarities to other lesions, which makes its diagnosis challenging for pathologists. It strikes distinct age groups, with an average patient age being 50 years. This lesion can involve either jaw, but the anterior region of the mandible is the most commonly affected area. It exhibits a tendency toward recurrence when conservative treatment is administered. It is believed that the low prevalence of GOC in the literature is due not only to its rarity, but also to the fact that its main characteristics are also found in other pathological entities. We report here radiologic-pathologic features of GOC of the maxilla in a 17-year-old female patient.

Assessing the Diagnostic Imaging needs for Five Selected Hospitals in Uganda

Michael G Kawooya — Sat,19 Nov 2011

Michael G Kawooya, George Pariyo, Elsie Kiguli Malwadde, Rosemary Byanyima, Harrient Kisembo

Journal of Clinical Imaging Science 2011 1(1):53-53

Introduction: Uganda has limited health resources. It is important to measure the need for imaging in order to set policy and plan for imaging services. Objectives: The first specific objective was to develop and apply four imaging needs indices on a case study basis, in five selected Ugandan hospitals. The indices were: Imaging Load (IL), Imaging Burden (IB), Type Specific Imaging Burden (TSIB), and Disease Specific Imaging Burden (DSIB). The second objective was to explore the perceptions of the patient, referring clinician, and radiologist regarding the values, meaning, and objective of imaging in patient care. Materials and Methods: This was a cross-sectional survey employing triangulation methodology, conducted in 5 Ugandan hospitals over a period of 3 years during 2005 - 2008. The subjects were divided into four clusters: Obstetrics and gynecology (obs/gynae), surgery, internal medicine, and pediatrics. For the quantitative component of the study, data from case notes was used to calculate the indices. The qualitative component explored the non-measurable aspects of imaging needs from the clinician's, radiologist's, and patient's perspective. Results: A total of 1961 patient case notes were studied. The IB was 460 per 1000 hospital patients per year. The highest TSIB was for ultrasound at 232 per 1000 hospital patients per year, followed by 191 patients for general X-ray. The majority of the patients interviewed had special desires, expectations, and misconceptions. Conclusions: There is a high IB of 460 per thousand patient populations per year, mainly due to ultrasound. The majority of the patients have perceptions, misconceptions, beliefs, and values which influence the need for imaging. There is a need to address the medical and non-tangible imaging needs of the patient and to counteract imaging-related misconceptions and over-expectations. Public awareness of the value, capabilities, limitations, and adverse effects of various imaging modalities need to be addressed to ensure that the patients make informed imaging choices and readily avail themselves of interventions in situations when imaging is crucial, for example in suspected high-risk pregnancy.

Paratesticular Solitary Plasmacytoma

Mehmet Ruhi Onur — Tue,25 Oct 2011

Mehmet Ruhi Onur, Ben Wandtke, Jorge L Yao, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):52-52

Primary solid neoplasms of the extratesticular tissues are rare. The reported prevalence rate of paratesticular neoplasms is between 3% and 16% of all patients referred for scrotal ultrasonography. A plasmacytoma is a discrete, solitary mass of malignant monoclonal plasma cells that can arise in any part of the body. In this report, we present a case of a paratesticular solid mass detected in an 80-year-old patient that proved to be primary extraosseous plasmacytoma on surgery, and discuss its sonographic features.

Non-Coronary Cardiac Findings and Pitfalls in Coronary Computed Tomography Angiography

Noriko Oyama-Manabe — Tue,25 Oct 2011

Noriko Oyama-Manabe, Teppei Sugaya, Takayoshi Yamaguchi, Satoshi Terae

Journal of Clinical Imaging Science 2011 1(1):51-51

Non-coronary incidental findings are not rare. Kirsch et al found 67% non-coronary abnormalities with coronary computed tomography angiography (CCTA). Radiologists are expected to identify the extracoronary, intra- and para-cardiac anatomical structures and distinguish them from pathologic processes in CCTA. We have reviewed 2000 CCTA studies done at our institution with 64-MDCT. This pictorial essay presents case studies of non-atherosclerotic cardiovascular findings to recognize cardiac anatomic structures and how to distinguish them from pathologic processes. Correct interpretation of benign, clinically insignificant findings is crucial to avoid unnecessary additional imaging tests.

Multimodality Imaging of Normal Hepatic Transplant Vasculature and Graft Vascular Complications

Jeffrey H Roberts — Tue,25 Oct 2011

Jeffrey H Roberts, Fernanda S Mazzariol, Susan J Frank, Sarah K Oh, Mordecai Koenigsberg, Marjorie W Stein

Journal of Clinical Imaging Science 2011 1(1):50-50

Orthotopic liver transplantation is an important treatment option for patients with end-stage liver disease. Advances in surgical technique, along with improvements in organ preservation and immunosuppression have improved patient outcomes. Post-operative complications, however, can limit this success. Ultrasound is the primary imaging modality for evaluation of hepatic transplants, providing real-time information about vascular flow in the graft. Graft vascular complications are not uncommon, and their prompt recognition is crucial to allow for timely graft salvage. A multimodality approach including CT angiography, MRI, or conventional angiography may be necessary in cases of complex transplant vascular anatomy or when sonography and Doppler are inconclusive to diagnose the etiologies of these complications. The purpose of this article is to familiarize radiologists with the normal post-transplant vascular anatomy and the imaging appearances of the major vascular complications that may occur within the hepatic artery, portal vein, and venous outflow tract, with an emphasis on ultrasound.

Imaging Acute Appendicitis: State of the Art

Diana Gaitini — Fri,7 Oct 2011

Diana Gaitini

Journal of Clinical Imaging Science 2011 1(1):49-49

The goal of this review is to present the state of the art in imaging tests for the diagnosis of acute appendicitis. Relevant publications regarding performance and advantages/disadvantages of imaging modalities for the diagnosis of appendicitis in different clinical situations were reviewed. Articles were extracted from a computerized database (MEDLINE) with the following activated limits: Humans, English, core clinical journals, and published in the last five years. Reference lists of relevant studies were checked manually to identify additional, related articles. Ultrasound (US) examination should be the first imaging test performed, particularly among the pediatric and young adult populations, who represent the main targets for appendicitis, as well as in pregnant patients. A positive US examination for appendicitis or an alternative diagnosis of possible gastrointestinal or urological origin, or a negative US, either showing a normal appendix or presenting low clinical suspicion of appendicitis, should lead to a final diagnosis. A negative or indeterminate examination with a strong clinical suspicion of appendicitis should be followed by a computed tomography (CT) scan or alternatively, a magnetic resonanace imaging (MRI) scan in a pregnant patient. A second US examination in a patient with persistent symptoms, especially if the first one was performed by a less experienced imaging professional, is a valid alternative to a CT.

Breast MR Imaging: What the Radiologist Needs to Know

Gurpreet S Dhillon — Mon,3 Oct 2011

Gurpreet S Dhillon, Nick Bell, Daniel T Ginat, Alena Levit, Stamatia Destounis, Avice O'Connell

Journal of Clinical Imaging Science 2011 1(1):48-48

Magnetic resonance imaging (MRI) of the breast is being performed more frequently to improve primary and recurrent tumor detection, characterization, and response to therapy. Sensitivity of this test approaches 90% and the specificity ranges from 37% to 100%. We present a concise tutorial for the general radiologist with a pictorial review of common lesions identified with breast MRI.

Congenital Agenesis of the Left Lung: A Rare Case

Tülin Durgun Yetim — Wed,21 Sep 2011

Tülin Durgun Yetim, Hanifi Bayarogullari, Hülya Polat Yalçin, Vefik Arica, Seçil Gunher Arica

Journal of Clinical Imaging Science 2011 1(1):47-47

Pulmonary agenesis is a rare congenital anomaly, the etiology of which is not clearly known. Other systemic comorbidities such as cardiovascular, gastrointestinal, musculoskeletal, and urogenital system anomalies can be observed in more than half of the patients. It is usually diagnosed during childhood. Diagnosis in adulthood is very rare. We present a case of pulmonary agenesis diagnosed in an adult.

Imaging Findings in Chiari I Malformation with Syringomyelia in a Case of Charcot Shoulder

Shantanu Kumar — Wed,21 Sep 2011

Shantanu Kumar, Vineet Sharma, Santosh Kumar, Sonal Jain

Journal of Clinical Imaging Science 2011 1(1):46-46

Neuropathic arthropathy of the shoulder is reported in only 5% of cases. Here, we report a rare case of neuropathic arthropathy of the shoulder, secondary to Chiari malformation Type I with associated syringomyelia, that remained undetected for four years. A 38-year-old female presented to our Department with a swelling over the right shoulder that had persisted for four years. X-ray of the joint showed destruction of the head of the right humerus, with typical blunt amputated appearance of the bone and increased joint space. Magnetic resonance imaging showed destruction and lateral dislocation of the head of the humerus. Large amount of fluid collection was seen in and around the right shoulder joint. Neuropathic osteoarthropathy can be defined as bone and joint changes that occurs secondary to loss of sensation. In our case, neuropathic shoulder joint was secondary to syringomyelia associated with Chiari I malformation.

Computed Tomography Findings in Xanthogranulomatous Pyelonephritis

Arumugam Rajesh — Sat,27 Aug 2011

Arumugam Rajesh, George Jakanani, Nick Mayer, Kevin Mulcahy

Journal of Clinical Imaging Science 2011 1(1):45-45

Background: Xanthogranulomatous pyelonephritis (XGN) is an uncommon condition characterized by chronic suppurative renal inflammation that leads to progressive parenchymal destruction. Purpose: To review the computed tomography (CT) findings of patients diagnosed with XGN. Materials and Methods: A retrospective review of CT findings in patients with histologically proven XGN was carried out. Results: Thirteen CT examinations of 11 patients were analyzed. Renal enlargement was demonstrable on the affected side in all patients. Nine patients (82%) had multiple dilated calyces and abnormal parenchyma. Six patients (55%) had a renal pelvis or upper ureteric calculus causing obstruction. Three patients (27%) had focal fat deposits identifiable within the inflamed renal parenchyma. Two patients had renal abscesses. Ten patients (91%) had extrarenal extension of the inflammatory changes. Three patients (27%) demonstrated extensive retroperitoneal inflammation. Conclusion: Unilateral renal enlargement and inflammation were the most consistent findings of XGN on CT. Perinephric inflammation and collections or abscess should also alert the radiologist to the possibility of this diagnosis.

Struma Ovarii with Papillary Thyroid Carcinoma

Daniel M Alvarez — Sat,27 Aug 2011

Daniel M Alvarez, Victor Lee, Shweta Bhatt, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):44-44

Struma ovarii is an uncommon condition, in which thyroid tissue is the predominant or exclusive element in an ovarian teratoma. Thyroid tissue may demonstrate the same spectrum of pathological features as in the normal thyroid including benign and malignant changes. We present a case of papillary thyroid carcinoma arising in a struma ovarii of the left ovary in a 21-year-old female.

Temporal and Pontine Involvement in a Case of Herpes Simplex Encephalitis, Presenting as Kluver Bucy Syndrome - A Case Report

Suresh Thirunavukarasu — Sat,27 Aug 2011

Suresh Thirunavukarasu

Journal of Clinical Imaging Science 2011 1(1):43-43

Bilateral temporal and frontal lobe involvement is a common characteristic of herpes simplex encephalitis (HSE). Clinical sequelae of herpes simplex encephalitis may manifest sometimes as Kluver Bucy syndrome (KBS). In herpes simplex encephalitis, apart from frontal lobe, extra temporal involvement is rare and uncommon. We report a case of HSE manifesting clinically as KBS with a rare radiological finding of temporal and extratemporal involvement of pons.

Angiographic-CT-FDG-Pathologic Correlations of the Incidentally Discovered Adrenal Mass

Bi-Fang Lee — Wed,17 Aug 2011

Bi-Fang Lee, Nan-Tsing Chiu, Hong-Ming Tsai, Hung-Wen Tsai, Chung-Jye Hung

Journal of Clinical Imaging Science 2011 1(1):42-42

During abdominal ultrasonography of a 37-year-old man a 3.2 cm hypoechoic mass in the right hepatic lobe was found incidentally. This prompted an abdominal CT, an FDG PET/CT, and an angiography to evaluate the nature of the mass. Laboratory data showed positive anti-HBs/anti-HBe, and negative HCV antibody. The alfa-fetoprotein and liver function tests were within normal limits. Contrast-enhanced CT found an enhanced hepatic tumor and primary hepatocellular carcinoma was suspected. PET/CT revealed no abnormal FDG accumulation in the right hepatic mass. The digital subtraction angiographies of the right inferior phrenic artery and right renal artery revealed a hypervascular tumor in the right adrenal gland. Therefore, a diagnosis of a right adrenal tumor was made. Serum aldosterone, serum cortisol, and urine vanillylmandelic acid, and catecholamine were all within normal limits. Laparoscopic right adrenalectomy was performed and adrenal cortical adenoma was diagnosed on a histological study.

Magnetic Resonance Enterography Findings in Crohn's disease in the Pediatric Population and Correlation with Fluoroscopic and Multidetector Computed Tomographic Techniques

Parul Patel — Sat,30 Jul 2011

Parul Patel, Margaret Ormanoski, Kim M Hoadley

Journal of Clinical Imaging Science 2011 1(1):41-41

Traditionally, fluoroscopic examinations such as enteroclysis, upper GI studies, and small bowel follow through exams have been the procedures of choice in evaluating inflammatory bowel disease (IBD) in pediatric populations. With the advent of multidetector computed tomography (MDCT), it has subsequently become a complementary examination in imaging inflammatory bowel disease. A major advantage of MDCT over fluoroscopic examination is its ability to directly visualize bowel mucosa, as well as demonstrate extra-enteric complications of IBD such as abscesses, fistulae, and sinus tracts. The major disadvantage of CT however is exposure to ionizing radiation, especially in IBD patients of the pediatric age group who maybe repeatedly imaged due to exacerbations. As a result, magnetic resonance enterography (MRE) is becoming increasingly important in the evaluation and follow-up of pediatric patients with IBD. This pictorial essay will summarize the multi-modality imaging findings of IBD with emphasis on MRE including the imaging protocol and procedure. For the purposes of this article, patients less than 17 years of age have been considered to represent the pediatric population.

The Forgotten Guide Wire: A Rare Complication of Hemodialysis Catheter Insertion

Said Abuhasna — Sat,30 Jul 2011

Said Abuhasna, Dirar Abdallah, Masood ur Rahman

Journal of Clinical Imaging Science 2011 1(1):40-40

A rare complication of a hemodialysis catheter insertion is the loss of the complete guide wire into the circulation. A complete guide wire in the circulation may not necessarily produce symptoms, and it may remain unnoticed for a significant period of time. We present a rare case where a complete guide wire was lost into the circulation during insertion of a hemodialysis catheter into the right femoral vein in a 19-year-old female with systemic lupus erythromatosis. The patient remained asymptomatic through two plasmapheresis treatments over a period of 2 days. The guide wire was eventually retrieved without complications. The factors leading to the wire being forgotten will be reviewed, and the measures initiated to prevent any future occurrence will be addressed.

Clinically Relevant Imaging in Tuberous Sclerosis

Rupa Radhakrishnan — Wed,27 Jul 2011

Rupa Radhakrishnan, Sadhna Verma

Journal of Clinical Imaging Science 2011 1(1):39-39

Tuberous sclerosis (TS), also known as Bourneville disease or Bourneville-Pringle disease, is an autosomal dominant genetic disorder classically characterized by the presence of hamartomatous growths in multiple organs. TS and tuberous sclerosis complex (TSC) are different terms for the same genetic condition. Both terms describe clinical changes due to mutations involving either of the two genes named TSC1 and TSC2, which regulate cell growth. The diagnosis of TSC is established using diagnostic criteria based on clinical and imaging findings. Routine screening and surveillance of patients with TSC is needed to determine the presence and extent of organ involvement, especially the brain, kidneys, and lungs, and identify the development of associated complications. As the treatment is organ specific, imaging plays a crucial role in the management of patients with TSC.

Angiogenesis Imaging in Neoplasia

David J Bowden — Wed,27 Jul 2011

David J Bowden, Tristan Barrett

Journal of Clinical Imaging Science 2011 1(1):38-38

Angiogenesis plays a key role in physiological and pathophysiological processes and is recognized as being essential for tumor growth and metastases. The recent oncological development of anti-angiogenic drugs brings with it a need for angiogenesis quantification and monitoring of response. The nature of these agents means that traditional anatomical methods of assessing morphologic change are outmoded and functional imaging techniques and/or agents are necessary. Herein, we describe the various imaging techniques that can be employed to assess angiogenesis, along with their inherent advantages and disadvantages and discuss the current and future developments in the field.

Crohn's disease: Multimodality Imaging of Surgical Indications, Operative Procedures, and Complications

B Kolar — Thu,14 Jul 2011

B Kolar, J Speranza, S Bhatt, V Dogra

Journal of Clinical Imaging Science 2011 1(1):37-37

Surgical management is considered for specific indications in Crohn's disease and a wide variety of surgeries is performed. The purpose of this pictorial essay is to depict manifestations of Crohn's disease that indicates surgery, various surgical procedures that are performed, and the complications arising from these surgical procedures. Surgical indications including obstruction due to strictures or adhesions, fistulae and abscesses, and surgeries for these conditions, such as, ileocecectomy, stricturoplasty, small bowel resection, fecal diversion, segmental colectomy, and lysis of adhesions and their complications will be discussed and their imaging will also be illustrated.

A Very Rapid Visual Recovery of Posterior Reversible Encephalopathy Syndrome

Harpreet S Walia — Sat,25 Jun 2011

Harpreet S Walia, F Lawson Grumbine, Neal V Palejwala, Gagan K Sawhney, David S Risner, Sandeep S Walia

Journal of Clinical Imaging Science 2011 1(1):36-36

Role of Magnetic Resonance Enterography in Differentiating between Fibrotic and Active Inflammatory Small Bowel Stenosis in Patients with Crohn's disease

Francesca Fornasa — Sat,25 Jun 2011

Francesca Fornasa, Chiara Benassuti, Luca Benazzato

Journal of Clinical Imaging Science 2011 1(1):35-35

Objective: To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in prospectively differentiating between fibrotic and active inflammatory small bowel stenosis in patients with Crohn's disease (CD). Materials and Methods: A total of 111 patients with histologically proven CD presenting with clinical and plain radiographic signs of small bowel obstruction underwent coronal and axial MRI scans after oral administration of polyethylene glycol solution. A stenosis was judged present if a small bowel segment had >80% lumen reduction as compared to an adjacent normal loop and mural thickening of >3 mm. At the level of the stenosis, both T2 signal intensity and post-gadolinium T1 enhancement were quantified using a 5-point scale (0: very low; 1: low; 2: moderate; 3: high; and 4: very high). A stenosis was considered fibrotic if the sum of the two values (activity score: AS) did not exceed 1. Results: A small bowel stenosis was identified in 48 out of 111 patients. Fibrosis was confirmed at histology in all of the 23 patients with AS of 0 or 1, who underwent surgery within 3 days of the MRI examination. In the remaining 25 patients (AS: 2-8), an active inflammatory stenosis was suspected and remission of the obstructive symptoms was obtained by means of medical treatment. One of these patients (AS: 2), however, underwent surgery after 14 days, due to recurrence. MRI had 95.8% sensitivity, 100% specificity, and 97.9% accuracy in the diagnosis of fibrotic stenosis. Conclusion: MRI is reliable in differentiating fibrotic from inflammatory small bowel stenosis in CD.

Sonographic Findings of Additional Malignant Lesions in Breast Carcinoma Seen by Second Look Ultrasound

Ana Delgado Laguna — Sat,25 Jun 2011

Ana Delgado Laguna, S Jimenez Arranz, V Quintana Checa, S Alonso Roca, D Expósito Jiménez, J Oliver-Goldaracena

Journal of Clinical Imaging Science 2011 1(1):34-34

Objective: The aim is to show ultrasound (US) findings of additional malignant lesions of breast carcinoma visualized on targeted second-look US that were not identified by mammography or US prior to the time of diagnosis. Materials and Methods: A double-blind retrospective review of the US results from January 2008 through August 2010 of 228 patients with known breast cancer was conducted by two expert radiologists. The focus of the review was on the second-look US characteristics (following BI-RADS criteria) of 26 documented additional malignant lesions of the 76 with successful sonographic correlation from the 123 lesions detected by magnetic resonance imaging (MRI). All of them, before the MRI, had an initial mammography and a US with a histopathological biopsy of the primary lesion. Results: Approximately 60 to 70% of the findings were classified as BI-RADS 2 and BI-RADS 3, while assessing the final US category. The review of the second-look US showed the size of the second malignant additional lesion ranged from 3 to 22 mm, of which 90% were smaller than 10 mm and 66% were smaller than 7 mm. Conclusions: Most additional malignant lesions, nonpalpable carcinomas, which were previously not detected by mammography and US at first-look diagnosis, were detected by a targeted second-look US examination. These lesions were of category BI-RADS 2 and BI-RADS 3 and smaller than 7 mm.

Communicating Tubular Duplication of Upper Esophagus-A Rare Occurrence

Jawahar Rathod — Tue,21 Jun 2011

Jawahar Rathod, Amit Disawal, Kishor Taori, Meenakshi Agrawal, Prajwaleet P Gaur, Vijay Jadhav, Krishna Prasad, Kanchan Wankhede

Journal of Clinical Imaging Science 2011 1(1):33-33

Duplications of esophagus are commonly classified into two types, tubular and cystic. Tubular duplication of esophagus is a rare occurrence and is much less common than cystic duplication of foregut. Most esophageal duplications are located in the lower third of the esophagus. A cervical esophageal duplication is extremely rare. Esophageal duplications have been reported twice as commonly on the right as on the left. We report a case of incidental finding identified on computed tomography of communicating tubular esophageal duplication involving the left side of the upper esophagus in a tuberculosis patient that was subsequently confirmed on barium swallow test.

Imaging Features of the Pleuropulmonary Manifestations of Rheumatoid Arthritis: Pearls and Pitfalls

Harbir S Sidhu — Tue,21 Jun 2011

Harbir S Sidhu, Gauraang Bhatnagar, Pervinder Bhogal, Richard Riordan

Journal of Clinical Imaging Science 2011 1(1):32-32

Rheumatoid arthritis (RA) is a common disorder that affects the joints. RA is a systemic disease associated with relatively frequent and variable pleuropulmonary manifestations. This article reviews the common and potentially serious thoracic sequelae in terms of pleural disease, pulmonary nodules, airways disorders, and interstitial disease, as well as pulmonary side effects of antirheumatic medication. An imaging-guided approach to classification of RA-associated lung disease is outlined and the comparative values of different imaging modalities are discussed. An appreciation of current knowledge of epidemiology, pathological correlation, and prognostic implications of different RA-associated lung disease is provided. We highlight importance of considering pertinent differential diagnoses to avoid misdiagnosis, and outline common pitfalls in dealing with pleuropulmonary rheumatoid disease.

Image-guided Percutaneous Drainage in the Pediatric Population: A Primer for Radiologists

Keerthi Arani — Tue,21 Jun 2011

Keerthi Arani, Kiran Nandalur, Christina M Tucker, David A Bloom

Journal of Clinical Imaging Science 2011 1(1):31-31

Image-guided percutaneous drainage is an excellent minimally invasive method for dealing with infectious complications in the pediatric population. A thorough understanding of drainage procedures in children can often lead to improved patient outcomes. Indications for percutaneous drainage will be reviewed, including abscesses related to appendicitis, post-surgical abscess formation, and abscesses related to Crohn's disease. This pictorial essay will help the radiologist better understand the common etiologies of abscesses in children that may require percutaneous drainage, the special considerations for catheter placement, patient preparation, and anesthesia or sedation issues unique to the pediatric population.

Imaging-guided Parenchymal Liver Biopsy: How We Do It

Gopal R Vijayaraghavan — Wed,15 Jun 2011

Gopal R Vijayaraghavan, Sheehan David, Myriam Bermudez-Allende, Hussain Sarwat

Journal of Clinical Imaging Science 2011 1(1):30-30

Liver biopsies are performed for both focal and nonfocal lesions (parenchymal). In our center, majority of liver biopsies are performed for parenchymal liver disease. Parenchymal liver biopsy plays a key role in the diagnosis of various diffuse liver dysfunctions. Results of the biopsy help grade the disease, facilitating prognostication, which helps in planning specific treatment strategies. Imaging guidance is gaining wide acceptance as the standard procedure. Ultrasound (US) guidance is currently considered the most cost-effective and safe way to perform parenchymal liver biopsies. Radiologists worldwide and particularly in the United States are increasingly performing this procedure. Radiologists performing biopsies generally use the cutting needle. Different needle sizes, techniques and preference for biopsy of the right or left lobe have been described. We attribute these preferences to prior training and individual radiologist's comfort level. We describe the algorithm followed at our institution for performing percutaneous US-guided parenchymal liver biopsy. While clinical societies have recommended a minimum of 40 liver biopsies as a requirement for proficiency of clinicians, specific to radiology trainees/fellows interested in pursuing a career in intervention, we feel a total of 20 liver biopsies (includes assisted and independently performed biopsies under supervision) should be adequate training.

The Fetal Magnetic Resonance Imaging Experience in a Large Community Medical Center

Peter M Ghobrial — Tue,31 May 2011

Peter M Ghobrial, Rebecca A Levy, Stephen C O'Connor

Journal of Clinical Imaging Science 2011 1(1):29-29

Fetal magnetic resonance imaging (MRI) continues to prove a useful problem solving tool for diagnostic and management decision making issues encountered in the antenatal period. In this paper, we attempt to review basic fetal MRI protocol considerations and demonstrate key imaging findings through multiple modalities, with pathologic correlation in several cases. A study of five fetal MRI cases, from our institution, were selected in order to highlight both the indications for, and benefits obtained from this advanced imaging technique. Fetal MRI proved useful in each case in better defining fetal anomalies, especially where ultrasound (due to drawbacks such as shadowing by pelvic bones) was unable to be completely diagnostic. The more in-depth study made possible by MRI also helped with formulation of disease prognosis and estimation of survival chances of the fetus. Further, MRI as a diagnostic and prognostic tool has become more ubiquitous across the medical community. This imparts tangible benefit to patients, who are now able to find this service within arm's reach. Whereas previously these patients were obligatorily referred up to 90 miles away from our centre for further medical work-up, now a large percentage can obtain their prenatal imaging and perinatal care locally. In addition, medical education benefits as new types of cases, those with pathology of the antenatal period, are retained for work-up and management in these large community settings. Cases from our institution exemplify these types of pathologies, from fetal chest masses to a syndromic presentation of bilateral renal agenesis.

Enforcing Quality Metrics over Equipment Utilization Rates as Means to Reduce Centers for Medicare and Medicaid Services Imaging Costs and Improve Quality of Care

Amit Sura — Tue,31 May 2011

Amit Sura, Alexander Ho

Journal of Clinical Imaging Science 2011 1(1):28-28

Radiology has been the focus of efforts to reduce inefficiencies while attempting to lower medical costs. The 2010 Medicare Physician Fee Schedule has reduced Centers for Medicare and Medicaid Services' (CMS) reimbursements related to the technical component of imaging services. By increasing the utilization rate, the cost of equipment spreads over more studies, thus lowering the payments per procedure. Is it beneficial for CMS to focus on equipment utilization as a cost-cutting measure? Can greater financial and quality of care rewards be made by improving metrics like appropriateness criteria and pre-authorization? On examining quality metrics, such as appropriateness criteria and pre-authorization, promising results have ensued. The development and enforcement of appropriateness criteria lowers overutilization of studies without requiring unattainable fixed rates. Pre-authorization educates ordering physicians as to when imaging is indicated.

Diffusion-weighted Magnetic Resonance Imaging: What Makes Water Run Fast or Slow?

Francesca Fornasa — Thu,19 May 2011

Francesca Fornasa

Journal of Clinical Imaging Science 2011 1(1):27-27

Diffusion-Weighted Magnetic Resonance Imaging (DWI) obtains information useful in diagnosing several diseases through the measurement of random, Brownian diffusion of water molecules in tissues. This pictorial essay illustrates the main factors, i.e., ratio between the volume occupied by cells and the extracellular space, composition of the extracellular space, and temperature, that determine the rate of the water diffusion. The mechanism through which these influencing factors affect water diffusion is explained. Clinical and experimental examples, derived both from physiology and from non-human models, are described.

Bronchial Artery Aneurysm due to Pulmonary Tuberculosis: Detection with Multidetector Computed Tomographic Angiography

Saurabh Karmakar — Thu,19 May 2011

Saurabh Karmakar, Alok Nath, Zafar Neyaz, Hira Lal, Rajendra V Phadke

Journal of Clinical Imaging Science 2011 1(1):26-26

A case of bronchial artery aneurysm due to pulmonary tuberculosis is reported. The patient presented with massive hemoptysis and the diagnosis was made using multidetector computed tomographic (MDCT) angiography. Selective bronchial arteriogram confirmed the MDCT findings and bronchial artery embolization was successfully performed with cessation of hemoptysis. Our article emphasizes the value of MDCT angiography in the diagnosis and management of such cases.

The Beginning

Vikram Dogra — Fri,6 May 2011

Vikram Dogra

Journal of Clinical Imaging Science 2011 1(1):25-25

Photoacoustic Imaging: Opening New Frontiers in Medical Imaging

Keerthi S Valluru — Fri,6 May 2011

Keerthi S Valluru, Bhargava K Chinni, Navalgund A Rao

Journal of Clinical Imaging Science 2011 1(1):24-24

In today's world, technology is advancing at an exponential rate and medical imaging is no exception. During the last hundred years, the field of medical imaging has seen a tremendous technological growth with the invention of imaging modalities including but not limited to X-ray, ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography. These tools have led to better diagnosis and improved patient care. However, each of these modalities has its advantages as well as disadvantages and none of them can reveal all the information a physician would like to have. In the last decade, a new diagnostic technology called photoacoustic imaging has evolved which is moving rapidly from the research phase to the clinical trial phase. This article outlines the basics of photoacoustic imaging and describes our hands-on experience in developing a comprehensive photoacoustic imaging system to detect tissue abnormalities.

Ureteritis Cystica: A Radiologic Pathologic Correlation

Jennifer G Rothschild — Sat,30 Apr 2011

Jennifer G Rothschild, Guan Wu

Journal of Clinical Imaging Science 2011 1(1):23-23

Ureteritis cystica (UC) is a benign condition that commonly affects the ureter and can mimic other conditions such as transitional cell carcinoma, blood clots, air bubbles, radiolucent stones, fibroepithelial polyps, and sloughed renal papillae. Radiographically, UC is characterized by multiple small, round, lucent defects, which cause scalloping of the ureteral margins when seen in profile. The scalloping is produced by the projection of the submucosal cysts into the lumen and represents an important differential feature of this disease. We present a case of UC with a radiological pathological correlation.

Imaging of the Bursae

Zameer Hirji — Sat,30 Apr 2011

Zameer Hirji, Jaspal S Hunjun, Hema N Choudur

Journal of Clinical Imaging Science 2011 1(1):22-22

When assessing joints with various imaging modalities, it is important to focus on the extraarticular soft tissues that may clinically mimic joint pathology. One such extraarticular structure is the bursa. Bursitis can clinically be misdiagnosed as joint-, tendon- or muscle-related pain. Pathological processes are often a result of inflammation that is secondary to excessive local friction, infection, arthritides or direct trauma. It is therefore important to understand the anatomy and pathology of the common bursae in the appendicular skeleton. The purpose of this pictorial essay is to characterize the clinically relevant bursae in the appendicular skeleton using diagrams and corresponding multimodality images, focusing on normal anatomy and common pathological processes that affect them. The aim is to familiarize radiologists with the radiological features of bursitis.

Imaging of Mechanical Cardiac Assist Devices

Daniel Ginat — Sat,30 Apr 2011

Daniel Ginat, Howard Todd Massey, Shweta Bhatt, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):21-21

Diagnostic imaging plays an important role in the assessment of patients with mechanical cardiac assist devices. Therefore, it is important for radiologists to be familiar with the basic components, function, and radiographic appearances of these devices in order to appropriately diagnose complications. The purpose of this pictorial essay is to review indications, components, normal imaging appearances, and complications of surgically and percutaneously implanted ventricular assist devices, intra-aortic balloon pumps, and cardiac meshes.

Diffusion-weighted Magnetic Resonance Imaging in the Early Diagnosis of Neonatal Adrenoleukodystrophy

R Nuri Sener — Thu,31 Mar 2011

R Nuri Sener, Mehmet H Atalar

Journal of Clinical Imaging Science 2011 1(1):20-20

A newborn baby girl developed seizures right after birth. On the fourth day, the baby was examined using diffusion sequence magnetic resonance imaging (MRI) and diagnosed to have neonatal adrenoleukodystrophy. Laboratory findings confirmed the diagnosis. This is the first case of neonatal adrenoleukodystrophy (NALD) where diffusion MRI sequence helped in the diagnosis. We find association of NALD with seizures at birth is an extremely rare occurrence, and so far, only one case has been mentioned in the literature.

Sonographic Upper Gastrointestinal Series in the Vomiting Infant: How We Do It

Thaddeus W Herliczek — Thu,31 Mar 2011

Thaddeus W Herliczek, Deepak Raghavan, Kathleen McCarten, Michael Wallach

Journal of Clinical Imaging Science 2011 1(1):19-19

Sonography (ultrasound) is used routinely to assess an infant with nonbilious projectile emesis. Fluoroscopic upper gastrointestinal (UGI) series has been the standard method to evaluate infants with bilious emesis. We use sonographic UGI routinely to assess infants with nonbilious emesis as well as infants with bilious emesis. This essay illustrates our technique, the results obtained using this technique for normal anatomy, and the commonly encountered pathology.

Macrodystrophia Lipomatosa: Radiologic-Pathologic Correlation

Deepika Upadhyay — Tue,22 Mar 2011

Deepika Upadhyay, Umesh C Parashari, Sachin Khanduri, Samarjit Bhadury

Journal of Clinical Imaging Science 2011 1(1):18-18

Macrodystrophia lipomatosa (MDL) is a rare cause of congenital macrodactyly, characterised by progressive proliferation of all mesenchymal elements, with disproportionate increase in fibro-adipose tissue. It occurs most frequently in lower limbs along the distribution of the medial plantar nerve. MDL presents as localised gigantism of the hand or foot and comes to clinical attention for cosmetic reasons, mechanical problems secondary to degenerative joint disease, or development of neurovascular compression. Here, we report a case of MDL, with altered soft tissue growth due to an earlier surgery, making clinical diagnosis difficult. However, with a complete radio-clinical work-up and review of the history, a provisional diagnosis of MDL was made, which was confirmed by histopathology and during surgery.

Traumatic Ectopic Dislocation of Testis

Eranga Perera — Thu,24 Feb 2011

Eranga Perera, Shweta Bhatt, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):17-17

Traumatic ectopic dislocation of testis is a rare occurrence and usually occurs following a motorcycle collision, in what is referred to as "fuel tank injury". Early identification and subsequent surgical management is of utmost importance to maintain normal spermatogenesis in the dislocated testis. In appropriate clinical setting, scrotal ultrasound examination with gray-scale and color flow Doppler imaging is the method of choice for diagnosis. Computed tomography of the abdomen is a useful adjunct procedure. We report a case of traumatic testicular dislocation with partial testicular torsion following a motorcycle collision, diagnosed with imaging, and subsequently confirmed on surgery.

X-ray Digital Linear Tomosynthesis Imaging for Artificial Pulmonary Nodule Detection

Tsutomu Gomi — Fri,11 Feb 2011

Tsutomu Gomi

Journal of Clinical Imaging Science 2011 1(1):16-16

The purpose of this paper is to identify indications for volumetric X-ray digital linear tomosynthesis (DLT) with single- and dual-energy subtraction techniques for artificial pulmonary nodule detection and compare X-ray DLT, X-ray digital radiography, and computed tomography.

Magnetic Resonance Imaging of Neurosarcoidosis

Daniel T Ginat — Fri,11 Feb 2011

Daniel T Ginat, Gurpreet Dhillon, Jeevak Almast

Journal of Clinical Imaging Science 2011 1(1):15-15

Neurosarcoidosis is an uncommon condition with protean manifestations. Magnetic resonance imaging (MRI) is often used in the diagnostic evaluation and follow-up of patients with neurosarcoidosis. Therefore, familiarity with the variety of MRI appearances is important. In this pictorial essay, the range of possible patterns of involvement in neurosarcoidosis are depicted and discussed. These include intracranial and spine leptomeningeal involvement, cortical and cerebral white matter lesions, corpus callosum involvement, sellar and suprasellar involvement, periventricular involvement, cranial nerve involvement, cavernous sinus involvement, hydrocephalus, dural involvement, ischemic lesions, perivascular involvement, orbit lesions, osseous involvement, nerve root involvement, and spinal cord intramedullary involvement. Differential diagnoses for each pattern of involvement of neurosarcoidosis are also provided.

Pseudoaneurysm of Uterine Artery: A Rare Cause of Secondary Postpartum Hemorrhage, Managed with Uterine Artery Embolisation

Pramya Nanjundan — Fri,11 Feb 2011

Pramya Nanjundan, Meenakshi Rohilla, Ainharan Raveendran, Vanita Jain, Niranjan Khandelwal

Journal of Clinical Imaging Science 2011 1(1):14-14

Uterine artery pseudoaneurysm is a rare cause of secondary postpartum hemorrhage but is potentially life-threatening and can occur after caesarean section (c-section) or a hysterectomy. A 28-year-old woman who developed secondary postpartum hemorrhage after c-section was diagnosed to have pseudoaneurysm from the left uterine artery on ultrasound (US) and computed tomography (CT) scan. She was treated with coiling of the pseudoaneurysm with stainless steel coil via selective catheterization of the uterine artery. The procedure was uneventful and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and effective method for treating postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Therefore, it should be considered as a treatment option before resorting to surgery, in appropriately selected cases.

Sprengel Deformity: Magnetic Resonance Imaging Findings in Two Pediatric Cases

Alper Dilli — Fri,11 Feb 2011

Alper Dilli, Umit Yasar Ayaz, Çagri Damar, Önder Ersan, Baki Hekimoglu

Journal of Clinical Imaging Science 2011 1(1):13-13

The characteristics of Sprengel deformity, which is also called congenital high scapula, are malposition and dysplasia of the affected scapula, with possible omovertebral connection. The aim of the present study was mainly to present the magnetic resonance imaging (MRI) findings of two pediatric cases of Sprengel deformity. A 7-year-old girl and a 9-year-old boy with deformities in their right shoulder were studied. Plain radiographs were obtained. MRI was performed for both children. The fibrous omovertebral connection is depicted in its longest form in one plane. Omovertebral band is best screened in coronal and axial cross sections. We are introducing a new MRI sign which we named as "Ra's eye" to define the appearance of omovertebral band within the surrounding fat tissue.

Pilomatrixoma of the Adult Male Breast: A Rare Tumor with Typical Ultrasound Features

Charles M Hubeny — Fri,11 Feb 2011

Charles M Hubeny, Jeremy B Sykes, Avice O'Connell, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):12-12

Pilomatrixomas are uncommon benign skin neoplasms arising from the hair follicle matrix. They occur more commonly in children than adults. Most originate on the head, neck, or upper extremities, less commonly on the trunk or lower extremities, and very infrequently in the breast. We present a rare case of pilomatrixoma of the breast in an adult male. As the patient had a strong family history of breast cancer, a full work-up of the breast mass was performed. Ultimately, an excisional biopsy was carried out for patient reassurance.

Acute Renal Artery Occlusion with Prolonged Renal Ischemia: A Case of Successful Treatment with Stent Placement and Catheter-directed Thrombolysis

Mohammad Arabi — Fri,11 Feb 2011

Mohammad Arabi, Ranjith Vellody, Kyung Cho

Journal of Clinical Imaging Science 2011 1(1):11-11

We present a case of acute renal artery occlusion caused by a high-grade stenosis associated with in-situ thrombosis. Endovascular renal artery stent placement combined with catheter-directed thrombolysis reversed the renal ischemia with restoration of renal function despite the prolonged ischemia.

Fibro-osseous Lesions of the Jaw: A Report of Two Cases

Guruprasad Yadavalli — Fri,11 Feb 2011

Guruprasad Yadavalli

Journal of Clinical Imaging Science 2011 1(1):10-10

Fibro-osseous lesions of the maxillofacial bones comprise a diverse group of pathologic conditions that include developmental lesions, reactive or dysplastic diseases, and neoplasms. The concept of fibro-osseous lesions has evolved over the last several decades and now includes two major entities: fibrous dysplasia and ossifying fibroma. The less common lesions include florid osseous dysplasia, periapical dysplasia, focal sclerosing osteomyelitis, proliferative periostitis of Garre, and osteitis deformans. We report two cases, the first, a craniofacial polyostotic fibrous dysplasia, and the second, a juvenile ossifying fibroma of maxilla.

Renal Collision Tumor in Association with Xanthogranulomatous Pyelonephritis

Jennifer Rothschild — Sat,8 Jan 2011

Jennifer Rothschild, Shweta Bhatt, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):9-9

Collision tumor is a rare condition in which two neoplasms (usually benign and malignant), both growing in the same general area, collide with each other and become intermingled. We present histopathology and imaging correlation of xanthogranulomatous pyelonephritis coexistent with squamous cell carcinoma and osteogenic sarcoma of the kidney.

Median Arcuate Ligament Compression of the Celiomesenteric Trunk

Victor Lee — Sat,8 Jan 2011

Victor Lee, Mauricio Daniel Alvarez, Shweta Bhatt, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):8-8

Median arcuate ligament (MAL) syndrome is a controversial condition characterized by compression of the celiac trunk and symptoms of intestinal angina. We present a case of MAL compressing the celiomesenteric trunk, a rare variation. We report computed tomography (CT) angiography and three-dimensional reconstructions of this rare phenomenon.

Inflammatory Pseudotumor of the Kidney

Mehmet Ruhi Onur — Sat,8 Jan 2011

Mehmet Ruhi Onur, Fatih Firdolas, Ercan Kocakoç, Irfan Orhan

Journal of Clinical Imaging Science 2011 1(1):7-7

Inflammatory pseudotumor of the kidney is a rare benign condition with unknown etiology that can mimic malignancy. We report a case of inflammatory pseudotumor of the kidney. A 59-year-old male patient was admitted with a complaint of right flank pain and hematuria. Ultrasonography and magnetic resonance imaging of the patient revealed a 9 cm × 10 cm mass originating from the renal parenchyma with posterior extension. Operative findings revealed a mass adhering to the psoas muscle. Histopathologic examination demonstrated spindle-shaped fibroblast cells accompanying inflammatory cells. The pathological diagnosis was renal inflammatory pseudotumor. Repeated US and computed tomography revealed complete remission.

Complications of Denver Shunt

Eranga Perera — Sat,8 Jan 2011

Eranga Perera, Shweta Bhatt, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):6-6

Hepatic hydrothorax secondary to transdiaphragmatic spread of peritoneal fluid can cause respiratory discomfort to the patient. Draining of hydrothorax helps relieve these symptoms. Pleurovenous shunt (Denver shunt) is a relatively non-invasive method of shunting the pleural fluid to the central venous system. Reported complications of pleurovenous shunts are shunt failure, pulmonary edema, post shunt coagulopathy, deep vein thrombosis, and infection. We report a rare case of a leak at the venous end of the catheter that was placed within the right internal jugular vein, resulting in a large collection in the neck.

Sonographic Spectrum of Tunica Albuginea Cyst

Daniel M Alvarez — Sat,1 Jan 2011

Daniel M Alvarez, Shweta Bhatt, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):5-5

Tunica albuginea (TA) cyst is the most common extratesticular benign mass, which is usually palpable. Ultrasound examination is the imaging modality of choice to characterize palpable testicular lesions. This pictorial essay presents the spectrum of sonographic features of TA cysts in order to assist radiologists in making the correct diagnosis and avoid unnecessary surgeries.

Bilateral Testicular Epidermoid Cysts

Norman Loberant — Sat,1 Jan 2011

Norman Loberant, Shweta Bhatt, Edward Messing, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):4-4

Testicular epidermoid cysts are the most common benign tumors of the testes, but account for only 1-2% of all testicular tumors. In a young man presenting with a testicular mass, a high index of suspicion must be maintained for the malignant testicular germ cell tumor, which is 50-times more common than testicular epidermoid cyst. Bilateral testicular epidermoid cysts are a very rare condition, with only a few reports in the literature. It is extremely important in this condition to make a correct pre-operative diagnosis on imaging to enable a testis-sparing surgery.

Unusual Case of Gunshot Injury to the Face

Yadavalli Guruprasad — Sat,1 Jan 2011

Yadavalli Guruprasad, Girish Giraddi

Journal of Clinical Imaging Science 2011 1(1):3-3

An unusual case of facial gunshot injury with the missile lodged in the cervical spine region, but without any neurological impairment, is reported. The extent of tissue damage and missile track termination in a male patient who sustained gunshot trauma to the face was assessed by plain radiography and by computed tomography scans. The patient was treated conservatively and observed for clinical manifestations of neurological deficit for one year. We present a case of gunshot injury to the face with the missile lodged in the cervical spine region and atypical absence of clinical manifestation that may occur even when a bullet remains in the vicinity of the cervical spine.

Cystic Duct Remnant Syndrome

Eranga Perera — Sat,1 Jan 2011

Eranga Perera, Shweta Bhatt, Vikram S Dogra

Journal of Clinical Imaging Science 2011 1(1):2-2

Post-cholecystectomy syndrome (PCS) is a common manifestation in patients with cholecystectomy. The patients exhibit a heterogeneous group of symptoms, such as upper abdominal pain, vomiting, gastrointestinal disorders, jaundice, and dyspepsia. Choledocholithiasis, biliary dyskinesia, and dilation of cystic duct remnants are common causes of these symptoms. The symptoms can recur after a symptom-free period following cholecystectomy or they can persist after surgery. Ultrasonography, computed tomography (CT), and magnetic resonance imaging scan, which are non-invasive methods of imaging, have a high sensitivity in detecting the causes of PCS. We report a case of an 84-year-old lady who came to the Ultrasound Department with recurrent episodes of abdominal pain following cholecystectomy. The gray-scale sonography showed a dilated cystic structure, which was confirmed as the duct remnant in follow-up contrast-enhanced CT.

New Horizons

Vikram Dogra — Sat,1 Jan 2011

Vikram Dogra

Journal of Clinical Imaging Science 2011 1(1):1-1