patient_id
int64 0
167k
| patient_uid
stringlengths 8
10
| PMID
int64 1.34M
35M
| file_path
stringlengths 31
35
| title
stringlengths 7
377
| patient
stringlengths 55
95.4k
| age
stringlengths 14
33
| gender
stringclasses 2
values | relevant_articles
stringlengths 15
20.5k
| similar_patients
stringlengths 2
1.26k
|
|---|---|---|---|---|---|---|---|---|---|
2,900 |
6159120-1
| 30,363,174 |
comm/PMC006xxxxxx/PMC6159120.xml
|
Isolated fungus ball in sphenoid sinus: tips and pitfalls of T1 hyperintense lesions
|
A 62-year-old female patient was admitted in April 2016 in another hospital complaining of severe persistent deep throbbing headache in the right retro-orbital region, not responsive to common non-steroidalanti-inflammatory drugs. Neurological examination did not show any signs of focal deficit. Ophthalmic examination of fundus oculi revealed normally appearing retina with normal eye pressure. In that occasion, the patient underwent brain CT, which showed no significant alterations of brain tissue; instead, obliteration of right sphenoidal sinus was observed and it was referred to sinusitis. After 1 month of oral antibiotic and corticosteroid treatments, symptoms partially reversed, with only a latent headache persisting during the follow-up period; however, throbbing headache recrudescence and posterior nasal drip occurred later in March 2017, when the patient came to our attention.
|
[[62.0, 'year']]
|
F
|
{'21819767': 1, '31950777': 1, '22411945': 1, '27877057': 1, '32063949': 1, '26708329': 1, '28251318': 1, '17848691': 1, '19374153': 1, '17361410': 1, '28438285': 1, '25991948': 1, '24772263': 1, '19688860': 1, '30363174': 2}
|
{}
|
2,901 |
6159121-1
| 30,363,173 |
comm/PMC006xxxxxx/PMC6159121.xml
|
Endovascular pharmacomechanical thrombolysis—a novel treatment for circumaortic left renal vein and inferior vena cava thrombosis in a paediatric patient with relapsing nephrotic syndrome
|
A 16-year-old male presented to the emergency department with acute onset left flank pain and frank haematuria. This patient had a longstanding history of relapsing nephrotic syndrome secondary to minimal change disease, with his most recent relapse occurring 2 weeks prior to this presentation after an attempt to wean his mycophenolate mofetil dosage. His medications on admission were furosemide 60 mg once daily by mouth, prednisone 60 mg once daily by mouth and mycophenolate mofetil 500 mg twice daily by mouth. There was no known family history of VTE or bleeding diatheses. The patient denied recent calf swelling, asymmetry in thigh circumference or leg pain. There was no history of prolonged immobilization, but the patient did report decreased oral intake throughout the week preceding his presentation, secondary to increasing flank pain and associated nausea.\nOn examination, the abdomen was soft, but the patient was tender to palpation in the left upper quadrant and left flank. Generalized oedema was noted; however, the lower extremities were symmetrical in size with no erythema or tenderness. The patient’s bloodwork showed a haemoglobin of 175 g l–1 (reference range: 131–169 g l–1), haematocrit 0.5 (reference range: 0.38–0.49), platelets 111 x 109 (reference range: 165–397 x 109) and white blood cell count 20.1 x 109 (reference range: 3.9–10.2 x 109). The patient had a normal electrolyte panel, creatinine of 100 μmol l–1 (reference range: 39–103 μmol l–1), urea 9.9 mmol l–1 (reference range: 2.5–7.1 mmol l–1) and albumin 23 mmol l–1 (reference range: 37–56 mmol l–1). His urinalysis showed 23.84 g l–1 protein, a urine protein:creatinine ratio of 1136 g mol–1 (reference range: 0–22 g mol–1), greater than 100 red blood cells hpf–1 (reference range: 0–3/hpf), 10–20 white blood cells hpf–1 (reference range: 0–5/hpf), along with the presence of hyaline and granular casts.\nThe initial imaging test ordered was a renal ultrasound to rule out renal calculus or renal vein thrombosis. The Doppler ultrasound showed asymmetric renal volumes with no evidence of hydronephrosis or post-renal obstruction. The renal vasculature, however, could not be adequately assessed. A contrast-enhanced CT scan of the abdomen and pelvis was then ordered, which demonstrated enlargement of the left kidney, moderate perinephric free fluid and a delayed left nephrogram []. Acute complete thrombosis was noted of the circumaortic left renal vein, with extension into the IVC, where it was non-occlusive but measured up to 12.0 cm in craniocaudal dimension []. There was significant intraperitoneal free fluid and a small left-sided pleural effusion. At this time, Paediatric Haematology and Nephrology were consulted for further management of the patient’s acute renal vein and IVC thrombosis.\nPaediatric Haematology began anticoagulation with unfractionated heparin; however, given the significant thrombus and the patient’s poor clinical status, interventional radiology was consulted to consider potential intervention. After clinical examination and review of the patient’s CT imaging, a decision was made to attempt endovascular pharmacomechanical thrombolysis and thrombectomy.\nThe patient was transferred to the angiography suite, intubated and placed under general anaesthetic. The patient's right neck and right groin were prepped and draped followed by ultrasound-assisted right internal jugular vein access. A cavogram was performed in the anteroposterior projection, demonstrating the known IVC thrombus, with tailing thrombus extending downstream to at least the level of the right renal vein [].\nFrom the neck access, an Option Elite IVC filter (Argon Medical Devices Inc., Plano, TX) was inserted in a suprarenal position above the level of the IVC thrombus [], which acted as a safeguard against potential periprocedural thromboembolic events. Hand injection venography was then performed, demonstrating no patency of the left renal vein with numerous capsular collaterals extending to venous pathways along the left lateral aspect of the spine [].\nAt this point, an Angiojet device (Boston Scientific Corporation, Marlborough, MA) was advanced into the left renal vein, at the level of the hilum. Pulse-spray tissue plasminogen activator (tPA) was administered via the Angiojet device into the left renal vein thrombus as the device was slowly withdrawn back to the expected level of the left renal vein/IVC junction. The catheter was then repositioned within the IVC thrombus and the Angiojet device was advanced to the expected left renal vein/IVC junction, at which point pulse-spray tPA was again performed. The Angiojet device was subsequently repositioned in the upstream portion of the left renal vein. As expected, hand injection performed at this time demonstrated minimal patency of the left renal vein with significant persistent thrombus burden.\nAfter waiting for 20 minutes following tPA administration, aspiration thrombectomy was performed using the Angiojet device for a total of 6 minutes, divided between the left renal vein and IVC thrombus. Angiography demonstrated progressive recanalization of the left renal vein with visualization of the anterior limb of the circumaortic left renal vein and restored flow into the IVC []. Balloon angioplasty of the retroaortic limb of the left renal vein was then performed to macerate all remaining thrombus and increase the surface area of thrombus available for exposure to blood flow, which further improved patency of the left renal vein []. Pigtail angiography performed following IVC aspiration thrombectomy showed wide patency, with a large thrombus having been captured by the recently placed IVC filter []. Repeat angiogram demonstrated good flow in the left renal vein [], and as such, no further recanalization intervention was pursued.\nFinally, mechanical aspiration thrombectomy of thrombus captured by the IVC filter was performed utilizing the Penumbra aspiration system (Penumbra Inc., Alameda, CA). The patient tolerated the procedure well with no immediate complications and the patient was continued on systemic anticoagulation. The IVC filter was removed without complications 4 days post-intervention, and follow-up renal ultrasound at 6 days post-intervention showed the IVC and left renal vein to be patent without evidence of residual or recurrent thrombus.
|
[[16.0, 'year']]
|
M
|
{'22344511': 1, '12032209': 1, '23465106': 1, '7967339': 1, '1509525': 1, '34395161': 2, '16687747': 1, '9856527': 1, '21072156': 2, '12944064': 1, '16604403': 1, '16828448': 1, '30363173': 2}
|
{'8354767-1': 1, '2966982-1': 1}
|
2,902 |
6159124-1
| 30,363,169 |
comm/PMC006xxxxxx/PMC6159124.xml
|
Painless lump over the forehead which turned painful: an unusual presentation of hepatocellular carcinoma
|
A 40-year-old male patient presented to us with a 3-month history of having noticed a painless lump over his forehead. He reportedly ignored the lump, initially assuming it to be a pimple, but became concerned when it continued to grow gradually. He stated that it turned painful, and that was when he came in seeking medical attention. On examination, the lump () over the frontal region was hard, fixed and tender on palpation. CT scan demonstrated that the lesion involved both the outer and the inner tables of the frontal bone (). Upon core needle biopsy, the lesion on haematoxylin and eosin staining () demonstrated pleomorphic tumour cells having predominantly eosinophilic cytoplasm, prominent nucleoli and cells arranged in both trabecular and solid patterns.\nConcurrently, a whole body 18-fludeoxyglucose positron emission tomography (18F-FDG-PET) scan was performed to look for potential sites of primary tumour. This revealed a very highly avid lesion (standardized uptake value of 28) in the right lobe of the liver, along with multiple other avid foci involving the liver, lungs and the dorsal vertebrae. The lesions in the liver, lungs and dorsal vertebrae were also visualized on digital reconstruction of CT images ().\nThus, further investigations were focused upon confirmation of HCC as the primary tumour. The patient’s α-fetoprotein (AFP) level was found to be 6889 ng ml−1. Immunohistochemistry showed positivity for HepPar1 and CD10. Negative staining was noted for TTF-1, CEA, ALK-1, LCA, S-100, vimentin and chromogranin. The patient was seropositive for HBsAg and negative for HCV. The patient reportedly was unaware of his prior HBsAg status. His liver functions tests were within normal limits at presentation. Serum CEA, CA 19-9, coagulation tests, liver function tests and other routine investigations were normal at presentation. The patient was a driver by occupation, and as a non-drinker and non-smoker. There was no history suggestive of aflatoxin exposure. There was no history of blood transfusions.\nGiven the detection of multiple lung and vertebral metastases, radical curative surgery and chemotherapy were not considered. The patient's Karnofsky Performance Status (KPS) at diagnosis was 70. After fixation of vertebral metastasis (), his involved vertebrae were irradiated with a dose of 20 Gy in five fractions with 6-MV beam by a single direct field, calculated using the skin–source distance of 100 cm with a depth of 4 cm. He was then treated with sorafenib (initiated at a dose of 400 mg, twice a day), which was tolerated well without any remarkable toxicity. He was also treated with oral ibandronate (150 mg, once a month) and oral analgesics (non-steroidal anti-inflammatory drugs, tramadol and gabapentin).\nThere was a clinically visible regression of his forehead lesion (it must be emphasized here that the forehead lesion was not irradiated, and the option of irradiation was reserved for use in case of non-response with sorafenib). Furthermore, there were minimal regressions/stabilizations in the sizes of the thoracic metastases, secondaries elsewhere as well as in the primary. The use of sorafenib had also led to an improvement in his performance status for a span of 6 months (from a pre-treatment KPS value of 70 to approximately 80–90 during the first 6 months while on sorafenib). However, despite the initial response after 6 months of initiation of sorafenib, the patient had progression of his lesions as well as the appearance of new lesions. Although sorafenib was continued, the patient ultimately succumbed to hepatic failure a year after diagnosis.
|
[[40.0, 'year']]
|
M
|
{'18570669': 2, '1724474': 1, '25120900': 1, '6295617': 1, '8527707': 1, '17180305': 1, '15508102': 1, '24812512': 2, '19095497': 1, '17570226': 1, '8519569': 1, '25625001': 1, '19705301': 1, '11564960': 1, '18650514': 1, '30363169': 2}
|
{'2467423-1': 1, '4011926-1': 1}
|
2,903 |
6159126-1
| 30,363,164 |
comm/PMC006xxxxxx/PMC6159126.xml
|
Post-traumatic osteoid osteoma in an 18-year-old adolescent
|
An 18-year-old female was referred to our institution complaining of pain in the left mid-forearm. Previous medical history included a fracture of both radius and ulna 12 years previously, which had been successfully treated with reduction and by intramedullary pinning (). Several months before the current referral, there was an insidious onset of pain, which was gradually increasing, more intense at night and relieved by salicylates. On physical examination, there was moderate swelling at the old fracture site. There were no signs of local or systemic inflammation. Conventional radiographs of the left forearm revealed a lucent area adjacent to the previous fracture site with surrounding sclerosis and cortical thickening (). Subsequent MRI showed an oval intracortical lesion in the ulna, with central hypointensity to skeletal muscle on both T1 and T2 weighted images. After administration of gadolinium contrast, there was marked peripheral enhancement of the lesion with perilesional bone marrow and soft-tissue oedema (). Because imaging characteristics were highly suggestive of an OO, an additional CT scan was performed (). This examination showed pathognomonic features of an OO with a central calcified nidus at the site of the previous fracture.
|
[[18.0, 'year']]
|
F
|
{'19926767': 1, '22530213': 1, '33830283': 1, '1496275': 1, '20462991': 1, '10672409': 1, '11547238': 1, '11400885': 1, '30850870': 1, '8659359': 1, '20524515': 1, '30363164': 2}
|
{}
|
2,904 |
6159131-1
| 30,363,176 |
comm/PMC006xxxxxx/PMC6159131.xml
|
Spontaneous infarction within a meningioma with negative DWI: an imaging pattern in patients with acute neurological deterioration
|
A 68-year-old female presented 4 days following the onset of nausea, headache and neck pain. Her symptoms were increasing in severity and associated with left-sided inco-ordination and subtle facial weakness. A CT scan was performed and demonstrated a 3-cm left extra-axial posterior fossa lesion abutting the tentorium suggestive of a meningioma and associated with significant cerebellar oedema but no hydrocephalus. As a result, an MRI of the brain was performed that demonstrated a lesion with marginal enhancement, causing adjacent significant oedema. Diffusion-weighted imaging (DWI) demonstrated no restriction in diffusion and therefore was suggestive of necrosis (). The patient underwent a left posterior fossa craniotomy and excision of the lesion. Histopathology confirmed a fibroblastic meningioma, WHO grade I with extensive infarct-type necrosis but no other atypical features. She recovered well from the procedure and was discharged home. At her 3-month review, the patient had made a full recovery, with resolution of her presenting symptoms and no signs of cerebellar dysfunction. Repeat MRI showed no evidence of recurrent tumour.
|
[[68.0, 'year']]
|
F
|
{'23114678': 1, '11181871': 1, '17961033': 1, '20821343': 1, '1859320': 1, '25158680': 1, '32503537': 1, '18726186': 1, '24289127': 1, '15135603': 1, '6860191': 1, '23463172': 1, '11158890': 1, '30363176': 2}
|
{'6159131-2': 2}
|
2,905 |
6159131-2
| 30,363,176 |
comm/PMC006xxxxxx/PMC6159131.xml
|
Spontaneous infarction within a meningioma with negative DWI: an imaging pattern in patients with acute neurological deterioration
|
A 34-year-old female was transferred from a peripheral hospital 10 days after an elective lower uterine section caesarean section for a breech presentation for which she had an epidural anaesthetic. She presented to her general practitioner with a 2-day history of increasing right leg weakness. She was referred to her local hospital where she presented as no longer able to walk. Her examination demonstrated 0/5 power in right ankle flexion, extension, eversion and inversion with increased tone. Her cranial nerve examination was normal as was her tone and reflexes. An urgent MRI of the spine was undertaken that revealed no evidence of epidural collection or neural compression. She subsequently underwent a CT scan of the brain that demonstrated a dural-based lobulated, heavily calcified left parafalcine mass associated with extensive oedema consistent with a meningioma (). The bulk of the calcification was at the periphery of the lesion with relative sparing of the central elements. 8-mg dexamethasone was administered intravenously prior to transfer to a tertiary centre where an MRI of the brain was undertaken. This showed a left extra-axial parafalcine mass compressing the pre- and postcentral gyri and abutting the paracentral lobule. It was isointense to cortex on T2 weighted images with hypointense peripheral component corresponding to areas of calcification. The mass demonstrated peripheral enhancement and an enhancing dural tail. There was no evidence of restricted diffusion. Overall, it was felt most likely to be a meningioma with some atypical features. She underwent a left frontoparietal craniotomy and resection of the lesion. Histology demonstrated a meningothelial meningioma, WHO grade I with focal areas of necrosis and features, raising the possibility of embolization-related changes. She recovered well and was discharged home after brief inpatient rehabilitation. At her 4-month review, she was walking with 5/5 power in hip and knee flexion and extension and 4/5 power in ankle dorsiflexion and plantaflexion. A 6-month follow-up MRI showed no recurrence.
|
[[34.0, 'year']]
|
F
|
{'23114678': 1, '11181871': 1, '17961033': 1, '20821343': 1, '1859320': 1, '25158680': 1, '32503537': 1, '18726186': 1, '24289127': 1, '15135603': 1, '6860191': 1, '23463172': 1, '11158890': 1, '30363176': 2}
|
{'6159131-1': 2}
|
2,906 |
6159137-1
| 30,363,182 |
comm/PMC006xxxxxx/PMC6159137.xml
|
Extensive migration of injected free liquid silicone for breast augmentation with related major complications
|
A 46-year-old female presented to her general practitioner with a painless left supraclavicular mass (). No further history was provided at the time. Initial imaging was performed with both ultrasound () and CT. The CT was performed as a non-contrast scan, as per the patient’s request. The lack of intravenous contrast made interpretation of the mass difficult and the study was of little help forming a differential diagnosis, which from the ultrasound was lymphangioma or cystic hygroma.\nThe patient was referred to interventional radiology for further investigation and possible treatment of the presumed lymphangioma.\nOn targeted investigation, she reported having had an elective mastopexy in Russia 3 years prior. Postoperatively, the patient was not satisfied with the result and desired a fuller appearance. The surgeon suggested free liquid silicone injection, as he claimed to have had good aesthetic outcomes from this technique in the past. As the procedure was carried out in Russia, no details were available as to the volume and grade of silicone injected. The patient reports having had an aesthetically pleasing result after the injections. The patient’s history included recent domestic violence, but breast trauma was denied. No other significant history was provided. Upon examination, in addition to the soft oblong left supraclavicular mass, the left breast was noted to be slightly smaller than the right one. No other masses were palpated.\nAn MRI was performed (3T Siemens Trio Tim magnet; Siemens Healthcare, Erlangen, Germany) () to further define the mass and its vascularity before treatment. Pre- and post-contrast T1, T2 and short tau inversion-recovery (STIR) weighted sequences were performed. Imaging showed a well-defined, T2 and STIR high signal, complex cystic lesion extending from the lower anterior left neck posteriorly into the supraclavicular fossa (). An asymmetry of the injected material into both breasts was also noted, with silicone migrating around the lateral border of the left pectoralis major muscle. A diagnosis of liquid silicone migration was made.\nAt this time, bilateral mastectomy was advised with cosmetic reconstructions. The patient declined this surgery.\nNearly 1 year later, the patient represented, acutely unwell, septic, with a swollen, tense left biceps region and left upper limb cellulitis. Blood tests confirmed a staphylococcus bacteraemia with a white cell count of 18.6 × 109 l−1 (4–11), neutrophils of 16.9 × 109 l−1 (2–9) and a C-reactive protein of 358 mg l−1 ( <5), normal ranges are given in brackets. An ultrasound scan was performed to exclude abscess formation, and it demonstrated a complex, heterogenous collection with nodular internal echogenic material, extending from the left supraclavicular fossa into the left chest wall as well as along the proximal, medial part of the left arm (). Although the history of silicone migration was known, the volume of the collection visualiszed on this presentation appeared to outweigh the presumed volume of injected silicone material.\nAfter consenting to intravenous contrast administration, she progressed to have a CT of the neck and left upper limb with split bolus intravenous contrast (). This showed extensive hypodense material within the distribution of the previously identified silicone migration site with a new distribution of hypodense material in the left arm, correlating well with the ultrasonographical findings. A slightly enhancing rim surrounding the arm collection suggested superimposed inflammation or infection.\nThe following day, an MRI was performed to delineate between the silicone and the infective process in the arm (). The volume of silicone within the left breast had decreased significantly from the previous MRI, and silicone was identified throughout the supraclavicular fossa migrating into the biceps compartment of the left arm (). This migrated liquid silicone was now compressing the adjacent lymphatic drainage as well as the veins. Surrounding the migrated silicone were several multiloculated mildly rim-enhancing collections, not following the signal of silicone.\nThe finding of suspected abscess collections was relayed to the treating surgical team and a large volume of pus (totalling approximately 600 ml) was drained. A CT sinogram was performed that, as expected, demonstrated a fluid pocket extending from the medial aspect of the left arm to the left axilla and supraclavicular fossa. The patient was placed on intravenous cephalexin followed by a long course of oral flucloxacillin. Following this major infective process in her arm, the patient agreed to bilateral mastectomy with reconstruction.
|
[[46.0, 'year']]
|
F
|
{'12055431': 1, '909962': 1, '24957586': 1, '33299689': 1, '18988932': 1, '16936547': 1, '15947350': 1, '33457456': 2, '12427435': 1, '5394228': 1, '16788958': 1, '30363182': 2}
|
{'7758073-1': 1}
|
2,907 |
6159139-1
| 30,363,198 |
comm/PMC006xxxxxx/PMC6159139.xml
|
Protoplasmic astrocytoma with multifocal involvement: case report and radiological findings
|
A 29-year-old male presented with progressively worsening symptoms, including altered mental status, lower extremity weakness, nausea and vomiting for 6 months, with symptomatology extending back more than 6 years prior to this decline. He also reported headaches, dizziness, multiple falls, and right facial numbness and tingling during his 6-month decline. Previously, he had had seizures that were controlled with medication. Prior to referral to neurosurgery, his presumptive diagnosis was hydrocephalus, for which he had a ventriculoperitoneal shunt placed. Neurological examination was significant for mild dysarthria, a non-reactive left pupil, nystagmus on primary gaze of the left eye, bilateral nystagmus on horizontal gaze and mild action tremors in both hands.\nInitial pre- and post-contrast-enhanced CT scans demonstrated diffuse enhancement of the basimeninges as well as heterogeneously enhancing cystic and solid lesions in the right temporal lobe and left cerebellum. Subsequent contrast-enhanced T1 weighted MRI of the brain demonstrated extensive post-contrast nodular enhancement of the basimeninges associated with an approximately 5 × 4 cm solid and cystic mass in the right temporal lobe (). An additional elongated enhancing mass was seen on the right side of the prepontine cistern measuring 2.3 × 1.1 cm in size, with an associated cystic component that extended towards the midline from this mass (). The left cerebellum was also involved, with a solid, enhancing mass that crossed the midline. On T2 weighted imaging, the cystic components of these lesions demonstrated extremely high signal intensity () that was suppressed on fluid-attenuated inversion-recovery (FLAIR) imaging, while T1 weighted imaging demonstrated hypointense signal.\nInitial laboratory findings were significant only for an elevated erythrocyte sedimentation rate and C-reactive protein. CT of the chest was performed, demonstrating no evidence of pulmonary sarcoidosis, and subsequent biopsies of the right temporal lobe and dura were negative for neoplasm or any other abnormality. In addition, analyses of aspirated cyst contents were negative for inflammation or malignancy. A presumptive diagnosis of neurosarcoidosis was considered and the patient was started on prednisone. He had symptomatic improvement with the prednisone and was discharged following recovery from the biopsy.\nFollow-up MRI 11 months later demonstrated progression of his disease with an interval increase in size of the intracranial lesions. Views of the spinal axis demonstrated diffuse nodular meningeal enhancement (). The patient underwent a repeat ultrasound-guided brain biopsy. This time, histopathological analysis of the biopsy specimen showed an astrocytoma with protoplasmic features (). Immunohistochemistry for Ki-67 (a cell proliferation marker) showed a labelling rate of approximately 5%, which was somewhat higher than the 0–2% commonly seen in low-grade tumours, suggestive of more aggressive behaviour ().\nOwing to the multicentric nature of the tumour, craniospinal radiation therapy was recommended instead of radical surgical resection. After multiple cycles of radiation therapy with cumulative doses totalling 1800 cGy to the brain and 1620 cGy to the spine, the patient underwent repeat MRI. The studies showed a slight interval increase in size of the brain lesions but decrease in nodular enhancement of the spinal meninges. A whole body PET-CT was performed to assess disease status and demonstrated a standard uptake value of 13 in the right temporal lesion and 12 in the left cerebellar lesion, which was consistent with a highly metabolically active tumour. No definite increase in uptake was seen in the spinal region or elsewhere.\nFollowing treatment, the patient continued to take dexamethasone for symptomatic relief. He reported a much improved condition despite mild difficulty ambulating, short-term memory loss, occasional euphoria and swollen tongue. However, his disease progressed () and did not respond to further medical or surgical management, and he ultimately passed away.
|
[[29.0, 'year']]
|
M
|
{'20644924': 1, '20049933': 1, '23724833': 1, '19407451': 1, '7785654': 1, '22779687': 1, '24377015': 1, '23662821': 1, '17618441': 1, '30363198': 2}
|
{}
|
2,908 |
6159140-1
| 30,363,194 |
comm/PMC006xxxxxx/PMC6159140.xml
|
Anomalous origin of the right coronary artery from the mid-left anterior descending coronary artery: association with acute myocardial infarction
|
A 65-year-old female with long-standing history of hypertension and Type II diabetes mellitus presented to the emergency department complaining of sudden onset of chest pain and dyspnea. Initial evaluation in the emergency department revealed a BP of 210/120 mmHg, sinus tachycardia at 120 beats min–1, and tachypnea. On examination, she had pulmonary oedema with symmetrical and equal pulses in both upper and lower limbs. She was given intravenous furosemide 100 mg, and an electrocardiogram (ECG) was obtained showing sinus rhythm with right bundle branch block (RBBB) and ST segment elevation in leads II, III and AVF (). She underwent emergent coronary angiography which showed normal coronary arteries but with aberrant take-off of the right coronary artery (RCA) from the mid-segment of the left anterior descending (LAD) artery (). Echocardiography showed inferior wall hypokinesis with an ejection fraction of 50%.\nPatient was admitted to the hospital where her course was stable and her pulmonary oedema resolved. A cardiac CT angiogram () was subsequently performed and it showed an aberrant origin of the RCA from the lateral aspect of the mid-segment of the LAD. The RCA courses circumferentially around the base of the pulmonary trunk and traverses laterally into the atrioventricular groove. The RCA then bifurcates into acute marginal and posterolateral branches. This rare variant has not been categorized in the classification of coronary anomalies; however, it closely resembles the IB1 type of Shirani and Roberts’s classification with the only exception of the RCA origin at the mid-segment and not the proximal segment of the LAD ().
|
[[65.0, 'year']]
|
F
|
{'27190134': 1, '19901422': 1, '32968647': 1, '17689704': 1, '2208265': 1, '23551776': 1, '12021235': 1, '30363194': 2}
|
{}
|
2,909 |
6159141-1
| 30,363,200 |
comm/PMC006xxxxxx/PMC6159141.xml
|
Cutaneous metastases as initial presentation of malignancy
|
A 73-year-old female presented to the emergency department with 1-week history of dry cough, intermittent light-headedness precipitated by cough, occasional mild chest pain and reduced exercise tolerance. She completed a course of antibiotics 2 weeks ago for respiratory tract infection with partial resolution of symptoms. Background history included asthma, hypertension and hyperthyroidism with total thyroidectomy 3 years ago for large goitre. Regular medications included bisoprolol, lisinopril, levothyroxine and inhalers. Her vitals were otherwise stable. On general examination, multiple subcutaneous nodules over both arms, chest wall and back were noted, they were non-tender, firm, non-pigmented, varying mobility and size. Masses were palpated in bilateral breasts with bilateral axillary and cervical lymphadenopathy. Rest of systemic examination was unremarkable. After further discussion, she mentioned that she only noticed the lumps on her arm a week ago and was not aware of presence of other masses.\nRoutine lab investigations revealed acute kidney injury with urea of 24.9 mmol l–1, creatinine 279 mmol l–1, potassium 6.5 mmol l–1 and haemoglobin of 10 g dl–1. She was immediately commenced on treatment for acute renal impairment and hyperkalaemia. Chest X-ray did not show any abnormality. CT of thorax, abdomen and pelvis was arranged once the renal function normalized which revealed multiple heterogeneous soft tissue nodules in neck, anterior chest wall on the left, axillary and inguinal regions, anterior abdomen with hilar and mediastinal lymphadenopathy; probable lesion in tail of pancreas and cortex of right kidney was described ().\nThyroid gland appeared to be normal and no skeletal lesion were seen. Subsequent CT-brain showed heterogeneous nodules in parotid glands bilaterally with multiple soft tissue nodules on the scalp. Possibility of metastatic lesions secondary to breast cancer was considered. PET scan showed diffuse metastatic disease including diffuse soft tissue nodules, peritoneal masses, inguinal lymphadenopathy and intramuscular deposits ().\nShe was then referred to breast clinic where a biopsy from the breast mass and axillary lymph node was taken. The biopsy results showed fatty tissue infiltrated by poorly differentiated malignant neoplasm with epithelioid and plasmacytoid morphology, with some nucleoli and necrosis. The tumour cells were positive for melanocytic markers including S100 and Melan A. HMB45 was negative and so were other epithelial (pan cytokeratin MNF-116, AE1/AE3, CK5/6, p63) and lymphoid (CD45, CD20) markers. The morphology and immunoprofile was consistent with metastatic malignant melanoma. The sample was tested for genetic mutation including BRAF V600E, NRAS, KIT and NTRK1/2/3 fusion of which BRAF V600E mutation was detected. However, the site of primary cutaneous melanoma could not be found.\nShe was referred to oncology services and commenced on dabrafenib and trametinib. Unfortunately, patient passed away within 6 months of initial diagnosis.
|
[[73.0, 'year']]
|
F
|
{'5763254': 1, '22526457': 1, '30363200': 2}
|
{'6159141-2': 2}
|
2,910 |
6159141-2
| 30,363,200 |
comm/PMC006xxxxxx/PMC6159141.xml
|
Cutaneous metastases as initial presentation of malignancy
|
A 72-year-old male presented to emergency department with tender mass on lower back and posterior aspect of neck. Apparently, he had noticed it on his lower back 6 months ago and had grown in size with another similar swelling appearing on his neck, also they were increasingly painful and sore to touch. He had a history of ongoing sore throat for 3 years for which he was extensively investigated by ENT services. His CT neck and mediastinum did not show any abnormalities at that time. This was followed by laryngoscopy which showed a white patch on the right vocal cord, biopsy of which showed non-specific chronic inflammatory changes and cultures grew candida. Background history included COPD; he was heavy current smoker and smoked about 60 cigarettes per day. His medications included salmeterol/fluticasone propionate and ipratropium bromide inhalers. Vitals were within normal range. On examination, 4 cm nodular, firm, tender, immobile mass on lower back and 3 cm mass on posterior aspect of lower cervical spine were noted.\nHis laboratory investigation including renal and liver function, full blood count and coagulation profile were normal. A CT of thorax, abdomen and pelvis was arranged which showed 2 × 2 cm mass in right lung lower lobe likely malignant with no hilar or mediastinal lymphadenopathy, also 3 × 3 cm soft tissue mass at C6-C7 level posteriorly and 4 × 2 cm mass was noted on lumbar region with multiple prominent inguinal lymph nodes ().\nA referral for bronchoscopy was sent and biopsy of the nodule was planned. While awaiting bronchoscopy appointment, biopsy was taken from mass in lower back and send for histopathology. Histology showed poorly differentiated tumour cells in cohesive groups and sheets with moderate pleomorphism and eosinophilic cytoplasm; immunohistochemistry was positive for AE1/3, cytokeratin 7 and carcinoembryonic antigen antibody stain and periodic-acid schiff. Weak nuclear positivity for TTF-1 was also seen. Overall features were consistent with poorly differentiated adenocarcinoma likely of lung origin.\nHe was then referred to oncology services and unfortunately passed away within 5 months of diagnosis.
|
[[72.0, 'year']]
|
M
|
{'5763254': 1, '22526457': 1, '30363200': 2}
|
{'6159141-1': 2}
|
2,911 |
6159142-1
| 30,363,183 |
comm/PMC006xxxxxx/PMC6159142.xml
|
Atypical hepatic haemangiomas
|
A 55-year-old female patient with a history of systemic lupus erythematosus was admitted to the haematology external consultation service as a result of a clinical picture of fatigue and constitutional syndrome of 5 months’ duration.\nShe presented with an extrainstitutional CT that demonstrated multiple focal, hypovascular liver lesions with microcalcifications () that occupied all segments of the liver, and was interpreted as possible metastatic disease.\nThe patient was evaluated without positive findings upon physical examination. The extrainstitutional paraclinical tests showed negative tumour markers and normal tests of liver function.\nBecause of the imaging findings, it was decided to hospitalize the patient to characterize the hepatic lesions with contrast MRI with gadopentetate dimeglumine (Magnevist), 15 ml, infusion rate 2.2 psi, to stage the possible tumour lesion with a study algorithm of an unknown primary tumour. No specific liver contrast medium was used.\nThe MRI findings () showed a liver of normal size and morphology, with multiple focal lesions distributed among all segments of the hepatic parenchyma, with variable sizes ranging from a few millimetres to several centimetres, the biggest lesion (in the right lobe) being 5 cm. These lesions appeared hyperintense in T2 sequences and hypointense in T1 sequences, without identification of a fatty component in their interior. Predominant restriction in the periphery was observed in diffusion sequences. After contrast administration, some lesions showed discrete heterogeneous peripheral enhancement, whereas others showed intralesional nodular enhancement. Cholangioresonance sequences were performed with results in normal ranges (). The lesions present very little contrast uptake even in the late 5-min sequences. This uptake is heterogeneous, being central in some lesions and peripheral in others (). Finally, in the MRI in the arterial phase, multiple low-intensity lesions are identified that do not show contrast media uptake (). Phase and out-of-phase sequences were performed without identifying change in intensity signal, suggesting microscopic fat content in the lesions ().\nThis study was complemented with ultrasound examination (), which demonstrated solid, frank echogenic lesions with multiple punctate echogenic foci in their interiors explained by the presence of calcifications; some exhibited annular hyperechogic halo with less echogenic centres. No alterations of the biliary tract were identified in the MRI or ultrasound image.\nPermeability of the intra-abdominal vascular structures was observed and morphological changes of chronic liver disease or cirrhosis could not be identified. No other intra-abdominal lesions or adenopathies were found.\nParaclinical studies (liver function test, carcinoembryonic antigen, clotting time, complete blood count and platelets) were requested but all results were in normal ranges.\nThe diagnostic possibilities based on the imaging findings were infectious involvement by echinococcus versus metastatic lesions of an unknown primary tumour.\nAn ultrasound-guided biopsy of the dominant lesion located in the right lobule was performed to clarify the diagnosis. A report was obtained within 3 days of the procedure; the pathology findings of the collected liver samples reported “fragments of liver tissue replaced by a benign lesion of vascular origin characterized by the presence of numerous anastomosing vascular channels within it, lined by endothelial cells without atypia, separated by fibrous connective tissue septa with ectatic and obliterated vessels; findings are consistent with sclerosing cavernous haemangioma” ().
|
[[55.0, 'year']]
|
F
|
{'23796395': 1, '26604646': 1, '9599391': 1, '10715338': 1, '22509075': 1, '30363183': 2}
|
{}
|
2,912 |
6159146-1
| 30,363,166 |
comm/PMC006xxxxxx/PMC6159146.xml
|
Calcium pyrophosphate dihydrate crystal deposition disease of the spinal dura mater: a case report
|
A 54-year-old male presented with progressively worsening neck pain and numbness of the left upper extremity and the left face for 2 weeks. He had no history of recent head or neck injuries. He was followed closely without further treatment because of his fluctuating subjective symptoms. However, the symptoms gradually worsened, and he visited our hospital for intensive examination and treatment 2 months after the onset. Neurological examination revealed a mildly spastic gait and exaggerated deep tendon reflexes in the bilateral upper and lower extremities. He also had mild dysuria and constipation. Muscle strength and vibration sense were normal, and no Babinski sign was present. Peripheral blood examination on admission revealed no significant abnormality. Cerebrospinal fluid examination was within normal limits except for slightly elevated protein (65 mg dl–1; normal, 10–40 mg dl–1). Unenhanced CT of the cervicothoracic spine showed diffuse dorsal epidural calcification at C3-T6. The lesion presented as a crescent shape along the spinal dura mater and had a well-defined border along the vertebral arch (). On MR imaging, the lesion appeared as a hypointense mass on both pre-contrast T1 and T2 weighted images. The lesion displayed heterogeneous enhancement, and caused cervical spinal canal stenosis (). Head CT and MR imaging revealed no significant abnormality. Based on these findings, CPPD crystal deposition disease of the ligamentum flavum was suspected. C5/6 laminectomy to biopsy for confirmation was performed. Perioperative findings revealed an intact ligamentum flavum. A solid, grayish-white lesion was found just beneath the ligamentum flavum (). Histopathological examination of the specimen demonstrated numerous granular calcium crystals within dense fibrous tissue with myxoid change (). Grocott, periodic acid-Schiff and Ziehl-Neelsen stains showed no obvious source of infection (e.g. fungal or tubercular), and there was no evidence of malignancy. These features confirmed the diagnosis of CPPD crystal deposition disease along the spinal dura mater. The patient’s neurological symptoms during the postoperative course was uneventful, and follow-up CT performed 4 months later revealed no regrowth of the calcified lesion.
|
[[54.0, 'year']]
|
M
|
{'33530050': 1, '15856241': 1, '22325558': 1, '6410817': 1, '21216817': 1, '27917333': 2, '33129302': 2, '11324932': 1, '20075086': 1, '27586801': 1, '19604435': 1, '20646716': 1, '31651848': 2, '30363166': 2}
|
{'5099304-1': 1, '6824699-1': 1, '7603775-1': 1, '7603775-2': 1}
|
2,913 |
6159148-1
| 30,363,197 |
comm/PMC006xxxxxx/PMC6159148.xml
|
Cystic duct remnant: a rare cause for post-cholecystectomy syndrome
|
A 59-year-old female patient presented with abdominal pain and bloating sensation after every meal. At times, pain was severe and was localized to the right hypochondrium. The patient had undergone laparoscopic cholecystectomy for similar complaints 6 months back. On clinical examination, there was positive Murphy’s sign. Laboratory investigations revealed normal bilirubin levels.\nUltrasound examination of abdomen done elsewhere revealed cystic lesion in the right hypochondrium in the gall bladder bed. magnetic resonance cholangiopancreatogram (MRCP) of the abdomen suggested for better evaluation of the cystic lesion. On MRCP (), there is an oblong cystic lesion seen in the gall bladder fossa. This cystic lesion is showing a focal T2* shortening which is interpreted as a remnant stone (,). The lesion is not connecting with the common biliary duct (CBD). Both the CBD and intrahepatic biliary radicles are otherwise unremarkable. Collectively, the MRCP is interpreted as remnant cystic duct with a calculus in situ.\nBased on the above findings, the patient was subjected to laparoscopic exploration and the residual cystic duct with calculus were successfully removed. Following surgery, the patient improved dramatically with alleviation of cholestatic symptoms and follow-up ultrasound abdomen every 6 months was unremarkable.
|
[[59.0, 'year']]
|
F
|
{'19857610': 1, '20335441': 1, '18722735': 1, '16860084': 1, '32577857': 2, '19337637': 1, '27656498': 1, '24523189': 1, '27307843': 1, '31844820': 1, '18990269': 1, '24094928': 1, '21915383': 1, '30363197': 2}
|
{'7311589-1': 1}
|
2,914 |
6159149-1
| 30,363,186 |
comm/PMC006xxxxxx/PMC6159149.xml
|
A cause of recurrent strokes: carotid webs detected by CT angiogram
|
An 85-year-old right-handed male presented with sudden onset right hemiparesis. His medical history was significant for hypertension, dyslipidaemia and prostate cancer. He never smoked cigarettes and had no known diabetes mellitus or atrial fibrillation. Pre-admission cardiovascular medications included aspirin 75 mg and atorvastatin 20 mg daily. Admission National Institutes of Health Stroke Scale was 6. Non-contrast CT head revealed established bilateral corona radiata infarcts. CT angiogram (CTA) demonstrated a left internal carotid artery (ICA) web (). Intravenous thrombolysis was administered with a door to needle time of 21 min. On carotid duplex ultrasonography, an irregular mixed echogenic plaque (query ulcerated) was seen at the origin of the left ICA causing a 0–29% stenosis (). MRI head demonstrated acute infarcts in the left parietal lobe. Magnetic resonance angiogram (MRA) carotid arteries also demonstrated a shelf-like projection arising from the posterior wall of the left ICA consistent with a carotid web ().\nFor secondary stroke prevention, he was prescribed clopidogrel 75 mg daily and atorvastatin 40 mg. He was subsequently transferred to a stroke rehabilitation centre.
|
[[85.0, 'year']]
|
M
|
{'17569958': 1, '28160261': 1, '25358695': 1, '906063': 1, '18936031': 1, '24936980': 1, '26471750': 1, '4835966': 1, '7229711': 1, '26228877': 1, '24447601': 1, '16097301': 1, '7604420': 1, '1852941': 1, '1987677': 1, '16227490': 1, '7295105': 1, '26622927': 1, '26029351': 1, '25632417': 1, '28495950': 1, '30363186': 2}
|
{'6159149-2': 2}
|
2,915 |
6159149-2
| 30,363,186 |
comm/PMC006xxxxxx/PMC6159149.xml
|
A cause of recurrent strokes: carotid webs detected by CT angiogram
|
A 38-year-old Middle Eastern male presented to the emergency department with sudden onset dense right hemiparesis, right facial droop and aphasia. His background history included a previous ischaemic stroke 15 months ago treated in a different institution. At that time, he presented with a headache and dysphasia and a CT brain showed a left temporo-parietal infarct. By 6 months later, he had returned to his baseline of full functional independence on treatment with clopidogrel 75 mg once daily and atorvastatin 40 mg daily.\nOn this admission, CT brain showed a left M1 occlusion and the patient was treated with intravenous alteplase and thrombectomy.\nHis CT angiogram intracranial confirmed an acute occlusion of the M1 portion of the left middle cerebral artery and revealed two separate foci of soft plaques arising from the posterior wall of the origin of the left and right ICA with accompanying carotid webs on both sides (). His MRA carotids showed a haemorrhagic “plaque” at the origin of the left ICA but no high-grade ICA stenosis or any evidence of dissection (). Axial fat-saturated T1W MRI demonstrated a crescentic hyperintense signal at the posterior aspect of the origin of the left ICA consistent with haemorrhage within the known carotid web (). His carotid Doppler was normal. Extensive stroke work-up did not reveal any other cause for his stroke.\nHe was started on dabigatran 150 mg twice daily and aspirin 75 mg. He has now been transferred to a stroke rehabilitation centre with residual speech apraxia, improving right limb weakness and ability to comprehend one step commands.
|
[[38.0, 'year']]
|
M
|
{'17569958': 1, '28160261': 1, '25358695': 1, '906063': 1, '18936031': 1, '24936980': 1, '26471750': 1, '4835966': 1, '7229711': 1, '26228877': 1, '24447601': 1, '16097301': 1, '7604420': 1, '1852941': 1, '1987677': 1, '16227490': 1, '7295105': 1, '26622927': 1, '26029351': 1, '25632417': 1, '28495950': 1, '30363186': 2}
|
{'6159149-1': 2}
|
2,916 |
6159151-1
| 30,363,225 |
comm/PMC006xxxxxx/PMC6159151.xml
|
Huge chondromyxoid fibroma of the right iliac wing with tremendous soft tissue extensions
|
A 63-year-old male presented first with right groin pain and back pain over a period of more than 2 years and received analgesics, which did not help much. A year later, he started to feel pain and swelling in the right gluteal region.\nConventional radiography of the lumbar spine showed mild left convex scoliosis and a partially elicited right iliac wing osteolytic lesion ().\nConventional radiography of the pelvis revealed a large osteolytic lesion involving the right iliac crest and wing with sclerotic margins and no obvious dominant gross matrix calcifications ().\nMR examination of the pelvis elicited a huge (about 176 × 129 × 94 mm) mass arising from the superior aspect of the right iliac wing, which is generally T1 homogenous hypointense and T2 heterogeneous hyperintense signal with internal dominant fluid-equivalent signal and peripheral nodular hypointense margin. The mass is saddle shaped, overhanging the right iliac crest with a pelvic (internal) limb displacing and attenuating the right iliopsoas muscle without invasion of the iliac vessels and gluteal (external) limb extending into the gluteal region between the gluteal medius and minimus muscles. No evidence of invasion or encasement of the surrounding structures or adjacent iliac vessels was observed, and there was no defined regional pelvic lymphadenopathy. The whole lesion was surgically excised. There was no defined invasion of the surrounding adjacent soft tissues of the pelvis or the right gluteal region (–).
|
[[63.0, 'year']]
|
M
|
{'9596266': 1, '11810171': 1, '7957292': 1, '2793160': 1, '12975513': 1, '10653103': 1, '6337162': 1, '23599102': 1, '16431065': 1, '594803': 1, '18312923': 1, '18498038': 1, '30363225': 2}
|
{}
|
2,917 |
6159152-1
| 30,363,178 |
comm/PMC006xxxxxx/PMC6159152.xml
|
Ruptured gastric artery aneurysms: two cases and emergency imaging findings
|
A 51-year-old female presented to the emergency department with sudden onset of epigastric pain and vomiting. There was no known history of visceral or other arterial aneurysm, pancreatitis or connective tissue disease and the patient was otherwise fit and well. On examination, she was hypotensive (85/60 mmHg), with rebound and four quadrant abdominal tenderness.\nUrgent portal venous phase abdominal CT was performed. The anteroposterior scout image showed a large epigastric density displacing the lesser curvature of the stomach inferiorly ( white arrow). Post administration of contrast, images showed extremely rapid extravasation of contrast from a ruptured bilobed 18 mm left gastric artery aneurysm ( black arrow). From the time of contrast injection to the time of imaging (approximately 70 s) a very large volume of contrast had extravasated into the peritoneal cavity, and was evident in the pelvis, left paracolic gutter ( black arrows) and lesser sac, confirming very rapid bleeding. An expanded haematoma was present and centred in the region of the lesser omentum and lesser sac. This haematoma displaced the gastric lesser curvature inferiorly, the pancreatic head and body posteriorly () and the underside of the left lobe of the liver superiorly. The haematoma was seen extending through the oesophageal hiatus, which was also expanded (). There were signs of hypoperfusion complex with flattened inferior vena cava and adrenal hyperattenuation. The patient underwent urgent surgery during which the aneurysm was clipped and resected, and she made an uneventful recovery.
|
[[51.0, 'year']]
|
F
|
{'21665424': 1, '20249245': 1, '5489293': 1, '22262112': 1, '29123747': 1, '25827968': 1, '24386016': 1, '30363178': 2}
|
{'6159152-2': 2}
|
2,918 |
6159152-2
| 30,363,178 |
comm/PMC006xxxxxx/PMC6159152.xml
|
Ruptured gastric artery aneurysms: two cases and emergency imaging findings
|
A 57-year-old female presented with abdominal pain radiating to the back, with presyncopal symptoms. There was no known relevant history. Urgent triple phase CT demonstrated a right gastric artery aneurysm, located near the region of its anatomical anastomosis with the left gastric artery. No definite active haemorrhage was seen at the time of the study. A very large volume haemoperitoneum was present. A haematoma with epicentre at the lesser omentum/lesser sac was present. The haematoma displaced the lesser curvature of the stomach inferolaterally and filled the lesser sac. There was mild compressive mass effect on the anterior aspect of the pancreas. Emergent surgery was performed, and the aneurysm oversewn. The patient made complete recovery.
|
[[57.0, 'year']]
|
F
|
{'21665424': 1, '20249245': 1, '5489293': 1, '22262112': 1, '29123747': 1, '25827968': 1, '24386016': 1, '30363178': 2}
|
{'6159152-1': 2}
|
2,919 |
6159154-1
| 30,363,172 |
comm/PMC006xxxxxx/PMC6159154.xml
|
Four cases of endometrioid borderline ovarian tumour: case reports and literature review
|
The patient was a 47-year-old, gravida 2, para 2 female. She presented with lower right abdominal pain. MRI revealed a complex solid and cystic lesion measuring 9 cm in the right ovary (, upper left;). Some of the cystic locules showed high signal intensity on T1 weighted image (WI), indicating haemorrhage. A large enhanced solid component showed marked fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) (). A malignant ovarian tumour was suspected, so she underwent laparotomy. Analysis of an intraoperative frozen section of the tumour suggested a malignant or borderline endometrioid tumour of the ovary. During surgery, peritoneal thickening and adhesion in the Douglas pouch were observed, indicating pelvic endometriosis. Analysis of formalin-fixed paraffin embedded (FFPE) specimens revealed islands of endometrioid tumour cells showing moderate cytologic atypia proliferating within dense fibrous stroma (, upper left). The case was diagnosed as EBT, pT1aN0M0.
|
[[47.0, 'year']]
|
F
|
{'32821173': 2, '11075848': 1, '12960810': 1, '10907178': 1, '22418038': 1, '21895958': 1, '26930463': 1, '21287653': 1, '3414893': 1, '30363172': 2}
|
{'6159154-2': 2, '6159154-3': 2, '6159154-4': 2, '7418455-1': 1}
|
2,920 |
6159154-2
| 30,363,172 |
comm/PMC006xxxxxx/PMC6159154.xml
|
Four cases of endometrioid borderline ovarian tumour: case reports and literature review
|
The patient was a 65-year-old, gravida 2, para 2 post- menopausal female. She presented with vaginal bleeding. She was pointed out a pelvic mass on clinical examination and ultrasound. MRI showed a multiloculated mass measuring 15 cm of mixed high and low signal intensities on T1WI. Within a cyst, irregular shaped papillary projections were observed at the tumour wall on T2WI and were well enhanced indicating solid components ( upper right, ). This lesion showed restricted water diffusion on diffusion weighted imaging (DWI) (). A malignant ovarian tumour was suspected, and laparotomy was performed. A large right ovarian tumour was found extending into the retroperitoneum, strongly adherent to the pelvic wall. Analysis of intraoperative frozen sections revealed EBT. Final pathological diagnosis was EBT, pT1aN0M0. Intracystic papillary proliferation of atypical endometrioid epithelium was observed (, upper right), with coincidental non-atypical endometriosis. A benign endometrial polyp was detected in the uterine endometrium.
|
[[65.0, 'year']]
|
F
|
{'32821173': 2, '11075848': 1, '12960810': 1, '10907178': 1, '22418038': 1, '21895958': 1, '26930463': 1, '21287653': 1, '3414893': 1, '30363172': 2}
|
{'6159154-1': 2, '6159154-3': 2, '6159154-4': 2, '7418455-1': 1}
|
2,921 |
6159154-3
| 30,363,172 |
comm/PMC006xxxxxx/PMC6159154.xml
|
Four cases of endometrioid borderline ovarian tumour: case reports and literature review
|
The patient was a 54-year-old, gravida 2, para 2 post-menopausal female. She presented with lower abdominal discomfort and a right ovarian mass was pointed out by pelvic examination. Endometrial cytology detected adenocarcinoma cells. MRI and CT revealed a complex solid and cystic lesion of 8.4 cm diameter within the right ovary. A papillary lesion was observed on the tumour septum on T2WI and enhanced on post-contrast CT ( lower left, ). PET-CT showed strong uptake within the solid component (). Endometrial lesions were indistinct on imaging studies including CT and MRI. Concurrent ovarian and endometrial cancer was suspected, and she underwent surgery. During the surgery, the multiloculated right ovary measuring 8 cm was found to be adherent to the pelvic peritoneum. Blueberry spots, or blue tiny spots on peritoneum were observed in the Douglas pouch, indicating pelvic endometriosis. Intraoperative frozen section analysis suggested EBT. Analysis of FFPE specimens revealed an intracystic proliferation of atypical endometrioid epithelium showing crowded fusing glands ( lower left). The area of confluent glands were smaller than 5 mm, and destructive stromal invasion was absent, justifying the diagnosis of EBT, pT1aN0M0. Coincidental endometrioid carcinoma, Grade 1, pT1aN0M0 was found in the uterine endometrium.
|
[[54.0, 'year']]
|
F
|
{'32821173': 2, '11075848': 1, '12960810': 1, '10907178': 1, '22418038': 1, '21895958': 1, '26930463': 1, '21287653': 1, '3414893': 1, '30363172': 2}
|
{'6159154-1': 2, '6159154-2': 2, '6159154-4': 2, '7418455-1': 1}
|
2,922 |
6159154-4
| 30,363,172 |
comm/PMC006xxxxxx/PMC6159154.xml
|
Four cases of endometrioid borderline ovarian tumour: case reports and literature review
|
The patient was a 41-year-old, gravida 0 female. She was diagnosed with a left ovarian endometriotic cyst and uterine myomas when she was 34-years-old. At the age of 36, she was diagnosed with breast cancer and underwent left mastectomy and axillary lymphadenectomy, chemotherapy, and radiotherapy. She then commenced gonadotropin-releasing hormone agonist and tamoxifen. MRI at the age of 37 revealed an endometriotic cyst in her left ovary; the cyst showing high intensity on T2WI and intermediate-to-low intensity on T1WI without any solid component (). At the age of 40, she experienced intermittent vaginal bleeding lasting 6 months. Endometrial biopsy under hysteroscopy revealed endometrioid carcinoma, Grade 1. On this occasion the left ovarian tumour was unchanged in size when compared to the previous MRI scan, but there was now solid areas with strong enhancement within the haemorrhagic cyst on MRI ( lower right, ). Those solid lesions showed restricted water diffusion. Endometrial lesion was not recognized on MRI. PET-CT demonstrated FDG uptake in the solid portion of the left ovarian tumour (). A malignant left ovarian tumour with endometrial cancer was suspected. She underwent surgery. The 3-cm left ovarian cyst was adherent to the peritoneum. Intraoperative frozen section analysis demonstrated a seromucinous borderline tumour. In FFPE specimens, a left ovarian cyst was identified, with intracystic proliferation of papillary endometrioid epithelium with cellular and structural atypia (, lower right). The case was diagnosed as EBT of the ovary, pT1aN0M0 and endometrioid carcinoma Grade 1 of the uterine endometrium, pT1aN0M0.\nlists patient characteristics, image study findings and pathological findings. lists the results of immunohistochemistry for estrogen receptor, p53, and ARID1A. None of the patients underwent adjuvant therapy, but they were all well without recurrence. All patients provided written informed consent.\nlists 122 reported EBT cases in the literature. Case reviews reporting more than 3 cases are included.
|
[[41.0, 'year']]
|
F
|
{'32821173': 2, '11075848': 1, '12960810': 1, '10907178': 1, '22418038': 1, '21895958': 1, '26930463': 1, '21287653': 1, '3414893': 1, '30363172': 2}
|
{'6159154-1': 2, '6159154-2': 2, '6159154-3': 2, '7418455-1': 1}
|
2,923 |
6159159-1
| 30,363,205 |
comm/PMC006xxxxxx/PMC6159159.xml
|
Rosai–Dorfman disease of the breast
|
A 56-year-old female was recalled for assessment following an incident round screening mammography that demonstrated a new density in the left breast. She was asymptomatic, fit and well, with no significant medical or family history. Bilateral breast examination was normal.
|
[[56.0, 'year']]
|
F
|
{'11835335': 1, '20518426': 1, '34833385': 2, '11570913': 1, '7319486': 1, '22137724': 1, '27594932': 1, '15583585': 1, '5782438': 1, '10495325': 1, '20227012': 1, '12558621': 1, '30363205': 2}
|
{'8624438-1': 1}
|
2,924 |
6159161-1
| 30,363,181 |
comm/PMC006xxxxxx/PMC6159161.xml
|
Congenital nasal pyriform aperture stenosis: a rare cause of neonatal nasal airway obstruction
|
A 4-month-old female infant presented to our ear, nose and throat department with nasal stenting for CNPAS, which was performed elsewhere, with the stents in place. On clinical examination, the stents were seen in the bilateral nares, with partial absence of the nasal septum. Previous CT images were obtained from the parents and reviewed. CT images showed a narrowed pyriform aperture measuring 5.4 mm (). Mild medial angulation of the nasal processes of the maxilla was noted, and a single central mega-incisor was also noted ( and ). CT scan of the brain showed no intracranial abnormalities.\nAs the surgeons wanted to know the patency of the airway after stent removal and plan for further surgical management, the child was subjected to a CT scan immediately after removal of the stents. These CT images showed a pyriform aperture measurement of 10.3 mm (considered satisfactory; ). A central mega-incisor was noted. The nasal septum was almost completely eroded, which was probably attributed to compression erosion by the stents ( and ). On posterior rhinoscopy, no significant stenosis was seen at the posterior choanae. After removal of the stents, the infant was observed for cyanosis, but no complications were noted. Hence she was discharged and was asked to come back for follow-up.
|
[[4.0, 'month']]
|
F
|
{'21423901': 2, '22731387': 1, '10903683': 1, '10551232': 1, '22359713': 1, '18203939': 1, '11687681': 1, '30363181': 2}
|
{'3056623-1': 1}
|
2,925 |
6159162-1
| 30,363,191 |
comm/PMC006xxxxxx/PMC6159162.xml
|
Acute paraumbilical vein recanalization: an unusual complication of acute pancreatitis
|
A previously well 52-year-old male presented to the hospital with a 5-day history of abdominal tenderness, which was maximal in the left iliac fossa.
|
[[52.0, 'year']]
|
M
|
{'3883708': 1, '32201605': 1, '6983253': 1, '3881894': 1, '21960890': 1, '12386553': 1, '8388620': 1, '20103016': 1, '18484606': 1, '15615955': 1, '29403671': 2, '30363191': 2}
|
{'5748311-1': 1}
|
2,926 |
6159163-1
| 30,363,213 |
comm/PMC006xxxxxx/PMC6159163.xml
|
A case of granulomatous slack skin cutaneous T-cell lymphoma: PET/CT imaging findings
|
A 24-year-old black female presented with widespread skin changes on the upper and lower extremities, torso and genitalia. 2 years after the initial presentation, owing to worsening of her skin, she underwent partial vulvectomy. Lesional skin histopathology revealed the diagnosis of granulomatous slack skin cutaneous T-cell lymphoma (GSS CTCL) (). Over the course of 3 years, she received a variety of therapies. However, owing to therapy-related complications, she discontinued treatment. While off therapy, new skin lesions and lymphadenopathy developed. Our patient’s disease progression was clearly demonstrated by 18F-fludeoxyglucose (FDG) positron emission tomography (PET)/CT findings ( and ).
|
[[24.0, 'year']]
|
F
|
{'16702495': 1, '19075143': 1, '24438969': 1, '17638728': 1, '20651187': 1, '30363213': 2}
|
{}
|
2,927 |
6159165-1
| 30,363,216 |
comm/PMC006xxxxxx/PMC6159165.xml
|
A rare case of ectopic pregnancy in a caesarean section scar: a case report
|
A 33-year-old Sudanese woman, gravida 8, para 7 with 2 months of amenorrhea, was admitted to hospital following complaints of minimal vaginal bleeding, lower abdominal pain, nausea and vomiting on the day of admission. She had undergone a caesarean section 3 years prior. The patient’s physical examination revealed abdominal distention and generalized tenderness during palpation. A bimanual vaginal examination demonstrated an enlarged uterus that seemed to be consistent in size with 8 weeks’ gestation. The patient’s serum beta human chorionic gonadotrophin (β-hCG) level was 7,928 mIU ml–1.
|
[[33.0, 'year']]
|
F
|
{'16603160': 1, '18061960': 1, '15802418': 1, '15942155': 1, '12698784': 1, '16738166': 1, '11604205': 1, '15847889': 1, '12666214': 1, '12039473': 1, '22567525': 1, '11844184': 1, '11384652': 1, '12187153': 1, '12768566': 1, '30363216': 2}
|
{}
|
2,928 |
6159166-1
| 30,363,232 |
comm/PMC006xxxxxx/PMC6159166.xml
|
Isolated septic non-otogenic lateral sinus thrombosis complicating nasopharyngitis in a 2-month-old infant: a case report
|
A 2-month-old male infant was referred to our intensive care unit (ICU) from a peripheral facility where he had presented with one day of progressively worsening difficulty in breathing and feeding associated with multiple convulsions of generalized tonic clonic nature. On examination, he was dyspneic, afebrile and tachycardic, with cold extremities, weak pulses and a delayed capillary refill of 4 s. His blood pressure was 98/64 mmHg and blood sugar 14.4 mmol l–1. An arterial blood gas showed a mixed metabolic/respiratory acidosis with a pH of 7.1, hypercapnia (pCO2 55 mmHg) and decreased bicarbonate levels (20 mEq l–1). He had a white cell count of 15.6 × 109 µl–1, largely neutrophils (76%), a reactive thrombocytosis (605 × 109 µl–1), an international normalized ratio (INR) 1.24 and a normal chest radiograph. Further history revealed that the infant had an uneventful natal and postnatal period, but had had 3 weeks of nasal congestion, treated with nasal saline drops, antihistamines, antibiotics and antipyretics.\nIn the ICU, he was immediately intubated (endotracheal tube 3.5 mm diameter, 11 cm length) and ventilated. He was put on broad spectrum antibiotics (ceftriaxone, clarithromycin) for severe pneumonia/sepsis, phenytoin and morphine.\nHe was further noted to have a firm, smooth, immobile left submandibular mass, extending to the neck levels II-V. A CT scan was done, revealing a 27 mm × 47 mm × 42 mm parapharyngeal/paravertebral cystic mass obliterating the oropharyngeal airway and acute left LST (); the latter confirmed on MRI (). He was started on low molecular weight heparin (Enoxaparin) at 1 mg/kg–1 and ultrasound-guided aspiration was done. This revealed pus and 20 ml drained and cavity flushed with 40 mg gentamycin and 1 g vancomycin.Staphylococcus aureus was grown on culture of the aspirate. There were no acid fast bacilli, and the human immunodeficiency virus (HIV) test done was negative. Ceftriaxone was then changed to clindamycin, with successful extubation 48 hours later, and transfer to the ward after 2 weeks of ICU care. A repeat MR venogram () done at the end of his 14 day stay in the ward showed partial re-cannulation in the sinuses.
|
[[2.0, 'month']]
|
M
|
{'10990497': 1, '15971649': 1, '16579197': 1, '18922587': 1, '15699061': 1, '19118248': 1, '15487635': 1, '16533968': 1, '19171642': 1, '26507671': 1, '30363232': 2}
|
{}
|
2,929 |
6159167-1
| 30,363,193 |
comm/PMC006xxxxxx/PMC6159167.xml
|
Imitators of chronic pancreatitis: diffuse neuroendocrine tumour of the pancreas
|
A 55-year-old female with no significant past medical history initially presented in 2006 with vague abdominal pain. Her past social history was negative for alcoholism or smoking. Work up of the patient including physical examination and laboratory indices were all normal. A multi-detector CT of the abdomen and pelvis utilizing a pancreatic mass protocol (arterial, portal venous and delayed phases) was performed which revealed a diffusely enlarged pancreas with extensive parenchymal calcifications (). No discrete mass was identified in the pancreas. Minimal pancreatic ductal dilatation was noted on the CT examination. The patient was diagnosed with chronic pancreatitis and followed clinically for several years. In 2015, the patient presented with recurrent abdominal pain. A CT of the abdomen and pelvis with pancreatic mass protocol was repeated (), which revealed new hypoattenuating masses in the pancreatic neck and tail. Some of the smaller tumours were hypervascular on the arterial phase imaging. There was redemonstration of extensive parenchymal calcifications. No pancreatic atrophy was identified. The pancreatic duct remained minimally dilated. Given the new masses many of which were arterially enhancing, the possibility of neuroendocrine tumour was raised. A MRI of the abdomen with pancreatic mass protocol (T2 with fat saturation, MRCP, in and out of phase T1 and unenhanced T1/arterial/portal/ 5 min delayed post-contrast T1) was performed (). The MRI confirmed multiple well-circumscribed masses throughout the pancreas, many of which had increased T2 signal with cystic change. The pancreatic duct was at most mildly prominent, and no lesions were identified outside of the pancreas. The largest pancreatic mass in the tail measured approximately 3.5 cm, with peripheral enhancement and central hypointense signal (). An endoscopic ultrasound was performed, which confirmed a hypoechoic mass in the tail of the pancreas, two isoechoic masses in the head of the pancreas, and diffuse parenchymal calcifications suggestive of chronic pancreatitis. Fine needle aspiration of the pancreatic masses in the head was performed, with cytology returning as concerning for neuroendocrine tumour. Given the suspicion for pancreatic neuroendocrine tumour, an indium-111 Octreotide scan was requested for further characterization. Fused SPECT-CT imaging was also performed for improved uptake localization (). The indium-111 scan revealed diffuse intense uptake of radiotracer throughout the entire pancreas. No extrapancreatic foci of uptake was identified. On the grounds of the clinical and imaging findings, it was decided the best course of action would be to perform a pylorus-preserving pancreaticoduodenectomy with total resection of the pancreas, splenectomy and cholecystectomy. Sectioning of the pancreas revealed numerous well-circumscribed, solid and tumoural masses ranging from minute up to the largest grossly identified lesion measuring 3.5 cm in diameter (). Many of the nodules were coalescing with only a scant amount of intervening normal pancreatic parenchyma present. The cut surfaces of the nodular masses were solid and showed a variegated pink to orange-red colour. No gross areas of necrosis were identified. Numerous representative histologic sections of the nodular masses were examined. The nodules were comprised of numerous insular nests and trabecular cords of fairly uniform epithelioid neoplastic cells with oval nuclei and speckled chromatin. Many of the nodules showed numerous calcifications and localized amyloid deposition (). Immunohistochemical stains were performed and the neoplastic cells marked strongly for the neuroendocrine markers chromogranin A and synaptophysin (). Multiple immunostains for pancreatic peptides were performed. The neoplastic cells were positive for pancreatic polypeptide and negative for insulin, glucagon and somatostatin. Only a rare mitotic figure was identified but the Ki-67 mitotic index marker was calculated at 5% as measured by the Aperio image analysis system. The findings were consistent with numerous neuroendocrine tumours of the pancreas, Grade II, as per the 2010 WHO criteria for neuroendocrine tumours of the pancreas. The neuroendocrine neoplastic nodules were all confined within the pancreatic parenchyma and all pancreatic resection margins were free of neoplasia. All regional lymph nodes sampled were negative for metastatic disease.
|
[[55.0, 'year']]
|
F
|
{'22826391': 1, '10405744': 1, '33717403': 1, '15763696': 1, '18025510': 1, '24259951': 1, '10080850': 1, '27303533': 1, '11960225': 1, '24591775': 1, '21808296': 1, '17848696': 1, '16009817': 1, '26550047': 1, '19605653': 1, '10713946': 1, '21071369': 1, '32399832': 1, '15547204': 1, '30363193': 2}
|
{}
|
2,930 |
6159168-1
| 30,363,215 |
comm/PMC006xxxxxx/PMC6159168.xml
|
May-Thurner variant secondary to degenerative lumbar spondylolisthesis: a case report
|
A 64-year-old female patient with background of a right iliac fossa renal transplant presented to the renal outpatient clinic complaining of unilateral swelling of the left lower limb for several weeks. The clinical history did not reveal any risk factors for deep vein thrombosis. On clinical examination the patient had unilateral leg swelling on the left with pedal oedema. Observations were normal and cardiovascular and abdominal system examinations were unremarkable.
|
[[64.0, 'year']]
|
F
|
{'17980284': 1, '27074066': 1, '18026865': 1, '7817240': 1, '34003124': 1, '13478912': 1, '15505333': 1, '10928517': 1, '21629167': 1, '9306535': 1, '12811270': 1, '9278077': 1, '15111841': 1, '24633533': 1, '17611208': 1, '34616817': 2, '19139672': 1, '11099239': 1, '17556124': 1, '30363215': 2}
|
{'8464458-1': 1}
|
2,931 |
6159173-1
| 30,363,235 |
comm/PMC006xxxxxx/PMC6159173.xml
|
Imaging of the spectrum of bony injuries in the diabetic foot: a case series with emphasis on non-Charcot fractures
|
A 58-year-old male with Type 2 diabetes mellitus and peripheral neuropathy, presented with left foot swelling and minimal pain. There was no history of trauma. Radiograph () demonstrates multiple healing stress fractures involving the diaphysis of the second, third, fourth and fifth metatarsals.
|
[[58.0, 'year']]
|
M
|
{'27444009': 1, '11678977': 1, '2743677': 1, '21354008': 1, '20412561': 1, '21325957': 1, '3809484': 1, '26111070': 1, '25897350': 1, '12143987': 1, '26447406': 1, '10745133': 1, '11046169': 1, '10429715': 1, '27145453': 1, '15062217': 1, '18313581': 1, '23931803': 1, '23204315': 1, '22294451': 1, '16636977': 1, '23824389': 1, '3652618': 1, '9559485': 1, '26244328': 1, '1925674': 1, '17216478': 1, '27796661': 1, '26989931': 1, '7352207': 1, '30363235': 2}
|
{'6159173-2': 2, '6159173-3': 2, '6159173-4': 2, '6159173-5': 2, '6159173-6': 2, '6159173-7': 2}
|
2,932 |
6159173-2
| 30,363,235 |
comm/PMC006xxxxxx/PMC6159173.xml
|
Imaging of the spectrum of bony injuries in the diabetic foot: a case series with emphasis on non-Charcot fractures
|
A 46 year-old female with a history of poorly controlled Type 1 diabetes mellitus and diabetic peripheral neuropathy presented with painless foot swelling. Radiograph performed 6 months prior to presentation () shows an ununited fracture of the proximal shaft of the fifth metatarsal. No specific treatment for the ununited fracture was documented. Six months later, a radiograph () performed for investigation of painless foot swelling demonstrates changes consistent with avascular necrosis of the heads of the second, third and fourth metatarsals. MRI () confirmed the findings. In the setting of diabetic peripheral neuropathy, we postulate that the development of avascular necrosis is most likely secondary to altered biomechanics due to the previous fifth metatarsal fracture and is a result of increased force exerted on the metatarsal heads, poor bone quality and microvascular ischaemia.
|
[[46.0, 'year']]
|
F
|
{'27444009': 1, '11678977': 1, '2743677': 1, '21354008': 1, '20412561': 1, '21325957': 1, '3809484': 1, '26111070': 1, '25897350': 1, '12143987': 1, '26447406': 1, '10745133': 1, '11046169': 1, '10429715': 1, '27145453': 1, '15062217': 1, '18313581': 1, '23931803': 1, '23204315': 1, '22294451': 1, '16636977': 1, '23824389': 1, '3652618': 1, '9559485': 1, '26244328': 1, '1925674': 1, '17216478': 1, '27796661': 1, '26989931': 1, '7352207': 1, '30363235': 2}
|
{'6159173-1': 2, '6159173-3': 2, '6159173-4': 2, '6159173-5': 2, '6159173-6': 2, '6159173-7': 2}
|
2,933 |
6159173-3
| 30,363,235 |
comm/PMC006xxxxxx/PMC6159173.xml
|
Imaging of the spectrum of bony injuries in the diabetic foot: a case series with emphasis on non-Charcot fractures
|
A 53-year-old male with Type 1 diabetes, peripheral neuropathy and previous partial amputation of the proximal phalanx of the left great toe presented with a non-healing, minimally painful ulcer at the stump of the left first toe. Radiograph of the left foot () demonstrates established avascular necrosis involving the heads of the left second and third metatarsals. Amputation of the proximal phalanx of the first toe with resultant alteration in biomechanics is the likely initiating factor for osteonecrosis of the metatarsal heads.
|
[[53.0, 'year']]
|
M
|
{'27444009': 1, '11678977': 1, '2743677': 1, '21354008': 1, '20412561': 1, '21325957': 1, '3809484': 1, '26111070': 1, '25897350': 1, '12143987': 1, '26447406': 1, '10745133': 1, '11046169': 1, '10429715': 1, '27145453': 1, '15062217': 1, '18313581': 1, '23931803': 1, '23204315': 1, '22294451': 1, '16636977': 1, '23824389': 1, '3652618': 1, '9559485': 1, '26244328': 1, '1925674': 1, '17216478': 1, '27796661': 1, '26989931': 1, '7352207': 1, '30363235': 2}
|
{'6159173-1': 2, '6159173-2': 2, '6159173-4': 2, '6159173-5': 2, '6159173-6': 2, '6159173-7': 2}
|
2,934 |
6159173-4
| 30,363,235 |
comm/PMC006xxxxxx/PMC6159173.xml
|
Imaging of the spectrum of bony injuries in the diabetic foot: a case series with emphasis on non-Charcot fractures
|
A 65-year-old male with Type 2 diabetes mellitus and peripheral neuropathy presented with a painless ulcer in the third toe. Radiograph performed on presentation () shows an ununited fracture of the head of the proximal phalanx of the fourth toe, consistent with previous trauma in an insensate foot. “Pencil point” deformity of the neck of the proximal phalanx of the fourth toe is compatible with bone remodelling, most likely related to chronic microtrauma associated with profound sensory neuropathy and altered biomechanics secondary to previous amputation. A radiograph () performed 5 years earlier shown for comparison demonstrates normal appearance of the proximal phalanx of the fourth toe.
|
[[65.0, 'year']]
|
M
|
{'27444009': 1, '11678977': 1, '2743677': 1, '21354008': 1, '20412561': 1, '21325957': 1, '3809484': 1, '26111070': 1, '25897350': 1, '12143987': 1, '26447406': 1, '10745133': 1, '11046169': 1, '10429715': 1, '27145453': 1, '15062217': 1, '18313581': 1, '23931803': 1, '23204315': 1, '22294451': 1, '16636977': 1, '23824389': 1, '3652618': 1, '9559485': 1, '26244328': 1, '1925674': 1, '17216478': 1, '27796661': 1, '26989931': 1, '7352207': 1, '30363235': 2}
|
{'6159173-1': 2, '6159173-2': 2, '6159173-3': 2, '6159173-5': 2, '6159173-6': 2, '6159173-7': 2}
|
2,935 |
6159173-5
| 30,363,235 |
comm/PMC006xxxxxx/PMC6159173.xml
|
Imaging of the spectrum of bony injuries in the diabetic foot: a case series with emphasis on non-Charcot fractures
|
A 52-year-old male patient with a history of diabetes mellitus and peripheral neuropathy presented with fifth toe swelling. MRI () and CT () demonstrate remodelling of the distal phalanx of the fifth toe. The MR appearances are suggestive of chronic microtrauma in the context of diabetic neuropathy with remodelling of the bone with periosteal and soft tissue reaction.
|
[[52.0, 'year']]
|
M
|
{'27444009': 1, '11678977': 1, '2743677': 1, '21354008': 1, '20412561': 1, '21325957': 1, '3809484': 1, '26111070': 1, '25897350': 1, '12143987': 1, '26447406': 1, '10745133': 1, '11046169': 1, '10429715': 1, '27145453': 1, '15062217': 1, '18313581': 1, '23931803': 1, '23204315': 1, '22294451': 1, '16636977': 1, '23824389': 1, '3652618': 1, '9559485': 1, '26244328': 1, '1925674': 1, '17216478': 1, '27796661': 1, '26989931': 1, '7352207': 1, '30363235': 2}
|
{'6159173-1': 2, '6159173-2': 2, '6159173-3': 2, '6159173-4': 2, '6159173-6': 2, '6159173-7': 2}
|
2,936 |
6159173-6
| 30,363,235 |
comm/PMC006xxxxxx/PMC6159173.xml
|
Imaging of the spectrum of bony injuries in the diabetic foot: a case series with emphasis on non-Charcot fractures
|
A 62-year-old male with a history of Type 2 diabetes was admitted with a chronic non-healing left calcaneal ulcer. Radiograph of the left calcaneus () was unremarkable. MRI () reveals a non-displaced insufficiency fracture of the calcaneus with no evidence of osteomyelitis.
|
[[62.0, 'year']]
|
M
|
{'27444009': 1, '11678977': 1, '2743677': 1, '21354008': 1, '20412561': 1, '21325957': 1, '3809484': 1, '26111070': 1, '25897350': 1, '12143987': 1, '26447406': 1, '10745133': 1, '11046169': 1, '10429715': 1, '27145453': 1, '15062217': 1, '18313581': 1, '23931803': 1, '23204315': 1, '22294451': 1, '16636977': 1, '23824389': 1, '3652618': 1, '9559485': 1, '26244328': 1, '1925674': 1, '17216478': 1, '27796661': 1, '26989931': 1, '7352207': 1, '30363235': 2}
|
{'6159173-1': 2, '6159173-2': 2, '6159173-3': 2, '6159173-4': 2, '6159173-5': 2, '6159173-7': 2}
|
2,937 |
6159173-7
| 30,363,235 |
comm/PMC006xxxxxx/PMC6159173.xml
|
Imaging of the spectrum of bony injuries in the diabetic foot: a case series with emphasis on non-Charcot fractures
|
A 73-year-old male with a history of Type 2 diabetes mellitus presented with a heel ulcer. Radiograph of the left foot () reveals a wedge-shaped avulsion fracture at the posterior calcaneus.
|
[[73.0, 'year']]
|
M
|
{'27444009': 1, '11678977': 1, '2743677': 1, '21354008': 1, '20412561': 1, '21325957': 1, '3809484': 1, '26111070': 1, '25897350': 1, '12143987': 1, '26447406': 1, '10745133': 1, '11046169': 1, '10429715': 1, '27145453': 1, '15062217': 1, '18313581': 1, '23931803': 1, '23204315': 1, '22294451': 1, '16636977': 1, '23824389': 1, '3652618': 1, '9559485': 1, '26244328': 1, '1925674': 1, '17216478': 1, '27796661': 1, '26989931': 1, '7352207': 1, '30363235': 2}
|
{'6159173-1': 2, '6159173-2': 2, '6159173-3': 2, '6159173-4': 2, '6159173-5': 2, '6159173-6': 2}
|
2,938 |
6159175-1
| 30,363,231 |
comm/PMC006xxxxxx/PMC6159175.xml
|
Diagnosis and management of intramural ectopic pregnancy in the second trimester—a case report
|
A 20-year-old asymptomatic female, G1P0, with a history of curettage, is presented to the Department of Gynecology and Obstetrics for termination of pregnancy. Her last menstrual period was 17 weeks and 2 days ago. Abdominal ultrasound revealed a clear gestational sac (GS), fetus with heartbeat and placenta previa. Abdominal ultrasound also showed the GS at a distance from the cavity, with a compressed myometrium between the two of them (). The patient received a MRI examination, showing an enlarged uterus of 13.0 cm ×11.7 cm × 7.9 cm, because of pieces of evidence. The MRI demonstrated a foetus with clear organs (), and compressed the lower uterine segment (). The GS was not connected with the uterine cavity and endometrium, but embedded into the myometrium in the right posterior wall of the uterine. A linear hypointensity of the junction zone was observed between the GS and the uterine cavity on T2weighted image ().\nThis result is likely to be placenta implantation as the myometrium cannot be separated from the placenta. The patient was at risk of the uterine rupture and life- threatening haemorrhage. Emergent management should be performed. Performing uterine artery embolization (UAE) and interventional therapy is inadvisable because of the obstructing myometrium between the cervix and placenta. Employing a surgical exploration of the abdomen was decided that was undertaken under temporary balloon occlusion of the abdominal aorta to reduce the loss of blood. The balloon was placed in the abdominal aorta between the opening of renal artery and iliac artery just before the operation. If the area of the focal damage was heavy, the subtotal hysterectomy or hysterectomy was needed. Otherwise, clinicians can perform excision by laparotomy and hysteroplasty. Given the age of patient, clinicians did their best to perform hysteroplasty instead of hysterectomy. The intramural ectopic GS in the second trimester was successfully excluded without life-threatening haemorrhage (). The patient had an uneventful postoperative course. Her β-hCG titre decreased to 1727 mIU ml–1 on the second day after operation, and then to 440.1 mIU ml–1 on the sixth day. She was discharged 6 days after surgery.
|
[[20.0, 'year']]
|
F
|
{'26819788': 2, '32041575': 2, '24421921': 1, '9351419': 1, '22605595': 1, '22567521': 1, '34778327': 1, '11336768': 1, '10866510': 1, '23465260': 1, '30363231': 2}
|
{'7011315-1': 1, '4706881-1': 1, '4706881-2': 1, '4706881-3': 1}
|
2,939 |
6159178-1
| 30,363,204 |
comm/PMC006xxxxxx/PMC6159178.xml
|
Use of single photon metal artefact reduction in the detection of an impacted capsule endoscope
|
An 80-year-old male was being investigated at a tertiary hospital for iron deficiency anaemia. His medical history, symptomology and physical examination did not indicate a cause. After gastroscopy and colonoscopy were also unremarkable he was referred for capsule endoscopy. The delivery of the capsule in the morning was routine; however, review of the images 8 hlater showed a static picture and no evidence the capsule had entered the stomach. The patient was clinically stable and contacted to present to the emergency department with a suspicion of capsule impaction.
|
[[80.0, 'year']]
|
M
|
{'25110430': 1, '19305454': 1, '21769288': 1, '27222275': 1, '25610531': 1, '16197536': 1, '26514739': 1, '22275012': 1, '15718872': 1, '30363204': 2}
|
{}
|
2,940 |
6159179-1
| 30,363,238 |
comm/PMC006xxxxxx/PMC6159179.xml
|
Swyer-James-MacLeod syndrome with unilateral pulmonary fibrosis: a case report
|
A 72-year-old Caucasian female patient was referred to the respiratory clinic with a 6-month history of exertional breathlessness. She gave a history of yearly chest infections, particularly in winter months. She, however, had no history of childhood respiratory problems or any significant respiratory symptoms during her adult life. She had a 30-pack-year smoking history but she quit 25 years prior to presentation. She worked as a nursing auxillary at a local hospital and had no prior asbestosis. She was on a 1 mg maintenance dose of prednisolone for polymyalgia rheumatica. Otherwise, she had no significant medical condition and was not on any regular medications. Her exercise tolerance was unlimited and she enjoyed a good health.\nHer O2 saturation was 95% on room air and her spirometry showed obstructive pattern with FEV1 1.14L (55%), FVC 2.09L (83%) and FEV1/FVC ratio 54%.\nAn initial chest radiograph 2 years prior to presentation suggested an increased radiolucency of the left lung but this was not investigated further (). Serial CXRs 2 years later showed a relatively unchanged appearance of the left hemithorax with progressively increased opacification in the periphery of the middle and lower zones, and accompanying reduction in lung volume, on the right side ().\nThe patient underwent a contrast-enhanced CT of the chest in view of the repeated chest infections and lack of complete resolution to rule out the possibility of an adenocarcinoma in situ or endobronchial lesion, respectively. Cross-sectional imaging was also carried out to assess the possibility of an underlying bronchiectasis in the presence of the recurrent chest infections and to further assess the interstitial changes seen on the CXR on the right side.\nHer CT showed hypoplastic left pulmonary artery (; arrow), attenuated peripheral pulmonary artery branches on the left (: arrows), hyperinflated left lung with air trapping and cystic bronchiectasis of the lingua and left lower lobe (). Features were in keeping with the diagnosis of Swyer-James-MacLeod syndrome (SJMS). Interestingly, the right lung was small in size with evidence of subpleural reticulation, traction bronchiectasis and ground-glass opacification suggesting an underlying pulmonary fibrosis (). The oligaemia of the left lung is shown as reduced FDG uptake () on PET CT, which was done to investigate a different pathology.\nSputum culture grew pseudomonas species and bronchoalveolar lavage from the right lung showed mixed cellularity with 22% eosinophils and a 36% neutrophils.
|
[[72.0, 'year']]
|
F
|
{'22679043': 1, '22541234': 1, '20471812': 1, '26029618': 1, '22387320': 1, '19164309': 1, '21571653': 1, '33754088': 2, '17332882': 1, '13077508': 1, '24050627': 1, '16844727': 1, '13179127': 1, '30363238': 2}
|
{'7971722-1': 1}
|
2,941 |
6159180-1
| 30,363,234 |
comm/PMC006xxxxxx/PMC6159180.xml
|
Heart or head?: A depression mimic delays diagnosis—oncotic cerebral aneurysms caused by atrial myxoma
|
An independent, healthy 48-year-old female presented to her general practitioner with a 3-week history of slurred speech, unsteadiness and fatigue. She took occasional iron supplements, but no regular medications.\nHer past medical history included iron deficiency anaemia and a melanoma, which had been excised 13 years previously.\nOne year prior to this presentation she had an admission spanning 4 weeks, with lingering depressive and anxiety symptoms after a presumed viral infection 6 months earlier. She had experienced lethargy, intermittent headaches, nausea, diarrhoea and 16 Kg of unintentional weight loss over a 6-month period. Following investigation with biochemical assessment, endoscopy, colonoscopy and a CT abdomen she was diagnosed with an episode of major depression and started on an antidepressant.\nClinical examination at this presentation demonstrated ataxia, with the patient being unable to walk heel-to–toe. Romberg’s test was negative. She had a subtle dysarthria. No other focal neurology was elicited on neurologic examination. Cardiorespiratory examinations were unremarkable. The general practitioner arranged a CT brain, which identified multifocal haemorrhagic sites in the right cerebellar and both cerebral hemispheres (). These ranged from subcentimetre in size to the largest—a 3-cm right cerebellar lobar bleed. The differential diagnoses postulated in the report were haemorrhagic metastases—possibly recurrent melanoma, or an atypical presentation of amyloid angiopathy.\nThe patient was commenced on dexamethasone and referred to the neurosurgical department. She was booked for a staging CT chest/abdomen and pre-operative stealth brain MRI, with a view to excise the right cerebellar lesion for histological diagnosis. The MRI confirmed multiple supra- and infratentorial lesions. Haemosiderin staining was seen in multiple sulci at the vertex in keeping with a low volume of subarachnoid blood, and a 4 mm posterior inferior cerebellar artery aneurysm was detected (–). The CT chest identified a mass in the left atrium concerning for an atrial myxoma (). In view of the suspected cardiac mass the neurosurgical biopsy procedure was postponed pending further work up.\nEchocardiography showed a large, mobile left atrial mass compatible with an atrial myxoma. There was no associated obstruction despite the mass occupying half of the left atrial volume. Left ventricular function was normal (Ejection Fraction 62%). Without histological support a melanoma deposit remained a possible diagnosis and, after discussion between neurosurgery, cardiology and cardiothoracic teams, a decision was made to proceed with the cerebellar excision. A cardiac MRI was also arranged.\nThe cerebellar excision was uncomplicated, but histological assessment was non-contributory towards a diagnosis. No melanoma or other malignant cells were identified. The excised material consisted of haemorrhage and some distortion of the underlying vascular architecture, without evidence of vasculitis or amyloid angiopathy. In the interval, the cardiac MRI demonstrated an interatrial septal stalk pathognomonic for atrial myxoma. The new favoured diagnosis was haemorrhagic transformation of embolic ischaemic infarcts secondary to the atrial myxoma.\nThe patient showed some symptomatic improvement with steroids and was referred to Interventional radiology for formal cerebral angiography assessment to evaluate for cerebral vasculitis. Both internal carotids and vertebral arteries were imaged. The procedure revealed extensive abnormalities, with diffuse irregularity of the medium to small vessels, most pronounced in the peripheral ICA and PCA branches. Distal, fusiform aneurysm formation was identified in at least two distinct sites in the peripheral intracranial branches (,). No central aneurysm was detected around the arterial circle of Willis.\nThe patient underwent excision of the left atrial mass under therapeutic heparin cover on a cardiopulmonary bypass machine. Histological assessment confirmed a left atrial myxoma, with the friable specimen demonstrating classical stellate mesenchymal tumour cells set in a loose myxoid stroma. The patient had an uncomplicated post-operative course and a normal post-operative echocardiogram. She was discharged home with a follow-up MRI and neurosurgical review booked at 6 weeks.
|
[[48.0, 'year']]
|
F
|
{'27086806': 1, '25018846': 1, '25737060': 1, '8281536': 1, '26351445': 2, '21253367': 2, '25369530': 1, '15760885': 1, '16595790': 1, '18824772': 1, '25797902': 1, '31646971': 2, '24109531': 2, '11306860': 1, '20566147': 1, '30363234': 2}
|
{'3021896-1': 1, '3787621-1': 1, '6813067-1': 1, '4560324-1': 1}
|
2,942 |
6159181-1
| 30,363,221 |
comm/PMC006xxxxxx/PMC6159181.xml
|
Radiological insertion of automated low flow ascitic pump (alfapump®) system for management of medically refractory ascites
|
A 63-year-old female patient was referred to the IR clinic with medically refractory ascites due to Child-Pugh Class B alcoholic-liver disease cirrhosis. The patients’ pre-procedure parameters were as shown in . The patient did not wish to be considered for OLT or TIPSS, and decision was made to insert an alfapump system.\nThe procedure was tolerated well by patient with no significant discomfort. Oozing of ascitic fluid from the peritoneal catheter access site was noted on day 1, which resolved spontaneously after 2 days and was presumed secondary to the elevated abdominal pressure due to volume of ascites.\nOn day 15, post-implantation patient’s sodium had improved from 130 mmol l–1 to 135 mmol l–1 and her albumin had decreased minimally from 43 g l–1 to 38 g l but remained within the normal range (). The patient did not require albumin infusion and her nutrition was maintained on oral diet. At last check, patient had 100 litres of ascites drained with a mean daily volume of 74.4 mls in the last 7 days. The patient did not develop renal failure ().\nAs the patient’s overall nutrition improved significantly following drainage of ascites, combined with decreasing pump volume, the decision was made to switch off the pump 224 days post implantation. The pump was electively explanted on the patient’s wishes immediately thereafter.
|
[[63.0, 'year']]
|
F
|
{'23318604': 1, '22997394': 1, '8831595': 1, '32704299': 1, '23993913': 1, '21292080': 1, '17054221': 1, '9588766': 1, '9609767': 1, '31999044': 1, '16966752': 1, '3804191': 1, '22234072': 1, '30363221': 2}
|
{'6159181-2': 2, '6159181-3': 2}
|
2,943 |
6159181-2
| 30,363,221 |
comm/PMC006xxxxxx/PMC6159181.xml
|
Radiological insertion of automated low flow ascitic pump (alfapump®) system for management of medically refractory ascites
|
A female patient aged 54 years, with Child-Pugh Class B cirrhosis secondary to excess alcohol intake, was referred to IR clinic with medically refractory ascites. Pre-procedure parameters were as documented in . The patient had previous encephalopathy, hence was not a candidate for TIPSS. Following much discussion, she was placed on the active liver transplant waiting list and decision was made to insert the alfapump system as a bridge-to-transplant.\nThe procedure was tolerated well by the patient with no significant discomfort.\nThe patient suffered with leakage of ascites from the peritoneal incision, initially 1 week after the procedure and then twice more during follow up. This was managed by increasing the pump output and by aspirating the subcutaneous fluid pocket to dryness. Intermittently the patient complained of bladder spasms (likely due to “dry pumping”), which resolved after adjusting the pump settings.\nThe patient also suffered with one episode of cellulitis near the skin incision, which responded to oral antibiotic therapy.\nThere were no significant adverse biochemical outcomes (). The patient underwent OLT 112 days after alfapump implantation. During this time, 77.7 litres of ascites was drained with a mean of 84.6 ml in the final 7 days up to transplant. On day 14 after implantation patient’s sodium levels had improved from 134 mmol l–1 to 137 mmol l–1 and her albumin levels had improved slightly from 30 g l–1 to 32 l–1. Patient required only 500 ml of 20% albumin infusion over the course of 112 days to maintain her nutritional status.\nThe patient underwent successful OLT and the pump was explanted during the same surgical episode.
|
[[54.0, 'year']]
|
F
|
{'23318604': 1, '22997394': 1, '8831595': 1, '32704299': 1, '23993913': 1, '21292080': 1, '17054221': 1, '9588766': 1, '9609767': 1, '31999044': 1, '16966752': 1, '3804191': 1, '22234072': 1, '30363221': 2}
|
{'6159181-1': 2, '6159181-3': 2}
|
2,944 |
6159181-3
| 30,363,221 |
comm/PMC006xxxxxx/PMC6159181.xml
|
Radiological insertion of automated low flow ascitic pump (alfapump®) system for management of medically refractory ascites
|
A 54-year-old female patient, with Child-Pugh C cirrhosis secondary to alcoholic liver disease, was referred to IR clinic for medically refractory ascites.\nPre-procedure parameters were as outlined in .\nThe patient tolerated the procedure well, with no complaints of discomfort.\nThe patient had two episodes of cellulitis (day 32 and 64) and one episode of urinary tract infection (month 8), which required antibiotics and hospital admission.\nThe patient had small volume ascitic fluid leakage through the pump wound at day 30 and moderate to large volume leakage, again after 4 months, with a large subcutaneous fluid pocket forming around the pump. This was attributed to a migrated bladder tube (seen on ultrasound); hence, pump revision was carried out on day 120 and both bladder and peritoneal tubings were changed.\nBloods on day 15 demonstrated an improvement in albumin; however a persistent acute kidney injury was noted (on background of chronic renal impairment), most likely consequent to hepatorenal syndrome ().\nThe patient continued to have persistent ascites, in spite of what seemed like adequate pump volume (1100 ml/day), and required 3 LVPs in a 6-month period. Due to patient choice, the pump was finally explanted 289 days after implantation. The patient died 315 days later due to sequelae of background liver pathology.
|
[[54.0, 'year']]
|
F
|
{'23318604': 1, '22997394': 1, '8831595': 1, '32704299': 1, '23993913': 1, '21292080': 1, '17054221': 1, '9588766': 1, '9609767': 1, '31999044': 1, '16966752': 1, '3804191': 1, '22234072': 1, '30363221': 2}
|
{'6159181-1': 2, '6159181-2': 2}
|
2,945 |
6159182-1
| 30,363,202 |
comm/PMC006xxxxxx/PMC6159182.xml
|
Gallstone ileus from a non-calcified stone: a challenging diagnosis
|
An 88-year-old female presented to the emergency department with abdominal pain and vomiting. She was mildly tender in her right upper quadrant but was focally more tender in her right lower quadrant. Her blood results showed an elevated white cell count of 12.9 × 109 l–1 and a neutrophil count of 10.4 × 109 l–1. Furthermore her C-reactive protein level was 34 mg/L. An abdominal ultrasound showed multiple calculi within the gallbladder. Gallbladder wall thickness was not assessed. A non-contrast CT scan, due to the patients impaired renal function, was then ordered as the patient’s physical exam findings were not in keeping with a diagnosis of cholecystitis.\nThe CT showed abnormal dilatation of the proximal small bowel with a possible transition point in the left iliac fossa. Pneumobilia was also noted due to prominence of the hepatic biliary tree (). No evidence of a ductal calculus was observed. The CT scan was reported as showing features of a bowel obstruction with a transition point in the left iliac fossa. The pneumobilia was reported as being possibly an indicator of previous sphincterotomy. There was no evidence of appendicitis or another inflammatory process in the right iliac fossa.\nThe following day, while proceeding with conservative management, the treating team requested a small bowel follow through to investigate the obstruction. After further review and discussion with the treating team it was revealed that there was no history of an endoscopic retrograde cholangio-pancreatography or cholecystectomy. An addendum was added to the CT report, suggesting that the appearances were indicative of a gallstone ileus from a choledochoduodenal fistula () with a non-calcified gallstone possibly being present at the transition point in the left iliac fossa ().\nThe patient underwent a laparotomy and a gallstone was found obstructing the distal jejunum. A 41 mm gallstone was removed by vertical enterotomy, later confirmed on histological diagnosis. The patient had an uneventful recovery in hospital and was discharged a few days later to a regional hospital for rehabilitation. A cholecystectomy or fistula closure was not performed and she was not referred for further surgical follow-up on discharge, likely due to the patient’s advanced age and medical comorbidities.
|
[[88.0, 'year']]
|
F
|
{'9171749': 1, '23764312': 1, '11104980': 1, '23295322': 1, '16508810': 1, '12658481': 1, '3797654': 1, '10636215': 1, '21862355': 1, '3706633': 1, '15093232': 1, '2200556': 1, '7596944': 1, '8198337': 1, '16247126': 1, '30363202': 2}
|
{}
|
2,946 |
6159184-1
| 30,363,214 |
comm/PMC006xxxxxx/PMC6159184.xml
|
Extensive pericardial calcification secondary to radiotherapy, causing mixed constrictive-restrictive pathology
|
We report the case of a 41-year-old male patient who suffered from a mediastinal neuroblastoma in his childhood (in 1977), having been treated by surgery, chemotherapy and radiotherapy.\nAt first, he was admitted to his referral hospital, presenting an episode of progressive dyspnea and angina pectoris (NYHA class III). A thoracic X-ray was performed, showing an extensive pericardial calcification without remarkable anomalies in the lung parenchyma.\nA thoracic CT revealed the presence of multiple calcifications in the atria walls, interatrial septum, right ventricular free wall, mitral and aortic valves and pericardium. A significant pericardial effusion was also present ().\nThe patient got worse, displaying signs of cardiac tamponade. Thus a pericardiocentesis was necessary. Nonetheless, the symptoms persisted even after reducing the pericardial effusion. Considering a pericardial window surgery, the patient was referred to our hospital.\nUpon his arrival, an electrocardiogram was performed, together with an echocardiography. It displayed the aforementioned calcifications, as well as a moderate–severe effusion (15–25 mm, surrounding the right ventricle free wall and its lower face), and protodiastolic movement of the interventricular septum.\nConsidering a mixed constrictive–restrictive pathology, an MRI was performed, acquiring axial DP and T2-STIR “black-blood” sequences, standard BALANCED Fast Field Echo sequences (axial, two-chamber view, four-chamber view and short-axis view), as well as delayed-enhancement and phase-contrast sequences (in aortic and pulmonary levels).\nThe images showed a segmental thickening of the pericardium and hypointense linear images in the interatrial septum and in the posterior wall of the atria (), corresponding to the calcifications that had already been described in the prior CT.\nThe ventricles were not enlarged, and ejection fraction was normal (54%). Yet, there was a protodiastolic movement of the interventricular septum, evidencing constriction (). The left atria was small sized (7 cm2), and the right atria was normal (19 cm2).\nAfter the administration of paramagnetic contrast, the pericardium and the soft tissue of the anterior thoracic wall enhanced, probably as a result of the recent surgical manipulation. The delayed-enhancement sequence showed small patched enhancing areas, almost transmural, in the interventricular septum () and in the lower and anterior ventricle walls ().\nThe MRI revealed a normal ventricular function, although with data of a mixed restrictive and constrictive physiology.\nA few days after the surgery, the patient improved his symptoms, showed a correct heart rate and haemodynamic stability, so he was finally discharged.
|
[[41.0, 'year']]
|
M
|
{'19020239': 1, '16228208': 1, '22723538': 1, '15093882': 1, '12482572': 1, '1732952': 1, '12802001': 1, '22391054': 1, '20197434': 1, '19394850': 1, '30363214': 2}
|
{}
|
2,947 |
6159186-1
| 30,363,175 |
comm/PMC006xxxxxx/PMC6159186.xml
|
Acute groin pain in pregnancy: a case of round ligament varicocele
|
A 22-year-old primigravida at 30 weeks of gestation presented with a painful right inguinal swelling. Pregnancy had been uneventful. Symptoms started at 24 weeks when she noticed a swelling in the right groin which became prominent on standing and disappeared on lying down. On routine obstetric visit, her obstetrician made a provisional diagnosis of inguinal hernia and referred her to surgery department for further management. The surgeon also came to the same clinical diagnosis. As the swelling was not reducible he referred her to the department of radiology for an inguinal sonogram to rule out strangulation.\nOn physical examination there was a 4 × 2 cm soft tender mass in the right groin following the course of the inguinal canal which became prominent on valsalva and was not spontaneously reducing on supination.\nOn grey-scale sonography performed using a 14 MHz linear transducer (Voluson 730 expert, GE medical systems, OH, USA) multiple anechoic tortuous tubular compressible channels were noted in the region of palpable mass (). Colour and power Doppler showed vascularity within these tubular channels ( and ). Pulse wave Doppler confirmed venous flow with reversal on valsalva (). As the vascular channels were completely compressible, echo free and showing complete filling on colour Doppler, the possibility of thrombosis was ruled out. There was no evidence of any herniating fat, bowel loop or lymphadenopathy in the inguinal region. The aforementioned sonological imaging findings were compatible with the diagnosis of round ligament varicocele.\nThe patient was managed conservatively and was followed up with repeated ultrasound evaluations on a monthly basis till term to rule out complications as she continued to have swelling and mild pain which was not increasing in intensity. She did not develop any complications and had an uneventful vaginal delivery at 38 weeks. The symptoms resolved completely by 3rd week postpartum.
|
[[22.0, 'year']]
|
F
|
{'26430450': 2, '8290419': 1, '18307205': 1, '22665693': 1, '19838990': 1, '14491330': 1, '19325063': 1, '18594758': 1, '9165684': 1, '25038812': 2, '31236186': 1, '30363175': 2}
|
{'4590387-1': 1, '4104952-1': 1, '4104952-2': 1}
|
2,948 |
6159189-1
| 30,363,244 |
comm/PMC006xxxxxx/PMC6159189.xml
|
Budd-Chiari syndrome due to right hepatic lobe herniation: CT image findings of two rare clinical conditions
|
A 75-year-old female presented insidiously with right upper quadrant abdominal tightness and band-like pain. This was associated with a right flank swelling. She had been suffering with progressively worsening abdominal discomfort for many years. There was a 2.5 kg history of weight loss, but no other associated symptoms including ascites or jaundice. Her past medical history included a right partial nephrectomy undertaken in her early 20 s for a renal abscess. The patient also had a history of atrial fibrillation managed with Rivaroxaban.\nOn examination the patient had a large body habitus and a right-sided subcostal “hockey-stick” scar. Lateral to this scar was a reducible, soft and non-tender hernia with no cough impulse. No hepatomegaly could be felt.
|
[[75.0, 'year']]
|
F
|
{'17690047': 1, '15877251': 1, '25631758': 1, '22411944': 1, '25518767': 1, '10926002': 1, '22216927': 1, '32432146': 1, '34539954': 1, '23188862': 1, '19196404': 1, '19012988': 1, '22234036': 2, '15376312': 1, '33573685': 1, '31016093': 2, '26155360': 1, '14762185': 1, '30363244': 2}
|
{'3268705-1': 1, '6464280-1': 1}
|
2,949 |
6159190-1
| 30,363,236 |
comm/PMC006xxxxxx/PMC6159190.xml
|
Pulmonary vein occlusion and lung infarction complicating non-treated moderate single pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation
|
A 35-year-old male patient, with persistent AF refractory to the pharmacologic treatment underwent RFA in our hospital. As a routine practice in our centre, the patient was assessed pre-procedurally by transesophageal echocardiography (TEE) on the day of procedure to delineate anatomy of pulmonary veins and left atrium (LA) and to exclude LA appendage thrombus. During RFA procedure all four PV were individually isolated under guidance of intracardiac echocardiography. RF energy was delivered using a conventional 4 mm and 8 mm tip ablation catheters and a power setting of 30 W, 50 °C around a circular decapolar catheter located at the pulmonary veins ostia. Application of the RF was immediately interrupted when microbubbles were detected by the intracardiac echocardiography (ICE). After a curative ablation therapy patient was kept on aspirin to prevent pulmonary venous or arterial thrombosis and recurrence of AF. Ambulatory follow-up cardiac computed tomography (CT) angiogram was done 3 months following RFA and showed approximately 60% left superior PVS but no intervention was performed because the patient was asymptomatic and he was kept on oral anticoagulation ().\nTwo months later, the patient developed cough associated with hemoptysis, mild intermittent fever, mild left-sided pleuritic chest pain and shortness of breath on exertion. He visited the primary health centre close to his residency where chest radiography was done and showed left upper lobe poorly marginated opacities and minimal left pleural effusion. Further laboratory studies were done to rule out pulmonary tuberculosis (TB) which were within normal limits. A definitive diagnosis was not made and the patient was given broad spectrum antibiotics and referred to pulmonology clinic in our hospital for further investigation.\nPatient presented to our hospital 6 months after ablation without improvement in the symptoms. Non-enhanced CT was done and showed increased parenchymal attenuation and multiple peripheral patchy consolidations in the apico-posterior and anterior segments of left upper lobe associated with minimal left pleural effusion (). Cryptogenic organizing pneumonia (COP), chronic eosinophilic pneumonia (CEP), fungal infection (pulmonary aspergillosis), lung cancer and primary pulmonary lymphoma were suggested as differential diagnosis and ultrasound-guided aspiration of the left-sided pleural effusion was carried out and the obtained specimen was fluid of serous nature. Besides that, lung biopsy was also performed and the histopathologic examination revealed surprisingly intimal hyperplasia associated with multifocal haemorrhagic infarction due to PVO and hypertensive pulmonary arteriopathy. After that contrast-enhanced CT scan was performed with 3D reconstruction and manifested clearly an occluded left superior pulmonary vein (LSPV) (). Occlusion was confirmed by conventional angiography. Ventilation/perfusion scan demonstrated absent perfusion of the involved lung parenchyma and left upper lobectomy was warranted.
|
[[35.0, 'year']]
|
M
|
{'19995881': 1, '24881072': 1, '34630797': 1, '19463436': 1, '17174188': 1, '20066143': 1, '32802544': 2, '18362249': 1, '15699274': 1, '14623799': 1, '15731371': 1, '9725923': 1, '14557499': 1, '30363236': 2}
|
{'7403928-1': 1}
|
2,950 |
6159191-1
| 30,363,242 |
comm/PMC006xxxxxx/PMC6159191.xml
|
Muscle ruptures in posterior hip dislocation—a case report
|
We present a 20-year-old female with athletic constitution in good health condition. She suffered trauma caused by an accident during skiing, where she jumped over a small hill border and landed in a small pit on the slope. The traumatic mechanism of the accident was a ventral-lateral (right side) collision with the solid iced slope in knee and hip flexion at intermediate speed.\nAccording to the patient’s narrative, she was never unconscious, but immediately felt strong pain in her right upper and lower extremities after trauma. Clinical examination of the peripheral extremities showed no signs of neurological or vascular trauma.\nThe patient was hospitalized via flying ambulance to the closest surgical-trauma department shortly after. At admission to the hospital, clinical examination and conservative X-rays in two planes showed a posterior dislocation of the right hip (Thompson–Epstein Grade I), but no signs of fracture. Additionally, X-rays in two perpendicular planes of the right forearm were performed, showing a combined radial and ulnar fracture. The fracture was splinted with split plaster cast of the right arm. The dislocation was treated by joint reduction (Böhler’s technique) under general anaesthesia. The procedure took place around 2 hours after trauma and was performed by a trauma surgeon. A CT scan of the hip was performed afterwards (, ), indicating an acetabular fracture line without any dislocation and consequently needing no further surgical treatment. After one night of medical surveillance, our patient was discharged from hospital with treatment recommendations to use underarm crutches and to consult the nearest trauma department for surgical therapy of the forearm fracture after returning back home. Regarding pain management, the patient received a prescription for non-steroidal anti-inflammatory drugs as prn medication.\nSince it was not possible for the patient to handle crutches with her fully casted right arm, she visited the nearest trauma ambulance 3 days after the accident. After denial of two orthopaedic surgeons to perform surgical stabilization of the radial and ulnar fracture, the patient was provided with an arm splint for better handling of the crutches. Owing to unsatisfying success of this option, our patient was advised to hobble. Additionally, she was referred to a physical therapist for remobilization of the injured arm. According to our patient, she was not aware of pain in the hip during this period, but stated that she might have been distracted by the subjectively more severely felt symptoms of her injured arm.\nA few weeks later, our patient consulted her general practitioner and presented with continuing moderate pain in the right hip. The general practitioner decided to request MRI sequences of the patient’s hip, which showed several trauma-related injuries. On the images (), the articulation of the femoral head within the acetabulum was congruent. The posterior and inferior muscles around the joint were altered with severe tissue oedema, visible as hyperintensity on T2-weighted images. The origin of the superior gemellus muscle was not visible, the muscle belly being retracted and thickened (). The obturator internus muscle tendon was surrounded by moderate effusion in the subjacent bursa (). The tendons of the inferior gemellus, the quadratus femoris and the external obturator muscles were normal; there was however severe tissue oedema in the muscle bellies of the quadratus femoris () and the external obturator muscles (). Piriformis, gluteal and tensor fasciae latae muscles were normal. No abnormalities of vessels or adjacent nerves were observed.\nAfter 19 months of conservative treatment post trauma, our patient was still complaining about mild hip pain. A second MRI was performed to exclude avascular necrosis of the femoral head. The follow-up MRI () showed an undulated shape of the tendon of the superior gemellus muscle (). Although the obturator muscle itself was without pathology in the first MRI, it now was partially ruptured (). There was some scarring around the quadratus femoris muscle (). Scarring of the femoral head was present (). Additionally, we detected hypertrophy of the piriformis muscle (), which was without pathological findings in the first MRI report.
|
[[20.0, 'year']]
|
F
|
{'2009661': 1, '24563964': 1, '23445909': 1, '18788266': 1, '7644933': 1, '18686832': 1, '12851341': 1, '26032283': 1, '25061422': 1, '16521016': 1, '12168177': 1, '14655233': 1, '30363242': 2}
|
{}
|
2,951 |
6159193-1
| 30,363,184 |
comm/PMC006xxxxxx/PMC6159193.xml
|
Isolated splenic tuberculosis detected only on FDG-PET
|
A 17-year-old female presented to the physician with a 4 weeks history of fever, predominantly with evening rise of temperature. The temperature fluctuated between 37.7 and 38.8°C. She had no history of cough, haemoptysis or significant loss of weight. Neither a previous history of TB nor a recent exposure to TB was evident. Physical examination of the patient did not reveal any positive information as there was neither hepatosplenomegaly nor lymphadenopathy. Routine haematological investigations were found be largely within normal limits except for elevated C-reactive protein (39 mg l–1) and mildly elevated gamma-glutamyl transferase (56 Ul–1). Her haemoglobin was 11 g dl–1, with slightly reduced mean corpuscular volume, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration. The investigations for various types of fevers, including Widal test for typhoid/ paratyphoid, malarial parasite, leptospira immunoglobulin M antibodies, Weil Felix test for rickettsial infection, urine test and sputum and blood culture were non-contributing. She tested negative for retrovirus infection. No significant pathology was identified on her chest radiograph. Abdominal ultrasound scan was unremarkable (). Finally, an 18-fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT scan was performed, which demonstrated multiple focal areas of abnormally high FDG uptake within the spleen (, ), which were not identifiable on CT scan images (non-contrast CT and contrast-enhanced images) (). No other focal abnormalities were detected anywhere else. MRI of the abdomen was performed for further characterization of the splenic lesions. However, MRI abdomen, including diffusion-weighted images, did not show any nodules in the spleen (). To avoid splenectomy for histopathological diagnosis, biopsy of the splenic lesions was planned, after ensuring that the coagulation profile was normal. True–cut biopsy was done by placement of a coaxial needle into one of the lesions under CT scan guidance, after carefully analysing the PET images.\nNecrotizing granulomatous lesions suggestive of TB were identified on histopathology, as described in . The patient was started on antitubercular therapy for 9 months. The fever resolved by 3 weeks after the beginning of the treatment.
|
[[17.0, 'year']]
|
F
|
{'17848689': 1, '19119039': 1, '8316667': 1, '15632034': 1, '17682577': 1, '19881087': 1, '33659113': 2, '20396657': 1, '34040315': 1, '20205479': 1, '23345365': 1, '21607149': 1, '19774173': 2, '30363184': 2}
|
{'2747427-1': 1, '2747427-2': 1, '7920217-1': 1}
|
2,952 |
6159194-1
| 30,363,227 |
comm/PMC006xxxxxx/PMC6159194.xml
|
Pleomorphic spindle cell sarcoma (PSCS) (formerly known as malignant fibrous histiocytoma, MFH) of the spleen, mimics an atypical haemangioma on 99mTc-RBC, CT and Ultrasound: staging with 18F-FDG PET/CT
|
A 63-year-old male presented with abdominal pain and was diagnosed with a 7.5 × 7.3 × 7.0 cm (AP × ML × CC) splenic mass on CT. It was predominantly hypo-attenuating with peripheral serpiginous enhancement. The lesion was very well defined and the imaging characteristics were interpreted as being consistent with a benign mass such as haemangioma or hamartoma; however, malignancy could not be excluded (). A three-phase 99mTc-RBC scan was performed to further characterize the splenic mass. It showed a normal blood flow and on delayed images showed a photopenic defect at the location of the mass with mild peripheral blood pooling ( and ), which was interpreted as possibly representing a haemangioma with central thrombosis, or an atypical haemangioma, however malignancy could not be excluded and further imaging was recommended.\nSince the patient was well clinically, the splenic mass was followed conservatively with serial ultrasounds. An initial ultrasound showed a heterogeneous, mostly hypoechoic mass with no internal vascularity and no focal lesions in the liver. The findings on the ultrasound study were interpreted as being in keeping with haemangioma (). A follow-up ultrasound performed 10 months later showed that the splenic mass was stable in size and was still likely a haemangioma. Sixteen months after the initial CT, however, the patient presented with a 2-month history of 35 lb weight loss, failure to thrive, 1 month of daily diarrhea, fever and drenching night sweats, bloating, distension and decreased appetite. His haemoglobin was 75 g l–1 (normal 120–160 g l–1), and platelets 9 (normal 140–450 109 l–1). A follow-up ultrasound showed an increase in the size of the splenic mass and new liver lesions.\nA core biopsy of the liver showed polymorphic atypical proliferation of poorly differentiated cells associated with coagulated necrosis and a sprinkling of small lymphocytes with eosinophils. These pleomorphic cells included large multinucleated forms with open vesicular chromatin and prominent eosinophilic nucleoli. Immunohistochemistry was positive for EBER and Fascin and negative for CD21, CD35, CAM 5.2, CD31, ERG, S100, pan-keratin, CD45, CD43, CD34, ALK-1, PAX 5, CD30, CD68, CD23, HMB-45, lysozyme, myeloperoxidase, podoplanin, CD20 and muscle specific A (). These findings were consistent with pleomorphic spindle cell sarcoma (PSCS, previously known as malignant fibrous histiocytoma, MFH). A bone marrow biopsy was negative.\nThe patient was referred for an 18F-FDG PET/CT for staging. Maximum intensity projection (MIP) images showed innumerable intensely 18F-FDG avid lesions in the liver and spleen (). The largest splenic mass measured 9.6 × 7.5 cm with maximum standardized uptake value (SUVmax) 15.8 (). The lesions were almost entirely necrotic, with a thin rim of intense 18F-FDG uptake. The patient passed away a few days later, before any treatment plan could be initiated.
|
[[63.0, 'year']]
|
M
|
{'15632034': 1, '20354829': 1, '11194923': 1, '9067668': 1, '20139854': 1, '8615251': 1, '22531528': 1, '17385309': 1, '20718917': 1, '18286476': 1, '14606728': 1, '9400508': 1, '23129168': 1, '21158336': 1, '30363227': 2}
|
{}
|
2,953 |
6159196-1
| 30,363,259 |
comm/PMC006xxxxxx/PMC6159196.xml
|
Isolated pulmonary IgG4-related disease mimicking lung malignancy
|
A 65-year-old female non-smoker of Indian origin living in the UK for 42 years was referred to rheumatology outpatients with a 5-year history of mild arthralgia affecting the shoulders, hands and elbows. A 6-month history of productive cough without haemoptysis and concurrent weight loss was also reported. No fever, night sweats, chest pain or shortness of breath on exertion was present. Examination of the chest, cardiovascular system and abdomen was unremarkable. The only finding was nodal osteoarthritis in the hands with evidence of Heberden’s and Bouchard’s nodes, but no evidence of active synovitis.
|
[[65.0, 'year']]
|
F
|
{'25422997': 1, '23849464': 1, '21719489': 1, '22796844': 1, '26456560': 1, '15082601': 1, '25809420': 1, '15299101': 1, '25590008': 1, '19221056': 1, '25237380': 2, '23992587': 1, '30363259': 2}
|
{'4165665-1': 1}
|
2,954 |
6159197-1
| 30,363,252 |
comm/PMC006xxxxxx/PMC6159197.xml
|
A rare case of adult ovarian hernia in MRKH syndrome
|
A 20-year-old female with history of primary amenorrhoea referred to our radiology department for further evaluation. On physical examination, all the secondary sexual features were well made out. In view of primary amenorrhoea, an abdominal sonography was performed which showed upper abdominal organs in normal anatomical location. On pelvic sonography, there was complete non- visualization of uterus, cervix and vagina (). Both the ovaries were not seen in their normal anatomical location and on extensive search, they were localized in bilateral inguinal canals (). On Doppler study there was no significant vascular compromise in both the ovaries. In addition to above findings bilateral ureteroceles were also noticed ().\nCT urogaphy and screening MRI pelvis were advised for detailed evaluation of urogenital anomalies which confirmed complete agenesis of the uterus, cervix and vagina (). Both the ovaries were visualized in bilateral inguinal canals (). In abdomen the kidneys were normal in size, morphology and located in normal anatomical location without any developmental anomalies (). Delayed CT KUB scan showed bilateral ballooning of vesicoureteric junction confirming the bilateral ureteroceles (). Genetic karyotyping showed 46XX chromosome pattern.\nThe diagnosis of Type I MRKH syndrome with bilateral ovarian hernias was established.
|
[[20.0, 'year']]
|
F
|
{'13468391': 1, '16172801': 1, '26351609': 1, '9728185': 1, '34055284': 2, '24899229': 1, '32021881': 1, '25283707': 1, '32326964': 2, '32819397': 1, '34474687': 2, '18214638': 1, '21213003': 1, '18880346': 1, '1941479': 1, '11744908': 1, '27609979': 1, '12719970': 1, '21036352': 1, '23271504': 1, '16150325': 1, '30363252': 2}
|
{'8414687-1': 1, '8153699-1': 1, '7181485-1': 1}
|
2,955 |
6159200-1
| 30,363,251 |
comm/PMC006xxxxxx/PMC6159200.xml
|
Gastric and colonic erosion caused by laparoscopic gastric band: a case report
|
A 62-year-old lady with past medical history of lupus anticoagulant on warfarin, and grade II obesity (body mass index of 38.5) status post laparoscopic gastric banding in 2003, presented with a 3-day history of bright red blood with clots per rectum. She presented with left-lower quadrant abdominal pain, nausea, emesis, lightheadedness, weakness and exertional dyspnea. On evaluation in the emergency department, patient was afebrile and vital signs were within normal limits. Physical examination was unremarkable. Haemoglobin was 9.4 and INR was 2.1 on admission.
|
[[62.0, 'year']]
|
F
|
{'25586631': 1, '11775567': 1, '22236382': 2, '26633046': 1, '22216927': 1, '26830623': 1, '24471382': 1, '20033349': 1, '21547403': 1, '16810770': 1, '30363251': 2}
|
{'3269383-1': 1}
|
2,956 |
6159202-1
| 30,363,220 |
comm/PMC006xxxxxx/PMC6159202.xml
|
Emphysematous aortitis: report of two cases and CT imaging findings
|
A 79-year-old male, with positive history of ischaemic heart disease and dyslipidemia, was referred to our centre for further management of an incidental finding of an abdominal aortic aneurysm (AAA). Initial CT angiography of the aorta revealed an infrarenal AAA measuring 6.3 cm × 7.0 cm × 20.0 cm, which extended to the level of the right common iliac artery. There were scattered wall calcifications. The thoracic aorta was normal. After discussing with the patient and family members, a decision was made to repair the AAA via an endovascular approach. A bifurcated endovascular stent graft was deployed via a percutaneous femoral route. The procedure was successful. However, 3 months post procedure, the patient came back with complaints of fever of 39°C, associated with chills, loss of appetite and back pain. He reported no vomiting or diarrhoea. Full blood count revealed a total white cell count of 15 × 109 l–1 with predominant neutrophilia. In view of the underlying AAA, a repeat CT was pursued. This revealed the presence of air surrounding the endovascular graft, with associated inflammatory changes and aortic wall thickening. The air was seen extending to the proximal common iliac artery (). Medical therapy and appropriate antibiotics were initiated, with a plan to embark on surgery once the patient was more stable. Blood cultures grew Staphylococcus aureus. Unfortunately, the patient succumbed to sepsis after 1 week of medical therapy.
|
[[79.0, 'year']]
|
M
|
{'19743492': 1, '25173340': 1, '20224641': 2, '24401053': 1, '19307090': 1, '26767087': 2, '24729264': 1, '23891316': 1, '27761883': 1, '22991323': 1, '20679577': 1, '21593042': 1, '30363220': 2}
|
{'6159202-2': 2, '2833300-1': 1, '4701074-1': 1}
|
2,957 |
6159202-2
| 30,363,220 |
comm/PMC006xxxxxx/PMC6159202.xml
|
Emphysematous aortitis: report of two cases and CT imaging findings
|
A 54-year-old male who was a chronic smoker and had long-standing heart failure was referred to our centre for investigation of abdominal pain with elevated liver enzymes. He reported with fever with recorded temperature of 38°C, with nausea, vomiting and diarrhoea. There were no chills and rigors. Full blood count showed a total white cell count of 20 × 109 l–1 with predominant neutrophilia. A multiphasic CT hepatobiliary system was initially planned, with a provisional diagnosis of hepatobiliary pathology. During the image acquisition, incidental finding of an infrarenal AAA was noted. The AAA measured 3.4 cm × 3.4 cm × 2.7 cm with protruding mural thrombus. No clear fat plane was identified, and multiple air pockets were seen. Retroperitoneal and para-aortic collections were present, with no bony destruction (). In view of the findings, blood cultures were taken and medical therapy instituted. The blood cultures came back positive for Salmonella; thus antibiotic therapy was commenced according to the sensitivity. However, after 14 days of hospitalization, the patient unfortunately succumbed to complications of exacerbated heart failure.
|
[[54.0, 'year']]
|
M
|
{'19743492': 1, '25173340': 1, '20224641': 2, '24401053': 1, '19307090': 1, '26767087': 2, '24729264': 1, '23891316': 1, '27761883': 1, '22991323': 1, '20679577': 1, '21593042': 1, '30363220': 2}
|
{'6159202-1': 2, '2833300-1': 1, '4701074-1': 1}
|
2,958 |
6159203-1
| 30,363,270 |
comm/PMC006xxxxxx/PMC6159203.xml
|
68Ga-DTPA Anti-HER2 positron emission tomography/CT successfully predicts the overexpression of human epidermal growth factor receptor in lung metastases from breast cancer
|
In August 2008, a 43-year-old female underwent a partial mastectomy with axillary lymph node dissection for right-sided breast cancer. Pathological diagnosis confirmed an infiltrating canalicular carcinoma (1.0 × 1.2 cm in diameter) as the primary tumour. Lymph node metastasis was observed in 6/34 harvested nodes. The disease was classified as stage IIIA according to the Union for International Cancer Control Tumour Node Metastasis classification for breast cancer(T1C N2 M0). A subsequent immunohistochemical examination revealed positive expression of hormone receptors in the primary tumour as well as the HER2 status as negative.\nAfter surgery, the patient received four cycles of 5-fluorouracil, adriamycin and cyclophosphamide, followed by radiotherapy (60 Gy) and 12 cycles of paclitaxel. Once adjuvant chemotherapy was completed, the patient received goserelin and tamoxifen during 2 and 5 years, respectively.\nSix years after surgery, in response to a complaint of respiratory symptoms, the patient underwent a CT. The CT revealed a mediastinal nodal conglomerate, multiple lung nodules and right pleural effusion. Then, the patient was subjected to a PET/CT with 2-deoxy-2-[fluorine-18] fluoro-D-glucose (18F-FDG) PET/CT to evaluate the extent of the metastatic lesions. The PET/CT revealed increased 18F-FDG uptake in the lungs, bones and axillary lymph nodes (). The largest pulmonary nodule (17 mm), localized at the posterior basal segment of the left lower lobe, showed an SUVmax value of 10.7, whereas a mediastinal lymph node had an SUVmax of 3.9.\nOwing to the aggressiveness of the disease, a phenotypic conversion at metastatic sites was suspected, including modification of the hormone receptor status (ER, PR). Thus, a parallel study using 68Ga-DTPA anti-HER2 and 18F-16α-17β-fluoroestradiol (18F-FES) was subsequently conducted ().\nMetastatic tumours of the lungs and lymph nodes were visualized with both radiotracers, and the SUVmax values from the largest lesions were presented as follows: 3.3 for the lung lesion and 3.4 for lymph node using 68Ga-DTPA anti-HER2, and 3.2 and 3.3 for the lung and lymph node with 18F-FES. Thus, the resulting biopsy specimens were obtained from both metastatic lesions exhibiting the highest uptake to confirm the HER2 overexpression.\nLastly, immunohistochemical examination revealed positive staining for hormone receptors in the breast (), lymph node () and lung (), whereas HER2 was negative in the breast () and indeterminate (2+) in both metastatic sites (). However, using fluorescence microscopy and in situ hybridization (FISH), HER2 overexpression was confirmed in the lymph node (4.18) as well as in the lung (3.19) (), whereas the primary tumour remained negative ().
|
[[43.0, 'year']]
|
F
|
{'11521731': 1, '20388508': 1, '23245638': 1, '16056258': 1, '10655437': 1, '25749472': 1, '11575295': 1, '25032257': 1, '16049480': 1, '24665085': 1, '12176781': 1, '19548375': 1, '24811890': 1, '11694790': 1, '26449837': 1, '22846838': 1, '20735208': 1, '26823864': 1, '21161512': 1, '20130858': 1, '33325685': 1, '19501012': 1, '20696930': 1, '17511881': 1, '12966347': 1, '24202395': 1, '20357763': 1, '20586616': 1, '20125090': 1, '20842031': 1, '20813970': 1, '20484419': 1, '30363270': 2}
|
{}
|
2,959 |
6159205-1
| 30,363,271 |
comm/PMC006xxxxxx/PMC6159205.xml
|
Chaos syndrome
|
A 27 year-old female came to the hospital for routine second trimester antenatal ultrasound. Clinical history did not reveal any predisposition to increased risk for genetic or familial disorder. Initial first trimester ultrasound scan was done at 6 weeks which did not show any significant abnormality. Then she reported directly at 24 weeks of gestation for follow-up second trimester foetal anomaly scan. Apart from second trimester ultrasound, other routine antenatal investigations did not reveal any significant abnormality. The foetal karyotype was normal.\nThe classical ultrasound signs of “CHAOS” are as follows:\nDilated airways below the level of obstruction ().\nHyperexpanded and hyperechoic lungs ().\nFlattened diaphragm ().\nThese signs were classically depicted in the foetal ultrasound scan images –.
|
[[27.0, 'year']]
|
F
|
{'34833471': 1, '10580940': 1, '24669041': 1, '15885333': 1, '16642370': 1, '20737145': 1, '19774196': 2, '32685231': 2, '12778398': 1, '18071686': 1, '20713212': 1, '33805876': 2, '7644306': 1, '30363271': 2}
|
{'8064368-1': 1, '8064368-2': 1, '7336206-1': 1, '2747465-1': 1}
|
2,960 |
6159206-1
| 30,363,254 |
comm/PMC006xxxxxx/PMC6159206.xml
|
Metastatic adenocarcinoma of the oesophagus to the submandibular gland—the imaging and pathological features of a rare phenomenon
|
A 55-year-old female presented to gastroenterology outpatients clinic with a 2-month history of dysphagia for solids. Her medical history included learning difficulties, but she was otherwise fit and well.\nAt upper gastrointestinal endoscopy there was an impassable stenosis 30 cm from the incisors. Biopsies were obtained and revealed a moderately differentiated oesophageal adenocarcinoma. Oesophageal stenting was performed for symptomatic relief. There were no demonstrable metastases on her initial staging CT chest and abdomen, but before proceeding with surgical management a PET scan was arranged.\nThis detected FDG avid uptake in the left submandibular gland (). An ultrasound scan confirmed a poorly defined mass within the left submandibular gland suspicious for malignancy ().\nTwo cream-coloured cores were obtained with an 18-gauge needle under ultrasound guidance. Microscopic appearances ( and ) were compatible with metastatic infiltration of the left submandibular gland from the known moderately differentiated oesophageal adenocarcinoma (CK7 and CDX-2 positive/CK-20 negative on immunohistochemistry). The patient was subsequently referred for palliative chemotherapy.
|
[[55.0, 'year']]
|
F
|
{'24267870': 1, '13901001': 1, '21917673': 1, '3310351': 1, '8630886': 1, '10543468': 1, '7496606': 1, '6821733': 1, '3562340': 1, '10326754': 1, '30363254': 2}
|
{}
|
2,961 |
6159208-1
| 30,363,226 |
comm/PMC006xxxxxx/PMC6159208.xml
|
Metastases to the breast: great radiological mimicker of primary breast carcinoma and a forgotten entity. A case series of three patients and a review of the literature
|
A 66-year-old Chinese lady presented with a retracted nipple and generalised thickening over the lateral aspect of her right breast. She had a medical history of metastatic adenocarcinoma of the lung which was initially diagnosed approximately one and a half years prior to the development of her breast symptoms.\nOn clinical examination, no palpable mass was found in both breasts, but there was mild skin thickening in right lateral breast. Mammography showed bilateral dense breasts with no dominant mass, suspicious micro-calcification or architectural distortion.\nUltrasonography, however, revealed diffuse stromal thickening in the background of heterogeneous parenchyma corresponding to the area of palpable thickening in the right lateral breast with no focal mass or nodule (). Ultrasound-guided 14G core needle biopsy was performed, and histology confirmed a metastatic adenocarcinoma with an immune-profile favouring a lung primary ().\nFurther imaging with a CT scan showed a lingula lobe primary tumour with extensive skeletal metastasis ( and ). Shortly thereafter, she progressed on to develop metastases to the cerebrospinal fluid (CSF) and succumbed within a month from diagnosis.
|
[[66.0, 'year']]
|
F
|
{'6604418': 1, '11745279': 1, '1921396': 1, '11511887': 1, '11071618': 1, '30729058': 1, '2342767': 1, '24497788': 1, '10759349': 1, '7089284': 1, '30363226': 2}
|
{'6159208-2': 2, '6159208-3': 2}
|
2,962 |
6159208-2
| 30,363,226 |
comm/PMC006xxxxxx/PMC6159208.xml
|
Metastases to the breast: great radiological mimicker of primary breast carcinoma and a forgotten entity. A case series of three patients and a review of the literature
|
A 59-year-old Chinese lady initially presented to her family physician for a routine check-up. Routine blood screening showed raised levels of tumour markers with abnormally raised levels CEA, CA125, CA153 and CA19.9. She had a previous total hysterectomy and bilateral salpingo-oophorectomy 15 years ago, for adenomyosis. Apart from that, she had no history of malignancy.\nDuring her consultation with the oncologist, she was found to have a mobile breast lump in the left breast. Subsequent mammography revealed a nodule in the lower inner quadrant of left breast with no associated micro-calcification or architectural distortion ().\nUltrasonography revealed a 0.6 × 0.6-cm iso-echoic nodule corresponding to the nodule in mammogram (). Ultrasound-guided 14G core needle biopsy was performed, and histology with immunostaining revealed a metastatic adenocarcinoma from a lung primary ().\nA CT scan was done as part of her metastatic workup and it revealed a mass in right lower lobe, associated precarinal lymphadenopathy and bony metastases. The patient died approximately 2 months after diagnosis.
|
[[59.0, 'year']]
|
F
|
{'6604418': 1, '11745279': 1, '1921396': 1, '11511887': 1, '11071618': 1, '30729058': 1, '2342767': 1, '24497788': 1, '10759349': 1, '7089284': 1, '30363226': 2}
|
{'6159208-1': 2, '6159208-3': 2}
|
2,963 |
6159208-3
| 30,363,226 |
comm/PMC006xxxxxx/PMC6159208.xml
|
Metastases to the breast: great radiological mimicker of primary breast carcinoma and a forgotten entity. A case series of three patients and a review of the literature
|
A 40-year-old Chinese lady presented to our institution with a left breast mass. Mammography and ultrasonography of the left breast. Imaging revealed a lobulated mass in the upper quadrant at 12 o’clock position with associated ipsilateral axillary lymphadenopathy. Several large cysts were also noted in both breasts ().\nMR of the breasts was performed to evaluate the size and number of lesions which were difficult to separate from the adjacent cysts. This showed a predominant 25 × 23 × 27-mm mass in the left breast, and several other smaller rim-enhancing lesions that demonstrated rapid enhancement with a plateau and washout on delayed phase. The smaller enhancing foci were thought to also represent metastatic lesions. The MR also further demonstrated a left lower lobe lung mass and associated atelectasis (–). On further questioning, the patient admitted to having had a cough for 1 month.\nUltrasound-guided 14G core biopsy of the left breast mass revealed a poorly differentiated adenocarcinoma, likely of lung origin (). Fine-needle aspiration (FNA) of the left axillary nodes were also positive for malignant cells.\nA staging CT scan confirmed the presence of a mass in the apical segment of the left lower lobe. There was also evidence of widespread sclerotic bony metastasis involving the axial skeleton. She was treated with chemotherapy but progressed to develop a solitary brain metastases in the left parietal lobe, approximately 13 months after diagnosis. Currently 7 years after diagnosis her disease remains fairly well controlled allowing her a good quality of life.
|
[[40.0, 'year']]
|
F
|
{'6604418': 1, '11745279': 1, '1921396': 1, '11511887': 1, '11071618': 1, '30729058': 1, '2342767': 1, '24497788': 1, '10759349': 1, '7089284': 1, '30363226': 2}
|
{'6159208-1': 2, '6159208-2': 2}
|
2,964 |
6159210-1
| 30,363,239 |
comm/PMC006xxxxxx/PMC6159210.xml
|
Inferior vena cava thrombus secondary to blunt abdominal trauma
|
A 15-year-old female presented to the emergency department of a level 1 trauma centre after being involved in a high-speed motor vehicle accident. After the initial survey was performed in the emergency department, the patient was found to be haemodynamically stable. She underwent a routine whole body scan as part of our institution’s polytrauma protocol. This includes a CT scan of the head and cervical spine followed by contrast-enhanced CT scan of the chest, abdomen and pelvis with reconstructions of the thoracic and lumbar spine. The contrast-enhanced examinations are obtained at the standard 60–70 s delay.\nThe CT of the abdomen and pelvis demonstrated Grade 5 (AAST liver injury scoring scale) liver lacerations in the right lobe extending to the right and middle hepatic veins (), a centrally located hypodense filling defect in the suprahepatic inferior vena cava (IVC) () extending to the base of the right atrium (), a right adrenal gland haematoma, a moderate haemoperitoneum and a grade 4 right kidney injury. Additional findings noted on CT scan of the chest included multiple rib fractures, lung contusions and bilateral small pneumothorax.\nDuring the first days of admission, initial goals were to monitor and manage the early complications of severe polytrauma including respiratory or haemodynamic decompensation, bleeding and coagulopathy. Following admission, the patient required multiple transfusions including packed red blood cells, fresh frozen plasma and platelets. The haemoglobin trended down from 12.3 g dl−1 on day 1 to 6.5 g dl−1 on day 3 (normal: 12–15 g dl−1). She developed consumption thrombocytopenia and the platelet count decreased from 222 000 ul−1 on day 1 to 87 000 ul−1 on day 3 (normal: 150 000–450 000 ul−1). She maintained a mildly elevated INR 1.2–1.7 (normal: 0.8–1.1), a normal partial thromboplastin time 24–30.9 (normal: 23.3–38.6) and mildly elevated fibrinogen levels of 432–720 (normal: 234–500). The severity of the concomitant injuries and the patient’s haemodynamic status precluded considering therapeutic anticoagulation or more invasive interventional or surgical thrombectomy procedures at this time.\nA repeat contrast-enhanced CT of the abdomen and pelvis on day 3 of admission demonstrated increased haemoperitoneum, stable solid organ injuries and IVC thrombus without active bleeding. The patient’s haemodynamic status and haemoglobin levels stabilized by day 5 and prophylactic low molecular weight heparin were started. An abdominal ultrasound was performed on day 6 to evaluate the IVC and did not demonstrate an intraluminal thrombus. The patient was noted to have intermittent macroscopic haematuria, and in the absence of clinical or laboratory signs of IVC thrombus progression (back pain, chest pain, oxygen desaturation on room air, lower extremity oedema, rising liver function tests) a decision was made to hold on starting therapeutic anticoagulation. The patient remained stable and was discharged home on day 10. She had no signs or symptoms to suggest progression of thrombosis on a scheduled 4-week outpatient follow-up.
|
[[15.0, 'year']]
|
F
|
{'23175542': 1, '26155259': 2, '21217492': 1, '18480478': 1, '6481860': 1, '21918052': 1, '20213198': 1, '7473935': 1, '9893241': 1, '26836612': 2, '2304119': 1, '23114483': 1, '24386029': 1, '30363239': 2}
|
{'4492325-1': 1, '4967362-1': 1}
|
2,965 |
6159232-1
| 30,363,269 |
comm/PMC006xxxxxx/PMC6159232.xml
|
The delivery of radical radiotherapy to the bladder and pelvis in node-positive (N1) bladder cancer: a five patient case series
|
A 79-year-old male presented with locally advanced transitional cell carcinoma (TCC) of the bladder. This was staged as T2 N1 M0 radiologically. Transurethral resection of the bladder tumour was performed and he was then treated with three cycles of gemcitabine and cisplatin chemotherapy. Post chemotherapy cystoscopy revealed normal appearances of the urothelium and bladder capacity of 400 ml. Post chemotherapy CT imaging showed almost total resolution of the pelvic lymphadenopathy.\nThe patient was treated with 64 Gy in 32 fractions over 6.5 weeks to his bladder together with 53 Gy in 32 fractions to his pelvic nodes at the same time. He received synchronous 5-flurouracil (5-FU) and mitomycin-C (MMC) in weeks 1 and 4 of treatment.\nTreatment was tolerated well with only mild, occasional diarrhoea. Full blood counts were largely normal despite the large volume irradiated. Platelet count was reduced with a minimum value of 82 × 109 l–1 in week 3 of treatment.\nThis patient has been followed up for 17 months and at that time remained disease and symptom free. A cystoscopy showed mild radiation changes throughout the bladder only.
|
[[79.0, 'year']]
|
M
|
{'29152552': 1, '9915424': 1, '12743142': 1, '11125364': 1, '11020560': 1, '22512481': 1, '11157016': 1, '30363269': 2}
|
{'6159232-2': 2, '6159232-3': 2, '6159232-4': 2, '6159232-5': 2}
|
2,966 |
6159232-2
| 30,363,269 |
comm/PMC006xxxxxx/PMC6159232.xml
|
The delivery of radical radiotherapy to the bladder and pelvis in node-positive (N1) bladder cancer: a five patient case series
|
A 77-year-old male presented with a background of metastatic prostate cancer. At the time of diagnosis with a TCC of the bladder his prostate cancer was well controlled with androgen deprivation therapy. He presented with haematuria, and cystoscopy identified muscle invasive disease. A single involved obturator node was identified on imaging that had developed alongside the bladder cancer while the prostate disease had been well controlled. He was therefore staged at T3 N1 M0.\nThe patient received three cycles of neoadjuvant gemcitabine and cisplatin chemotherapy following transurethral resection of the bladder tumour. Post treatment cystoscopy showed only scarring where the tumour had been excised. His CT imaging showed that the obturator node had regressed significantly.\nThe patient subsequently received concurrent chemoradiotherapy. 64 Gy was delivered in 32 fractions with concurrent 5-FU and MMC. The patient tolerated therapy well. No significant toxicities were reported. He did however, experience thrombocytopenia, with the lowest recorded result 92 × 109 l–1.\nNineteen months after completion of his treatment, the patient remains well. No long-term consequences of his therapy have been reported and he has had no relapse of his bladder cancer as monitored by CT imaging and cystoscopy.
|
[[77.0, 'year']]
|
M
|
{'29152552': 1, '9915424': 1, '12743142': 1, '11125364': 1, '11020560': 1, '22512481': 1, '11157016': 1, '30363269': 2}
|
{'6159232-1': 2, '6159232-3': 2, '6159232-4': 2, '6159232-5': 2}
|
2,967 |
6159232-3
| 30,363,269 |
comm/PMC006xxxxxx/PMC6159232.xml
|
The delivery of radical radiotherapy to the bladder and pelvis in node-positive (N1) bladder cancer: a five patient case series
|
A 74-year-old male with T3 bladder TCC with left internal iliac and obturator lymph node positivity presented with hydronephrosis. This was treated with the insertion of a nephrostomy before neoadjuvant gemcitabine and cisplatin chemotherapy was started.\nFollowing three cycles of chemotherapy a CT scan showed excellent response with complete resolution of the previously identified pelvic lymphadenopathy.\nThe patient then received radical radiotherapy, 64 Gy in 32 fractions to the bladder with 53 Gy in 32 fractions to pelvic lymph nodes. Treatment was delivered concurrently with 5-FU and MMC chemotherapy in week 1 only. Week 4 chemotherapy was cancelled owing to thrombocytopenia (platelets of 86 × 109 l−1). The patient otherwise tolerated therapy well with no other side effects reported.\nA follow-up scan 6 months after treatment showed no evidence of metastatic disease or local relapse. No permanent sequelae of his therapy are reported.
|
[[74.0, 'year']]
|
M
|
{'29152552': 1, '9915424': 1, '12743142': 1, '11125364': 1, '11020560': 1, '22512481': 1, '11157016': 1, '30363269': 2}
|
{'6159232-1': 2, '6159232-2': 2, '6159232-4': 2, '6159232-5': 2}
|
2,968 |
6159232-4
| 30,363,269 |
comm/PMC006xxxxxx/PMC6159232.xml
|
The delivery of radical radiotherapy to the bladder and pelvis in node-positive (N1) bladder cancer: a five patient case series
|
A 67-year-old female presented with a high-grade transitional cell carcinoma after presenting with cystitis. Initial staging was T2 N0 and the patient underwent three cycles of neoadjuvant gemcitabine and cisplatin chemotherapy before a restaging scan showed two enlarged iliac lymph nodes despite an otherwise good response to treatment. The multidisciplinary meeting at the treating hospital agreed that these lymph nodes were likely to be malignant and therefore the patient went on to have radiotherapy where the treatment volume included the pelvic nodes also. 64 Gy in 32 fractions was delivered to the bladder, the suspicious pelvic node received 52 Gy in 27 fractions and the bilateral nodal volume received 48 Gy in 27 fractions. MMC and 5-FU chemotherapy was given concurrently.\nThe patient tolerated the therapy extremely well. No detrimental fall in the full blood count was observed and all chemotherapy was delivered as planned. She complained of no acute radiation toxicity other than mild lethargy and diarrhoea.\nUnfortunately, while her post treatment restaging scan showed that the pelvic lymphadenopathy had regressed, there was significant lymphadenopathy outside the radiotherapy volume in the retroperitoneum, mediastinum and both sides of the neck. A biopsy confirmed this to be metastatic TCC.\nThe patient went on to receive vinflunine chemotherapy as the standard treatment arm in a clinical trial. Despite an initial good response, chemotherapy had to be discontinued owing to neutropenia. The patient developed metastaic liver lesions and was started on weekly paclitaxel, which continues for 9 months after completing radical treatment.
|
[[67.0, 'year']]
|
F
|
{'29152552': 1, '9915424': 1, '12743142': 1, '11125364': 1, '11020560': 1, '22512481': 1, '11157016': 1, '30363269': 2}
|
{'6159232-1': 2, '6159232-2': 2, '6159232-3': 2, '6159232-5': 2}
|
2,969 |
6159232-5
| 30,363,269 |
comm/PMC006xxxxxx/PMC6159232.xml
|
The delivery of radical radiotherapy to the bladder and pelvis in node-positive (N1) bladder cancer: a five patient case series
|
A 70-year-old male of previous excellent health presented with haematuria and was found to have T2 N1 TCC of the bladder. He underwent four cycles of neoadjuvant chemotherapy with gemcitabine and cisplatin without complication and was shown to have had a good response. He was felt to be inoperable owing to the node-positive state and was therefore considered for radiotherapy.\nThe patient received 64 Gy in 32 fractions to the bladder and positive nodes. A prophylactic dose of 53 Gy in 32 fractions was delivered to the bilateral pelvic nodes. No concurrent chemotherapy was given.\nThe patient tolerated therapy without significant problems although he reported mild diarrhoea for which he did not require medication.\nThis patient’s follow-up CT scan unfortunately showed retroperitoneal lymphadenopathy. A CT PET scan was performed to see if this was solitary metastatic disease and therefore to assess his suitability for salvage therapy. Unfortunately, the CT PET scan, performed 5 months after treatment, showed extensive retrocrural and supraclavicular lymphadenopathy. Eight months after completing radical treatment he continues on palliative carboplatin and gemcitabine therapy.\nprovides a summary of patient characteristics, treatment parameters and outcomes for ease of comparison.
|
[[70.0, 'year']]
|
M
|
{'29152552': 1, '9915424': 1, '12743142': 1, '11125364': 1, '11020560': 1, '22512481': 1, '11157016': 1, '30363269': 2}
|
{'6159232-1': 2, '6159232-2': 2, '6159232-3': 2, '6159232-4': 2}
|
2,970 |
6159233-1
| 30,363,224 |
comm/PMC006xxxxxx/PMC6159233.xml
|
Solitary pulmonary hyalinising granuloma: a rare cause of pulmonary nodule
|
A 74-year-old female was referred to the respiratory clinic with incidental finding of a pulmonary nodule on chest X-ray. She did not have any other respiratory symptoms. She was a non-smoker throughout her life and had no exposure to asbestos or tuberculosis. Her past medical history was significant only for chronic lymphoedema and recent hip replacement.
|
[[74.0, 'year']]
|
F
|
{'24744965': 2, '22498827': 1, '12135180': 1, '1280866': 1, '17599621': 1, '6200274': 1, '1713275': 1, '3799538': 1, '262110': 1, '12498224': 1, '30363224': 2}
|
{'3988602-1': 1}
|
2,971 |
6159235-1
| 30,363,265 |
comm/PMC006xxxxxx/PMC6159235.xml
|
Deep head and neck infection causing pathological fracture of the mandibular condyle
|
A 46-year-old male was referred to the Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark, with a 3-week history of infection after tooth extraction in the left side of the mandible. He was diagnosed with gout in 2004, and was on regular medication with allopurinol, prednisolone and alendronate for the last 14 months. He was a non-smoker with moderate use of alcohol (two to three units daily).\nThe patient presented with a large swelling in the left side of the face with pus from the extraction sockets of the lower left first and second molars. Despite medical advice he refused admission for treatment with intravenous antibiotics and drainage, but accepted a prescription for oral antibiotics (penicillin one MIU four times daily and metronidazol 500 mg three times daily) to use at home. One month later, he went to his general dentist with persistent infection and worsening of the swelling. The infection had escalated dramatically and he was immediately admitted to the hospital for treatment. Subjective symptoms were trismus, moderate pain and the feeling of impending rupture. He felt no impairment of breathing or pain when swallowing, but he had been sleeping in a sitting position and only had liquid food for several days. Objectively, a large swelling on the left side of the face extended from the zygomatic arch to the submandibular region and with a focus of the size of a tennis-ball around the mandibular angle. The swelling was warm, red and had several non-ruptured pus-filled foci (). His body temperature was 37.7 °C, C-reactive protein was 125 mg l–1, white cell count was 13800 µl and blood pressure 108/68 mmHg with a pulse rate of 97. Intraorally, there were signs after extraction of two molars of the left side of the mandible, no spontaneous pus from the alveolus and only a slight swelling of the floor of the mouth on the left side. The patient proceeded to venous phase contrast-enhanced CT imaging, which was performed using a dual-source 128-multiple detector CT scanner (Somatom Definition Flash, Siemens Healthcare). CT imaging demonstrated a transspatial, multilocular abscess with extension from the zygomatic arch to the level of C4/C5 and posterior from the sternocleidomastoid muscle along the base of the left mandible to the midline involving the buccinator space, the masticator space, the submandibular space, the lateral pharyngeal space and the retropharyngeal space (). Bone resorption at the lingual aspect of the molar region in the left mandible indicated the origin of infection from a molar tooth. The extension of the infection both on the lateral and the medial aspects of the left condyle led to bone destruction and fracture with some displacement of the left mandibular condyle (). Diffuse stranding, reduced space in oropharynx, compression of the internal jugular vein and several enlarged lymphatic glands of the left side of the neck were observed.
|
[[46.0, 'year']]
|
M
|
{'23294978': 1, '19446222': 1, '25457827': 1, '24436752': 1, '26749781': 1, '18760616': 1, '16916672': 1, '26636905': 1, '20346713': 1, '18952475': 1, '23224675': 1, '9662010': 1, '25911121': 1, '17561083': 1, '21111134': 1, '30363265': 2}
|
{}
|
2,972 |
6159236-1
| 30,363,250 |
comm/PMC006xxxxxx/PMC6159236.xml
|
Successful embolisation of intrahepatic portosystemic venous shunt using AMPLATZER Vascular Plug II
|
An 83-year-old male with chronic hepatitis was noted to have a hepatic mass with early enhancement in the right lobe of the liver. A PV shunt was also noted close to the tumour on dynamic abdominal CT. The hepatic tumour was diagnosed as hepatocellular carcinoma by ultrasound-guided biopsy, and transcatheter arterial chemoembolisation was performed. This patient had mild encephalopathy, and the serum ammonia level was already increased to 104 μg dl−1 before the chemoembolisation. Hyperammonaemia worsened to 144 μg dl−1 and mild hepatic encephalopathy continued after treatment of the hepatocellular carcinoma. Amino acid solution (Aminoleban; Otsuka Pharmaceutical, Tokyo, Japan) and lactulose did not alleviate the hyperammonaemia. Therefore, transcatheter embolisation of the PV shunt was planned.\nProcedure: The right femoral vein was punctured using ultrasound guidance, and a 6 Fr 11 cm sheath introducer was inserted. The right hepatic vein was catheterized using a 6 Fr 20 mm balloon catheter (SELECON, Terumo, Tokyo, Japan). Two pathways from the portal vein to the hepatic vein were seen on the preoperative dynamic CT. Since the right hepatic vein was dilated and because flow at the PV shunt was rapid, occlusion of the right hepatic vein was deemed impossible using the 20 mm balloon catheter. Therefore, only one pathway could be catheterized and balloon-occluded. After the balloon occlusion, the location of the PV shunt was confirmed using retrograde venography. One of the pathways of the PV shunt was embolized using 10 Interlock detachable coils (six 14 mm × 30 cm, two 14 mm × 20 cm and two 12 mm × 30 cm) (Striker, Tokyo, Japan) under flow control using the balloon catheter. Next, an attempt was made to catheterize the other pathway, but it was unsuccessful despite the use of several different preshaped catheters. Meanwhile, the patient was not able to remain still on the bed because of hepatic encephalopathy. Thus, embolisation of the right hepatic vein using an AVP II was planned.\nAfter the right jugular vein was punctured using ultrasound guidance, a 9 Fr 11 cm sheath was inserted. A 9 Fr multipurpose-type catheter (Bright tip, Cordis Corporation, Miami, FL) was led into the right hepatic vein, and the AVP II (22 mm) was deployed at the right hepatic vein. The procedural time was 135 min. The next morning, the serum ammonia level decreased to 34 mg dl–1, and hepatic encephalopathy had improved. Successful embolisation of the PV shunt was confirmed on abdominal dynamic CT that was performed 2 months after the embolisation ().
|
[[83.0, 'year']]
|
M
|
{'12058220': 1, '26257785': 2, '12857710': 1, '23436862': 1, '22526108': 1, '10844336': 1, '1450499': 1, '2117349': 1, '17065278': 1, '19499309': 1, '18553284': 1, '17035699': 1, '14072076': 1, '23118586': 2, '12818832': 1, '30363250': 2}
|
{'6159236-2': 2, '3484308-1': 1, '4516830-1': 1}
|
2,973 |
6159236-2
| 30,363,250 |
comm/PMC006xxxxxx/PMC6159236.xml
|
Successful embolisation of intrahepatic portosystemic venous shunt using AMPLATZER Vascular Plug II
|
A 75-year-old female presented to the emergency room of our hospital after sudden onset of confusion and incontinence. She had no medical history of trauma, liver disease or loss of consciousness. Her serum ammonia level was elevated to 330 mg dl–1. Head CT showed no obvious cause for her confusion. Consequently, she was diagnosed with hepatic encephalopathy. Based on our experience with the case described above, an embolisation of the PV shunt using the AVP II was planned.\nProcedure: The right jugular vein was punctured under ultrasound guidance, and a 9 Fr 11 cm sheath was inserted. Then, a 9 Fr multipurpose type catheter (Bright tip, Cordis Corporation) was advanced to the left hepatic vein. Digital subtraction venography showed the location of the PV shunt. Then, a 14 mm AVP II was deployed at the left hepatic vein through the catheter. Retrograde venography of the left hepatic vein indicated obstruction of the PV shunt. The procedural time was 45 min. The next morning, the serum ammonia level had decreased to 30 mg dl–1, and the hepatic encephalopathy had improved markedly. The success of embolisation of the PV shunt was confirmed on abdominal dynamic CT performed 1 month after the embolisation (). The hepatic encephalopathy did not reappear, and the ammonia level did not increase to more than 80 μg dl–1 up to 5 months later in both cases.
|
[[75.0, 'year']]
|
F
|
{'12058220': 1, '26257785': 2, '12857710': 1, '23436862': 1, '22526108': 1, '10844336': 1, '1450499': 1, '2117349': 1, '17065278': 1, '19499309': 1, '18553284': 1, '17035699': 1, '14072076': 1, '23118586': 2, '12818832': 1, '30363250': 2}
|
{'6159236-1': 2, '3484308-1': 1, '4516830-1': 1}
|
2,974 |
6159238-1
| 30,363,211 |
comm/PMC006xxxxxx/PMC6159238.xml
|
Unsuspected radiolucent partial denture impaction in the sigmoid colon mimicking malignancy
|
A 79-year-old male was referred to the surgical outpatient department with a 2-month history of altered bowel habit. Abdominal examination and digital rectal examination in the outpatient clinic were unremarkable.\nThe laboratory studies, full blood count and biochemistry were normal. A colonoscopy study identified four abnormal lesions, two of which were colonic subcentimetre polyps. More distally in the mid-rectum, at 15 cm from the anal verge, there was a sizeable, villous polypoidal lesion, which was proved on biopsy to be a tubulovillous adenoma (TVA) showing low-grade dysplasia. More proximally in the distal sigmoid colon at 25 cm there was a segment of a malignant-looking lesion associated with a stricture (). However, biopsy samples from this region showed hyperplastic colonic mucosa showing lamina propria fibrosis and mild chronic active inflammation with separate pieces of granulation tissue and ulcer slough but no evidence of malignancy.\nAs per local protocol for malignant-appearing lesions on endoscopy, a staging CT scan was arranged on the basis of the colonoscopy appearances to facilitate the cancer pathway. This demonstrated, at the site of the presumed malignancy in the distal sigmoid colon, a 7 cm segment of circumferential thickening on a background of diverticulosis (). This was associated with a few subcentimetre locoregional and inferior mesenteric lymph nodes. There was no suggestion of malignancy elsewhere; so the proposed CT staging was T2/3 N1 M0.\nAlthough the 5 cm rectal TVA could explain the patient’s symptoms it was felt at the multidisciplinary team discussion that either lesion could be responsible for the patient’s symptoms. Despite the lack of malignant cells from the biopsy samples the surgical team were still concerned about a potential sigmoid colon malignancy from the endoscopy and CT appearances. It was felt that the colonoscopy sampling was not truly representative of the malignant appearing sigmoid colon lesion seen at colonoscopy and CT. An anterior resection was planned for the patient to remove both the TVA and presumed sigmoid colon malignancy. An MRI scan of the rectum was performed in order to preoperatively assess the rectal polyp further. The sigmoid tumour was incidentally included in the MRI scan field owing to proximity to the rectal lesion (); however, this did not add any diagnostic value preoperatively.\nThe patient underwent an uncomplicated laparoscopic-assisted anterior resection with defunctioning loop colostomy. Post-surgical histology confirmed that the rectal polyp was a low-grade TVA. However, histological assessment of the presumed distal sigmoid cancer at 25 cm demonstrated mucosal ulceration with underlying fibrosis and diverticulosis. The ulceration was associated with a 5 cm jagged edged intraluminal dental plate containing a single front upper incisor prosthetic tooth found impacted at this site, with no metallic components (). The dental prosthesis was so impacted that endoscopic retrieval would be unlikely to have been successful. No malignancy was demonstrated in the post-surgical specimen. There were a few enlarged local lymph nodes present in the specimen, which were all benign. The patient had a good post-surgical recovery and went on to have an uncomplicated reversal of defunctioning colostomy several months later.\nRetrospective review of the patient’s previous imaging revealed that the patient had attended the accident and emergency department 2 years earlier, having accidentally swallowed “false teeth” during a meal. An abdominal plain radiograph had been taken at the time, which did not demonstrate any radiopaque foreign body. The CT scout view also demonstrates no radiopaque foreign body (). The patient denied any symptoms and had been discharged with no further follow-up. Interestingly, the patient claims he has always known that he had not passed the swallowed dental prosthesis.
|
[[79.0, 'year']]
|
M
|
{'30891177': 1, '20087445': 2, '14749401': 1, '8594095': 1, '10372496': 1, '26227416': 1, '17885231': 1, '30363211': 2}
|
{'2808324-1': 1}
|
2,975 |
6159239-1
| 30,363,277 |
comm/PMC006xxxxxx/PMC6159239.xml
|
Synchronisation between contrast media administration and caudocranial scan direction increases visualisation of altered coronary artery blood flow in patients presenting with dual left anterior descending coronary artery
|
We present a case of a 51-year-old male who presented with atypical chest pain. As part of his workup and coronary artery disease (CAD) risk stratification, he underwent a Coronary CT angiography (CCTA) scan at our institution. The “short” LAD was not short since it branched out of the LMCA and coursed along the epicardial surface of the left ventricular anterior wall all the way to the apex of the heart. A long LAD branches out of the RCA and courses along the epicardial surface of the right ventricular and into and along the distal AIVG. In our patient, the long LAD joined the AIVG at its mid part. Both LAD arteries were similar in length ( and ).\nWith the patient positioned supine and arms placed above his head, electrocardiogram-gated cardiac/coronary CTA was performed using a 256-MDCT scanner (Philips iCT, Philips Healthcare, Amsterdam, The Netherlands). Anteroposterior and lateral scout scans were performed, with a scan range from the apex of the chest to the costophrenic angle. Scan parameters were as follows: detector width of 256 × 0.625 mm, pitch of 0.2:1 ratio, rotation time of 0.27 s, 100 kVp, 200 mA, with z-axis modulation, and scanning time of 2.1 s. A caudocranial scan direction was employed.\nVia a 22 gauge venous catheter, placed in the right brachiocephalic vein, contrast media (CM) was injected with an automated dual-barrel power injector (Optivantage, Mallinckrodt, Cincinnati). Right-sided venous access was used in this study because it provides a uniform opacification incontrast to the heart; with the least possible dilution. Hence, this approach promotes optimal image quality coupled with reduced contrast volumes. Both the contrast media and saline injection rates were 4.5 ml s−1.\nBolus geometry is an opacification pattern measured in the region of interest. and plotted on a time (s)/attenuation Hounsfield units curve; after an intravascular injection of contrast material. This technique was employed where the region of interest was plotted inside the abdominal aorta; at the level of the aortic hiatus. The procedure comprised of a small amount of contrast material (5 mL); injected at the same rate as that of the main bolus. region of interest assessed the time to peak and determined the arteriovenous circulation time for the thoracic vasculature at the level of the aortic hiatus ().\nTo synchronize data acquisition with optimal arterial opacification, it has been recommended that scan direction during CTA should be in the opposite direction of CM flow during CTA. During CTA, it is feasible to scan at a faster rate than that of CM traversing the vessel. A drawback to faster scan acquisitions is poor arterial opacification, particularly when antegrade blood flow from the brachiocephalic trunk to the coronary arteries exists. Such pathological processes cause turbulence of blood flow before, within and after the origin of the ascending aorta, resulting in a slowing down of the passage of contrast associated with the antegrade blood flow from the origin of the ascending aorta to the distal segments of the coronary arteries. Even though there are clear limitations in the literature regarding the impact of fast scan times and associated contrast/blood flow dynamics, a practical solution to overcome such limitation is to measure the opacification peak of the descending thoracic aorta at the distal segment. Once these data are available, the exact contrast/blood flow dynamics can be predicted irrespective of blood flow dynamics. Therefore, optimal synchronisation between blood/contrast media flow with a caudocranial CT scan direction, achieves peak opacification throughout the entire hypoplastic ascending aorta and coronary arteries ().\nThe following parameters were set: standard reconstruction of axial images at 0.625 mm slice width, reconstruction interval of 0.5 mm, field of view of 180 × 180 mm and an iterative reconstruction technique software (iDose4; Philips Healthcare, Cleveland, OH, USA) with a window width and level of 420 and 65, respectively. The electrocardiogram-gated scan reconstruction interval, with the least motion artefacts, was determined by reconstructing a slice at the mid segment of the ascending aorta in 2% steps from 35% to 75% of the R–R interval. For diagnostic interpretation, reconstruction of the CTA images was used; where a time point with the least motion artefact was located at the mid segment of the ascending aorta (48%).
|
[[51.0, 'year']]
|
M
|
{'2492650': 1, '23732690': 1, '9004361': 1, '23601772': 1, '25333217': 1, '23088881': 1, '21953811': 1, '6829406': 1, '30363277': 2}
|
{}
|
2,976 |
6159240-1
| 30,363,279 |
comm/PMC006xxxxxx/PMC6159240.xml
|
Perineural spread of recurrent cutaneous melanoma along cervical nerves into the spinal cord
|
A 45-year-old Caucasian male presented with right arm pain and a palpable mass below the right mandibular angle, 2 years after resection of a cutaneous melanoma in the right jaw. The initial resection 2 years prior was followed by a repeat local excision and level I–V lymph node dissection, with none of the 48 lymph nodes showing metastatic involvement. Ultrasound-guided biopsy of the recently developed mass confirmed recurrence of melanoma.\n18F-fludeoxyglucose (FDG) positron emission tomography (PET)/CT was performed for restaging of disease, demonstrating an intensely metabolically active tumour mass in the resection bed, with perineural spread along the right C3 and C4 nerves and contiguous invasion into the spinal cord ().\nMRI was subsequently performed for more detailed morphological characterization of local tumour recurrence and regional spread. This showed an irregularly enhancing soft tissue mass in the right side of the neck, with contiguous abnormal thickening and enhancement of the C3 and C4 nerve roots extending through enlarged intervertebral foramina into the right side of the spinal cord. Post- gadolinium T1 fat-suppressed images were particularly helpful in demonstrating the solid mass-like pattern of perineural nodular enhancement progressing retrogradely into the cervical cord substance ().\nOwing to the rapid growth of the recurrent mass in the submandibular region leading to ulceration of the overlying skin and significant discomfort, it was surgically resected for local control, and the patient was started on combined immunomodulatory treatment with ipilimumab and targeted radiation therapy.\nHistopathologically, the resected mass contained desmoplastic stroma infiltrated by malignant cells with spindle and epithelioid morphology and enlarged nuclei containing prominent nucleoli. On immunohistochemical analysis, the cells were positive for S100 protein (). The architecture of some nerves included in the resection specimen was disrupted and replaced by tumour.
|
[[45.0, 'year']]
|
M
|
{'14729519': 1, '9070205': 1, '8912568': 1, '19095149': 1, '25614946': 1, '1852933': 1, '21438911': 1, '21548747': 1, '11839322': 1, '10652412': 1, '18209529': 1, '9232390': 1, '15489147': 1, '30363279': 2}
|
{}
|
2,977 |
6159242-1
| 30,363,273 |
comm/PMC006xxxxxx/PMC6159242.xml
|
Congenital transpositions of stomach and spleens with partial pyloric stenosis
|
A 2 year old male child with a history of recurrent projectile non-bilious vomiting, since 4 weeks after birth, was referred for a barium meal study to rule out pyloric stenosis or gastro-oesophageal reflux disease. The patient experienced persistent hunger and was always underweight. The results of a full blood count test were within normal limits. A barium examination localised the stomach in the right upper quadrant of the abdomen, on the same side as the liver ().\nSubsequent images revealed a distended stomach with indented gastric antrum, narrowed pylorus and delayed emptying suggestive of partial pyloric stenosis ().\nComplementary ultrasound examination localised the spleen (which showed no abnormality) and two other structures with the same appearance as the spleen in the right upper quadrant adjacent to the right kidney (). The suspicion of other abnormalities and congenital transpositions of other organs lead to suggestions for other radiological procedures. Although MRI scan is the standard reference for definitive diagnosis of organ transposition, the procedure was, however, not performed owing to breakdown of the MRI equipment at that time. Hence a CT abdominal scan was undertaken with parental consent.\nThe CT scan confirmed the normal position of the internal viscera of the thorax and the abdomen, except the stomach and the spleen. The CT scan showed a dilated stomach on the right posterior to the liver and partial pyloric stenosis. The pyloric canal appeared elongated, and the whole pylorus was thickened. In addition, the spleen and the other structures with similar appearance as the spleen (suggesting multiple spleens) were found at the right side of the patient adjacent to the right kidney (). A surgical correction of the partial pyloric stenosis further confirmed the anomaly.\nA post-operative MRI scan performed 5 months later confirmed the anomaly as described above (–). The procedure was a free-breathing MRI scan as parental consent was without sedation. It also showed a thickened pyloric wall at the site of the repair and revealed the patient had multiple spleens (3) on the right ( and ). The child has had a normal life since the correction of the partial pyloric stenosis 2 years ago.
|
[[2.0, 'year']]
|
M
|
{'10021341': 1, '20021643': 2, '16012841': 1, '19123935': 1, '15939849': 1, '15425691': 1, '13089103': 1, '30363273': 2}
|
{'2803176-1': 1}
|
2,978 |
6159243-1
| 30,363,278 |
comm/PMC006xxxxxx/PMC6159243.xml
|
Traumatic hepatic arteriohepatic venous fistula managed with selective coil embolization: a case report
|
A 45-year-old male with history of blunt abdominal trauma was brought to casualty with abdominal distension and drop in haemoglobin levels. Initial ultrasound imaging revealed free fluid in the abdomen. Exploratory laprotomy was done that show hemoperitoneum, and liver laceration in the right lobe. Perihepatic packing was done to achieve hemostasis.\nCT imaging done on day two revealed replaced right hepatic artery arising from superior mesenteric artery (SMA) with hepatic laceration involving segment VI and VII. Arterial phase CT images showed a prominent segmental branch of the right hepatic artery with a fistulous track communicating with the right hepatic vein (–). Two days later in view of the further drop in hemoglobin and rising SGPT/SGOT levels, it was decided to intervene.\nFrom a transfemoral approach, the superior mesenteric artery was catheterized with 6F catheter (Chuang-William Cook Europe APS). Selective angiogram showed two prominent hepatic artery segmental branches leading to the lacerated liver parenchyma with early filling of the right hepatic vein suggesting post-traumatic arteriovenous fistulae (). The replaced right hepatic artery was catheterized coaxially with a progreat microcatheter (Terumo Corporation, Tokyo, Japan) and then navigated into the segmental arterial branches leading to the arteriovenous fistulae. The segmental branches leading to the arteriovenous fistulae were embolized with multiple 018 micro coils (Tornado Embolisation Coils Cook, Bloomington, IL). Post-embolization angiography showed completely occluded arteriovenous fistulae (). The patient was followed up for 2 weeks and he made an uneventful recovery.
|
[[45.0, 'year']]
|
M
|
{'8513209': 1, '10217224': 1, '648810': 1, '2487062': 1, '33521108': 2, '8260435': 1, '15290948': 1, '15248923': 1, '34430636': 1, '14676654': 1, '30363278': 2}
|
{'7812888-1': 1}
|
2,979 |
6159245-1
| 30,363,219 |
comm/PMC006xxxxxx/PMC6159245.xml
|
MR urogram findings and diffusion restriction in the renal papilla and calyx in papillary necrosis—a new finding: preliminary report
|
Case1: Reported here is a 41-year-old male patient who had previously undergone pyeloplasty for right pelviureteric junction obstruction. The patient was diabetic since 10 years and had developed chronic kidney disease 5 years ago. The patient presented with fever with chills, burning micturition and right flank pain.\nOn examination the patient was febrile. Urine examination done just before the MR urogram showed 32 white blood cells/hpf and 1 bacteria/hpf. The creatinine level of the patient was 3.9 mg dl–1, which prevented the administration of contrast.\nCT imaging was performed, which showed perinephric fat stranding and hydronephrosis with sudden tapering of the right ureter at the pelviureteric junction ().\nMRI was performed to image the ureter and to diagnose the cause of obstruction. Clinical suspicion was of a post-pyeloplasty stricture. The patient’s high creatinine level prevented the administration of iodinated contrast.\nMRI showed hydronephrosis of the right kidney with sudden tapering at the level of the pelviureteric junction with diffusion restriction at the tip of the renal pyramid, with widening of the fornices, clubbing of the calyces and filling defects in the lower pole and interpolar calyx. Additionally, cleft was noted at the lower pole. These imaging findings were suggestive of a right pelviureteric junction stricture with papillary necrosis ().\nHowever,there was no growth of bacteria on urine culture for this patient. There was growth of Candida species other than Candida albicans on fungal culture. Nevertheless, the patient was started on broad-spectrum antibiotics with systemic antifungals with resultant resolution of fever and flank pain with the urinary white blood cell count returning to normal. Post treatment urine culture was normal.
|
[[41.0, 'year']]
|
M
|
{'14072373': 1, '7579092': 1, '24526279': 1, '7997538': 1, '21703884': 1, '2096126': 1, '15006054': 1, '10713948': 1, '11058626': 1, '6996964': 1, '7997563': 1, '17102053': 1, '30363219': 2}
|
{'6159245-2': 2, '6159245-3': 2, '6159245-4': 2, '6159245-5': 2}
|
2,980 |
6159245-2
| 30,363,219 |
comm/PMC006xxxxxx/PMC6159245.xml
|
MR urogram findings and diffusion restriction in the renal papilla and calyx in papillary necrosis—a new finding: preliminary report
|
Case 2: Reported here is a 48-year-old female patient who is a known case of diabetes with chronic kidney disease. She previously had bilateral emphysematous pyelonephritis, which resolved with treatment. Stenting was done for the patient at that time, which was removed with resolution of patient symptoms and normalization of routine urine analysis and culture. In the current episode the patient presented with right flank pain and fever. Serum creatinine level of the patient was 6.1 mg dl–1.\nMRI was requested in view of bilateral hydronephrosis on ultrasound imaging with the clinical differential diagnosis of pyelonephritis and ureteric calculus.\nMRI showed mild bilateral hydronepehrosis and bilateral perinephric fat stranding, which was more on the right side. Multiple filling defects were noted within the pelvicalyceal system on both sides, with diffusion restriction noted at the tips of two of the renal pyramids on the right side. A ring sign was seen in the calyces on the right side (). Complimentary non-contrast CT was performed following the MRI, to definitively rule out a ureteric calculus. This CT showed papillary calcifications on both sides ().\nUrine examination of the patient showed 10 white blood cells/hpf and culture showed growth of Klebsiella. Right-sided ureteric stenting was performed. The patient was treated with antibiotics following which her symptoms reduced and urine routine and culture returned to normal.
|
[[48.0, 'year']]
|
F
|
{'14072373': 1, '7579092': 1, '24526279': 1, '7997538': 1, '21703884': 1, '2096126': 1, '15006054': 1, '10713948': 1, '11058626': 1, '6996964': 1, '7997563': 1, '17102053': 1, '30363219': 2}
|
{'6159245-1': 2, '6159245-3': 2, '6159245-4': 2, '6159245-5': 2}
|
2,981 |
6159245-3
| 30,363,219 |
comm/PMC006xxxxxx/PMC6159245.xml
|
MR urogram findings and diffusion restriction in the renal papilla and calyx in papillary necrosis—a new finding: preliminary report
|
Case 3: Reported here is a 66-year-old non-hypertensive, non-diabetic female patient, known to have chronic renal failure who presented with progressively increasing flank pain. Initial evaluation by ultrasound imaging showed left-sided hydronephrosis (). The creatinine level of this patient was 4.5 mg dl–1.\nMRI was requested to rule out pyelonephritis. MRI showed filling defect in the proximal ureter causing hydroureteronephrosis. Further, coronal slice of the 3D MR cholangiopancreatography image showed filling defect in the upper polar calyx and diffusion-weighted images showed diffusion restriction in the calyx and renal pyramid ().\nThe patient underwent ureteric stenting under antibiotic coverage, where a brownish black irregular slough was removed. This was followed by relief of symptoms. The stent was removed after 3 months and the patient had an uneventful course at 6 month follow-up.
|
[[66.0, 'year']]
|
F
|
{'14072373': 1, '7579092': 1, '24526279': 1, '7997538': 1, '21703884': 1, '2096126': 1, '15006054': 1, '10713948': 1, '11058626': 1, '6996964': 1, '7997563': 1, '17102053': 1, '30363219': 2}
|
{'6159245-1': 2, '6159245-2': 2, '6159245-4': 2, '6159245-5': 2}
|
2,982 |
6159245-4
| 30,363,219 |
comm/PMC006xxxxxx/PMC6159245.xml
|
MR urogram findings and diffusion restriction in the renal papilla and calyx in papillary necrosis—a new finding: preliminary report
|
Case 4: Reported here is a 47-year-old male who underwent radical cystoprostatectomy with bilateral ureteric reimplantation into the ileum for bladder carcinoma. The patient subsequently developed increased creatinine and acute renal failure with a creatinine level of 6.6 mg dl–1. Laboratory evaluation showed increased white blood cell count and the presence of bacteria in urine routine examination. MRI was requested to establish the diagnosis of pyelonephritis and to rule out the recurrence of bladder carcinoma.\nEvaluation by MRI showed a medially deviated left ureter with a filling defect in the left lower pole calyx. Further, a bulky right kidney with areas of parenchymal diffusion restriction surrounded by free fluid with filling defects in the right ureter, calyces and the renal pelvis suggested a diagnosis of right-sided pyelonephritis with bilateral papillary necrosis (). Further evidence of diffusion restriction was seen at the calyces and the tips of the renal pyramids ().\nThe medially deviated left ureter probably represents its post surgical course, ultimately terminating in its ureteric implantation. The filling defect in the left lower pole represents old papillary necrosis, either secondary to obstruction or due to an older event of pyelonephritis. This slough poses a risk of causing obstructive uropathy and hence left-sided percutaneous nephrostomy was done as a preventive measure.\nIn view of ureteric reimplantation into the ileum, a right percutaneous nephrostomy was done with removal of slough. After the procedure, a nephrostogram showed free flow of contrast through the right pelvicalyceal system into the ileum ().\nThe urine culture of the patient showed growth of Proteus vulgaris. The patient improved with antibiotics and was put on twice weekly follow-up. This was followed up by a percutaneous nephrostomy on the left side.
|
[[47.0, 'year']]
|
M
|
{'14072373': 1, '7579092': 1, '24526279': 1, '7997538': 1, '21703884': 1, '2096126': 1, '15006054': 1, '10713948': 1, '11058626': 1, '6996964': 1, '7997563': 1, '17102053': 1, '30363219': 2}
|
{'6159245-1': 2, '6159245-2': 2, '6159245-3': 2, '6159245-5': 2}
|
2,983 |
6159245-5
| 30,363,219 |
comm/PMC006xxxxxx/PMC6159245.xml
|
MR urogram findings and diffusion restriction in the renal papilla and calyx in papillary necrosis—a new finding: preliminary report
|
Case 5: Reported here is a 64-year-old male patient, a known case of diabetes since 18 years, who presented with fever and burning micturition. The patient had an elevated creatinine level of 3.5 mg dl–1 and presented with back pain and fever raising a suspicion of pyelonephritis. Ultrasound imaging showed bilateral hydroureteronephrosis. Laboratory investigation revealed increased white blood cell count.\nMRI was requested to elucidate the cause of the bilateral hydronephrosis. Evaluation by MRI additionally showed filling defects in the calyces of both kidneys (). Further, the right kidney showed a thin rim of parenchymal diffusion restriction with diffusion restriction of the calyces and the tip of the medullary pyramids in both kidneys (). This suggested a possibility of early right-sided pyelonephritis with a diagnosis of bilateral papillary necrosis. Other features of papillary necrosis such as filling defects, clefts and phantom calyces were seen. Urine culture demonstrated the growth of Escherichia coli ().\nThe patient underwent bilateral ureteric stenting, followed by a course of antibiotics. This resulted in improvement of patient symptoms with return of routine urine examination and urine culture to normal.\nThus diffusion restriction at the calyx and tip of the renal pyramid with filling defects within the pelvicalyceal system was seen in all five cases of papillary necrosis. A cleft in the region of the tip of the renal pyramid was seen in two of the five patients. This led us to conclude that diffusion restriction at the calyx and tip of the renal pyramid with filling defects within the pelvicalyceal system is an important finding in papillary necrosis.\nAlso to be noted in this series is that all patients had elevated creatinine levels, which prevented the use of intravenous urography (conventional) or contrast-enhanced CT or MR urography. MRI can provide valuable information by imaging the urine-filled ureter. Thus, at our institution, in this subset of patients, imaging with MRI is preferred. Further, in contrast to CT, MRI does not deliver any radiation dose to the patient. This becomes important since many patients with diabetes and patients with renal failure undergo multiple imaging examinations.
|
[[64.0, 'year']]
|
M
|
{'14072373': 1, '7579092': 1, '24526279': 1, '7997538': 1, '21703884': 1, '2096126': 1, '15006054': 1, '10713948': 1, '11058626': 1, '6996964': 1, '7997563': 1, '17102053': 1, '30363219': 2}
|
{'6159245-1': 2, '6159245-2': 2, '6159245-3': 2, '6159245-4': 2}
|
2,984 |
6159246-1
| 30,363,229 |
comm/PMC006xxxxxx/PMC6159246.xml
|
Adult-onset medulloblastoma presenting as slow-growing, atypical mass: a case report
|
A 31-year-old male patient first presented to our clinic (time point A, ) with daily vertigo, aggravated by sudden movements of the head and complicated by nausea and vomiting, as well as difficulties sustaining his balance in confined spaces. His medical history was blank except for meningitis at 2 years of age; his family history showed no vertigo, epilepsy or hearing loss and no familial cancer syndromes (such as Gorlin-, Li-Fraumeni-, Turcot-, Gardner- or Cowden syndrome). He had not experienced headaches, and neurologic and audiometric examination only revealed perceptive high tone loss in his right ear with unknown cause; a subsequent MRI examination focused on the cerebellum and cerebellopontine angle half a year later (time point B) was normal. A diagnosis of probable benign paroxysmal positional vertigo (BPPV) was made, and the patient was given home exercises to alleviate his symptoms ().\nThree years later (time point C), the patient sought medical attention again because of a persistent balance disorder (his initial symptoms of vertigo had disappeared), present throughout the day with no predilection to one side. Concomitant with these symptoms, he had noticed decreased vision in his lateral visual fields for fast-approaching objects, such as tennis balls. Neurological examination showed a new bilateral horizontal nystagmus when looking laterally, the tandem gait was performed below normal for his age, he had difficulties standing still with closed eyes, and the Dix-Hallpike test (classical test for diagnosing BPPV clinically) was positive with a predilection to the right. Audiometric evaluation showed persistent perceptive high tone loss in his right ear. However, a follow-up MRI examination, including thin slices through the cerebellum and cerebellopontine angle and series after contrast administration, again showed no pathology. The initial diagnosis of BPPV was maintained, and the patient was again given home exercises for symptom alleviation. One-half year later, the patient presented for the third time (time point D), and was seen in our dizziness clinic with a balance disorder, difficulties in processing information and in typing (wrong characters), which had been present since 3–4 months after the second MRI examination. Symptoms progressed to dysarthria, decreased vision with diplopia and optokinetic photophobia within the next few months. A full overview of the timeline can be found in .
|
[[31.0, 'year']]
|
M
|
{'7760992': 1, '8179647': 1, '21553317': 1, '27635620': 1, '27334102': 1, '25600839': 1, '23245832': 1, '27576698': 1, '27540083': 1, '12819839': 1, '26026861': 1, '26940908': 1, '18078755': 1, '22134537': 1, '19021841': 1, '27106407': 1, '30363229': 2}
|
{}
|
2,985 |
6159248-1
| 30,363,293 |
comm/PMC006xxxxxx/PMC6159248.xml
|
A rare case of splenobronchial fistula formation post-embolisation therapy following acute blunt trauma
|
A 26-year-old male presented to Accident and Emergency following assault with a baseball bat. His past medical history consisted of longstanding Hepatitis C infection only, he was on no regular medications nor had any known allergies.\nOn admission, the patient had complained of bilateral pleuritic pain on inspiration with visible, tender bruising to the posterior thoracic region bilaterally. There were no urinary, bowel or neurological symptoms reported and no open wounds were visible on examination. The anterior abdomen was soft and non-tender to palpation.\nA CT scan of chest (performed at 30s post i.v. injection) showed acute fractures of left 10th/11thand right 8th/9th ribs, but no evidence of pneumothorax or lung contusion. A splenic laceration was not suspected clinically and the timing of the scan, optimized for the chest, only showed subtle splenic changes which were not identified by the original reporter ().\nLater that day, the patient complained that their pain had spread from the chest down to the right and left flanks. This prompted a CT scan of abdomen/pelvis (performed at 70 s), which demonstrated a contained splenic laceration with no evidence of capsular breach (). Both the rib fractures and splenic injury were treated conservatively with bed rest and analgesia.\nThe patient abruptly deteriorated becoming hypotensive and tachycardic in keeping with hypovolaemic shock. A further CT scan showed splenic capsular rupture, active bleeding and large-volume intraperitoneal haemorrhage ().\nThis was managed urgently with endovascular embolisation. While the patient gave informed consent for the procedure he indicated that he was unlikely to be compliant with some aspects of his aftercare and likely to self-discharge very soon after completion of the procedure.\nFollowing local anaesthesia an ultrasound guided puncture of the right common femoral artery was performed and the splenic artery selectively catheterized with a Sim 1 catheter (a reverse angled catheter). Angiography revealed three pseudoaneurysms, two arising from a second order upper pole branch and one from a third order equatorial branch (). These were then superselectively catheterized and embolized with a series of 3, 4 and 5 mm microcoils (Nester & Vortex, Nester = Cook Medical, Bloomington, IN, USA, Vortex = Boston Scientific, Watertown, MA, USA), delivered through a microcatheter. This abolished filling of the pseudoaneurysms but there was more devascularisation of the upper half of the spleen than envisaged when the decision to perform superselective embolisation was made. The right common femoral artery was then closed with a Starclose vascular closure device (Abbott Medical).\nThe decision to perform superselective embolisation was made with the intention of achieving definitive haemostasis in a patient who was likely to leave hospital at the earliest possible opportunity and not comply well with the procedural aftercare (). There was no further bleeding.\nDay 1 post-procedure, the patient developed a post-embolisation syndrome (PES) characterized by fever, nausea and left abdominal pain. A fourth CT scan was performed. This showed splenic necrosis, parenchymal and intravascular gas, which is an expected appearance post-embolisation. No fluid collection was demonstrated. Conservative resuscitation was initiated with i.v. fluid and antibiotic administration.\nThere was no indication for surgical drainage at this point as the CT scan showed only splenic necrosis, with no evidence of abscess formation. The patient’s temperature and clinical features were also settling, further reassuring stabilisation of his condition ().\nThe patient recovered from this episode a few days later, and deemed medically fit, was subsequently discharged home.\n3 weeks later, the patient presented to Accident & Emergency once again; this time with episodes of frank haemoptysis. He had an associated fever, and left upper quadrant (LUQ) pain.\nBlood tests showed elevated inflammatory markers, suggesting an infection, thought to be of likely respiratory origin at this time.
|
[[26.0, 'year']]
|
M
|
{'27306445': 1, '16489650': 1, '21217497': 1, '23729986': 1, '23798951': 2, '20668852': 1, '21326756': 1, '3596135': 1, '15792763': 1, '30363293': 2}
|
{'3687891-1': 1}
|
2,986 |
6159249-1
| 30,363,287 |
comm/PMC006xxxxxx/PMC6159249.xml
|
Cryptococcal pneumonia: the great mimicker
|
A 40 year-old immunosuppressed male diagnosed with AIDS presented with complaints of cough and fever. Initial chest X-ray showed nodular opacities in bilateral lung fields (). Plain CT scan showed multiple small (<2 mm) nodules distributed in the bilateral lung fields. On further analysis of the distribution of nodules they were predominantly seen along the peribronchovascular interstitium and subpleural (perilymphatic) regions (). Multiple enlarged lymph nodes were seen in the mediastinum and axillary regions (). Image-guided fine needle aspiration cytology of the axillary node was performed and the diagnosis of cryptococcal infection was made () based on the histopathological findings, which demonstrated capsulated organisms. The patient was started on antifungal therapy and dramatically improved clinically.
|
[[40.0, 'year']]
|
M
|
{'11428412': 1, '12016357': 1, '4843285': 1, '5540461': 1, '6609567': 1, '8838946': 1, '16239102': 1, '8011818': 1, '23864332': 1, '16120909': 1, '7660343': 1, '7489624': 1, '20592924': 1, '1404545': 1, '15987984': 1, '2671735': 1, '16478849': 1, '326497': 1, '31032130': 2, '30363287': 2}
|
{'6159249-2': 2, '6159249-3': 2, '6458939-1': 1}
|
2,987 |
6159249-2
| 30,363,287 |
comm/PMC006xxxxxx/PMC6159249.xml
|
Cryptococcal pneumonia: the great mimicker
|
A 30-year-old immunocompetent female patient came with complaints of fever and headache for 1 month associated with vomiting. The patient was evaluated for immune-suppressed states such as diabetes mellitus, AIDS and hepatitis B and C virus infections, and was negative. In view of the fever and headache, a provisional diagnosis of meningoencephalitis was made and CT brain scan with contrast was ordered. CT brain scan with contrast showed multiple ring-enhancing lesions. MRI brain spectroscopy was performed, which showed ring-enhancing lesions with surrounding oedema (). These lesions were reported to be tuberculomas based on the imaging findings and MRI spectroscopy findings.\nCT thorax scan was performed with administration of intravenous contrast, which showed consolidation with cavitation in the left upper lobe ( and ). There was associated soft tissue extension along the left hilum encasing and narrowing the left pulmonary vessels and left bronchus with features of fibrosing mediastinitis (). Enlarged mediastinal lymph nodes were seen. In view of the brain lesions and the lung findings the possibility of tuberculosis was raised. CT-guided biopsy of the thick-walled cavity was performed and histopathological and microbiological findings showed features of cryptococcus pneumonia. The patient was started on antifungal therapy and he improved symptomatically.
|
[[30.0, 'year']]
|
F
|
{'11428412': 1, '12016357': 1, '4843285': 1, '5540461': 1, '6609567': 1, '8838946': 1, '16239102': 1, '8011818': 1, '23864332': 1, '16120909': 1, '7660343': 1, '7489624': 1, '20592924': 1, '1404545': 1, '15987984': 1, '2671735': 1, '16478849': 1, '326497': 1, '31032130': 2, '30363287': 2}
|
{'6159249-1': 2, '6159249-3': 2, '6458939-1': 1}
|
2,988 |
6159249-3
| 30,363,287 |
comm/PMC006xxxxxx/PMC6159249.xml
|
Cryptococcal pneumonia: the great mimicker
|
A 5-year-old boy on immunosuppressive therapy after bone marrow transplantation presented with cough. In view of the persistent symptoms, CT thorax scan (plain) was performed. CT thorax scan showed a mass in the right lower lobe with mild irregular margins simulating a malignant mass lesion (). In view of the suspicious features, CT-guided biopsy was performed. A diagnosis of cryptococcal infection was made based on the histopathological features. The patient was started on antifungal therapy but succumbed owing to widespread sepsis.
|
[[5.0, 'year']]
|
M
|
{'11428412': 1, '12016357': 1, '4843285': 1, '5540461': 1, '6609567': 1, '8838946': 1, '16239102': 1, '8011818': 1, '23864332': 1, '16120909': 1, '7660343': 1, '7489624': 1, '20592924': 1, '1404545': 1, '15987984': 1, '2671735': 1, '16478849': 1, '326497': 1, '31032130': 2, '30363287': 2}
|
{'6159249-1': 2, '6159249-2': 2, '6458939-1': 1}
|
2,989 |
6159250-1
| 30,363,301 |
comm/PMC006xxxxxx/PMC6159250.xml
|
Bilateral adrenal haemorrhages: a crucial incidental finding
|
A 50-year-old male presented to the emergency department with sudden onset right upper quadrant (RUQ) abdominal pain. It was described as a colicky sharp stabbing pain, which progressed to a constant dull discomfort, worse with coughing and deep inspiration. This was preceded by a 1 week history of productive cough with yellow sputum. His past medical history included absence of trauma, undifferentiated immunodeficiency, idiopathic thrombocytopaenia (ITP) with splenectomy, a previous possible stroke, and paroxysmal atrial fibrillation on warfarin. He had multiple courses of antibiotics in the past for recurrent lower limb cellulitis and respiratory tract infections post splenectomy.\nThe patient weighed 152 kg, with a body mass index of 45. His vital signs were stable. There was pain in the RUQ on palpation. Blood test revealed a platelet count of 232 × 109 l−1, mildly elevated white cell count of 13.8 × 109 l−1 and C-reactive protein of 12.7 mg l−1. Liver function tests were normal. International normalized ratio (INR) was elevated at 3.8. Lactate was elevated at 2.7 mmol l−1. Possible differentials included acute cholecystitis and right lower lobe pneumonia with associated pleurisy.\nThe patient’s body habitus was deemed unsuitable for a reliable abdominal ultrasound; therefore, the patient underwent a CT abdomen and pelvis with oral and intravenous contrast. Portal venous phase and 10 min delayed phase were obtained. The study revealed a well-defined ovoid mass of 37 × 27 mm with Hounsfield Unit (HU) of 51 (both in portal venous phase and delayed phase) with no washout, suggestive of an adrenal lesion (). The left adrenal was of normal “Y” shape in appearance. There was no evidence of cholecystitis. There was patchy consolidation in the right lower lobe. The patient was commenced on intravenous antibiotics for a lower respiratory tract infection.\nOver 12 h the pain had migrated from the RUQ to the left flank. The patient underwent a further non- contrast CT scan of abdomen and pelvis with portal venous phase (). The study showed persistent right adrenal mass of 40 × 31 mm with a HU of 36. There was a new enlargement in the left adrenal gland measuring 34 × 24 mm with a HU of 25. The sudden enlargement of the left adrenal gland strongly suggested acute haemorrhage. To further evaluate this adrenal finding, an adrenal CT protocol was carried out with pre, arterial, portal venous and 10 min delayed images, 1 week after the initial scan. There was no discrete adrenal mass and densities of adrenals were consistent in all phases, measuring 40 HU.
|
[[50.0, 'year']]
|
M
|
{'25593820': 1, '25741090': 1, '24605256': 1, '10464802': 1, '26867912': 1, '25276353': 2, '22479678': 2, '24505223': 1, '25572538': 1, '23671745': 1, '19829879': 2, '30363301': 2}
|
{'4168371-1': 1, '3318239-1': 1, '2740141-1': 1}
|
2,990 |
6159251-1
| 30,363,263 |
comm/PMC006xxxxxx/PMC6159251.xml
|
Leiomyosarcoma of the portal vein: a case report and review of the literature
|
A 67-year-old male initially underwent contrast-enhanced multidetector CT of the abdomen in Sept 2014 at another hospital, which showed an incidental 4.2 × 3.9 cm mass in the upper abdomen. This was interpreted as a head of pancreas mass causing portal vein compression. The patient was asymptomatic; physical and laboratory examinations were all unremarkable.\nThe patient was lost to follow-up and did not receive any further investigation or treatment. Although still asymptomatic, he re-presented 12 months later for a repeat MDCT, which showed that the mass had increased in size to 4.8 × 5.0 cm. Cavernous transformation of the portal vein was also observed. The patient underwent exploratory laparotomy, which showed a tumour at the upper border of the pancreas and duodenum compressing the portal vein. A 1-cm lesion in the subcapsular aspect of segment II of the liver was also seen. The presumed pancreatic tumour was deemed unresectable and multiple biopsies were taken. The liver lesion was resected and the histology of both samples showed spindle cell tumour. The patient also underwent a positron emission tomography-CT, which showed the lesion to be hypermetabolic with SUVmax of 7.3. No metastatic disease was identified.\nThe patient was then referred to the hepatobiliary team in Queen Mary Hospital in Hong Kong for further assessment. The patient remained asymptomatic clinically with normal laboratory results including liver biochemistry (bilirubin 4 μmol l–1, alkaline phosphatase 54 U l–1, alanine aminotransferase 29 U l–1 and aspartate aminotransferase 23 U l–1). A repeat MDCT 2 months later showed that the lesion had a soft tissue density on non-contrast scans. The mass now measured 5.3 × 5.9 × 6.4 cm, extending from the superior mesenteric vein/splenic vein confluence to the porta hepatis. It exhibited heterogeneous enhancement with feeding vessels seen on the arterial phase, both within and around the mass. On the portal venous phase, numerous collaterals were seen surrounding the mass with a sharp interface between the mass and opacified portion of the main portal vein at the porta hepatis giving the appearance of a “beak” (). The pancreatic duct was mildly dilated and measures 3 mm. The biliary tree was not dilated. There was splenomegaly measuring 13.5 cm craniocaudally. No gastroesophageal varices or ascites was appreciated. Based on these MDCT and histological findings, a preoperative diagnosis of primary leiomyosarcoma of the main portal vein was made.\nThe patient underwent Whipple’s procedure and portal vein reconstruction using cadaveric graft. Intraoperative findings confirmed the tumour arising from inside the portal vein and confined to the lumen with no macroscopic evidence of disease spread. Histological examination of the tumour showed spindle cells with enlarged, pleomorphic, hyperchromatic nuclei and abundant eosinophilic cytoplasm. Patchy coagulative necrosis was also seen. Mitotic figures were at 8 per 50 high power fields, and atypical mitotic figures were found. There was focal infiltration into adjacent pancreatic parenchyma. Immunohistochemical stains showed the tumour was positive for actin, h-caldesmon and desmin but negative for myogenin, c-kit and S100 protein. The final histological diagnosis was of a primary LMS of the portal vein (). The patient made an uneventful recovery and no adjuvant radiotherapy or chemotherapy was given. He was followed up for 4 months in our institute with no complications.
|
[[67.0, 'year']]
|
M
|
{'8920790': 1, '2266177': 1, '7776656': 1, '6488138': 1, '26802297': 1, '12110806': 1, '1560548': 1, '22922951': 1, '17581912': 1, '3495979': 1, '32215762': 1, '15644039': 1, '21356533': 1, '3344346': 1, '24250242': 1, '10024103': 1, '1439022': 1, '22618717': 1, '10398896': 1, '25262724': 1, '21686492': 1, '19557475': 1, '18362061': 1, '22051866': 1, '15041973': 1, '17139437': 1, '25087678': 1, '17449777': 1, '30363263': 2}
|
{}
|
2,991 |
6159253-1
| 30,363,288 |
comm/PMC006xxxxxx/PMC6159253.xml
|
MR imaging findings of metastatic hepatocellular carcinoma in the nasal cavity: a rare site of spread
|
A 53-year-old male patient (hepatitis B carrier), who had been suffering for 3 months from HCC with multiple lung metastases, was admitted complaining of headache. A brain MRI scan that was performed to identify brain metastasis showed a solid mass occupying the left nasal cavity (3.7 × 1.8 × 2.8 cm). The mass showed iso-signal intensity on T1 weighted image, high signal intensity on T2 weighted image, and heterogeneous well enhancement on Gd-T1 weighted image (). Gradient-echo images showed small foci of low signal, suggesting haemorrhage in the mass. Restricted diffusion was not noted in the mass on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) map. Metastasis of HCC was suggested, as the nasal cavity was normal on a positron emission tomography CT scan that had been performed 3 months ago. The patient had developed left nasal obstruction, clear rhinorrhea and left facial pain. A CT scan that was performed for excisional biopsy (17 days after the MRI scan) showed that the mass had rapidly increased in size (6.2 × 2.2 × 3.4 cm) with involvement of the ostium of the nasolacrimal duct and the lateral wall of the anterior nasal cavity (). There was no calcification in the mass on the pre-contrast CT scan. A punch biopsy was performed. Histological examination revealed tumour cells with enlarged nucleoli and clear cytoplasm arranged in trabecular cords and glandular arrays, consistent with metastatic HCC (). The tumour was grade 2 (moderately differentiated). While the patient was awaiting resection of the tumour, his general condition declined and he was transferred to another hospital owing to his location.
|
[[53.0, 'year']]
|
M
|
{'2171748': 1, '21053584': 1, '6089722': 1, '17921228': 1, '20461183': 1, '10696564': 1, '10966697': 1, '12517047': 1, '23532660': 1, '16024288': 1, '14986018': 1, '24932824': 1, '15305412': 1, '10828817': 1, '16177918': 1, '9695400': 1, '1851774': 1, '12924460': 1, '6295617': 1, '18040899': 1, '8027653': 1, '23638212': 1, '14043146': 1, '17606038': 1, '17180305': 1, '17857618': 1, '24202324': 1, '3363145': 1, '5930356': 1, '30363288': 2}
|
{}
|
2,992 |
6159257-1
| 30,363,304 |
comm/PMC006xxxxxx/PMC6159257.xml
|
Diagnosing urethral duplication including a novel radiological diagnostic algorithm
|
A 24-year-old previously asymptomatic male presented to his primary care physician with a complaint of focal penile irritation related to sexual intercourse. The irritation originates from a lesion along the midline on the dorsum of his penile glans. He was referred to a urologist for further evaluation.\nThe patient reported noticing a small dimple along the midline on the dorsum of his glans for as long as he could remember. The lesion had not previously caused him any discomfort, nor did he report a history of discharge, including urine, semen, blood or pus from the orifice. In recent months, the patient has become more sexually active and he has become aware that during and after intercourse the site is painful and inflamed for a short period of time. The patient wants to make sure there is not something wrong with his anatomy and seeks a solution.\nThe patient had no significant past medical history. There is no family medical history of relevance, specifically no one has reported any genital malformation. Physical examination by a urologist demonstrated a well-developed adult male. A small midline opening was present on the dorsum of the penile glans. There was no focal erythema or discharge present at the time of examination. Manipulation of the opening demonstrated a thin lumen that appeared to continue proximally along the dorsum of the penile shaft. The most likely aetiology was determined to be urethral duplication. Imaging was necessary for confirmation and to delineate the particular anatomic presentation in order to plan treatment. Demonstration of communication with the urethra or bladder would require more extensive surgical intervention to eliminate the sequelae of discharge accumulation in the lumen causing infection, cyst formation or recanalisation of the accessory orifice. The patient was referred to radiology for urethrography.\nSince no urine, semen or other discharge had ever been noted to exude from the accessory urethra, a retrograde urethrogram (RUG) was performed (). A 5F paediatric catheter was advanced 3 cm through the dorsal accessory meatus. Simultaneously, a 6F Foley catheter was inserted into the orthotopic urethral meatus and the retention balloon inflated in the fossa navicularis. Cystografin contrast was manually instilled into both catheters. Opacification of the accessory meatus demonstrated a hypoplastic urethra traversing the dorsum of the penis and terminating blindly at the level of the levator musculature. No contrast was visualized refluxing into either the orthotopic urethra or the bladder. Contrast injected into the orthotopic urethra demonstrated a normal appearing urethra terminating at the sphincteric musculature. There was 2 mm of distance separating the terminal blind end of the accessory urethra and the orthotopic urethra. Based on the radiographic evidence a Type 1-A urethral duplication was diagnosed.\nAfter confirming a Type 1-A urethral duplication the patient was offered and consented to operative reconstruction. A short rigid ureteroscope was used to inspect the main urethra and bladder demonstrating the appearance of normal verumontanum and sphincteric mechanisms confirming the ventral urethra as the functional urethra. The ureteroscope was then used to evaluate the accessory urethra and passed through to the blind-end. The accessory urethra was cauterized as the ureteroscope was withdrawn.\nThe patient tolerated the procedure well without any reported postoperative complications. At follow-up the patient did not report recurrent irritation during sexual intercourse and was pleased with the cosmetic result.
|
[[24.0, 'year']]
|
M
|
{'23506728': 1, '534829': 1, '943804': 1, '25912290': 1, '23623406': 1, '16469034': 1, '19608363': 1, '19716341': 1, '19881093': 2, '21139990': 1, '32514325': 1, '15343605': 1, '23543127': 1, '5981976': 1, '11980018': 1, '25337048': 1, '11553824': 1, '10799233': 1, '30363304': 2}
|
{'2766873-1': 1}
|
2,993 |
6159259-1
| 30,363,300 |
comm/PMC006xxxxxx/PMC6159259.xml
|
An unusual case of fatty posterior mediastinal ganglioneuroma
|
A 48-year-old male presented with a paraspinal mass seen on preoperative chest X-ray obtained for knee arthroscopy. He reported relatively constant sharp left axillary pain radiating to the anterior chest wall for about 8 months.
|
[[48.0, 'year']]
|
M
|
{'15026603': 1, '15450577': 1, '16282916': 1, '33354270': 1, '10646980': 1, '15022069': 1, '21263353': 1, '22573298': 1, '26096483': 1, '9207519': 1, '8785637': 1, '19095098': 1, '16286419': 1, '17959913': 1, '25319096': 2, '9024521': 1, '2429396': 1, '30363300': 2}
|
{'4204430-1': 1}
|
2,994 |
6159261-1
| 30,363,291 |
comm/PMC006xxxxxx/PMC6159261.xml
|
Symptomatic synovial herniation pit—MRI appearances pre and post treatment
|
Mr JA, a 59-year-old active doctor with no significant medical history, presented with a 4-month history of right-sided hip pain radiating to the groin following minor trauma incurred by a jump from a wall. Conservative measures such as rest, non-steroidal anti-inflammatory medication and physiotherapy provided minor relief but failed to resolve the pain. Clinical examination suggested impingement and a labral tear as the source of the pain. The patient went on to have an MRI of the hip, which demonstrated a small synovial herniation pit within the anterior aspect of the superolateral femoral head and neck junction measuring 5 mm with a mild amount of surrounding bone oedema and subtle lateral femoral head–neck junction contour abnormality suggestive of early cam-type impingement morphology. There was no fracture evident and the articular surfaces, labrum and the remainder of the pelvis were normal ().\nFlouroscopically guided intra-articular steroid injection of 8 mg dexamethasone mixed with 2 cc of 0.25% bupivacaine was performed resulting in symptom improvement immediately following the procedure. Within 6 days the symptoms had completely resolved.\nFollow-up MRI 1 month later demonstrated complete resolution of the bone oedema surrounding the herniation pit (). At 1-year follow-up the patient remained asymptomatic.
|
[[59.0, 'year']]
|
M
|
{'6979213': 1, '32665834': 2, '16714671': 1, '34691348': 1, '11162690': 1, '5889051': 1, '2740509': 1, '17233032': 1, '8976938': 1, '14646708': 1, '22009841': 1, '6225600': 1, '1414772': 1, '15987977': 1, '30363291': 2}
|
{'7332285-1': 1}
|
2,995 |
6159262-1
| 30,363,276 |
comm/PMC006xxxxxx/PMC6159262.xml
|
Case report: Castleman’s disease in trachea
|
A 43-year-old female with dyspnoea was transferred to our emergency department for further treatment. She had dyspnoea and cough about 6 months ago. No sputum or haemoptysis was observed. She worked as a farmer for about 10 years, and such symptoms had never happened. Occupational poison contact was denied. Her parents were healthy, with no similar family history or medical history. Empiric anti-infective therapy and antituberculosis therapy were given in the last few months at a local hospital, but the symptoms of dyspnoea worsened. Plain CT of the chest revealed a mass with well-circumscribed soft-tissue attenuation, which measured about 25 Hounsfield units (HU) on the lateral wall of the trachea (). It was about 2 × 1 × 1 cm3 in size. Contrast-enhanced CT revealed marked homogeneous enhancement (), with the highest density of 122 HU in the arteries that declined gradually to 85 HU at 120 s after injecting the contrast medium. No metastatic lymph nodes or infiltration into nearby structures was observed. No similar lesions were found in the lungs, mediastinum or abdomen. Tracheotomy was arranged. Macroscopically, the mass was about 2 × 1 × 1 cm3 with a distinct border and smooth surface. No enriched vasculature was observed. Microscopically, the lesion was composed of a large amount of lymphatic tissue and hyperplastic vascular and lymphoid follicles, with atrophy of the germinal centre (). Immunohistochemical staining of the specimen confirmed the diagnosis of Castleman’s disease (CD). The specimen was CD20(+)/CD79(+) in B lymphocytes and CD3(+)/CD5(+) in a few T lymphocytes. Plain CT of the chest 3 months after the surgery excluded relapse or residual lesions in the trachea. The patient was then under regular follow-up, and her physical condition was quite good.
|
[[43.0, 'year']]
|
F
|
{'24929266': 1, '24792274': 1, '23883210': 1, '21997995': 1, '25310208': 1, '23669413': 1, '14975984': 1, '13356266': 1, '17296666': 1, '13111435': 1, '30363276': 2}
|
{}
|
2,996 |
6159263-1
| 30,363,306 |
comm/PMC006xxxxxx/PMC6159263.xml
|
An unusual presentation of adenoid cystic carcinoma of the breast with metastatic disease in the clavicle
|
A 63-year-old female presented in 2016 with pain in her left clavicle while out walking her dog. She had a history of grade I, node negative, triple receptor negative ACC of the left breast, which was treated with mastectomy in 2003. Eight years later she was diagnosed with a new primary tumour in the contralateral (right) breast. This was a grade III, 3/17 node positive, ER positive/HER2 negative invasive ductal carcinoma, which was treated with mastectomy, axillary node clearance, chemoradiotherapy and letrozole (Femara, Novartis, UK). The patient had been disease free up to the latest presentation in 2016. The clavicular pain initially settled spontaneously but recurred and prompted further investigations. Clinical examination revealed a mass involving the left clavicle measuring 5 cm in transverse diameter. A radiograph of the left clavicle showed evidence of an expansile destructive lesion at its medial end (). This finding, in addition to the soft tissue invasion, was confirmed on CT (), bone scintigraphy () and PET-CT (). Given the atypical nature of this lesion on a background of breast cancer, a bone biopsy was performed. Histology showed cores of bone invaded by a tumour with a biphasic pattern of epithelial and myoepithelial cells forming cribriform and tubular structures containing eosinophilic secretions (). There were no solid areas to indicate high grade disease and no perineural invasion was seen. Immunohistochemical staining was positive for keratin 7 but negative for ER/PR/HER2, keratin 20, gross cystic disease fluid protein-15 and thyroid transcription factor-1. The histology from the original breast carcinoma was reviewed and this showed a similar histomorphological pattern. In the absence of an additional radiological primary site, the bone lesion was reported as primary metastatic ACC in keeping with the previously diagnosed left breast cancer and recommended for multidisciplinary team discussion. The patient underwent surgical resection of the lesion and clavicle. Macroscopic examination showed an expansile tumour in the clavicle with probable extension into soft tissues (). In concordance with the biopsy, histology revealed a tumour with classic ACC features invading bone and confirmed soft tissue extension. The patient is now undergoing adjuvant radiotherapy to the area.
|
[[63.0, 'year']]
|
F
|
{'20653964': 1, '2549491': 1, '20410430': 1, '22154460': 1, '24520228': 2, '8390344': 1, '6305483': 1, '21790841': 1, '1655210': 1, '25516849': 1, '30363306': 2}
|
{'3918532-1': 1, '3918532-2': 1, '3918532-3': 1, '3918532-4': 1, '3918532-5': 1}
|
2,997 |
6159265-1
| 30,363,260 |
comm/PMC006xxxxxx/PMC6159265.xml
|
Liver lipoma: a case report
|
A 72 year old female, with no significant past medical history, was sent to our hospital by her primary care physician for vague abdominal pain and dyspepsia. The patient had no history of alcohol abuse neither abdominal operation. We performed an abdominal ultrasonography, which revealed a large and well-defined mass of mixed echogenicity (iso-hyperechoic), with posterior attenuation, in the left lobe of the liver (). The maximum axial diameter of the mass was about 10 cm, and a colour Doppler modality has been used to study the lesion showing a perilesional vascularisation (). Gallbladder lythiasis was detected, with no dilatation of biliary system; there were no signs of cholecystitis. There were no splenomegaly or ascites. Laboratory studies including the blood cells count and liver function tests were within the limits, only triglycerides and glucose were altered, with a body mass index of 30.8. Hepatitis serology and tumour markers (e.g. alpha-fetoprotein, protein induced by vitamin K absence/antagonist II, carcinoembryonic antigen and carbohydrate antigen 19.9) were negative.
|
[[72.0, 'year']]
|
F
|
{'21752564': 1, '11159098': 1, '5459759': 1, '19779784': 1, '15788580': 1, '15798052': 1, '21967263': 1, '16477402': 1, '30363260': 2}
|
{}
|
2,998 |
6159268-1
| 30,363,299 |
comm/PMC006xxxxxx/PMC6159268.xml
|
Whole-body magnetic resonance for staging and response assessment of lymphoma in a pregnant woman treated with antenatal chemotherapy
|
A 32-year-old female at pregnancy week 22 was admitted to the haematology department with bilateral supraclavicular swelling, diffuse itching and right shoulder pain. Ultrasound imaging showed pathological bilateral supraclavicular enlarged lymph nodes, which were biopsied. A diagnosis of nodular sclerosis Hodgkin’s lymphoma (HL) was made.\nFetal ultrasound screening was normal. In view of the patient’s desire to proceed with the pregnancy, a multidisciplinary follow-up (by haematologists, gynaecologists, radiologists and neonatologists) was scheduled.\nCombined fludeoxyglucose positron emission tomography (FDG-PET)/CT scan was not performed before the delivery because of the risk of radiation exposure during pregnancy.\nIt was decided to stage the disease through ultrasound and whole-body MRI (WB-MRI), which showed right cervical, bilateral supraclavicular and mediastinal lymph node involvement without a bulky mass (axial diameter 4.7 × 4.1 cm), indicating Stage IIA disease, according to Ann Arbor classification ().\nThe multidisciplinary team decided to start chemotherapy only if clinically necessary. Accordingly, the patient was followed up with ultrasound, WB-MRI, haematology consults and gynaecological examinations. Furthermore, therapy with steroid and paracetamol was started to slow down the progression of disease, and treat the itching and shoulder pain.\nAt pregnancy week 27, WB-MRI demonstrated a slight progression of the disease, seen as an enlargement of the lymph node packages, the largest was in the mediastinum with an axial diameter of 5.4 × 4.5 cm.\nAt pregnancy week 29, the clinical conditions got worse and the patient presented with coughing, night sweating, numbness and pain radiating across the shoulder down the arm. An ultrasound examination showed enlargement of a right axillary lymph node and the internal jugular vein thrombosis that was treated with enoxaparin, which allowed complete recanalization in just a week. Thus, it was decided to start chemotherapy.\nWB-MRI was performed at pregnancy week 30, before the beginning of chemotherapy, confirming the progression of disease with right axillary involvement and further enlargement of the supraclavicular and mediastinal lymph nodes (the largest lesions with axial diameters of 5.8 × 4.7 cm), but without the involvement of extranodal or subdiaphragmatic sites; so the disease stage had not changed ().\nThe patient received two courses of chemotherapy (adriamycin, bleomycin, vinblastine and dacarbazine) and showed an improvement in her clinical status a few days after the beginning of therapy, with disappearance of the coughing and sweating, and a decrease in the cervical swelling, numbness and pain.\nAt pregnancy week 38, the patient gave birth to a healthy child, with a weight of 3.110 kg, via spontaneous delivery. A week after delivery, the patient presented with worsening of clinical symptoms, the reappearance of sweating and asthenia, signs of increased cervical swelling, and she received another course of adriamycin, bleomycin, vinblastine and dacarbazine. Ultrasound and WB-MRI were then performed to assess the response to treatment and showed progression of the supraclavicular lymphadenopathy and an enlargement of the longest axial diameter of the spleen from 11 to 14.5 cm, concluding that the disease was a resistant lymphoma ().\nAfter WB-MRI, the patient underwent FDG-PET/CT scan that confirmed the MRI findings ().\nAfter confirming the findings, the haematologists decided to change the chemotherapy regimen and thus the patient received three courses of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone and three standard bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone.\nAfter chemotherapy, the patient underwent WB-MRI and FDG-PET/CT, which showed disappearance of the nodal locations of the disease and normal splenic size ().
|
[[32.0, 'year']]
|
F
|
{'24518428': 1, '15339791': 1, '22414282': 1, '22325663': 1, '23749243': 1, '20229593': 1, '26781135': 1, '27603267': 1, '1733434': 1, '25113753': 1, '15514377': 1, '27114337': 1, '2678489': 1, '27519911': 1, '21680687': 1, '24043736': 1, '30363299': 2}
|
{}
|
2,999 |
6159271-1
| 30,363,245 |
comm/PMC006xxxxxx/PMC6159271.xml
|
Diffusion-weighted MR imaging and assessment of ovarian carcinomas with vaginal deposit accidentally detected during pregnancy
|
We report a case of a 40-year-old female (gravida 5 para 4, gestational age 32 weeks) who attended the obstetrics and gynaecology outpatient clinic in our institute. She complained of repeated episodes of vaginal bleeding. Abdominal examination revealed a disproportionately high uterine fundal level that was not matching her corresponding gestational age. Abdominal ultrasound examination showed a viable, single intrauterine 32 weeks fetus. On screening the adnexal regions, bilateral highly vascular complex adnexal masses were identified, measuring 8 × 6 cm² on the right side and 12 × 8 cm² on the left side (). Transvaginal ultrasound imaging showed an additional highly vascular polypoidal mass projecting in the upper vagina, indistinct from a rather bulky cervix. Solid peritoneal deposits were also identified in the Douglas pouch (). Further evaluation of the pelvis by MRI was requested and a non-contrast study was performed at the same institute after a 1-week interval, which was interpreted by a different set of readers. T2 weighted images showed findings matching those of the preliminary pelvic ultrasound imaging (). Functional data concerning the cellularity and integrity of the cell membranes of the adnexal and vaginal masses was provided by the diffusion-weighted MRI (DWI) sequence. On the DWI sequence, the masses showed restricted diffusion in the form of persistent bright signal intensity and low apparent diffusion coefficient (ADC) values, which strongly favoured likely malignant pathology (). Laboratory data were within normal limits apart from a raised CA-125 level. Corticosteroids were administered to ensure fetal lung maturity. The pregnancy was terminated by an elective caesarean section at 34 weeks gestation via a midline subumbilical incision. A 2.5 kg living normal fetus was extracted. The abdomen was explored and the bilateral complex adnexal masses were identified, together with the multiple omental metastatic nodules and bloody ascites. The right ovarian mass was attached to the posterior abdominal wall and was inseparable from the sacral promontory. Debulking of the ovarian lesions, panhysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed. Minimal tumour residue that was adherent to bone could not be removed. Vaginal exploration was also performed to remove the polypoidal vaginal component, which was grasped and totally excised. It was completely separable from the cervix. Pathological examination revealed an undifferentiated ovarian adenocarcinoma (grade 3), metastasizing to the upper vagina with clear cervical margins. The patient is now undergoing chemotherapy.
|
[[40.0, 'year']]
|
F
|
{'10817054': 1, '20198766': 1, '20042265': 1, '9315194': 1, '10411786': 1, '14520194': 1, '21081581': 1, '20393410': 1, '19509538': 1, '22360037': 1, '8504991': 1, '16973774': 1, '30363245': 2}
|
{}
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.