2023

Jump to: 2022, 2021, 2020

6 pages, 3067 KiB

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Coexistence of Ehlers–Danlos Syndrome with Coronary–Pulmonary Arterial Fistula and Other Multiple Coronary Artery Anomalies

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Diagnostics 2023, 13(23), 3555; https://doi.org/10.3390/diagnostics13233555 - 28 Nov 2023

Viewed by 196

Abstract

This case report presents a 34-year-old male with Ehlers–Danlos syndrome, type 2 diabetes mellitus, aortic valve regurgitation, and aortic bulb aneurysm. Following spine surgery for thoracic–lumbar stabilization, the patient underwent assessment for aortic bulb aneurysm and aortic valve replacement surgeries. Five months post [...] Read more.

This case report presents a 34-year-old male with Ehlers–Danlos syndrome, type 2 diabetes mellitus, aortic valve regurgitation, and aortic bulb aneurysm. Following spine surgery for thoracic–lumbar stabilization, the patient underwent assessment for aortic bulb aneurysm and aortic valve replacement surgeries. Five months post spinal surgery, a coronary computed tomography angiography was performed. The coronary computed tomography angiography revealed unique findings, including the absence of the left main coronary artery, right coronary artery dominance, ectopic origin of the left circumflex artery from the right sinus of the valsalva, a coronary–pulmonary arterial fistula originating from the right sinus of the valsalva, and an additional right pulmonary vein. The patient was qualified for surgical treatment for an aortic bulb aneurysm, was informed about the high surgical risk, and is awaiting surgery. This case underscores the rarity of Ehlers–Danlos syndrome coexisting with multiple coronary artery anomalies. The presence of a coronary–pulmonary arterial fistula further emphasizes the need for specialized patient monitoring when Ehlers–Danlos syndrome and coronary anomalies converge. Full article

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3 pages, 537 KiB

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Two Birds with One Stone: Hepatocellular Carcinoma and Small Cell Lung Cancer Imaged with [¹⁸F]Fluorocholine Positron Emission Tomography/Computed Tomography

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Marco Cuzzocrea

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Gaetano Paone

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Giorgio Treglia

Diagnostics 2023, 13(16), 2639; https://doi.org/10.3390/diagnostics13162639 - 10 Aug 2023

Viewed by 653

Abstract

We describe the case of a 67-year-old male patient with a moderately differentiated hepatocellular carcinoma (HCC) of the right liver lobe who underwent [¹⁸F]fluorocholine positron emission tomography/computed tomography (PET/CT) for staging due to a suspicious lung lesion at previous CT scan. [...] Read more.

We describe the case of a 67-year-old male patient with a moderately differentiated hepatocellular carcinoma (HCC) of the right liver lobe who underwent [¹⁸F]fluorocholine positron emission tomography/computed tomography (PET/CT) for staging due to a suspicious lung lesion at previous CT scan. [¹⁸F]fluorocholine PET/CT showed increased radiopharmaceutical uptake in a liver lesion corresponding to the known HCC. Furthermore, a right pulmonary hilar lesion suspicious for metastatic spread of HCC showed increased radiopharmaceutical uptake. Surprisingly, the histological assessment of the thoracic lesion demonstrated the presence of small cell lung cancer (SCLC). The patient underwent treatment with radiation therapy and chemotherapy for the SCLC and selective internal radiation therapy (SIRT) for the HCC. The patient died after one year due to progressive SCLC. This case demonstrates that coexisting tumors showing increased cell membrane turnover, including SCLC, can be detected by [¹⁸F]fluorocholine PET/CT. In our case, [¹⁸F]fluorocholine PET/CT findings influenced the patient management in terms of histological verification and different treatment of the detected lesions. Full article

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4 pages, 1550 KiB

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Failed Dental Implant: When Titanium Fractures

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João Paulo Mendes Tribst

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Arie Werner

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Erik J. Blom

Diagnostics 2023, 13(12), 2123; https://doi.org/10.3390/diagnostics13122123 - 20 Jun 2023

Cited by 2 | Viewed by 826

Abstract

Despite the widespread use of titanium implants in orthopedic and dental surgeries, concerns have recently emerged regarding potential deformations and fractures after osseointegration. In a recent clinical case, a titanium implant fractured after successful osseointegration. This fracture occurred despite the absence of any [...] Read more.

Despite the widespread use of titanium implants in orthopedic and dental surgeries, concerns have recently emerged regarding potential deformations and fractures after osseointegration. In a recent clinical case, a titanium implant fractured after successful osseointegration. This fracture occurred despite the absence of any significant trauma or excessive external force applied to the area. The fracture was attributed to a combination of factors, including abutment design flaws, material fatigue, and biomechanical stress imposed on the implant during functional loading. This raises concerns about the long-term durability and reliability of titanium implants, particularly in high-stress areas such as the posterior region or weight-bearing bones. An image was made with scanning electron microscopy showing the fracture region near the prosthetic platform and highlighting the knowledge that despite their ductility, titanium implants can fracture. Full article

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9 pages, 5019 KiB

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Imaging Criteria for the Diagnosis of Progressive Supranuclear Palsy: Supportive or Mandatory?

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Nicoleta Lupascu

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Ioan Cristian Lupescu

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Ionuț Caloianu

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Florin Naftanaila

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Remus Relu Glogojeanu

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Carmen Adella Sirbu

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Marian Mitrica

Diagnostics 2023, 13(11), 1967; https://doi.org/10.3390/diagnostics13111967 - 05 Jun 2023

Cited by 1 | Viewed by 2645

Abstract

We present the case of a 54-year-old male, without any significant medical history, who insidiously developed speech disturbances and walking difficulties, accompanied by backward falls. The symptoms progressively worsened over time. The patient was initially diagnosed with Parkinson’s disease; however, he failed to [...] Read more.

We present the case of a 54-year-old male, without any significant medical history, who insidiously developed speech disturbances and walking difficulties, accompanied by backward falls. The symptoms progressively worsened over time. The patient was initially diagnosed with Parkinson’s disease; however, he failed to respond to standard therapy with Levodopa. He came to our attention for worsening postural instability and binocular diplopia. A neurological exam was highly suggestive of a Parkinson-plus disease, most likely progressive supranuclear gaze palsy. Brain MRI was performed and revealed moderate midbrain atrophy with the characteristic “hummingbird” and “Mickey mouse” signs. An increased MR parkinsonism index was also noted. Based on all clinical and paraclinical data, a diagnosis of probable progressive supranuclear palsy was established. We review the main imaging features of this disease and their current role in diagnosis. Full article

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6 pages, 3732 KiB

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Minimal Fat Content in Papillary Renal Cell Carcinoma Diagnosed with Dual-Layer Dual-Energy CT

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Diagnostics 2023, 13(10), 1742; https://doi.org/10.3390/diagnostics13101742 - 15 May 2023

Viewed by 989

Abstract

A 56-year-old man with a previous right nephrectomy for multiple papillary renal cell carcinomas (pRCC) underwent a follow-up CT scan. Using a dual-layer dual-energy CT (dlDECT), we demonstrated the presence of a small amount of fat in a 2.5 cm pRCC that mimicked [...] Read more.

A 56-year-old man with a previous right nephrectomy for multiple papillary renal cell carcinomas (pRCC) underwent a follow-up CT scan. Using a dual-layer dual-energy CT (dlDECT), we demonstrated the presence of a small amount of fat in a 2.5 cm pRCC that mimicked the diagnosis of angiomyolipoma (AML). Histological examination demonstrated the absence of macroscopic intratumoral adipose tissue, showing a fair amount of enlarged foam macrophages loaded with intracytoplasmic lipids. The presence of fat density in an RCC is an extremely rare occurrence in the literature. To our knowledge, this is the first description using dlDECT of a minimal amount of fat tissue in a small RCC due to the presence of tumor-associated foam macrophages. Radiologists should be aware of this possibility when characterizing a renal mass with DECT. The option of RCCs must be considered, especially in the case of masses with an aggressive character or a positive history of RCC. Full article

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3 pages, 794 KiB

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In Vivo Fibroblast Activation of Systemic Sarcoidosis: A ⁶⁸Ga-FAPI-04 PET/CT Imaging Study

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Diagnostics 2023, 13(8), 1450; https://doi.org/10.3390/diagnostics13081450 - 17 Apr 2023

Viewed by 821

Abstract

A 47-year-old female with cardiac dysfunction and lymphadenopathy underwent ¹⁸FDG PET/CT and ⁶⁸Ga-FAPI-04 imaging for tumor screening. Mild uptake in the left ventricular wall was detected on the oncology ¹⁸FDG PET/CT. True myocardiac-involvement could not be distinguished with physiological uptake. [...] Read more.

A 47-year-old female with cardiac dysfunction and lymphadenopathy underwent ¹⁸FDG PET/CT and ⁶⁸Ga-FAPI-04 imaging for tumor screening. Mild uptake in the left ventricular wall was detected on the oncology ¹⁸FDG PET/CT. True myocardiac-involvement could not be distinguished with physiological uptake. The following ⁶⁸Ga-FAPI-04 showed intense heterogeneous uptake in the left ventricular wall, particularly in the septum and apex area, corresponding with the late gadolinium enhancement regions shown by cardiac MR. Intense uptake was also noted in the mediastinal and bilateral hilar lymph nodes. Endomyocardial biopsy demonstrated sarcoidosis. Full article

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6 pages, 1165 KiB

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Transarterial Embolization of Ruptured Pancreaticoduodenal Artery Pseudoaneurysm Related to Chronic Pancreatitis

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Lucian Mărginean

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Adrian Vasile Mureșan

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Emil Marian Arbănași

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Cătălin Mircea Coșarcă

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Eliza Mihaela Arbănași

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Eliza Russu

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Rares Cristian Filep

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Réka Kaller

Diagnostics 2023, 13(6), 1090; https://doi.org/10.3390/diagnostics13061090 - 14 Mar 2023

Cited by 1 | Viewed by 933

Abstract

We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × [...] Read more.

We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × 4 cm² in size) located intra-abdominally, adjacent to the duodenojejunal area, with hyperdensity around the duodenum, positioned inferior to the pancreas (30–59 HU). Moreover, the CT scan also revealed an enhancing lesion as a pseudoaneurysm of the inferior pancreaticoduodenal artery, measuring 5 × 8 × 8 mm³ with active bleeding and associated hematoma. Following these investigations of the abdominal area, a decision was made to proceed with an endovascular intervention within the interventional radiology department. With the patient under conscious sedation, via a right common femoral artery approach, the superior mesenteric artery was catheterized. While injecting the contrast agent to obtain a better working projection, the pseudoaneurysm ruptured, and acute extravasation of the contrast agent was noted, followed by injection of a mixture of 1 mL Glubran 2 with 2 mL Lipiodol until complete obliteration of the pseudoaneurysm was obtained. The patient was hemodynamically stable at the end of the procedure and was discharged 6 days later in a good condition without active bleeding signs. Full article

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6 pages, 3932 KiB

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Orbital Metastases of Breast Cancer in Males

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Cosmin Adrian Teodoru

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Mihai Dan Roman

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Horațiu Dura

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Maria-Emilia Cerghedean-Florea

Diagnostics 2023, 13(4), 780; https://doi.org/10.3390/diagnostics13040780 - 18 Feb 2023

Viewed by 1200

Abstract

We report a case of orbital metastasis of infiltrative breast carcinoma in a 65-year-old man. The patient was diagnosed with stage four breast cancer one year before, for which a mastectomy was performed. He refused postoperative radiotherapy and chemotherapy at that time. He [...] Read more.

We report a case of orbital metastasis of infiltrative breast carcinoma in a 65-year-old man. The patient was diagnosed with stage four breast cancer one year before, for which a mastectomy was performed. He refused postoperative radiotherapy and chemotherapy at that time. He had a history of lung, liver, and mediastinal metastases. At admission, he presented with blurred vision, diplopia, ocular pain, and mild swelling of the upper lid of the left eye (LE). Computed tomography (CT) of the brain and orbit revealed a front-ethmoidal tissue mass with left orbital and frontal intracranial extension. Ophthalmologic examination revealed exophthalmos on the LE with a downward and outward deviation of the eyeball, proptosis, and intraocular pressure (IOP) of 40 mmHg. The patient’s treatment started with topical maximal anti-glaucomatous drops and radiotherapy sessions. After three weeks of follow-up, there was a gradual improvement of local symptoms and signs and a normal IOP. Full article

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2022

Jump to: 2023, 2021, 2020

5 pages, 1683 KiB

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Cor Triatriatum Sinister Presenting as Cardioembolic Stroke in a Young Woman

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Diagnostics 2023, 13(1), 97; https://doi.org/10.3390/diagnostics13010097 - 29 Dec 2022

Cited by 2 | Viewed by 1051

Abstract

Cor triatriatum sinister is a rare congenital heart disease characterized by an additional fibromuscular membrane in the left atrium. Cardioembolic stroke is a rare complication of cor triatriatum sinister, especially among women. We hereby describe the case of an 18-year-old female patient, without [...] Read more.

Cor triatriatum sinister is a rare congenital heart disease characterized by an additional fibromuscular membrane in the left atrium. Cardioembolic stroke is a rare complication of cor triatriatum sinister, especially among women. We hereby describe the case of an 18-year-old female patient, without a past medical history, presenting with cardioembolic stroke in the territory of the right posterior cerebral artery. During extensive diagnostic work-up, nonrestrictive cor triatriatum sinister and patent foramen ovale were diagnosed using transthoracic and transesophageal echocardiography. In clinical practice, it is important to identify congenital cardiac defects as potential substrates for cardioembolism in young patients. In our case, cor triatriatum sinister presenting as ischemic stroke was diagnosed, which is an uncommon finding, especially in young females. Determining the optimal management strategy for patients with cor triatriatum sinister complicated by cardioembolic stroke requires a multidisciplinary approach. Full article

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7 pages, 1468 KiB

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New Imaging Features of Multinodular and Vacuolating Neuronal Tumor Revealed by Alcohol and Illicit Drugs Consumption

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Alexandra Giorgiana Calu

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Dragos Catalin Jianu

Diagnostics 2022, 12(11), 2779; https://doi.org/10.3390/diagnostics12112779 - 14 Nov 2022

Cited by 1 | Viewed by 1625

Abstract

It has been almost a decade since the multinodular and vacuolating neuronal tumor (MVNT) was first described. In 2021, WHO classified it as a defined entity, and it is considered one of the glioneuronal and neuronal tumors. Due to its similarities with dysembryoplastic [...] Read more.

It has been almost a decade since the multinodular and vacuolating neuronal tumor (MVNT) was first described. In 2021, WHO classified it as a defined entity, and it is considered one of the glioneuronal and neuronal tumors. Due to its similarities with dysembryoplastic neuroepithelial tumors (DNET), some authors consider it a variant of these, ranking in the category of malformations, but genetic alterations favor a neoplastic origin. We present a 29-year-old male with a generalized onset tonic-clonic seizure after a nightclub party. Imaging studies revealed a right temporal multinodular and vacuolating neuronal tumor confirmed by biopsy. It is considered a nonaggressive, “leave me alone” brain lesion, which does not require biopsy because of well-defined MRI characteristics. Surgery is indicated only in symptomatic cases. We consider that this lesion was revealed by his seizure, most probably provoked (with normal video EEG recording) by the consumption of a lot of alcohol, illicit drugs, and sleep loss after a club party. We recommended close monitoring, but our patient preferred the surgery. Our case added more imaging details corroborated with the histopathology features of MVNT. FLAIR images revealed hypointense nodules surrounded by hyperintense peripheral rings and areas of high signal intensity between the nodules, which correspond to the histopathological architecture. To our knowledge, this is the first case of MVNT with diffusion tensor imaging and fiber tractography imaging studies. Full article

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11 pages, 4692 KiB

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Incidental Vascular Findings in Computed Tomography Performed in the Qualification for the TAVI Procedure

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Paweł Gać

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Aleksandra Grochulska

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Rafał Poręba

Diagnostics 2022, 12(11), 2773; https://doi.org/10.3390/diagnostics12112773 - 13 Nov 2022

Viewed by 1156

Abstract

Transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) is now a very widespread treatment method for symptomatic and severe aortic stenosis as an alternative for patients at intermediate or high risk of surgery or contraindications to surgery. The key role [...] Read more.

Transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) is now a very widespread treatment method for symptomatic and severe aortic stenosis as an alternative for patients at intermediate or high risk of surgery or contraindications to surgery. The key role of imaging examinations before TAVI is to assess the morphology of the aortic valve, the routes of surgical access, and non-cardiac and extravascular structures. The objective of this article is to present and discuss the importance of selected accidental vascular findings in computed tomography examinations of the heart and large vessels performed in the TAVI qualification procedure: persistent left superior vena cava (SVC) with absent right SVC, right aortic arch, ectopic right coronary artery ostium, and left superior pulmonary vein draining into left brachiocephalic vein. Full article

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4 pages, 967 KiB

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Different Uptake of ⁶⁸Ga-FAPI and ¹⁸F-FDG in Lymphadenopathy Caused by Angioimmunoblastic T-Cell Lymphoma in a Patient with Colon Cancer

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Meiqi Wu

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Qingqing Pan

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Yaping Luo

Diagnostics 2022, 12(9), 2211; https://doi.org/10.3390/diagnostics12092211 - 13 Sep 2022

Viewed by 1326

Abstract

An 82-year-old man with a history of colon cancer was found with multiple lymphadenopathies and a pulmonary mass. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) detected generalized hypermetabolic lymph nodes and an FDG-avid pulmonary mass. PET/CT with ⁶⁸Ga-labeled fibroblast [...] Read more.

An 82-year-old man with a history of colon cancer was found with multiple lymphadenopathies and a pulmonary mass. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) detected generalized hypermetabolic lymph nodes and an FDG-avid pulmonary mass. PET/CT with ⁶⁸Ga-labeled fibroblast activation protein inhibitor (FAPI) revealed intense uptake in the lung mass, consistent with metastatic disease from colon cancer. However, the lymphadenopathies were not avid for ⁶⁸Ga-FAPI, suggesting a different etiology. The biopsy of a cervical node confirmed angioimmunoblastic T-cell lymphoma. The case showcased the potential of ⁶⁸Ga-FAPI in differentiation of solid tumor and hematological disease due to different histopathologic nature of stromal fibrosis. Full article

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4 pages, 1929 KiB

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Multiple Clay Shoveler’s Fractures of the Thoracic Spine

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Wilbur Teng Jun Hoong

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Arun-Kumar Kaliya-Perumal

Diagnostics 2022, 12(9), 2190; https://doi.org/10.3390/diagnostics12092190 - 09 Sep 2022

Viewed by 1336

Abstract

Typically, a clay shoveler’s fracture is a stress-type avulsion fracture involving the spinous processes of the lower cervical or upper thoracic vertebrae. Even though C7 and T1 are the most commonly involved spinal levels, these avulsion fractures can occur at any lower cervical [...] Read more.

Typically, a clay shoveler’s fracture is a stress-type avulsion fracture involving the spinous processes of the lower cervical or upper thoracic vertebrae. Even though C7 and T1 are the most commonly involved spinal levels, these avulsion fractures can occur at any lower cervical or upper thoracic level, either as solitary or multiple fractures. This fracture used to be common in workers who shovel heavy loads of clay for long periods, hence its name. It does not cause any structural, functional, or neurological impairments and is therefore considered a stable fracture. Management is mostly conservative, involving rest, analgesics, and activity modification for a period of 4–6 weeks. Here, we present a 35-year-old male who sustained a motor vehicle accident. Except for midline tenderness in the back, there were no other positive findings. Plain radiographs showed a T11 vertebral compression fracture and absent or deviated spinous process shadows for most of the upper thoracic vertebrae. Computed tomography (CT) imaging clearly revealed multiple spinous process fractures extending from T2 to T8 levels. Considering the stability of these fractures, the patient was managed conservatively with rest, bracing, and analgesics. The recovery was quick, and he was back to his full functional status by six weeks. Full article

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8 pages, 2077 KiB

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MRI Evolution of a Patient with Viral Tick-Borne Encephalitis and Polymorphic Seizures

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Aurelian Emil Ranetti

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Any Docu-Axelerad

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Aida Mihaela Manole

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Ion Stefan

Diagnostics 2022, 12(8), 1888; https://doi.org/10.3390/diagnostics12081888 - 04 Aug 2022

Viewed by 1708

Abstract

Some neurotropic viruses induce specific lesions in the deep structures, such as basal ganglia and thalamus. These anatomical structures play an important role in initiating and maintaining different types of epileptic seizures. We present the case of a 25-year-old male, transferred to our [...] Read more.

Some neurotropic viruses induce specific lesions in the deep structures, such as basal ganglia and thalamus. These anatomical structures play an important role in initiating and maintaining different types of epileptic seizures. We present the case of a 25-year-old male, transferred to our clinic one week after the onset of the symptomatology, with a recent history of traveling to Turkey and Egypt. At the moment of his hospital admission, his symptoms included altered consciousness, agitation, and seizures. Shortly after, his state worsened, requiring intubation. Viral tick-borne encephalitis diagnoses were favored by the CSF (cerebrospinal fluid) analysis, EEG (Electroencephalography), MRI (magnetic resonance imaging) images presenting symmetric hyper signal in the basal ganglia, and IgM antibodies for anti-tick-borne encephalitis. These lesions persisted for several weeks, and the patient’s seizures were polymorphic, originally generalized onset motor, generalized onset non-motor, and focal myoclonic. The patient achieved his independence, seizures decreasing both in intensity and frequency; the MRI images became almost normal. The reduction in antiepileptic doses was not followed by seizure recurrence. Full article

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4 pages, 2295 KiB

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A Case Report of a Gluteus Hematoma Detected on ^99mTc-MDP Bone Scan

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Miju Cheon

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Jang Yoo

Diagnostics 2022, 12(6), 1383; https://doi.org/10.3390/diagnostics12061383 - 03 Jun 2022

Viewed by 1377

Abstract

This is a case report of a gluteal hematoma detected on ^99mTc-methylene diphosphonate (MDP) whole-body bone scan in a 77-year-old male who had experienced a road traffic accident. Full article

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5 pages, 1965 KiB

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Border-Zone Infarction Due to Cerebrovascular Fibromuscular Dysplasia

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Yu-Ming Chen

Diagnostics 2022, 12(6), 1337; https://doi.org/10.3390/diagnostics12061337 - 27 May 2022

Cited by 1 | Viewed by 1728

Abstract

A 45-year-old male presented with acute-onset left-sided weakness and slurred speech. Non-contrast-enhanced brain magnetic resonance imaging revealed cortical and internal border-zone infarcts compatible with stroke. A survey of ischemic stroke risk factors in young adults excluded coagulopathy, vasculitis, and cardiac disease. Nevertheless, neck-computed [...] Read more.

A 45-year-old male presented with acute-onset left-sided weakness and slurred speech. Non-contrast-enhanced brain magnetic resonance imaging revealed cortical and internal border-zone infarcts compatible with stroke. A survey of ischemic stroke risk factors in young adults excluded coagulopathy, vasculitis, and cardiac disease. Nevertheless, neck-computed tomography angiography revealed a long-segmental narrowing of the right internal carotid artery with wall thickening and a “string-of-beads” appearance suspicious for fibromuscular dysplasia, which was confirmed on further angiography. His clinical condition stabilized after intensive medical therapy. This case demonstrates cerebrovascular fibromuscular dysplasia as a possible cause of ischemic stroke in young adults. Full article

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4 pages, 799 KiB

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Neuroimaging Findings in a Patient with Anti-IgLON5 Disease: Cerebrospinal Fluid Dynamics Abnormalities

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Carlo Maria Iacolucci

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Chiara Zecca

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Maria Teresa Dell’Abate

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Francesca Andreetta

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Giancarlo Logroscino

Diagnostics 2022, 12(4), 849; https://doi.org/10.3390/diagnostics12040849 - 30 Mar 2022

Cited by 3 | Viewed by 2002

Abstract

Anti-IgLON5 disease is a recently described autoimmune neurodegenerative disorder characterized by insidious onset, slow progression and a variety of neurological features. Neuroimaging in most patients with anti-IgLON5 disease is normal or shows nonspecific findings. Here, we report a case of anti-IgLON5 disease presenting [...] Read more.

Anti-IgLON5 disease is a recently described autoimmune neurodegenerative disorder characterized by insidious onset, slow progression and a variety of neurological features. Neuroimaging in most patients with anti-IgLON5 disease is normal or shows nonspecific findings. Here, we report a case of anti-IgLON5 disease presenting with parkinsonism, falls, sleep problems with severe nocturnal dyspnea attacks, dysphagia, and dysautonomia. Imaging findings were initially suggestive of progressive supranuclear palsy. An altered cerebrospinal fluid dynamic was found on an MRI as well as high-convexity hyperperfusion on a brain SPECT. Further case descriptions with neuroimaging are required to characterize cerebral and cerebrospinal fluid dynamics abnormalities in this rare condition. Full article

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7 pages, 2620 KiB

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Magnetic Resonance Imaging of Multiple Cerebral and Spinal Cavernous Malformations of a Patient with Dementia and Tetraparesis

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Florian Antonescu

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Ioana Butnariu

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Florentina Melania Cojocaru

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Daniela Nicoleta Anghel

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Dana Antonescu-Ghelmez

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Sorin Tuță

Diagnostics 2022, 12(3), 677; https://doi.org/10.3390/diagnostics12030677 - 10 Mar 2022

Cited by 1 | Viewed by 2285

Abstract

Cavernomas are rare cerebrovascular malformations that usually occur in sporadic forms with solitary lesions located most often in the hemispheric white matter, but also in the infratentorial or spinal region. Multiple lesions at different CNS levels are considered a hallmark for the familial [...] Read more.

Cavernomas are rare cerebrovascular malformations that usually occur in sporadic forms with solitary lesions located most often in the hemispheric white matter, but also in the infratentorial or spinal region. Multiple lesions at different CNS levels are considered a hallmark for the familial form of the disease. The diagnostic modality of choice for cerebral cavernous malformations (CCMs) is magnetic resonance imaging (MRI). We present an intriguing case of a 65-year-old male admitted to our hospital with tetraparesis and cognitive impairment where highly sensitive MRI sequences identified many cerebral cavernous lesions at the supra-, infratentorial and cervical–thoracic spine levels, some of them with recent signs of bleeding in a patient with oral anticoagulant therapy due to atrial fibrillation. The mechanism of cognitive impairment in this patient is most probably the interruption of strategic white matter tracts, as it is known to happen in other subcortical vascular pathologies. MRI can be helpful not only in mapping the anatomical distribution of lesions, but also in weighing the risks and making decisions regarding whether or not to continue oral anticoagulant therapy. Full article

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2 pages, 1199 KiB

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Specifically Regional Cerebral Hypoperfusion in a Case of Highly Suspected Sporadic Creutzfeldt-Jakob Disease on ^99mTc-ECD SPECT/CT with Easy Z-Score Imaging System Analysis

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Shun-Chieh Chen

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Daniel Hueng-Yuan Shen

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Hung-Yen Chan

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Ming-Hui Yang

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Hung-Pin Chan

Diagnostics 2022, 12(2), 437; https://doi.org/10.3390/diagnostics12020437 - 08 Feb 2022

Viewed by 1197

Abstract

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly-progressive dementing illness, the challenge of diagnosis during life. We presented a 78-year-old woman reported stupor, right facial palsy, and fluctuations in consciousness. ^99mTc-ECD brain SPECT/CT with eZIS analysis revealed significant decreased regional cerebral blood flow [...] Read more.

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly-progressive dementing illness, the challenge of diagnosis during life. We presented a 78-year-old woman reported stupor, right facial palsy, and fluctuations in consciousness. ^99mTc-ECD brain SPECT/CT with eZIS analysis revealed significant decreased regional cerebral blood flow mainly in specific regions of Alzheimer’s disease as the published article reported with involving frontal region. Brain DWI MRI increased signal intensities corresponding to similar location of ^99mTc-ECD brain SPECT/CT. In this case, we reported the pattern of decreased rCBF may correlate to rapidly progressive dementia and associated neurodegenerative symptoms of the highly suspected sCJD patient. Full article

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5 pages, 1427 KiB

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Significant Stenosis of the Brachiocephalic Trunk and Moderate Stenosis of the Left Circumflex Artery in Computed Tomography Angiography Images

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Paweł Gać

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Rafał Poręba

Diagnostics 2022, 12(1), 200; https://doi.org/10.3390/diagnostics12010200 - 14 Jan 2022

Viewed by 1658

Abstract

Atherosclerosis, as a civilization disease, is a serious epidemiological problem. Significant carotid disease and significant coronary artery disease result in acute consequences, such as ischemic stroke and myocardial infarction, which are the major causes of cardiovascular mortality. Typically, atherosclerosis of the aortic arch [...] Read more.

Atherosclerosis, as a civilization disease, is a serious epidemiological problem. Significant carotid disease and significant coronary artery disease result in acute consequences, such as ischemic stroke and myocardial infarction, which are the major causes of cardiovascular mortality. Typically, atherosclerosis of the aortic arch branches involves the bulbs of the common carotid arteries and the proximal segments of the internal carotid arteries, and can be effectively assessed by ultrasonography. Computed tomography angiography enables the identification of patients with less typical clinical manifestations of atherosclerosis, e.g., brachiocephalic trunk stenosis with symptoms of the steal syndrome and moderate stenosis in the coronary arteries. We present examples of computed tomography angiography images of this type of changes. Full article

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2021

Jump to: 2023, 2022, 2020

2 pages, 428 KiB

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Fractional Flow Reserve in the Diagnosis of Ischemic Heart Disease in a Patient with Coronary Artery Ectasia

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Malgorzata Zalewska-Adamiec

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Lukasz Kuzma

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Hanna Bachorzewska-Gajewska

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Slawomir Dobrzycki

Diagnostics 2022, 12(1), 17; https://doi.org/10.3390/diagnostics12010017 - 23 Dec 2021

Viewed by 2053

Abstract

Coronary artery ectasias (CAE) are diffuse dilatations of coronary artery segments with a diameter 1.5 times greater than the largest adjacent normal segment of the vessel. They are found in 0.3–5.0% of coronary angiography. Risk factors for CAE include atherosclerosis, previous percutaneous coronary [...] Read more.

Coronary artery ectasias (CAE) are diffuse dilatations of coronary artery segments with a diameter 1.5 times greater than the largest adjacent normal segment of the vessel. They are found in 0.3–5.0% of coronary angiography. Risk factors for CAE include atherosclerosis, previous percutaneous coronary interventions, arterial inflammation and connective tissue diseases. The diagnosis of CEA in a patient is a considerable diagnostic and therapeutic problem due to the unfavorable prognosis and the lack of guidelines. We present a case of a 69-year-old male patient with a history of retrosternal pain admitted to the clinic for the diagnosis of coronary artery disease. In coronary angiography, numerous ectases of the main coronary arteries and atherosclerotic lesions causing border stenosis of the left anterior descending (LAD), diagonal (2D) and marginal branch (OM). The heart team decided to assess the significance of the changes with the fractional flow reserve (FFR). The FFR was performed and haemodynamically insignificant stenoses of the ectatically dilated coronary arteries were found. The patient was qualified for conservative treatment. Full article

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2 pages, 542 KiB

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Breast Carcinomatous Lymphangitis as an Unusual Presentation of Ovarian Cancer

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Diagnostics 2021, 11(11), 2106; https://doi.org/10.3390/diagnostics11112106 - 14 Nov 2021

Viewed by 1485

Abstract

We describe the case of a 45-year-old woman with an unusual presentation of metastatic ovarian cancer. The patient presented to the oncological clinic with a three-week history of skin rash on the right breast. She underwent a chest and abdomen CT scan, which [...] Read more.

We describe the case of a 45-year-old woman with an unusual presentation of metastatic ovarian cancer. The patient presented to the oncological clinic with a three-week history of skin rash on the right breast. She underwent a chest and abdomen CT scan, which showed skin thickening of the right breast, right pleural effusion and bilateral cystic ovarian masses. Biopsy of a left ovarian lesion by diagnostic laparoscopy revealed the presence of ovarian serous carcinoma. Biopsy of the breast skin lesion revealed the presence of carcinomatous lymphangitis and immunohistochemistry documented the ovarian origin. Full article

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4 pages, 2652 KiB

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[⁶⁸Ga]Ga-NODAGA-E[(cRGDyK)]₂ Angiogenesis PET/MR in a Porcine Model of Chronic Myocardial Infarction

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Karina Poulsdóttir Debes

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Trine Pagh Ludvigsen

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Cecilie Bjørstrup Larsen

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Helle Hjorth Johannesen

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Thomas Jespersen

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Andreas Kjaer

Diagnostics 2021, 11(10), 1807; https://doi.org/10.3390/diagnostics11101807 - 30 Sep 2021

Cited by 4 | Viewed by 1889

Abstract

Angiogenesis is crucial in tissue repair and prevents scar tissue formation following an ischemic event such as myocardial infarction. The ischemia induces formation of new capillaries, which have high expression of integrin α_vβ₃. [⁶⁸Ga]Ga-NODAGA-E[(cRGDyK)]₂ ([⁶⁸ [...] Read more.

Angiogenesis is crucial in tissue repair and prevents scar tissue formation following an ischemic event such as myocardial infarction. The ischemia induces formation of new capillaries, which have high expression of integrin α_vβ₃. [⁶⁸Ga]Ga-NODAGA-E[(cRGDyK)]₂ ([⁶⁸Ga]Ga-RGD) is a promising PET-radiotracer reflecting angiogenesis by binding to integrin α_vβ₃. A Göttingen mini-pig underwent transient catheter-induced left anterior descending artery (LAD) occlusion for 120 min, and after 8 weeks was imaged on a Siemens mMR 3T PET/MR system. A large antero-septal infarction was evident by late gadolinium enhancement (LGE) on the short axis and 2–4 chamber views. The infarcted area corresponded to the area with high [⁶⁸Ga]Ga-RGD uptake on the fused PET/MR images, with no uptake in the healthy myocardium. To support the hypothesis that [⁶⁸Ga]Ga-RGD uptake reflects angiogenesis, biopsies were sampled from the infarct border and healthy myocardium. Expression of α_vβ₃ was evaluated using immunohistochemistry. The staining showed higher α_vβ₃ expression in the capillaries of the infarct border compared to those in the healthy myocardium. These initial data confirm in vivo detection of angiogenesis using [⁶⁸Ga]Ga-RGD PET in a translational model, which overall support the method applicability when evaluating novel cardio-protective therapies. Full article

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4 pages, 978 KiB

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Two Birds with One Stone: Skull Base Meningioma and Jugulotympanic Paragangliomas with Somatostatin Receptor Positron Emission Tomography

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Diagnostics 2021, 11(9), 1669; https://doi.org/10.3390/diagnostics11091669 - 13 Sep 2021

Viewed by 1344

Abstract

We describe the case of a 74-year-old female patient previously treated with radiation therapy for a meningioma of the skull base and with surgery for a right tympanic paraganglioma. After the morphological progression of the meningioma demonstrated by magnetic resonance imaging (MRI), the [...] Read more.

We describe the case of a 74-year-old female patient previously treated with radiation therapy for a meningioma of the skull base and with surgery for a right tympanic paraganglioma. After the morphological progression of the meningioma demonstrated by magnetic resonance imaging (MRI), the patient underwent somatostatin receptor positron emission tomography/computed tomography (SR-PET/CT) with Gallium-68 DOTATATE for restaging. This examination showed increased somatostatin receptor expression by the meningioma and confirmed its extension as already assessed by MRI (endocranial extension, skull base involvement and invasion of the right orbit). Furthermore, SR-PET/CT detected two small right jugulotympanic pararagangliomas with high somatostatin receptor expression. Lastly, SR-PET/CT demonstrated that this patient would be an ideal candidate for peptide receptor radionuclide therapy (PRRT) that can be used for the treatment of progressive/treatment-refractory meningiomas and relapsed paragangliomas with high somatostatin receptors expression, both conditions coexisting in this case. Full article

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5 pages, 3449 KiB

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Cell Proliferation PET Imaging with 4DST PET/CT in Colorectal Adenocarcinoma and Adenoma

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Ryogo Minamimoto

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Hisako Endo

Diagnostics 2021, 11(9), 1658; https://doi.org/10.3390/diagnostics11091658 - 10 Sep 2021

Viewed by 1313

Abstract

An age of 70-year-old man was incidentally found two focal high 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) uptake in the descending colon and in the sigmoid colon. We observed the feature of these two areas in the preplanned 4′-[methyl-11C]-thiothymidine (4DST) positron emission tomography (PET)/computed Tomography (CT)providing cell [...] Read more.

An age of 70-year-old man was incidentally found two focal high 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) uptake in the descending colon and in the sigmoid colon. We observed the feature of these two areas in the preplanned 4′-[methyl-11C]-thiothymidine (4DST) positron emission tomography (PET)/computed Tomography (CT)providing cell proliferation imaging. A mass forming high 4DST uptake in the descending colon and focal moderate 4DST uptake in the sigmoid colon was confirmed, and that were proven pathologically as adenocarcinoma and moderate to severe type tubular adenoma, respectively. This is the first report to present that colorectal adenoma can be visualized by proliferation PET imaging and the degree of uptake may enable discrimination of colorectal adenoma from adenocarcinoma, based on pathological considerations. Full article

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3 pages, 716 KiB

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An Incidental Pancreatic Finding at 18F-Choline PET/CT: Chronic Mass-Forming Pancreatitis

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Laura Evangelista

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Alessandro De Pellegrin

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Diagnostics 2021, 11(8), 1490; https://doi.org/10.3390/diagnostics11081490 - 17 Aug 2021

Viewed by 1784

Abstract

We present a case of a chronic mass-forming pancreatitis (CMFP) detected by 18F-choline (FCH) PET/CT in a male affected by prostate cancer. FCH PET/CT scan showed a focal uptake in the uncinate process of the pancreas, later diagnosed as a CMFP at biopsy. [...] Read more.

We present a case of a chronic mass-forming pancreatitis (CMFP) detected by 18F-choline (FCH) PET/CT in a male affected by prostate cancer. FCH PET/CT scan showed a focal uptake in the uncinate process of the pancreas, later diagnosed as a CMFP at biopsy. Although the physiological distribution of FCH in the pancreas, a careful interpretation of the images in this area is warranted. Full article

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4 pages, 1891 KiB

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Diagnostics 2021, 11(8), 1426; https://doi.org/10.3390/diagnostics11081426 - 06 Aug 2021

Cited by 2 | Viewed by 1731

Abstract

A 61-year-old man was referred for myocardial perfusion scintigraphy (MPS) by an occupational physician to exclude coronary artery disease (CAD). The patient had a complete left bundle branch block (LBBB) that rendered the routine exercise stress test non-diagnostic, but otherwise had no history [...] Read more.

A 61-year-old man was referred for myocardial perfusion scintigraphy (MPS) by an occupational physician to exclude coronary artery disease (CAD). The patient had a complete left bundle branch block (LBBB) that rendered the routine exercise stress test non-diagnostic, but otherwise had no history of heart diseases, good stress tolerance with no symptoms of angina, and no abnormalities in transthoracic echocardiogram, apart from contraction patterns typical for LBBB. Initial MPS, performed using technetium-labeled Sestamibi on a Discovery NM 530c camera equipped with solid-state semiconductor detectors, revealed a significant stress-induced ischemia that did not match the good overall condition of the patient. A motion detection procedure revealed significant heart motion in Z-axis during the stress study. Upon inquiry, the patient reported breathing difficulties caused by the mandatory mask, which slipped into an uncomfortable position during the study. Repeated acquisition, without motion artifacts, revealed no features of ischemia. Full article

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5 pages, 1326 KiB

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Evolution of ¹⁸F-FDG Uptake as a Pitfall of Image Diagnosis for Systemic Anaplastic Large Cell Lymphoma

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Hung Chang

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Wen-Yu Chuang

Diagnostics 2021, 11(8), 1387; https://doi.org/10.3390/diagnostics11081387 - 31 Jul 2021

Viewed by 1163

Abstract

In most patients, systemic anaplastic large cell lymphoma (sALCL) is an ¹⁸F-FDG-avid tumor. Both ALK-positive and ALK-negative tumors can be evaluated by PET scans as both tumor types uptake ¹⁸F-FDG in PET. The PET scan is also valuable in predicting prognosis [...] Read more.

In most patients, systemic anaplastic large cell lymphoma (sALCL) is an ¹⁸F-FDG-avid tumor. Both ALK-positive and ALK-negative tumors can be evaluated by PET scans as both tumor types uptake ¹⁸F-FDG in PET. The PET scan is also valuable in predicting prognosis during and after the treatment course. The evolution of ¹⁸F-FDG uptake in patients with sALCL has not been reported. For tumors lacking ¹⁸F-FDG uptake, there is a diagnostic pitfall of underestimating the cancer stage and misjudgment of metastases. In the present case, the PET scan results were negative at diagnosis but disseminated ¹⁸F-FDG avid lesions were found at relapse. Biopsy of bone marrow and lymph nodes revealed the pathological features were identical to the original tumor at the time of diagnosis. In the wake of such evolutional change, physicians dealing with sALCL should be cautious in interpretation of PET/CT scans. Full article

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4 pages, 1674 KiB

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A Rare Case of Primary Breast Osteosarcoma Evaluated with Multiple Modalities

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Diagnostics 2021, 11(7), 1170; https://doi.org/10.3390/diagnostics11071170 - 28 Jun 2021

Viewed by 1591

Abstract

Primary breast osteosarcoma (PBO) is very rare. This report presents a case of POB that was evaluated by multiple modalities. A woman in her 70s presented with a mass of increasing size in her right breast. A mammogram and an ultrasound visualized a [...] Read more.

Primary breast osteosarcoma (PBO) is very rare. This report presents a case of POB that was evaluated by multiple modalities. A woman in her 70s presented with a mass of increasing size in her right breast. A mammogram and an ultrasound visualized a lobulated mass containing coarse calcification in the right breast. Magnetic resonance imaging showed a strong enhancement effect and high signal on diffusion-weighted imaging. Further imaging on 18F-fluorodeoxyglucose positron-emission tomography and computed tomography exhibited a high uptake. A right total mastectomy was performed. Histologic examination revealed abundant periosteal formation, areas of calcification and moderately pleomorphic oval to spindle-shaped stromal cells, leading to the diagnosis of PBO. The presence of calcified breast tumors exhibiting aggressive growth indicates that PBO should be added to the differential diagnosis. Full article

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3 pages, 1072 KiB

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Active Herpes Zoster Mimicking Worsening of Axillary Lymph Node Metastases of Breast Cancer after Chemotherapy on 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography

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Diagnostics 2021, 11(6), 1085; https://doi.org/10.3390/diagnostics11061085 - 14 Jun 2021

Cited by 2 | Viewed by 2743

Abstract

A woman in her 60s presented to our hospital with a left breast mass that was diagnosed as breast cancer. 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) revealed intense, hot uptake in the cancerous mass and left axillary lymph node metastasis. After chemotherapy, another [...] Read more.

A woman in her 60s presented to our hospital with a left breast mass that was diagnosed as breast cancer. 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) revealed intense, hot uptake in the cancerous mass and left axillary lymph node metastasis. After chemotherapy, another PET/CT scan was performed. Although the mass and left axillary lymph nodes shrank and FDG uptake decreased, enlarged lymph nodes with high FDG uptake appeared in the right axilla. The patient had a painful vesicular eruption on the front to the back of the right upper hemithorax, which was diagnosed as active herpes zoster. Active herpes zoster mimics a worsening axillary lymph node metastasis on the PET/CT scan. Full article

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3 pages, 1102 KiB

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Clinical Application of Dynamic SPECT/CT in a Patient with Prior Myocardial Infarction Underwent Percutaneous Coronary Intervention Twice

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Diagnostics 2021, 11(6), 1028; https://doi.org/10.3390/diagnostics11061028 - 03 Jun 2021

Viewed by 1605

Abstract

We present a case of CAD with anteroseptal MI after stent insertion for revascularization due to symptoms presented. MPI with dynamic SPECT/CT provided useful information in terms of flow parameters and matched territories of stenting results as well as providing coronary artery flow [...] Read more.

We present a case of CAD with anteroseptal MI after stent insertion for revascularization due to symptoms presented. MPI with dynamic SPECT/CT provided useful information in terms of flow parameters and matched territories of stenting results as well as providing coronary artery flow phenomenon underwent PCI. In this case, dynamic SPECT/CT may minimize errors with proper stents treatment, especially for controversial MPI results. Full article

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3 pages, 661 KiB

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Sarcoid-Like Reaction in Non-Hodgkin’s Lymphoma—A Diagnostic Challenge for Deauville Scoring on ¹⁸F-FDG PET/CT Imaging

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Diagnostics 2021, 11(6), 1009; https://doi.org/10.3390/diagnostics11061009 - 31 May 2021

Cited by 2 | Viewed by 2028

Abstract

The sarcoid-like reaction represents an autoinflammatory cause of mediastinal and hilar lymphadenopathy but may also involve other lymph node regions and organs. This rare phenomenon has mainly been reported in patients with Hodgkin’s lymphoma (HL) or solid tumors (particularly melanoma) undergoing immunotherapy and [...] Read more.

The sarcoid-like reaction represents an autoinflammatory cause of mediastinal and hilar lymphadenopathy but may also involve other lymph node regions and organs. This rare phenomenon has mainly been reported in patients with Hodgkin’s lymphoma (HL) or solid tumors (particularly melanoma) undergoing immunotherapy and chemotherapy. Cases in non-Hodgkin’s lymphoma (NHL) are very uncommon. We present an uncommon case of a patient with primarily mediastinal diffuse large B-cell lymphoma (DLBCL) who showed a CT-based partial response in interim staging, whereas at end-of-treatment multiple newly enlarged and hypermetabolic mediastinal and bilateral hilar lymph nodes were detected by ¹⁸F-FDG PET/CT imaging. A subsequent histological workup determined a sarcoid-like reaction without any lymphomatous tissue. Therefore, sarcoid-like reactions should be considered as a potential pitfall in Deauville staging with ¹⁸F-FDG PET/CT imaging for patients with NHL. Full article

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4 pages, 1950 KiB

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Imaging of Fibrous Dysplasia Protuberans, an Extremely Rare Exophytic Variant of Fibrous Dysplasia

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Amin Haghighat Jahromi

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William F. James

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Michael D. Starsiak

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Eugene D. Silverman

Diagnostics 2021, 11(6), 1006; https://doi.org/10.3390/diagnostics11061006 - 31 May 2021

Viewed by 2196

Abstract

This paper details the case report of a 26-year-old man who presented with a growing right-sided skull mass evaluated with ultrasound, non-contrast CT, contrast-enhanced MRI and ^99mTc-MDP whole body bone scan with SPECT/CT. These studies suggested a broad differential diagnosis favoring benign [...] Read more.

This paper details the case report of a 26-year-old man who presented with a growing right-sided skull mass evaluated with ultrasound, non-contrast CT, contrast-enhanced MRI and ^99mTc-MDP whole body bone scan with SPECT/CT. These studies suggested a broad differential diagnosis favoring benign osseous lesions. Given a more recent increase in the rate of growth, headache and large size, the lesion was excised via craniotomy followed by cranioplasty. Pathology confirmed fibrous dysplasia (FD) as the diagnosis. Interestingly, this report is the imaging evaluation of the exophytic subtype of FD, the so-called FD protuberance, an extremely rare variant of FD, of which only two case reports are found in the literature. Full article

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4 pages, 1677 KiB

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A “Galactic” Chest X-ray

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Diagnostics 2021, 11(5), 899; https://doi.org/10.3390/diagnostics11050899 - 18 May 2021

Viewed by 2185

Abstract

Clinical manifestations accompanying respiratory failure with insidious and rapidly progressive onset are often non-specific. Symptoms such as a cough, dyspnea, and fever are common to a large number of inflammatory, infectious, or neoplastic diseases. During the COVID-19 pandemic it is essential to limit [...] Read more.

Clinical manifestations accompanying respiratory failure with insidious and rapidly progressive onset are often non-specific. Symptoms such as a cough, dyspnea, and fever are common to a large number of inflammatory, infectious, or neoplastic diseases. During the COVID-19 pandemic it is essential to limit the use of hospital services and inappropriate diagnostic techniques. A particular radiological pattern can orient the clinical and laboratory scenario and guide the diagnostic workup. A 58-year-old woman was admitted to our COVID-19 unit for suspected coronavirus infection. She was complaining of worsening dyspnea, tachycardia, and low grade fever. A chest X-ray showed diffuse, alveolar, and interstitial lung involvement with micronodules tending to coalescence. This radiographic pattern known as “galaxy sign”, consistent with diffuse, coalescing nodular miliary pulmonary involvement, simulating a non-specific alveolar opacification of the lungs is typical of a few pneumological differential diagnoses, represented by sarcoidosis, tuberculosis, pneumoconiosis, and metastatic lesions, and virtually excludes an interstitial viral pneumonitis. The use of endoscopic techniques can, in such cases, confirm the clinical suspicion for initiating appropriate targeted therapies. Full article

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3 pages, 15183 KiB

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Role of ¹¹C-Methionine PET/CT in ^99mTc-Sestamibi-Negative Parathyroid Adenoma: A Case Report

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Jang Yoo

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Miju Cheon

Diagnostics 2021, 11(5), 831; https://doi.org/10.3390/diagnostics11050831 - 04 May 2021

Viewed by 1632

Abstract

We report a case of 16-year-old female primary hyperparathyroidism patient who underwent cervical ultrasonography and ^99mTc-sestamibi single photon emission computed tomography/computed tomography, both of which were negative for parathyroid adenoma. Subsequent ¹¹C-methionine positron emission tomography/CT showed positive focal uptake suggesting parathyroid [...] Read more.

We report a case of 16-year-old female primary hyperparathyroidism patient who underwent cervical ultrasonography and ^99mTc-sestamibi single photon emission computed tomography/computed tomography, both of which were negative for parathyroid adenoma. Subsequent ¹¹C-methionine positron emission tomography/CT showed positive focal uptake suggesting parathyroid adenoma, which then was confirmed pathologically. Full article

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4 pages, 1446 KiB

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Pilomatrixcarcinoma of the Foot: A New Localization of an Extremely Rare Adnexal Tumour

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Diagnostics 2021, 11(5), 793; https://doi.org/10.3390/diagnostics11050793 - 28 Apr 2021

Cited by 1 | Viewed by 1487

Abstract

Pilomatrixcarcinoma is a very rare follicular neoplasm that shows matrical differentiation. The majority of these lesions originate de novo, while only a few cases of transformation of pilomatricoma (calcifying epithelioma of Malherbe) have been described in the literature. The neoplasm affects mostly middle-aged [...] Read more.

Pilomatrixcarcinoma is a very rare follicular neoplasm that shows matrical differentiation. The majority of these lesions originate de novo, while only a few cases of transformation of pilomatricoma (calcifying epithelioma of Malherbe) have been described in the literature. The neoplasm affects mostly middle-aged males with a male-to-female ratio of 3–4:1. The most common localizations are the face, head, trunk and extremites, though there are a few reports of pilomatrixcarcinoma of the eyelid, eyebrow, axilla and clitorid. Here, we describe the first case of a pilomatrixcarcinoma on the anterolateral surface of the first toe of the left foot of an 83-year-old patient, which developed in less than six months and led to amputation of the distal phalanx. We report a brief review of the current literature with particular emphasis on histopathological features useful for diagnosis. Full article

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4 pages, 2154 KiB

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Eosinophilic Cystitis Presenting as Possible Pediatric Rhabdomyosarcoma in Conventional Imaging Including ¹⁸F-FDG-PET/CT/MRI—A Rare Case

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Naja Enevold Olsen

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Marie Øbro Fosbøl

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Jorgen Thorup

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Helle Hjorth Johannesen

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Lise Borgwardt

Diagnostics 2021, 11(4), 672; https://doi.org/10.3390/diagnostics11040672 - 08 Apr 2021

Cited by 1 | Viewed by 2273

Abstract

Eosinophilic cystitis (EC) is a relatively rare, but benign inflammatory bladder disease compared to that of the malignant pediatric rhabdomyosarcoma (RMS), in which it can be mimicking on initial suspicion. The origin, symptoms and findings of both EC and RMS are still discussed [...] Read more.

Eosinophilic cystitis (EC) is a relatively rare, but benign inflammatory bladder disease compared to that of the malignant pediatric rhabdomyosarcoma (RMS), in which it can be mimicking on initial suspicion. The origin, symptoms and findings of both EC and RMS are still discussed and hence, lead to the challenge in distinguishing them by cystoscopy and several image modalities. We present a case in which cross-sectional imaging modalities including fluorine-18-fluro-2-deoxy-D-glucose (¹⁸F-FDG)-positron emission tomography (PET) / computed tomography (CT) / magnetic resonance imaging (MRI) (¹⁸F-FDG-PET/CT/MRI (The imaging modality ¹⁸F-FDG-PET/CT/MRI referring to two continuous scans scanned on the same ¹⁸F-FDG-tracer dose for both the whole-body ¹⁸F-FDG-PET/CT and the regional ¹⁸F-FDG-PET/MRI of the pelvis.)) raised suspicion of RMS. Hence, the final diagnosis of EC was established by repeated histopathology. It is important to have EC in mind when seeking differential diagnosis of malignant diseases like RMS in order to provide the correct treatment for the patient and highly homogenously increased ¹⁸F-FDG-uptake should raise the suspicion of EC as a differential diagnosis. Furthermore, ¹⁸F-FDG-uptake rate is suggested as a future potential biomarker for monitoring of therapeutic response in eosinophilic inflammatory diseases, thus more research on this topic is needed. Full article

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2 pages, 434 KiB

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A Case of Chronic Neutrophilic Leukemia Incidentally Detected by ¹⁸F-FDG PET/CT

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Diagnostics 2021, 11(4), 654; https://doi.org/10.3390/diagnostics11040654 - 05 Apr 2021

Viewed by 1802

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Chronic neutrophilic leukemia (CNL) is a rare, potentially aggressive, myeloproliferative neoplasm. To the best of our knowledge, there are no previous reports dealing with ¹⁸F-FDG PET findings in CNL. We describe a case of CNL in a 69-year-old male, imaged with ¹⁸ [...] Read more.

Chronic neutrophilic leukemia (CNL) is a rare, potentially aggressive, myeloproliferative neoplasm. To the best of our knowledge, there are no previous reports dealing with ¹⁸F-FDG PET findings in CNL. We describe a case of CNL in a 69-year-old male, imaged with ¹⁸F-FDG PET/CT at diagnosis and during treatment. Full article

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3 pages, 522 KiB

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Acute Necrotizing Encephalopathy in a Four-Year-Old Boy

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Cheng-Hsien Tsai

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Wei-Sheng Lin

Diagnostics 2021, 11(3), 568; https://doi.org/10.3390/diagnostics11030568 - 22 Mar 2021

Cited by 1 | Viewed by 2164

Abstract

Acute necrotizing encephalopathy is a devastating clinico-radiological syndrome characterized by fulminant neurological deterioration after an antecedent febrile illness, as well as the imaging hallmark of bilateral thalamic involvement. Herein, we describe a 4-year-old boy with typical clinical and neuroimaging features of acute necrotizing [...] Read more.

Acute necrotizing encephalopathy is a devastating clinico-radiological syndrome characterized by fulminant neurological deterioration after an antecedent febrile illness, as well as the imaging hallmark of bilateral thalamic involvement. Herein, we describe a 4-year-old boy with typical clinical and neuroimaging features of acute necrotizing encephalopathy. The bithalamic swelling led to a block of cerebrospinal fluid circulation at the foramen of Monro, thereby causing the mild dilatation of lateral ventricles. The periventricular areas could, therefore, have been potentially affected by the acute necrotizing encephalopathy per se and/or transependymal edema secondary to obstructive hydrocephalus. The information from diffusion imaging allows for differentiation between these two pathophysiological processes. Full article

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5 pages, 2417 KiB

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Left Ventricular Rupture as a Complication of Anterior Wall Myocardial Infarction on Computed Tomography Angiography and Ventriculography

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Diagnostics 2021, 11(3), 525; https://doi.org/10.3390/diagnostics11030525 - 16 Mar 2021

Viewed by 1823

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Rupture of the free wall of the left ventricle, rupture of the interventricular septum and acute mitral regurgitation are mechanical complications of myocardial infarction. They are rare; left ventricular rupture occurs in about 2–4% of patients with myocardial infarction. We present the case [...] Read more.

Rupture of the free wall of the left ventricle, rupture of the interventricular septum and acute mitral regurgitation are mechanical complications of myocardial infarction. They are rare; left ventricular rupture occurs in about 2–4% of patients with myocardial infarction. We present the case of an 85-year-old woman with an anterior wall infarction complicated by left ventricular rupture. We present diagnostic images of pathology visualized by computed tomography angiography, performed in order to exclude aortic dissection as the cause of the presence of fluid in the pericardial sac. Images from ventriculography are also presented. Summing up, during the diagnostic and therapeutic process of acute coronary syndrome, it is important to bear in mind the risk of possible complications, such as left ventricular rupture. Full article

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Acute Labyrinthitis Revealing COVID-19

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Diagnostics 2021, 11(3), 482; https://doi.org/10.3390/diagnostics11030482 - 09 Mar 2021

Cited by 21 | Viewed by 3862

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An 84-year-old man presented to the emergency department for acute vomiting associated with rotational vertigo and a sudden right sensorineural hearing loss. A left peripheral vestibular nystagmus was highlighted. The patient was afebrile, without respiratory signs or symptoms. Blood sampling at admission showed [...] Read more.

An 84-year-old man presented to the emergency department for acute vomiting associated with rotational vertigo and a sudden right sensorineural hearing loss. A left peripheral vestibular nystagmus was highlighted. The patient was afebrile, without respiratory signs or symptoms. Blood sampling at admission showed lymphopenia, thrombopenia and neutrophil polynucleosis, without elevation of C reactive protein. Cerebral magnetic resonance imaging eliminated a neurovascular origin. Vestibule, right semicircular canals and cochlear FLAIR hypersignals were highlighted, leading to the diagnosis of right labyrinthitis. A nasopharyngeal swab sampled at admission returned positive for SARS CoV2 by polymerase chain reaction. The etiologic investigation, including syphilitic and viral research, was otherwise negative. An oral corticotherapy (prednisone 70 mg daily) was introduced, followed by a progressive clinical recovery. Although acute otitis media have already been highlighted as an unusual presentation of COVID-19, radiology-proven labyrinthitis had to our knowledge, never been described to date. Full article

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4 pages, 957 KiB

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Neuroendocrine Differentiation of Prostate Cancer Is Not Systematically Associated with Increased 18F-FDG Uptake

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Diagnostics 2021, 11(3), 468; https://doi.org/10.3390/diagnostics11030468 - 08 Mar 2021

Cited by 5 | Viewed by 1685

Abstract

Neuroendocrine differentiation (NED) of prostate cancer represents an acknowledged predictor of resistant and more aggressive disease. NED can be functionally exploited in vivo using PET/CT imaging with somatostatin analogs radiolabeled with 68Ga. Many previous reports have shown that 18F-FDG PET/CT should also be [...] Read more.

Neuroendocrine differentiation (NED) of prostate cancer represents an acknowledged predictor of resistant and more aggressive disease. NED can be functionally exploited in vivo using PET/CT imaging with somatostatin analogs radiolabeled with 68Ga. Many previous reports have shown that 18F-FDG PET/CT should also be used in cases such as guiding management, as NED is systematically associated with increased glycolysis. We hereby discuss the case of a metastatic prostate cancer patient in which 68Ga-Dotatoc PET/CT revealed the occurrence of NED with low FDG-avidity. Full article

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5 pages, 4263 KiB

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Unraveling an Unusual Phenocopy of Hypertrophic Cardiomyopathy: MELAS Syndrome

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Diagnostics 2021, 11(2), 295; https://doi.org/10.3390/diagnostics11020295 - 12 Feb 2021

Cited by 1 | Viewed by 1807

Abstract

The mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is an uncommon cause of cardiac hypertrophy, fibrosis, and dysfunction. It shares similar features to numerous other causes of left ventricular hypertrophy, and therefore, because of its rarity, may not be immediately [...] Read more.

The mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is an uncommon cause of cardiac hypertrophy, fibrosis, and dysfunction. It shares similar features to numerous other causes of left ventricular hypertrophy, and therefore, because of its rarity, may not be immediately considered as a diagnosis. Prompt recognition of clinical and cardiac imaging features may expedite diagnosis and management. We report the case of a 38-year-old man admitted with neurological symptoms and in whom the diagnostic workup led to the diagnosis of MELAS syndrome with cardiac involvement. Full article

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5 pages, 5373 KiB

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Systemic Mastocytosis Associated with “Smoldering” Multiple Myeloma

by

Magda Zanelli

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Stefano Ricci

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Maurizio Zizzo

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Francesca Sanguedolce

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Diagnostics 2021, 11(1), 88; https://doi.org/10.3390/diagnostics11010088 - 07 Jan 2021

Cited by 10 | Viewed by 2164

Abstract

A 79-year-old woman presented with a long history of peripheral eosinophilia. Previous right hemicolectomy for colonic polyposis was reported. Laboratory tests were notable for mild macrocitic anaemia and eosinophilia. β2 microglobulin and serum tryptase levels were elevated. Serum immunofixation revealed IgA/kappa monoclonal protein. [...] Read more.

A 79-year-old woman presented with a long history of peripheral eosinophilia. Previous right hemicolectomy for colonic polyposis was reported. Laboratory tests were notable for mild macrocitic anaemia and eosinophilia. β2 microglobulin and serum tryptase levels were elevated. Serum immunofixation revealed IgA/kappa monoclonal protein. Bence-Jones protein was positive. Bone marrow (BM) biopsy revealed the coexistence of two neoplastic components. Cohesive clusters of bland-looking, spindle-shaped mast cells, representing 20% of marrow cellularity, were close to aggregates of mature plasma cells occupying 40% of marrow cellularity. Molecular analysis on marrow aspirate demonstrated KIT D816V mutation, TET2 mutation, monoallelic deletion of TP53/17p13 and trisomy of ATM/11q23. A bone density study revealed mild osteoporosis. Full skeletal X-rays and magnetic resonance imaging (MRI) of spine and hips showed multiple, small rarefaction areas and an old L1-L2 fracture, both ascribed to osteoporosis. The association of systemic mastocytosis (SM) and multiple myeloma (MM) is very uncommon. The coexistence of SM with MM placed our patient in the SM with associated clonal haematological non-mast-cell lineage disease (SM-AHN) subtype. Midostaurin therapy was started. Full article

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2020

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4 pages, 596 KiB

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Magnetic Resonance Imaging of Intramyocardial Fat Deposition in Tuberous Sclerosis

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Diagnostics 2020, 10(12), 1031; https://doi.org/10.3390/diagnostics10121031 - 01 Dec 2020

Viewed by 1688

Abstract

Tuberous sclerosis complex (TSC) is a rare autosomal dominant neurocutaneous syndrome. The phenotype is highly variable and may affect several organ systems, the hallmark of the disease being widespread hamartomas or abnormal growth of normal tissues. Although cardiac rhabdomyomas are the most common [...] Read more.

Tuberous sclerosis complex (TSC) is a rare autosomal dominant neurocutaneous syndrome. The phenotype is highly variable and may affect several organ systems, the hallmark of the disease being widespread hamartomas or abnormal growth of normal tissues. Although cardiac rhabdomyomas are the most common cardiac manifestation of TSC, being developed quite early, even during the second semester of the gestation, they tend to regress spontaneously over a period of months or years. On the other hand, the presence of intramyocardial fat deposition has been significantly associated with brain involvement and other extracardiac manifestations. We report the case of a 37-year-old man with TSC who presented to hospital with loss of consciousness, head injury and amnesia and in whom cardiac magnetic resonance imaging revealed the presence of multiple areas intramyocardial fat deposition. Full article

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4 pages, 5974 KiB

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¹⁸F-FDG PET/CT for Response Assessment in Pediatric Sebaceous Carcinoma of the Parotid Gland

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Adrien Holzgreve

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Thomas Pfluger

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Irene Schmid

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Orlando Guntinas-Lichius

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Diagnostics 2020, 10(11), 908; https://doi.org/10.3390/diagnostics10110908 - 06 Nov 2020

Cited by 2 | Viewed by 2173

Abstract

A 16-year-old male patient underwent ¹⁸F-FDG PET/CT staging after multiple surgical resections and radiotherapy of an uncommon metastatic pediatric sebaceous carcinoma of the parotid gland. Initial PET/CT imaging exhibited a recurrent paravertebral metastasis (C4) as well as a metabolically active tumor tissue [...] Read more.

A 16-year-old male patient underwent ¹⁸F-FDG PET/CT staging after multiple surgical resections and radiotherapy of an uncommon metastatic pediatric sebaceous carcinoma of the parotid gland. Initial PET/CT imaging exhibited a recurrent paravertebral metastasis (C4) as well as a metabolically active tumor tissue at the primary site. Follow-up PET/CT after radiotherapy of the cervical spine (C4) and four cycles of chemotherapy with cisplatin and palbociclib revealed complete functional remission in the cervical spine and partial remission at the primary site. This case illustrates the ¹⁸F-FDG-uptake behavior and the disease course of a very rare malignant epithelial tumor of the salivary glands. Full article

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4 pages, 7067 KiB

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Massive Relief: Papillary Adenoma of the Lung in Asymptomatic Former Smoker Patient

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Diagnostics 2020, 10(11), 906; https://doi.org/10.3390/diagnostics10110906 - 06 Nov 2020

Cited by 2 | Viewed by 2304

Abstract

Benign epithelial tumors of the lung are uncommon and can represent a diagnostic challenge. Herein, we describe one such emblematic case. A 59-year-old former smoker male was admitted to the hospital complaining of cough for a long time. A radiological examination showed a [...] Read more.

Benign epithelial tumors of the lung are uncommon and can represent a diagnostic challenge. Herein, we describe one such emblematic case. A 59-year-old former smoker male was admitted to the hospital complaining of cough for a long time. A radiological examination showed a centrally excavated mass strictly connected to the visceral pleura. The patient underwent tumorectomy. At gross examination, the tumor was composed of solid and cystic areas containing clear liquid. Histological examination highlighted a sub-pleural encapsulated tumor, with foci of capsular invasion, characterized by a single layer of columnar and cuboidal epithelial cells lining moderately cellular fibro-vascular cores. A wide spectrum of immunohistochemical markers was performed. The final diagnosis was suggestive of a peripheral pulmonary papillary tumor of undetermined malignant potential. At the last follow-up, six years after surgery, no recurrence or metastases were described. Reporting this case, we would like to point out the existence of these rare entities that should be taken into account in the diagnostic process, thus avoiding potential misdiagnosis. Moreover, the presence of capsular invasion should be better investigated in order to reconsider the exact terminology of the tumor and the classification of its malignant potential. Full article

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4 pages, 1757 KiB

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CT Findings in Negative Pressure Pulmonary Edema

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Adrien Holzgreve

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Matthias P. Fabritius

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Philippe Conter

Diagnostics 2020, 10(10), 749; https://doi.org/10.3390/diagnostics10100749 - 25 Sep 2020

Cited by 5 | Viewed by 2681

Abstract

Negative pressure pulmonary edema (NPPE) is a rare, potentially life-threatening, and yet diagnostically challenging perioperative complication. Most cases of NPPE occur in the context of anesthetic procedures, mainly caused by upper airway obstruction, and are diagnosed during the recovery period. We present a [...] Read more.

Negative pressure pulmonary edema (NPPE) is a rare, potentially life-threatening, and yet diagnostically challenging perioperative complication. Most cases of NPPE occur in the context of anesthetic procedures, mainly caused by upper airway obstruction, and are diagnosed during the recovery period. We present a case of fulminant NPPE in a patient during general anesthesia which illustrates the eye-catching CT findings that can occur in NPPE and eventually support diagnosis. With regard to the current pandemic, we include a discussion of the typical imaging patterns of COVID-19 as a radiological differential diagnosis of NPPE. A 42-year old male patient presented with sudden respiratory insufficiency during arthroscopic knee lavage and subsequently required highly invasive ventilation therapy and catecholamine administration. Postoperative CT imaging of the thorax exhibited extensive, centrally accentuated consolidations with surrounding ground-glass opacity in all lung lobes, suggestive of pulmonary edema. In view of the clinical course and the imaging findings, a negative pressure pulmonary edema (NPPE) was diagnosed. Full article

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3 pages, 1411 KiB

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Mesonephric Adenocarcinoma of the Uterine Fundus Exhibiting High ¹⁸F-FDG Uptake

by

Hyung Kyung Kim

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Kyu Yeoun Won

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Chanwoo Kim

Diagnostics 2020, 10(9), 729; https://doi.org/10.3390/diagnostics10090729 - 21 Sep 2020

Cited by 1 | Viewed by 2057

Abstract

Mesonephric adenocarcinoma is a rare tumor that is considered to develop from mesonephric remnants of the female genital tract. This tumor usually occurs in the lateral wall of the uterine cervix. Herein, we present an exceptionally rare case of mesonephric adenocarcinoma located in [...] Read more.

Mesonephric adenocarcinoma is a rare tumor that is considered to develop from mesonephric remnants of the female genital tract. This tumor usually occurs in the lateral wall of the uterine cervix. Herein, we present an exceptionally rare case of mesonephric adenocarcinoma located in the uterine fundus. The tumor exhibited intense hypermetabolism on ¹⁸F-FDG PET/CT. Based on the characteristic histologic features and immunohistochemical phenotypes, the diagnosis of mesonephric adenocarcinoma was confirmed. The patient underwent hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection, and no lymph node or distant metastasis was identified. After 20 months of surveillance without adjuvant therapy, she remains free of relapse. Full article

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5 pages, 2252 KiB

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Primary Cardiac Intimal Sarcoma Visualized on 2-[¹⁸F]FDG PET/CT

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Kim Francis Andersen

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Nahid Sharghi Someh

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Annika Loft

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Jane Maestri Brittain

Diagnostics 2020, 10(9), 718; https://doi.org/10.3390/diagnostics10090718 - 18 Sep 2020

Cited by 3 | Viewed by 2161

Abstract

Primary cardiac tumors are extremely rare, with an incidence of 0.001–0.03%. Twenty-five percent of these tumors are malignant, with sarcomas accounting for approximately 95%. Cardiac intimal sarcoma is the least reported subtype of primary cardiac sarcoma. These endocardial mesenchymal tumors most often arise [...] Read more.

Primary cardiac tumors are extremely rare, with an incidence of 0.001–0.03%. Twenty-five percent of these tumors are malignant, with sarcomas accounting for approximately 95%. Cardiac intimal sarcoma is the least reported subtype of primary cardiac sarcoma. These endocardial mesenchymal tumors most often arise from great arterial vessels, and are rarely located in the heart. They often present with an aggressive clinical course and have a poor prognosis, with surgical resection with achievement of free margins being the mainstay of treatment. This emphasizes the importance of an early, correct diagnosis and timely intervention. We report a 60-year-old Caucasian male with several former cardiac surgical procedures due to congenital aortic stenosis, presenting with functional mitral stenosis/insufficiency and left ventricular outflow tract obstruction (LVOTO) due to massive masses in the left ventricle and atrium of the heart. Hybrid imaging with 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission tomography/computed tomography (2-[¹⁸F]FDG PET/CT) was performed prior to surgery to characterize the intracardiac masses and estimate tumor burden, as well as to identify a potential extracardiac primary malignancy. Full article

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2 pages, 471 KiB

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Monostotic Fibrous Dysplasia Mimicking Metastasis in the Femoral Neck on Bone Scintigraphy and ¹⁸F-FDG PET/CT

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Diagnostics 2020, 10(9), 682; https://doi.org/10.3390/diagnostics10090682 - 10 Sep 2020

Cited by 1 | Viewed by 2975

Abstract

A 51-year-old woman who had lung adenocarcinoma was found to have a high uptake area over the right femoral neck by means of bone scintigraphy, suggesting a suspicious bony metastasis. ¹⁸F-FDG PET/CT was arranged, and showed an FDG-avid lesion in the same [...] Read more.

A 51-year-old woman who had lung adenocarcinoma was found to have a high uptake area over the right femoral neck by means of bone scintigraphy, suggesting a suspicious bony metastasis. ¹⁸F-FDG PET/CT was arranged, and showed an FDG-avid lesion in the same region. However, after augmented CT, a well-defined ground-glass lesion with circular calcification was found, which is the favored benign lesion of fibrous dysplasia. The following imaging of bone scintigraphy and ¹⁸F-FDG PET/CT presented no apparent change. This case demonstrates that the treatment scheme should not be solely guided by abnormalities in scintigraphy. Additional imaging is recommended for accurate staging or development of an appropriate treatment plan. Full article

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5 pages, 2044 KiB

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Brain Metastases Unresponsive to Immunotherapy Detected by 18F-FDG-PET/CT in a Patient with Melanoma

by

Rosa Fonti

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Sara Pellegrino

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Ciro Gabriele Mainolfi

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Elide Matano

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Silvana Del Vecchio

Diagnostics 2020, 10(6), 410; https://doi.org/10.3390/diagnostics10060410 - 17 Jun 2020

Cited by 4 | Viewed by 3489

Abstract

Recently, newer therapies such as immunotherapy have been increasingly used in the treatment of several tumors, including advanced melanoma. In particular, several studies showed that the combination of ipilimumab, an anti-Cytotoxic T-lymphocyte Associated Protein 4 (CTLA-4) monoclonal antibody and nivolumab, an anti-Programmed Death [...] Read more.

Recently, newer therapies such as immunotherapy have been increasingly used in the treatment of several tumors, including advanced melanoma. In particular, several studies showed that the combination of ipilimumab, an anti-Cytotoxic T-lymphocyte Associated Protein 4 (CTLA-4) monoclonal antibody and nivolumab, an anti-Programmed Death 1 (PD-1) monoclonal antibody, leads to improved survival in patients with metastatic melanoma. Despite that, immunotherapeutic agents may not reach therapeutic concentration in the brain due to the blood–brain barrier. We report the case of a 50-year-old man with advanced melanoma who underwent whole-body 18F-FDG-PET/CT before and after treatment with immunotherapy showing resistant brain metastases confirmed by subsequent MRI of the brain. Moreover, 18F-FDG-PET/CT was able to detect an immune-related adverse event such as enterocolitis that contributed to the worsening of patient conditions. This case shows how a whole-body methodology such as 18F-FDG-PET/CT can be useful in identifying melanoma cancer patients unresponsive to immunotherapy that may benefit from traditional palliative therapy in the effort to improve their quality of life. Full article

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4 pages, 607 KiB

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Dural Metastases of Advanced Prostate Cancer Detected by ¹⁸F-Fluorocholine

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Diagnostics 2020, 10(6), 385; https://doi.org/10.3390/diagnostics10060385 - 08 Jun 2020

Viewed by 3002

Abstract

Prostate cancer with extensive dural metastases is very rare, with only few cases described in the literature. We report one such case of a 74-year-old man with advanced prostate cancer, and in relatively good clinical condition. The patient returned with complaints of headache [...] Read more.

Prostate cancer with extensive dural metastases is very rare, with only few cases described in the literature. We report one such case of a 74-year-old man with advanced prostate cancer, and in relatively good clinical condition. The patient returned with complaints of headache and diplopia. Fluorocholine (¹⁸F) chloride (¹⁸F-FCH) is an analog of choline in which a hydrogen atom has been replaced by fluorine (¹⁸F). After crossing the cell membrane by a carrier-mediated mechanism, choline is phosphorylated by choline kinase to produce phosphorylcholine. ¹⁸F-FCH positron emission tomography–computed tomography (PET/CT) is widely used to stage and restage patients affected by prostate cancer with good sensitivity. ¹⁸F-FCH PET/CT showed disease progression with the onset of multiple skull lesions. Numerous suspicious dural hypermetabolic lesions indicating neoplastic involvement were detected along the fronto-parietal convexities, in the left fronto-orbital region and right lateral wall of the orbit, concerning for metastases in these regions. A contrast-enhanced computed tomography (CECT) scan was performed which showed corresponding enhancing tissue which correlated with the PET findings. The final imaging diagnosis was osteo-dural metastases from prostate cancer associated with poor outcome. Awareness of this pattern of metastases may be of clinical relevance in order to avoid unnecessary invasive diagnostic procedures in groups of patients with a dismal prognosis. Full article

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4 pages, 1082 KiB

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Diagnosis of Dizziness Due to a Core Vestibular Projection Injury in a Patient with Intracerebral Hemorrhage

by

Hyeok Gyu Kwon

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Chul Hoon Chang

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Sung Ho Jang

Diagnostics 2020, 10(4), 220; https://doi.org/10.3390/diagnostics10040220 - 15 Apr 2020

Cited by 4 | Viewed by 2909

Abstract

Herein, we present a patient diagnosed with dizziness due to a core vestibular projection injury following intracerebral hemorrhage (ICH). A 51-year-old female patient underwent conservative management for a spontaneous ICH in the left hemisphere (mainly affecting the basal ganglia and insular cortex). When [...] Read more.

Herein, we present a patient diagnosed with dizziness due to a core vestibular projection injury following intracerebral hemorrhage (ICH). A 51-year-old female patient underwent conservative management for a spontaneous ICH in the left hemisphere (mainly affecting the basal ganglia and insular cortex). When she visited the rehabilitation department of the university hospital at two years after the ICH onset, she advised of the presence of moderate dizziness (mainly, light-headedness) that started after ICH onset. She mentioned that her dizziness had decreased slightly over time. No abnormality was observed in the vestibular system of either ear on physical examination by an otorhinolaryngologist. However, diffusion tensor tractography results showed that the core vestibular projection in the left hemisphere was discontinued at the basal ganglia level compared with the patient’s right core vestibular projection and that of a normal subject. Therefore, it appears that the dizziness in this patient can be ascribed to a left core vestibular projection injury. Full article

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3 pages, 587 KiB

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“Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation

by

Wonho Lee

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Mathieu Boudier-Revéret

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Du Hwan Kim

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Min Cheol Chang

Diagnostics 2020, 10(4), 185; https://doi.org/10.3390/diagnostics10040185 - 27 Mar 2020

Cited by 2 | Viewed by 2387

Abstract

A 77-year-old woman having back pain due to an L2 vertebral body compression fracture took a lumbar spine magnetic resonance imaging (MRI). In MRI, in addition to the L2 vertebral body fracture, invagination of the small intestine into the intervertebral disc space at [...] Read more.

A 77-year-old woman having back pain due to an L2 vertebral body compression fracture took a lumbar spine magnetic resonance imaging (MRI). In MRI, in addition to the L2 vertebral body fracture, invagination of the small intestine into the intervertebral disc space at L5-S1 was found by chance. On a lateral lumbar spinal X-ray, the lordotic angle was markedly increased at the L5-S1 level. Additionally, the L5-S1 disc space had widened. These X-ray findings indicate the segmental instability at L5-S1. The spinal fusion operation on L3-4-5 seems to have resulted in overt mechanical loading on the inferior spinal segment (L5-S1). We think the instability damaged the anterior longitudinal ligament and caused a tear in the anterior portion of the annulus fibrosus. The defect in the L5-S1 intervertebral disc after the tear would have caused the vacuum, which is presumed to have pulled the patient’s small intestine into the empty space within the L5-S1 intervertebral disc. Although intervertebral invagination of intra-abdominal structures is not common, clinicians should be aware of the possibility of this complication in patients who have spinal segmental instability. Full article

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