Acute bilateral macular necrosis in a young healthy patient without herpetic virus infection: sequential multimodal imaging features

Background: Mass-Forming Chronic Pancreatitis (MFCP) is rare. Moreover, atypical MFCP is difficult to differentiate from Pancreatic Carcinoma (PC) in clinical manifestations, laboratory, and imaging examinations. Diagnosis could be supported by the pathological findings of focal inflammatory fibrosis without evidence of tumor in the pancreas. Case summary: A 52-year-old man had acute pancreatitis twice over 7 months. Amylase and lipase levels were three times higher than the normal range without any clinical symptoms. At the 6th month, the patient lost 15 kg of weight, and abdominal ultrasonography revealed pancreatic head space occupied. All the findings in multimodal imaging including computed tomography image, Magnetic Resonance (MR) imaging with MR cholangiopancreatography, and 18F-FDG positron emission tomography/computed tomography showed an irregular nodule with low density, low signal, and low echo in the head of the pancreas, which were lower than those in the normal pancreatic tissue. The proximal main pancreatic duct was truncated and stenosed, and the distal duct was dilated. Subsequently, he developed progressive painless jaundice, and the specific tumor marker levels were increased. Most of these manifestations were suggestive of the pancreatic malignant tumor; however, multiple specimen pathological findings obtained from laparotomy and endoscopic ultrasonography-guided fine-needle aspiration revealed focal chronic inflammation, fibrosis, and necrosis. Conclusion: This report describes a case of atypical MFCP mimicking PC at clinical presentation and laboratory findings, especially in multimodal imaging. However, the combination of atypical multimodal imaging features, which support MFCP rather than PC, and endoscopic ultrasonography-guided fine-needle aspiration are useful for improving the diagnostic rate of atypical MFCP and avoiding unnecessary surgery.

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Diffuse infiltrating retinoblastoma: A diagnostic conundrum

IP International Journal of Ocular Oncology and Oculoplasty ◽

10.18231/j.ijooo.2021.040 ◽

2021 ◽

Vol 7 (2) ◽

pp. 204-206

Author(s):

Harsha Bhattacharjee ◽

Aditi Mehta ◽

Dipankar Das ◽

Kasturi Bhattacharjee ◽

Manabjyoti Barman ◽

...

Keyword(s):

Family History ◽

Multimodal Imaging ◽

Positive Family History ◽

Neovascular Glaucoma ◽

Exudative Retinal Detachment ◽

Imaging Features ◽

Diagnostic Challenge ◽

Progressive Loss ◽

History Of ◽

High Index Of Suspicion

Diffuse infiltrating retinoblastoma (DIR) is characterized by absence of intraocular mass, lack of calcification. It may mimic inflammatory uveitis or exudative retinopathy. An eight-years-old boy presented with progressive loss of vision in left eye. Clinical evaluation revealed neovascular glaucoma with a yellow–gray fundal glow, exudative retinal detachment, subretinal exudation and telangiectatic vessels. The presentation was consistent with exudative retinopathy (Coat’s disease) but for the presence of a family history of retinoblastoma in the younger sibling. Despite the absence of an intraocular mass or calcification on multimodal imaging, the enucleation was done on the basis of clinical suspicion of retinoblastoma. Histopathology confirmed a diagnosis of DIR.: DIR can pose a diagnostic challenge due to its non-characteristic clinical and imaging features and atypical presentation. A high index of suspicion along with a positive family history was key to diagnosis in our case; histopathology was confirmatory.

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Indocyanine green angiography imaging findings in artery occlusions

European Journal of Ophthalmology ◽

10.1177/11206721211037832 ◽

2021 ◽

pp. 112067212110378

Author(s):

Ramesh Venkatesh ◽

Nikitha Gurram Reddy ◽

Vishma Prabhu ◽

Pukhraj Rishi ◽

Arpitha Pereira ◽

...

Keyword(s):

Indocyanine Green ◽

Multimodal Imaging ◽

Indocyanine Green Angiography ◽

Retinal Vessel ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Imaging Features ◽

Retinal Artery ◽

Choroidal Perfusion ◽

Rouleaux Formation

Purpose: To describe the multimodal imaging features including indocyanine green angiography (ICGA) in cases diagnosed clinically as central retinal artery occlusion (CRAO) at its different disease stages. Methods: In this retrospective observational study, patients diagnosed clinically as CRAO or hemi-CRAO were included. All patients underwent multimodal imaging with optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were studied. Analysis of ICGA images in different stages of artery occlusions and its correlation with accompanying FFA and OCT images was done. Results: Eight such studies in five patients were available for analysis. The most important observation noted on ICGA was the presence of hypercyanescent spots seen during the acute stages of the disease in four of the five cases. The spots were accompanied by retinal vessel staining on FFA in the corresponding region. As the disease showed signs of resolution, the hypercyanescent spots on ICGA and retinal vessel staining on FFA disappeared. The hypercyanescent spots seen on the ICGA were noted due to the red blood cell aggregation or ‘rouleaux’ formation. In addition, choroidal perfusion abnormalities were noted on ICGA in all five cases in the acute stage. Conclusion: Choroidal perfusion changes can be identified in acute phase of retinal artery occlusion. Rouleaux formation in the retinal circulation occurs due to the slowing of the blood flow following artery occlusion. These are seen as hypercyanescent spots in the late phase on ICGA.

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Noninvasive multimodal imaging in diagnosing polypoidal choroidal vasculopathy

BMC Ophthalmology ◽

10.1186/s12886-019-1244-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Jingyuan Yang ◽

Mingzhen Yuan ◽

Erqian Wang ◽

Song Xia ◽

Youxin Chen

Keyword(s):

Polypoidal Choroidal Vasculopathy ◽

Multimodal Imaging ◽

High Sensitivity ◽

Age Related Macular Degeneration ◽

Fundus Photography ◽

Diagnostic Strategy ◽

Imaging Features ◽

Imaging Methods ◽

Age Related ◽

Choroidal Vasculopathy

Abstract Purpose To investigate the diagnostic accuracy of noninvasive multimodal imaging methods in diagnosing polypoidal choroidal vasculopathy (PCV) and distinguishing PCV from typical neovascular age-related macular degeneration (nvAMD). Methods Retrospective study. Imaging features of noninvasive multimodal imaging methods, including fundus photography (FP), B-scan optical coherence tomography (OCT), en face OCT, OCT angiography, and autofluorescence, of 103 eyes with PCV or typical nvAMD were reviewed. Diagnostic strategy was established based on imaging features and was validated in other 105 eyes with PCV or typical nvAMD. Results Features of subretinal orange nodule on FP, thumb-like PED on OCT, notched PED on OCT, bubble sign on OCT, and Bruch’s membrane depression under serosanguinous PED on OCT were more common. When the diagnostic strategy of using at least 2 of 5 features was performed, there is 0.88 sensitivity and 0.92 specificity for diagnosing PCV. The results of the validation test further confirmed the diagnostic strategy with 0.94 sensitivity and 0.93 specificity. Conclusions Noninvasive multimodal imaging, especially FP and B-scan OCT, provide high sensitivity and specificity for diagnosing PCV and distinguishing PCV from typical nvAMD, when at least 2 of 5 suggestive imaging features are present.

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Multimodal imaging of Hurler syndrome-related keratopathy treated with deep anterior lamellar keratoplasty

BMC Ophthalmology ◽

10.1186/s12886-020-01689-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Elodie Da Cunha ◽

Cristina Georgeon ◽

Nacim Bouheraoua ◽

Marc Putterman ◽

Françoise Brignole-Baudouin ◽

...

Keyword(s):

Visual Acuity ◽

Multimodal Imaging ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Imaging Features ◽

Hurler Syndrome ◽

Hematopoietic Stem ◽

First Choice ◽

Anterior Lamellar Keratoplasty ◽

Sd Oct

Abstract Background Hurler syndrome-associated keratopathy is an exceedingly rare corneal disorder that requires corneal transplantation in advanced stages. Precise assessment of the corneal condition is necessary for deciding which type of keratoplasty (i.e., deep anterior lamellar or penetrating) should be proposed. We aimed to confront the results of multimodal imaging with those of histology in a case of Hurler syndrome-associated keratopathy. Case presentation A 16-year-old patient with Hurler’s syndrome treated with hematopoietic stem cell transplantation was referred for decreased vision related to advanced keratopathy. The patient was treated with deep anterior lamellar keratoplasty (DALK) in both eyes with uncomplicated outcome. Visual acuity improved from 0.1 (20/200) preoperatively to 0.32 (20/63) and 0.63 (20/32) after transplantation. The corneal endothelial cell density was 2400 cells/mm2 in both eyes 3 years after transplantation. In vivo confocal microscopy (IVCM) and spectral domain optical coherence tomography (SD-OCT) were performed preoperatively. The corneal buttons retrieved during keratoplasty were processed for histology. In SD-OCT scans, corneal opacities appeared as diffuse stromal hyperreflectivity associated with increased corneal thickness. IVCM showed diffuse cytoplasmic granular hyperreflectivity and rounded/ellipsoid aspects of keratocytes, presence of small intracellular vacuoles, and hyperreflective epithelial intercellular spaces. Bowman’s layer was thin and irregular. The corneal endothelium was poorly visualized but no endothelial damage was observed. Histology showed irregular orientation and organization of stromal lamellae, with the presence of macrophages whose cytoplasm appeared clear and granular. A perinuclear clear halo was visible within the epithelial basal cells. Bowman’s layer featured breaks and irregularities. Conclusions The observed corneal multimodal imaging features in mucopolysaccharidosis-related keratopathy were concordant with histology. Compared with standard histology, multimodal imaging allowed additional keratocyte features to be observed. It revealed both morphological and structural changes of all corneal layers but the endothelium. This information is essential for therapeutic management which should include DALK as the first-choice treatment in case of impaired visual acuity.

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Multimodal imaging of amelanotic choroidal melanoma

European Journal of Ophthalmology ◽

10.1177/1120672120936182 ◽

2020 ◽

pp. 112067212093618

Author(s):

Luisa Pierro ◽

Alessandro Arrigo ◽

Emanuela Aragona ◽

Francesco Bandello

Keyword(s):

Optical Coherence Tomography ◽

Blood Vessels ◽

Malignant Tumor ◽

Multimodal Imaging ◽

Optical Coherence Tomography Angiography ◽

Complex Structure ◽

Choroidal Melanoma ◽

Relevant Information ◽

Vascular Network ◽

Imaging Features

Amelanotic choroidal melanoma (ACM) is an extremely rare malignant tumor affecting the uvea. Because of the complex structure characterizing this kind of lesions, its morphologic features are partially understood, especially if looking to its vascular network. In this paper, we described in details the multimodal imaging features of ACM. Moreover, we disclosed new insights about different orders of blood vessels characterizing this tumor. Despite the entire vascular network is partially detectable by conventional dye-based angiography, it was reconstructed in its entirety by means of optical coherence tomography angiography. In conclusion, multimodal imaging represents a feasible and useful set of tools, able to describe in deep ACM features and its vascular network organization, and to provide clinically relevant information for ACM management.

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Multimodal imaging features of intraocular foreign bodies

Seminars in Ophthalmology ◽

10.1080/08820538.2019.1674894 ◽

2019 ◽

Vol 34 (7-8) ◽

pp. 518-532 ◽

Cited By ~ 2

Author(s):

Andrew J. Rong ◽

Kenneth C. Fan ◽

Behrad Golshani ◽

Matthew Bobinski ◽

John P. McGahan ◽

...

Keyword(s):

Multimodal Imaging ◽

Foreign Bodies ◽

Imaging Features

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Choroidal neovascular membranes secondary to intraocular tuberculosis misdiagnosed as neovascular age-related macular degeneration

European Journal of Ophthalmology ◽

10.5301/ejo.5001047 ◽

2017 ◽

Vol 28 (2) ◽

pp. 216-224 ◽

Cited By ~ 3

Author(s):

Alessandro Invernizzi ◽

Aniruddha Agarwal ◽

Maura Di Nicola ◽

Fabio Franzetti ◽

Giovanni Staurenghi ◽

...

Keyword(s):

Macular Degeneration ◽

Choroidal Neovascularization ◽

Multimodal Imaging ◽

Age Related Macular Degeneration ◽

Enhanced Depth Imaging ◽

Fundus Photography ◽

Imaging Features ◽

Neovascular Amd ◽

Age Related ◽

Intraocular Tuberculosis

Purpose: Intraocular tuberculosis (IOTB) can be complicated by choroidal neovascularization (CNV). However, when the CNV development is not accompanied by clear signs of inflammation, the etiology can be missed, especially in countries nonendemic for tuberculosis. We describe the clinical and imaging features of CNVs presenting as the first sign of IOTB initially misdiagnosed as exudative age-related macular degeneration (AMD). Methods: A retrospective review of clinical and imaging data of patients initially misdiagnosed with neovascular AMD later diagnosed with inflammatory CNV secondary to IOTB at tertiary referral centers was conducted. Features of fundus photography, fluorescein angiography, indocyanine green angiography, and enhanced depth imaging optical coherence tomography were analyzed. Distinguishing features between neovascular AMD and IOTB-associated CNV were evaluated. Results: Five patients over 55 years of age, erroneously diagnosed with exudative AMD, were included in the study. Multimodal imaging analysis allowed identification of peculiar choroidal alterations such as choroidal granulomas or choroiditis suggestive for posterior uveitis. Systemic workup for granulomatous uveitis including immunologic investigations such as tuberculin skin test or QuantiFERON TB Gold® and radiologic investigations revealed tubercular etiology in all the cases, allowing correct diagnosis and management of the uveitis and related CNV. Conclusions: Choroidal neovascularization represents a rare and unusual presenting sign of IOTB that can be misleading especially when it occurs in the elderly living in countries with low prevalence of the disease. Multimodal imaging can be helpful and should be employed, especially in atypical cases of CNV, in order to avoid misdiagnosis and/or diagnostic delays.

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