Cystic retroperitoneal metastasis from testicular seminoma, radiologically mimicking as lymphangioma

Background Retroperitoneal nodal metastasis in a primary testicular tumor is not uncommon and usually presents as solid or solid-cystic nodal masses. A completely cystic appearance with fluid attenuation or fluid signal intensity on computed tomography (CT) and magnetic resonance imaging (MRI), respectively, is an uncommon presentation. There are many case reports of different types of cystic retroperitoneal masses; however, to our knowledge, metastatic retroperitoneal cystic masses showing fluid attenuation/fluid signal intensity on CT/ MRI secondary to primary testicular seminoma masquerading as cystic lymphangioma has been rarely reported in the medical literature. Our case report reports a case of a metastatic retroperitoneal cystic mass in a known case of testicular seminoma patient, which was misdiagnosed as cystic lymphangioma initially based on imaging. Case presentation A 55-year-old—patient presented to our hospital with abdominal pain, which was on and off in character. The patient underwent routine ultrasound abdomen, CT and MRI, which revealed multiple cystic lesions in the retroperitoneum. Initially, a provisional diagnosis of cystic lymphangioma was made based on the utterly cystic nature of the lesion and the presence of calcification. However, fine-needle aspiration cytology (FNAC) confirmed the metastatic origin of the lesion and was strengthened by the previous clinical history of orchidectomy. Conclusion The treatment strategy for cystic retroperitoneal masses varies depending on the cause and its nature, so differentiation between the cystic masses is essential. Metastasis should also be kept in the differentials in all cystic retroperitoneal masses. Moreover, clinical history and FNAC can assist in making the correct diagnosis.

Juxtaglomerular cell tumour of the kidney: a rare cause of resistant hypertension

Summary Juxtaglomerular cell tumour (JGCT) is an unusually encountered clinical entity. A 33-year-old man with severe long-standing hypertension and hypokalaemia is described. The patient also suffered from polyuria, polydipsia, nocturia and severe headaches. On admission, laboratory investigation revealed hypokalaemia, kaliuresis, high aldosterone and renin levels, and the abdomen CT identified a mass of 4 cm at the right kidney. Kidney function was normal. Following nephrectomy, the histological investigation revealed the presence of a JGCT. Immunostaining was positive for CD34 as well as for smooth muscle actin and vimentin. Following surgery, a marked control of his hypertension with calcium channel blockers and normalization of the serum potassium, renin or aldosterone levels were reached. According to our findings, JGCT could be included in the differential diagnosis of secondary hypertension as it consists of a curable cause. The association of JGCT with hypertension and hypokalaemia focusing on the clinical presentation, diagnostic evaluation and management is herein discussed and a brief review of the existing literature is provided. Learning points Juxtaglomerular cell tumours (JGCT), despite their rarity, should be included in the differential diagnosis of secondary hypertension as they consist of a curable cause of hypertension. JGCT could be presented with resistant hypertension along with hypokalaemia, kaliuresis and metabolic alkalosis. Early recognition and management can help to prevent cardiovascular complications. Imaging (enhanced CT scans) may be considered as the primary diagnostic tool for the detection of renal or JGCT. For the confirmation of the diagnosis, a histopathologic examination is needed.

Multisystem inflammatory syndrome in children associated with SARS-CoV-2: extracardiac radiological findings

Objective: Multisystem inflammatory syndrome in children (MIS-C) is seen as a serious delayed complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to describe the most common imaging features of MIS-C associated with SARS-CoV-2. Methods: A retrospective review was made of the medical records and radiological imaging studies of 47 children (26 male, 21 female) in the age range of 25 months–15 years who were diagnosed with MIS-C between August 2020 and March 2021. Chest radiographs were available for all 47 patients, thorax ultrasound for 6, chest CT for 4, abdominal ultrasound for 42, abdomen CT for 9, neck ultrasound for 4, neck CT for 2, brain CT for 1, and brain MRI for 3. Results: The most common finding on chest radiographs was perihilar–peribronchial thickening (46%). The most common findings on abdominal ultrasonography were mesenteric inflammation (42%), and hepatosplenomegaly (38%, 28%). Lymphadenopathy was determined in four patients who underwent neck ultrasound, one of whom had deep neck infection on CT. One patient had restricted diffusion and T2 hyperintensity involving the corpus callosum splenium on brain MRI, and one patient had epididymitis related with MIS-C. Conclusion: Pulmonary manifestations are uncommon in MIS-C. In the abdominal imaging, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites and bowel wall thickening are the most common findings. Advances in knowledge: The imaging findings of MIS-C are non-specific and can mimic many other pathologies. Radiologists should be aware that these findings may indicate the correct diagnosis of MIS-C.

Adrenal incidentaloma: prevalence and referral patterns from routine practice in a large UK university teaching hospital

Context Adrenal incidentalomas are increasingly being identified during unrelated imaging. Unlike AI clinical management, data on referral patterns in routine practice are lacking. Objective To identify factors associated with AI referral Design We linked data from imaging reports and outpatient bookings from a large UK teaching hospital. We examined; (i) AI prevalence and (ii) pattern of referral to endocrinology, stratified by age, imaging modality, scan anatomical site, requesting clinical specialty and temporal trends. Patients Utilising key radiology phrases to identify scans reporting potential AI, we identified 4,097 individuals from 479,945 scan reports (2015-19). Main Outcome Measures Prevalence of AI and referral rates Results Overall, AI lesions were identified in 1.2% of scans. They were more prevalent in abdomen CT and MRI scans (3.0% and 0.6%, respectively). Scans performed increased 7.7% year-on-year from 2015-19, with a more pronounced rise in the number with AI lesions (14.7% pa). Only 394/4097 patients (9.6%) had a documented endocrinology referral code within 90 days, with medical (11.8%) more likely to refer than surgical (7.2%) specialties (p<0.001). Despite prevalence increasing with age, older patients were less likely to be referred (p<0.001). Conclusions While overall AI prevalence appeared low, scan numbers are large and rising; the number with identified AI are increasing still further. The poor AI referral rates, even in centres such as ours where dedicated AI multi-disciplinary team meetings and digital management systems are used, highlights the need for new streamlined, clinically-effective systems and processes to appropriately manage the AI workload.

Lebereigene Tumoren – Hepatozelluläres und das Cholangiozelluläre Karzinom

Zusammenfassung. Lebertumoren werden häufig als Zufallsbefund in der Sonographie entdeckt. Weiterführende Diagnostik sind das MRT mit Gadolinium-Kontrastmittel oder das 3-Phasen-Abdomen-CT. Auf eine Biopsie bei einem Leberrundherd kann bei genauer Kenntnis der radiologischen und klinischen Präsentation verzichtet werden. Patienten mit Lebereigenen Tumoren und / oder unklaren Befunden sollten in einem Leberzentrum vorgestellt werden. Nur die chirurgisch-onkologische R0-Resektion ist kurativ.

UNUSUAL PRESENTATION OF REACTIVE ARTHRITIS AFTER SALMONELLA ENTERITIS IN A 6-YEAR-OLD BOY

ABSTRACT: Reactive arthritis, formerly called Reiter’s syndrome is extra-articular oligoarthropathy, which can be due to bacterial infection or genetic predisposition. The infections are either urogenital (chlamydia being most notorious) or gastrointestinal (e.g. salmonella, yersinia, etc.). The human leukocyte antigen (HLA-B27) antigen has been implicated as the most common predisposing factor. Reactive arthritis often involves the joints of the lower limb. Bacterial enteric infections are a potential threat in a Pediatric population that can be due to an acute illness or its sequelae. Reactive arthritis following outbreaks of enteric infections with Salmonella is uncommon in the pediatric population. We report a rare case of a 6 years old boy who came to ER with high-grade fever and severe pain in the right iliac fossa. Clinical diagnosis of appendicitis was made by the physicians on physical exam but after radio-pathological investigation like CBC, ESR, CRP, Blood culture, USG abdomen, CT abdomen, and MRI, diagnosis of reactive arthritis secondary to salmonella enteritis was made and the patient underwent right hip arthrotomy after which he was discharged. Thus, imaging played a pivotal role in the right diagnosis of a patient with proper management guidelines. This also showed that salmonella enteritis can present atypically mimicking septic arthritis or acute appendicitis. Reactive arthritis after salmonella infection is a very rare and one of its kind case reported in Pakistan.

Breast Carcinomatous Lymphangitis as an Unusual Presentation of Ovarian Cancer

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.

Impacts of Phantom Off-Center Positioning on CT Numbers and Dose Index CTDIv: An Evaluation of Two CT Scanners from GE

The purpose of this work is to evaluate the impacts of body off-center positioning on CT numbers and dose index CTDIv of two scanners from GE. HD750 and APEX scanners were used to acquire a PBU60 phantom of Kagaku and a 062M phantom of CIRS respectively. CT images were acquired at various off-center positions under automatic tube current modulation using various peak voltages. CTDIv were recorded for each of the acquisitions. An abdomen section of the PBU60 phantom was used for CT number analysis and tissue inserts of the 062M phantom were filled with water balloons to mimic the human abdomen. CT numbers of central regions of interests were averaged using the Fiji software. As phantoms were lifted above the iso-center, both CTDIv and CT numbers were increased for the HD750 scanner whilst they were approximately constant for the APEX scanner. The measured sizes of anterior-posterior projection images were also increased for both scanners whilst the sizes of lateral projection images were increased for the HD750 scanner but decreased for the APEX scanner. Off-center correction algorithms were implemented in the APEX scanner. Matching the X-ray projection center with the system’s iso-center could improve the accuracy of CT imaging.

The potential cancer risk on body organs as abdomen CT-scan exposure result

Research has been carried out on the Potential Risk of Cancer in Body Organs Due to Abdomen CT Scan Radiation. The use of a CT-Scan tool that emits radiation has the potential to have quite a serious impact. An abdominal CT-Scan is one part of the examination that is often done because in that section many organs are very vital. The organs found in the abdomen include the liver, spleen, stomach, intestines, kidneys, gonads, pancreas, bladder, and ureters. The study used data on abdominal CT-Scan patients at Sanglah Hospital Denpasar, in the age range from 41 years to 56 years without distinguishing gender. From the CT-Scan data, the CTDIVol and DLP values ??of each patient can be taken. Furthermore, it is analyzed to determine the patient's effective dose so that the percentage of cancer risk in each of these organs can be known. The results showed that the potential risk of cancer for critical organs such as the bladder, stomach, and gonads, was 0.218 %, 0.262 %, and 0.390 % respectively. The most at risk for potential cancer occurs in the gonads.