MRI diffusion-weighted imaging detects a fresh portal vein thrombus as a high intensity lesion in a patient with a liver transplant: A case report

Portal vein thrombosis is one of the most serious complications after liver transplantation. It is important to determine the age of the thrombus for management of portal vein thrombosis. We present a case report of histologically confirmed heterogenous fresh portal vein thrombus which was depicted heterogenous high signal intensity on magnetic resonance diffusion weighted imaging. The sequence may be a useful imaging tool for detecting fresh thrombus components in the portal vein thrombosis.

A Rare Case of Wilson’s Disease in a 17 Years Old Girl

Introduction: Wilson’s disease (WD) is an autosomal recessive disorder involving cellular copper transport. A defect in biliary excretion leads to accumulation of copper in the liver, causing progressive liver injury and cirrhosis. Approximately 1 in 40,000 people have Wilson’s Disease. It affects both men and women equally. Symptoms appear between ages 5 and 35. Case Presentation: This is a case of 17 years old girl came with complained of dysphagia, irritability, breathlessness, weakness in both upper and lower limb at left side for 6 months. She had difficulty in going up and coming down a staircase and in getting up from the squatting position. She could walk with support for the first 6 months of his illness but later, had required crutches. After her admission diagnostic evaluation was done, and in the findings was chest x-ray was done which was normal. ECG showing normal sinus rate and rhythm. Ophthalmology call was done and slit lamp examination was noted which was showing KF ring was present bilaterally. MRI brain suggested symmetrical altered signal intensity lesion in bilateral thalami and lentiform nucleus, midbrain and pons appearing hyper intense on T2/FLAIR sequences in bilateral gangliocapsular region (mainly in putamen) and thalami as well as midbrain and dorsal aspect of pons as described above. A possibility of Wilson’s Disease can be considered, blood test show that Hb was decrease that is -9.7gm%, S.G.O.T was 34.0U/L, S.G.P.T was 32.0U/L, was normal at the time of discharge early ambulation, nutrition, psychological support was given. Therapeutic interventions and outcome: In the present case received syndopa 110/4, BD, orally. Tablet Zinc, OD, orally. Tablet Pan D, OD, orally., inj. Dexamethasone 2 mg I.V, T.D.S., Syrup Sumax, 10ml, BD. Now the patient condition is stable. Conclusion: This presented case of Wilson’s Disease is a rare disease condition. It is an autosomal recessive disease.In this case study, author mainly focus on expert medical management and excellent nursing care which leads to fast recovery of patient. After conversation with patient her response was positive and after nursing management and treatment she was discharged with satisfaction of recovery.

Mesenchymal Chondrosarcoma: A Rare Aggressive Variant of Chondrosarcoma

A 15-year-old boy reported a 2-month history of severe left thigh pain Physical examination revealed left thigh swelling measuring 6x5 cm. X-ray of the region showed mixed lytic and sclerotic lesion involving the femoral head and neck. A Computed Tomography scan showed mixed lytic and sclerotic lesion involving the femoral head and neck with cortical irregularity and mild periosteal reaction with associated soft tissue in the anterior aspect. Magnetic resonance imaging demonstrated heterogeneous signal intensity lesion with areas of sclerosis involving the femoral head and neck. The large associated soft tissue in the anterior aspect appears predominantly hyperintense on T2W images. On post-contrast axial and sagittal images, heterogeneous enhancement with areas of necrosis involving soft tissue was seen. A presumptive radiological differential diagnosis of Ewing Sarcoma and Osteosarcoma was made. However, on histopathology, it was a case of mesenchymal chondrosarcoma.

NI-11 Clinical significance of intracystic diffusion hyperintensity lesions remaining after treatment of intracranial germ cell tumor

Background and purpose: About 30% of intracranial germ cell tumors are mixed germ cell tumors and teratomas are often found as those components. Intense chemoradiotherapy is performed according to the malignancy of the histopathology, but high-intensity lesion inside the cystic tumor on diffusion weighted imaging (DWI) sometimes remains after completion of the chemoradiotherapy. In this study, we examined the clinical significance of the DWI high-intensity lesion remaining in the cyst. METHODS: Five patients after initial chemoradiotherapy were resected residual tumor by craniotomy at our hospital from 2009 to 2019. Preoperative gadolinium-enhanced MRI defined the non-contrast-enhanced part of the tumor as intracystic, and DWI intensity was classified by its look as low-intensity, equal-intensity, and high-intensity compared to the cortex of the same slice. DWI signals in the solid area, cyst wall, and cyst were evaluated. Results: All cases were mature teratoma in histopathology, and no other tumor components were observed. On DWI, the cyst wall and solid part were visualized with low signal. High-intensity lesions and equal-intensity lesions in the cyst cavity were found in 3 and 1 cases, respectively. In these cases, pathological findings revealed a keratin-like substance in the cyst. Discussion: The intracystic high and equal intensity lesions on DWI removed after completion of chemoradiotherapy are considered to reflect the keratin-like component of mature teratoma. If DWI- high intensity and equal intensity lesions remain in the cyst of the tumor after the completion of chemoradiotherapy, tumor shrinkage cannot be expected even if the chemotherapy is strengthened. In such cases, we should consider to removing them by surgery. Conclusion: When DWI high and equal intensity lesions are found in the cysts of tumors remaining after chemoradiotherapy for intracranial germ tumors, it is possible that mature teratoma remains.

Campylobacter fetus Meningitis and Pyogenic Spondylodiscitis in a Healthy Young Woman

We report a rare case of Campylobacter fetus meningitis and pyogenic spondylodiscitis in a healthy young woman. A 35-year-old woman without significant medical history presented with fever, headache, and low back pain. C. fetus was detected from the blood culture. Cerebrospinal fluid analysis showed bacterial meningitis 2 days after onset. Although initial magnetic resonance imaging (MRI) did not reveal abnormal findings, repeated MRI showed a low-signal-intensity lesion on T1-weighted image (T1WI) and a high-signal-intensity lesion on T2WI between the L5 and S1 vertebral bodies 11 days after onset. The mode of infection was considered to be the consumption of raw chicken meat. After antibiotic treatment with 12 g/day ampicillin following 6 g/day meropenem, she was discharged 51 days after onset. As the inflammatory signs on MRI improved, oral antibiotic therapy was discontinued 85 days after onset. Although the initial MRI showed no abnormal findings, repeat MRI should be performed for patients who have persistent low back pain and fever.

Primary Spinal Cord Melanoma of Intradural Extramedullary Origin

Primary malignant melanoma is the very rare entity of the central nervous system. It accounts only 1% of all melanoma cases. A 67-year-old patient presented to us with lower back pain radiating to the left lower limb and progressive weakness of both lower limbs. She underwent magnetic resonance imaging scan of lumbosacral region that suggested T1 hyperintense, T2 hypointense, extramedullary altered signal intensity lesion at L1 and L2 vertebral level compressing terminal spinal cord, and cauda equine region. On histopathological examination, findings were suggestive of malignant melanoma that was confirmed with immunohistochemistry examination (positive for S-100, Melan-A, and HMB-45). Here, we are discussing an unusual case of primary malignant melanoma of conus and cauda equine region with comprehensive review regarding management and prognosis of the tumor.

Isolated peripheral-type facial palsy due to the central lesion:two-case reports

Background Isolated peripheral facial palsy (P-FP) can lead to lesions involving the inferomedial tegmentum of the pons. However, cases with P-FP in result of a medullary lesion have rarely been reported and result from a paraventricular lesion have never been reported before. Cases presentation We described a 63-year-old man presenting with isolated P-FP due to ipsilateral pontomedullary infarction. Brain diffusion MRI revealed a hyper-intense signal on the left dorsolateral portion of the upper medulla and pontomedullary junction. And then we experienced a 77-year-old man presenting with lateral paraventricular infarction who showed contralateral peripheral type facial palsy. Brain diffusion-weighted image(DWI) showed a high-signal intensity lesion in the right lateral paraventricule and part of the posterior limb of the right internal capsule. Conclusions These two cases caution that a central nervous etiology should be considered in patients with P-FP, especially if they have high risk factors of cerebral infarction.

Incidental ancient schwannoma of the posterior mediastinum in a young male: a rare scenario

Ancient schwannoma is a distinctive type of schwannoma occurring mostly in the retroperitoneum. The presentation in the posterior mediastinum is rare. The term ‘ancient’ represents a group of neurogenic tumours showing degenerative changes with marked nuclear atypia. A 26-year-old man was incidentally detected to have an upper mediastinal mass lesion in the chest X-ray. MRI chest revealed a mixed signal intensity lesion in the left side upper para spinal region of the posterior mediastinum. The patient underwent left posterior thoracotomy and excision of the mass was done. Postoperative period was uneventful. The histopathological feature was typical of Ancient schwannoma. The patient is on regular follow-up and disease free until.

A case of avascular necrosis of capitate bone in an air compressor jack hammer worker

Introduction: Avascular necrosis (AVN) is very rare in capitate bone. It mostly occurs due to direct trauma to wrist. However, it could also occur as the result of disturbed blood supply due to repetitive micro-trauma in rare cases. Case Report: In this report, a 30-year-old man who was an air compressor jack hammer worker with chronic wrist pain was presented. Imaging revealed a low-signal intensity lesion on T1-weighted which supported AVN of capitate. Blood supply damage was due to continuous stress to palmar hand as the consequence of working with air compressor jack hammer which led to AVN of capitate. Conclusion: AVN of capitate could occur as the result of repetitive micro-trauma. It has a high correlation with the job of patients. Radiography does not help in the first stages. Magnetic resonance imaging (MRI) has high diagnostic sensitivity. In the primary stages in patients with occupation-induced AVN, it could be improved by changing the job and temporary immobilization.

Isolated Intracranial Myeloid Sarcoma Occurring as Relapse in Acute Myeloid Leukemia

ABSTRACTMyeloid sarcoma (MS) or chloroma is a rare extramedullary tumor composed of extramedullary proliferation of blasts of granulocytic, monocytic, erythroid, or megakaryocytic lineage occurring at sites outside the bone marrow. MS occurs in 2%–8% of patients with acute myeloid leukemia (AML), sometimes it occurs as the presenting manifestation of relapse in a patient in remission. We describe the case of a young male with AML in remission for 6 years presenting with central nervous system symptoms. Magnetic resonance imaging showed an extra-axial altered intensity lesion in the parasagittal parietal region, infiltrating anterosuperiorly into anterior falx, and posterosuperior aspect of the superior sagittal sinus. A biopsy from the lesion was diagnostic of MS which was positive for myeloperoxidase. He did not have any other sites of disease. He has received chemotherapy with FLAG (Fludarabine, Cytosine arabinoside) followed by cranial irradiation and is in complete remission.