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November 2014 Issue

 




Other Radiology articles from the Neuroradiology section Neuroradiology

Atypical Imaging Features of Tuberculous Spondylitis: Case Report with Literature Review by Rita Momjian et al.

Published: 2014 Nov
Issue: 8(11) :: Pages: 1-14


Free full text article: Atypical Imaging Features of Tuberculous Spondylitis: Case Report with Literature Review

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Abstract: Spinal tuberculosis in its typical form that shows destruction of two adjacent vertebral bodies and opposing end plates, destruction of the intervening intervertebral disc and a paravertebral or psoas abscess, is easily recognized and readily treated. Atypical tuberculous spondylitis without the above mentioned imaging features, although seen infrequently, has been well documented. We present, in this report, a case of atypical tuberculous spondylitis showing involvement of contiguous lower dorsal vertebral bodies and posterior elements with paravertebral and epidural abscess but with preserved intervertebral discs. The patient presented in advanced stage with progressive severe neurological symptoms due to spinal cord compression. Non-enhanced magnetic resonance imaging led to misdiagnosis of the lesion as a neoplastic process. It was followed by contrast enhanced computed tomography of the chest and abdomen that raised the possibility of an infectious process and, post-operatively, histopathological examination of the operative specimen confirmed tuberculosis. This case indicates the difficulty in differentiating atypical spinal tuberculosis from other diseases causing spinal cord compression. The different forms of atypical tuberculous spondylitis reported in the literature are reviewed. The role of the radiologist in tuberculous spondylitis is not only to recognize the imaging characteristics of the disease by best imaging modality, which is contrast enhanced magnetic resonance imaging, but also to be alert to the more atypical presentations to ensure early diagnosis and prompt treatment to prevent complications. However, when neither clinical examination nor magnetic resonance imaging findings are reliable in differentiating spinal infection from one another and from neoplasm, adequate biopsy, either imaging guided or surgical biopsy is essential for early diagnosis.


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Magnetic Resonance Imaging, Computed Tomography, Conventional Radiography, Microscopic pathology, Table

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Other Radiology articles from the Cardiac Imaging section Cardiac Imaging

The quadricuspid aortic valve by Arie Franco et al.

Published: 2014 Nov
Issue: 8(11) :: Pages: 25-29


Free full text article: The quadricuspid aortic valve

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Abstract: The quadricuspid aortic valve is a very rare congenital defect that may be an isolated entity or associated with a multitude of cardiovascular abnormalities. Isolated cases usually manifest late in life with the complication of aortic regurgitation, which can be delayed by early valve replacement. We present a case of quadricuspid aortic valve associated with truncus arteriosus, ventricular septal defect, and interrupted aortic arch.


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Magnetic Resonance Imaging, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Ovarian Sertoli-Leydig cell tumor with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review by Mariana Horta et al.

Published: 2014 Nov
Issue: 8(11) :: Pages: 30-41


Free full text article: Ovarian Sertoli-Leydig cell tumor with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review

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Abstract: Here we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alpha-fetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrine-inactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker.


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Ultrasound, Magnetic Resonance Imaging, Macroscopic pathology, Microscopic pathology, Table

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Other Radiology articles from the Nuclear Medicine / Molecular Imaging section Nuclear Medicine / Molecular Imaging

FDG Positron Emission Tomography and Computed Tomography Demonstration of Carcinoma Arising in an Epiphrenic Diverticulum by Thomas J Eluvathingal Muttikkal et al.

Published: 2014 Nov
Issue: 8(11) :: Pages: 42-46


Free full text article: FDG Positron Emission Tomography  and Computed Tomography Demonstration of  Carcinoma Arising in an Epiphrenic Diverticulum

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Abstract: Esophageal carcinoma arising within an epiphrenic diverticulum is rare. We describe a case of a carcinoma in a long-standing epiphrenic diverticulum in a 62-year-old patient. Fluorine-18-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography and Computed Tomography, and endoscopic ultrasound revealed a hypermetabolic mass within the diverticulum. A preoperative diagnosis was made via endoscopic biopsy. The patient underwent Ivor-Lewis esophagectomy. He remains well and free of recurrence 18 months after surgery.


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Other Radiology articles from the Thoracic Radiology section Thoracic Radiology

Apical Pneumocystis jiroveci as an AIDS defining illness: A case report illustrating a change in the paradigm by Kyle Pfeifer et al.

Published: 2014 Nov
Issue: 8(11) :: Pages: 15-24


Free full text article: Apical Pneumocystis jiroveci as an AIDS defining illness: A case report illustrating a change in the paradigm

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Abstract: Pneumocystis jiroveci pneumonia is a common acquired immune deficiency syndrome defining illness. Pneumocystis jiroveci pneumonia is classically described as having symmetrical bilateral perihilar ground-glass opacities on chest radiographs. We present an "atypical" case of Pneumocystis jiroveci pneumonia presenting as symmetric biapical cystic spaces with relative sparing of the remainder of the lungs in a 22 year-old male, previously undiagnosed with acquired immune deficiency syndrome. Our case illustrates that formerly unusual presentations of Pneumocystis jiroveci pneumonia are becoming more common as acquired immune deficiency syndrome defining illnesses as more patients are being imaged with further imaging such as high resolution computed tomography.


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Conventional Radiography, Computed Tomography, Microscopic pathology, Table

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