Published: 2010 Feb
Issue: 4(2) :: Pages: 9-17

   

Abstract: A 36-year-old female presented with constant, worsening left lower quadrant pain without associated fever or vaginal discharge. Pelvic and transvaginal ultrasound examinations were performed which demonstrated a large complex cystic structure in the left adnexa with peripheral flow on color Doppler imaging. Given the sonographic appearance and patient symptoms, possibilities included endometrioma or hemorrhagic cyst. Tubo-ovarian abscess (TOA) and other cystic ovarian masses were considered less likely. Two days later, the patient returned with severe pelvic pain as well as fever and leukocytosis. Follow-up ultrasound showed enlargement of the mass and a tubo-ovarian abscess (TOA) was suspected. Ultrasound-guided transvaginal abscess drainage was performed with removal of purulent fluid. The case demonstrates that the radiological features of TOA may mimic those of adnexal cystic masses such as an endometrioma or hemorrhagic cyst. A complementary case is also included which demonstrates similar sonographic findings in a patient with endometrioma. In addition to sonographic imaging, a thorough clinical and laboratory evaluation is important in differentiating these entities. Furthermore, we provide a comprehensive discussion about imaging features of cystic ovarian mass on different imaging modalities.

Published: 2010 Feb
Issue: 4(2) :: Pages: 18-22

   

Abstract: Pseudoaneurysms of the cystic artery secondary to calculus cholecystitis are rare. In this report we describe a case of an elderly female who presented with abdominal pain, pyrexia, anaemia and jaundice. She had known chronic cholecystitis, but was not considered a suitable surgical candidate. Contrast enhanced computed tomography (CECT) demonstrated a probable aneurysm within the gallbladder fossa. The patient proceeded to digital subtraction angiography (DSA), which confirmed an aneurysm arising from the cystic artery and was subsequently managed with transcatheter arterial embolisation using coils. This case report reviews the diagnosis and management of this rare complication.

Published: 2010 Feb
Issue: 4(2) :: Pages: 5-8

   

Abstract: Vicarious renal excretion of iodinated contrast introduced into the bowel is a known phenomenon that has rarely been reported. In clinical settings like Crohn`s disease in which evaluation for recto-vesical fistula is frequently requested, vicarious excretion can cause misapprehension and error in diagnosis. We present a case of Crohn`s disease in which gastrografin enema was performed to evaluate for fistula and initial interpretation was mistakenly positive, however, simple methods of elucidation were utilized to prevent error in diagnosis.

Published: 2010 Feb
Issue: 4(2) :: Pages: 31-37

   

Abstract: There are several artifacts unique to PET/CT imaging, with CT-based attenuation correction (AC) artifacts being among the most commonly reported. AC artifacts from calcified lymph nodes represent clinically significant and easily misinterpreted PET/CT artifacts that have received little attention in the literature. In this case series, we report three cases of calcified lymph nodes causing an AC artifact and one case of a highly calcified lymph node without an AC artifact. All three cases of calcified lymph nodes causing an AC artifact would have resulted in a change in patient staging, and likely management, if the nodes had been misinterpreted as malignant nodes. In PET/CT imaging, this artifact needs to be considered as a potential cause of apparent FDG activity when calcified lymph nodes are present on the CT portion of a PET/CT study in order to avoid misinterpretation and potential patient mismanagement.

Published: 2010 Feb
Issue: 4(2) :: Pages: 23-30

   

Abstract: We describe a case of chronic pulmonary aspergillosis complicated with a slowly growing aspergilloma followed for two decades without specific intervention. It developed with no background of local or systemic immune dysfunction in a middle aged female. The case illustrates many features of this disease as well as uniquely documenting the natural radiological evolution from a small non-specific cystic lesion to a massive aspergilloma. The aspergilloma subsequently autolysed and the patient`s condition changed to an allergic phenotype with development of widespread bronchiectasis and pulmonary fibrosis. We briefly discuss the range of disease aspergillus can cause in humans, its differential diagnosis and treatments.

Published: 2010 Feb
Issue: 4(2) :: Pages: 1-4

   

Abstract: Primary urethral stones are a rare form of urolithiasis accounting for less than 0.3% of urinary stones. We are reporting a case of a giant primary urethral stone that developed in the penile urethra resulting from a post-surgical complication of urethral stricture. The patient presented with difficulty urinating, ejaculatory dysfunction, and a hard palpable scrotal mass.

Published: 2010 Feb
Issue: 4(2) :: Pages: 40

   

Abstract: This article describes updates on author guidelines for manuscripts submitted after February 1st 2010 to the interactive Journal of Radiology Case Reports.