Hinman Syndrome: A Rare Entity With Neurogenic Bladder-Like Symptoms.

Hinman syndrome, as is the case with many other rare conditions, is a disease very commonly under-considered or missed in the diagnosis of patients with the presenting symptoms. Clinical and radiographic manifestations of the condition are easily confused with neurogenic bladder without proper history collection and neurological examination. Patients typically present with symptoms including enuresis, urinary retention, reoccurring urinary tract infections, and encopresis. Imaging often shows hydroureteronephrosis and marked bladder wall thickening. While these signs are characteristic of neurogenic bladder, routine neurologic examinations and MRIs of patients with Hinman syndrome often show normal results, and their condition is currently thought to be an acquired behavioral and psychological disorder, often associated with abnormal family dynamics. We present the case of a 14-year-old boy, who presented to the emergency department with nausea, bilateral flank pain, and urinary retention. The patient had an over seven-year history of recurrent urinary tract infections (UTI) and intermittent encopresis and followed up with different providers. Due to the patient's extensive history and the failure of previous treatments, he was evaluated for causes of neurogenic bladder, but the MRI of the lumbar spine was normal. Fluoroscopic voiding cystourethrogram (VCUG) was ordered and demonstrated abnormal and trabeculated contour of the urinary bladder with bilateral vesicoureteral reflux consistent with the diagnosis of Hinman syndrome.

Adrenal Vein Sampling: Tips and Tricks.

Adrenal vein sampling (AVS) is the standard method for distinguishing unilateral from bilateral sources of autonomous aldosterone production in patients with primary aldosteronism. This procedure has been performed at limited specialized centers due to its technical complexity. With recent advances in imaging technology and knowledge of adrenal vein anatomy in parallel with the development of adjunctive techniques, AVS has become easier to perform, even at nonspecialized centers. Although rare, anatomic variants of the adrenal veins can cause sampling failure or misinterpretation of the sampling results. The inferior accessory hepatic vein and the inferior emissary vein are useful anatomic landmarks for right adrenal vein cannulation, which is the most difficult and crucial step in AVS. Meticulous assessment of adrenal vein anatomy on multidetector CT images and the use of a catheter suitable for the anatomy are crucial for adrenal vein cannulation. Adjunctive techniques such as intraprocedural cortisol assay, cone-beam CT, and coaxial guidewire-catheter techniques are useful tools to confirm right adrenal vein cannulation or to troubleshoot difficult blood sampling. Interventional radiologists should be involved in interpreting the sampling results because technical factors may affect the results. In rare instances, bilateral adrenal suppression, in which aldosterone-to-cortisol ratios of both adrenal glands are lower than that of the inferior vena cava, can be encountered. Repeat sampling may be necessary in this situation. Collaboration with endocrinology and laboratory medicine services is of great importance to optimize the quality of the samples and for smooth and successful operation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Splenogonadal fusion presenting as a testicular mass, a case report and literature review.

Splenogonadal fusion is a rare, frequently misdiagnosed, congenital anomaly in which the splenic tissue is abnormally attached to the gonadal or mesonephric remnants. It is commonly found as an incidental finding at autopsy, during orchiopexy or hernia repair. However, it can present as a testicular mass or as an acute scrotal pathology such as testicular torsion or epididymoorchitis. It poses as a diagnostic challenge preoperatively and often leads to unnecessary orchiectomy. We present a case of a 15-year-old male who presented with a long-standing left testicular mass thought to be a testicular tumor. Resection of the lesion along with partial left orchiectomy was done and histopathologic evaluation revealed splenogonadal fusion.

Sterile cerebrospinal fluid ascites, hydrothorax and hydrocele as a complication of ventriculoperitoneal shunting in an elderly patient.

An 89-year-old man with a history of multiple abdominal surgeries and ventriculoperitoneal (VP) shunt placement for normal pressure hydrocephalus presented for intractable abdominal bloating and scrotal swelling, for which imaging revealed massive ascites, bilateral hydrocele and small bilateral pleural effusions. Cardiac, hepatic and renal workup were insignificant. Culture and cytology of ascitic fluid were negative for infection or malignancy. Aetiology of the ascites as secondary to Cerebrospinal fluid (CSF) from the VP shunt was confirmed via ligation of the shunt. Sterile CSF ascites, hydrothorax and hydrocele are rare complications of VP shunt for hydrocephalus and are mostly presented in paediatric patients. We report the first known case of concurrent CSF ascites, hydrothorax and hydrocele in an elderly patient. We examine the difficulty of shunt replacement as a diagnostic and treatment modality in this age group and propose the use of reversible shunt ligation as a diagnostic modality.

Intussusception secondary to signet ring cell adenocarcinoma in adolescent.

Despite the overall decrease in incidence and mortality rates for older adults, colorectal cancer in young adults is increasing. We present a case of a 15-year-old male who presented with 1.5 weeks of intermittent, sharp, severe right-sided abdominal pain. Abdominal radiograph demonstrated an air-fluid level within the right hemiabdomen. Computed tomography demonstrated marked wall thickening and a mass at the junction of the ascending colon and hepatic flexure causing obliteration of the lumen with a fluid-filled, dilated ascending colon. Follow-up ultrasonography demonstrated a 5.9 × 3.9 cm targetoid lesion in the right upper quadrant concerning for intussusception. Contrast enema revealed failure of contrast filling beyond the hepatic flexure due to a lobulated central filling defect surrounded by a claw-like contrast extension. Pathology of the polypoid lesion revealed poorly differentiated signet ring cell adenocarcinoma of the colon at the hepatic flexure. Despite its rarity, this case elucidates the need to consider colorectal carcinoma in adolescent and young adult patients who present with recurrent abdominal signs and symptoms.

Characteristics, fates and complications of long-term silicone oil tamponade after pars plana vitrectomy.

BACKGROUND: Silicone oil tamponade has become a mainstay in treatment of advanced retinal detachment due to multiple etiologies. The aim of this study is to assess the characteristics, fates and complications of long-term silicone oil tamponade after par plana vitrectomy (PPV), and to compare the outcomes of different silicone oil viscosities used in a cohort of consecutive patients. METHODS: This is a retrospective comparative case series of eyes undergoing vitrectomy with silicone oil tamponade for retinal detachment by a single surgeon using different oil viscosities that were followed for one year with the silicone oil in situ. Visual acuity (VA), intraocular pressure (IOP) and complications associated with the follow up period were analyzed and compared. RESULTS: Eighty-five eyes of 85 patients were included in this study. Forty three patients had 1000 centistoke (cs) oil injected and 42 patients had 5000cs oil utilized. Demographic, cause of retinal detachment and preoperative ocular characteristics were similar in both groups. Long term complications in both groups included ocular hypertension (67.4% vs 66.7%), keratopathy due to silicone oil emulsification and migration to the anterior chamber (7.0% vs 11.9%), recurrent retinal detachment (4.7% vs 19%) and epiretinal membrane formation (7% vs 19%). In the 1000cs oil group, there was no significant difference between baseline IOP and any subsequent visit. There was a significant difference between baseline IOP and visits at day 1 (with IOP difference of 2.61 mmHg (±6.5)) (p = 0.028), 1 month (with IOP difference of 3.52 mmHg (±8.1)) (p = 0.026), 4 months (with IOP difference of 6.38 mmHg (±9.3)) (p = 0.005), and one year (with IOP difference of 4.24 mmHg (±11.1)) (p = 0.048), all higher in the post-operative period in the 5000cs oil group. Excluding the first post-operative day, no significant difference was found for VA between baseline visits and subsequent visits for either silicone oil groups. CONCLUSION: In this cohort of patients with long-term silicone oil tamponade after PPV to treat retinal detachment, IOP increased significantly in patients who received 5000cs silicone oil. There was no significant difference between other complication rates in patients receiving either oil viscosities. Long term silicone oil tamponade remains a viable option in certain cases, and a vigilant follow up for complications is necessary to limit any adverse effects and improve visual and surgical outcomes.