Deep Vein Thrombosis Secondary to Extrinsic Compression: A Case Report.

May-Thurner syndrome (MTS) is defined as extrinsic venous compression by the arteries of the iliocaval system. The most common manifestation of MTS is compression of the left common iliac vein by the right common iliac artery. May-Thurner syndrome is pathologically seen in 2%-5% of patients presenting with symptomatic deep vein thrombosis (DVT). As an anatomic variant, the prevalence is predicted to be much higher as most patients with MTS anatomy are asymptomatic and do not seek evaluation.  Symptomatic clinical presentations can include left lower extremity pain, swelling, skin discoloration, ulceration, and venous claudication. Here we present a patient with symptomatic MTS. A 64-year-old female with no pertinent past medical history presented with complaint of worsening left lower extremity swelling and pain. Clinical picture was concerning for phlegmasia cerulea dolens and ultrasound was bypassed in favor of a CT scan of the lower extremities bilaterally. The CT showed occlusion of the deep veins of the left leg secondary to stenosis of the left common iliac vein just posterior to the right common iliac artery; a finding consistent with MTS. Interventional radiology performed a catheter-directed thrombolysis with stenting of the left common iliac and external iliac veins. The patient clinically improved and was discharged with anticoagulative therapy.  May-Thurner syndrome is a condition that typically manifests due to external anatomic compression of the left common iliac vein. It is our belief that patients (with the appropriate risk factors) presenting with signs and symptoms consistent with proximal lower extremity DVT would benefit from further radiographic studies to fully evaluate for iliocaval venous stenosis and subsequent catheter-directed thrombolysis with endovascular stenting.

Type two or localized endobronchial non-Hodgkin lymphoma.

We present chest x-ray, chest CT, and FDG PET images of a patient diagnosed with endobronchial lymphoma. The commonly involved thoracic structures in non-Hodgkin lymphoma are mediastinal lymph nodes. Non-Hodgkin lymphoma involving the tracheobronchial tree is rare. Localized primary endobronchial lymphoma confined to the tracheobronchial tree with no dissemination classified as type-2 is extremely rare. This is a report describing the type-2 endobronchial DLBCL. The patient also had a history of rheumatoid arthritis and was treated with methotrexate for 10 years. The other interesting aspect of this case is its association with rheumatoid arthritis and methotrexate treatment. Although there are reports documenting this type of association in the literature, there is almost no documented evidence of this association specifically with type-2 endobronchial non-Hodgkin lymphoma.

F-18 FDG PET-CT imaging in gastric sarcoma.

We report the F-18 fluorodeozyglucose positron emission tomography computed tomography appearance of a biopsy-proven primary gastric sarcoma in a 24-year-old man who presented with early satiety, dyspepsia, and weight loss. Gastric sarcoma is a rare form of malignancy constituting approximately 0.3% to 8% of malignant soft tissue tumors of the stomach. The tumor appears as an ill-defined heterogeneous mass protruding off the lesser curvature of the stomach on computed tomography with central photopenia and peripheral intense uptake on positron emission tomography images.

FDG PET Appearance of "Cannonball" Pulmonary Metastases.

We present the case of a 67-year-old woman with a recent tissue diagnosis of endometrial cancer whose FDG PET scan exhibited multiple hypermetabolic foci through out both the lungs. Contemporaneously acquired conventional radiolographs showed parenchymal nodules that demonstrated the classic "cannon ball" appearance of pulmonary metastases. Pulmonary metastasis from an endometrial primary is a rare event, as are the presence of pulmonary findings at the time of initial staging. Thus, this case demonstrates rare, and yet, distinctive aspects of the disease presentation and image correlation across the various imaging modalities.

Focal FDG Activity in the Region of Right Atrium: Coregistered CT Identifies Three Benign Etiologies.

We present the whole body FDG PET-CT images on 3 different patients with benign focal activity in the region of the right atrium. Co-registered CT correctly identified the cause of focal FDG activity as: right atrial appendage, lipomatous hypertrophy of the interatrial septum, and catheter-related activity. Although all these have been reported separately in the literature, we are presenting them together to emphasize the importance of recognizing the benign causes of FDG uptake in the region of right atrium and the role of co-registered CT in improving the accuracy and specificity of the FDG PET.