Chronic lymphoid leukemia metastasis to the gallbladder as a focal mass: A case report.

Chronic lymphocytic leukemia (CLL) is the second most common hematologic malignancy, and it is characterized by lymphocytic leukocytosis and secondary hematologic deficiencies. While it most commonly presents as a systemic disease, extramedullary involvement may rarely occur. The literature surrounding CLL metastatic disease to the gallbladder is particularly sparse. Interestingly, we describe a case of a 67-year-old female who presented with painless jaundice and was found to have a rapidly growing gallbladder wall mass which was determined to be CLL metastatic disease after extensive surgical resection. It is important for radiologists to recognize the possibility of CLL metastatic disease to the gallbladder when evaluating potential cases of cholecystitis due to the overlapping spectrum of imaging findings. Cognizant radiologists can potentially save patients from surgical intervention as CLL is classically treated with chemotherapy.

Cerebral syphilitic gumma presenting with intracranial gumma and pathologic vertebrae fractures.

A 37-year-old female was admitted with worsening neurologic function. On arrival from an outside hospital, the patient was obtunded and intubated. Magnetic resonance imaging of the brain revealed nodular enhancement of the leptomeninges, intracranial osteolytic lesions, and diffuse vasogenic edema causing mass effect. Imaging of the thoracic spine revealed pathologic compression fractures of 4 thoracic vertebrae. On review of the patient's electronic medical record, the patient had previously received treatment for secondary syphilis with intramuscular benzathine penicillin G. Surgical biopsies of the frontal bone and dura showed diffuse, chronic inflammation while a biopsy of the adjacent brain parenchyma revealed replicating spirochetes. The patient was subsequently prescribed dexamethasone and benzathine penicillin G. She regained neurologic function but later signed out against medical advice without completing her treatment regimen.

Cutaneous metastatic seeding as a sequela of nephrostomy catheter placement.

Urothelial carcinoma and nephrolithiasis are a common cause of obstructive uropathy which can be relieved by percutaneous nephrostomy catheter placement. A rare, but known complication of this procedure is iatrogenic seeding of tumor cells along the nephrostomy tract. We describe a case of 68-year-old-female with cutaneous metastasis of high-grade urothelial carcinoma with seeding of tumor cells along the percutaneous nephrostomy catheter tract 8 months after the removal of the catheter. Given its severity, interventional radiologists should be mindful of the number of percutaneous access attempts, exchanges, and catheter manipulations in patients with urothelial carcinoma due to the risk of metastatic seeding along the percutaneous tract or to nearby tissues.

Complications of Ileal Conduits after Radical Cystectomy: Interventional Radiologic Management.

Since their introduction into clinical practice in the 1950s, ileal conduits have been the most common type of urinary diversion used after radical cystectomy worldwide. Although ileal conduits are technically simpler to construct than other forms of urinary diversion, a variety of complications can occur in the early and late postoperative periods. Early complications include urine leakage, urinary obstruction, postoperative fluid collection (eg, urinoma, hematoma, lymphocele, or abscess), and fistula formation. Late complications include ureteroileal anastomotic stricture, stomal stenosis, conduit stenosis, and urolithiasis. Although not directly related to ileal conduits, ureteroarterial fistula can occur in patients with an ileal conduit. Interventional radiologists can play a pivotal role in diagnosis and management of these complications by performing image-guided minimally invasive procedures. In this article, the authors review the surgical anatomy of an ileal conduit and the underlying pathophysiology of and diagnostic workup for complications related to ileal conduits. The authors also discuss and illustrate current approaches to interventional radiologic management of these complications, with emphasis on a collaborative approach with urologists or endourologists to best preserve patients' renal function and maintain their quality of life. ©RSNA, 2020.

Case 284: Posterior Quadrantic Dysplasia.

History A 36-year-old left-handed woman with a history of developmental delay and medical refractory seizures since birth most recently presented with continuous simple partial seizures and occasional breakthrough complex partial seizures with postictal migraines. These were described as the patient "becoming pale with sinking to the floor and staring for approximately 1 minute with confusion thereafter." The patient had years of reported seizure freedom until 2010 when she was evaluated for intractable headaches, and electroencephalography revealed her focal subclinical status. At that time, ambulatory electroencephalography findings showed asymmetric left parietal-occipital high-amplitude spike-and-wave discharges in her best awake and alert state. Since that time, the patient developed and continues to have complex partial seizures every 2-3 months that are persistent despite the implementation of several medical regimens. At the time of recent presentation, the patient initially underwent unenhanced head CT in the emergency department followed by unenhanced MRI of the brain due to increased seizure activity at the patient's group home despite continued compliance with her antiepileptic regimen. Contrast material-enhanced imaging was not available at the time of recent presentation, so comparison was made with gadolinium-enhanced brain MRI performed approximately 9 years earlier.

Intraluminal hyperdense appearance of the small bowel on high resolution computed tomography of the abdomen and pelvis secondary to use of Calcium Carbonate tablets (Tums) mimicking a small bowel fistula.

Hyperdensity within the small bowel is most commonly seen with positive oral contrast agents, intraluminal hemorrhage and less likely an abnormal fistulous connection with the colon containing rectally administered contrast. We present the case of a 57-year-old female with a complex history of breast cancer and multiple abdominal surgeries presenting with intraluminal hyperdense small bowel on computed tomography (CT) performed with rectal contrast. Postsurgical CT with rectal contrast, and no oral contrast, showed multifocal regions of intraluminal hyperdensity with the small bowel anterior to and close to the surgical anastomosis. This raised concerns for a fistula between the colon and small bowel; however, surgical exploration demonstrated an intact anastomosis without a coloenteric fistula. Additional history notes that the patient consumed an increased dose of calcium carbonate tablets for a few days prior to obtaining the scan and this intraluminal hyperdense appearance of the small bowel was then attributed to this. We conclude that ingested over the counter medications can pose an imaging dilemma for radiologists as their appearance on CT could falsely mimic pathology. It is imperative to obtain a thorough clinical history in such cases to provide accurate diagnoses and decrease unwanted imaging and clinical intervention. It is also important for radiologists to be aware of the appearances of commonly consumed over the counter medications that can mimic pathology as demonstrated by this case.