ABSTRACT
Exostosis, or osteochondroma, represents the most prevalent primary benign bone tumor, often viewed as a developmental anomaly rather than a true neoplasm. This article presents 2 cases illustrating complications associated with tibial osteochondroma. The first case involves a 25-year-old patient with recurrent medial knee pain attributed to pes anserine bursitis secondary to tibial osteochondroma, managed successfully with surgical excision. The second case features a 15-year-old with similar symptoms and unsuccessful conservative management, highlighting the diagnostic challenges and therapeutic options for this condition. Discussion encompasses the clinical presentation, diagnostic modalities including MRI and ultrasound, and management strategies such as conservative measures, corticosteroid injections, and surgical excision. Recognizing and promptly managing complications like pes anserine bursitis in tibial osteochondroma is crucial to prevent chronic pain and functional impairment, emphasizing the importance of a multidisciplinary approach involving orthopedic surgeons, radiologists, and physical therapists.
ABSTRACT
Cerebellar liponeurocytoma is a rare WHO grade II glioneuronal tumor, characterized by a benign course and a more favorable prognosis. In this paper, we report a 52-year-old man, hospitalized in emergency because of clinical signs of increased intracranial pressure, and gait disturbances. The MRI revealed a lateral well shaped solid lesion within the left cerebellar hemisphere, having a low signal intensity compared to the cerebrospinal fluid, and causing a triventicular hydrocephalus and tonsillar herniation. The patient underwent a direct approach of the tumor through a left suboccipital craniectomy. Total removal of the lesion was achieved, and the histological diagnosis was cerebellar liponeurocytoma. The tumor cell proliferation index was < 6 %, therefore, radiotherapy and chemotherapy were not implemented after surgery. After 5 years of close follow-up there were no clinical or radiological signs of recurrence. Our objective in reporting another case of this unusual tumor is to discuss clinical profile, radiologic and histologic features as well as treatment and prognosis of this rare posterior fossa tumor.
ABSTRACT
The prevalence of intracranial aneurysms (IA) is higher in patients with stenosis of the internal carotid artery (ICA), the intracavernous internal carotid aneurysm is an intracranial aneurysm causing major functional and vital complications. We report the case of a 26-year-old man who consulted for a reduction in visual acuity, converging strabismus and ptosis of the right eye evolving for 7 months before his consultation, the various neuro-radiological examinations made it possible to identify diagnose a giant aneurysm of the right intracavernous internal carotid artery associated with severe stenosis of the contralateral internal carotid artery, hence the performance of a therapeutic arteriography consisting of an occlusion of this aneurysm. In summary, we describe successful management of a giant aneurysm of the intracavernous portion of a single functional internal carotid artery, while preserving optimal cerebral vascularization.
ABSTRACT
Wilm's tumor (WT) accounted for the vast majority of renal tumors in children (92%). However, there are many atypical or rare forms of kidney cancer, and it is certainly useful to have a diagnostic orientation in imaging to differentiate between the different diagnoses, guiding that way the therapeutic management. We report the cases of 3 patients who were initially diagnosed with nephroblastoma on the basis of radiological data (via PACS search), underwent pre-operative chemotherapy and then nephrectomy, and whose anatomopathological evidence came back in favor of benign renal tumors. Nephroblastoma is the most common renal tumor in children, but other benign tumors should not be neglected, radiological signs that may point to this entity should be taken into account, so that neoadjuvant chemotherapy with its enfeebling side effects can be avoided.
ABSTRACT
Lipoma arborescens is a rare and benign intra-articular lesion characterized by a lipomatous proliferation of the synovial membrane, usually affects the knee joint. It presents as an unusual cause of intermittent knee pain and joint effusion. We report a case of lipoma arborescens of the knee in a 23-year-old man that initially resembled inflammatory arthropathy. The diagnosis of Lipoma arborescens was made by magnetic resonance imaging of the knee and confirmed histologically by synovectomy. The purpose of our case is to show the imaging features enabling early diagnosis and appropriate treatment.
ABSTRACT
The pseudoaneurysms of the cystic artery (CAP) are very uncommon. They usually develop as a result of an acute cholecystitis or after a cholecystectomy. Among the complications, we can find hemorrhaging, biliary blockage, and haemobilia. Limited understanding of the illness makes managing specific cases difficult. We describe a case of a cystic artery pseudoaneurysm complicating an acute cholecystitis that was successfully treated by transcatheter arterial embolization.
ABSTRACT
Blood supply to the human thalami is complex and multiple variants exist. The artery of Percheron is one of those variants and is characterized by a solitary arterial trunk that branches from one of the proximal segments of either posterior cerebral artery and sup- plies blood to the paramedian thalami. Its occlusion results in bilateral paramedian thalamic infarction sometimes extending to the midbrain. We report a case of bithalamic infarction secondary to occlusion of the artery of Percheron. We will illustrate the complex clinical symptomatology and underscore the role of imaging, especially MRI, for diagnosis.
ABSTRACT
Empyema necessitans is a rare condition where tuberculosis is the most common cause. It can be found in both immunocompromised and immunocompetent patients, especially in endemic areas. We report a case of a 29-year-old male from North Africa, with an enlarging mass on the right thoracic wall. Imaging, particularly CT showed a cystic lesion in the right chest wall communicating with homolateral pleural effusion, compatible with empyema necessitans. It also showed patterns of pulmonary tuberculosis in the right upper lung. Treatment of empyema necessitans is a combination of medical and surgicaltreatment. Our patient underwent a surgical treatment consisting of flattening of the empyema with a Gene X-pert study of the fluid and the shell, followed by an anti-TB treatment. Anatomopathology confirmed the diagnosis of caseo-follicular tuberculosis.
ABSTRACT
Mycetoma or Madura's foot is a rare condition in Morocco. It is a chronic infection that affects deep subcutaneous tissues and may eventually spread to deep tissues, muscles, and bones. It is caused by fungi or bacteria and most often affects the foot. Biopsy and microbiological examination help to establish a definitive diagnosis, but may delay it. Imaging plays a crucial role in early diagnosis, particularly MRI findings that show a pathognomonic sign of mycetoma which is the dot-in-the-circle sign. Computed tomography provides a better analysis of bone changes than plain radiography. Treatment is very difficult, especially if the diagnosis is delayed, and may even lead to amputation. We present here a case of mycetoma of the foot with some MRI features.
ABSTRACT
Malignant rhabdoid tumor is an uncommon pediatric tumor that often arises from the kidneys but can also develop in other soft tissues including the orbits, where it is known as atypical teratoid rhabdoid tumor. Orbital location is exceptional, with just a few reported cases. Imaging allows for an accurate diagnosis, but histological confirmation is required. The treatment is yet unclear but nearly often surgical, either with or without chemotherapy. In this report, we present a case of a neonate of 1-month-old with an orbital primary malignant rhabdoid tumor with synchronous cerebellar location. The patient was unable to undergo surgery, he had chemotherapy, and unfortunately died 1 week after following palliative treatment. We will illustrate this clinical experience and point out the importance of radiological imaging in the assessment of this uncommon condition.
ABSTRACT
Endometrial stromal sarcoma (ESS) is an uncommon uterine mesenchymal neoplasm. The primary extra-uterine location of ESS is a very rare occurrence. We present a case of a 39-year-old woman presented with severe abdominal pain, MRI showed bilateral ovarian tumors with heterogeneous intensity on T2-weighted imaging (T2WI) and T1-weighted imaging (T1WI), with restricted diffusion, including hyperintense areas on T1WI, not erased on T1-weighted fat-suppressed imaging, hypointense on T2WI, and not enhanced after contrast. This mass extended to the Douglas and invaded the uterine and the rectum serosa suggesting an underlying endometriosis. No abnormalities were suspected in the endometrium. The exploration revealed a friable mass arising from ovaries associated with nodules in the small intestine and sigmoid. The patient underwent bilateral adnexectomy and the anatomopathological study revealed a low-grade endometrial stromal sarcoma. This is one of the few reports covering the radiological features of low-grade extra-uterine ESS in the ovary which is probably secondary to degeneration of endometriosis with no evidence of primary uterine ESS.
ABSTRACT
Accessory breast tissue (supernumerary breast tissue) is due to the absence of regression of the primitive milk lines during embryonic life which extends from the axilla to the groin. It is mostly located in the axilla where it is often confused with the axillary extension of the breast, or any pathological process occurring in armpits. Ectopic mammary glands should not be misdiagnosed as it can potentially undergo the same pathological processes that occur in a normally located breast including benign or malignant breast tumors. We report the case of an intracystic papilloma arising from left axillary accessory breast tissue in a 63-year-old woman. The principal symptom was pain in a palpable left axillary mass without inflammatory signs. Subsequent imaging and histopathologic examination proved it to be a papillary tumor in ectopic breast tissue.
ABSTRACT
Aortic coarctation is a congenital malformation that is relatively prevalent, occurring in approximately 5 out of every 1000 births. The narrowing typically happens at the aortic isthmus between the left subclavian artery and the arterial ligament. It is frequently associated with a bicuspid aortic valve. Generally, coarctation of the aorta is identified and treated during childhood or early adulthood. If left untreated, this condition can lead to a reduced life expectancy in individuals who have not received treatment. We present a case of a 52-year-old man who complained of chest pain, sputum, and hemoptysis persisting for approximately 2 years. Contrast-enhanced computed tomography (CT) scans revealed the presence of an anterior mediastinal mass, which was later confirmed to be a thymic carcinoma (on histological study). Additionally, an incidental finding of a thoracic aortic coarctation with a well-developed collateral circulation was observed. The discovery of aortic coarctation in adult patients as an incidental finding is rare and particularly uncommon in association with mediastinal or thoracic tumor pathology. Adult and elderly patients with uncorrected coarctation generally have a low survival rate, and the management strategies for such cases are controversial, especially when it is associated to other pathologies. Due to the complexity of therapeutic management and the limited literature available on postsurgical outcomes in these cases, making therapeutic decisions requires a multidisciplinary approach and personalized consideration for each individual case. This approach is necessary to evaluate the risk-benefit ratio and determine the most suitable therapeutic solution.
ABSTRACT
Cystic hydatidosis is an endemic parasitic disease with usual localization in liver and lungs. Rarely it localizes in uncommon sites, the right ventricle being an exceptional localization. We present an extremely rare case of a young man with hydatid pulmonary embolism complicating right-ventricle hydatid cysts. Echocardiography, CT pulmonary angiogram and MR-angiography were performed for the diagnostic evaluation. Our patient did not undergo surgery. He was discharged on a regimen of albendazole, and is still being followed-up. Hydatid disease rarely presents with pulmonary embolism. It has uncharacteristic clinical features, requiring particular diagnosis and therapy.
ABSTRACT
Adnexal torsion is a common gynecological emergency and a significant cause of acute pelvic pain in women. Hydrosalpinx-induced torsion of the adnexa is a rare situation and requires prompt and accurate management. Twenty-three years old nulliparous woman admitted in our structure for acute pelvic pain. The ultrasound revealed an enlarged right ovary with an adnexal cystic mass. We suspected the diagnosis of a right adnexal torsion due to cystic ovarian mass. Laparotomy revealed torsion of the right adnexa and a second large mass appearing to be a hydrosalpinx. Diagnosis of adnexal torsion is difficult and is based on a range of arguments obtained by anamnesis, clinical examination, ultrasonography and other investigations. Early diagnosis is important for preserving tubal and ovarian function, given the risk of ovarian necrosis in young women. Laparoscopy is the gold standard for diagnosing and treating adnexal torsion. The treatment can be conservative or radical, consisting of detorsion of the twisted adnexa, with or without adnexectomy.
ABSTRACT
Pelvic or pelviperineal cellulitis is a rare but serious complication of bartholinitis and can be life-threatening. It is described of polymicrobial nature. The diagnosis of pelvic cellulitis remains essentially clinical with signs of local inflammation. The interest of imaging, CT in particular, is to assess the extent of the infection and abcess. In this report, we describe 2 cases of pelvic cellulitis complicating a bartholin's abscess caused by negative gram bacilli in 2 diabetic women in their sixties.
ABSTRACT
Hydatidosis is an echinococcosis caused by the development of Echinococcus granulosus larvae in humans. The lung is the second most frequent site after the liver. The primary mediastinal and pericardial localisations are extremely rare. Ultrasound and CT scans play an important role in the diagnosis of this disease.We report the case of an 11-year-old female patient from a rural environment with a history of dogs contact, whose symptomatology consisted of chest pain, dyspnoea, all evolving in a febrile context. The imagery showed the existence of multiple mediastinal and pericardial collections. This patient was rapidly managed with albendazole (ABZ) and scanography revealed an excellent therapeutic response. Primary mediastinal and pericardial hydatidosis is a very uncommon disease. It can be unfortunately revealed at the stage of vital prognosis complications. Ultrasound and computerized tomography (CT) are helpful for localizing and defining the morphologic features of hydatid cysts. It should be kept in mind, especially in patients from endemic areas.
ABSTRACT
Spinal dural arteriovenous fistulas (SDAVFs) are rare entities and are often misdiagnosed. They usually occur in adults above the age of 50 and 60 years. While they most commonly involve the thoracolumbar region, they can occur anywhere along the spinal cord. Clinical symptoms are insidious and not specific and may progress slowly, over several years, to severe myelopathy with paraplegia. Early diagnosis is critical because the deficits are potentially reversible if carefully treated. Delayed treatment may result in severe and irreversible neurological disability. Imaging diagnosis relies on MRI and conventional spinal angiography. Once identified, the dural arteriovenous fistula should be immediately treated by either endovascular embolization or surgical ligation. In this report, we present a case of SDAVF in a 65-year-old male that was managed by open surgery.
ABSTRACT
Although it was first described over 100 years ago, lumbar puncture is still an important diagnostic tool for a variety of infectious and noninfectious neurologic conditions. With the widespread use of this common and relatively safe performed medical procedure, minor and major complications can occur even when standard infection control measures and good techniques are used, including post lumbar puncture headaches, infection, bleeding, cerebral herniation, radicular pain, and even pneumocephalus in extremely rare cases. We describe a previously unreported complication of lumbar puncture performed for the diagnosis of meningitis in a 33-year-old woman with no medical history causing pneumorrachis, tension pneumocephalus, and sacral meningocele infection leading to death. Lumbar puncture is a simple diagnostic procedure with few complications, but if the technique is incorrectly performed, or if it is accompanied by occult congenital malformations such as sacral anterior meningocele in our case, the consequences can be fatal.
ABSTRACT
Close follow-up of patients with liver cirrhosis has led to increased detection of hepatocellular carcinoma (HCC) at an early stage, especially with magnetic resonance imaging (MRI) innovations. We report the case of a 70-year-old man, with a recent history of liver cirrhosis due to chronic hepatitis C virus (HCV) complicated by hepatocellular carcinoma (HCC), and for whom trans-arterial chemoembolization (TACE) was planned, as the patient was assigned Child B7 at admission. Angiography performed during the first TACE cycle shows not only the "tumor blush" corresponding to previously detected HCC but also an additional small foci of HCC uptake seen within a large dysplastic nodule giving the appearance of "nodule-within-nodule." Early detection of hepatocellular carcinoma improves prognosis. Hence, it is essential to be aware of all early aspects of HCC, including the nodule-within-nodule appearance on cross-sectional imaging, and also in angiography, as in this case.