Melanoma of the lacrimal sac: An extremely rare location From a radiologist perspective.

Lacrimal sac tumors are rare with epithelial tumors being the most common type. Melanoma of the lacrimal sac is an exceptional finding. Few cases have been reported so far in the literature. We report the case of a sixth year old male, with no pathological background, who was referred to the hospital for chronic dacryocystitis resistant to treatment. Computed tomography dacryocystography and magnetic resonance imaging were performed, in favor of a large mass of the lacrimal sac and lacrimal canal suggestive of melanoma. Biopsy confirmed the diagnosis. PET-CT was positive and showed abnormal activity in the lung, liver and bones, in favor of metastasis.

Bilateral renal lipomatosis: A case report.

Renal replacement lipomatosis is a rare condition characterized by fatty tissue proliferation. It has been associated with aging, lithiasis disease, and renal transplantation. The clinical presentation is non-specific, and imaging is essential to confirm and make the differential diagnosis. We report a case of a patient followed for endometrial thickening or the diagnosis of renal lipomatosis that was discovered incidentally on an abdominopelvic CT scan.

A rare presentation of multiple sclerosis: Schilder's disease.

Schilder's disease is a rare form of multiple sclerosis. It concerns mostly teenagers and young adults. The Clinical signs and symptoms might be atypical for early multiple sclerosis which often mimics intracranial neoplasm or abscess. Their coursemay be either progressive or relapsing and remitting, with a high sensitivity to steroids. The knowledge of this rare form ofmultiple sclerosis may help radiologists in assessing a precise diagnosis. We report the case of a young 22-year-old patientadmitted to the emergency room with an array of headache, vomiting and frontal syndrome. Magnetic resonance imaging shows2 bilateral demyelinating frontal areas. The patient was put under corticosteroids bolus with discreet improvement in her clinicalcondition. After 6 months of follow-up, we did not notice any real clinical improvement. Although Schilder's disease isconsidered to be a variant of Multiple Sclerosis, its clinical and imaging features behaves more like a demyelinating conditionwith its monophasic course with, however, serious clinical consequences if the treatment is delayed.

Kienbock's disease: A radiological case report.

Kienböck's disease is a condition characterized by avascular necrosis of the lunate. It is also known as lunatomalacia and aseptic or ischemic necrosis of the lunate. The aim of this work is to summarize and illustrate, through a case diagnosed in our institution, the radiological aspects of this rare entity, which occupy a prominent place in the diagnosis. A better understanding of this recently described nosological entity and a wide dissemination of its diagnostic criteria, especially by radiologists, should facilitate the diagnosis and treatment of patients.

Painful bipartite patella following injury: a case report.

Bipartite patella is a normal variation in ossification development. This variation is usually asymptomatic but can cause persistent and debilitating anterior knee pain with an injury. We report the case of a 56-year-old man complaining of persistent anterior left knee pain following trauma. Standard knee radiographs show a bilateral Bipartite Patella appearance, and magnetic resonance imaging shows discrete bony edema of the cancellous bone of the accessory bone and about the synchondrosis explaining the anterior knee pain, associated with a crack in the posterior compartment of the medial meniscus. Conservative care including medical treatment with non-steroidal anti-inflammatory drugs, physical therapy was used. Magnetic resonance imaging is the most valuable diagnostic tool for evaluating detailed morphologic and pathologic changes in patients with the bipartite patella.

A rare combination of complications of ruptured carotid artery aneurysm: A case report.

The giant aneurysm of the subclinoid portion of the internal carotid artery is a relatively rare disease that can present serious complications. We present the case of a 40-year-old guy who was suffering from a headache and had complete ophthalmoplegia in his right eye. A brain scan shows a right temporal subdural hematoma, associated with subarachnoid hemorrhage, and total Sylvian subacute ischemic stroke. CT angiography and MRI showed a ruptured and partially thrombosed aneurysm of the subclinoid portion of the right internal carotid artery complicated by subarachnoid hemorrhage, a right subdural temporal hematoma, and total Sylvian ischemic stroke. Our purpose is to recognize the possibility of an aneurysmal rupture when evaluating an acute subdural hematoma, alone or in combination with Ischemic stroke.

Facial infiltrating lipomatosis, a rare cause of facial asymmetry to be known: Case report and literature review.

Facial infiltrating lipomatosis is a rare lipomatous lesion, first described by Slavin in 1983. It is a benign pseudotumor pathology. It corresponds to a non-encapsulated collection of mature adipocytes infiltrating the local tissue and hyperplasia of underlying bone leading to a craniofacial deformity. Very few cases have been reported in the literature. We report the case of a 19-year-old female patient, who was consulted for a swelling of the right hemiface progressively evolving since birth. Physical examination revealed facial asymmetry. On palpation, the mass was soft, painless, not compressible, not pulsatile, not fluctuating. In view of the asymptomatic nature and slow progression of the lesion, a lipomatous tumour, namely lipoma, was suggested. CT scan image shows a hyperplastic subcutaneous fat on the right hemiface. On the right jugal and temporal areas, there is a subcutaneous formation of fatty density, poorly limited, with no detectable peripheral capsule. It merges with the adjacent fat. In the bone window, there was a hyperplasia of underlying bone. Facial lipomatosis infiltration of the face is a benign pseudotumor pathology. As a result, it can be confused with other disorders, in particular, hemifacial hyperplasia. Combination of physical and radiological findings can establish the diagnosis. Surgical treatment is done for cosmetic purposes.

Cerebral fat embolism syndrome after long bone fracture: A case report.

Cerebral fat embolism is a rare and potentially fatal condition that may occur following a long bone fracture. Its characterized by respiratory, neurological, and mucocutaneous signs. Isolated severe brain syndrome remains exceptional. We report a 21-year-old male patient admitted for the cerebral manifestation of a fat embolism syndrome due to a fracture of long bone after a traffic accident injury. Neurological deterioration after a free interval was seen with generalized tonic-clonic seizures. MRI of the brain was indicated which showed numerous multifocal hyperintensities involving the deep white matter of both hemispheres producing a "starfield" appearance. This pattern of cytotoxic cerebral edema, with lesions in the white matter rather than the grey matter, is indicative of the subacute stage of fat embolism. The patient was treated with comprehensive support in the intensive care unit, he returned to normal neurological function and was discharged after 3 weeks of hospitalization.

Renal angiomyolipoma with renal vein extension.

Renal angiomyolipomas are uncommon benign tumors containing fatty tissue. Only a few cases of infiltrating angiomyolipomas have been reported. We aimed to describe a case of a 65-year-old woman presenting a peripheral angiomyolipoma of the left kidney with CT evidence of involvement of the renal vein. The lesion has been found incidentally during abdominal CT for an unrelated reason. The patient underwent surgical treatment considering the vascular extension of the lesion and the risk of thromboembolic complications. The pathological analysis confirmed the diagnosis of renal AML in the upper pole of the left kidney invading the renal vein without malignancy.No post-operative complications and the evolution was favorable.

Pancreatic Lipoma: A Pancreatic Incidentaloma Diagnosis with Computed Tomography.

Lipoma of the pancreas is a rare benign tumour which is usually discovered incidentally on imaging. We present a case of an incidentally discovered pancreatic lipoma in a 79-year-old man with non-metastatic prostate adenocarcinoma who was referred to radiology for follow-up imaging. Fat-containing tumours originating from the pancreas are very rare. Most lipomas show characteristic features on imaging that allow their differentiation. We present the imaging features of a pancreatic lipoma on ultrasound, CT and MRI, discuss the differential diagnosis, and provide a brief review of the literature. LEARNING POINTS: Pancreatic lipoma is a rare mesenchymal tumour that is being increasingly recognized.Pancreatic lipoma is commonly asymptomatic and incidentally detected.CT and MRI allow confirmation of the diagnosis and elimination of other differential diagnoses.

Unusual Location of a Giant Cell Tumour.

Giant cell tumours (GCT) are rare aggressive non-cancerous tumours which usually affect the long bones. We describe a case of GCT of the first rib in a young woman without a relevant history. The patient presented a left cervico-thoracic mass which was biopsied in our department (CT-guided biopsy). She was referred to the thoracic surgery department after histological results. LEARNING POINTS: Giant cell tumours (CGT) are benign tumours that usually occur on long bones with costal localization being a rare entity.Ultrasound can be a useful tool to assess the nature of the lesion.Diagnosis is based on lesion biopsy, but aggressive surgical resection can be performed.CGT should be considered in the differential diagnosis of costal tumours.

Curvilinear pericallosal lipomas diagnosed incidentally during evaluation following trauma with corpus callosum abnormalities in two patients.

Pericallosal lipomas are the most habitual location for an intracranial lipoma. They are fat-containing lesions arising from the interhemispheric fissure intimately related to the corpus callosum, which is often abnormal. They originate from aberrant differentiation of the persistent primitive meninx. Most Pericallosal lipomas are asymptomatic and come into clinical attention during neuroradiological investigations for other conditions. MRI is the modality of choice to characterize not only the extent of the lipoma but also the frequently associated agenesis/dysgenesis of the corpus callosum. Pericallosal lipomas can be divided into two groups: The Tubulonodular type and The curvilinear type. Curvilinear lipomas are less common than Tubulonodular. We report the clinical and radiological findings of curvilinear Pericallosal lipoma in two patients with corpus callosum abnormalities revealed incidentally during evaluation following trauma.

[Imaging features of multiple maxillomandibular brown tumors: a case report]. / Imagerie des tumeurs brunes maxillo-mandibulaires multiples: à propos d'un cas.

Brown tumors are rare osteolytic lesions occurring in 1.5-1.7% of patients with chronic end-stage renal failure. They are caused by PTH-induced bone remodeling. We here report the case of a young woman on hemodialysis for chronic end-stage renal failure with painless maxillo-mandibular swellings occurred 7 months before. Clinical examination showed facial deformity with two maxillary and mandibular masses to palpation. Laboratory tests revealed hypocalcemia, hyperphosphatemia with hyperparathyroidism. CT scan of the face revealed multiple osteolytic masses in the maxillary and mandibular bones, with significant bone rarefaction and signs of diffuse bone resorption. The diagnosis of multiple brown tumors of the face was retained based on clinical, biological and radiological features. Brown tumors are a rare entity usually characterized by maxillomandibular involvement in patients with chronic renal failure. Practitioners should suspect them, hence the interest in this study.

Amyotrophic Monoplegia Secondary to Posttraumatic Rupture of the Brachial Plexus's Roots: A Case Report and Review of the Literature.

Brachial plexus lesions most often occur in multiple trauma. We report a case of a 37-year-old patient who presented an upper left limb total sensitivomotor deficit and amyotrophy after a cervical and upper limb trauma. Cervical magnetic resonance imaging (MRI) was performed. It noted pseudomeningoceles at the levels of C6-C7, C7-D1, and D1-D2 in T1 hyposignal , T2 and STIR hypersignal , not enhanced by the injection of Gadolinium extending in foraminal and extraforaminal spaces without visualization of the corresponding rootlets. Traumatic brachial plexus injury is a potentially serious debilitating injury which can be well explored on MRI.

Cerebral cryptococcosis with pseudo-meningiomatous revelation?

We report the case of a 28-year-old woman with history of lupus treated by Mycophenolate Mofetil and admitted for febrile meningeal syndrome associated with diplopia. Both initial and control brain MRI showed pseudo-meningiomatous lesion while second CSF microscopy revealed characterizing images of Cryptococcus neoformans.

Sinonasal Chondrosarcoma, an Unusual Location.

INTRODUCTION: Chondrosarcoma is a tumour with a cartilaginous matrix frequently encountered in long bones and the pelvis with rare sinonasal location. PATIENT AND METHODS: We report the case of a 25-year-old patient who was referred to us for an extension work-up for sinonasal chondrosarcoma confirmed by anatomopathological examination. RESULTS: Facial magnetic resonance imaging (MRI) confirmed by a CT scan showed an osteolytic tumour process of the hard palate and walls of the left maxillary sinus that was locally advanced. CONCLUSION: The sinonasal location of a chondrosarcoma is rare. Characterized by cross-sectional imaging, confirmation was provided by histological assessment. LEARNING POINTS: The sinonasal location of a chondrosarcoma is rare.A slow-growing tumour with a cartilage matrix in adults, it is revealed mainly by neurosensorial signs and mass effect in its sinonasal location.Radiological characterization includes areas with a weak signal on T1- and T2-weighted images in MRI, not enhanced by gadolinium, corresponding to the cartilage matrix.

Unusual Location of a Recurrent Epidermoid Cyst.

INTRODUCTION: Epidermoid cysts of the temporal bone are rare, benign and slow-growing lesions. PATIENT AND METHODS: We report the case of a 69-year-old female patient followed up for a symptomatic intradiploic epidermoid cyst of the temporal scale and left mastoid region, which had been operated on but recurred. RESULTS: MRI demonstrated a well-limited lesion seen as a hyposignal on T1-weighted images, hypersignal on T2-weighted images, on FLAIR and on diffusion-weighted images not enhanced by gadolinium. The tumour was compressive, and bone lysis was seen on CT. CONCLUSION: Epidermoid cysts of the temporal bone are rare, benign lesions whose diagnosis is based on fluid signals seen on MRI but absent on FLAIR sequences. LEARNING POINTS: Epidermoid cysts of the temporal bone are rare, benign and slow-growing lesions.Larger cysts are easier to identify.Diagnosis is based on the presence of a fluid signal on all MRI sequences except for FLAIR imaging, and on confirmation by pathological examination.

[Bilateral adrenal tuberculosis: about a case]. / Tuberculose surrénalienne bilatérale: à propos d'un cas.

Isolated adrenal tuberculosis accounts for less than 2% of adrenal incidentalomas. This is the most frequent infectious cause of adrenal insufficiencies. We report the case of a 53-year old patient with no previous medical history presenting with adrenal insufficiency with slow progression over six months. Physical examination didn't show any mass or hepatosplenomegaly. Blood pressure was 120/60 mmHg. Laboratory tests didn't show inflammatory syndrome. LDH level was normal. CT scan showed bilateral hypertrophy of the adrenal glands characterized by calcifications. Intradermo tuberculin reaction was positive at 25mm. The analyses to detect Koch's bacillus in the sputum and in the urine were negative. Quantiferon® test was positive. Trial antibacillar treatment was started with clinical improvement and 5kg weight gain in 12 months. Hormonal assays were low.