Primary pulmonary synovial sarcoma: a case report with unique and impressive computed tomography findings.

Primary pulmonary synovial sarcoma (PPSS) is a rare malignancy. Its etiology, imaging features and optimal treatment are not well understood. Pulmonary pseudoaneurysms and lymphadenopathy are rare complications of synovial sarcomas. A 40-year-old woman with mild hemoptysis and thoracic back pain underwent a computed tomography scan that revealed multiple pulmonary lesions, paraesophageal lymphadenopathy and incidental bilateral pulmonary emboli. A diagnosis of PPSS was made through the identification of an SS18 translocation by fluorescence in situ hybridization. She was started on adriamycin, ifosfamide and mesna chemotherapy. Over the subsequent two months, she developed three pulmonary artery pseudoaneurysms, ultimately requiring endovascular coiling. Seven months after starting treatment, the patient was asymptomatic. The lesions and lymphadenopathy decreased in size. The present case highlights complications of a rare malignancy and demonstrates positive response to ifosfamide-based chemotherapy in the setting of PPSS.

Diagnosing burned-out hypertrophic cardiomyopathy: Daughter's phenotype solidifies father's diagnosis.

Patients with hypertrophic cardiomyopathy classically have preserved systolic function in the setting of impaired diastolic function and decreased left ventricular end-diastolic volume. However, in a small sub-population, patients paradoxically develop systolic dysfunction, left ventricular dilatation, and ventricular wall thinning. This pattern is one that is likened to dilated cardiomyopathy and is known as end-stage hypertrophic cardiomyopathy or "burned-out cardiomyopathy." The role of cardiac magnetic resonance imaging is well defined in narrowing the differential diagnosis of impaired left ventricular function, including that of hypertrophic cardiomyopathy. However, the importance of obtaining a family history and obtaining details of diagnosis for both preceding and future generations cannot be under-estimated. We report a case of end-stage hypertrophic cardiomyopathy that highlights how important family history can be in making a diagnosis. .

Coronary artery compression three months after transcatheter pulmonary valve implantation.

We report a case of a 29-year-old man who developed exercised-induced myocardial infarction 3 months post Melody valve implantation. We introduce the concept of ruling out dynamic coronary artery compression by simulating transcatheter pulmonary valve implant while increasing cardiac output and thus aortic dimensions in the catheterization laboratory. © 2014 Wiley Periodicals, Inc.

An unusual case of dual left anterior descending artery with coronary computed tomographic angiographic correlation.

Dual left anterior descending artery (LAD) is a rare coronary anomaly that is important to recognize at coronary imaging as it may influence reperfusion strategies. Four types of dual LAD are described by the traditional literature. We present a novel case of dual LAD with coronary computed tomographic angiographic correlation that does not fit into this classification system. Rather, our case supports the recently proposed notion of adding a fifth variant to the traditional dual LAD classification system.

Arteriovenous fistula as a complication of transradial coronary angiography: a case report.

INTRODUCTION: Iatrogenic arteriovenous fistula is a vascular condition that may result from coronary angiography. Many case reports have described arteriovenous fistula occurrence after coronary angiography using the transfemoral access route, but rarely as a complication of using the transradial approach. We report a rare case of a patient with arteriovenous fistula following transradial artery coronary angiography. CASE PRESENTATION: A 62-year-old Caucasian man underwent emergent coronary angiography using the right radial artery approach. One month after angiography, he discovered a turbulent sound near the access site. A right radial arteriovenous fistula was found upon duplex ultrasound investigation. The patient was treated conservatively. At 1-year follow-up, the arteriovenous fistula was unchanged and the patient remained hemodynamically stable and asymptomatic. CONCLUSION: Iatrogenic arteriovenous fistula is a rare vascular complication of transradial artery coronary angiography. The natural history of arteriovenous fistula is benign and is thought to resolve spontaneously; therefore, a conservative approach, as opposed to surgical ligation, is recommended as the first-line treatment.

Cardiac computed tomography in the management of iatrogenic coronary ostial stenosis after aortic valve replacement.

Although rare, iatrogenic coronary ostial stenosis is an important complication of aortic valve replacement and Bentall procedure. We report a 32-year-old male presenting an acute coronary syndrome post-Bentall procedure and the role of computed tomography in diagnosis and management of iatrogenic coronary ostial stenosis. Such occlusions are commonly identified in the left main coronary artery, but can develop in venous bypass grafts at anastomoses with Dacron aortic grafts. Cardiac computed tomography is valuable to exclude noncoronary causes of chest pain, assess ostial stenosis of manipulated arteries post reimplantation, and shed light on mechanisms and management of these lesions.

Minute pulmonary meningothelial-like nodules: a case of incidentally detected diffuse cystic micronodules on thin-section computed tomography.

Minute pulmonary meningothelial-like nodules are common incidental pathologic findings but are sparsely described in the radiology literature. They are of uncertain origin and significance, but they can occasionally manifest as mild restrictive lung disease or as incidental micronodules on computed tomography. We present a case of multiple incidentally detected, randomly distributed, cavitating micronodules with pathologic correlation. Awareness of the rare presentation of this entity is important because it may simulate neoplastic or other nonneoplastic diseases.

Modularity and intersection of "what", "where" and "how" processing of visual stimuli: a new method of FMRI localization.

Research on the modularity of perceptual and cognitive processes has often pointed to a ventral-dorsal distinction in cortical pathways that depend upon the nature of the stimuli and the task. However, it is not clear whether the dorsal, occipital-parietal stream specializes in locating visual objects (i.e., a "where" stream), or taking action toward objects (i.e., a "how" stream), although there is some consensus for a ventral, occipital-temporal "what" stream that specializes in the identification of visual objects. It is also not clear to what extent word and picture processing are modular along these streams, as functional imaging maps to date have not addressed the modularity question directly. Here we present two types of functional imaging maps that directly show modularity and intersection of processing function for word and picture stimuli in tasks that require decisions about "what is", "where is", or "how do you interact with" a stimulus (N=6 participants). Our results reveal a middle dorsal "how" stream with some modular regions of activation that are distinct from activation during "where" processing, and that words and pictures involve several modular regions of activation along these streams.

Renal cell carcinoma as a second malignant neoplasm in a patient with non-syndromic hemihypertrophy and previous Wilms tumor.

Survivors of childhood Wilms tumors are at an increased risk of second malignant neoplasms. Recently, it has been postulated that renal cell carcinoma is among the malignancies for which this population is at risk. We present the unique case of an adult Wilms tumor survivor with non-syndromic hemihypertrophy (NSHH) who developed renal cell carcinoma. This case highlights the need for close follow-up in two populations: adults who have survived Wilms tumor and those with NSHH.

West Nile Virus: a case report with flaccid paralysis and cervical spinal cord: MR imaging findings.

We present a case of serologically proved West Nile virus (WNV) flaccid paralysis of the right upper extremity. Radiologic correlation revealed striking T2 hyperintensities in the anterior horns of the cervical spinal cord, similar to those seen in cases of poliomyelitis. Recognition of the MR imaging findings in cases of WNV flaccid paralysis can provide early evidence of infection.