Aberrant Right and Left Gastric Veins as a Cause of Hepatic Pseudolesions: A Report of Three Cases.

The complex structure of the liver and its elaborate hemodynamics can cause hepatic pseudolesions on contrast-enhanced imaging, making the interpretation of diagnostic liver imaging challenging. Aberrant gastric veins are rare; most of their epidemiology data comes from small single-center studies. While current literature suggests that pseudolesions originating from aberrant gastric veins mainly present as hyperdense defects, some cases can also show up as hypodense, as shown in these cases. Differences in flow rates between the portal and aberrant veins and the timing of the scans could explain this contradiction. Identifying aberrant gastric veins on cross-sectional imaging is crucial because they could be misdiagnosed as liver lesions, granting further unnecessary workups or invasive procedures. Aberrant gastric veins can also act as pathways for the spread of gastric cancer. This manuscript presents one aberrant right gastric vein and two aberrant left gastric veins causing hepatic pseudolesions.

Incipient Melanonychia: Benign Finding or Occult Malignancy? A Case Report of Subungual Melanoma.

Subungual melanomas are rare neoplasms that tend to debut as longitudinal melanonychia. They are primarily found in patients over 60 years of age and are usually diagnosed late, representing a diagnostic challenge. We present a case report of a 59-year-old female Hispanic patient who initially presented with melanonychia and was eventually diagnosed with subungual melanoma in situ. She was surgically treated and, after three months, remained healthy. Relevant risk factors, clinical and onychoscopic findings, diagnostic criteria, and treatment options are also discussed. Since many benign entities present similarly, high clinical suspicion is critical for diagnosing this entity.

Severe Frostbite Due to Extreme Altitude Climbing in South America: A Case Report.

Frostbite is a tissue injury secondary to freezing that can currently be categorized using two schemes (Cauchy and clinical scheme). However, we present a fourth-degree frostbite case with overlapping features between both classifications, generating difficulty in categorizing it using either. We wanted to raise awareness of such an atypical presentation and propose employing both classifications to define the extent and compromise of frostbite more appropriately.

Clinical and Radiological Characteristics to Differentiate Between EGFR Exon 21 and Exon 19 Mutations in Patients With Lung Adenocarcinoma: A Systematic Literature Review and Meta-Analysis.

Epidermal Growth Factor Receptor (EGFR) mutations in lung adenocarcinoma have been previously associated with specific clinical characteristics and Computed Tomography (CT) patterns. However, associations among individual EGFR mutations have not been evaluated. We aim to differentiate if the most common EGFR mutations (exon 21 and 19) are related to specific clinical characteristics or CT patterns. A systematic review and meta-analysis of 5 databases were conducted with literature from January 2002 to July 2021. Eligible studies were of an experimental or observational design that included lung adenocarcinoma patients with confirmed EGFR exon mutations (21 and 19) and associated clinical characteristics and CT imaging patterns. Quality was assessed using the QUADAS-2 tool. The association between clinical and CT patterns and EGFR exon mutations 21 and 19 was evaluated using odds ratios (OR) and then pooled and analyzed with a fixed or random-effects model. This study follows the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A total of 12 retrospective diagnostic accuracy studies were included. Pooled analysis showed that characteristics such as absence of smoking status (OR 1.29 [95% CI 0.97 - 1.70]), and female sex (OR 1.23 [95% CI 0.83 - 1.82]); and CT patterns such as Ground Glass Opacities (GGO) (OR 1.03 [95% CI 0.78 -1.34]), air bronchogram (OR 0.78 [95% CI 0.44 -1.39]), pleural retraction (OR 0.83 [95% CI 0.53 - 1.28]), and spiculation (OR 0.80 [95% CI 0.48 - 1.31]) were not significantly associated to a specific mutation. Specific EGFR exon 21 and 19 mutations cannot be differentiated through characteristics (absence of smoking status and female sex) or radiological patterns (GGO, air bronchogram, pleural retraction, and speculation). There is limited data to assess if early disease stage or vascular convergence aids in differentiating exon 21 from 19 mutations in patients with lung adenocarcinoma.

Capgras Syndrome Due to Cannabinoids Use: A Case Report With Radiological Findings.

Capgras syndrome is a part of the delusional misidentification syndromes. In this condition, the patient believes that identical individuals have impersonated the people close to them, leading to aggression or even homicide of their relatives. The following article describes the case of a 28-year-old patient with a history of cannabis consumption who arrived at the emergency department due to an unsuccessful murder attempt against his neighbor. At the mental examination, the patient believed their parents were killed some time ago, and impostors were replacing them; laboratory tests showed tetrahydrocannabinol in the urine sample. Therefore, the diagnosis of Capgras syndrome due to cannabis consumption was performed, and treatment was established with two antipsychotics and one mood stabilizer drug, showing satisfactory results after two months.

Magnetic resonance versus computed tomography for the detection of retroperitoneal lymph node metastasis due to testicular cancer: A systematic literature review.

INTRODUCTION: It is essential to see if MRI can be used as an alternative to CT for the detection of retroperitoneal lymphadenopathy in patients with testicular neoplasms. By doing so, the amount of radiation received by these young patients might be reduced. MATERIAL AND METHODS: A systematic literature review was carried out in 5 databases between January 1984 until December 2020. The articles included were randomized and non-randomized clinical trials, cross-sectional studies, cohort, case and control, and retrospective studies that compare the accuracy of MRI against CT to detect retroperitoneal lymph nodes in patients with testicular neoplasms. RESULTS: The search string initially retrieved 222 non duplicated papers from which a total of 3 studies of diagnostic accuracy were included for analysis. These articles evaluated a total of 127 patients with testicular neoplasm; the sample size per study ranged from 25 to 52 patients, with a mean age between 29-34 years. MRI presented a sensitivity ranging from 98-80% and specificity of 100 % when read by an experienced radiologist. However, when it was read by a radiologist with 1 year of experience, the sensitivity dropped to 78 % and specificity to 91%. CONCLUSION: This systematic literature review shows a knowledge gap since not much has been published regarding this topic; therefore, randomized clinical trials are mandatory. Research on when to use MRI over CT is necessary to reduce radiation exposure. The authors strongly suggest that readers start researching on this subject.

Acute Cholecystitis in a Patient With Situs Inversus Totalis: An Unexpected Finding.

Situs inversus totalis (SIT) has an incidence in the general population of 1/10,000, with a female-male ratio of 1:1.5 without racial predilection. Clinically, SIT by itself tends to be asymptomatic; however, when it is associated with other conditions such as cholecystitis or appendicitis, the diagnosis may represent a challenge due to the reversed anatomical location of symptoms. This article presents a case of a 46-year-old female who arrived at the emergency department due to one week of non-bilious vomiting and colicky abdominal pain located in the left hypochondrium; therefore, abdominal ultrasonography was performed, showing transposition of abdominal organs associated with cholelithiasis plus acute cholecystitis. As a result, the patient was scheduled for laparoscopic cholecystectomy, resulting in an appropriate post-surgical evolution, for which discharge was given with a general surgery control appointment. Laparoscopic cholecystectomy in patients with SIT represents a challenge due to the technical complexity derived from the transposition of the abdominal organs; therefore, the surgeon is forced to perform the procedure by placing three trocars with a specular approach plus the umbilical trocar.

What is the role of ultrasonography in the early diagnosis of scaphoid fractures?

Scaphoid fractures are the most prevalent type of carpal bone fractures. High-spatial-resolution sonography detects direct signs of scaphoid fractures such as scaphoid cortical disruption; nevertheless, indirect signs such as radiocarpal effusion and scapho-trapezium-trapezoid effusion can also be visible. The diagnosis is performed when both direct and indirect signs of scaphoid fracture are presented. The presence of indirect signs alone is not enough to complete the diagnosis, for which more advanced imaging modalities are usually required. Here, we review the anatomy of the scaphoid, the clinical manifestations of scaphoid fractures, as well as ultrasonographic findings and differential diagnosis.

Pleuroperitoneal Hernia in an Adult Patient.

INTRODUCTION: Pleuroperitoneal hernia is the most frequent diaphragmatic congenital hernia, appearing in 1 in 3,000 births. This diaphragmatic defect is located on the left side in 80% to 90% of cases. Pleuroperitoneal hernia is usually diagnosed in the first 8 weeks of life due to respiratory compromise caused by the herniation of abdominal organs into the thoracic cavity; therefore, adult presentation is a rare condition. CASE PRESENTATION: We present a case of a 55-year-old man with a history of long-term cigarette smoking who arrived at the emergency department with a chronic cough. Initially, the patient was misdiagnosed as exacerbated chronic obstructive pulmonary disease, for which a contrast chest computed tomography was performed showing a left posterior pleuroperitoneal hernia that contained the upper pole of the ipsilateral kidney and adrenal fatty tissue. The surgical approach chosen in this case was through laparoscopy, resulting in an appropriate postsurgical evolution, for which the patient was discharged with a general surgery control appointment. The patient was evaluated 1 week and 1 month after surgery, showing a normal physical examination and resolution of the respiratory symptoms. CONCLUSION: Pleuroperitoneal hernia symptoms in adults most commonly affect the gastrointestinal and the respiratory tract. The diagnosis is performed by computed tomography or magnetic resonance imaging, in which a diaphragmatic defect can be seen. Pleuroperitoneal hernia complications must always be discarded by computed tomography and transthoracic echocardiogram. The treatment is based on surgical repair of the diaphragmatic defect. The surgical approach chosen may vary according to the surgeon's expertise.

Fournier's Gangrene With Retroperitoneal Extension as the First Manifestation of the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS).

Fournier's gangrene (FG) is an atypical, life-threatening polymicrobial infection characterized by the rapid destruction of soft tissue, predominantly in the perineal region. Retroperitoneal spread of FG represents an uncommon condition described in a few case reports, and its presentation as the first manifestation of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is even more infrequent. Here, we present the case of a 40-year-old male who was admitted to the emergency department with a low-grade fever of 37.8°C, abdominal pain, and four-day history of sharp, bilateral testicular pain and swelling. On physical examination, the patient was hypotensive with necrotic tissue in the perineum. A computed tomography study displayed an extensive retroperitoneal spread of suspected FG. Due to the massive spread of the infection, an HIV test was requested, yielding positive results, which indicated that HIV/AIDS had first manifested as FG with retroperitoneal extension. This is an extremely rare initial presentation of HIV/AIDS. To treat the patient and address the severe necrosis, a peritoneal lavage, surgical debridement, right orchiectomy, and colostomy were performed. After the procedure, antiretroviral therapy was established with tenofovir, emtricitabine, and efavirenz.