RESUMEN
45-year-old female presenting initially with fever, nonproductive cough, night sweats, pleuritic chest pain, fatigue and weight loss over the past month.
Asunto(s)
Blastomyces/aislamiento & purificación , Blastomicosis/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagen , Blastomicosis/diagnóstico , Líquido del Lavado Bronquioalveolar/microbiología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Tos/diagnóstico , Tos/etiología , Diagnóstico Diferencial , Fatiga/diagnóstico , Fatiga/etiología , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Persona de Mediana Edad , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Tuberculosis Pulmonar/diagnóstico , Pérdida de PesoRESUMEN
A 39 year-old male with a history of diabetes, retinitis pigmentosa, and genital warts presented with intractable occipital headaches accompanied with nausea and vomiting. The patient had markedly depressed CD4 counts. Furthermore the patient tested negative for HIV and HTLV 1/2 and had normal immunoglobulin levels. During hospital course the patient underwent a lumbar puncture and multiple imaging exams, including both CT and MR. Except for occasional nausea and vomiting controlled by therapeutic lumbar punctures, phenergan, and dilaudid the patient's hospital course was uncomplicated.
Asunto(s)
Absceso Encefálico/diagnóstico por imagen , Huésped Inmunocomprometido , Meningitis Criptocócica/diagnóstico por imagen , Linfocitopenia-T Idiopática CD4-Positiva/diagnóstico por imagen , Linfocitopenia-T Idiopática CD4-Positiva/inmunología , Adulto , Antifúngicos/uso terapéutico , Absceso Encefálico/fisiopatología , Absceso Encefálico/terapia , Terapia Combinada , Estudios de Seguimiento , Humanos , Hidromorfona/uso terapéutico , Interleucina-2/uso terapéutico , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética/métodos , Masculino , Meningitis Criptocócica/fisiopatología , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/etiología , Prometazina/uso terapéutico , Enfermedades Raras , Medición de Riesgo , Punción Espinal/métodos , Linfocitopenia-T Idiopática CD4-Positiva/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
A 56 year old African-American man presented to the emergency department with dyspnea and dysphagia with drooling. On his initial evaluation, disproportionate obesity of the face, neck and shoulders were noted. The patient's history was significant for obstructive sleep apnea, end-stage renal disease, alcoholic liver disease, pulmonary hypertension and alcoholic cardiomyopathy. He had multi-decade history of heavy alcohol abuse, but quit drinking two years previously.
Asunto(s)
Alcoholismo/complicaciones , Lipomatosis Simétrica Múltiple/diagnóstico por imagen , Humanos , Lipomatosis Simétrica Múltiple/etiología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A 33-year-old female presents with persistent lateral foot pain. Patient does not recall prior trauma that may have led to injury. Symptoms are significantly improved with rest and nonsteroidal anti-inflammatory medications.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Pie/diagnóstico por imagen , Dolor/etiología , Huesos Sesamoideos/lesiones , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Dolor/tratamiento farmacológicoRESUMEN
A 71 year-old female with a past medical history significant for hypertension, hyperlipidemia, diabetes, and strokes, presented initially to the stroke service with a sudden onset of right facial droop, right-sided weakness, dysarthria, and seizures that had gotten progressively worse for six weeks.
Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Neuroepiteliales/diagnóstico por imagen , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Accidente Cerebrovascular/etiologíaRESUMEN
A 36-year-old woman with past medical history of HIV/AIDS not on HAART therapy (CD4 count of 34) and recurrent Pneumocystis jiroveci pneumonia presented to the emergency room for cough, chest pain, and worsening shortness of breath over the past 72 hours.
Asunto(s)
Infecciones por VIH/complicaciones , Neumonía por Pneumocystis/complicaciones , Neumotórax/diagnóstico por imagen , Adulto , Dolor en el Pecho/etiología , Tos/etiología , Femenino , Humanos , Radiografía Torácica , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
An MRI of the brain and spine of an 11-year-old male revealed the following abnormality which is consistent with his chronic condition.
Asunto(s)
Errores Innatos del Metabolismo de los Aminoácidos/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Globo Pálido/diagnóstico por imagen , Anomalías Múltiples , Niño , Humanos , Imagen por Resonancia Magnética , MasculinoAsunto(s)
Coristoma/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Disgenesias Tiroideas/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Coristoma/patología , Diagnóstico Diferencial , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Persona de Mediana Edad , Disgenesias Tiroideas/patología , Neoplasias de la Tiroides/secundarioRESUMEN
Imaging of the submandibular glands can provide vital information about malignant neoplastic processes. One of these modalities, fluorine-18 fluorodeoxyglucose-positron-emission tomography/computed tomography (FDG-PET/CT), has become very important in the detection of malignancies because it provides functional and metabolic information as well as anatomic localization. However, there are several pitfalls associated with FDG-PET/CT in terms of salivary gland imaging. For example, a normal increase in the uptake of radiotracer might be mistaken for a neoplastic process. Other routine findings may include normal physiologic uptake in some structures, benign tumors and medical conditions, and iatrogenic abnormalities. We review a case in which compensatory hypertrophy of a submandibular gland was suspected to be a possible malignancy.
Asunto(s)
Errores Diagnósticos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Glándula Submandibular/diagnóstico por imagen , Glándula Submandibular/diagnóstico por imagen , Adulto , Femenino , Fluorodesoxiglucosa F18/farmacocinética , Humanos , Radiofármacos/farmacocinéticaRESUMEN
A 67-year-old female presented to our institution with a progressive history of hoarseness for the past six months. The patient also referred shoulder weakness and cough during the same period of time. She denied weight loss and tobacco use. Past medical history was negative for squamous cell carcinoma of the head and neck region. Physical examination demonstrated asymmetry of the sternocleidomastoid and trapezius muscles. Flexible laryngoscopy was performed and revealed complete unilateral vocal cord paralysis on the right. Magnetic Resonance (MR) of the brain with intravenous contrast (Figure 1) and computer tomography (CT) of soft tissue of the neck with contrast (Figure 2) were performed for further evaluation.
Asunto(s)
Enfermedades de los Nervios Craneales , Tomografía Computarizada por Rayos X , Disfunción de los Pliegues Vocales , Anciano , Enfermedades de los Nervios Craneales/complicaciones , Enfermedades de los Nervios Craneales/diagnóstico por imagen , Enfermedades de los Nervios Craneales/fisiopatología , Femenino , Humanos , Disfunción de los Pliegues Vocales/diagnóstico por imagen , Disfunción de los Pliegues Vocales/etiología , Disfunción de los Pliegues Vocales/fisiopatologíaRESUMEN
PURPOSE: Obtaining a tissue sample diagnostic of pulmonary Langerhans cell histiocytosis (PLCH) by transbronchial biopsy is notoriously difficult. The condition's appearance on computed tomography is well described and singularly characteristic, perhaps adequate for definitive diagnosis. We propose an approach to diagnosis of these patients. METHODS: Radiology case report of PLCH in a middle-aged female smoker with two week history of nonproductive cough, low grade fevers, and fatigue. RESULTS: Computed tomography (CT) provided the diagnosis of PLCH. Transbronchial biopsies failed to provide a definitive diagnosis. CONCLUSIONS: Utility of transbronchial biopsy in diagnosis of PLCH is limited. Patients who present with signs, symptoms and high resolution computed tomography typical of PLCH do not require a correlation by tissue diagnosis. If cancer is suspected, a wedge biopsy should be performed for tissue diagnosis.
Asunto(s)
Histiocitosis de Células de Langerhans/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Fumar/efectos adversos , Tomografía Computarizada por Rayos X , Femenino , Humanos , Persona de Mediana EdadRESUMEN
A 23-year-old man presented to the clinic with a oneweek history of left upper and lower extremity numbness, starting in his left hand and progressing to his left foot. He then experienced intermittent difficulty walking and left-sided drooling. The patient also reported having a left arm abscess one week earlier, for which he received penicillin and oxycodone and acetaminophen. He denied any weakness, seizure, headache, fever, nausea, vomiting, or focal neurological deficit, as well as any recent history of immunization or upper respiratory infection symptoms. During the initial visit, magnetic resonance images were obtained. Over the course of the next year, the patient presented to the hospital six times for additional symptoms including weakness, slurred speech, and seizures. During this period, brain biopsy, serology tests, and MR spectroscopy were performed confirming the initial diagnosis. Moreover, multiple MR images were performed showing progression and relapsing. RADIOLOGICAL DIAGNOSIS: Multiphasic Acute Disseminated Encephalomyelitis.
Asunto(s)
Encéfalo/diagnóstico por imagen , Encefalomielitis Aguda Diseminada/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Debilidad Muscular/etiología , Convulsiones/etiología , Adulto JovenRESUMEN
Arteriovenous malformations (AVMs) are a rare source of potentially life-threatening uterine bleeding, and should be suspected in patients presenting with metromenorrhagia. Histologically, AVMs are characterized as having both arterial and venous tissues without an intervening capillary network.1 The etiology may be either congenital or acquired secondary to prior uterine surgery or uterine malignancy.2 Congenital lesions are thought to result from arrested vascular development and contain a nidus of multiple feeding arteries anastomosed to multiple draining veins. In contrast, acquired lesions contain small fistulas between a single feeding artery and draining vein.4 While angiography is considered the gold standard for diagnosing AVMs, its limitations include exposure to contrast and radiation and the inability to accurately detect the degree of pelvic extension.5 As a result, ultrasound (US) with color Doppler is the imaging modality of choice in suspected AVM and can be confirmed noninvasively with magnetic resonance imaging (MRI).6 Angiography remains the preferred method of imaging when there is a high index of suspicion of AVM in a patient who may potentially undergo embolization as treatment.3 Historically, the definitive treatment for AVMs has been either hysterectomy or uterine artery ligation. However, embolotherapy has become a well-recognized alternative to surgery since the first reported case in 1982.5 One of the advantages of embolotherapy is the preservation of reproductive structures. Currently, treatment for AVMs is based on the patient's desire to maintain fertility. The objective of this study was (1) to describe the diagnostic features of an AVM on Doppler ultrasound in a patient who presented with vaginal bleeding and (2) discuss the treatment and outcome of this patient using uterine artery embolization.
Asunto(s)
Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Ultrasonografía Doppler/métodos , Embolización de la Arteria Uterina/métodos , Arteria Uterina/diagnóstico por imagen , Hemorragia Uterina/diagnóstico por imagen , Adulto , Malformaciones Arteriovenosas/complicaciones , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Resultado del Tratamiento , Hemorragia Uterina/etiología , Hemorragia Uterina/cirugíaRESUMEN
A 42-year-old man with diabetes and hypertension presented to the emergency room after experiencing a several month history of gradually increasing abdominal girth with the sudden onset of abdominal pain.
Asunto(s)
Neoplasias Peritoneales/diagnóstico por imagen , Seudomixoma Peritoneal/diagnóstico por imagen , Dolor Abdominal/etiología , Adulto , Humanos , Masculino , Tomografía Computarizada por Tomografía de Emisión de PositronesRESUMEN
To assess an elevated creatinine, a 67-year old woman underwent renal ultrasound which incidentally revealed an abdominal aortic aneurysm (AAA).
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico , Creatinina , Anciano , Femenino , Humanos , Hallazgos Incidentales , Riñón/diagnóstico por imagenRESUMEN
A 61-year-old male with a past medical history of chronic, uncontrolled hypertension received a non-contrasted computed tomogram (CT) of the chest and abdomen to investigate for possible Conn syndrome. This noncontrast study showed some areas of nodularity around the vertebral bodies bilaterally and extending into the posterior mediastinal region. A CT of the chest with intravenous contrast, and 3D reconstruction were then obtained.
Asunto(s)
Aorta , Coartación Aórtica , Hiperaldosteronismo , Hipertensión , Tomografía Computarizada por Rayos X , Aorta/diagnóstico por imagen , Aorta/fisiopatología , Coartación Aórtica/diagnóstico por imagen , Coartación Aórtica/fisiopatología , Dilatación Patológica , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/fisiopatología , Hipertensión/diagnóstico por imagen , Hipertensión/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
A 55-year-old African-American woman presents with progressive shortness of breath, non-productive cough, and muscle aches for two weeks. Her medical history is non-contributory. She is a current smoker with a 20-year history of smoking one pack per day. Vital signs and oxygen saturation are normal. Physical exam reveals crackles over the right middle lobe of her lung. The remainder of her physical exam is unremarkable. Blood tests demonstrate a mild leukocytosis.
Asunto(s)
Tos/diagnóstico , Disnea/diagnóstico , Leucocitosis/diagnóstico , Pulmón/fisiopatología , Debilidad Muscular/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Tos/diagnóstico por imagen , Diagnóstico Diferencial , Disnea/diagnóstico por imagen , Femenino , Humanos , Leucocitosis/diagnóstico por imagen , Persona de Mediana Edad , Debilidad Muscular/diagnóstico por imagenRESUMEN
A 62-year-old male with controlled hypertension, coronary artery disease, and borderline diabetes presented to the emergency room after experiencing a gradual one-month progression of slurring of speech and difficulty reading. The patient maintained his vital signs throughout his ambulance ride to the hospital and was clinically stable at time of arrival to the emergency department.
Asunto(s)
Neoplasias Encefálicas , Dislexia Adquirida , Imagen por Resonancia Magnética , Neoplasias de la Próstata/diagnóstico por imagen , Trastornos del Habla/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Carcinoma de Células Pequeñas/diagnóstico por imagen , Dislexia Adquirida/diagnóstico por imagen , Dislexia Adquirida/etiología , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la NeoplasiaRESUMEN
Castleman's disease is an uncommon benign lymphoproliferative disorder characterized by hypervascular lymphoid hyperplasia. Two distinct histologic variants of Castleman's disease exist - hyaline vascular type and plasma cell type. The etiology is uncertain; however, it is thought to be inflammatory or hamartomatous in nature. Castleman's disease can occur at any age with a peak incidence in the third to fourth decade. This article presents a case of Castleman's disease in a female patient and aims to educate about the natural history, diagnosis, and management of the disease.