Rare Manifestation of the Cutaneous and Cervical Lymph Node Metastases of Urothelial Carcinoma of Urinary Bladder: A Case Report.

Lymph node metastasis from bladder cancer mainly involves the external/internal iliac and obturator nodes as the primary lymphatic drainage sites of the bladder, and common iliac sites as the secondary drainage. Lymph node involvement above the diaphragm is rare. Metastasis to the head and neck region is associated with poor prognosis and low survival rate. Herein, we report a case of cervical cutaneous and lymph node metastases in a patient with bladder cancer. This is a rare case of advanced urothelial carcinoma presenting as an aggressive inflammatory process with extensive lymph node involvement, without bony or visceral metastasis.

Concurrent Medullary Carcinoma and Hashimoto's Thyroiditis: A Case Report with an Emphasis on US Features.

Medullary thyroid carcinoma (MTC) is a rare malignancy that originates from the parafollicular cells of the thyroid gland. Hashimoto's thyroiditis (HT) is an autoimmune thyroid disease and is the most common cause of hypothyroidism. Previous studies have frequently discussed the association among HT, papillary thyroid carcinoma, and thyroid lymphoma. However, there have been few reports on the ultrasonographic findings of concomitant HT and MTC. In the present case, a heterogeneous hypoechoic background parenchymal echogenicity, with intraglandular echogenic strands, and increased vascularity were observed. A concurrent, ill-defined, parallel-oriented, heterogeneous hypoechoic mass with central microcalcifications was located at the left thyroid gland, consistent with reported US findings of medullary thyroid carcinoma except for an ill-defined margin in our case.

Unusual sonographic appearance of breast cancer metastasis to the pectoralis muscle.

Breast cancer is one of the most common malignancies in women. It frequently metastasizes to the lungs, liver, and bone. Breast cancer metastasis to skeletal muscles is rare. Chest wall recurrence in patients that have undergone mastectomy is the most frequent form of local recurrence, and it is generally accompanied by nodules or masses on the chest wall. Here, we describe a case of the unusual appearance of invasive lobular cancer metastasis to the pectoral muscles without discrete nodules or masses in a patient who had undergone mastectomy 12 years ago.

Ultrasonographic Findings of a Chondrolipoma Arising from the Left Supraclavicular Region: A Case Report.

Chondrolipomas, which are lipomas with chondroid metaplasia, are rare benign soft tissue tumors with no relevant epidemiological reports or radiological information. A limited number of lipomas with osteo/chondroid differentiation have been reported in the literature between 1960 and 2008. Moreover, only few studies have described the radiologic findings of chondrolipomas. Herein, we present a case of chrondrolipoma arising from the left supraclavicular region in a 77-year-old female.

Sonographic appearance of a large lipoma of the spermatic cord presenting clinically as an inguinoscrotal hernia.

Lipoma of the spermatic cord or the round ligament is called inguinal canal lipoma. It may present as an inguinal herniating mass of fat tissue, with or without an accompanying herniating sac. There are few reports about large lipomas of the spermatic cord. We describe a case of a large spermatic cord pure lipoma, initially suspected to be an inguinal hernia upon physical examination. We diagnosed the lipoma with ultrasound and magnetic resonance imaging. The patient subsequently underwent left orchiectomy.

A Complex Cortical Malformation Caused by a Mutation in the Tubulin-Encoding TUBB3 Gene.

Tubulinopathy commonly refers to complex congenital and non-progressive brain malformations caused by mutations in the tubulin genes. Among tubulin-encoding genes, TUBB3 has rarely been reported as a cause of complex cortical malformations. Herein, we report a case of tubulinopathy in a 21-month-old boy who presented with delayed development. He could not walk on his own and was not able to speak more than five words. Physical examination revealed right esotropia and hypotonia of the lower extremities. MRI showed dysmorphic brainstem and dysmorphic and hypertrophic basal ganglia. The right thalamus was relatively smaller than the left one. The cerebellum showed disorganization of the cerebellar folia. DNA sequencing revealed a missense mutation of the TUBB3 gene.

Serial Magnetic Resonance Imaging Findings in Hyperglycemia-Related Osmotic Demyelination Syndrome: A Case Report.

We report a rare case of hyperglycemia-related osmotic demyelination syndrome (ODS) with focus on the imaging findings. A 61-year-old man with diabetes was admitted for general weakness and severe thirst. A few days later, he complained of dysarthria, dysphasia, and dysmetria. Laboratory examinations showed significant hyperglycemia, but normal electrolyte levels. Brain MRI revealed T2-signal abnormalities that were symmetrical, non-space occupying, and located in the central pons with a peripheral sparing pattern, which were suggestive of ODS. In addition, subsequent MRI revealed progression of signal hyperintensity; however, the patient's symptoms improved.

Giant Intramyocardial Aneurysm in a Patient with Intercoronary Communication between the Left Circumflex Artery and Right Coronary Artery: A Case Report.

Coronary artery aneurysm is a rare disease. It occurs in the epicardial space, mostly along the course of major coronary arteries. Here, we report a case of a giant incidental aneurysm embedded in the basal posterior wall of the left ventricle. A 43-year-old woman was referred to our institution for the evaluation of cardiac palpitations that had been present from the previous 2 months. She reported no medical history (such as Kawasaki's disease or hypertension) or previous operative history. Echocardiogram and subsequent cardiac CT revealed a giant aneurysm in the left ventricle, with a direct fistulous connection to a dilated and tortuous left circumflex artery, which showed direct communication with the straight right coronary artery.

Magnetic Resonance Imaging and Clinical Features of Chlorfenapyr-Induced Toxic Leukoencephalopathy: A Case Report.

Chlorfenapyr is widely used as an insecticide, despite it being fatal to humans. However, chlorfenapyr-induced central nervous system toxicity has rarely been reported. We report the magnetic resonance imaging (MRI) findings in a rare case of chlorfenapyr-induced toxic leukoencephalopathy. A 71-year-old man who had ingested chlorfenapyr approximately two weeks prior visited our hospital and presented with bilateral lower motor weakness and voiding dysfunction that had developed two days before admission. Brain MRI revealed extensive bilateral white matter abnormalities involving the corpus callosum, internal capsule, brain stem, and bilateral middle cerebellar peduncle. Furthermore, spine MRI revealed diffuse swelling and hyperintensity on the T2-weighted images.

Magnetic resonance imaging of patients with lateral epicondylitis: Relationship between pain and severity of imaging features in elbow joints.

OBJECTIVE: The aim of this study was to determine the inter- and intra-observer reliabilities of magnetic resonance imaging (MRI) for the diagnosis of lateral epicondylitis, to examine whether degree of common extensor tendon (CET) injury is related to other elbow abnormalities on MRI, and to investigate the correlation between elbow abnormalities on MRI and patients' symptoms. METHODS: Fifty-one patients (32 women and 19 men; mean age: 50 years (range, 22-63)) with a diagnosis of lateral epicondylitis were included in the study. The average duration of symptoms was 2.3 years. MRI scoring system was used to grade the CET injuries and associated injuries in the elbow joint. Three independent radiologists retrospectively reviewed MRI images. Inter- and intra-observer reliabilities for diagnosing lateral epicondylitis were calculated using kappa statistics, and Spearman's rank correlation analysis was used to analyze relationships between degree of CET injury and the associated abnormalities of elbow joints. Statistical relations were considered significant for p values of <0.05. In addition, using Spearman's rank correlation analysis, CET injuries and associated abnormalities of elbow joints were correlated with clinical symptoms using visual analog scale pain scores. RESULTS: Various degrees of CET injuries were found in total of 51 patients. Radial collateral ligament and lateral ulnar collateral ligament (RCL/LCL) was the most common accompanying elbow abnormality other than CET injuries. Inter- and intra-observer agreements of CET and RCL/LUCL injuries on MRI were excellent. There were significant correlation between degrees of CET and RCL/LUCL injuries (correlation coefficient r = 0.667, p < 0.01) and between degree of RCL/LUCL injuries and visual analog 11-point pain box scale (VAS) scores (correlation coefficient r = 0.478, p = 0.033). CONCLUSION: MRI showed excellent inter- and intra-observer reliabilities for the evaluation of lateral epicondylitis. In addition to common extensor tendinopathy, RCL/LUCL abnormality was the most common accompanying finding and degree of RCL/LUCL injuries positively correlated with degree of CET injuries. Furthermore, degree of RCL/LUCL injuries positively correlates with severity of pain. LEVEL OF EVIDENCE: Level IV, Diagnostic study.

Imaging sonographic findings of in a case of proliferating trichilemmal tumor of a finger: A case report.

Proliferating trichilemmal tumor (PTT) is a rare tumor that originates from the outer root sheath of a hair follicle. About 90% of PTTs occur on the scalp. The sonographic findings of PTT in the subungual region have not been reported previously. In our case, sonography showed a heterogeneous mass containing echogenic foci with no detectable intratumoral vascularity. These echogenic foci probably represent keratin and cholesterol. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:215-217, 2018.

Sonographic appearance of an eccrine spiradenoma: A case report.

Eccrine spiradenoma is a rare, benign, adnexal skin tumor of the sweat gland, which may manifest in any part of the body. It is typically located in the dermal or the subcutaneous fat layer. Eccrine spiradenomas rarely progress to malignant transformation and only a few cases of malignant transformation have been reported. Due to its rarity, there have been few reports about the sonographic appearances of eccrine spiradenoma. We report the sonographic findings in one case of eccrine spiradenoma, located in the subcutaneous fat and the deep dermal layers of the upper arm in a middle-aged woman.

Magnetic Resonance Imaging Findings in Small Patella Syndrome.

Small patella syndrome (SPS) is characterized by aplasia or hypoplasia of the patella and pelvic girdle abnormalities, including bilateral absence or delayed ossification of the ischiopubic junction and infra-acetabular axe-cut notches. Here, we report a case of SPS in a 26-year-old female. Magnetic resonance image (MRI) showed a small patella with thick eccentric non-ossified patellar cartilage and femoral trochlear dysplasia with hypoplastic patellar undersurface. To our knowledge, this is the first report of MRI findings in SPS. MRI findings could be clinically relevant because elongation of the medial patellofemoral ligament and trochlear dysplasia with eccentric non-ossified patellar cartilage might lead to patellofemoral maltracking with an osteochondral lesion or acute dislocation or an extensor mechanism injury. Though the patient presented in this case report only had a gastrocnemius injury at the origin site, physicians should carefully examine abnormalities with MRI when an SPS patient has a trauma to the knee.

Three-dimensional isotropic T2-weighted fast spin-echo (VISTA) knee MRI at 3.0 T in the evaluation of the anterior cruciate ligament injury with additional views: comparison with two-dimensional fast spin-echo T2-weighted sequences.

Background There has been no comparison study to assess the diagnostic efficacy of additional anterior cruciate ligament (ACL) views in three-dimensional (3D) volume isotropic turbo spin-echo acquisition (VISTA) and two-dimensional (2D) fast spin-echo (FSE) T2-weighted (T2W) images for the diagnosis of ACL tear. Purpose To compare the diagnostic performances of additional ACL views on VISTA with those on the 2D FSE T2W images. Material and Methods This retrospective study included 78 patients who were suspected to have ACL injury and underwent both 2D TSE T2W magnetic resonance imaging (MRI) and 3D VISTA MRI of the knee between November 2012 and March 2013. The diagnostic performance of each oblique sagittal and coronal view and the combined images was evaluated for sensitivity, specificity, and accuracy for diagnosing an ACL tear. The arthroscopically and clinically confirmed diagnoses were used as the reference standard. The values were statistically analyzed using the McNemar test. Results The inter-observer agreement between two readers of the additional ACL views on 3D VISTA and 2D FSE T2W images were substantial on 2D FSE images and nearly concurred on the VISTA image. When considering both views of the oblique sagittal and coronal images, the inter-observer agreement between readers nearly concurred. There were no statistically significant differences in the sensitivity, specificity, and accuracy between 2D FSE images and VISTA images. Conclusion The performance of the additional ACL view on 3D VISTA MRI is comparable to that of 2D FSE T2W MRI in the diagnosis of ACL tear though the image quality of the 3D VISTA MRI is not equal to that of 2D FSE MRI.

Modified thoracolumbar injury classification and severity score (TLICS) and its clinical usefulness.

BACKGROUND: Thoracolumbar injury classification and severity score (TLICS) is not very reliable for assessment of injury to the posterior ligament complex, even when scored by experts. It is not reasonable to score every compression fracture or burst fracture the same as there is great variety in the severity of compression fractures and burst fractures. PURPOSE: To propose a modified TLICS (mTLICS) and evaluate the performance of the mTLICS system by measuring the agreement between scores determined by radiologists using both systems and actual treatment procedure delivered. MATERIAL AND METHODS: We retrospectively evaluated 134 patients with acute lumbar and thoracic spinal trauma after undergoing magnetic resonance imaging (MRI) using new mTLICS and conventional TLICS system. Inter-observer agreements of TLICS and mTLICS scores were analyzed using the kappa statistic. Nonparametric correlation analysis was used to determine correlation (R) among each score and the surgical intervention. RESULTS: The mTLICS system showed slightly higher correlation than TLICS (Rs, TLICS, 0.592 and 0.613 vs. mTLICS, 0.628 and 0.639). If we consider a total maximal score of 4 to be a negative surgical indication, mTLICS showed significantly higher sensitivities than TLICS, and if we consider a total minimal score of 4 to be a positive surgical indication, mTLICS showed significantly higher specificities than TLICS. CONCLUSION: The mTLICS score corrects deficiencies in the TLICS system that lead to ambiguity in the radiological diagnostic criteria. mTLICS is a more suitable scoring system than TLICS for predicting surgical management accurately, especially for morphological injuries.

Comparison between arthroscopic findings and 1.5-T and 3-T MRI of oblique coronal and sagittal planes of the knee for evaluation of selective bundle injury of the anterior cruciate ligament.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic usefulness of combining oblique sagittal and oblique coronal MRI views of the anterior cruciate ligament (ACL) with traditional orthogonal views for the evaluation of selective-bundle ACL injury and to evaluate whether there is a statistical difference in diagnostic ability between 1.5-T and 3-T MRI. MATERIALS AND METHODS: This retrospective study included 114 patients who underwent knee MRI (46 on 1.5 T and 68 on 3 T) and arthroscopy at our institution. Two radiologists evaluated orthogonal views and ACL views on 1.5-T and 3-T MRI in variable combinations. They diagnosed ACL views as normal, entire ligament tear, anteromedial bundle tear, or posterolateral bundle tear. The surgeon then confirmed tears in the anteromedial or posterolateral bundle of the ACL arthroscopically if a selective-bundle tear did exist. The arthroscopically confirmed diagnoses were used as the reference standard. The values were statistically analyzed. RESULTS: Sixty-seven percent of patients showed an ACL tear on arthroscopy, and 33% had a selective bundle tear; of these, 75% were anteromedial bundle tears and 25% were posterolateral bundle tears. On 1.5-T MRI, specificities of each view and combined views were the same (80%). The sensitivities and accuracies of the combined views were higher than the individual views; differences between individual views ranged from 4% to 15%. Reader 1 saw statistically significant differences between the oblique coronal and combined views. Although the performances of reader 2 showed similar results, the p values exceeded the critical value of statistical significance (0.063). On 3-T MRI, differences in specificities between the orthogonal and combined views and between the orthogonal and oblique coronal views were statistically significant (p, 0.016 and 0.008 for readers 1 and 2, respectively). There were no significant differences in the diagnostic performance of 1.5-T and 3-T MRI. CONCLUSION: The oblique coronal view and the combination of the orthogonal view and both additional ACL views provide better diagnostic information with an improvement in specificity on 3-T MRI compared with orthogonal views alone in the diagnosis of selective-bundle tears. Although diagnostic performance was not improved with the addition of the oblique views over orthogonal views on 1.5-T imaging, diagnostic performance was improved on 3-T MRI. Accuracies for individual imaging planes were not significantly different when comparing 1.5-T and 3-T MRI.

Breast-specific gamma imaging: correlations with mammographic and clinicopathologic characteristics of breast cancer.

OBJECTIVE: The purpose of this article is to evaluate the correlations between breast-specific gamma imaging (BSGI) findings and mammographic and clinicopathologic characteristics of breast cancer. MATERIALS AND METHODS: Our study included 56 breast cancers that had undergone BSGI between August 2010 and December 2012. We reviewed imaging findings (BSGI and mammography) with histopathologic findings, including tumor size, histologic type, nuclear grade, presence of ductal carcinoma in situ (DCIS), and presence of extensive intraductal component (EIC); and immunochemical features, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (ERBB2, formerly HER2), Ki67, and p53. We classified cancers into positive or negative groups on the basis of BSGI visibility and investigated the statistical differences in mammographic and histopathologic characteristics between the BSGI-positive and -negative groups. RESULTS: Among 56 malignancies, 48 (85.7%) were shown to be BSGI positive. Patients in the BSGI-positive group were statistically significantly older than those in the BSGI-negative group (p = 0.027). BSGI-positive cancers were statistically significantly larger than BSGI-negative cancers (p = 0.002). Cancers 1.0 cm or larger, unlike those of subcentimeter size, were statistically significantly more visible on BSGI (p = 0.004). The mammographic findings and mammographic densities did not statistically significantly differ between the BSGI-positive and -negative groups. Invasiveness of cancer showed no statistically significant difference on BSGI finding. Cancers with a DCIS component tended to be BSGI positive, but without statistical significance (p = 0.051). Visibility on BSGI was not statistically significantly associated with EIC, nuclear grade, ER, PR, ERBB2, Ki67, and p53. CONCLUSION: The sensitivity of BSGI for breast cancer was 85.7%. Breast cancers in older patients, cancers larger than 1.0 cm, and cancers with the DCIS component tended to be visible on BSGI. BSGI was an equally sensitive tool to detect the breast cancer in women with fatty and dense breast.

Multiple osteochondritis dissecans of knee joint in a patient with Wilson disease, focusing on magnetic resonance findings.

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.

A practical MRI grading system for osteoarthritis of the knee: association with Kellgren-Lawrence radiographic scores.

PURPOSE: To propose a reproducible and constant MR grading system for osteoarthritis of the knee joint that provides high interobserver and intraoberver agreement and that does not require complicated calculation procedures. MATERIALS AND METHODS: This retrospective study sample included 44 men and 65 women who underwent both MRI and plain radiography of the knee at our institution. All patients were older than 50 years of age (mean 57.7) and had clinically suspected osteoarthritis of the knee. The standard of 4 grades on the MR grade scale was based mainly on cartilage injury and additional findings. Kellgren-Lawrence grades were assessed for the same patient group. The relationship between the results was determined. Statistical analyses were performed including kappa statistics, categorical regression analysis and nonparametric correlation analysis. RESULTS: The interobserver and intraoberver agreements between the two readers in the grading of osteoarthritis were found to be almost perfect. Interobserver and intraobserver agreements were slightly lower for the MR grading system than for the Kellgren-Lawrence grading scale. The correlation between the MR grade and Kellgren-Lawrence grade was very high and did not differ with patient age. The MR grades were highly correlated with the Kellgren-Lawrence grades and showed excellent interobserver and intraobserver agreements. CONCLUSION: This new MR grading system for osteoarthritis of the knee joint is reproducible and may be helpful for the grading of osteoarthritis of the knee without requiring reference to plain radiography.