Radiologic features of all-trans-retinoic acid syndrome (ATRAS) : case report

Background: ATRA Syndrome appears as a side effect of acute promyelocytic leukemia treatment with ATRA, vitamin A derivative. The etiopathogenesis of the syndrome remains unclear. Fever, generalized edema, pleural or pericardial effusion, respiratory distress, coagulation disorders and sometimes renal failure are the most common clinical symptoms of ATRAS. Radiological features of the syndrome are very diverse. Early diagnosis followed by introduction of appropriate treatment (corticosteroids) prevents worsening of the patients' condition and significantly reduces the risk of death. Although clinical symptomatology of ATRAS has been widely described, there are still few descriptions of its radiological manifestation. Case report: A 53-year-old female was referred to the Hematology Department for further detailed diagnostics and appropriate therapy from the district hospital, where she had been primarily admitted due to weakness, easy fatigue, loss of appetite and blood extravasations on the skin of the extremities. The patient's general condition on admission was assessed as quite good. Acute promyelocytic leukemia (AML M3 according to FAB classification) was diagnosed. The introduced treatment included ATRA. On the second day of treatment, the patient developed fever, dyspnea, generalized edema, and coagulation disorders increased. Chest X-ray findings reminded ARDS. The diagnosis of ATRAS was established, which resulted in ATRA withdrawal. After administration of corticosteroids, the patient's condition improved gradually within a few days. ATRA was reintroduced then, since the signs of leukemia had intensified. The patient remains in charge of the Hematology Department. Conclusions: Changes of chest X-ray pictures in AML patients treated with ATRA should be interpreted in clinical context due to lack of radiological features specific for ATRAS

Gallstone ileus : a rare complication of cholecystolithiasis : a case report

Background: Gallstone ileus is a rare, serious and usually specific to elderly age complication of cholecystolithiasis associated with very high mortality. It occurs when a concrement from the gallbladder becomes incarcerated in the lumen of the digestive tract. In this report, a case of gallstone ileus is presented, where a concrement moved through a cholecystoduodenal fistula to the lumen of the small intestine. Case report: A 80-year-old woman who suffered from cholecystolithiasis and diabetes mellitus was admitted to hospital with abdominal pain, flatulence and loss of appetite which lasted a few days. In ultrasonography of the abdomen, a gallbladder hydrops was found and the patient was qualified to cholecystectomy. The night before the planned surgery, the patient reported her abdominal complaints to more intense, and vomiting occurred. Abdominal ultrasonography was repeated, revealing wide intestinal loops with the gallbladder poorly visible; the examiner also noticed a hyperechogenic shadow in the stomach and in conclusions suggested the possibility of perforation. In CT imaging, one concrement in the jejunum and several ones in the colon were found to confirm the diagnosis. During the surgery, perforations of the gallbladder and pylorus were found and a gallstone wedged in the lumen of the jejunum blocking the passage. Conclusions: Cholecystolithiasis, as a disorder common in our population, should be considered in differential diagnosis of intestinal obstruction. Gallstone ileus as a rare but highly dangerous complication of cholecystolithiasis is more often seen in elderly patients with rich medical past. None of radiological methods used separately is able to give a full diagnosis - only their combination leads to an accurate diagnosis. That is why only rapid and well selected path of imaging diagnostics (ultrasonography, plain abdominal radiogram, CT imaging), good anamnesis and cooperation with a clinician is the way to obtain a therapeutic success

Rapid progression of massive hepatic calcification visible by CT : the case of a dialyzed patient

Background: There have been single reported cases of patients with diffuse hepatic calcifications revealed 4-36 months after the first examination in the course of hemodialysis-treated renal failure, severe heart failure, shock liver, primary amyloidosis, or corticosteroid administration. In the presented case, many different factors for liver calcification and dynamic tomographic manifestation are seen. Case Report: A 23-year-old man who was on hemodialysis because of acute renal failure after a motor vehicle accident (multiorgan trauma) with occurrence of hypovolemic shock was admitted to the hospital's intensive care unit presenting with clostridial infection of the lower extremities. During his stay at a prior hospital, ultrasonography did not reveal hepatic lesions. He underwent 22 sessions of treatment with hyperbaric oxygen as well as several necrectomies and amputation of both lower limbs. Abdominal CT performed three weeks after the accident demonstrated diffuse hepatic calcification which was later confirmed during autopsy. Liver parenchymal calcifications may be related to elevated calcium-phosphorus products in the uremic state and after multiple bone fractures and possible ischemic liver injury. Although a definitive explanation for the unusually short time of the appearance of liver calcification was not obtained, it may be related to many factors acting synergistically. Hyperbaric oxygen treatment is of unknown significance in this process. Conclusions: CT plays a basic role in detecting and assessing liver calcifications forming both diffuse lesions and those with well-defined borders. Diffuse calcifications revealed by CT must be analyzed together with the patient's history, especially considering renal and heart failure, bone fractures, states of shock, and treatment. Diffuse liver calcifications in these patients after respiratory therapy and transfusions when no subcapsular hematoma is found should be considered of metabolic origin

Współczesne metody diagnostyki obrazowej zmian udarowych w obrębie struktur mózgowych tylnego dołu czaszki

Obrazowanie wczesnych zmian udarowych w obrębie struktur tylnego dołu czaszki nadal stanowi ważki problem współczesnej neuroradiologii, zwłaszcza że rokowanie u chorych z udarami mózgu w przebiegu zaburzeń krążenia kręgowo-podstawnego jest gorsze niż w przypadku niedrożności tętnicy szyjnej wewnętrznej. Metody neuroobrazowania, takie jak: tomografia komputerowa (CT, computed tomography), standardowy rezonans magnetyczny (MRI, magnetic resonance imaging), angiografia CT i MR (angio-CT/MR), angiografia subtrakcyjna, badania doplerowskie czy, wreszcie, badania izotopowe, nie dają odpowiedzi na wszystkie pytania stawiane przez neurologa. Jednak na wiele z tych pytań można odpowiedzieć, dysponując najnowszymi techniki obrazowania mózgowia, takimi jak tomografia perfuzyjna CT i MRI oraz dyfuzja MR. Kompilacja powyższych metod diagnostycznych nie tylko pozwala na określenie przyczyny czy też dokładnej lokalizacji udaru, ale daje również podstawy do prawidłowej kwalifikacji chorego w celu dalszego leczenia. Autorzy dokonali przeglądu najczęściej stosowanych, a jednocześnie najbardziej użytecznych, metod diagnostycznych wczesnego udaru mózgu w obrębie struktur podnamiotowych

Postępujące kostniejące zapalenie mięśni — wciąż aktualny problem diagnostyczny

Postępujące kostniejące zapalenie mięśni (FOP, fibrodysplasia ossificans progressiva) jest rzadką chorobą genetyczną, charakteryzującą się zaburzeniem osteogenezy pod postacią wrodzonych malformacji i heterotopowego kostnienia, wywołanych mutacją genu receptora aktywiny typu 1. Progresja choroby prowadzi do znacznego upośledzenia ruchomości pacjenta i przedwczesnego zgonu. Jednym z głównych objawów jest obrzęk tkanek miękkich, który może być powodem skierowania chorego do reumatologa. W artykule przedstawiono przypadek 32-letniej pacjentki, u której wystąpił nagły epizod FOP imitujący zakrzepicę żylną. Diagnozę postawiono po 17 latach od wystąpienia pierwszych objawów. Z racji rzadkiego występowania FOP nadal stanowi więc poważny problem diagnostyczny i terapeutyczny

Is hepatotropic contrast enhanced MR a more effective method in differential diagnosis of hemangioma than multi-phase CT and unenhanced MR?

<p>Abstract</p> <p>Background</p> <p>Cavernous hemangiomas are the most frequent neoplasms of the liver and in routine clinical practice they often need to be differentiated from malignant tumors and other benign focal lesions. The purpose of this study is to evaluate whether diagnostic accuracy of magnetic resonance imaging (MRI) of hepatic hemangiomas, showing atypical pattern on US, improves with the use of Gd-BOPTA in comparison with contrast-enhanced multi-phase computed tomography (CT).</p> <p>Methods</p> <p>178 consecutive patients with ambiguous hepatic masses showing atypical hyperechoic pattern on grey-scale US, underwent unenhanced and contrast-enhanced multi-phase multi-detector CT and MR (1.5T) with the use of liver-specific contrast medium gadobenate dimeglumine (Gd-BOPTA). After intravenous contrast administration arterial (HAP), venous-portal (PVP), equilibrium phases (EP) both in CT and MR and additionally hepatobiliary phase (HBP) in MR were obtained. 398 lesions have been detected including 99 hemangiomas and 299 other lesions.</p> <p>Results</p> <p>In non-enhanced MDCT examination detection of hemangiomas was characterized by sensitivity of 76%, specificity of 90%, PPV of 71%, NPV of 92% and accuracy of 86%.</p> <p>Non-enhanced MR examination showed sensitivity of 98%, specificity of 99%, PPV of 99%, NPV of 99% and accuracy of 99%.</p> <p>After intravenous administration of contrast medium in MR the mentioned above parameters did not increase significantly.</p> <p>Conclusion</p> <p>Gd-BOPTA-enhanced MR in comparison with unenhanced MRI does not improve diagnostic accuracy in discriminating hemangiomas that show non-specific appearance in ultrasound examination. Unenhanced MR as a method of choice should directly follow US in course of diagnostic algorithm in differentiation of hemangiomas from other liver tumors.</p

Zakrzepica zatok żylnych w badaniach obrazowych

Dural venous sinus thrombosis (DVST) is a relatively infrequent but potentially serious neurological disorder. Diagnosis of DVST remains difficult due to extremely wide spectrum of clinical presentation and variable mode of onset. Accurate recognition of DVST is crucial, because appropriate and early treatment&#8217;s approach significantly reduces the risk of fatal outcome. Neuroimaging plays an important role in visualization of this disease. Computed tomography (CT), magnetic resonance imaging (MRI), CT- and MR-venography followed by digital subtraction angiography and scintigraphy are the most useful diagnostic methods in DVST. The authors illustrate radiological features of thrombosed venous sinus and present diagnostic limitations of these techniques.Zakrzepica zatok żylnych (DVST) jest stosunkowo rzadką, ale potencjalnie poważną patologią ośrodkowego układu nerwowego. Kliniczne rozpoznanie DVST jest trudne z powodu szerokiego spektrum mało specyficznych objawów towarzyszących. Szybkie i precyzyjne dokonanie rozpoznania DVST pozwala na włączenie skutecznego leczenia i obniżenie ryzyka poważnych powikłań. Metody diagnostyki obrazowej odgrywają istotną rolę w rozpoznaniu DVST. Podstawowe znaczenie mają: tomografia komputerowa (TK), rezonans magnetyczny (MR, magnetic resonance), wenografia TK/MR, cyfrowa angiografia subtrakcyjna czy wreszcie badania radioizotopowe. Celem autorów niniejszej pracy jest zapoznanie Czytelnika z najbardziej przydatnymi metodami diagnostyki obrazowej DVST opony twardej

Guz Krukenberga – problem interdyscyplinarny – opis przypadku

Metastatic lesions within the ovary constitute a serious diagnostic problem in daily practice. We present an interesting case of Krukenberg tumor in a woman 13 years after partial gastrectomy due to stomach cancer. Our case confirms that every woman with history of cancer should remain under gynecological control. It is important due to a high risk of metastatic changes localized in the ovaries, regardless of the time elapsed since the diagnosis of the primary tumor.Ogniska przerzutowe w obrębie jajnika stanowią trudny interdyscyplinarny problem diagnostyczny. Część zmian wykrywana jest przypadkowo, a brak pełnych danych klinicznych może utrudnić rozpoznanie zarówno radiologowi analizującemu badania obrazowe jak również patomorfologowi oceniającemu materiał histopatologiczny. W pracy przedstawiono kazuistyczny przypadek pacjentki z guzem Krukenberga, rozpoznanym trzynaście lat po częściowej gastrektomii z powodu raka gruczołowego żołądka. Potwierdza on konieczność okresowej kontroli ginekologicznej pacjentek z przeszłością nowotworową ze względu na wysokie ryzyko wystąpienia zmian przerzutowych w obrębie jajników, niezależnie od okresu jaki upłynął od rozpoznania nowotworu pierwotnego

Subarachnoid Space: New Tricks by an Old Dog

PURPOSE: The purpose of the study was to: (1) evaluate the subarachnoid space (SAS) width and pial artery pulsation in both hemispheres, and (2) directly compare magnetic resonance imaging (MRI) to near-infrared transillumination/backscattering sounding (NIR-T/BSS) measurements of SAS width changes in healthy volunteers. METHODS: The study was performed on three separate groups of volunteers, consisting in total of 62 subjects (33 women and 29 men) aged from 16 to 39 years. SAS width was assessed by MRI and NIR-T/BSS, and pial artery pulsation by NIR-T/BSS. RESULTS: In NIR-T/BSS, the right frontal SAS was 9.1% wider than the left (p<0.01). The SAS was wider in men (p<0.01), while the pial artery pulsation was higher in women (p<0.01). Correlation and regression analysis of SAS width changes between the back- and abdominal-lying positions measured with MRI and NIRT-B/SS demonstrated high interdependence between both methods (r = 0.81, p<0.001). CONCLUSIONS: NIR-T/BSS and MRI were comparable and gave equivalent modalities for the SAS width change measurements. The SAS width and pial artery pulsation results obtained with NIR-T/BSS are consistent with the MRI data in the literature related to sexual dimorphism and morphological asymmetries between the hemispheres. NIR-T/BSS is a potentially cheap and easy-to-use method for early screening in patients with brain tumours, increased intracranial pressures and other abnormalities. Further studies in patients with intracranial pathologies are warranted