Gastrointestinal involvement in Henoch Schonlein purpura : A Case Report

Henoch-Schonlein purpura or anaphylactoid purpura is a systemic vasculitis of unknown cause that affects small vessels and mainly involves the skin, joints, gastrointestinal tract and kidneys. Gastrointestinal involvement occurs in more than half of patients and is thought to be related to edema and intramural haemorrhage. Radiologically the gastrointestinal findings are mainly those of bowel ischemia with “thumbprinting” and bowel wall oedema. Although this disease is usually treated conservatively, aggressive intervention is occasionally performed because of acute abdominal symptoms due to complications, such as perforation, intussusception and obstruction. This report illustrates a case of Henoch-Schonlein purpura with acute abdominal symptoms due to intussusception

Mondor’s Disease

A Mondor’s disease is a rare, benign and self-limiting condition. It is due to thrombophlebitis of the superficial veins of the breast and chest wall. It usually occurs in middle-aged women who present with a palpable cordlike structure, often painful in the acute phase. The aetiology is unknown, and may be related to trauma, surgery, infection or tight clothing. The finding of a superficial vessel seen as a linear opacity on mammography and a tubular structure on ultrasound is typical. An intra-luminal thrombus may be seen on ultrasound, and there may be absent flow on Doppler imaging. Conservative treatment is usually instituted, although surgery may be indicated in certain circumstances

Calcification of the alar ligament mimics fracture of the craniovertebral junction (CVJ): an incidental finding from computerised tomography of the cervical spine following trauma

When performing a radiological assessment for a trauma case with associated head injury, a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of ligament calcification would be considered. We present a case involving a previously healthy 44-year old man who was admitted following a severe head injury from a road traffic accident. CT scans of the head showed multiple intracrania haemorrhages, while scans of the cervical spine revealed a small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a fracture fragment. Although such calcification is uncommon, accident and emergency physicians and radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or traumatic head injury

Retrocaval ureter: an unsual cause of hydronephrosis in an adult

Retrocaval ureter is a rare congenital anomaly. We describe a case of right upper tract collecting system dilatation caused by a retrocaval ureter in an adult patient. Conflicting initial radiological findings had misled the surgeons in managing this patient. This case illustrates the importance of an accurate radiological diagnosis of this condition prior to any surgical intervention for an appropriate and successful surgical management

Inverted papilloma of the urinary bladder: A rare cause of haematuria in a young girl

Inverted papilloma of the urinary bladder is rare. In the paediatric group, this condition is even more rare. To date only five cases have been reported in the English literature. Due to its rarity, the morphology and biological behaviour are still uncertain. We report a case of inverted papilloma of the urinary bladder in a 12-year-old girl who presented with recurrent haematuria. The patient’s symptoms resolved after endoscopic resection with no recurrence on cystoscopy surveillance for last two years. The magnetic resonance imaging features of this lesion are described

Differentiating features of Benign vs. Malignant Phyllodes Tumours: a case series

Introduction: Phyllodes tumours of the breast, first dubbed cystosarcoma phyllodes are rare fibroepithelial tumours, accounting for less than 1% of all breast neoplasms. The World Health Organization (WHO) classified these tumours into three categories, i.e benign, borderline and malignant based on histopathological features. Benign phyllodes tumour comprised most of the tumours (35-64%), whereas the incidence of malignant phyllodes tumour is 25%. Imaging features of benign phyllodes tumour include well-circumscribed margin and homogenous echotexture, whereas malignant phyllodes tumour often demonstrate irregular margin, intratumoral cystic spaces, heterogenous echotexture and internal vascularity. Case Series: We present 4 cases of female patients initially presented with breast lump. Histopathological examination of the first two cases is malignant phyllodes tumour with background of fibrocystic changes. The first case is a 46-year-old lady whose mammogram showed a well-defined equal-density lesion. Ultrasound showed a lobulated mass, partially circumscribed margin, heterogenous internal echo and intratumoral cystic spaces. The second case is a 36-year-old lady with a high-density lesion associated with multiple dystrophic calcifications on mammogram. Ultrasound showed a heterogenous mass with irregular margin and posterior shadowing. The third and fourth cases are histopathologically confirmed as benign phyllodes tumour. The third case is a 46-year-old lady whose mammogram showed an equal density lesion while sonography revealed a well-defined oval lesion with heterogenous echotexture but no intralesional cystic spaces. Another case is a 46-year-old lady with a high-density lesion on mammogram while sonographically showed a well-defined, lobulated lesion with heterogenous echotexture and intralesional cystic spaces. Conclusion: In conclusion, benign and malignant phyllodes tumours manifest several differentiating features sonographically though some of the features may overlap. Lesion margin, internal echoes and vascularity as well as presence of liquefaction may help to identify different pathological grades of phyllodes tumour. This is crucial due to diverse potential for recurrence and metastasis

Spectrum of breast asymmetries: a pictorial essay

Introduction: Asymmetric breast tissue is a relatively common mammographic finding and is usually benign. It might be due to a normal variation, postoperative changes or hormone replacement therapy. However, an asymmetric area may indicate a developing mass or an underlying cancer. Method: We collected random cases of asymmetric breast densities on mammography, and present examples of the four types according to the recent ACR BIRADs classification. The four types are global asymmetry (previously known as asymmetric breast tissue), asymmetry (previously known as density seen on one projection), focal asymmetry (previously known as focal asymmetric density) and a developing asymmetry (replacing architectural distortion). The final diagnoses are given, confirmed on further investigations such as biopsy and FNAC or supplementary imaging. Conclusion: Accurate interpretation of breast asymmetry found on a mammogram may needs additional imaging studies such as supplementary views, ultrasonography or magnetic resonance imaging. Radiologist should be aware of this condition and further assessment should be carried out in a logical work flow for optimum patient care

Multislice computed tomography (MSCT) of blunt abdominal trauma: incidental findings related to the genitourinary tract

Background: MSCT is currently the imaging modality of choice in the assessment of hemodynamically stable patients with blunt abdominal trauma. Widespread use of this modality can reveal incidental findings that vary in their importance, from trivial lesions to findings that may alter the management of these trauma patients. Objective: To determine the frequency of incidental findings related to the genitourinary tract at MSCT of blunt abdominal trauma and the effect of these findings on subsequent patient’s management. Material and Methods: MSCT examinations of blunt abdominal trauma in 151 consecutive patients within two years (2008-2009) were retrospectively reviewed. Demographic data and incidental findings related to the genitourinary tract were recorded. The subsequent management of these findings was reviewed from patient’s case note. Results: Twenty one (13.9%) patients had incidental findings related to the genitourinary tract in 151 cases reviewed. Majority of them (n=18) do not require surgical intervention. However, in 3 of these 21 patients, surgical intervention was needed. Conclusion: Incidental findings related to the genitourinary tract in MSCT of blunt abdominal trauma were common. However, those requiring a surgical intervention are rare

Difference between Alar ligament of male and female: MRI perspectives

Background: Road traffic accidents have caused serious public health concerns; which include whiplash-associated disorders involving cervical spine. MRI is often required to supplant diagnosis of this condition. Nevertheless, alar ligament of the cervical spine may show variability in MR appearance; most profoundly signal hyperintensity easily mistaken as injury. Purpose: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female in terms of its course, shape, orientation and signal homogeneity, despite determining the association between the heights of respondents with alar ligament dimensions. Methodology: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. Results: Male respondents were 70% more likely to exhibit alar ligament signal inhomogeneity which is statistically significant (p = 0.02). No significant difference in alar ligament shape, size and orientation was seen between both genders. However positive correlation between height and the craniocaudal diameter of the alar ligament as well as the anteroposterior diameter, regardless of gender; which were statistically significant (r = 0.25, n = 100, p = 0.01 and r = 0.201, n = 100, p = 0.045 respectively). Conclusion: Presence of gender variability of alar ligament MR signal intensity as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury. Acknowledgement: Radiology Department, Sultan Ahmad Shah Medical Centre (SASMEC

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury