Rapid spontaneous resolution and redistribution of acute subdural hematoma in a patient with chronic alcoholism: a case report

We report a case of a 54-year-old man who had documented traumatic acute subdural hematoma. He suffered from a transient episode of confusion and a follow-up CT scan of brain 6 h after the initial scan showed resolution and redistribution of the subdural hematoma. In this case report, we review the literature for the underlying pathophysiology of this uncommon phenomenon.     

Bilateral tentorial subdural hematoma without subarachnoid hemorrhage secondary to anterior communicating artery aneurysm rupture: a case report and review of the literature

A case of acute subdural hematoma over the tentorium secondary to rupture of an anterior communicating artery aneurysm is reported. A 42-year-old female patient presented with acute-onset, severe bifrontal and retro-orbital headache. CT revealed only symmetric thickening of the tentorium. MR imaging revealed the presence of a 10-mm anterior communicating artery aneurysm, which was confirmed by digital subtraction angiography. The radiologic findings and possible mechanisms of this hemorrhage are discussed.     

Acute, Post-Traumatic Subdural Hygroma. Natural Course with Angiographic Documentation.

Acute, post-traumatic subdural hygromas, in contrast to benign chronic subdural hygromas, may be life-threatening. Two cases are presented in which a rapidly enlarging subdural hygroma either prevented improvement over a 1-2 week period or resulted in rapid deterioration of the patient. Angiographic documentation and the natural course of this condition are revealed.     

Discrepancy of clinical symptoms and prognosis of a patient--forensic significance of "talk and die" head injury

Deaths of patients who had talked after sustaining a head injury and were then assumed clinically to be recovering from the head trauma raise medicolegal questions about the precise causes of deaths. A forensic autopsy on a 77-year-old man who had been talking after a road traffic accident and died on the sixth day showed slight subdural hematoma, bifrontal cerebral contusions and diffuse axonal injury. No natural diseases or delayed complications of injury were found. The cause of death was certified as head injury due to a traffic accident. This is a case of "talk and die" head injury. Forensic autopsy is important in patients with "talk and die" to clarify the causal relation to the head trauma in relation to any further forensic dispute.     

Posttraumatic pseudoaneurysm of the posterior cerebral artery

We present the case of a traumatic posterior cerebral artery pseudoaneurysm of a 29-year-old man due to a penetrating stab wound to the brain. The patient was brought to the emergency room in coma. The neurological examination revealed a Glasgow Coma Scale Score of 8 and left hemiplegy. The initial CT scan showed right temporal lobe haemorrhage with penetration in the lateral ventricle and subarachnoid haemorrhage. The cerebral angiography performed after three weeks, revealed a high PCA pseudoaneurysm. After surgery, a pseudoaneurysm was demonstrated in the histological study.     

Contrast medium precipitation in the stomach between contiguous plain and contrast CT scans

Precipitation of diluted Gastrografin (meglumine sodium amidotrizoate) occurred in the stomach during computed tomography (CT) examination in a 43-year-old man with fasting. Precipitation was not observed on the initial plain CT scan, but was demonstrated on the contrast-enhanced CT scan following the plain CT. Hyperacidity in the stomach might be promoted during CT examination and cause precipitation between scans.     

Death due to delayed onset intracranial bleeding in a patient with an acute subdural hematoma

We report a fatal case of acute subdural hematoma (ASDH) involving the delayed onset of subdural bleeding after a head trauma. There were no central nervous symptoms after the head trauma and an initial head computed tomography (CT) scan did not exhibit any abnormal findings. On the second day, the patient suddenly complained of a headache and vomiting, and she lost consciousness. An emergency head CT scan detected a right-sided ASDH and severe cerebral herniation. As the patient was taking triple anticoagulant therapy, surgery could not be performed. She died 2 weeks after the onset of the ASDH. Even in cases of head trauma that do not exhibit abnormal findings on head CT, it is necessary to follow up the patient’s clinical condition. Specifically, controlling coagulability and performing repeated head CT examinations are considered to be beneficial for preventing abundant subdural bleeding and facilitating the early detection of delayed onset ASDH.     

A case of subdural hemorrhage due to ruptured cerebral aneurysm presenting with atypical imaging features

Acute subdural hemorrhage caused by ruptured cerebral aneurysms is rare. Herein, we report an atypical case of subdural hemorrhage caused by ruptured anterior communicating artery aneurysm in a 49-year-old woman. Computed tomography revealed subarachnoid, intracerebral, and subdural hemorrhages. After the treatment with endovascular coiling significantly decreased the patient''s subdural hemorrhage. However, the subdural hemorrhage revealed and became iso-attenuation compared with the white matter on the 11th day, and hypo-attenuation on the 19th day. On the 33rd day, this subdural hemorrhage completely resolved after discontinuation of dual antiplatelet therapy. Due to rapid changes in the radiologic features of SDH, frequent computed tomography scans at least once a week may be needed especially in patients who receive antiplatelet therapy during the vasospasm phase.     

Q Fever masquerading as prostate cancer metastases

We report a case of Q fever demonstrated on (99m)Tc methylene diphosphonate bone scan and fluorodeoxyglucose (FDG) PET/CT. A 66-year-old man with newly diagnosed, low-grade prostate cancer presented with abdominal and bone pain. Bone scan revealed multiple lesions suspicious for prostate cancer metastases. Because of liver abnormalities on noncontrast CT, an FDG PET/CT was performed and demonstrated FDG-avid sclerotic bone lesions, infiltrative liver disease, and retroperitoneal adenopathy. This appearance, thought unusual for low-grade prostate cancer, prompted extensive clinical evaluation for several months. Liver and iliac bone biopsies showed noncaseating granulomas without neoplasia. Extensive serologic evaluation eventually demonstrated elevated Q fever titers.     

迟发性外伤性颅内病变的CT检查

目的：为了及早诊治外伤性颅内迟发性病变,探索ＣＴ复查的合适时间。材料与方法：搜集颅脑外伤后ＣＴ复查时发现新病变的ＣＴ资料１３１例,统计分析颅内的新病变和发现新病变的时间。结果：发现颅内迟发性病变２０１个,常见的病变有颅内血肿,脑挫裂伤和硬膜下积液等。接近半数的病变在伤后３天内出现,１０天内发现的病变占８４％。结论：颅脑外伤后３、６、１０天是ＣＴ复查的最佳时机,伤后１０天内积极复查ＣＴ能及早发现颅内迟发性病变     

CSF flow jet: novel CT myelogram finding of CSF leak through dural tear in traumatic pseudomeningocele

Determining the exact location of dural violation after traumatic pre-ganglionic (avulsion) injury of the brachial plexus with associated progressively enlarging pseudomeningocele is critical for treatment, but current imaging by MR and CT myelogram remains inadequate as there are often only indirect imaging features. We present a case of a 25-year-old man with history of motorcycle accident and left brachial plexus injury, who was found to have an extensive anterior epidural CSF collection, resulting in the contralateral neurologic deficit. Surgical treatment relies upon the identification of the site of the dural violation. On dynamic CT myelogram images, a thin hyperdense line of contrast was seen, representing “CSF flow jet” extravasating into the pseudomeningocele. Subsequent laminectomy and foraminotomy revealed a left avulsed nerve root and a dural tear at the site localized on the CT myelogram. To our knowledge, this is the first case of using dynamic CT myelography to visualize “CSF flow jet,” revealing the exact location of dural violation resulting in the expanding pseudomeningocele, providing crucial information for perioperative planning.     

CT, MR, and Angiography Findings of a Solitary Fibrous Tumor of the Larynx: a Case Report

This report details the CT, MR, and angiography findings of a solitary fibrous tumor involving the larynx of a 34-year-old man. A precontrast CT scan revealed a well-defined isodense mass in the submucosal region of the supraglottic larynx. The tumor appeared as a mixed intensity lesion on the T1- and T2-weighted MR images. A T2-weighted MR image showed a central, round, and low signal intensity area within the mass. For both the CT and MR images, the mass demonstrated heterogeneous enhancement following the administration of contrast material. The angiography showed a hypervascular tumor with heterogeneous persistent staining.     

Arachnoid cyst with complicating intracystic and subdural haemorrhage

Intracranial arachnoid cysts are usually non-symptomatic. Intracystic and subdural haematomas induced by even minor head injury may turn an asymptomatic AC into a symptomatic one, necessitating surgical treatment. We present a case of a previous asymptomatic AC, spontaneously complicated with subdural hygroma and development of intracystic and subdural haematoma. Clinical follow-up and control CT regime of patients with AC are recommended.     

Soft tissue aneurysmal bone cyst

A soft tissue aneurysmal bone cyst located in the right gluteus medius of a 21-year-old man is reported. On conventional radiography, the lesion demonstrated a spherically trabeculated mass with a calcific rim. On CT scan, it showed a well-organized peripheral calcification resembling a myositis ossificans. On MRI, it presented as a multilocular, cystic lesion with fluid-fluid levels. The lesion had no solid components except for intralesional septa. Although findings on imaging and histology were identical to those described in classical aneurysmal bone cyst, diagnosis was delayed because of lack of knowledge of this entity and its resemblance to the more familiar post-traumatic heterotopic ossification (myositis ossificans).     

Serial computed tomography findings in Creutzfeldt-Jakob disease

Summary Serial CT investigations of 3 patients with histologically confirmed Creutzfeldt-Jakob disease revealed persisting slight brain atrophy to progressive extreme atrophy corresponding to the absolute, not the individual duration of illness. No correlation was observed between CT findings and the patients' condition or electroencephalographic results. In one case with a duration of about 16 months and a terminal brain weight of 750 g a massive bilateral, later unilateral subdural hygroma appeared which probabely was caused by retraction of the brain showing an enormous atrophy.     

Massive systemic air embolism treated with hyperbaric oxygen therapy following CT-guided transthoracic needle biopsy of a pulmonary nodule

A rare complication of computed tomography (CT)-guided biopsies of pulmonary lesions is systemic air embolism, with hyperbaric oxygen therapy being considered the mainstay of therapy. The authors describe the case of a 47-year-old man with a left upper lobe mass invading the chest wall who underwent CT-guided needle biopsy of a right lung base nodule to evaluate for metastatic disease. This procedure was complicated by massive systemic air embolism confirmed by CT scan. After initial resuscitative measures, the patient received on-site hyperbaric oxygen therapy and demonstrated no residual clinical sequelae from this complication.     

Intracerebral extension of nasal dermoid cyst: CT appearance

We report on a 46-year-old man with a congenital nasal dermoid cyst that extended intracranially to form large bifrontal intraaxial dermoid cysts, which became secondarily infected through a nasal dermal sinus tract. Computed tomography demonstrated bilateral frontal lobe ring enhancing cystic masses containing fat-fluid levels consistent with dermoid cyst abscesses. Axial and coronal CT of the skull base and nose demonstrated a midline bony canal extending from two dimples on the dorsum of the patient's nose to the base of the anterior cranial fossa. The clinical, CT, and surgical findings are reviewed as well as the embryogenesis of congenital nasal dermoid cysts.     

Testicular seminoma presenting with mediastinal lymphadenopathy and gynecomastia

Chest computed tomography (CT) of a 22-year-old man with a history of long-term low fever and nonproductive cough demonstrated lymphadenopathy in the superior, middle, and posterior mediastinum. Slight bilateral gynecomastia was also observed on the CT scan. Subsequent physical examination and ultrasonography revealed a left testicular mass, and abdominal CT showed retroperitoneal lymphadenopathy. Left orchiectomy was performed, with the histological examination confirming the diagnosis of seminoma.     

Chronic suppurative otitis media complicated by subdural and Bezold abscesses: A case report

Complications of chronic suppurative otitis media (CSOM) are divided into intracranial and extracranial complications. Bezold abscess is a very rare extracranial complication with an incidence of 1.5% of the total complications of CSOM in a study conducted in China, similarly subdural abscess is a rare intracranial complication with an incidence of 0.3% in the same study. If not given proper and immediate treatment, these complications can be fatal. Head and neck computed tomography (CT) scan is the main modality for diagnosing complications of CSOM. We report the case of a 15-year-old girl with CSOM who suffered from multiple rare and life-threatening intracranial and extracranial complications. CT scan of the head and neck revealed multiple complications, including cholesteatoma with the destruction of the ossicles, a Bezold abscess inferiorly and a subdural abscess intracranially. Surgery was performed twice to remove the abscess, accompanied by antibiotic therapy according to the type of bacterial culture.     

PET detection of solitary distant skeletal muscle metastasis of esophageal adenocarcinoma

A 67-year-old man with progressive dysphagia was recently diagnosed with a gastroesophageal junction adenocarcinoma. Contrast-enhanced CT scans of the abdomen and pelvis reported a large GE junction tumor without evidence of metastatic disease. FDG positron emission tomography revealed intense tracer accumulation in the soft tissue mass at the GE junction consistent with the primary neoplasm. In addition, PET scan also identified a solitary focus of intense FDG accumulation at the musculotendinous junction of the right gluteus minimus muscle. Subsequent MRI demonstrated mild enhancement and could not differentiate between tumor versus inflammation. Needle biopsy was performed and confirmed metastatic esophageal adenocarcinoma. A case of skeletal muscle metastases from late-stage (IV) gastroesophageal adenocarcinoma was previously reported. However, a solitary metastasis to a distant skeletal muscle without evidence of other lymphatic and hematogenous metastasis is quite unusual. The case supports the previous report that PET is superior in detecting distant metastases for initial staging of esophageal carcinoma over CT.