Angiomyoma of the knee joint: value of magnetic resonance imaging

A case of angiomyoma as an unusual cause of knee pain is presented and the usefulness of magnetic resonance imaging in such a situation is discussed.     

Unusual diastatic separation of the sagittal suture: Avoiding confusion with inflicted head trauma

Certain artifacts presenting on a fetus due to maceration or birth trauma, mimic inflicted head trauma (IHT) occurring post partum. In such cases, absent a thorough history and examination of the circumstances, the distinction may be impossible. This case report presents an unusual artifact occurring in a stillbirth delivered after the mother had complained of not feeling fetal movements for at least 24 hours. At autopsy, the macerated fetus presented with unusual widening of the sagittal suture and galeal/subgaleal hematomas. There were no other injuries. Review of the mothers antenatal, personal and social history combined with the absence of other injuries to the mother and fetus, helped distinguish the unusual birth-related diastatic separation from IHT. Consequently, in a case where the pathologist is presented with limited information for instance an abandoned fetus, a cautious approach to the determination of the cause and manner of death is strongly recommended.     

Rupture of the renal pelvis of a ureteropelvic junction hydronephrosis after blunt abdominal trauma

In the present case report, we present the unusual occurrence of traumatic rupture of a ureteropelvic junction hydronephrosis, and discuss the potential mechanisms producing such a rupture and the management options.     

Leiomyoma in a female urethral diverticulum

Neoplasms arising within urethral diverticula are rare. It is important to know if a diverticulum is filled by tumor, but traditional diagnostic methods, such as voiding cystourethrography, cannot detect a tumor or diverticulum, as in our case. We report an unusual case of leiomyoma developing in a female urethra diverticulum and review the literature.     

Fire during arthroscopy — an unusual complication

We report a case of fire during routine arthroscopy. This is an unusual but potentially disastrous complication. Recommendations are presented for preventing such an event.     

Generalized skull vault thickening in association with a large arteriovenous malformation

Generalized thickening of the skull is unusual but has a number of recognized associations such as chronic severe anaemia, Paget disease and phenytoin therapy. We report a case of generalized skull vault thickening seen in association with a large arteriovenous malformation of the brain.     

Extension of hepatic matastatic tumor along a biliary drainage catheter tract: Case report

Extension of hepatic metastatic tumor along a biliary drainage catheter tract is an unusual occurrence. We believe this is the first report of such a case presenting as a calcified, subcutaneous mass at the catheter entry site.     

Diffuse pneumocephalus due to Clostridium septicum cerebritis in haemolytic uraemic syndrome: CT demonstration

Summary The computed tomography finding of diffuse pneumocephalus due to infection by gas-forming organisms is very unusual. We report such a case due to secondary infection byClostridium septicum in a child with diarrhoea-associated haemolytic uraemic syndrome.     

Balloon-Occluded Percutaneous Transhepatic Obliteration of Isolated Vesical Varices Causing Gross Hematuria

Gross hematuria secondary to vesical varices is an unusual presentation. We report such a case recurrent gross hematuria in a male patient who had a history of bladder substitution with ileal segments that had been treated by balloon-occluded percutaneous transhepatic obliteration of vesical varices.     

The five-vessel arch: independent origin of both vertebral arteries from the aortic arch

An independent origin of the left vertebral artery from the aortic arch is the second most common aortic arch anomaly and occurs in 7% of otherwise healthy persons. Bilateral and independent origins of vertebral arteries are distinctly unusual. We present and illustrate such a case.     

Plastic bag asphyxia – A case report

Suicides due to plastic bag asphyxia have been reported in the literature but remain unusual. The circumstances of such deaths are reviewed and illustrated by the case of a 32-year-old male who was found dead in a lorry cab. The remarkable point is that the victim followed instructions from an American movie he had watched. This case emphasizes the importance of the investigation to determine the manner of death.     

CT findings in transdiaphragmatic empyema necessitatis due to tuberculosis

A case of transdiaphragmatic empyema necessitatis due to tuberculosis presented clinically as a subcutaneous mass in the posteroinferior right chest. Imaging studies revealed a 12 cm diameter suprahepatic mass contiguous with thickened and calcified right pleura. Even in the preantibiotic era, such a presentation of empyema necessitatis was very unusual.     

Multiloculated chronic posttraumatic aneurysm of the thoracic aorta with late acute rupture

A highly unusual case of a multiloculated chronic posttraumatic aneurysm of the thoracic aorta is presented. Angiographically, there was marked enlargement over a 7-year interval, resulting in acute rupture. The initial trauma had occurred over 30 years previously, emphasizing the need for a careful history in such patients.     

Case reports. 2. Accidental strangulation: a case report

Accidental strangulation, though reported, is uncommon. We report a case of an unusual accidental strangulation in which the floating end of the 'saree' of the pillion rider of a two-wheeler motorcycle got entangled in the moving rear wheel and constricted her neck. To our knowledge this is the first case of its type involving a two-wheeler motorcycle. Comments are also given on traditional Indian wear and safety measures required in two-wheelers to prevent such incidents.     

Delayed femoral vein thrombosis after ultrasound-guided thrombin injection of a postcatheterization pseudoaneurysm

Ultrasound-guided thrombin injection is a highly effective therapy for postcatheterization pseudoaneurysm. Despite a very low complication rate, a number of severe arterial thrombotic events have been reported. We present an unusual case of acute femoral vein thrombosis occurring several hours after successful treatment of femoral artery pseudoaneurysm by ultrasound-guided thrombin injection. Pathophysiologic mechanisms are discussed. This case highlights the potential hazards of instilling such a powerful thrombogenic substance in the immediate vicinity of other vascular structures.     

Post-traumatic intrathoracic splenosis and role of Tc-99m Sulfur colloid scintigraphy in confirmation

Splenosis is acquired ectopic splenic tissue, usually a sequela of trauma. Its imaging appearance is can be deceiving, and at unusual locations may be mistaken for an alternate cause mass lesion. We present one such unusual case of splenosis in a 53 year-old man with history of heart failure involving the thoracic cavity identified as splenosis on nuclear medicine imaging and suspicion was raised given the remote history splenectomy after splenic rupture during trauma. We will discuss the imaging appearances of splenosis on CT, MRI and nuclear medicine studies, with emphasis on using nuclear medicine as a modality of choice to avoid biopsy. We will also go on to include a brief review of literature on this topic in this article. The key facts are role of detailed clinical history and requirement of high index of suspicion to avoid unnecessary intervention in the case of splenosis.     

Fatty degeneration in a Wilms' tumour after chemotherapy

We report a case of extensive fatty change in a Wilms' tumour after chemotherapy demonstrated on CT associated with an increase in tumour volume, in a 10-month-old girl with Beckwith-Wiedemann syndrome. Changes in tumour characteristics after chemotherapy on imaging usually reflect necrosis, haemorrhage and calcification. Assessment of response to therapy is dependent on a documented reduction in tumour volume. In this case, CT showed an increase in tumour size with development of an extensive fatty component following treatment. Subsequent histological examination on the nephrectomy specimen confirmed an extensive fatty component with no evidence of residual blastema. The development of such an extensive fatty component is very unusual. In this case such fatty change was an indicator of tumour sensitivity and response to treatment.     

Gallium-67 breast uptake in a patient with hypothalamic granuloma (sarcoid)

An unusual case is presented of bilateral breast uptake of [67Ga]citrate in a patient with a hypothalamic granuloma in the absence of galactorrhea is presented. A possible mechanism for this incidental finding is elevated prolactin levels, as other causes of gallium breast uptake such as drug therapy, and intrinsic breast disease, were not present.     

Serial sonographic evaluation of "buckshot colic" following a penetrating gunshot wound.

This paper demonstrates the findings of various radiologic imaging modalities in a case of shotgun injury to the kidney. This case is unusual because buckshot entered the renal collecting system, and subsequently passed through the urinary tract in the urine, causing "bullet colic." References to such injury in the literature are discussed, along with role of each imaging modality in the initial and subsequent radiologic workup, with particular emphasis on the usefulness of ultrasonography in evaluation of this patient.     

Actinomycotic brain abscess: CT findings

An unusual case of actinomycotic brain abscess with histologic documentation is reported. Commonly, a primary focus of actinomycosis in the cervicofacial, thoracic, or abdominal areas is found. In our particular case such a primary source of infection was not evident. Cranial CT showed a thick-walled ring enhancing lesion deeply located in the left parietal region. This CT finding was useful but not diagnostically pathognomonic. Correct diagnosis was made based on histologic findings. Sulfur granules and Gram-positive branching organisms were seen in the purulent material.