Intraosseous hibernoma: Two case reports and a review of the literature

Intraosseous hibernomas are exceedingly rare tumors with only 35 cases reported worldwide. They are composed of vestigial brown adipose tissue and require biopsy and pathologic analysis for definitive diagnosis. Given their propensity to mimic more insidious malignant neoplasms, early and accurate identification may spare the patient both anxiety and invasive therapeutic interventions. In this report, we present two cases of intraosseous hibernomas and provide a review of current literature to further characterize the clinical, radiographic, and histopathologic parameters of these lesions. Clinicians should consider the diagnosis of intraosseous hibernoma when evaluating patients with characteristic presentations as it may be more prevalent than currently reported.     

肠系膜血管瘤1例及文献复习

目的探讨肠系膜血管瘤的MRI表现,提高对肠系膜血管瘤的认识。方法回顾性分析1例经手术证实的肠系膜血管瘤病人MRI资料并行文献复习。结果 MRI检查显示下腹部及盆腔巨大、呈扇形分布的囊实性肿块,于T_1WI、T_2WI及精准频率反转恢复序列信号混杂,其内可见多发线样分隔,呈蜂窝样改变;病变边缘于T_2WI还可见多发细小血管流空影,邻近肠管受压移位,局部肠壁与病变分界不清。结论肠系膜血管瘤的影像表现较具特异性,熟悉肠系膜解剖结构及血管瘤的特征性影像表现有助于本病的诊断,确诊需依赖病理组织学检查。     

Cherubism: a rare case report with literature review

Cherubism is an autosomal dominant disorder caused by a mutation of the gene encoding the binding protein SH3BP2. However, non-hereditary forms are observed, probably related to a de novo mutation. It is clinically manifested by an enlargement or a deformation of the jaw associated with a malposition of the teeth. In severe forms, these deformations can have a psychological impact, associated with ocular complications, as well as a reduction of the pharynx lumen and phonation disorders. The appearance of the lesions on imaging is not very specific, however it remains essential for the mapping of the lesions. We report a case of cherubism in a 12-year-old boy with no family history. This case report''s objective is to identify the radiological aspect of this pathology and establish an early diagnosis to oriented therapeutic interventions.     

Jejunogastric intussusception: a case report with the review of literature

Jejunogastric intussusception (JGI) is a rare but potentially lethal complication of gastrectomy or gastrojejunostomy. In the acute setting, early diagnosis and prompt surgical intervention are mandatory to avoid mortality. We present a case of JGI in a patient with a history of gastrojejunostomy who had increasing vomiting, hematemesis, and abdominal pain for 1 day.     

Thyroid hemangioma: a case report with a review of the literature

A 53-year-old man was found serendipitously to have increased blood-pool uptake in the right lobe of the thyroid during a radionuclide ventriculography study for left ventricular function. Primary thyroid hemangioma is a rare condition, with only two cases reported in the literature. Secondary hemangioma may occur as a result of fine-needle aspiration. This technique may cause hematoma formation, which generally resolves normally, but on rare occasions it can lead to cavernous hemangioma formation. In patients with a thyroid swelling who have a cold nodule on a thyroid scan and only blood on repeated fine-needle aspiration, Tc-99m erythrocyte blood-pool imaging may be performed to diagnose hemangioma.     

Tension pneumocephalus: a case report with review of literature

Tension Pneumocephalus (PC) was described 50 years ago. A case of pneumocephalus (PC) following cervical epidural injection in a 50-year-old male worsened by air travel and manifested as tension pneumocephalus, confirmed by advanced neuroimaging, is reported for the first time along with literature review. The patient underwent emergent frontal burr hole evacuation and air gushed under pressure. The patient recovered well and is stable during a follow-up of 12 months. Presenting features and clinical course along with Mount Fuji sign, Peaking sign, and air bubble sign observed in this case are described. Also, the importance of considering neurosurgical and spinal procedures leading to PC have to be considered by practitioners before issuing fitness certificate before air travel, as PC is likely to get transformed to tension PC and can cause an in-flight emergency.     

Cystic meningioma: A case report with a literature review

Cystic meningiomas are very rare tumors of the central nervous system. We report the case of a 62-year-old female how presented headaches resistant to usual analgesics with behavior disorders. Cerebral CT scan showed a right frontal extra-axial tumor with firm and cystic component, brain MRI evoked the diagnosis, surgery removed the entire tumor and histological examination confirmed it. A cystic meningioma should not be omitted from the differential diagnosis of brain tumors with a cystic component and which clinical, radiological, histological and therapeutic features are discussed.     

Cadasil syndrome: A case report with a literature review

“CADASIL” is a genetic microangiopathy with autosomal dominant inheritance. Its epidemiology and physiopathogenesis are poorly specified, but it is proven that this disease is due to a mutation of the NOTCH3 gene resulting in a loss of elasticity of the media of the affected vessels. The clinical expression is variable, dominated by migraine attacks with aura, ischemic vascular accidents and psychiatric disorders, in particular depression. MRI is essential for diagnosis even in the pre-symptomatic phase. It shows signal abnormalities in the basal ganglia and white matter, characteristic especially when located in the anterior part of the temporal lobes. The management of CADASIL is multidisciplinary, psychological for the most part without specificity of a particular treatment.     

Dyke-Davidoff-Masson syndrome: A case report with a literature review

Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon neurological disease defined as cerebral hemiatrophy with a contralateral motor deficit, facial asymmetry, and seizures. Classic imaging findings are cerebral hypoplasia, ventriculomegaly, paranasal sinus hyper-pneumatization, and compensatory osseous enlargement. The diagnosis of DDMS is based on the correlation between clinical and neuroimaging features. The management of DDMS is based on anticonvulsant medication with physiotherapy. We describe an unusual case of DDMS presented with frequent and persistent seizures.     

成人不典型表现髓母细胞瘤1例及文献复习

目的探讨成人不典型髓母细胞瘤的MRI表现,提高对髓母细胞瘤的认识。方法回顾性分析1例经手术病理证实的成人髓母细胞瘤病人MRI资料并行文献复习。结果 1例不典型成人髓母细胞瘤的影像表现:CT上双侧小脑半球、小脑蚓部呈弥漫高密度,边界不清;MRI表现为双侧小脑半球、小脑蚓部及左侧桥臂呈弥漫性稍长T1、稍长T2信号,DWI上呈稍高信号,ADC图上呈稍低信号,增强扫描病变大部分未强化,局部呈脑回样强化。1H-MRS检查可见桥臂区病变Cho峰升高,NAA峰减低,Cho/NAA明显升高。PET显像中病变呈18F-FDG低代谢,11C-MET高代谢。结论成人髓母细胞瘤的影像表现不典型,多种影像检查对诊断本病有重要价值,确诊需依赖病理组织学检查。     

Kozlowski type spondylometaphyseal dysplasia: a case report with literature review

Spondylometaphyseal dysplasia is a type of bone dysplasia characterized by vertebral and metaphyseal changes of varying severity. Diagnosis of the disease is difficult because the severity of bone involvement differs and symptoms change according to the age of the patient. In this study, radiographic findings of a 16 month-old male patient diagnosed as Kozlowski type spondylometaphyseal dysplasia is reported.     

Bilateral giant hydroureteronephrosis--a case report with a review of the literature

Giant hydronephrosis and hydroureteronephrosis are rare conditions, but must be kept in mind in especially children and in young-to-middle-aged adults with long-standing, often symptomless, enlargement of the abdomen. A case of bilateral giant hydroureteronephrosis due to calculi in the ureters is reported. Despite renal insufficiency the patient denied any treatment, but survived 42 months after the primary diagnosis. For diagnostic purposes intravenous pyelography, ultrasonography and computerized tomography are preferable. Supplementary ante- and retrograde pyelography is valuable in locating stenosis or calculi.     

原发性肺隐球菌病1例

患者女性,41岁。因＂反复头晕、视物旋转伴恶心2年,乏力1年入住心内科。原有高血压病1年。近期偶有少量咳嗽,无畏寒、发热,无消瘦、夜间盗汗。入院查体：T36.8°C,P100次/min,R 20次/min,BP 130/80mmHg。神清,精神可,浅表淋巴结未及肿大。双肺呼吸音清,未闻及干湿性罗     

心脏血管瘤1例并文献复习

目的 探讨心脏血管瘤的临床表现、影像特征和病理特点,以提高对心脏血管瘤的认识和鉴别诊断能力。 方法 回顾性分析1例经手术病理证实的心脏血管瘤病人的影像及病理资料并行文献复习。 结果 超声心动图上可见胸腔内主动脉根部右后方、腹主动脉膈肌水平左前方一实性为主的中等回声团,内部可见低、无回声区,周边可见强回声的钙化,血流未见异常。CT显示心脏肿物位于左室下壁,密度欠均匀,内部及边缘可见明显钙化;增强后病变轻度强化。MRI显示左室下壁基底段肿物明显向腔外突出,信号不均匀,增强后呈不均匀轻度强化。选择性冠状动脉造影可见肿瘤供血动脉来源于右冠状动脉。PET/CT显示病灶呈糖代谢缺失。正电子发射计算机断层扫描（PET/CT）显示病灶呈糖代谢缺失。 结论 心脏血管瘤可发生于心脏肌层,如发现心脏肌层肿物存在冠状动脉供血及明显蛋壳样钙化时,即使不具有典型强化表现,也需考虑血管瘤的诊断。     

Intraosseous hibernoma: characterization of five cases and literature review

Objective

To describe the imaging and histopathological findings and provide an overview of a recently described and rare cause of bone sclerosis.

Materials and methods

Five cases of intra-osseous hibernoma of bone that presented over the last year. The imaging and histopathology is reviewed.

Results

All cases were identified in asymptomatic middle-aged to elderly adults as incidental findings with bone sclerosis in the axial skeleton. MRI showed lesions that were T1 hypointense to subcutaneous fat and hyperintense to skeletal muscle and one showed contrast enhancement. Glucose avidity was demonstrated on FDGPET in both cases tested and isotope bone scan performed in three cases showed strong positivity in two, but uptake was inconspicuous in one case.

Conclusions

Intra-osseous hibernoma is a rare cause of sclerotic bone lesions, predominating in the axial skeleton of middle-aged and elderly adults. They have a non-aggressive appearance on CT and on MRI are T1 hypointense to subcutaneous fat and hyperintense to skeletal muscle. They are usually T2 hyperintense and may show peripheral contrast enhancement. They may show increased glucose avidity on FDGPET and may or may not be positive on isotope bone scans. We suspect that with ever-increasing use of a variety of imaging techniques, particularly in a setting of staging for malignant disease, more such cases will come to light. This diagnosis should be added to the differential diagnosis of sclerotic bone lesions.     

Xanthoma disseminatum: a case report and literature review

This case report describes the neuro-opthalmologic and respiratory manifestations of xanthoma disseminatum, a rare histiocytosis syndrome characterized by disseminated lesions in a young male adult. Multimodality management of this disease, including the role of local radiotherapy, is discussed accompanied by a review of the literature.     

Ureteral intussusception: a case report and literature review

We present the case of a 64-year-old man with intussusception of the right ureter as a complication of an underlying transitional cell carcinoma. To our knowledge, this is the first case report that illustrates ureteral intussusception by both multidetector computerized tomography and magnetic resonance imaging. Although ureteral intussusceptions are thought to be associated with benign masses, our comprehensive review of the literature demonstrates that almost half of the cases are associated with underlying malignancy.     

Perisplenic pseudolesion: a case report and literature review

Distinguishing a normal variant from true pathology is a frequent task of the imager. In the assessment of the trauma patient, rapid determination of the presence or absence of intraabdominal injury is of paramount importance. We present the sonographic findings of an anatomic variant detected in a patient following blunt abdominal trauma. Trauma sonogram revealed an elongated left lobe of the liver mimicking a subcapsular splenic hematoma. This case illustrates the importance of recognizing this potential pitfall in the setting of abdominal trauma. An equivocal trauma sonogram can lead to critical delays in treatment of associated injuries and unnecessary additional imaging or even surgery.