The role of unhenanced CT in a ruptured parathyroid adenoma: A case report.

Acute bleeding is a rare and potentially life-threatening complication of a Parathyroid Adenoma described in just a few cases in literature. We describe the case of a healthy 53-years-old female patient without prior history of parathyroid pathology who presented with acute onset of neck and mediastinal hemorrhage. Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) combined with laboratory tests led to the diagnosis of a bleeding Parathyroid adenoma. This case is presented to sensitize both Radiologists and Clinicians about this rare presentation that should be put into differential diagnosis of acute neck swelling and pain.     

Successful repeat transcatheter ablation of a mediastinal parathyroid adenoma 6 years after alcohol embolization

Recurrent hyperparathyroidism is rare following transcatheter ablation of mediastinal parathyroid adenomas. When it occurs it is usually early and resistant to further attempts at ablation. We present a patient with primary hyperparathyroidism in whom two surgical attempts at cure had been unsuccessful. Subsequently, a mediastinal adenoma was demonstrated angiographically and embolized with absolute alcohol. Hyperparathyroidism recurred 6 years later and the mediastinal adenoma was subsequently successfully ablated a second time by angiographic embolization with ionic contrast medium.     

MRI appearances of an ectopic pituitary adenoma: case report and review of the literature

MR images of an ectopic pituitary adenoma have been published in only a single case, a suprasellar mass. We present a patient with Cushing's disease in whom MRI revealed a pituitary adenoma within the sphenoid sinus. Radiologic characteristics of ectopic pituitary adenomas are reviewed, with emphasis on MRI, which demonstrates a soft tissue mass, isointense with gray matter on T1-weighted images, which enhances in a heterogeneous manner.     

Giant mediastinal bronchial artery aneurysm mimicking mediastinal mass: A case report and brief review of the literature

Bronchial artery aneurysm and pseudoaneurysm is a rare but life-threatening diagnosis due to catastrophic complications from rupture. Prompt detection and management is key to prevent complications. CT angiogram and digital subtraction angiography are preferred diagnostic imaging modalities. Being very uncommon, these entities can be misdiagnosed as a nonspecific mediastinal soft tissue mass, which can lead to delay in diagnosis and inappropriate or delayed management. We present a case of 72-year-old woman with incidentally detected large bronchial artery pseudoaneurysm, incorrectly classified as mediastinal malignancy at outside facility, receiving follow-up exams for 2 years, before correct diagnosis and management.     

甲状旁腺腺瘤的MRI诊断

目的研究甲状旁腺腺瘤的MRI表现,并结合文献复习评价其诊断价值。方法6例经病理证实甲状旁腺腺瘤合并甲状旁腺机能亢进患者均经SE序列T1加权成像和T2加权成像,部分患者还经FL2D T1加权成像及STIR序列成像,以及Gd—DTPA增强扫描。结果研究证实,甲状旁腺腺瘤在T1WI上呈稍低信号,在T2WI上呈高信号;增强扫描呈轻一中度强化。结论MRI能清晰显示甲状旁腺腺瘤的大小、形态、部位及其与周围组织结构的关系,因此,它是诊断本病的最佳方法之一。     

Paradoxical technetium-thallium subtraction scan in a case of parathyroid adenoma

A technetium-thallium (^99mTcO₄-²⁰¹Tl) subtraction scan was performed in a patient with clinical and biological evidence of hyperparathyroidism. The ²⁰¹Tl image indicated a normal thyroid gland. The ^99mTcO₄ image revealed a left inferior thyroidal extension with an intense and transient focus corresponding to an ultrasonographic nodule. The transient character of the focus was not explicable in terms of vascular kinetics. A supplementary scintigram using ¹²³I confirmed the presence of an inferior extension of the thyroid, but no increased uptake was found. A nodule weighing 250 mg containing a parathyroid adenoma surrounded by normal thyroidal tissue was excised at the focus site. Biological serum levels returned to normal after the operation. It is concluded that the analysis of ^99mTcO₄ dynamic data could improve the accuracy of parathyroid subtraction scintigraphy.     

甲状旁腺腺瘤的临床影像分析

目的:探讨甲状旁腺腺瘤的CT和MR表现,提高对其认识水平。方法:回顾性分析10例经手术病理证实的甲状旁腺腺瘤患者的临床、CT和MR资料。结果:10例甲状旁腺腺瘤,6例起源于下甲状旁腺,3例起源于上甲状旁腺,均位于气管食管旁沟内,1例起源于异位甲状旁腺。肿瘤最大径为1.0~4.0cm,平均2.8cm。肿瘤呈圆形或卵圆形、边缘清楚的结节或肿块影,6例CT表现为等密度,4例MR表现为T1WI低信号或等信号,T2WI等信号或高信号。8例轻至中度强化,2例明显强化。6例强化均匀,4例强化不均匀。7例有全身广泛性骨质疏松,其中3例合并棕色瘤。结论:CT和MR易于检出甲状旁腺腺瘤,可准确显示其部位、形态、大小及与周围组织的关系,并对多数腺瘤作出定性诊断,对临床诊治具有重要价值。     

Preoperative angioembolisation of a mediastinal accessory ectopic spleen: A case report and review of the literature

A 50-year-old male presented to our institution for embolization of an incidentally detected mediastinal mass prior to surgical resection. The patient had undergone extensive pre-procedural imaging as well as bronchoscopy and mediastinoscopy. Ultimately, resection was required for a definitive diagnosis of congenital ectopic mediastinal accessory spleen. This case represents the first reported incidence of ectopic splenic tissue in this location and illustrates the difficulties in establishing a pre-operative diagnosis with often confounding imaging findings.     

Computed tomographic characteristics of the normal thymus gland: Relationship to mediastinal hematoma

Computed tomography (CT) is frequently used in the screening process to determine the need for angiography in patients with possible blunt thoracic aortic injury. Misinterpretation of normal mediastinal structures (particularly the thymus in patients under age 40 years) as mediastinal hematoma may result in a significant number of false-positive scans. During a 20-month period, we reviewed the chest CT examinations of 1247 patients to select two groups of patients: group I, in whom the mediastinum was normal by CT, and group II, in whom the CT identification of a mediastinal hematoma had been proven surgically. Two major mediastinal CT differences were noted between the groups. The first was a normal cleavage plane between the lateral aspect of the aortic arch and the soft tissue density of the thymus seen in 100% of patients with normal mediastinum (group I) and 0% of patients with known mediastinal hematoma (group II). The second difference relates to the anatomic fact that the thymus is normally present only in the anterior mediastinum. Thus, the presence of a soft tissue density throughout the right paratracheal region of the middle mediastinum, which was seen in 100% of group II (mediastinal hematoma) patients and in 0% of group I (normal) patients, represented blood and not thymus tissue. These results demonstrate fundamental differences in appearance between thymic tissue, regardless of its state of involution, and a mediastinal hematoma on unenhanced mediastinal CT (UMCT). It is important that these differences be recognized so that thymic tissue is not confused with a mediastinal hematoma resulting in unnecessary thoracic aortography. Supported in part by the John S. Dunn Research Foundation.     

Congenital spondylolytic spondylolisthesis of the cervical spine: A case report and literature review

Congenital spondyloytic spondylolisthesis (CSS) is characterized as a pars-interarticularis well-corticated cleft with antherolithesis. The presence of spina bifida and vertebral dysplastic changes corroborate the possibility of a congenital etiology. It is a rare condition, usually discovered incidentally, especially after a trauma and should be differentiated from traumatic spondylolysis, which requires aggressive treatments. The management is often conservative, with surgery being indicated for symptomatic or unstable lesions. We report the case of a sixth cervical vertebra Congenital Spondylolytic Spondylolisthesis (CCS), discovered fortuitously following a minor trauma, in a 19-year-old male patient, treated conservatively with a favorable evolution.     

Epidural hematoma as a complication of sphenoid sinusitis and epidural abscess: a case report and literature review

Imaging is of paramount importance in early diagnosis of epidural abscess and its intracranial complications. Typical CT imaging features of an epidural abscess include a hypodense lentiform extra-axial collection with rim enhancement. We present a case of epidural abscess that was hyperdense on CT scan due to the presence of associated epidural hematoma. The literature is reviewed regarding this unusual complication of epidural abscess.     

无症状甲状旁腺腺瘤合并甲状腺乳头状癌的主要特征

 目的 总结无症状甲状旁腺腺瘤(parathyroid adenoma,PA)合并甲状腺乳头状癌(pillary thyroid carcinoma,PTC)的主要特征,以提高两病并存时的诊断水平。方法 回顾分析新疆医科大学附属肿瘤医院2005-01至2014-12诊断的12例无症状PA合并PTC患者一般资料及病理组织形态学特点。结果 12例中,2例血清钙和血清甲状旁腺素(parathyroid hormone ,PTH)增高、 血清磷降低。PA镜下实质细胞由主细胞、嗜酸性细胞混合组成。瘤细胞排列成巢状、片状或囊状,核稍大,偶见核分裂象。肿瘤均包膜完整,未见坏死。免疫组化表型所有 12 例PA 病例CK19、PTH、嗜铬粒素A(CgA)均为阳性;甲状腺转录因子-1(TTF-1),甲状腺球蛋白(TG),降钙素均为阴性,Ki-67阳性指数 ＜3%。结论 无症状PA合并PTC临床上比较少见,术前应仔细检查,排除两病共存的情况,避免遗漏。术中有必要行冷冻病理切片检查,而且还应与甲状旁腺癌、PTC等肿瘤鉴别。     

Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review

Nontraumatic intramural duodenal hematoma (IDH) is rare disease and it is generally related to coagulation abnormalities. Reports of nontraumatic IDH associated with pancreatic disease are relatively rare, and various conditions including acute or chronic pancreatitis are thought to be associated with nontraumatic IDH. However, the association between IDH and acute pancreatitis remains unknown. We report the case of a 45-year-old man who presented with vomiting and right hypochondrial pain. He had no medical history, but was a heavy drinker. The diagnosis of IDH was established by computed tomography, ultrasonography and endoscopy, and it was complicated by acute pancreatitis. The lesions resolved with conservative management. We discuss this case in the context of previously reported cases of IDH concomitant with acute pancreatitis. In our patient, acute pancreatitis occurred concurrently with hematoma, probably due to obstruction of the duodenal papilla, or compression of the pancreas caused by the hematoma. The present analysis of the published cases of IDH with acute pancreatitis provides some information on the pathogenesis of IDH and its relationship with acute pancreatitis.     

后纵隔类实性髓脂肪瘤的影像表现与文献复习

目的:探讨类实性原发性纵隔髓脂肪瘤(PMM)的影像特征,以提高对该病的诊断水平.方法:搜集经病理证实且影像资料完整的类实性PMM 3例,结合文献复习,分析该病的影像表现.结果:纳入7例PMM共20个病灶,均为男性;单侧单发病灶多见(5/7,71.43％),病灶多呈椭圆形或卵圆形(16/20,80.00％);边缘可伴浅分...     

Association of parathyroid adenoma and autonomous nodule of the thyroid. Diagnostic efficacy of 201thallium-99mtechnetium scintigraphy

The thallium-technetium subtraction technique, proposed originally by Ferlin and co-workers, is now widely used to localize parathyroid adenoma. We report here the case of a hypercalcemic woman, referred to our ward with the biologically assessed diagnosis of primary hyperparathyroidism. Thallium-technetium subtraction scintigraphy not only successfully localized the parathyroid adenoma but also revealed the existence of an autonomous nodule of the thyroid, which was not suspected. It has previously been shown that this method can localize parathyroid adenoma in cases of cold thyroid nodule. This report shows that this is also true in the case of hot thyroid nodule. No observations of concomitant parathyroid adenoma and autonomous nodule of the thyroid have been reported (at least during the two past decades). Is this association casual or has it never been noticed? Further examinations can be performed with thallium when a hot thyroid nodule is found in a hypercalcemic patient.     

纵隔包虫病CT及CMR表现并文献复习

目的 探讨纵隔包虫病的影像特点及鉴别诊断。 方法 回顾性分析1例经临床证实的纵隔包虫病CT和心脏MR表现并进行文献复习。 结果 CT平扫显示右侧冠状沟类圆形囊状稍低密度,密度均匀,局部壁钙化,右侧房室交界部及右冠状动脉近段受压推移。 心脏MR显示病灶T₁WI呈等信号,T₂WI黑血序列呈稍高信号,电影序列示右房、右室运动及三尖瓣开放受限,病灶随房室运动轻度抖动,T₁ mapping显示腔内信号均匀。静息首过灌注及延迟增强影像均显示病灶未见明显强化。 结论 纵隔包虫病较为罕见,诊断时应结合其流行病学史、CT和MRI的影像特点,临床工作中诊断纵隔囊性占位也应考虑到纵隔包虫病感染的可能。     

Computed tomography of mediastinal cystic hygroma in an adult: case report and review of the literature

Conventional and computed tomography findings in a cystic hygroma (lymphangioma) of the middle mediastinum in an adult are reported and compared with previously reported cases. The pertinent literature is reviewed.     

IgG4 aortitis of the ascending thoracic aorta: A case report and literature review

IgG4 aortitis is a recently recognized entity that can have clinical and imaging features that mimic acute aortic syndrome. Therefore, it is imperative for radiologists to be aware of how to potentially differentiate the two. Although this entity has been previously described via case reports and meta-analysis in the context of inflammatory abdominal aortic aneurysm, very few cases of ascending aortic involvement have been reported. In this case report, we present a case of a 60-year-old female transferred from another facility for an initial diagnosis of intramural hematoma of the ascending aorta and later found to have IgG4 aortitis post aortic root repair. This is a histologically confirmed case of multi-segmented IgG4 aortitis with rare involvement of both ascending and infra-renal aorta. We will briefly discuss the pathophysiology of IgG4 aortitis, along with review of literature.     

Dysphagia caused by an anterior cervical osteophyte: case report

Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are commonly asymptomatic. Dysphagia caused by cervical osteophyte formation is rare. We report a case of spondylotic dysphagia with striking radiographic findings. A massive anterior cervical hyperostosis was resected via the anterior cervical approach with excellent relief of dysphagia.