Sudden unexpected death due to inflammatory myofibroblastic tumor of the heart: a case report and review of the literature

Inflammatory myofibroblastic tumor (IMT) or inflammatory pseudotumor is a rare primary cardiac tumor that may result in sudden death. We report a sudden unexpected death due to occlusion of the coronary arteries by IMT arising from the left coronary cusp of the aortic valve. An 8-year-old child suddenly woke up from his sleep with complaint of severe chest pain to his parents, and shortly he became unresponsive. He expired 40 min later in the hospital despite resuscitation efforts. The postmortem examination revealed a 2.5 × 2 × 1-cm mass composed of multiple entangled slender cylindrical fronts, filling the coronary sinus and obstructing the coronary ostia. The patient had complained of recurrent chest pains about 2 weeks prior to his death. Echocardiogram was conducted on the patient but did not recognize the mass. Histological examination of the mass established the diagnosis of primary cardiac IMT. The detailed pathological findings are described. In addition, the literature is reviewed, and pathogenesis, clinical presentation, and the importance of forensic autopsy examination are discussed.     

Inflammatory Pseudotumor of the Breast: a Case Report with Imaging Findings

Inflammatory pseudotumor, also known as inflammatory myofibroblastic tumor and plasma cell granuloma, is an uncommon low-grade lesion composed of spindle cells admixed with mature plasma cells and other inflammatory cells, such as histiocytes, lymphocytes, and eosinophils. Here, we describe the mammographic and ultrasonographic findings of a case of an inflammatory pseudotumor of the breast in a 60-year-old woman. With the suspicion of malignancy, core needle biopsy and surgical excision confirmed the mass as being an inflammatory pseudotumor of the breast.     

Perinephric myxoid pseudotumor of fat: A very rare entity that can mimic a renal cyst and retroperitoneal liposarcoma on imaging

We present a case of perinephric myxoid pseudotumor of fat, a rare benign entity that often occurs in patients with non-neoplastic renal disease. In our case, an 80 year old man with end-stage renal disease was imaged over the course of 5 years during evaluation for renal transplantation. Imaging identified a left perinephric mass whose appearance over time and on different imaging modalities variably suggested a simple cyst, cystic neoplasm, and liposarcoma. Contrast enhanced examination was necessary to discern the solid nature of this mass, and ultimately, tissue sampling with histopathologic evaluation and molecular testing were required to make the diagnosis of myxoid pseudotumor of fat and exclude the imaging mimics.     

Inflammatory pseudotumor of the liver: ferumoxide-enhanced MR imaging as a tiebreaker

We examined a 70-year-old male patient with an inflammatory pseudotumor of the liver mimicking a peripheral-type cholangiocellular carcinoma. Ferumoxide-enhanced magnetic resonance (MR) imaging revealed residual Kupffer cell function in liver parenchyma in and surrounding the inflammatory pseudotumor involvement, which suggested the diagnosis of inflammatory pseudotumor of the liver. We correlate the MR imaging and pathologic findings in this report.     

Contrast-enhanced power Doppler US in the diagnosis of renal pseudotumors

The term "pseudotumor" is used to refer to several anatomic variants that can simulate a renal mass, the most frequent of which are hypertrophied column of Bertin, persistence of fetal lobation, and the dromedary or splenic hump. We describe the findings of power Doppler US after the ultrasound contrast agent (Levovist, Schering, Berlin, Germany) administration in 4 patients with a renal focal lesion in whom gray-scale and baseline power Doppler US was not able to certainly differentiate pseudotumor from neoplasm.     

Comparison of different pseudotumor grading systems in a single cohort of metal-on-metal hip arthroplasty patients

Objective

Follow-up of pseudotumors observed with metal-artefact reducing sequence (MARS)-magnetic resonance imaging (MRI) following metal-on-metal total hip arthroplasty (MoMTHA) depends on how severe these pseudotumors are graded. Several pseudotumor grading systems for MARS-MRI have emerged but little is known of their validity. We studied the intra- and interobserver reliability of three different pseudotumor grading systems in a single cohort of MoMTHA.

Patients and methods

Two experienced musculoskeletal radiologists independently used three different pseudotumor grading systems for classifying MARS-MRI results of the same cohort of 42 MoMTHA patients (49 hips, mean follow-up 5.2 years). Intraobserver and interobserver reliability for each grading system was measured using Cohen’s kappa (κ). Variance in pseudotumor severity grading between systems was analyzed.

Results

Intraobserver reliability on grading pseudotumor severity with the Anderson, Matthies, and Hauptfleisch grading system scored 0.47, 0.10, and 0.35 (observer 1), and 0.75, 0.38, and 0.42 (observer 2), respectively. Interobserver reliability scores for pseudotumor severity were 0.58, 0.23, and 0.34, respectively.

Conclusions

Intraobserver reliability for grading pseudotumor severity on MARS-MRI ranged from poor to good, dependent on observer and grading system used. Interobserver reliability scored best with the Anderson system. A more succinct pseudotumor severity grading system is needed for clinical use.     

Inflammatory pseudotumor of the kidney with renal artery penetration

Inflammatory pseudotumor (IPT) is a quasineoplastic lesion that most commonly involves the lung and the orbit; kidney involvement is rare. We report a case of inflammatory pseudotumor of the kidney. The patient was a 61-year-old man who presented with no symptoms. Nonenhanced computed tomography (CT) demonstrated an ill-defined, isodensity mass measuring 3.5 cm in the lower portion of the left kidney. Contrast-enhanced CT showed that branches of the renal artery without encasement penetrated the tumor; there was a little enhancement in the mass on the arterial phase and homogeneous enhancement on the venous phase. On magnetic resonance imaging the mass showed intermediate signal intensity on T1-weighted images (T1WIs) and low signal intensity on T2WIs. Most IPTs of the kidney appear as an ill-defined, hypovascular, homogeneous tumor on CT images, with variable signal intensity on MRI T1WIs and low signal intensity on T2WIs. Our case had the same imaging findings, with branches of the renal artery penetrating the tumor. If the renal tumor has these radiological findings, the tumor may be IPT.     

Biliary inflammatory pseudotumor: imaging features in seven patients

OBJECTIVE: Hepatic biliary pseudotumor is a benign, rare, and poorly understood tumor that is typically diagnosed after aggressive surgical intervention. The purpose of this report is to describe the clinical and imaging features of this tumor in seven patients. CONCLUSION: Although secondary clinical features may rarely suggest inflammatory pseudotumor, the typical presenting symptom--painless obstructive jaundice--is indicative of malignancy. The imaging appearance of hepatic hilar biliary pseudotumor is also indistinguishable from that of cholangiocarcinoma.     

Inflammatory pseudotumor of the maxillary sinus in a 15-year-old boy.

Inflammatory pseudotumor is a benign neoplasm composed of fibroblasts, histiocytes, and inflammatory cells. Its occurrence in the paranasal sinuses is rare. We report a case of a 15-year-old boy with a maxillary sinus inflammatory pseudotumor that simulated an aggressive neoplasm on CT scan.     

Necrotic pseudotumor caused by a metal-on-metal total hip prosthesis: imaging characteristics on <Superscript>18</Superscript>F-FDG PET/CT and correlative imaging

Necrotic pseudotumor is a complication of metal-on-metal arthroplasty that has been reported with increasing frequency in the last 5 years. It is believed to be the result of a hypersensitivity reaction to metal ions such as nickel, cobalt, or chromium that are released in large quantities from these prostheses. The imaging appearance of a necrotic pseudotumor caused by a metal-on-metal prosthesis, on ¹⁸F-FDG PET/CT or ^99mTc-MDP bone scan has not been previously described in the literature. Our case demonstrates that a necrotic pseudotumor can be detected incidentally in oncologic patients referred for an ¹⁸F-FDG PET/CT or a ^99mTc-MDP bone scan, and recognizing this process is vital in preventing further tissue necrosis and patient morbidity, as the offending prosthesis must be promptly removed. The imaging characteristics of a necrotic pseudotumor on PET/CT and bone scan may also mimic a malignant process such as a necrotic sarcoma, and can represent a potential pitfall leading to a false positive diagnosis in an oncologic patient.     

A Case Report of Inflammatory Pseudotumor Involving the Clivus: CT and MR Findings

The authors describe a rare case of inflammatory pseudotumor involving the clivus, where a soft tissue mass lesion, with extension into the prevertebral retropharyngeal space and the cavernous sinuses, was detected by CT and MRI. The mass resembled a malignant tumor or aggressive infectious lesion, and the final diagnosis of inflammatory pseudotumor was a diagnosis of exclusion, decided after histopathological examination.     

Inflammatory pseudotumor: the great mimicker

OBJECTIVE: The purpose of this review is to describe the pathophysiologic findings, differential diagnosis, imaging features, and management of inflammatory pseudotumor in various locations throughout the body. CONCLUSION: Inflammatory pseudotumor is a rare benign process mimicking malignant processes and has been found in almost every organ system. Radiologists should be familiar with this entity as a diagnostic consideration to avoid unnecessary surgery.     

Extraskeletal mesenchymal chondrosarcoma of the rectus sheath

 Mesenchymal chondrosarcomas (MSCs) are a rare form of chondrosarcoma which usually arise in bone. Extraskeletal chondro-sarcomas constitute a minority (14–25%) of MSCs. We describe the imaging features of an extraskeletal mesenchymal chondrosarcoma that arose from the rectus abdominus muscle.     

<Superscript>18</Superscript>F-FDG PET/CT in inflammatory pseudotumor of the colon causing intussusception

Inflammatory pseudotumor is a rare benign lesion mimicking malignancy both clinically and radiologically. An accurate diagnosis is still difficult and is based on the histological examination. Since inflammatory pseudotumor is exceptionally rare in the colon, this unexpected lesion can be mistaken for malignancy. We report the first case of inflammatory pseudotumor in the colon that showed ¹⁸F-fluorodeoxyglucose (FDG) uptake and acted as the lead point causing colocolic intussusception.     

Inflammatory Pseudotumor in the Mediastinum: Imaging with 18F-Fluorodeoxyglucose PET/CT

Mediastinal inflammatory pseudotumor is a rare benign disease with its capability for local invasion and rapid growth. We present a case of middle-mediastinal inflammatory pseudotumor and report its contrast-enhanced chest computed tomography, ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography and pathologic findings.     

CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique

Objective  

To describe an “indirect” cervical nerve root injection technique with a dorsal approach that should carry less inherent risk than the “direct” cervical transforaminal injection approach, and to compare the immediate post-injection results of the two procedures.     

Fibrous dysplasia of the spine,costae and hemipelvis with sarcomatous transformation

 We describe a patient with polyostotic fibrous dysplasia and secondary malignant fibrous histiocytoma in a spinal lesion.     

Double-bundle anterior cruciate ligament reconstruction using two different suspensory femoral fixation: a technical note

We describe a novel double-bundle reconstruction method for ACL deficient knee. Grafts are tibialis allograft for AMB (anteromedial bundle) and semitendinosus autograft for PLB (posterolateral bundle). Femoral fixations are done by Bio-TransFix for AMB and EndoButton for PLB. Tibial fixations are done by Bio-interference screw for AMB at 60–70° knee flexion and secure the PLB and remnant AMB graft simultaneously onto anteromedial aspect of tibia at 10–20° knee flexion with spiked washer and screw. With our technique, graft lengths are not restricted and we provide strong femoral and tibial fixation if it is compared with previous techniques.     

Osseous metaplasia associated with amyloid-producing plasmacytoma of bone: a report of two cases

 Amyloid-producing plasmacytoma of bone is a rare myeloma variant. We describe two patients with plasmacytomas of bone with extensive amyloid deposition and metaplastic bone formation which can be confused on imaging with osteosarcoma. Histologic confirmation was obtained in both cases. Metaplastic new bone formation was identified within these lesions and appears to be responsible for the radiographic appearances.