Case report: the incidental lipid embolization to the brain and kidney after lymphography in a patient with malignant lymphoma: CT findings

Lipid embolization to the brain and kidney is reported, confirmed by computed tomography (CT) following lymphography in a man with malignant lymphoma. The patient complained of headache and unstable gait and became blind and hemiplegic immediately after the examination. With supportive therapy he recovered from the complications in 5 months except for slight gait disturbance, probably explained by cerebral infarction. Mechanisms of the combined brain and renal embolization are discussed.     

Ecthyma gangrenosum in a patient with non-Hodgkin lymphoma

INTRODUCTION: Ecthymagangrenosum is a rare disease of the skin that causes the localized necrosis of the skin and subcutaneous fat tissue, leading to the multiple ulcerations surrounded by local hyperaemia. The ulcerations are usually localized in groins, and perianal area. In the majority of cases ecthyma is caused by a Pseudomonas aeruginosa sepsis. The disease usually appears in immunocompromized, most frequently hematological patients. CASE REPORT: We presented a 78-year-old woman who had been treated for non-Hodgkin lymphoma for the last 18 years. She had recently been given cytotoxics which led to neutropenia. The patient suddenly developed high fever, chill and diarrhea, followed by ecthyma gangrenosum cutaneous lesions in groins, axillas, right side of the neck and umbilicus. Pseudomonas aeruginosa and Proteus mirabilis, that were sensitive to several antibiotics were isolated. The treatment included rehydratation, antibiotics, surgical debridement and regular dressing with antiseptics. The healing of all lesions was achieved after sixteen weeks of the treatment. CONCLUSION: If haemorrhagic-necrotic lesions of the skin are developed in immunocompromised, usually haematologic patients, an Ecthyma gangrenosum has to be considered immediately, material for identification of a cause has to be taken, followed by immediate administration of antibiotics effective against Pseudomonas aeruginosa. Surgical debridement and other therapeutic modalities are to be considered in some patients.     

Case report: renal lymphoma in a patient with Waldenstrom's macroglobulinaemia

A case of lymphoma confined solely to the kidneys in a patient with Waldenstrom's macroglobulinaemia is described. Primary lymphomatous involvement of the kidney is very rare in this condition. Ultrasound showed enlarged kidneys partially encased by tumour masses. The radiological features are described and the literature reviewed.     

原发性肺T细胞淋巴瘤一例

患者男,33岁.于1个月前开始不明原因发热,体温最高达39℃;伴少量咳嗽,痰少量、呈白色偶带黄色,痰中无血丝.当地医院CT检查:两肺有多发结节影,拟诊为"韦格肉芽肿",予抗感染治疗,为求进一步诊治来我院.体检:体温37.1℃;脉搏92 次/min;呼吸22 次/min;血压134/83 mm Hg(1 mm Hg=0.133 kPa);神志清,全身浅表未触及肿大淋巴结,胸骨无压痛,两肺未闻及干、湿性啰音.     

超选择性肾动脉栓塞治疗肾活检后大出血1例

报告1例应用超选择性肾动脉栓塞抢救肾活检后大出血成功,提示在肾活检率逐年提高、肾活检人数逐渐增多的今天,即使发生严重的大出血,不再必须切除肾脏,介入治疗可以取得良好效果,而且能够尽可能地保护残存的肾功能.     

Post-anaesthetic maternal death in a patient with mediastinal large B-cell lymphoma: a case report

A 32-year-old female underwent laparoscopic salpingectomy of an ectopic (third) pregnancy under general anaesthesia, at approximately six weeks' amenorrhoea. She developed severe respiratory distress after extubation and died on the second postoperative day. It appears that she had a history of a mild, persistent productive cough for a period of about a month prior to the operation that was attributed to an upper respiratory tract infection. Autopsy demonstrated the presence of a large mediastinal tumour, whose existence was apparently unsuspected preoperatively, encasing the ascending thoracic aorta, aortic arch and the proximal segments of the brachiocephalic and subclavian arteries, and causing extrinsic airway compression. Subsequent microscopic examination showed histological and immunohistochemical features of a mediastinal large B-cell lymphoma. It is thought that the mechanical effects exerted by the advanced mediastinal tumour upon the airways and the thoracic cage, coupled with the pathophysiological effects of general anaesthesia on respiratory movement and airway patency, had led to the patient's unfortunate demise in early pregnancy.     

CT-guided radiofrequency ablation of renal cell carcinoma in a patient with solitary kidney after contralateral nephrectomy: a case report

A 62-year-old man with renal cell carcinoma in the solitary kidney after right nephrectomy underwent CT-guided radiofrequency ablation. The tumor, which was located in the dorsal part of the lower aspect of the kidney, was exophytic and measured 2 cm in diameter. A 17-gauge, internally cooled radiofrequency needle electrode was placed percutaneously into the center of the lesion. Dynamic CT 6 days after the first ablation showed band-like residual lesion along the intact renal parenchyma. A second ablation was performed for the residual lesion. CT both 1 and 3 months after the second procedure demonstrated complete ablation with the normal renal parenchyma maintained.     

介入栓塞治疗肾特发性巨大动静脉瘘一例

患者女,57岁.体检B超检查发现右肾血管畸形5 d入院.既往无肾脏疾病及外伤史.体检:体温36.6℃,心率78次/min,血压140/70 mm Hg(1 mm Hg=0.133 kPa),意识清,精神可,腹平软,全腹无压痛及反跳痛,肝脾肋下未及,双侧肾区无叩痛,右腰背部听诊闻及连续性隆隆样杂音,心肺听诊未发现异常.实验室检查:尿常规、血沉、肝功能、肾功能、血糖、血脂、电解质、CRP、血常规、凝血功能均在正常范围.     

Cerebral air emboli from angiography in a patient with stroke. A case report

A 42-year-old woman with subarachnoid and intracerebral hemorrhage was investigated with diagnostic angiography, disclosing an occlusion of the left internal carotid artery and the middle cerebral artery. CT examination immediately after the angiography revealed a 12-h-old infarct of the left middle cerebral artery territory. There was also gas in the arteries supplying the infarcted part of the brain, but not in other vessels. Air had most probably been introduced during the angiography and had consequently been "trapped" in the cortical arteries of the ischemic brain. In the non-ischemic parts of the brain air may have passed through the vessels leaving no trace.     

Cerebral mucormycosis: a case report

Mucormycosis is an unusual complication in immunosuppressed and diabetic patients. Disseminated mucormycosis is even more unusual. One patient with both pulmonary and cerebral mucormycosis is presented. The clinical course is outlined and computed tomographic (CT) findings are presented.     

双侧肾上腺及垂体非霍奇金淋巴瘤的诊断(附1例报告)

目的探讨双侧肾上腺及垂体非霍奇金淋巴瘤的诊断思路。方法回顾性分析1例以发热和顽固性低钠血症为首发表现的双侧肾上腺及垂体非霍奇金淋巴瘤,并通过复习相关文献,总结双侧肾上腺及垂体非霍奇金淋巴瘤的诊治经验。结果本例患者临床表现缺乏特异性,实验室检查未发现感染和自身免疫性疾病的证据,但血清乳酸脱氢酶(LDH)、β2微球蛋白异常升高,CT引导下穿刺活检证实为双侧肾上腺非霍奇金淋巴瘤。患者进一步行内分泌功能检测显示垂体前叶功能减退,氟-18标记的氟代脱氧葡萄糖正电子断层显像-CT(18F-FDGPET-CT)扫描发现垂体、肝脏和颈部淋巴结等均已浸润。给予氢化可的松治疗后,顽固性低钠血症得到纠正,CHOP方案治疗3个疗程后垂体和肾上腺病变消失,3个月后垂体和肾上腺功能恢复正常。结论双侧肾上腺及垂体非霍奇金淋巴瘤非常罕见,正确的诊断思维和18F-FDGPET-CT扫描技术的应用有助于临床的早期诊断。     

PET versus PET-CT in patient with suspicion of non-Hodgkin lymphoma recurrence

We present the case of a 62-year-old patient with a history of non-Hodgkin lymphoma (stage III) in complete remission after 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab (CHOP-R) in 2006. The patient was referred for a PET-CT scan because of suspicion of recurrence. On PET there were multiple lung lesions, a submandibular lesion (right side) and an impressive retroperitoneal mass with a hypermetabolic wall, and central necrosis invading all retroperitoneal structures (aorta). There was also an additional lesion in the anterior abdominal wall below the liver. It was concluded that it was recurrent non-Hodgkin lymphoma (stage IV). Contrast enhanced CT demonstrated a large, rupturing abdominal aortic aneurysm (AAA) with saccular ectasia of the posterior wall compatible with a mycotic aneurysm. The other sites of hypermetabolism corresponded to metastatic infectious lesions. Histopathology confirmed the mycotic infection. The patient underwent urgent surgery including bilateral axillofemoral stenting and removing a clot from the AAA twice. Intravenous antibiotics were started. This case clearly denotes the importance of contrast enhanced hybrid PET-CT systems in which the CT information is relevant for PET interpretation and not only for anatomic repair. With PET alone, the diagnosis would have been completely different.     

Urinary extravasation and leakage after renal transplantation: a case report

OBJECTIVE: This case report illustrates urinary extravasation and leakage after renal transplantation, as documented by nuclear medicine renal imaging. The extravasation and leakage were identified only on images acquired after the patient voided. The surgical wound site dressings were found to contain radioactive contamination as well.     

儿童骨原发性非霍奇金淋巴瘤三例

儿童原发于骨的非霍奇金氏淋巴瘤（non—Hodgkin lymphoma，NHL）极为少见，临床上很难与其他儿童骨的恶性肿瘤鉴别。现报告3例经病理证实的儿童骨原发性NHL，并分析其影像特征。