Diagnostic image (253). A man with a swollen penile base and scrotum

A 29-year-old man heard a snap during sexual intercourse followed by immediate detumescence and a swelling of the penile basis and scrotum, due to a penile fracture.     

Gouty arthritis: decision-making following dual-energy CT scan in clinical practice,a retrospective analysis

To establish whether dual-energy CT (DECT) is a diagnostic tool, i.e., associated with initiation or discontinuation of a urate lowering drug (ULD). Secondly, to determine whether DECT results (gout deposition y/n) can be predicted by clinical and laboratory variables. Digital medical records of 147 consecutive patients with clinical suspicion of gout were analyzed retrospectively. Clinical data including medication before and after DECT, lab results, and results from diagnostic joint aspiration and DECT were collected. The relationship between DECT results and clinical and laboratory results was evaluated by univariate regression analyses; predictors showing a p?<?0.10 were entered in a multivariate logistic regression model with the DECT result as outcome variable. A backward stepwise technique was applied. After the DECT, 104 of these patients had a clinical diagnosis of gout based on the clinical judgment of the rheumatologist, and in 84 of these patients, the diagnosis was confirmed by demonstration of monosodium urate (MSU) crystals in synovial fluid (SF) or by positive DECT. After DECT, the current ULD was modified in 33 (22.4%) of patients; in 29 of them, ULD was started and in 1 it was intensified. Following DECT, the current ULD was stopped in three patients. In the multivariable regression model, cardiovascular disease (OR 3.07, 95% CI 1.26–7.47), disease duration (OR 1.008, 95% CI 1.001–1.016), frequency of attack (OR 1.23, 95% CI 1.07–1.42), and creatinine clearance (OR 2.03, 95% CI 0.91–1.00) were independently associated with positive DECT results. We found that the DECT result increases the confidence of the prescribers in their decision to initiation or discontinuation of urate lowering therapy regimen in of mono- or oligoarthritis. It may be a useful imaging tool for patients who cannot undergo joint aspiration because of contraindications or with difficult to aspirate joints, or those who refuse joint aspiration. We also suggest the use of DECT in cases where a definitive diagnosis cannot be made from signs, symptoms, and MSU analysis alone.     

Radiation-Induced Giant Cell Granuloma Mimicking Relapsed Hodgkin Lymphoma at FDG-PET/CT

A 22-year-old woman was diagnosed with intermediate risk stage II Hodgkin lymphoma and treated with three cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by involved-field radiation therapy. A complete metabolic remission was achieved after two cycles of ABVD, which was maintained until three years after completion of treatment. Follow-up FDG-PET/CT four years after completion of treatment, however, showed a new FDG-avid (Deauville score of 4) lesion in the right scapula, suggesting relapsed disease. Computer tomography (CT)-guided biopsy of this lesion was performed and subsequent histological examination revealed a radiation-induced giant cell granuloma.     

Serious complication 1 year after sacrospinous ligament fixation

Myositis of the gluteal region caused by group A streptococci 1 year after a sacrospinous ligament fixation was recognised as a serious complication of this procedure. Most likely, the infection was spread to the gluteal region through a port d'entree caused by vaginal atrophy, via the non-resorbable sutures. The patient was treated successfully with antibiotics intravenous and local estrogens.     

Reflex sympathetic dystrophy syndrome of one finger

Summary Reflex sympathetic dystrophy syndrome (RSDS) is a common but often unrecognized syndrome. It usually affects a leg or arm but may also be limited to parts of the extremity. We report a case of a 48-year-old patient who developed RSDS of only one finger. Especially, a limited form may delay recognition and therapy of a disease which can be treated successfully in an early phase.     

Postpartum ovarian vein thrombosis: report of a case and review of literature

Postpartum ovarian vein thrombosis (POVT) is an uncommon disease and it may complicate streptococcal group B infection of the vagina and endometrium. Obstruction of the right ureter is an uncommon complication of POVT. We present a case of POVT complicated by thrombus extension in the inferior vena cava and ureteral obstruction with urinary leakage, and outline the clinical presentation, radiological investigations useful in diagnosis and treatment of the disease process.