Focal Xanthogranulomatous Pyelonephritis Associated with Xanthogranulomatous Cholecystitis: A Case Report

Xanthogranulomatous inflammation is a rare inflammatory reaction, characterized by lipid-laden macrophages, known as xanthomas, in histopathologic examination. Aggressive xanthogranulomatous inflammation often manifests as local infiltration but does not affect distant organs unless combined with rare systemic diseases. We report a case of focal xanthogranulomatous pyelonephritis (XGP) associated with severe xanthogranulomatous cholecystitis. Focal XGP was suspected in radiologic examination that showed a cystic lesion with an infiltrative margin, which were surgically resected and confirmed in pathologic examination. To our knowledge, this is the first report of focal xanthogranulomatous pyelonephritis associated with xanthogranulomatous cholecystitis. Moreover, we found peripheral hypointensity around the cystic lesion in the T2-weighted image, probably reflecting hemorrhage and fibrosis of the xanthogranulomatous inflammation.

Scapular Dyskinesis Assessment with Low Dose Three-Dimensional Wing Computer Tomography after Anatomical Union of Clavicle Fracture / 대한스포츠의학회지

PURPOSE: Malunions after clavicle fractures are generally considered to cause scapular dyskinesis. This study aims to verify the incidence of scapular dyskinesis following anatomically reduced clavicle fracture and to verify the usefulness of low-dose three-dimensional (3D) scapular wing computed tomography (3D-scapula wing-CT) analysis.METHODS: Twenty-four patients with mid-clavicle fracture and four patients with distal clavicle fracture were recruited. After anatomical reduction and bony union, scapular dyskinesis was assessed by history taking and physical examination by two orthopedic doctors. The mean follow-up period for the assessment was 14.3±10.1 months. Low-dose 3D-scapular wing-CT analysis in prone position was performed with calculated effective dose 2.35 mSv, which means approximately 25% dose of conventional setting. Four observers evaluated five angles (upward rotation, internal rotation, anterior tilting, superior translation, protraction) from 3D-reconstructed images on both shoulders of a patient. Authors analyzed the results between injured to normal shoulder.RESULTS: Scapular dyskinesis or significant shortening of injured clavicle (mean clavicle length difference, − 1.77±6.36 mm) were not observed among the included 28 subjects. The difference values of the five angles between the fractured side and normal side showed no statistical significance (upward rotation: 1.51, p=0.13; superior translation: 0.89, p=0.327; anterior tilting: 1.7, p=0.096; protraction: 0.83, p=0.374; internal rotation: 0.98, p=0.406). As the interclass correlation coefficients of four observers was 0.988 (p=0.00), images from low-dose 3D-wing-CT are clear enough to assess scapular dyskinesis (interclass correlation coefficient, 0.996; p=0.00).CONCLUSION: It is important to make anatomical reduction and length restoration of clavicle fracture for preventing scapular dyskinesis. Low-dose 3D-scapular wing-CT is an effective tool for assessing scapular dyskinesis, which provides images of sufficient quality with little increase in morbidity from radiation hazard.

Exercise-Induced Paraspinal Muscle Rhabdomyolysis with Seconary Compartment Syndrome: A Case Report

Lumbar paraspinal compartment syndrome is an uncommon cause of acute lower back pain. It can result from intense physical activity or as a complication of surgery or medication. Lumbar paraspinal compartment syndrome without external trauma is rarely reported in literature. We report a case of compartment syndrome that followed back muscle exercise and caused rhabdomyolysis. MRI findings include bilateral bulging of the paraspinal muscle, hyperintensity on T2-weighted image, and heterogeneous enhancement. Moreover, loss of intramuscular vasculature on a contrast-enhanced CT scan attributed to diagnose compartment syndrome in this case.

MRI Findings of Accessory Popliteus Muscle: A Case Report

Accessory muscles located in the region of the popliteal fossa are very rare. MRI scan performed in a 52-year-old man with right knee pain revealed an anomalous muscle in the region of the popliteal fossa. Considering the muscle originated from the medial side of the lateral head of the gastrocnemius muscle and attached to the posteromedial articular capsule of the knee joint, it is consistent with the accessory popliteus muscle, previously reported. To our best knowledge, MRI finding about the accessory popliteus muscle has been reported in only one case. We present a case of the accessory popliteus muscle incidentally identified on MRI.

Cerebral Air Embolism after Central Venous Catheter Removal in a Patient with a Patent Foramen Ovale: A Case Report and Literature Review

Central venous catheterization is a routinely performed procedure in clinical practice. While cerebral air embolism after the removal of the central venous catheter is very rare, it is one of the most serious complications that can lead to fatal outcomes. In this report, we present a rare case of a cerebral air embolism after the removal of the central venous catheter in a patient with a patent foramen ovale.

Synchronous Primary Leiomyosarcoma in the Thoracic Vertebra and the Liver / 대한소화기학회지

This is a case report of simultaneous primary leiomyosarcomas in the spine and liver. A 64-year-old woman presented to the Seoul Paik Hospital with epigastric discomfort and constipation that she had experienced for two months. A physical examination revealed severe tenderness around the thoraco-lumbar junction. Esophagogastroduodenoscopy showed an ulceroinfiltrative lesion on the gastric angle. An abdominopelvic CT scan revealed two low attenuated lesions in the S4 and S8 regions of the liver, as well as a soft tissue mass at the T10 vertebra. Percutaneous ultrasonography-guided needle biopsy of the hepatic nodules revealed a leiomyosarcoma. The tumor at the T10 vertebra was removed to avoid spinal cord compression. The histology of this tumor was compatible with that of leiomyosarcoma. The potential primary sites for leiomyosarcoma, including the lung, thyroid, breast, kidney, genitourinary organs, and gastrointestinal tract, were subsequently investigated. No detectable abnormal findings that would suggest the origin of the tumor were found. Synchronous primary leiomyosarcomas in the spine and liver are quite rare and have a poor prognosis.

Synchronous Primary Leiomyosarcoma in the Thoracic Vertebra and the Liver / 대한소화기학회지

This is a case report of simultaneous primary leiomyosarcomas in the spine and liver. A 64-year-old woman presented to the Seoul Paik Hospital with epigastric discomfort and constipation that she had experienced for two months. A physical examination revealed severe tenderness around the thoraco-lumbar junction. Esophagogastroduodenoscopy showed an ulceroinfiltrative lesion on the gastric angle. An abdominopelvic CT scan revealed two low attenuated lesions in the S4 and S8 regions of the liver, as well as a soft tissue mass at the T10 vertebra. Percutaneous ultrasonography-guided needle biopsy of the hepatic nodules revealed a leiomyosarcoma. The tumor at the T10 vertebra was removed to avoid spinal cord compression. The histology of this tumor was compatible with that of leiomyosarcoma. The potential primary sites for leiomyosarcoma, including the lung, thyroid, breast, kidney, genitourinary organs, and gastrointestinal tract, were subsequently investigated. No detectable abnormal findings that would suggest the origin of the tumor were found. Synchronous primary leiomyosarcomas in the spine and liver are quite rare and have a poor prognosis.

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting

BACKGROUND: This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. METHODS: ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). RESULTS: The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. CONCLUSIONS: The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.

Rare Form of Rheumatoid Nodule around Ischial Tuberosity Mimicking Ischiogluteal Bursitis

We are reporting about a case of a rheumatoid nodule, beneath the ischial tuberosity, mimicking ischiogluteal bursitis. Rheumatoid nodules are frequently seen, at the subcutaneous soft tissues of repetitive mechanical irritation points, and prominent bones. There have been no reported cases of rheumatoid nodules, extending just beneath the ischial tuberosity bone. A 68-year-old woman with a seven-year history of rheumatoid arthritis, suffered for six months, from right buttock swelling and discomfort in seating. A cystic lesion postero-inferior to the ischial tuberosity, was noted in the MRI scan, which was thought to be ischiogluteal bursitis, because of its characteristic location and appearance. Histopathologic analysis and gross findings on the operation, revealed no evidence of bursitis.

Rare Form of Rheumatoid Nodule around Ischial Tuberosity Mimicking Ischiogluteal Bursitis

We are reporting about a case of a rheumatoid nodule, beneath the ischial tuberosity, mimicking ischiogluteal bursitis. Rheumatoid nodules are frequently seen, at the subcutaneous soft tissues of repetitive mechanical irritation points, and prominent bones. There have been no reported cases of rheumatoid nodules, extending just beneath the ischial tuberosity bone. A 68-year-old woman with a seven-year history of rheumatoid arthritis, suffered for six months, from right buttock swelling and discomfort in seating. A cystic lesion postero-inferior to the ischial tuberosity, was noted in the MRI scan, which was thought to be ischiogluteal bursitis, because of its characteristic location and appearance. Histopathologic analysis and gross findings on the operation, revealed no evidence of bursitis.

Rare Form of Schwannoma as a Purely Hemorrhagic Cystic Tumor Located in an Intermuscular Plane

Schwannomas are mostly solid tumors, some of which may contain cystic degenerations or hemorrhages. However, a schwannoma seen as a purely hemorrhagic cystic tumor is very rare. A 63-year-old woman was referred to the hospital due to a slow-growing mass (present for about 5 years) on her right thigh. She complained about vague pain but without neurologic symptoms such as numbness or tingling sensations. MR images showed an oval lesion with defined margins surrounded by the rectus femoris, vastus lateral, and the vastus intermedius. It was characterized as a multilocular cystic lesion composed of hemorrhagic fluid. In addition, the benign hemorrhagic cystic lesion was differentially diagnosed by radiological techniques as a hemorrhagic ganglion cyst. The lesion was surgically excised and, based on pathological features, was diagnosed as being a schwannoma. We report a purely hemorrhagic cystic schwannoma located in an intermuscular plane.

The MRI Findings of Flexor Digitorum Accessorius Longus Muscle: a Case Report

The flexor digitorum accessorius longus (FDAL) is the most common accessory muscle found in the posterior compartment of the ankle area. The accessory muscle in this area such as the FDAL may be incidentally identified on magnetic resonance images (MRI). There are some case reports about the FDAL in cadaver researches. However, the MRI findings about the FDAL have been reported in a few cases. In this paper, we report a case of the FDAL incidentally identified on MRI with review of the literature about the FDAL.

Hemangioma Diagnosed by Gadoxetate Disodium-Enhanced MRI in a Patient with Chronic Hepatitis C

A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend to be found incidentally, but should be differentiated from malignant tumors, especially in patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT) revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed for further evaluation. But abdominal US also showed atypical finding. For the confirmative diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist(R), Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium was done, and the patient was diagnosed as hepatic hemangioma.

Anomalous Insertion of the Medial Meniscus into the Anterior Cruciate Ligament: A Case Report

Anomalies of the medial meniscus are rare and difficult to diagnose clinically. Among these anomalies, anomalous insertion of the medial meniscus into the anterior cruciate ligament is rare. Most of the reported cases had no relation to clinical symptoms and were found incidentally during arthroscopy. We report a rare case of anomalous insertion of the medial meniscus into the anterior cruciate ligament with a brief review of the literature.

Simultaneous Bilateral Quadriceps Tendon Rupture in Patient with Secondary Hyperparathyroidism due to Chronic Renal Failure: A Case Report

Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders, such as secondary hyperparathyroidism due to chronic renal failure. We describe a case of simultaneous spontaneous bilateral quadriceps tendon tupture in a 36-year-old male patient with secondary hyperaprathyroidism due to chronic renal failure.

Desmoplastic Fibroma of Distal Femur: A Case Report

Desmoplastic fibroma of bone is an extremely rare tumor that was first described by Jaffe in 1958. It histologically resembles the desmoid tumor of soft tissue. It is known as locally aggressive tumor but we experienced definitely benign and resembling simple bone cyst radiographically. We report a case of desmoplastic fibroma of bone and it should be included in the differential diagnosis list of any lytic bone lesion. The radiograph, MR imaging features, radiological and pathological differential diagnosis of the case are described, and literatures are reviewed.

Leiomyosarcoma of the Ovarian Vein: a Case Report with Radiological Findings

Leiomyosarcomas of the ovarian vein are very rare. Four cases have been reported in the English language clinical literature. We present a case of leiomyosarcomas where the use of multi-detector CT had a substantial role in the establishment of the preoperative diagnosis. The radiological images as well as intraoperative features are illustrated. We also discuss the radiological findings of the ovarian vein leiomyosarcoma in comparison with those of other venous or retroperitoneal leiomyosarcomas. We expect that the use of multi-detector CT will be the choice for the diagnostic work-up of vascular leiomyosarcomas.

A Case Report of the Occurrence of a Rare Middle Mediastinal Thymoma in a Young Woman

Thymomas are the most common form of primary tumor in the anterior mediastinum. However, the occurrence of thymomas in the middle mediastinum is rare. To the best of our knowledge, no cases have been reported in young patients. Here, we report the CT and MRI findings of a middle mediastinal thymoma case in a 21-year-old woman.

Metastatic Renal Cell Carcinoma to Unusual Locations: A Case Report

Renal cell carcinoma is a tumor that commonly occurs with distant metastases and typically metastasizes to the following distant sites, listed in order of descending frequency: the lung and mediastinum, bone, liver, contralateral kidney or adrenal gland, and brain. However, metastases to the face, skin, and skeletal muscle are extremely rare. We report here a case of a metastatic renal cell carcinoma involving the face, skeletal muscles and skin simultaneously.

MRI findings of Root Tear of Medial Meniscus

PURPOSE: This study was to elevate the accuracy of MRI diagnosis by means of inspection of the demonstrable findings of the root tear of medial meniscus. MATERIALS AND METHODS: From September 2003 to August 2004, MR images were obtained from 15 of 29 patients who had a root tear of medial meniscus on arthroscopic examination. Each sagittal, axial and coronal images was obtained. Of 15 patients, three were men and 12 were women. The mean age was 59.3 years. RESULTS: All of 15 patients were diagnosed as medial meniscus root tear. Sagittal images showed loss of shape and signal intensity. Axial images showed radial linear defect. And coronal images showed vertical linear defect. CONCLUSION: The characteristic findings from three planes of MRI were helpful for diagnosis of medial meniscus root tear.