Lemierre syndrome from a neck abscess due to methicillin-resistant Staphylococcus aureus

Lemierre syndrome is characterized by acute septic thrombophlebitis of the internal jugular vein (IJV) that develops after an oropharyngeal infection, and can be complicated by septic emboli to lungs and other organs. The most frequent causative agent is Fusobacterium necrophorum, an anaerobic bacillus found in normal oropharyngeal flora. Staphylococcus aureus has emerged as a cause of Lemierre syndrome in the last decade. We report a case of a 24-year-old man who developed septic IJV thrombosis and necrotizing pneumonia due to S. aureus from an infected hematoma in the right sternocleidomastoid muscle. Antibiotics are the mainstay of therapy with few cases needing anticoagulation. A good outcome is dependent upon an awareness of the condition, a high index of suspicion, and prompt initiation of antibiotic therapy. Recognition of S. aureus as a cause of Lemierre syndrome can guide the choice of initial antibiotics to cover this virulent pathogen.

Elastofibroma dorsi: an under-diagnosed entity -clinical, imaging and pathological features

To report clinical, radiological and histopathological findings of elastofibroma dorsi.Thepurposeis to increase awareness among radiologists and clinicians of this under-diagnosed and interesting benign lesion. Retrospective review of 624 consecutive thoracic Computed Tomography [CT], 92 ultrasounds and 130 Magnetic Resonance Image [MRI] scans for detection of elastofibroma dorsi along with review of the clinical and histopathological findings. Three radiologists evaluated the imaging features using previously definedcriteria. A histopathologist reviewed the pathological findings. A tertiary level hospital and a specialized orthopedic center. Patients who were subjected to CT, Ultrasound and MRI scans of the thorax Interventions: CT, MRI, Ultrasound scans of the thorax and surgical excision. Detection of elastofibromasand their clinical, radiological and histopathologic findings. Only 50% of patients with elastofibrom a dorsicouldbe detected by all modalities though, on review, all lesions showed characteristic location, morphology, imaging as well as typical clinical and pathological features. Significant contrast enhancement of all lesions on MRI was an unusual finding in our study. An awareness of the radiological findingsand enhancement patterns on CT and MRI can help in the proper diagnosis of elastofibroma dorsi an entity often misdiagnosed in a high percentage of patients

Cerebral autosomal dominant arteriopargy with subcortical infarcts and leukoencephalopath: an imaging mimic of multiple sclerosis

To describe the imaging findings of two cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy [CADASIL] mimicking multiple sclerosis. Two cases presenting with neurological signs and symptoms were referred for magnetic resonance imaging [MRI] evaluation of the brain. Case 1 was a 36-year-old female patient presenting with recurrent headaches and recent onset numbness in the fingers of the right hand. Neurological examination showed a mild sensory deficit in the right hand. Case 2 was a 31-year-old female patient presenting with attacks of right-sided numbness of the face and body. The neurological examination revealed a sensory loss in the face and brisk deep tendon reflexes. Routine MRI sequences showed two types of lesions in both cases: 'punctate' hyperintense lesions on T[2]-weighted images [T[2]WI]/fluid-attenuated inversion recovery [FLAIR] images, hypointense on T[1]-weighted images [T[1]WI] and 'diffuse' white matter lesions, hyperintense on T[2]WI/FLAIR sequences and isointense to hypointense on T[1]WI. All lesions showed no contrast enhancement. Both cases were previously clinically and radiologically diagnosed as multiple sclerosis. There was a strong family history consistent with recurrent infarctions in other family members of both patients. Both cases were later diagnosed as CADASIL by skin biopsy/genetic linkage studies and follow-up. The cases showed that CADASIL causes stroke-like episodes in adults and can mimic multiple sclerosis on imaging. Clinical evaluation and MRI findings allow a differentiation of the two entities