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.

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.

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.

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.

Diagnosis of Persistent Primitive Olfactory Artery Using Computed Tomography Angiography

Persistent primitive olfactory artery (PPOA) is a rare anomaly of the anterior cerebral artery. We present one case of PPOA incidentally diagnosed with the aid of computed tomography (CT) angiography. A 24-year-old woman was admitted to our hospital after sudden onset of vertigo. Three-dimensional CT angiography revealed an anomalous artery arising from the terminal portion of the right internal carotid artery. The proximal portion of the anomalous artery coursed anteromedially and made a hairpin turn posterosuperior to the midline. PPOA may be overlooked because of its rarity, but CT angiography can be useful in detecting this rare vascular anomaly. Follow-up study is necessary in our case to confirm whether an aneurysm occurs on the PPOA.

Infraoptic Course of the Anterior Cerebral Artery: Case Report / 대한뇌혈관외과학회지

An infraoptic course of the anterior cerebral artery (ACA) is a rare anomaly of the anterior part of the circle of Willis. About 56 cases have been reported, often in association with cerebral aneurysm. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. A 52-year-old man experienced a sudden onset of severe headache without focal neurological deficits. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Three-dimensional computed tomographic angiography and conventional angiography revealed a saccular aneurysm in the left middle cerebral artery. An anomalous arterial branch, originating from the right internal carotid artery at the level of the ophthalmic artery was also visible. This vessel followed an infraoptic course. The aneurysm was successfully embolized with coils. We review the literature for the possible genesis of this anomaly and consider treatment of the associated aneurysm.

Two Cases with Persistent Falcine Sinus as Congenital Variation

The falcine sinus is an abnormal anatomic structure located in the falx cerebri that is closed after birth and is rarely observed. We describe two cases of persistent falcine sinus. A 60-year-old woman presented with headache. An 11-year-old girl presented with intermittent headache and a palpable scalp mass in the middle of the high parietal area. The straight sinuses were absent in both patients. In both patients, drainage of the galenic system took place through a sinus within the falx, also known as a falcine sinus. Suspicious dysplastic tentorium cerebelli was observed in one patient. It can be concluded that a mesenchymal disorder can be the primary cause for a persistent falcine sinus.

The Incidence and Clinical Implications of Congenital Defects of Atlantal Arch

OBJECTIVE: Atlantal arch defects are rare. Few cadaveric and imaging studies have been reported on the variations of such anomalies. Our goal in this study was to examine the incidence and review the clinical implications of this anomaly. METHODS: A retrospective review of 1,153 neck or cervical spine computed tomography (CT) scans was performed to identify patients with atlantal arch defects. Neck CT scans were performed in 650 patients and cervical spine CT scans were performed in 503 patients. Posterior arch defects of the atlas were grouped in accordance with the classification of Currarino et al. In patients exhibiting this anomaly, special attention was given to defining associated anomalies and neurological findings. RESULTS: Atlantal arch defects were found in 11 (11/1153, 0.95%) of the 1,153 patients. The type A posterior arch defect was found in nine patients and the type B posterior arch defect was found in two patients. No type C, D, or E defects were observed. One patient with a type A posterior arch defect had an anterior atlantal-arch midline cleft (1/1153, 0.087%). Associated cervical spine anomalies observed included one C6-7 fusion and two atlantal assimilations. None of the reviewed patients had neurological deficits because of atlantal arch anomalies. CONCLUSION: Most congenital anomalies of the atlantal arch are found incidentally during investigation of neck mass, neck pain, radiculopathy, and after trauma.

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.

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.

Spontaneous Regression of the Pseudoaneurysm Developed after Balloon Occlusion of the Direct Carotid-cavernous Fistula

Direct carotid-cavernous fistula (CCF) is a common post-traumatic disease. However, pseudoaneurysm formation after balloon occlusion is a rare complication. The author present such a case with review of the literature. A 26-year-old man involved in a motor vehicle accident as a driver. Only mild conjunctival injection and minimal exophthalmos on the right eye were noted after trauma. However, angiography revealed a direct CCF and dissection of the proximal intracranial internal carotid artery (ICA). After first balloon occlusion of the CCF, the patient redeveloped fistula due to early deflation of the balloon. After the second balloon occlusion, pseudoaneurysm and diplopia were developed with the change of balloon position and shape. However, visual symptom spontaneously resolved and pseudoaneurysm was also decreased within 6 months after balloon occlusion.

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.

Persistent Trigeminal Artery Variant Detected by Conventional Angiography and Magnetic Resonance Angiography: Incidence and Clinical Significance

OBJECTIVE: Persistent trigeminal artery variant (PTAV) is an anastomosis between the internal carotid artery (ICA) and the cerebellar artery without any interposing basilar artery segment. We discuss its probable embryological origin and emphasize clinical implications. METHODS: Retrospectively 1250 conventional cerebral angiograms and 2947 cranial magnetic resonance angiographies (MRAs) were evaluated for the patients with PTAV. RESULTS: Five patients (four men and one woman, 23 to 76 years of age, median age 65 years) had a PTAV. Three patients who underwent MRA had a PTAV (3/2947=0.1%). Four of the patients who underwent cerebral angiography had a PTAV (4/1250=0.32%). Two of 143 patients who underwent both conventional angiography and cranial MRA showed PTAV. The PTAV was an incidental finding in all five patients. The PTAV originated from the cavernous segment of the left ICA in four patients and from the cavernous segment of the right ICA in one patient. The terminal branch of the PTAV was the anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA) in two patients and the AICA only in the other three patients. CONCLUSION: Neurosurgeons should be aware of possible presence of PTAV. Manipulation of this vessel during a surgical approach to the parasellar region and percutaneous gasserian ganglion procedure may result in hemorrhage or ischemia.

A Case of Brain Abscess Complicating Methicillin-resistant Staphylococcus aureus Sepsis in a Premature Infant

Brain abscess is an uncommon complication of bacterial meningitis or sepsis in neonatal and young infants. Especially, brain abscess associated with staphylococcal bacteremia in early infancy is serious and very rare. So, Staphylococcal bacteremia in infants should be vigorously treated to prevent life-threatening complications. We report a case of the premature infant who developed brain abscess 2 months after an episode with Methicillin-resistant Staphylococcus aureus (MRSA) sepsis.