Clinics in diagnostic imaging (203). Focal infarction of the falciform ligament fatty appendage

A 56-year-old man presented to the emergency department with acute upper abdominal pain and mild leucocytosis. The pain was not relieved by intravenous analgesia. Computed tomography of the abdomen and pelvis demonstrated a focal area of fat stranding with a thin peripheral rim of high attenuation and a punctate central hyperdense dot in the vicinity of the falciform ligament. The diagnosis of focal infarction of the falciform ligament fatty appendage was made based on the imaging findings. The patient responded well to conservative management and was discharged for outpatient follow-up. Focal infarction of the falciform ligament fatty appendage is extremely rare and can mimic various causes of acute abdomen that require emergency surgery. Hence, correct radiological diagnosis is essential to avoid unnecessary surgical intervention. We herein discuss the similarities and differences with other common companion cases such as epiploic appendagitis and omental infarction.

Clinics in diagnostic imaging (173). Scimitar syndrome with horseshoe lung

A 56-year-old Chinese man presented with giddiness and vertigo. Subsequent chest radiography showed the classic scimitar sign of an abnormal pulmonary venous return. Further evaluation with non-contrast computed tomography substantiated the finding of a partial anomalous venous drainage pattern and identified an associated rare lung anomaly, horseshoe lung. The imaging findings of scimitar syndrome and its association with horseshoe lung are reviewed.

Clinics in diagnostic imaging (175). Corpus callosum glioblastoma multiforme (GBM): butterfly glioma

A 54-year-old man presented with change in behaviour, nocturnal enuresis, abnormal limb movement and headache of one week's duration. The diagnosis of butterfly glioma (glioblastoma multiforme) was made based on imaging characteristics and was further confirmed by biopsy findings. As the corpus callosum is usually resistant to infiltration by tumours, a mass that involves and crosses the corpus callosum is suggestive of an aggressive neoplasm. Other neoplastic and non-neoplastic conditions that may involve the corpus callosum and mimic a butterfly glioma, as well as associated imaging features, are discussed.

Clinics in diagnostic imaging (166). Nonketotic hyperglycaemic chorea-hemiballismus

A 68-year-old woman with poorly controlled diabetes mellitus presented to the emergency department with choreoathetoid movements affecting the upper and lower left limbs. Computed tomography of the brain did not show any intracranial abnormalities. However, subsequent magnetic resonance (MR) imaging of the brain revealed an increased T1 signal in the right basal ganglia, raising the suspicion of nonketotic hyperglycaemic chorea-hemiballismus. Management consisted of adjusting her insulin dose to achieve good glycaemic control. The patient subsequently recovered and was discharged after eight days. There are many causes of basal ganglia T1 hyperintensity, including hyperglycaemia in patients with poorly controlled diabetes mellitus. This case emphasises the importance of MR imaging in the early diagnosis of hyperglycaemia as a cause of chorea-hemiballismus, to enable early treatment and a better clinical outcome.

Pancreatico-Colonic Fistula-Demonstrated by Multidetector-Row CT

No abstract available.

Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting

Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgical planning. Imaging features of acute cholecystitis have been described in the literature and are variable, depending on the stage of inflammation. This article discusses the spectrum of cholecystitis-associated complications and their imaging manifestations. We also suggest a checklist for the prompt and accurate identification of complications in acute cholecystitis.

Massive mediastinal teratoma mimicking a pleural effusion on computed tomography

Mediastinal teratomas have been reported to mimic pleural effusions on chest radiography. Further evaluation of such tumours using computed tomography usually yields diagnostic characteristics that distinguish them from pleural collections. We report a patient with a mediastinal teratoma that mimicked a massive left pleural effusion on chest radiography and computed tomography.