Imaging of an exceptional urinoma complicating a cervical cancer and leading to death: A case report.

Spontaneous urinoma is a rare urological complication that can occur following acute urinary obstruction. It involves a collection of urine that typically forms around the kidney as a result of rupture of the fornix. There are several causes of acute urinary stasis, including lithiasis, tumors, prostatic hypertrophy, and others. We present a unique case of an asymptomatic spontaneous urinoma discovered incidentally during the extension study of a 66-year-old woman with cervical cancer. The positive diagnosis was made through a combination of ultrasound and uro-computed tomography scan. The evolution was marked by the occurrence of a uremic encephalopathy, leading to death before any treatment.

Bilateral Nephroblastomatosis With a Unilateral Wilms Tumor: A Case Report Highlighting Imaging Characteristics.

Nephrogenic rests (NRs) are foci of embryonic nephrogenic cells that persist beyond the 36th week of gestation. They are precursor lesions of Wilms tumor and are found incidentally in approximately 1% of infants. The term nephroblastomatosis (NBS) is utilized when nephrogenic rests extensively or multifocally affect the kidneys. We report a case of a left nephroblastoma with bilateral nephroblastomatosis, treated with neoadjuvant chemotherapy followed by a left nephrectomy, highlighting the imaging features of nephrogenic rests on ultrasound, CT, and MRI, and the potential possibilities of distinguishing nephroblastomas from nephrogenic rests in one hand, and the possibilities of distinguishing active nephrogenic rests from inactive ones in the other hand. We furthermore discuss the role of histology in making those distinctions, and the role of chemotherapy in reducing nephrogenic rests' size and cellularity.

Pain in the back after a brain trauma-The revelation of a spinal subdural hematoma: A case report with a literature review.

Traumatic spinal subdural hematoma is a rare condition mostly favored by an anticoagulation therapy, a traumatic lumbar puncture, a hematologic disease, or an epidural anesthesia. This pathological condition can be subtle or be at the origin of a compression of the spinal cord and the rootlets resulting in an irreversible damage if an emergent surgery is not performed. We report the case of a 45-year-old man who has been a victim of a brain trauma which resulted in a cerebral edema. A week later, the patient came to the emergency department for disabling abdominal pain, predominant in the back. An abdominal computed tomography was performed and showed an incidentally spontaneous hyperdensity in the spinal cord, which raised the suspicion of a spinal hematoma that has been confirmed through spine magnetic resonance imaging. In this case, we discuss the different subtypes of spinal hematoma. We recall the main differential diagnoses to help setting an accurate diagnosis and to not delay the adequate therapy that is most of the time emergent when indicated.

Mesenchymal Hamartoma With Elevated Alpha-Fetoprotein: A Diagnostic Pitfall.

Mesenchymal hamartoma (MH) is a benign liver tumor accounting for 3% to 8% of all liver tumors in children, commonly manifesting before 3 years of life. Distinguishing MH from hepatoblastoma and other liver tumors relies on imaging and alpha-fetoprotein (which is usually within normal range in MH), before histologic examination. We report a case of a hepatic MH associated with elevated alpha-fetoprotein, leading to a misdiagnosis of hepatoblastoma and the administration of chemotherapy. We draw the attention to the diagnostic difficulty and pitfalls related to alpha-fetoprotein elevation in the setting of a liver tumor, and we highlight the importance of imaging and histology in establishing the diagnosis.

Central neurocytoma-positive and differential diagnosis: An example through a case report.

Central neurocytoma is a rare intraventricular tumor, occurring typically in the lateral ventricle of young adults. It is considered as a neuronal-glial benign tumor with favorable prognosis. Imaging is a cornerstone allowing the accurate preoperative diagnosis on the basis of several characteristic features. We report the case of a 31-year-old man who has been complaining of progressive headaches and in whom brain magnetic resonance imaging revealed a central neurocytoma. We remind then, through a literature review, the main criteria to set the diagnosis of this tumor and rule out the other possible diagnoses.

Pediatric testicular posttraumatic dislocation presenting as a testicular torsion: A case report.

Traumatic dislocation of the testicle is a rare complication that occurs after blunt trauma to the scrotum or abdominopelvic injury. The majority of cases occur in young adults following severe scrotal trauma in a motorcycle accident. We report the case of a 1.5-year-old infant admitted for left scrotal swelling with a left inguinal mass. Ultrasound and Doppler examination showed a twisted necrotic testicle with inguinal adenopathy. Surgical exploration in the emergency room confirmed that the inguinal mass was a dislocated testicle with an intrascrotal hematoma that was evacuated followed by orchidopexy of the dislocated testicle.

Saphenous Nerve Schwannoma: A Rare Differential Diagnosis of Knee Pain in Children.

Schwannomas are uncommon benign tumors of the peripheral nerves with a low risk of malignant transformation. They rarely affect children, can affect any part of the body but rarely occur in the lower extremity and typically present with a palpable mass, pain or neurological signs. Imaging helps to orient the diagnosis and anatomopathological examination helps to confirm it. We report a case of a 12-year-old girl who presented with left knee pain with subcutaneous mass overlying the tibial tuberosity medially. Clinical examination revealed a positive Tinel's sign. Magnetic resonance imaging (MRI) of the knee was performed, which revealed an encapsulated subcutaneous soft tissue mass overlying the tibial tuberosity medially, eccentric to the course of the infrapatellar branch of the saphenous nerve. The patient was operated with total intracapsular excision of the lesion and the anatomopathological study of the surgical specimen came back in favor of a schwannoma. Postoperatively, the patient showed a good recovery with disappearance of pain and swelling.

Fulminant Susac syndrome-a rare cause of coma: The history of the fatal course in a young man.

Susac syndrome is a rare microangiopathy of indeterminate etiology, presumably autoimmune, characterized by a triad of encephalopathy, sensorineural hearing loss, and branch retinal artery occlusions occurring predominantly in women. The onset and progression patterns are multiple, mainly of three modes. Fulminant evolution is exceptional, rarely reported across literature. We report through this case a Susac syndrome in a young man in whom evolution was fatal. Magnetic resonance imaging is essential to raise the diagnosis and for follow-up, with almost pathognomonic findings, all the more useful as the clinical triad is usually incomplete and as the encephalopathy is the most limiting of the symptoms.

Low phospholipids associated cholelithiasis syndrome in a young women: A rare case report.

Low phospholipid-associated cholelithiasis (LPAC) is a rare, still poorly understood genetic disorder characterized by the association of an ABCB4 mutation and low biliary phospholipid concentration with recurrent cholelithiasis, responsible for the development of intrahepatic lithiasis in adults. The mutation of the ABCB4 gene, which codes for the ABCB4/MDR3 ductal protein, a biliary transporter, leads to precipitation of cholesterol crystals in the bile ducts leading to the formation of intrahepatic stones. The diagnosis should be suspected when at least 2 of the following criteria are present: onset of symptoms before age 40; recurrence of biliary symptoms (biliary colic, jaundice, cholangitis, acute pancreatitis) after cholecystectomy; presence of echogenic foci in the liver indicative of intrahepatic stones or biliary sludge; previous episode(s) of intrahepatic cholestasis during pregnancy; and a family history of gallstones in first degree relatives. Imaging techniques, especially ultrasound, play an important role in the detection of intrahepatic stones. The majority of clinical situations are simple and not serious, often managed by medical treatment with ursodeoxycholic acid, but certain complicated forms may require more invasive endoscopic or surgical treatment. We report a case of a 43-year-old woman, cholecystectomized 5 years ago, who presented with liver colic-like pain with cytolysis and biological cholestasis. Ultrasound and MRI showed the presence of intrahepatic calculi disseminated along the bile duct pathway creating a comet tail appearance and generating a posterior shadow cone. The interrogation of the patient showed that her sister was being followed for LPAC syndrome. The diagnosis of LPAC syndrome was retained and the patient was put under medical treatment with ursodeoxycholic acid with regular clinical, biological and radiological follow-up.

Posterior reversible encephalopathy syndrome (PRES): Should more attention be paid to the atypical forms?

Posterior reversible encephalopathy syndrome (PRES) is an uncommon, but important, pathology affecting primarily the posterior cerebral circulation. Typical imaging features include vasogenic edema involving the bilateral occipital and parietal lobes. We report 4 cases of atypical PRES: The first one is a 59-year-old woman with a medical history of diabetes and hypertension who presented a consciousness disorder. MRI of this patient revealed signal abnormalities in the thalamus, the cerebellum, the brainstem and the corpus callosum with microbleeds and vascularization disorders. The second patient is a 41-year-old woman admitted for right hemiparesis and facial paralysis. Physical examination found a hypertension and the atypical imaging features on MRI were low ADC values with a pearl necklace appearance on ARM sequences. The third patient is a 32-year-old woman who undergone a surgery for an ectopic pregnancy and went in a coma for 8 days. Physical and biological parameters were normal. Diagnosis was delayed because of atypical signal abnormalities in caudal and lentiform nuclei that worsened on follow-up MRI, resulting in a dramatic evolution to bilateral cecity and psychosis. The last case is a 34-year-old woman with terminal renal failure hospitalized for spontaneously resolving tonic-clonic seizures. Biology showed high uremia and brain MRI revealed a gyriform enhancement at gadolinium injection with unilateral putamen lesion. The patient improved after blood purification. Knowledge of these atypical findings can help the radiologist make an accurate, timely diagnosis, and improve patient care.

Multiple brown tumors in primary hyperparathyroidism.

Brown tumors are benign bone tumors that rarely complicate hyperparathyroidism, manifesting as fibrous and erosive lesions secondary to rapid and localized osteoclast turnover. These lesions are typical of primary hyperparathyroidism, but they are not often observed. We present the case of a 72-year-old woman presenting with asthenia, bone pain, and hemiplegia. Biological analysis showed primary hyperparathyroidism, cervical ultrasound a right parathyroid adenoma that fixed on scintigraphy. When cross-sectional imaging was performed, it revealed multiple bone tumors of the axial and peripheral trunk with spinal cord compression which were diagnosed as brown tumors related to parathyroid adenoma. We illustrate through this case the importance of multidisciplinary imaging techniques before raising the diagnosis, especially in unusual pathologies such as brown tumors.

Appendiceal mucocele with pseudomyxoma peritonei mimicking ovarian tumor with peritoneal carcinomatosis.

Appendiceal mucocele with unprompted pseudomyxoma peritonei is a rare malignant tumor, which is difficult to diagnose before surgery. We present a case of a 62-year-old woman, and subsequently discuss the clinical and imaging presentation of mucoceles. Findings on CT scan suggested 2 diagnoses: appendiceal mucocele with pseudomyxoma peritonei and malignant ovarian tumor with peritoneal carcinosis. MRI suggested the former diagnosis, showing a large tubular mass at the base of appendix with discontinuous wall, and no ovarian abnormality, which was confirmed by mini laparotomy and histological study of peritoneal thickened tissue. Treatment consisted of neoadjuvant chemotherapy, with a good response. This case shows the role of imaging in the preoperative diagnosis of appendicular mucoceles; CT scan and MRI, which are useful tools in identifying undetermined lesions of the appendix.

Cadasil syndrome: A case report with a literature review.

"CADASIL" is a genetic microangiopathy with autosomal dominant inheritance. Its epidemiology and physiopathogenesis are poorly specified, but it is proven that this disease is due to a mutation of the NOTCH3 gene resulting in a loss of elasticity of the media of the affected vessels. The clinical expression is variable, dominated by migraine attacks with aura, ischemic vascular accidents and psychiatric disorders, in particular depression. MRI is essential for diagnosis even in the pre-symptomatic phase. It shows signal abnormalities in the basal ganglia and white matter, characteristic especially when located in the anterior part of the temporal lobes. The management of CADASIL is multidisciplinary, psychological for the most part without specificity of a particular treatment.

An unusual presentation of hydatid cyst: A tight mass a case report with a literature review.

Hydatidosis is a worldwide infectious disease caused by the larval form of a parasitic tapeworm of helminths affecting mainly the liver and lungs in cattle- and sheep-raising regions. Muscle localization remains extremely rare and its diagnosis is sometimes challenging. We report the case of a 45-year-old man presenting with a swelling of the left thigh gradually increasing in size. Clinical examination was non-specific, sonographic evaluation suggested the diagnosis, and the patient underwent successful surgical treatment. Intramuscular hydatid cyst is an uncommon disease even in endemic countries, usually confused with other lesions which is a source of delayed treatment and fatal complications. MRI is the gold standard allowing diagnosis and providing the characteristic aspects which are of major importance for optimal management.

Cerebellar hemangioblastoma: Case report with review of the literature.

Originally recognized by Cushing and Bailey, hemangioblastoma is a developmental vascular neoplasm that is predominantly found in the posterior fossa. It is a highly vascularized tumor, with well-differentiated histologic features. Although rare, it remains the most common primary tumor of cerebellum in adults, along with metastases. MRI is the gold standard, allowing a precise characterization of the lesion's features, and its relationship with the surrounding structures. We report the case of a patient with a cerebellar symptomatology, in whom brain MRI raises the diagnosis of hemangioblastoma, which was then confirmed by histopathologic examination.

Cystic meningioma: A case report with a literature review.

Cystic meningiomas are very rare tumors of the central nervous system. We report the case of a 62-year-old female how presented headaches resistant to usual analgesics with behavior disorders. Cerebral CT scan showed a right frontal extra-axial tumor with firm and cystic component, brain MRI evoked the diagnosis, surgery removed the entire tumor and histological examination confirmed it. A cystic meningioma should not be omitted from the differential diagnosis of brain tumors with a cystic component and which clinical, radiological, histological and therapeutic features are discussed.