Endovascular management of spontaneous intracranial pseudoaneurysms in a pediatric patient with Noonan syndrome. A mere coincidence or a possible association with the disorder?

BACKGROUND: Noonan syndrome (NS) is a rare autosomal-dominant neurodevelopmental disorder, which typically develops abnormalities of the craniofacial development and congenital heart defects. A number of cerebrovascular anomalies have also been occasionally described previously in the setting of NS. The assumption that NS can induce the formation of intracranial pseudoaneurysm (IAP) or the rupture of an already existing abnormality is yet unknown. CASE DESCRIPTION: We encountered a rare case of a 9-year-old NS patient with two IAPs presenting with episodes of intracerebral hemorrhage that were successfully managed with endovascular embolization. CONCLUSION: This case represents a possible association between NS and the presence of ruptured IAPs.

Endovascular treatment of a post-traumatic pseudoaneurysm arising from a ruptured posterior tibial artery with Menox. A case report.

Posterior tibial artery pseudoaneurysms are rare and can occur in the setting of trauma. Endovascular treatment of post-traumatic pseudoaneurysms has become a viable less-invasive method particularly in young patients in whom the presence of collaterals guarantees distal vascularization. We report an unusual case of a 16-year- old patient who sustained blunt trauma to his right lower extremity due to a bicycle injury and developed a delayed symptomatic pseudoaneurysm of the posterior tibial artery in the absence of tibia fracture. Superselective endovascular treatment with Ethylene Vinyl Alcohol Copolymer based liquid embolic system (Menox) was successfully performed, achieving exclusion of the pseudoaneurysm with preservation of the remaining vascularization of the lower limb.

Intraperitoneal focal fat infarction: the great mimicker in the acute setting.

The term intraperitoneal focal fat infarction (IFFI) includes various self-limiting clinical conditions that are caused by focal fatty tissue necrosis. Most of the cases of IFFI concern torsion or infarction of the greater omentum or the epiploic appendages. However, although rarely, perigastric ligaments can also undergo torsion also leading to fat infarction. IFFI clinically may mimic other pathologies, such as acute appendicitis or diverticulitis, making their clinical diagnosis a challenge. Ultrasound (US) and computed tomography (CT) have a high sensitivity and specificity for the diagnosis of IFFI excluding other pathologies, and in most cases, the clinical evolution is spontaneously favorable, thus helping to reduce the need for unnecessary surgical intervention. We review cases with IFFI in order to identify specific involvement patterns. Cases of epiploic appendages reported to an acute, subacute, and more chronic phase in order to present the self-limiting nature of this entity and the resultant absorption. We also present cases with falciform ligament infarction, as well as primary ("whirl sign" on CT due to greater omentum torsion) and secondary omental infarctions. The aim of this pictorial review is not only to extensively explore the imaging findings of IFFI but to also describe the clinical presentation and pathophysiology of the prementioned conditions.

CT guided mediastinal biopsy facilitated by PET/CT imaging: Our experience.

The purpose of this retrospective study is to assess the efficacy of mediastinal tumor biopsies guided by computed tomography (CT) and facilitated by positron emission tomography (PET)/CT in our hospital. We also wanted to prove the use of PET/CT in performing such biopsies. Fifty-two patients were biopsied under CT guidance with PET/CT visual co-registration (35) and facilitated PET/CT registration (17). In 49 patients, a diagnosis from the guided biopsy performed was successful and in 3 patients the results were inconclusive. Our results allow us to claim that the accuracy of CT-guided mediastinal biopsies facilitated by PET/CT allow for precise localization of higher tumor metabolism, potentially reduce the number of needle passes needed and increase the success rate of the procedure.

Intramural gastric air in an acutely ill patient with endoscopic and surgical correlation.

Intramural gastric air is a rare but potentially life-threatening imaging finding. We present the case of a 56-year-old female patient with a history of schizophrenia, who presented with multiple episodes of vomiting and altered mental status. CT scan revealed intramural gastric air and portal venous gas. The patient was treated conservatively with a favorable outcome. Gastric emphysema and emphysematous gastritis should be considered in the differential diagnosis of air in the gastric wall. It is critical to distinguish between these 2 entities as their clinical course and management differ significantly, although radiographic findings may mimic each other.