Neuroimaging findings of retroclival hemorrhage in children: a diagnostic conundrum.

BACKGROUND: Retroclival hemorrhage in children may occur in three compartments, namely epidural, subdural, and subarachnoid, frequently secondary to trauma. Retroclival epidural hematoma may be associated with ligamentous injury, which may further result in instability at the craniocervical junction. Retroclival subdural hematoma may indicate a sentinel event for traumatic injury elsewhere within the brain or posterior fossa. Retroclival subarachnoid hemorrhage may have severe clinical consequences related to vasospasm. OBJECTIVE: Neuroimaging is essential in the recognition, localization, and characterization of retroclival hemorrhage into various compartments and for evaluating potential severe clinical consequences such as craniocervical junction instability, underlying traumatic brain injury, and ischemia secondary to vasospasm. The goal of this paper is to discuss the anatomy and biomechanics of the craniocervical junction as well as the neuroimaging findings associated with various compartments of retroclival hemorrhage in children.

Diagnosis and management of an isolated pediatric plexiform neurofibroma involving the hepatic and celiac plexus using multimodality approach: problem solving with diffusion-weighted magnetic resonance imaging.

Plexiform neurofibroma with involvement of the gastrointestinal tract is a very rare entity in children. Here, we present a rather unique case of a 9-year-old boy with no clinical signs or features of neurofibromatosis type 1. A periportal mass lesion was incidentally found after performing an ultrasound in this previously healthy child. Computed tomographic scan was subsequently performed which showed a low-density mass in a periportal distribution with extension along the celiac axis. Because the findings were nonspecific, a pre- and postcontrast magnetic resonance imaging of the abdomen was performed which included diffusion-weighted imaging. The lesion was then confirmed to be a plexiform neurofibroma with open biopsy. Management of plexiform neurofibromas varies widely. Given the extensive nature of the lesion, managing the patient with follow-up rather than surgical excision was favored.

Gummatous syphilis of the adrenal gland.

A 55-year-old man with no relevant history was analyzed for weight loss, night sweats, and left upper quadrant pain. An abdominal ultrasound and CT scan were performed, revealing a lobulated rim-enhancing mass in the left adrenal gland. Further analysis by an F-FDG PET/CT scan demonstrated high uptake in the periphery of the adrenal lesion with central photopenia. Because a primary malignancy was suspected, an adrenalectomy was performed. Histopathology, however, revealed a necrotizing granulomatous infection. Serum was tested positive for syphilis and Treponema pallidum infection. Results of additional HIV tests were negative. The adrenal tumor proved to be an expression of gummatous syphilis.

[Liver rupture caused by migrating gallstones]. / Leverruptuur door een migrerende galsteen.

Gallstones can work their way through different tissue layers by means of chronic irritation and the formation of abscesses. Here we present the case of a 74-year-old man who, after having attacks of pain in the upper abdominal region for years, was admitted with signs of peritoneal irritation and haemodynamic shock. An emergency laparotomy revealed old blood, pus and a large hole in the frontal part of the liver. A loose gallstone was found in the cavity. Each step this gallstone had taken from the gallbladder to the peritoneal cavity could, with hindsight, be traced back to the clinical course of the disease. Liver abscesses and rupture are rare complications of cholelithiasis.