Aortosternal Venous Compression: A Review of Two Cases.

Aortosternal venous compression (AVC) is a rare venous compression syndrome that involves brachiocephalic venous compression due to its positioning between the sternum and the aorta. One of the features of AVC involves compression of the left innominate vein with variability in luminal caliber on inspiration and expiration. Imaging modalities such as computed tomography (CT) examination can aid in initial diagnosis; however, venography can be utilized for confirmatory diagnosis due to its higher specificity during the inspiratory and expiratory phases. Through findings demonstrated during venography, we herein present two cases of confirmed AVC secondary to an aberrant right subclavian artery. Characteristic imaging features in the diagnosis of AVC and its etiology are discussed.

Embolization of parastomal and small bowel ectopic varices utilizing a transhepatic antegrade approach: A case series.

Background: The ideal approach to managing parastomal and small bowel ectopic varices (EVs) is yet to be established. Purpose: To evaluate outcomes following percutaneous antegrade transhepatic venous obliteration (PATVO) in patients presenting with bleeding from parastomal or small bowel EVs. Material and Methods: A case series of 12 patients presenting with active or recurrent bleeding from parastomal or small bowel EVs who underwent 17 PATVO interventions at our tertiary care institution was performed. Data extraction from electronic medical records included baseline characteristics and procedural details. Endpoints included technical success, early clinical success, and re-bleeding. Results: Technical success was 100% (n = 17), and early clinical success was 82.3% (n = 14). No patient experienced any intra- or post-operative complications. Rebleed rates after initial PATVO in patients who achieved early clinical success was as follows: 3-month, 0% (n = 0); 6-month, 20% (n = 2); 12-month, 20% (n = 2). Rebleed rates after all PATVO procedures (including patients undergoing repeat procedures) that achieved early clinical success were as follows: 3-month, 0% (n = 0); 6-month, 14% (n = 2; 12-month, 14% (n = 2). All patients with re-bleeding required reintervention with either PATVO, transjugular intrahepatic portosystemic shunt (TIPS) or both. Conclusion: PATVO can be safely performed to treat bleeding from parastomal and small bowel EVs. In patients who present with recurrent bleeding despite PATVO, TIPS with/without embolization of bleeding varices remains a valid option as described by the literature.

Liquid buccal mucosa graft endoscopic urethroplasty: a validation animal study.

PURPOSE: To validate a novel method of urethral stricture treatment using liquid buccal mucosal grafts (LBMG) to augment direct vision internal urethrotomy (DVIU) in an animal model. MATERIALS AND METHODS: A rabbit stricture model was used to test this method. Strictures were induced in 26 rabbits using electroresection of urethral epithelium. The animals were randomized into two groups: Group-1, treated with DVIU and LBMG in fibrin glue, and Group-2, DVIU with fibrin glue only. LBMG was prepared by suspension of mechanically minced buccal mucosa micrografts in fibrin glue. This LBMG-fibrin glue mixture was later injected into the urethrotomies of Group-1 animals. All animals were killed at 24 weeks after repeat retrograde urethrogram (RUG) and urethroscopy by surgeon blinded to the treatment arm. Radiographic images and histological specimens were reviewed by a radiologist and a pathologist, respectively, blinded to the treatment arm. Stricture treatment was considered a success if a diameter measured on RUG increased by ≥ 50% compared to pre-treatment RUG diameter. Histological specimens were assessed for the presence of BMG engraftment. RESULTS: In Group-1, 8/12(67%) animals demonstrated engraftment of LBMG, compared to none in Group-2 (p = 0.0005). 7/12(58%) in Group-1 showed radiographic resolution/improvement of strictures compared to 5/13 Group-2 rabbits (38%, p = 0.145). The median percent change for the Group-1 was 59%, compared to 41.6% for Group-2 (p = 0.29). CONCLUSION: This proof-of-concept study demonstrates feasibility of LBMG for endoscopic urethral stricture repairs. Further studies are needed to establish the role of this novel concept in treatment of urethral strictures.

Pathogenesis And Radiological Findings In Rare Case Of Salter Harris Type I Distal Tibial Fracture With Associated Osteonecrosis In The Paediatric Population.

Salter-Harris type I fractures of the distal tibia are commonly seen in paediatrics and management of such fractures follows an algorithm established in the literature. Despite this, osteonecrosis of the distal tibia can subsequently develop. Osteonecrosis or avascular necrosis is cell death that occurs secondary to trauma, metabolic disturbances, sickle cell disease, or medication side effect. It most frequently affects the femur, talus, or humerus, and rarely the tibia. Radiographs and MRI are pivotal in making a timely diagnosis in order to minimize patient discomfort. To the best of our knowledge, there has only been one previous documented case of osteonecrosis following a Salter Harris Type I distal tibial fracture. Here, we present the second such case.

Clinical Significance of T2*gradient-recalled Echo/susceptibility-weighted Imaging Sequences in Evaluating Superficial Siderosis in the Setting of Intracerebral Tumors: Pilocytic Astrocytoma.

Superficial siderosis is the slow accumulation of hemosiderin on the pial surfaces of the brain and spinal cord. The most common cause of intracranial superficial siderosis is secondary to subarachnoid hemorrhage. Rarely, superficial siderosis can also be caused by tumors. Superficial siderosis presents clinically as hearing loss and gait instability that progressively worsen. The diagnosis is primarily made by magnetic resonance imaging; however, susceptibility-weighted imaging (SWI) and T2* gradient echo (GRE) sequences demonstrate the highest sensitivity in detecting this condition. To the best of our knowledge, there has been only one previous case of superficial siderosis secondary to a pilocytic astrocytoma of the spine. However, we present a case of intracerebral pilocytic astrocytoma resulting in superficial siderosis, with emphasis on acquisition and use of T2*GRE/SWI sequences.

Avoiding the Trap of Misdiagnosis: Valuable Teaching Points Derived from a Case of Longstanding Popliteal Artery Entrapment Syndrome.

Popliteal artery entrapment syndrome (PAES), a condition predominantly affecting young individuals, is a rare clinical entity that can result in significant morbidity. The presence of lower limb pain and claudication in young, physically active individuals should prompt consideration for PAES. Early diagnosis and management is crucial to prevent long-term complications; however, diagnosis is fraught with challenges due to the rarity of the disease and its similar clinical presentation with more common conditions. We present a case of a young female with PAES who was misdiagnosed and underwent a tarsal tunnel release for suspected tarsal tunnel syndrome and subsequent fasciotomies for presumed chronic exertional compartment syndrome (CECS) without any relief. We outline the insidious undiagnosed course of her condition over a period of 12 years, discuss teaching points of how to recognize key differences of PAES and associated conditions, and provide recommendations for how to make the right diagnosis.

Clinically significant anatomical variation of the retropharyngeal internal carotid arteries.

Although interpatient variations in the course and anatomy of extracranial internal carotid arteries (EICAs) have been described previously, intrapatient variability is rarely cited in the literature. Distance between EICAs and the pharyngeal wall is an important determinant of vascular injury risk. A retropharyngeal EICA has crucial implications in patients undergoing pharyngeal procedures, and important in otorhinolaryngology and emergency medicine. Surgical exploration without identification of anatomical landmarks, or emergent intubation in the emergency room poses high risk for EICA injury. Other critical clinical considerations include intra-arterial involvement of tonsillitis, peritonsillar abscesses, or parapharyngeal neoplasms due to close proximity to the EICA. We present 2 cases with short-term change in retropharyngeal course of EICA to highlight this further. Although no clear etiology for these changes has been identified, we hypothesize that embryology, weight alterations, atherosclerotic disease, and postradiation changes are contributory. Thus, one radiologic study does not exclude variation in vascular anatomy.

Tongue base schwannoma: differential diagnosis and imaging features with a case presentation.

Schwannomas are slow growing, encapsulated neoplasms that arise from the nerve sheath. A vast majority of these benign neoplasms occur in the head and neck region, most commonly involving the 8th cranial nerve. Schwannomas arising from the base of tongue are very rare and, thus, can easily escape the list of differential diagnosis for a posterior tongue mass. A systematic approach is recommended for diagnosis of a posterior tongue mass, with neoplastic, infectious, and congenital categories. We report a case of a 24-year-old female, who presented with pressure sensation in the throat. On imaging, she was found to have a mass in the right posterior tongue with follow-up biopsy results yielding a schwannoma. Characteristic imaging features for various possible etiologies of a posterior tongue mass are also discussed.

Recurrent solitary fibrous tumor of lumbar spine with vertebral body involvement: imaging features and differential diagnosis with report of a case.

Solitary fibrous tumors (SFTs) of the spine are exceedingly rare tumors of mesenchymal origin. Most spinal SFTs arise from the thoracic spine, followed by cervical spine, and last lumbar spine with only 6 cases reported in literature. SFTs represent a wide range of neoplasms, ranging from benign to malignant. These tumors can develop a late recurrence, even after a decade or more of initial presentation, requiring long-term follow-up. We present a case of recurrent SFT of the lumbar spine with vertebral body involvement, presenting more than a decade after initial resection. It was initially misdiagnosed as a paraganglioma. To the best of our knowledge, there have been only 3 previous cases reporting SFT with vertebral body involvement.

Enhancing Mass Lesion of the Sphenoid: Atypical Presentation of Ongoing Pneumatization.

Sinus pneumatization is a complex variable process that begins in early life and continues for many years. We present a case of a 6-year-old boy with progressive headaches and neurologic symptoms suggestive of intracranial pathology. The presence of enhancing tissue within the sphenoid sinus created a diagnostic dilemma which leads to a transsphenoidal biopsy. Knowledge of imaging characteristics associated with incomplete pneumatization can help differentiate it from more ominous skull base pathology and prevent unnecessary testing. We describe four-year imaging follow-up in a patient with incomplete pneumatization of the sphenoid sinus presenting as an enhancing mass lesion with subsequent follow-up imaging demonstrating gradual regression and increased aeration of the sphenoid sinus.

Prepubertal gynecomastia and chronic lavender exposure: report of three cases.

INTRODUCTION: Prepubertal gynecomastia is a rare condition characterized by the growth of breast tissue in males as a consequence of early exposure to sexual hormones. When this condition is present, pathological sources of testosterone/estrogen production, such as adrenal or gonadal tumors must be searched for. A few reports have described an association between gynecomastia and substances that produce stimulation of the estrogen receptor, such as lavender and tea tree oil. METHODS: Here we describe the cases of three boys who presented with prepubertal gynecomastia and were chronically exposed to lavender. Two of these boys were exposed to a cologne, named agua de violetas, used by Hispanic communities in the US, and in their countries of origin. RESULTS: We studied a sample of the cologne used by one of the patients. Analysis of the chemical composition of the agua de violetas cologne was performed using high-performance liquid chromatography as well as off-line mass spectrometric detection. All these, combined with the physical appearance and the smell, determined that the cologne had lavender as an ingredient. CONCLUSION: Exposure to estrogenic substances, such as lavender, should be explored in children presenting with prepubertal gynecomastia/thelarche.

Varicocele Embolization Following Failure Of Varicocelectomy: A Case Series And Review Of Literature.

Varicocelectomy remains the same mainstay of treatment for varicoceles. However, with growing focus on minimally invasive techniques, recent literature has investigated the use of venous embolization for the treatment of varicoceles in patients with recurrence after surgical treatment. Embolization has many advantages, including use of local anaesthesia, lower operating time, decreased risk of hydrocele and faster recovery times. In addition to this direct visualization of the vasculature during embolization allows for identification of any anatomic variants or collateral vessel accounting for the recurrence. This permits more definitive treatment in case of prior surgical failure. We present a case series where venous embolization is successfully done following failure of varicocelectomy. For patients who experience recurrence after a varicocelectomy, we recommend consideration for varicocele embolization.

Midbrain tremor: a tremor resistant to treatment.

Midbrain tremor is a resting, postural, action and intentional tremor of the upper extremity. Partial response to pharmacological agents makes the treatment of this tremor difficult. We report, herein, three cases of patients with midbrain tremors involving their midbrain and thalamic area in ischemic and hemorrhagic strokes. In the first case, the patient presented with a midbrain tremor of the right upper extremity involving left midbrain and thalamic area. After MRI examination, he was placed on benztropine, amantadine, pramipexole and eventually levodopa for treatment, all of which were unsuccessful in improving his tremor. In the second case, the patient presented with a midbrain tremor of the right upper extremity after an hemorrhagic stroke. After viewing CT and MRI scans, the patient was placed on amantadine, pramipexole and eventually levodopa, all of which made no contributions to his tremor. The patient in the third case presented with a blunt trauma to the head which led to the development of a midbrain tremor of his left arm. CT and MRI scans showed abnormalities in the right side of the midbrain and pons. He was initially started on amantadine, with no improvement of his tremor. However, he was eventually placed on trihexyphenidyl which contributed to a 70% improvement in his tremor. In the event of midbrain tremor, treatment should be assessed on a case by case basis, and all options should be considered after a risk-benefit assessment.