Pancreatic schwannoma: a rare differential diagnosis for a pancreatic mass.

Pancreatic schwannomas are rare benign tumors with low malignant potential and are often difficult to diagnose due to their non-specific presenting symptoms and overlapping radiological imaging characteristics. Cross-sectional imaging plays an important role in the initial diagnosis and in delineating the extent of the lesion. However, biopsy and histopathological examination remains the gold-standard for a definite diagnosis. The management of pancreatic schwannomas includes surgical resection often yielding excellent clinical outcomes with low recurrence rates. We present a case of a 33-year-old female patient with a history of a recurrent vague upper abdominal pain where CT of the upper abdomen showed a hypodense pancreatic mass. Robotic subtotal pancreatectomy was done with histopathology showing spindled Schwann cells indicative of a pancreatic schwannoma.

Giant cavernous internal carotid aneurysm presenting with dizziness and bradycardia: A case report and a review of literature.

Giant cavernous carotid aneurysms are rare pathologic entities that are typically benign and are considered less life-threatening due to the low risk of rupture of bleeding. They present with clinical features usually due to localized mass effects on adjacent neural structures, mainly the III, IV, V, and VI cranial nerves. There are various treatment options, including occlusion of the feeding vessel, immediate surgery on the aneurysm, bypass procedures, and use of endovascular devices. We present a case of a 36-year-old male presented to the emergency department with 5 days history of right retro-orbital pain and diplopia. The patient's imaging workup revealed a right giant cavernous carotid aneurysm. Along with the conventional symptoms, physical examination revealed sinus bradycardia. Internal carotid artery occlusion was performed, and his symptoms gradually resolved.

Ductal carcinoma in situ of the breast arising in a solitary intraductal papilloma.

Ductal disease is a broad group encompassing both benign and malignant entities which may overlap clinically and radiologically. Ductal carcinoma in situ (DCIS) is a noninvasive breast malignancy accounting for 20% of newly diagnosed breast cancer cases. It involves malignant epithelial cells confined to the duct(s). Although they are commonly diagnosed incidentally on screening mammography, DCIS may present with nipple discharge or a palpable lump. Benign diseases of the duct include intraductal papilloma and may present similarly with bloody or serous nipple discharge. Imaging evaluation will help in differentiating between the 2 entities and pathological examination will provide the final diagnosis. We present a case of a 72-year-old female who was presented with serous and bloody discharge and histology revealed intermediate grade ductal carcinoma in situ involving an intraductal papilloma.

Giant appendiceal mucocele as a first manifestation in a patient with silent ulcerative colitis: A case report.

Appendiceal mucocele (AM) is a rare lesion found in only 0.3% of all appendectomies and it is characterized by distention of the appendix by the accumulating intraluminal mucinous material. Four main histopathological subtypes of appendiceal mucocele has been described including: retention cyst, mucosal hyperplasia, mucinous cystadenoma, and cystadenocarcinoma. We report a case of 48-year-old middle eastern female, previously healthy, presented to the primary health center with right iliac fossa discomfort, and referred to our hospital for further evaluation. Contrast enhanced computed tomography of the abdomen and pelvis and focused ultrasonography over the right iliac fossa showed the characteristic CT and sonographic appearance of appendiceal mucocele. An additional incidental note of lack of colonic haustral pattern involving the rectum and descending colon was noted on abdominal CT raising the suspicion of Ulcerative Colitis which was then confirmed by colonoscopy and histopathology. Although no causal relationship between appendicular mucocele and inflammatory bowel disease has been established yet and few case reports had reported appendicular mucocele in patients with ulcerative colitis, close surveillance in these patients, and early recognition of the characteristic imaging features is crucial in preventing dreadful complications like pseudomyxoma peritonei.

Unruptured bilateral supra-clinoid internal carotid artery aneurysms: A case report.

Unruptured supra-clinoid carotid aneurysms are rare aneurysmal dilatation of the supra-clinoid segment of internal carotid artery. Most cases are asymptomatic and discovered incidentally, while others may present with compressive symptoms on cranial nerve II, the optic nerve. We present a case of a 44-year-old female who presented with chronic headache and gradual decreased visual acuity. The patient's imaging workup revealed bilateral supra-clinoid carotid aneurysms.

Computed tomographic and digital subtraction angiography evaluation of ophthalmic-ethmoidal artery dural arteriovenous fistula.

Ophthalmic-ethmoidal dural arteriovenous fistula (DAVFs) is a rare type of dural arteriovenous fistulas and usually presenting with spontaneous subarachnoid hemorrhage, subdural hemorrhage or ocular symptoms. We present a case of a 59-year old gentleman presenting with acute headache, vomiting and generalized weakness. CT study of the brain revealed a large left frontal hematoma and abnormal aneurysmal sac with dilated cortical vein, communicating with the superior sagittal sinus. Conventional angiography confirmed diagnosis of ruptured ophthalmic-ethmoidal DAVF, resulting in a frontal intra-axial hemorrhage. Anterior fossa DAVFs are extremely rare, difficult to diagnose and treat. CT angiography is initial method of diagnosis, but digital substruction angiography remains the gold standard of confirming dural fistulas.

Post COVID-19 vaccination neuromyelitis optica spectrum disorder: Case report & MRI findings.

There are rising concerns among the medical community and the public regarding the side effects of different vaccines developed throughout the world and their short and long-term effects, particularly COVID19 vaccines. Most notably, post-vaccination demyelinating diseases such as acute disseminated encephalomyelitis, transverse myelitis, and multiple sclerosis relapses have been reported. We present a case of a 32-year-old male who presented with a 2 weeks history of acute confusional state and imbalance 1 week after receiving the second dose of COVID19 vaccination. MRI findings showed typical distribution of neuromyelitis optica spectrum disorder and the patient was positive for AQP4 IgG. The pathogenesis behind developing neuromyelitis optica and vaccines is still unknown. Few case reports have been reported of post-vaccination neuromyelitis optica spectrum disorder but to our knowledge, this would be the first case published of neuromyelitis optica following exposure to COVID19 vaccine.

Intrahepatic gallbladder mimicking a cystic liver lesion: A case report & literature review.

Intrahepatic gallbladder is a rare congenital variant that occurs due to migration arrest of the gallbladder from reaching its normal position. We present a case of a 60year-old gentleman presenting with chronic abdominal pain and impaired liver enzymes. Abdominal ultrasonography showed a hepatic cystic lesion which later was identified as an ectopic gallbladder within the liver parenchyma through magnetic resonance imaging study of the liver. Although ectopic gallbladder is a rare anomaly, awareness and correct identification of the abnormality prevents misdiagnosis with other liver pathologies as it may mimic other pathologies as presented in this case. It also allows better operative planning when indicated.

Ovarian vein thrombosis as a first manifestation of COVID-19 infection.

Coronavirus disease 2019 (COVID-19) infection is associated with high risk of venous thromboembolic events mainly pulmonary embolism or deep venous thrombosis of the lower limbs. Ovarian vein thrombosis is a rare and serious condition usually seen in the immediate postpartum period and other conditions including pelvic inflammatory diseases, gynecological malignancies, hypercoagulable states, and few cases to date have reported ovarian vein thrombosis as a complication of COVID-19 infection. Patient with ovarian vein thrombosis usually presents with fever and lower abdominal pain that can mimic acute surgical abdomen and high index of suspicion is required for diagnosis. We report a case of a 41-year-old Asian female presented to our hospital with fever and acute lower abdominal pain. Laboratory findings show positive COVID-19 test and high D-dimer. Patient underwent computed tomography of the abdomen and pelvis and a confirmed diagnosis of right ovarian vein thrombosis was made. Patient was treated with anticoagulation and empirical antibiotics and her symptoms have significantly improved.

Acute pancreatitis as a late complication of intra-gastric balloon insertion.

Intra-gastric balloon (IGB) insertion is a safe, well-tolerated and an effective weight loss procedure. It is commonly used as a step prior to bariatric surgery in obese patients with co-morbidities and failed conservative weight-loss methods. The main side effects post-IGB placement include nausea, vomiting and abdominal pain. The reported complications of IGB include balloon over-inflation, balloon migration, esophagitis, ulceration, gastric perforation and bowel obstruction. We report a case of acute pancreatitis attributed to IGB placement, which is a rare complication of this procedure. The diagnosis of acute pancreatitis due to IGB was made after excluding other causes of acute pancreatitis by radiological imaging. The patient underwent endoscopic IGB removal with rapid post-surgical improvement of her clinical course.

Pure testicular choriocarcinoma Cannonball metastases as a presenting imaging feature: A case report and a review of literature.

Pure testicular choriocarcinoma is an extremely rare subtype of nonseminomatous germ cell tumor, accounting for less than 1% of all germ cell tumors and only 0.19% of all testicular tumors. It is a highly aggressive malignant tumor with early multiorgan metastasis and poor prognosis. We present a case of 23-year-old male presented to the hospital with mild hemoptysis which was thought as a sequela of his past COVID-19 pneumonia infection, however; chest radiograph showed multiple rounded cannonball opacities seen throughout both lungs raising the suspicion of metastatic deposits to the lungs. During physical examination, left testicular painless swelling was noted leading to an ultrasound of the scrotum which revealed a left intratesticular infiltrative, heterogeneous mass. Tumor markers, including beta-human chorionic gonadotropin, lactate dehydrogenase and alpha fetoprotein were extremely high. Computed tomography scan of the brain, chest, abdomen, and pelvis showed hemorrhagic metastatic deposits to the brain, chest, and left para-aortic lymph nodes. The patient underwent radical orchiectomy and histopathology reports confirmed the diagnosis of pure testicular choriocarcinoma.