Closed Thoracic Trauma as an Exceptional Cause of Pneumorrhachis: A Case Report.

Pneumorrhachis, a rare clinical entity, refers to the presence of air in the spinal canal. Air can enter the spinal canal through various pathways, including the lungs and mediastinum (the space between the lungs), or directly from external sources due to trauma or infection. In rare cases, pneumorrhachis may result from repeated secondary Valsalva maneuvers, which is a complication of large-area pneumothorax. In this case report, we discuss a 36-year-old male patient who was involved in a high-intensity road accident. The injury assessment revealed significant findings including a large left pneumothorax, a right pneumothorax, multiple rib fractures, and the presence of pneumorrhachis. The entry of air into the spinal canal originated from the pleural space, likely through injuries to the parietal pleura. Rarely reported, closed thoracic trauma is an exceptional cause of pneumorrhachis. This unique mechanism of injury has been described in a limited number of publications addressing traumatic pneumorrhachis. The identification of pneumorrhachis in a traumatized patient should prompt further investigation to explore other potential injuries that may elucidate the formation of this intraspinal gas collection.

Genetic Polymorphisms in ERCC1 Gene and Their Association with Response to Radiotherapy in Moroccan Patients with Nasopharyngeal Carcinoma.

OBJECTIVE: Nasopharyngeal carcinoma (NPC) is a severe malignant disease. Despite its low frequency, NPC is very common in North African population. Radiotherapy is the standard therapeutic treatment of NPC. However, radioresistance hampers the success of treatment. At the molecular scale, radioresistance is due to genetic variations involved in DNA repair pathways in NPC patients. Several studies reported that single nucleotide polymorphisms (SNPs) in excision repair cross complementing group 1 (ERCC1) could be associated with radioresistance. In this optic, the present study aimed to evaluate the association between DNA repair gene polymorphisms ERCC1 C8092A and ERCC1 C118T and radiotherapy response of patients with NPC. METHODS: A total of 95 patients with confirmed NPC were recruited at the Mohammed VI Center for Cancer Treatment, Casablanca - Morocco between 2016 and 2018. Two single nucleotide polymorphisms in ERCC1 gene were genotyped. Multiple analysis software was used to assess the correlation between these SNPs and radio-therapeutic response. RESULTS: Sequencing of ERCC1 C8092A polymorphism revealed that CC and CA genotypes were found in 51.6% and 45.3% of cases, respectively, whereas the homozygote AA genotype was reported in only 3.1% of cases. For ERCC1 C118T polymorphism, the heterozygote CT genotype was identified in 49.5% of cases. Homozygotes genotypes CC and TT were detected in 17.9% and 32.6% respectively of NPC cases. Of note, no significant association was found between the ERCC1 C8092A polymorphism and response to radiation therapy (p=0.81). Similarly, there was no significant association between the response to radiotherapy and allelic distribution (p=0.56). Likewise, no correlation was observed neither with genotypes (p=0.07) nor with alleles (p=0.09) of ERCC1 C118T polymorphism and response to radiation therapy. CONCLUSION: Our results clearly showed that ERCC1 C8092A and ERCC1 C118T polymorphisms were not associated with response to radiotherapy in Moroccan NPC patients. Large studies are warranted to confirm the role of these SNPs in therapeutic response of NPC patients.

Pretreatment [18F]FDG PET/CT and MRI in the prognosis of nasopharyngeal carcinoma.

OBJECTIVE: The present study aimed to assess the prognostic interest of metabolic and anatomic parameters derived from 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) and head and neck magnetic resonance imaging (HN-MRI) for better management of nasopharyngeal carcinoma (NPC). METHODS: In this study, pre-treatment [18F]FDG PET/CT and HN-MRI parameters of NPC patients diagnosed between January 2017 and December 2018, were prospectively investigated. Correlation between those parameters and 4-year patient's survival outcomes was evaluated using Kaplan-Meier and Cox-regression analyses. RESULTS: Our results revealed a significant association between pre-treatment nodal-maximum standardized uptake value (N-SUV max) and N categories (p = 0.01), between pre-treatment node-to-tumor SUV ratio (NTR) and both tumor size (p = 0.01) and N categories (p = 0.009), as well as between metabolic tumor volume (MTV) and both tumor size and NPC overall stage (p < 0.000). In multivariate analyses, pre-treatment N-SUV max, NTR and MTV were significant independent predictors of overall survival, distant metastasis-free survival, and progression-free survival (PFS) (p < 0.05). N-SUV max and MTV were also found to be significant independent predictors of loco-regional recurrence-free survival (p < 0.05), whereas HN-MRI detection of skull-base bone invasion was an independent factor associated with worse PFS in NPC (p = 0.03). CONCLUSIONS: The present study highlights N-SUV max, NTR and MTV derived from [18F]FDG PET/CT, and skull-base bone invasion defined by HN-MRI, as promising metabolic and anatomic prognosis biomarkers for NPC.

Painful bipartite patella following injury: a case report.

Bipartite patella is a normal variation in ossification development. This variation is usually asymptomatic but can cause persistent and debilitating anterior knee pain with an injury. We report the case of a 56-year-old man complaining of persistent anterior left knee pain following trauma. Standard knee radiographs show a bilateral Bipartite Patella appearance, and magnetic resonance imaging shows discrete bony edema of the cancellous bone of the accessory bone and about the synchondrosis explaining the anterior knee pain, associated with a crack in the posterior compartment of the medial meniscus. Conservative care including medical treatment with non-steroidal anti-inflammatory drugs, physical therapy was used. Magnetic resonance imaging is the most valuable diagnostic tool for evaluating detailed morphologic and pathologic changes in patients with the bipartite patella.

A rare combination of complications of ruptured carotid artery aneurysm: A case report.

The giant aneurysm of the subclinoid portion of the internal carotid artery is a relatively rare disease that can present serious complications. We present the case of a 40-year-old guy who was suffering from a headache and had complete ophthalmoplegia in his right eye. A brain scan shows a right temporal subdural hematoma, associated with subarachnoid hemorrhage, and total Sylvian subacute ischemic stroke. CT angiography and MRI showed a ruptured and partially thrombosed aneurysm of the subclinoid portion of the right internal carotid artery complicated by subarachnoid hemorrhage, a right subdural temporal hematoma, and total Sylvian ischemic stroke. Our purpose is to recognize the possibility of an aneurysmal rupture when evaluating an acute subdural hematoma, alone or in combination with Ischemic stroke.

Acute spontaneous hematoma of the corpus callosum in a COVID-19 patient: a case report.

Neurovascular involvement is a frequent occurring reported in COVID-19 patients. However, spontaneous hematomas of the corpus callosum are exceptionally seen. The authors of this article aim to report an unusual case of corpus callosum hematoma in a COVID-19 patient and discuss potential etiologies and mechanisms responsible for intracranial hemorrhage.

Pancreatic Lipoma: A Pancreatic Incidentaloma Diagnosis with Computed Tomography.

Lipoma of the pancreas is a rare benign tumour which is usually discovered incidentally on imaging. We present a case of an incidentally discovered pancreatic lipoma in a 79-year-old man with non-metastatic prostate adenocarcinoma who was referred to radiology for follow-up imaging. Fat-containing tumours originating from the pancreas are very rare. Most lipomas show characteristic features on imaging that allow their differentiation. We present the imaging features of a pancreatic lipoma on ultrasound, CT and MRI, discuss the differential diagnosis, and provide a brief review of the literature. LEARNING POINTS: Pancreatic lipoma is a rare mesenchymal tumour that is being increasingly recognized.Pancreatic lipoma is commonly asymptomatic and incidentally detected.CT and MRI allow confirmation of the diagnosis and elimination of other differential diagnoses.

Unusual Location of a Giant Cell Tumour.

Giant cell tumours (GCT) are rare aggressive non-cancerous tumours which usually affect the long bones. We describe a case of GCT of the first rib in a young woman without a relevant history. The patient presented a left cervico-thoracic mass which was biopsied in our department (CT-guided biopsy). She was referred to the thoracic surgery department after histological results. LEARNING POINTS: Giant cell tumours (CGT) are benign tumours that usually occur on long bones with costal localization being a rare entity.Ultrasound can be a useful tool to assess the nature of the lesion.Diagnosis is based on lesion biopsy, but aggressive surgical resection can be performed.CGT should be considered in the differential diagnosis of costal tumours.

Circulating cell-free epstein-barr virus DNA levels and clinical features in Moroccan patients with nasopharyngeal carcinoma.

BACKGROUND: The identification of effective prognosis biomarkers for nasopharyngeal carcinoma (NPC) is crucial to improve treatment and patient outcomes. In the present study, we have attempted to evaluate the correlation between pre-treatment plasmatic Epstein-Barr virus (EBV) DNA load and the conventional prognostic factors in Moroccan patients with NPC. METHODS: The present study was conducted on 121 histologically confirmed NPC patients, recruited from January 2017 to December 2018. Circulating levels of EBV DNA were measured before therapy initiation using real-time quantitative PCR. RESULTS: Overall, undifferentiated non-keratinizingcarcinoma type was the most common histological type (90.1 %), and 61.8 % of patients were diagnosed at an advanced disease stage (IV). Results of pre-treatment plasma EBV load showed that 90.9 % of patients had detectable EBV DNA, with a median plasmatic viral load of 7710 IU/ml. The correlation between pre-treatment EBV DNA load and the conventional prognostic factors showed a significant association with patients' age (p = 0.01), tumor classification (p = 0.01), lymph node status (p = 0.003), metastasis status (p = 0.00) and overall cancer stage (p = 0.01). Unexpectedly, a significant higher level of pre-treatment EBV DNA was also found in plasma of NPC patients with a family history of cancer (p = 0.04). The risk of NPC mortality in patients with high pretreatment EBVDNA levels was significantly higher than that of those with low pre-treatment plasma EBV-DNA levels (p < 0.05). Furthermore, patients with high pre-treatment EBV-DNA levels (≥ 2000, ≥ 4000) had a significant low overall survival (OS) rates (p < 0.05). Interestingly, lymph node involvement, metastasis status and OS were found to be the most important factors influencing the EBV DNA load in NPC patients. CONCLUSIONS: The results of the present study clearly showed a high association between pre-treatment EBV DNA load, the crucial classical prognostic factors (T, N, M and disease stage) of NPC and OS, suggesting that pre-treatment EBV DNA can be a useful prognostic biomarker in clinical decision-making and improving NPC treatment in Morocco.

Amyotrophic Monoplegia Secondary to Posttraumatic Rupture of the Brachial Plexus's Roots: A Case Report and Review of the Literature.

Brachial plexus lesions most often occur in multiple trauma. We report a case of a 37-year-old patient who presented an upper left limb total sensitivomotor deficit and amyotrophy after a cervical and upper limb trauma. Cervical magnetic resonance imaging (MRI) was performed. It noted pseudomeningoceles at the levels of C6-C7, C7-D1, and D1-D2 in T1 hyposignal , T2 and STIR hypersignal , not enhanced by the injection of Gadolinium extending in foraminal and extraforaminal spaces without visualization of the corresponding rootlets. Traumatic brachial plexus injury is a potentially serious debilitating injury which can be well explored on MRI.

Sinonasal Chondrosarcoma, an Unusual Location.

INTRODUCTION: Chondrosarcoma is a tumour with a cartilaginous matrix frequently encountered in long bones and the pelvis with rare sinonasal location. PATIENT AND METHODS: We report the case of a 25-year-old patient who was referred to us for an extension work-up for sinonasal chondrosarcoma confirmed by anatomopathological examination. RESULTS: Facial magnetic resonance imaging (MRI) confirmed by a CT scan showed an osteolytic tumour process of the hard palate and walls of the left maxillary sinus that was locally advanced. CONCLUSION: The sinonasal location of a chondrosarcoma is rare. Characterized by cross-sectional imaging, confirmation was provided by histological assessment. LEARNING POINTS: The sinonasal location of a chondrosarcoma is rare.A slow-growing tumour with a cartilage matrix in adults, it is revealed mainly by neurosensorial signs and mass effect in its sinonasal location.Radiological characterization includes areas with a weak signal on T1- and T2-weighted images in MRI, not enhanced by gadolinium, corresponding to the cartilage matrix.

Unusual Location of a Recurrent Epidermoid Cyst.

INTRODUCTION: Epidermoid cysts of the temporal bone are rare, benign and slow-growing lesions. PATIENT AND METHODS: We report the case of a 69-year-old female patient followed up for a symptomatic intradiploic epidermoid cyst of the temporal scale and left mastoid region, which had been operated on but recurred. RESULTS: MRI demonstrated a well-limited lesion seen as a hyposignal on T1-weighted images, hypersignal on T2-weighted images, on FLAIR and on diffusion-weighted images not enhanced by gadolinium. The tumour was compressive, and bone lysis was seen on CT. CONCLUSION: Epidermoid cysts of the temporal bone are rare, benign lesions whose diagnosis is based on fluid signals seen on MRI but absent on FLAIR sequences. LEARNING POINTS: Epidermoid cysts of the temporal bone are rare, benign and slow-growing lesions.Larger cysts are easier to identify.Diagnosis is based on the presence of a fluid signal on all MRI sequences except for FLAIR imaging, and on confirmation by pathological examination.

[MRI relevance in femoral head osteonecrosis: 3 case studies]. / Interet de l'irm dans l'osteonecrose la tete femorale a propos de 3 cas.

INTRODUCTION: Aseptic osteonecrosis of the femoral head is the partial or total destruction of the femoral head due to impaired blood flow. It affects young adults (30-60 years), predominantly male (3 male:1 female) and is often bilateral. The aim of the present work is to define the role of MRI in the diagnosis, classification and therapeutic management of osteonecrosis of the femoral head. MATERIALS AND METHODS: This study focused on three observations of osteonecrosis of the femoral head in the 20 Aout Radiology Department of the Ibn Rochd of Casablanca University Hospital with a review of the literature. All patients underwent MRI of both hips with sagittal sequences, coronal T1, T2 and T2 SE DP Fat Sat. RESULTS: The ages of our patients were 62 years for case 1 (male); 37 years for case 2 (female) and 58 years for case 3 (male). The MRI in all 3 patients objectified: subchondral bone fragment on the outer compartment of the femoral head bilaterally with minimal bilateral effusion in the first patient. In the other two patients, we note the presence of subcortical signal abnormalities of the femoral heads with demarcation piping T1 hypointense, T2 hyperintense and associated subchondral fractures. A minimal effusion was also observed. CONCLUSION: Medical imaging is an essential element of the radiological diagnosis of osteonecrosis of the femoral head. MRI finds its best indication in the precocious and differential diagnosis, as well as the classification of osteonecrosis of the femoral head.

INTRODUCTION: L'ostéonécrose aseptique de la tête fémorale est la destruction partielle ou totale de la tête du fémur due à l'altération de la circulation sanguine. Elle touche l'adulte jeune (30­60 ans) avec prédominance masculine (3H/1F). L'atteinte est souvent bilatérale. Le but de ce travail est de définir la place de l'IRM dans le diagnostic, la classification et la prise en charge de l'ostéonécrose aseptique de la tête fémorale. MATERIEL ET METHODE: L'étude porte sur 3 observations d'ostéonécrose aseptique de la tête fémorale colligées au Service de Radiologie 20Aout du CHU Ibn Rochd de Casablanca avec revue de littérature. Tous les malades ont bénéficié d'une IRM des hanches avec séquences sagittale, coronale T1, T2 SE et T2 DP Fat Sat. RESULTATS: Les âges de nos patients étaient de 62 ans, 37 ans et 58 ans avec 2 hommes et une femme. L'IRM réalisé chez les 3 patients a objectivé un fragment osseux sous chondral au niveau du compartiment externe de la tête fémorale de façon bilatérale chez le premier patient et chez les deux autres patients, la présence des anomalies de signal sous corticales des têtes fémorales avec les liserés de démarcation en hyposignal T1 et hypersignalT2 associés à des fractures sous chondrales. L'épanchement articulaire minime a été observé chez tous les patients. CONCLUSION: L'imagerie médicale constitue l'élément essentiel du diagnostic radiologique d'ostéonécrose aseptique de la tête fémorale. L'IRM trouve sa meilleure indication dans le diagnostic positif, différentiel et la classification de l'ostéonécrose de la tête fémorale.

[Osteosarcoma at a rare location: a case study]. / Osteosarcome a localisation rare. a propos d'un cas.

Bone sarcomas are uncommon tumors (3 to 5% of all bone tumors), they are even more rare after an irradiation 0.5 at 2%. Mandibular location is barely described in the literature; it mainly affects adults in their thirties. We report the case of a 43 years old man with a painful right cheek mass evolving 7 years after the end of treatment for undifferentiated nasopharyngeal carcinoma. Medical imaging has enabled us to situate the lesion, guide us towards an etiology, and to the staging and to post therapeutic monitoring. Mandibular bone osteosarcoma is a rare malignant tumor in Morocco.

Les sarcomes osseux sont des tumeurs peu fréquentes (3 à 5 % de l'ensemble des tumeurs osseuses), ils sont encore plus rares après une irradiation 0.5 à 2 %. La localisation mandibulaire est peu décrite dans la littérature, elle atteint surtout les sujets d'âge adulte (3éme décennie). Nous rapportons le cas d'un sujet de 43 ans présentant une masse jugale droite douloureuse d'évolution progressive apparue 7ans après la fin de son traitement pour carcinome indifférencié du nasopharynx. L'imagerie médicale a permis de situer la lésion, d'orienter vers une étiologie, de faire le bilan d'extension et le suivi post thérapeutique. L'ostéosarcome à localisation mandibulaire reste une tumeur maligne osseuse très rare au Maroc.