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Thoracic outlet syndrome (TOS) is a constellation of symptoms that occur due to the compression of neurovascular structures traversing the thoracic outlet. TOS manifests in 3 distinct forms: neurogenic, venous, and arterial. Among these, arterial TOS is the rarest. A 32-year-old man presenting with severe right arm pain was referred for CT angiography. The imaging revealed bilateral cervical ribs, with the right side showing more pronounced development and fusion with the first thoracic rib. At the fusion site of the right cervical rib and the first thoracic rib, a pseudoaneurysm of the right subclavian artery was detected. Additionally, there was evidence of acute thromboembolism in the right brachial artery at the mid-humerus. Arterial thoracic outlet syndrome is a rare form of TOS that can have detrimental consequences due to associated complications. Cross-sectional imaging, such as CT scans and MRI, is the preferred method for diagnosing TOS and identifying its specific form. Physicians are expected to be familiar with the various forms of TOS, the lesions mimicking TOS, and the imaging tools utilized for diagnosis.
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Blunt chest trauma may cause variable degrees of thoracic injuries. Most of the patients may remain asymptomatic after sustaining blunt chest trauma. But in rare instances, life-threatening conditions such as coronary artery dissection may occur. The authors present a 29-year-old male adult with persistent chest pain following blunt trauma with a rise in cardiac troponins and elevated ST segment in ECG. Coronary CT and conventional angiography demonstrated dissection of the left main coronary artery. It is deemed necessary to suspect cardiac injury in patients with a history of blunt chest trauma in appropriate clinical settings. Early recognition of coronary artery dissection is vital to reduce morbidity and mortality. ECG combined with cardiac enzymes can be essential tools helping the physicians raise the suspicion towards a cardiac injury followed by cross-sectional and conventional angiographies for confirmation.
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Hydatid disease is an indolent parasitic infection by a microorganism, echinococcosis granulosis. The disease can infect almost any human organ but is exceedingly rare involving the mediastinum and the heart. It can be lethal if complications occur. CT scan is the modality of choice for the diagnosis of the disease. The coverage of cardiac structures in the abdominal CT scan survey may be helpful for the detection of possible cardio-mediastinal hydatid disease. The authors present a case of hydatid cyst in the left ventricular wall alongside hepatic hydatid cysts. The definitive treatment includes surgery under cardiopulmonary bypass and needs to be treated as soon as it is diagnosed to prevent lethal complications.
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Teratoma is a congenital neoplasm deriving from one or more embryonic layers. Fetiform teratoma is a highly differentiated rare type of teratoma. The authors present a 1-day-old neonate for a lumbar region mass, grossly appearing like an extremity. CT scan was performed showing a highly organized extremity skeleton in the lumbar region consisting of flat, long and short bones. Fetiform teratoma should be differentiated from a fetus in fetu, as the former lacks axial skeleton while it is the main feature of the latter, respectively. Both have different prognostic implications, and surgical excision is the treatment of choice.
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Wolman disease is a lethal rare autosomal recessive disorder defined by the deficiency of acid lipase enzyme. The disease is a lysosomal storage disease. Multiple organs such as adrenal glands, liver, spleen, bone marrow, small bowel loops, and abdominal lymph nodes are infiltrated by the deposition of lipids. Infants generally present with failure to thrive, abdominal distention, vomiting, steatorrhea, and hepatosplenomegaly. Authors' present a 1 month-old male infant with abdominal distention and failure to thrive who was referred for abdomen CT scan. The CT scan revealed stippled calcifications of both enlarged adrenal glands, without the distortion of the adreniform shape, fatty liver, splenomegaly and thickened small bowel loops; characteristic imaging findings of Wolman disease. CT scan is the imaging modality of choice for the recognition of the disease. There is no definite cure explained yet. Further studies are required to find the definite treatment of the disease.
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Zinner syndrome is a rare congenital anomaly of the genitourinary tract, consisting of ipsilateral renal agenesis, seminal vesicle cysts, and ejaculatory duct obstruction. Besides, quadruplication of the ureter is the rarest anomaly composed of proximal four ureters ending with a single distal ureter. The authors present an adult male patient with left flank pain and dysuria who was referred for abdomen CT scan. The CT scan revealed renal agenesis, seminal vesicle cysts, and obstructed ejaculatory duct, all in the right side (Zinner syndrome), and quadruplication of the ureter on the left side. The additional finding of hemivertebra was present resulting in kyphoscoliosis. Zinner syndrome and quadrupled ureter, are both rare anomalies, and the occurrence of both entities at the same patient is exceptionally rare, and have not been reported yet in the English literature. Furthermore, standard treatment protocols have to be pursued, as such patients hold a single kidney with the quadrupled ureter.
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Teratomas commonly occur within ovaries, sacrococcygeal regions, testis, mediastinum, and intracranial regions. One of the rare sites for this tumor includes kidneys. Renal anomalies such as horseshoe kidneys with teratoma are one of the extremely rare presentations. The authors present a case of a large teratoma within a horseshoe kidney in an 8-year-old girl whose main clinical manifestation was abdominal distension. Intrarenal teratoma within horseshoe kidneys is a rare and interesting clinical entity that would require an appropriate therapeutic approach to salvage the kidneys and remove the mass.
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Urethral duplication is an extremely rare condition discovered in adults where most of them are diagnosed in childhood. Overall, it has 3 types according to Effman et al. The authors presented a case of an adult male complaining of dysuria, who was diagnosed with urethral duplication type IIB after performing retrograde urethrography and micturating cystourethrography. This is an extremely rare type of duplication of the urethra (type IIB) with late presentation. Further study may be required regarding the surgical management.
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Scrotal cystocele (massive inguino-scrotal herniation of urinary bladder) is an extremely rare event occurring in pediatric population. Authors present a case of a massive herniation of urinary bladder into the scrotum in a 1-year-old male infant who presented with markedly enlarged scrotum. Extremely rare case of massive urinary bladder herniation into scrotum, as we were able to find only one reported case in literature search. Enlarged scrotum in infants can be due to multiple causes in which one of them can be herniation of urinary bladder and it is key to know the contents of hernia sac before any intervention.
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Diastematomyelia with tethered cord is an uncommon congenital anomaly that is generally diagnosed in childhood but may rarely present in adulthood, we present the case of a 48-year-old man with diastematomyelia and tethered cord whose diagnosis was initially missed, leading to unnecessary spine surgery. The correct diagnosis was made from follow-up imaging. Because common clinical complaints such as back pain may be caused by unusual conditions, the authors suggest that radiologists and treating physicians should remain vigilant for unusual presentations of rare diseases.
