Bilateral Orbital Myeloid Sarcomas: A Unique Presentation of Acute Myeloid Leukemia.

Myeloid sarcomas (MS) are solid manifestations of acute myeloid leukemia (AML) and are commonly present in children. These tumors can arise in many tissues including bone, soft tissue, or skin, and are commonly seen in the orbit. As practically all MS will, if left untreated, eventually present as AML, early diagnosis and initiation of treatment are imperative. We highlighted a case of bilateral orbital MS in a pediatric patient that presented concurrently with AML and the steps taken to diagnose and initiate treatment. Our case highlights the potentially occult presentation of AML as well as myeloid sarcoma and, therefore, the importance of swift workup and diagnosis. Epidemiology, radiographic features, diagnosis, and treatment for myeloid sarcoma and AML were discussed.

An Unfortunate Union: A Case of Multiple Magnet Ingestion in a Pediatric Patient.

Magnets are among the most dangerous foreign objects that a child can ingest. If more than one magnet is ingested, the attraction between loops of the bowel can bring adjacent loops closer together, leading to perforation, obstruction, or fistulization. Pediatric magnet ingestion patients often require endoscopic or surgical intervention to retrieve the objects and repair the damage created by the magnets. Due to the risks of surgical intervention, management is done with strict adherence to the rare earth magnet ingestion algorithm. We highlighted a pediatric case of multiple magnet ingestion, and the steps that were taken to manage the patient. Our case highlights the potential for complications and the importance of adherence to the management algorithm in these patients. Epidemiology, mechanisms, algorithms, and outcomes for pediatric magnet ingestion patients were discussed.

A Unique Case of Sporadic Optic Pathway Glioma in an Infant With Acute Nystagmus.

Optic pathway gliomas (OPGs) are a classic pathology seen in patients with neurofibromatosis I (NF-1); however, they are frequently seen as sporadic masses in patients with mutations activating the mitogen-activated protein kinase (MAPK) pathway. These sporadic tumors present rapidly with vision deficits, compared to those in neurofibromatosis I, which may be found incidentally. They can involve multiple aspects of the optic pathway and have classic imaging findings that make definitive diagnosis possible with magnetic resonance imaging. This case highlights a six-month-old boy who had an acute history of nystagmus and severe milestone regression, who was diagnosed with bilateral optic pathway gliomas. This case describes the associated imaging findings in addition to a discussion of management and overall prognosis of sporadic compared to NF-1-associated optic pathway gliomas.

Incidental Discovery of a Left Ventricular Aneurysm After a Syncopal Episode.

A left ventricular aneurysm is a rare post myocardial infarction complication. Ventricular aneurysms form as post-ischemic cardiac remodeling creates a weaker, fibrotic area that may bulge outwards against interventricular pressures over time. Patients with ventricular aneurysms have increased mortality and are at higher risk of various cardiac complications, such as cardiac arrest, arrhythmias, thrombus formation, reduced cardiac output, or aneurysmal rupture. Prompt diagnosis and treatment are critically important in these patients. We highlight the hospital course of a patient with an extensive cardiac history presenting for syncope with the discovery of a left ventricular aneurysm. The radiographic features of the left ventricular aneurysm are described, as well as formation, risk factors, and complications.

An Unusual Case of Retroperitoneal Plexiform Neurofibromas Found in a Trauma Patient.

The spectrum of presentation for patients who have neurofibromatosis type 1 (NF1), or von Recklinghausen disease, is very diverse due to a phenomenon known as variable expressivity. Patients may or may not present with cutaneous lesions or central nervous system (CNS) manifestations. However, multiple neurofibromas are the pathognomonic hallmark of NF1. The most common abdominal neoplasm is plexiform neurofibromas that affect the retroperitoneal region. We highlight the hospital course of a patient with an unknown history of NF1 who presented for head trauma with plexiform neurofibromas found incidentally on imaging. The radiographic features of neurofibromas are described in addition to the discussion of management and prognosis of NF1.

Miraculous Recovery After Penetrating Trauma to the Mediastinum.

Traumatic injury to the mediastinum can damage critical surrounding structures, including the pericardium, aorta, and bronchial tree. We highlight a miraculous case of a 13-year-old female with no past medical history who presented to the emergency department after being impaled in the chest by a metal fence post. After median sternotomy, the foreign object was removed, and the patient fortunately recovered with no permanent sequelae. The radiographic features of the injury are described, and potential unseen cardiovascular and respiratory complications are discussed.

Post-Cesarean Section Abdominal Wall Endometrioma.

A 30-year-old female with a history of multiple cesarean sections presents to the emergency department with several months of right lower quadrant abdominal pain only associated with her menstrual cycles. CT abdomen and pelvis with contrast was remarkable for an abdominal wall mass that likely represented an endometrioma, and she was subsequently discharged with pain medications and conservative treatment. However, three months later, she returned to the ED, because her pain was unbearable and refractory to medical management. Interventional radiology was consulted for percutaneous biopsy of the soft tissue mass located in her rectus abdominus muscle. Following the procedure, the patient was started on ORILISSA® (elagolix), the first FDA-approved oral treatment for the management of severe pain associated with endometriosis. We highlight an interesting case of post-cesarean section abdominal wall endometrioma implantation and describe the patient's clinical course and disease management. The radiographic features of the mass are described and proposed mechanisms for the development of an abdominal wall endometrioma following a C-section is discussed.