Intralobar pulmonary sequestration: incidental finding in an asymptomatic patient.

We describe a case of a 58-year-old male who presented to the emergency room with symptoms related to an appendicitis. A computed tomography scan with contrast confirmed the diagnosis of acute appendicitis but also revealed a mass medially in the base of the inferior lobe of the right lung. The mass measured 6.7 cm AP × 3.7 cm transverse. It had multiple lobulations and the anterior aspect was of very low density, possibly representing accumulated mucoid material. The mass had an arterial connection from the descending thoracic aorta and a venous drainage into the right pulmonary vein, classical features of intralobar pulmonary sequestration. The physical exam was unremarkable, and the patient had no history of pulmonary symptoms. This case helps increase awareness of intralobar pulmonary sequestration, a rare condition that may be asymptomatic.

A case of thoracoabdominal splenosis.

We describe a case of a 38-year-old male with a remote history of motor vehicle trauma who presented to the emergency department with 1-week history of progressively worsening abdominal pain localized to the epigastric region. Patient history included splenectomy. Computerized tomography demonstrated multiple masses in the left pleural space as well as masses continuous with the diaphragm and abdominal wall in the left upper quadrant. In addition, a lobulated mass was identified in the right upper quadrant along the anterior right hepatic lobe. A diaphragmatic defect was noted containing splenic tissue. A diagnosis of splenosis was made. Disseminated splenosis presenting in both the thorax and abdomen is rare and poorly documented. This case serves to further illuminate this condition.

The Posterior Axial Oblique Projection for Radiographic Examination of the Patella.

BACKGROUND: Images of the patella are invaluable for demonstrating fractures, acute injuries, and degenerative pathology of the patellar region. However, quality images of the patella can be difficult to acquire because of the distal femur obscuration. This article presents a method of imaging the patella, using film-screen radiography, computed radiography, or digital radiography that virtually eliminates the problem associated with distal femur obscuration and describes 7 radiography cases that demonstrate the clinical utility of the method. DISCUSSION: The described method of imaging the patella is simple, reproducible, and uses 2 projections-the posterolateral axial oblique and the posteromedial axial oblique-which help eliminate distal femur obscuration. CONCLUSION: The presented method demonstrates the base, body, apical, lateral, and medial borders of the patella without significant distal femur obscuration. In addition, radiologists and orthopedic surgeons express positive impressions of the resulting images' diagnostic usefulness.

Giant hepatic cyst as a cause of gastric outlet obstruction.

We describe the case of a 58-year-old female who presented to her primary care provider with lifelong anorexia, 6-week history of liquid only diet and new onset epigastric abdominal pain radiating to the back accompanied by nausea and abdominal distension. An initial computed tomography scan with contrast demonstrated a massive simple hepatic cyst with mass effect compression of the duodenal sweep. Repetitive treatment with aspiration sclerotherapy using hypertonic saline provided initial resolution of symptoms and led to substantial reduction of cyst diameter. Repeat imaging demonstrated complete drainage of the cyst and decompression of the duodenum. Ultimately, the patient's symptoms returned 6 weeks later at which time she opted for surgical deroofing of the cyst. Surgery provided for complete resolution. This case appears to be the first to document the compression of second portion of the duodenum by a massive simple hepatic cyst causing anorexia and mimicking gastric outlet obstruction.

Intercostal artery pseudoaneurysm following thoracentesis: multi-modal imaging and treatment.

BACKGROUND: A pseudoaneurysm occurs as the result of a contained rupture of an arterial wall, yielding a perfused sac that communicates with the arterial lumen. Pseudoaneurysm of an intercostal artery is an extremely rare event but it carries with it a significant risk of rupture and subsequent hemothorax. It must be considered as a potential complication of thoracentesis. CASE PRESENTATION: Here, we report a rare case of an intercostal artery pseudoaneurysm following thoracentesis in an 82-year old male. The patient presented with respiratory distress 1 day after a therapeutic thoracentesis had been performed. Computed tomography (CT) with contrast revealed a left intercostal pseudoaneurysm with hemothorax and adjacent compressive atelectasis. Doppler ultrasound revealed bidirectional blood flow in the pseudoaneurysm sac. An intercostal arteriogram and thoracic aortogram aided in confirmation of the pseudoaneurysm and successful treatment with coil embolization. CONCLUSIONS: An intercostal pseudoaneurysm complication following thoracentesis is very rare but important to rule out as a possible cause of hemothorax after the procedure. Capturing this finding with the aid of multiple imaging modalities allowed for diagnostic certainty and rapid treatment with coil embolization, leading to a successful patient recovery.

Internal hernia with incarceration of the cecum through a loop created by an elongated fallopian tube.

We describe a case of a 61-year-old female who presented to the emergency department with a 2-week history of severe right and left lower abdominal quadrant abdominal pain that radiated to the back and was accompanied by nausea and vomiting. An initial computed tomography scan with contrast demonstrated unusual loops of small bowel in the left paracentral pelvis. Follow-up computed tomography scans revealed worsening dilation of the cecum. Exploratory laparotomy was indicated and revealed a mobile right mesenteric stalk, which had migrated to the left lower abdominal quadrant and become incarcerated within a loop formed by a 25 cm long left fallopian tube. The distal end of the fallopian tube was firmly adherent to the parietal peritoneum of the left lower quadrant. A right hemicolectomy and a left salpingo-oophorectomy were performed. This case appears to be the first to document the internal herniation of a mobile cecum and right mesenteric stalk through a highly unusual loop created by an elongated left fallopian tube.

Large intramuscular lipoma of the tongue.

We describe a case of a 57-year-old man referred to an oral maxillofacial surgeon for a nontender, large intramuscular tongue mass. A computed tomography scan with contrast showed a homogenous right tongue intramuscular fatty mass measuring 3.8 cm × 2.8 cm in the axial dimension and 2.2 cm in the craniocaudal dimension. Histologic examination revealed multiple lobulated sections of mature adipocytes and occasional entrapped skeletal muscle fibers. The final pathologic diagnosis was intramuscular lipoma. Although lipomas account for approximately 50% of all soft tissue neoplasms, intramuscular (infiltrating) lipoma of the tongue is exceedingly rare.