Superior Mesenteric Artery Thrombosis and Intestinal Ischemia as a Consequence of COVID-19 Infection.

COVID-19-associated arterial and venous thrombotic events are multifactorial in origin, resulting in significant morbidity and mortality. Intestinal ischemia due to thrombus is a rare manifestation of COVID infection. Here, we report the case of a patient who presented with fever, malaise, and diarrhea, and was found to be COVID-19 positive; his clinical course was further complicated by devastating thrombosis of the superior mesentery artery (SMA) associated with COVID-19 infection.

Bilateral supraclavicular abscesses following trigger point injections.

A 54-year-old-woman presented to the emergency department with worsening bilateral shoulder pain six days after trigger point injections in the bilateral supraclavicular areas for chronic pain. A computed tomography scan of the neck revealed bilateral irregular rim enhancing fluid collections. Image-guided percutaneous drainage resulted in marked improvement and near complete resolution by 17 days post-drainage. This case demonstrates the need for early detection of soft-tissue infection and abscess formation related to interventional pain procedures to avoid potentially life-threatening complications, such as Staphylococcus aureus bacteremia.

Laryngeal involvement in a patient with active postprimary tuberculosis: Case report of a rare extrapulmonary manifestation.

A 43-year-old woman was found to have active post-primary tuberculosis and a lateral neck radiograph showing a thickened epiglottis. Bronchoscopy-guided biopsies of the epiglottis and lung were acid fast bacilli stain positive. Histopathology from both showed multiple caseating granulomas. The patient's condition improved with RIPE therapy. This case illustrates the importance for physicians to be aware of possible laryngeal involvement in tuberculosis and that it can present even without evidence of active or latent tuberculosis.

Asymptomatic chyluria presenting with fat-fluid level after renal microwave ablation.

We present a case of asymptomatic chyluria in a 70-year-old man detected two years after microwave ablation of renal cell carcinoma. Chyluria is a rare complication of partial nephrectomy, but has not been previously reported after renal microwave ablation therapy. Recently, percutaneous thermal ablation techniques for T1a renal cancers are in surge due to comparable treatment efficacy, less invasive nature and lower complications. It is imperative to be aware of the post-ablation imaging findings and complications for correct diagnosis. Most patients with chyluria are clinically asymptomatic; therefore, serendipitous diagnosis on imaging detecting fat-fluid level may not be unusual.

Roca disease: An osteochondrosis of the inferior pole of the scapula with review of the literature.

Osteochondrosis is a developmental condition affecting the endochondral ossification. It is commonly idiopathic however can be due to vascular anomalies, dietary conditions, hormonal irregularity, or overuse trauma. Osteochondrosis occurring in the inferior pole of the scapula is an extremely rare condition and is referred to as roca disease. A higher degree of suspicion is required especially in a young patient with atraumatic shoulder pain and additional unconventional MRI sequences focusing on the inferior pole of scapula can be taken to rule out such conditions. We report a case of Roca disease in a 16-year male who presented with right shoulder pain. This is the third case report of roca disease in the English literature according to our knowledge and the first case report to demonstrate extensive MRI imaging features with a normal radiograph. Imaging, particularly MRI, plays a pivotal role in the diagnosis of this extremely rare entity. Also, the inferior pole of the scapula is usually not included in routine shoulder MRI imaging thus close scrutiny with additional MRI sequences should be done to diagnose such a rare entity.

An unresponsive COVID-19 patient.

Neurological manifestations and complications are increasingly reported in coronavirus disease-19 (COVID-19) patients. Although pulmonary manifestations are more common, patients with severe disease may present with neurological symptoms such as in our case. We describe a case report of a 50-year-old male without previous known comorbidity who was found unresponsive due to COVID-19-related neurological complications. During this pandemic, an emergency radiologist should be well acquainted with various neurological manifestations of COVID-19. In this article, we will discuss the pathogenesis, imaging findings, and differentials of this disease.

Intrahepatic splenosis demonstrated by diffusion weighted MRI with histologic confirmation.

Acquired ectopic splenic tissue is called splenosis, which is common after the history of trauma or surgical exploration. We present a rare case of intrahepatic splenosis in 36-year-old male patient mimicking a liver neoplasm on imaging however presented with left flank pain for 5 months and had remote history of splenectomy after splenic rupture from trauma. We discuss various imaging modalities and the role of various magnetic resonance imaging sequences and nuclear medicine examination. We also discuss the differentiating features to be kept to make the correct diagnosis along with a brief review of literature. We mentioned signal intensities of splenic lesions and normal signal intensity of spleen in different magnetic resonance imaging sequences and with high suspicion how we can diagnose splenosis and avoid unnecessary biopsy and its result related stress.

Rectovaginal septum primary squamous cell cancer: Extremely rare entity.

Rectovaginal septum primary cancer is an extremely rare entity including gastrointestinal stromal tumor , adenocarcinoma (endometriosis related/unrelated) and Mullerian cell remnant cancer. These cancers are usually asymptomatic, but can grow large enough to present with pelvic discomfort or pressure symptoms (urinary retention or constipation). Imaging plays an important role in detection, characterization, staging workup and follow-up. Despite adenocarcinoma being the histology seen in most cases of primary rectovaginal septum carcinoma, 1 prior case of squamous cell cancer was reported in 2016. To the best of our knowledge, our case is the second reported case of this same extremely rare entity. We discuss a 35-year female with a rectovaginal mass which was detected by pelvic ultrasound, worked up by computed tomography (CT), positron emission tomography-CT and diagnosed by large incisional transvaginal biopsy. The patient underwent combined chemoradiotherapy, which resulted in complete resolution of the mass on follow up pelvic magnetic resonance imaging. Standard management guidelines are not available due to lack of adequate data.

Axumin Positron Emission Tomography: Novel Agent for Prostate Cancer Biochemical Recurrence.

Prostate cancer remains one of the top common cancers in terms of incidence and cancer-related deaths. Approximately 1/3rd cases develop biochemical recurrence during surveillance post-definite therapy. Multiple imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI) (including multiparametric prostate MRI), bone scan, and positron emission tomography (PET) using different tracers are being used for the characterization of the prostate cancer recurrence. CT and MRI do not provide physiological information, thus have lower sensitivity in detecting the metastasis. A bone scan has low sensitivity (depending on the prostate-specific antigen level) with low specificity as well. Among different PET tracers, Axumin PET appears to be the most promising tool. Axumin PET is Food and Drug Administration approved for the evaluation of prostate cancer biochemical recurrence. Several studies have shown that Axumin PET findings played a key role in treatment modification by finding otherwise undetected lesions. We briefly discuss the salient characteristics, imaging protocol and image interpretation criteria for Axumin PET in the workup of prostate cancer biochemical recurrence.

Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation.

Soft tissue tumors involving the hand are common and most often benign. It is important to know the spectrum of soft tissue tumors of the hand and understand the typical as well as atypical imaging features are seen on different imaging modalities. The imaging features are largely determined by the tumor histopathology; thus, the basic idea about the tumor histopathology will always be useful. This article intends to focus on a comprehensive approach including demographics, clinical presentation, and imaging findings required to diagnose the tumor definitely or narrow the differentials. This article discusses common soft tissue tumor mimics of the hand as well, however, excludes the bone tumors for the sake of brevity.

"The Great Masquerader": Sonographic Pictorial Review of Testicular Tuberculosis and its Mimics.

Testicular tuberculosis (TB) is an uncommon presentation of extrapulmonary TB. Although rare in incidence, it is a great masquerader and should be kept in consideration while assessing focal abnormalities involving the testis. Ultrasound findings alone may be non-specific and mimic other diagnoses including infection, inflammation, tumor, infarct, and trauma. The main objective of this sonographic pictorial review is to discuss the imaging findings, specific differentiating features against each differential and use of ancillary imaging findings whenever available. Concurrent involvement of epididymis, septated hydrocele, scrotal wall edema, and calcification of tunica vaginalis provides strong evidence in an appropriate setting. Available extratesticular ancillary imaging findings must be correlated for correct diagnosis due to non-specific imaging and clinical presentation. Misdiagnosis of scrotal TB may lead to otherwise avoidable epididymo-orchiectomy.

Multisystem imaging review of human schistosomiasis: characteristic imaging findings.

Human schistosomiasis is one of the major tropical/subtropical parasitic diseases with significant morbidity and mortality. Although, the majority of the cases are seen within the endemic region, upsurge in recent immigration as well as frequent travel to endemic areas allows cases reported worldwide. Thus, it is important for radiologists and physicians be familiarized with the imaging features of schistosomiasis. Human schistosomiasis affects multiple target organs among which hepatosplenic, gastrointestinal and genitourinary organs are common. Rarely does it also affect pulmonary, central nervous system, testes etc. This article presents a comprehensive review of the characteristic imaging findings of schistosomiasis involving multiple target organs. The typical imaging findings are thoroughly correlated with the pathophysiology of parasite in human body. In addition, we have emphasized the key learning points to differentiate it from close differentials.