Clayton Chi-Chang Chen

Adenocarcinoma arising from colonic duplication cyst with metastasis to omentum: A case report

Gastrointestinal tract duplications are uncommon congenital abnormalities. Carcinoma arising from duplication cyst is extremely rare, not to mention metastasis to other organs. We present a case of adenocarcinoma arising from a colonic duplication cyst with invasion of the serosa and metastasis to the omentum in a 40‐year‐old man. Duplication cysts should be included in the differential diagnosis of cystic masses of the gastrointestinal tract. Because these lesions occur so infrequently, they are often not suspected until encountered intraoperatively. The specific findings and advantages of sonography are reviewed.

Combination of transverse myelitis and arachnoiditis in cauda equina syndrome of long-standing ankylosing spondylitis: MRI features and its role in clinical management

The cauda equina syndrome (CES) is a rare neurological complication of ankylosing spondylitis (AS). Imaging diagnosis of CES in long-standing AS patients (CES-AS) using myelography, computed tomography (CT), and magnetic resonance imaging (MRI) were reported in the literature. They, however, demonstrate only the chronic abnormalities of CES-AS, i.e., dural ectasia, dorsal dural diverticula, and selective bone erosion at the posterior elements of the vertebrae. To our knowledge, imaging features of acute intradural inflammation in CES-AS were not described. We report a patient of CES-AS in whom MRI disclosed acute transverse myelitis and arachnoiditis along the lower spinal cord, and discuss the pathogenesis of CES-AS and the role of MRI in clinical management.

Neuroimaging in seizure patients associated with nonketotic hyperglycemia.

Nonketotic hyperglycemia (NKH) is a clinical syndrome consisting of hyperglycemia, hyperosmolality and intracellular dehydration but not ketoacidosis. This prospective study evaluated the clinical and magnetic resonance imaging abnormalities in six patients with NKH complicated with simple or complex partial seizures. Subcortical T2 hypointensity rather than hyperintensity together with contrast enhancement was a characteristic feature of seizures associated with NKH. Restricted diffusion on DWI and decreased NAA and/or Choline on MRS studies were also noted.

Soft Tissue Hemangiomas: High-resolution Grayscale and Color Doppler Ultrasonographic Features in 43 Patients

Background High-resolution ultrasonography (HRUS) is the first-line imaging modality for the assessment of soft tissue tumors. The reported HRUS features of soft tissue hemangiomas vary greatly. We reviewed 43 histologically proven soft tissue hemangiomas and describe the HRUS and color Doppler ultrasound (CDUS) features, and propose a convenient CDUS sign for diagnosis. Materials and Methods HRUS data of 43 proven soft tissue hemangiomas were included in this study. Data assessment included tumor margin, tumor echogenicity and echotexture, presence of phleboliths, fluid–fluid level in the masses, and CDUS features. In masses with weak or no color Doppler signal, color Doppler enhancing maneuver (CDEM) was applied, which was carried out using light compression on the masses or on the soft tissues adjacent to the masses. CDEM was considered positive when the color Doppler signal in a mass was more prominent and/or extensive. Results Twenty-three hemangiomas were ill-defined and 20 were well-defined. Twenty-six hemangiomas were hypoechoic and 17 were hyperechoic. Thirty-seven masses were heterogeneous in echotexture. Phleboliths were found in only nine hemangiomas. Thirty-seven hemangiomas had multiple cystic spaces and fluid–fluid levels were noted in 12. Color Doppler signals were detected in 37 hemangiomas, i.e. 33 masses had weak signals and four masses had strong signals. CDEM was positive in all 33 hemangiomas with weak color Doppler signals and was positive in four of six hemangiomas with no detectable color Doppler signal. Conclusion Typical HRUS features of a soft tissue hemangioma were an ill-defined or well-defined hypoechoic mass of heterogeneous echotexture with multiple cystic spaces. On CDUS, there may be no detectable or only weak color Doppler signals. CDEM was helpful in the diagnosis of soft tissue hemangiomas, especially in masses with no detectable color Doppler signal.

Ossified Intramuscular Hemangioma

Although hemangioma is a common benign soft-tissue tumor, the formation of intratumoral ossification is rare. Ossified intramuscular hemangioma, an infrequent benign tumor, is characterized by a progressively enlarging painless mass in the lower extremity of young female. Herein, we report a case of 27-year-old female suffered from a progressively enlarging painless mass in her left thigh. The mass showed a ”Swiss cheese”-like calcification on plain radiographs. Magnetic resonance images revealed multiple cystic spaces with marked contrast enhancement suggesting vascular nature and intratumoral non-enhanced foci of very low signal intensity. The image finding may prompt the diagnosis of ossified intramuscular hemangioma, which was confirmed by the histologic examination. Our report emphasized that the characteristic imaging features of ossified intramuscular hemangioma might be helpful for the correct diagnosis preoperatively.

Angioplasty as the First-Line Therapeutic Option for Venous Hypertension with Outlet Obstruction of Dural Sinus

We describe a nonconventional endovascular approach to the treatment of pseudotumor cerebri with venous outlet stricture or obstruction. In three patients presenting with acute visual loss, angiograms showed sinus occlusion and stasis of contrast material, with an increased pressure gradient in the venous system. We used venous sinus angioplasty as the first therapeutic option. This treatment was effective, and symptoms and signs of all three patients subsided quickly. In our initial and limited experience, sinus balloon angioplasty appeared to be a good first-line treatment for patients with pseudotumor cerebri, sinus outlet obstruction and acute vision loss. We prefer to use sinus stent placement as a second-line option when initial attempts are unsuccessful, especially in pediatric and young-adult patients, as illustrated in our cases.