Maja Prutki

Cross-sectional imaging of the pelvic tumors and tumor-like lesions in gynecologic patients—misinterpretation points and differential diagnosis

Computed tomography and/or magnetic resonance imaging were performed in 42 female patients with suspected pelvic mass. Surgical and histopathological reports were compared to the imaging findings, yielding mismatch in five (17.8%) patients. One benign cyst and one case of postirradiation fibrosis were characterized as recurrent tumors, one surgically transposed ovary as metastasis, and an ovarian torsion as ovarian tumor, and a pelvic hematoma was mistaken for abscess. The most common false-positive finding on a per-lesion basis was that of enlarged lymph nodes.

Role of breast imaging in predicting outcome of lesions of uncertain malignant potential (B3) diagnosed at core needle biopsy.

Aims To elucidate whether breast imaging can predict final histologic diagnosis of lesions of uncertain malignant potential diagnosed at ultrasound core needle biopsy (CNB). Methods The imaging characteristics (mammography, ultrasound, and magnetic resonance imaging [MRI]) of lesions of uncertain malignant potential in the breast that were obtained by ultrasound CNB were retrospectively analyzed in 87 women. Radiologic characteristics of lesions were compared to definitive histopathologic findings. Results Out of 87 breast lesions of uncertain malignant potential, 27 (31%) were diagnosed as papillary lesions, 24 (28%) atypical ductal hyperplasia, 19 (22%) lobular intraepithelial neoplasia, 9 (10%) phyllodes tumors, 3 (3%) radial sclerosing lesions, and 5 (6%) unspecified lesions of uncertain malignant potential. The underestimation rate of malignancy at CNB based on the total number of lesions on final follow-up was 22%. Using multivariate logistic regression, Breast Imaging-Reporting and Data System (BI-RADS) score (odds ratio [OR] = 12.29, p = 0.027) and Göttingen MRI scoring system (OR = 8.1, p = 0.008) were found to be independent predictors of malignancy. Receiver operating characteristic analysis showed that Göttingen MRI score >3 provides a plausibly good cutoff value with sensitivity of 100 (95% confidence interval [CI] 74%-100%) and specificity of 76% (95% CI 61%-88%). Conclusions Lesions of uncertain malignant potential classified as BI-RADS 5 and Göttingen score 4 or higher are at significantly higher risk of harboring malignancy and therefore should be recommended for surgical excision.

Traumatic mesenteric bleeding: early diagnosis and interventional management

We report a rare case of mesenteric bleeding following blunt abdominal trauma successfully treated with transcatheter arterial embolization (TAE) of the ileal artery branch. A 27-year-old man presented with mesenteric bleeding after motorcycle accident. Computed tomography (CT) demonstrated mesenteric hematoma with extravasation of contrast material, and no associated major injuries to other organs. A superior mesenteric angiogram revealed pseudoaneurysm of the ileal branch. After TAE with a single microcoil, control angiography showed cessation of bleeding. There was no need for repeat embolization or additional surgery due to mesenteric bleeding nor ischemic gastrointestinal complications during the 5 months following TAE. In isolated mesenteric injuries, TAE may be a reasonable minimally invasive alternative to emergency laparotomy.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) represents a clinical continuum of an infection of upper female genital tract not associated with surgery or pregnancy. Ascending infection from the endocervix causes endometritis, salpingitis, oophoritis, pyosalpinx, tubo-ovarian abscess, and pelvic abscesses. PID is one of the most serious complications of sexually transmitted diseases most commonly caused by Neisseria gonorrhoeae or Chlamydia trachomatis, although 30–40% are polymicrobial [1].

Malignant mixed müllerian tumor mimicking cervical carcinoma.

A 58-year-old female patient presented with fever lasting for 30 days, frequent urination, pressure in the lower abdomen, and vaginal discharge. Laboratory findings showed elevated serum inflammatory parameters and normal levels of tumor markers (CA 125, CA 19-9, Ca 15-3). A gynecological examination revealed a necrotic mass in the vagina with the suspicion of bilateral parametrial invasion and invasion of the pelvic wall. Abdominal ultrasound (US) revealed a 9-cm uterine mass and transvaginal US identified a cystic mass within the cervix likely filled with purulent content. The clinical diagnosis was cervical carcinoma FIGO3B. Cervical biopsy was repeated five times in the next 20 days, but the histopathological examination revealed necrosis without tumor elements. Owing to the discordance between the clinical and histopathological findings, magnetic resonance imaging (MRI) of the pelvis was performed. MRI revealed a large, well-defined heterogeneous cervical mass protruding into the vagina, but no signs of vaginal wall or parametrial infiltration were detected (Fig. 1). On contrast-enhanced images, the upper part of the tumor mass showed progressive enhancement indicating a high content of fibrous tissue. The lesion was necrotic in the lower part, which explained the repeated negative findings in the cervical biopsies. Based on the MRI appearance, cervical carcinoma

Secondary omental torsion as a cause of acute abdomen in a patient with long-standing right-sided inguinal hernia

Omental torsion (OT) is a rare disease entity and in most cases it requires an emergent surgical procedure. Here we report the successful surgical management of secondary omental torsion in a patient who presented with acute abdomen. After the right diagnosis was established by CT-scan the patient underwent surgical procedure where the torsioned and necrotic omentum was successfully identified and resected. The outcome was satisfactory as patient discharged home quickly and recovery was uneventful.

Abdominal aortic aneurysm mimicking L2–L3 disc herniation

An 89-year-old man was brought to our emergency room because of right leg weakness. His symptoms started 2 months earlier with back pain. He was seen by a neurologist 2 weeks prior. Neurological examination showed hypoesthesia in the L2–L3 dermatome and MRI of the lumbosacral spine was recommended. On admission, his neurological examination showed muscle strength of the right iliopsoas and quadriceps femoris 2/5, absent patellar reflex on the right leg and urinary retention (1500 ml of urine after catheterization). His straight leg-raise test was normal bilaterally. Blood pressure was 100/60 mmHg, heart rate was 83 beats per minute and he was afebrile. His abdomen was soft and flat, and bowel sounds were normal. He had no abdominal tenderness or palpable mass. Laboratory findings revealed 16.43 9 10/l leukocytes (3.4–9.7), 10.2 mmol/l glucose (4.4–6.4) and 108.15 mg/l C-reactive protein (5). Emergency CT of the lumbosacral spine showed disc bulging in the L4–L5 segment and wedge compression fracture of the L2 vertebrae (Fig. 1a). In addition, this examination showed an aneurysm of the abdominal aorta with hematoma in the right psoas muscle (Fig. 1b). CT aortography confirmed the diagnosis showing ruptured right common iliac artery and extravasation of the contrast material into the right psoas muscle indicating active bleeding (Fig. 1c). The following day resection of both the abdominal aneurysm and the aneurysm of the right common iliac artery was performed followed by reconstruction with InterVascular silver graft 22 9 11. Three days later the patient died due to septic shock.

Eiternde Osteomyelitis mit Epiduralabszess bei einem Erwachsenen mehr als ein Jahrzehnt nach zervikaler Wirbelsäulenverletzung@@@Purulent osteomyelitis with epidural abcess in an adult over a decade after cervical spine injury

Cervical osteomyelitis and epidural abscess are rare and potentially fatal conditions with severe neurological manifestations. Changes on plain radiography and computed tomography are non-specific, while contrast enhanced magnetic resonance imaging shows high sensitivity and specificity in establishing early diagnosis.ZusammenfassungZervikale Osteomyelitiden und epidurale Abszesse sind seltene und potenziell tödlich verlaufende Störungen mit schweren neurologischen Manifestationen. Die Veränderungen im konventionellen Röntgenbild und in der Computertomographie (CT) sind unspezifisch, während die kontrastverstärkte Magnetresonanztomographie (MRT) eine frühzeitige Diagnose mit hoher Sensitivität und Spezifität ermöglicht.AbstractCervical osteomyelitis and epidural abscess are rare and potentially fatal conditions with severe neurological manifestations. Changes on plain radiography and computed tomography are non-specific, while contrast enhanced magnetic resonance imaging shows high sensitivity and specificity in establishing early diagnosis.

Eiternde Osteomyelitis mit Epiduralabszess bei einem Erwachsenen mehr als ein Jahrzehnt nach zervikaler Wirbelsäulenverletzung

Cervical osteomyelitis and epidural abscess are rare and potentially fatal conditions with severe neurological manifestations. Changes on plain radiography and computed tomography are non-specific, while contrast enhanced magnetic resonance imaging shows high sensitivity and specificity in establishing early diagnosis.ZusammenfassungZervikale Osteomyelitiden und epidurale Abszesse sind seltene und potenziell tödlich verlaufende Störungen mit schweren neurologischen Manifestationen. Die Veränderungen im konventionellen Röntgenbild und in der Computertomographie (CT) sind unspezifisch, während die kontrastverstärkte Magnetresonanztomographie (MRT) eine frühzeitige Diagnose mit hoher Sensitivität und Spezifität ermöglicht.AbstractCervical osteomyelitis and epidural abscess are rare and potentially fatal conditions with severe neurological manifestations. Changes on plain radiography and computed tomography are non-specific, while contrast enhanced magnetic resonance imaging shows high sensitivity and specificity in establishing early diagnosis.

EWING’S SARCOMA OF THE THIRD METATARSAL: A CASE REPORT AND REVIEW OF THE LITERATURE

We report a rare case of Ewings sarcoma involving the third metatarsal bone and spreading into adjacent bone in a 23-year-old man, with special emphasis on imaging characteristics. On radiographs the tumor presented as a permeative lytic lesion with aggressive periosteal reaction and cortical destruction. Computed tomography and magnetic resonance imaging delineated the osseous and soft tissue extent of the tumor. A large soft-tissue mass around the involved bone was highly indicative of Ewings sarcoma. Cortical invasion of the neighboring second metatarsal was seen only on magnetic resonance imaging. Increased up-take of technetium 99m methylene diphosphonate was noticed on bone scintigraphy. An early diagnosis of Ewings sarcoma, even when it occurs in unusual locations, is necessary for adequate treatment and is of particular importance in terms of prognosis. The optimal imaging modality for the diagnosis of Ewings sarcoma is magnetic resonance imaging since it allows accurate analysis of the soft-tissue component and visualization of possible local invasion of adjacent structures.