Marc Z. Simmons

Extramedullary hematopoiesis presenting as a focal splenic mass: a case report

We report the ultrasound, computed tomographic, and magnetic resonance imaging findings in a case of extramedullary hematopoiesis presenting as a focal splenic mass in a patient with myelodysplastic syndrome. Ultrasound demonstrated a well-circumscribed hyperechoic mass, whereas computed tomography showed a heterogeneous mass better visualized after administration of intravenous contrast. On magnetic resonance imaging, the lesion was hypointense to the spleen on T1-weighted images, with increased signal on T2-weighted images, and demonstrated enhancement after intravenous contrast administration. Extramedullary hematopoiesis should be considered in the differential diagnosis for a splenic mass in any patient with a hematologic disorder.

Controversies in transrectal ultrasonography and prostate biopsy.

Transrectal ultrasound-guided biopsy of the prostate is the gold standard for the detection of prostate cancer. In its current form, transrectal gray-scale ultrasound is unable to differentiate malignant prostate tissue from benign tissue. The general indications for performing a sonographic guided biopsy of the prostate are an abnormal digital rectal examination or an abnormal prostate-specific antigen (PSA). Several controversial areas remain: the ideal number of biopsy cores, the use of PSA velocity, free PSA, PSA density, age- and race-adjusted PSA, the use of local anesthetics, and the overall best patient preparation methods, including such topics as routine antibiotic prophylaxis or bowel enemas, remain unsettled. There are also unanswered questions regarding repeat biopsy and protocols for managing patients with a diagnosis of high-grade intraepithelial neoplasia. This article will explore some of the current controversies and review the pertinent literature.

Spectrum of congenital renal anomalies presenting in adulthood

There is a wide range of congenital renal anomalies that can present in adulthood. These include unilateral agenesis, ectopia, as well as malrotation and fusion anomalies. These may have clinically relevant associated anomalies. Alternatively, these may present due to related sequela of urinary stasis or malposition. We will discuss the imaging findings of a spectrum of congenital renal anomalies presenting in adults.

Cholangiographic demonstration of the cholecystohepatic duct of Luschka

Abstract. The cholecystohepatic duct of Luschka is demonstrated. This anomaly directly connects the gallbladder to the bile ducts, draining a portion of the right lobe of the liver. The pertinent embryology is reviewed. When accidentally severed, it may cause a bile leak leading to biloma formation. It should be recognized before surgery to alert the surgeon.

Sarcoid myopathy: Imaging findings

Sarcoidosis is a granulomatous multisystem disorder that may uncommonly involve muscle. Muscular sarcoid may be nodular, atrophic myopathic, or acute myositic. We illustrate a case of the myopathic type of muscular sarcoid that is unusual because the abdominal wall muscles, rather than the extremity muscles, were involved. Muscular involvement by sarcoid should be considered in the differential diagnosis of focal muscle disease, especially in a patient with a known history of sarcoid. The presence of typical bilateral hilar adenopathy on a chest radiograph as well as the presence of abdominal findings (hepatosplenomegaly and retroperitoneal adenopathy) may help establish the diagnosis. Otherwise, sonographically guided biopsy may be necessary for definitive diagnosis.

Spontaneous dissection of air into the transverse mesocolon during double-contrast barium enema

Intramural perforation of the colon proximal to the rectosigmoid is a rare complication of the barium enema examination. We present a case in which air and barium entered the wall of the transverse colon, and then dissected through the transverse mesocolon during double-contrast barium enema in an asymptomatic patient with no known underlying colonic disease.

Inflammatory fibroid polyp of the esophagus in an HIV-infected individual: Case study

We report an unusual case of a large esophegeal inflammatory fibroid polyp in a man infected with the human immunodeficiency virus complaining of dysphagia. Barium studies and computed tomography demonstrated a long, submucosal-appearing, distal esophageal mass which extended into a hiatal hernia. Inflammatory fibroid polyps should be considered in the differential diagnosis of submucosal and polypoid esophageal masses, although distinctive radiographic features are not found.

The radiology of bone changes in rhabdomyosarcoma

Rhabdomyosarcoma usually presents as a soft tissue mass, which may invade adjacent bone. However, the patient presents occasionally with bony metastases. Recognition of these is important for staging and management. Fifty-eight cases have been reviewed; 14 of these had local bone invasion by the soft tissue tumour. All bones involvel were flat bones; 12 showed permeated bone destruction and two showed geographic destruction. Bone expansion was seen in half the involved bones. Twelve of the 58 cases showed secondary bone deposits, which were the presenting feature in five. Although 10 cases had permeated bone destruction, two were very well defined with a wide range of radiological appearances. The radiological differential diagnosis includes neuroblastoma, leukaemic infiltration, lymphoma, histiocytosis X, solitary and multifocal osteosarcoma and other deposits.

Dilatation of the inferior vena cava in patients with cirrhotic portal hypertension: Causes and imaging findings

Dilatation of the inferior vena cava is a frequent finding in patients with cirrhosis and portal hypertension, and may be produced by various mechanisms. In this article we illustrate the spectrum of causes and appearances of inferior vena caval dilatation in patients with cirrhosis and portal hypertension.

FDG PET/CT findings in a rare case of giant fibrovascular polyp of the esophagus harboring atypical lipomatous tumor/well-differentiated liposarcoma.

A 70-year-old man with a history of chronic lymphocytic leukemia (CLL) underwent FDG PET/CT scan, which revealed a large polypoid soft tissue lesion in the esophagus with peripheral FDG avidity. An endoscopic biopsy revealed inflammatory changes with scattered CLL cells. The final histopathology demonstrated an 18-cm long and 4-cm wide giant fibrovascular polyp that was removed in 2 pieces. The polyp was composed of atypical adipose tissue with scattered giant cells and spindle-shaped cells as well as foci of CLL. Mouse double minute 2 homolog amplification was noted by fluorescence in situ hybridization diffusely in the giant polyp consistent with well-differentiated liposarcoma in a giant fibrovascular polyp.