Perry S. Gerard

Primary carcinoid tumor of the testis.

Primary carcinoid tumors of the testis are exceedingly rare. Thirty-one primary tumors have been reported in the literature, none of which have been diagnosed preoperatively. We present a case report demonstrating the sonographic features of a testicular carcinoid which may contribute to an early preoperative diagnosis.

Severe allergic reaction: An unusual complication of barium enema

This article describes a severe allergic reaction to a barium sulfate compound used during double-contrast colon examination. This unusual complication is probably induced by chemical agents used as additives in the commercially available barium preparations. The pertinent literature is briefly reviewed.

Bilateral renal oncocytomatosis in a patient with renal failure

Bilateral multifocal renal oncocytomas are very rare disorders with only 6 previously reported cases in the world literature, of which only 3 have had pathologic confirmation. We present the first reported case of diffuse, bilateral, multifocal renal oncocytomatosis in a patient with end-stage renal disease requiring hemodialysis. Our patient was found to have hundreds of nodular tumors in both kidneys on exploration, representing the second such reported finding.

Xanthogranulomatous pyelonephritis in children: Analysis by diagnostic modalities

Xanthogranulomatous pyelonephritis (XGP), an uncommon chronic inflammatory renal disorder of middle-aged women, is rarely seen in childhood. We report the sonographic findings in a 2-year-old girl with the diffuse form of XGP and discuss the role of newer imaging modalities in the diagnosis and management of this disorder.

Bilateral Neonatal Testicular Torsion: Ultrasonographic Evaluation

We report a case of neonatal bilateral spermatic cord torsion, and present the sonographic and radioisotope findings. Real-time ultrasound scans performed at 2-hour intervals showed changes highly suggestive of the acute nature of the torsion rather than that of a process that had occurred in utero.

Histoplasmosis of the Penis

Histoplasmosis is a common cause of systemic mycosis in endemic areas of the United States. Genitourinary and cutaneous involvement with this dimorphous fungus is rare. We report a case of disseminated histoplasmosis associated with nonpainful ulcerative lesions of the glans and shaft of the penis.

Metastatic hypernephroma masquerading as acute cholecystitis.

Renal cell carcinoma can metastasize to multiple anatomic sites. The metastasis may simulate certain disease entities depending on the location and particular organ involved. It is important to recognize that these metastases can present many years after the primary tumor has been treated. We present a case in which a primary hypernephroma was surgically removed and subsequently 13 years later presented with metastatic disease to the gallbladder clinically simulating acute cholecystitis.

PET-CT scan in a patient with Kikuchi disease.

Sir, Kikuchi-Fujimoto disease (KFD), also known as necrotizing histiocytic lymphadenitis, is a rare cause of self-limited lymphadenopathy of unknown etiology that manifests with systemic signs of fever, weight loss and malaise. The clinical course is typically benign, with symptoms lasting 6–8 weeks. KFD should be considered in the differential diagnosis of prolonged fever in children with cervical lymphadenopathy [1]. The disease process has been associated with autoimmune diseases such as systemic lupus erythematosus and chronic Epstein-Barr viral disease [2–4]. The differential diagnosis of cervical lymphadenopathy with constitutional symptoms can be challenging, and up to 29% of KFD cases receive an initial pathological diagnosis of malignant lymphoma [5]. To cite a unique example of this rare but serious illness, a previously healthy 19-year-old girl of Pakistani descent presented with a 3-week history of fever up to 103°F (39.4°C), mildly painful left neck swelling, and a 10-pound (4.5-kg) weight loss. There was no history of recent travel, exposure to tuberculosis, autoimmune disease or contact with pets or other animals. She received a course of oral antibiotics (Augmentin) from her primary care physician with no reduction in neck swelling. Physical examination revealed multiple, enlarged, 2-cm left cervical and supraclavicular nodes that were matted and mildly tender to palpation. There was no right cervical, axillary, or inguinal lymphadenopathy appreciated. The examination of other systems was within normal limits. Her CBC revealed leukopenia and mild thrombocytopenia. Her sedimentation rate was slightly elevated and ferritin and blood chemistry were normal. Serological titers were negative for EBV and CMV. A Mantoux PPD test was negative. The patient underwent a PET-CT scan, which revealed multiple supraclavicular lymph nodes with 18-fluorodeoxyglucose (FDG) uptake (standardized uptake value, SUV, 10.5), compatible with malignant adenopathy. Additionally noted was FDG uptake in left hilar nodes (SUV 4) and subcarinal node (SUV 2.6) along with vague groundglass nodular densities that did not have increased uptake. Figure 1 shows supraclavicular and hilar node uptake in transverse PET images, and also shows corresponding CT and MIP images. Cervical lymph node biopsy revealed histological findings consistent with KFD: lymph node tissue with paracortical hyperplasia, karyorrhectic debris, immunoblasts, and crescent histiocytes. Additionally, tissue biopsy analyzed by flow cytometry revealed a polyclonal population, that was negative for malignant lymphoma. The supraclavicular lymph node involvement, 4-week duration, constitutional symptoms, and radiographic findings in this case are all features classically considered to be consistent with a malignant cause of lymphadenopathy. Imaging in this patient was ordered to characterize any suspected malignancy. FDG-PET scan is often used in the diagnosis and staging of malignancies, as FDG uptake correlates with the metabolic activity of the cell and is believed to be substantially increased in inflammatory and Pediatr Radiol (2008) 38:596–597 DOI 10.1007/s00247-007-0742-4

Elongation of the Anterior Tubercle of a Cervical Vertebral Transverse Process: An Unusual Variant

Elongation of the anterior tubercle of a transverse process of a cervical vertebra is a congenital anomaly that should be considered in a patient demonstrating a bony mass projecting anterior to the vertebral body on a lateral radiograph of the cervical spine. Reported is a case of elongation of the tubercles of the transverse processes of both C5 and C6 with the formation of an articulation. Computed tomography was used to definilation. Computed tomography was used to definitively differentiate this variant from a fracture fragment, bone tumor, or osteophyte. This anomaly is probably a form of supernumerary cervical rib developing at a level above the lowest cervical vertebra.

Positive In-111 WBC scan in a patient with ischemic ileocolitis and negative colonoscopies.

Early ischemic bowel disease may be apparent on in-111 WBC scan before endoscopic changes of the mucosa. This may indicate a subacute process. The case in point did have angiographic findings of lleocolitis despite repeated colonoscopy.