Yuko Kobashi

Petersen hernia after open gastrectomy with Roux-en-Y reconstruction: a report of two cases and literature review.

Petersen hernia is a rare internal hernia that occurs after Roux-en-Y (R-Y) reconstruction. To our knowledge, there are a few reports on internal hernia, especially Petersen hernia after open gastrectomy for gastric cancer. Two rare cases of Petersen hernia are presented in this report. A man in his 70s was referred to our hospital due to a complaint of postprandial sudden abdominal pain. He had a history of open total gastrectomy with R-Y jejunal reconstruction through the antecolic route for gastric corpus cancer. On computed tomography (CT), bowel obstruction and strangulation of the small intestine were suspected. Emergency laparotomy was done, and an internal herniation of the small intestine through Petersen space was observed. A man in his 50s was referred to our hospital due to a complaint of severe sudden abdominal pain. He had a history of open gastrectomy and abdominal/lower intrathoracic esophageal resection with R-Y jejunal reconstruction of an antecolic jejunal limb for esophagogastric junction carcinoma. On CT, internal herniation of the small intestine was suspected. During emergency laparotomy, an internal herniation of the bowel through the Petersen space was observed. Though history of R-Y reconstruction surgery may be helpful, preoperative diagnosis of Petersen hernia is difficult to establish. Here we present two rare cases of this type of internal hernia.

Schwannoma assumedly originating from the submandibular ganglion or glandular branches radiologically mimicking a submandibular gland tumor

Schwannoma is a benign nerve sheath tumor composed of Schwann cells. Schwannomas originating from ganglia are rare, and schwannomas of the submandibular ganglion or glandular branches have not been reported to date. We present a case of a Japanese woman in her sixties with a submandibular schwannoma originating from the submandibular ganglion, mimicking a submandibular gland tumor on radiological findings. As the radiological findings were nonspecific, the key finding in the present case may be the characteristic location of the tumor suspended from the undersurface of the lingual nerve and situated above the deep portion of the submandibular gland.

CT imaging features of antiresorptive agent-related osteonecrosis of the jaw/medication-related osteonecrosis of the jaw

OBJECTIVES Antiresorptive agent-related osteonecrosis of the jaw (ARONJ)/medication-related osteonecrosis of the jaw (MRONJ) include both bisphosphonate-related osteonecrosis of jaw (BRONJ) and denosumab-related osteonecrosis of jaw (DRONJ). The purpose of this study is to study radiological characteristics of ARONJ/MRONJ. These imaging features may serve as one useful aid for assessing ARONJ/MRONJ. METHODS CT scans of 74 Japanese patients, who were clinically diagnosed by inclusion criteria of ARONJ/MRONJ, obtained between April 1, 2011 and September 30, 2016, were evaluated. We investigated the CT imaging features of ARONJ/MRONJ, and clarified radiological differentiation between BRONJ and DRONJ, BRONJ due to oral bisphosphonate administration and due to intravenous bisphosphonate administration, BRONJ with respective kinds of medication, BRONJ with long-term administration and short-term administration, BRONJ with each clinical staging respectively. Fishers exact test, χ2 test, Students t-test and analysis of variance were performed in the statistical analyses. RESULTS Unilateral maxillary sinusitis was detected in all patients with upper ARONJ/MRONJ (100%). DRONJ showed large sequestrum more frequently than BRONJ (3/4, 75 vs 3/35, 8.6%, p < 0.05). DRONJ showed periosteal reaction more frequently than BRONJ (4/10, 40 vs 7/65, 10.1%, p < 0.05). Patients of BRONJ resulting from intravenous bisphosphonate administration showed larger and more frequent buccolingual cortical bone perforations than BRONJ resulting from oral bisphosphonate administration (7/8, 87.5 vs 11/30, 36.7%, p < 0.05). There was no significant correlation between CT findings and respective kinds of medication, long/short-term administration, clinical stages of BRONJ. CONCLUSIONS ARONJ/MRONJ has characteristic CT image findings which could be useful for its assessment.

Wandering carotid arteries: Reciprocating change between normal and retropharyngeal positions on serial CT studies

Positional change in the retropharyngeal carotid artery, a rare phenomenon over time, is even rarer in previous reports, and it is important to be aware of this before any neck surgical procedure. A woman in her 50s underwent an anterior maxillectomy for upper gingival cancer, without neck dissection. The patient had medical histories of diabetes mellitus and liver dysfunction, with unremarkable family histories. Serial neck contrast-enhanced computed tomography for detecting locoregional recurrence had been performed as a follow-up during 4 years. A radiological course of moving carotid arteries in serial computed tomography studies showed reciprocating positional changes (wandering) between normal and retropharyngeal regions. There was no locoregional recurrence of the gingival cancer. This is the first case to describe a so-rare presentation of wandering carotid arteries. It is important for clinicians to be aware of a wandering carotid artery to avoid potentially fatal complications.

Evaluation of the Ossification of the Cervical Posterior Longitudinal Ligament Utilizing X-Ray, CT and MR Imaging

Citation Kobashi Y, Munetomo Y, Baba A, Yamazoe S, Mogami T. Evaluation of the ossification of the cervical posterior longitudinal ligament utilizing Xray, CT and MR imaging. Orthop Res Traumatol Open J. 2017; 2(1): 35-39. doi: 10.17140/ORTOJ-2-109 Volume 2 : Issue 1 Article Ref. #: 1000ORTOJ2109 Evaluation of the Ossification of the Cervical Posterior Longitudinal Ligament Utilizing X-Ray, CT and MR Imaging

Ankle and Foot Injuries: MRI Pitfalls

Magnetic resonance imaging (MRI) is an excellent modality for assessment of sports and overuse injuries of the ankle and foot. However, the anatomy of this region is complex, with several bones, ligaments, and tendons being subject to possible trauma. A good working knowledge of the appearances of normal anatomy, anatomical variants, and pathology is needed to avoid misdiagnosis. This chapter aims to discuss potential pitfalls in the MRI of the ankle and foot, categorizing the injuries into five painful sites, namely, lateral, medial, dorsal, and posterior ankle and mid- and anterior foot.

A rare presentation of Klippel–Trenaunay syndrome with bilateral lower limbs

Abstract Klippel–Trenaunay syndrome (KTS) is a vascular lymphatic malformation underlying with bony and soft tissue hypertrophy. It is a rare condition presenting in 1 out of 10 000 people. The growth disturbance due to KTS is more commonly unilateral (85%) than bilateral (12.5%), and most rarely crossed-bilateral (2.5%). A man in his 40s presented to our hospital with a complaint of lower limb discomfort. Radiograph, ultrasonography, computed tomography venography, magnetic resonance (and venography) showed various radiological findings characteristic for KTS. Because the patient was symptomatic, he underwent stripping of bilateral great saphenous vein and varicectomy of bilateral legs. The surgical procedures were undertaken successfully, and there has been no recurrent symptom for about 2 years and a half. In this study, we report a very rare case of bilateral KTS diagnosed by radiological and clinical manifestations with some literature review.

Iliopsoas Tendon Injury In an Adolescent: A Case Report

1Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugao, Ichikawa, Chiba, 271-8513, Japan 2Department of Radiology, Fujisawa Shonandai Hospital, Kanagawa Prefecture 252-0802, Fujisawa, Japan *Corresponding author Yuko Kobashi, MD Department of Radiology Tokyo Dental College Ichikawa General Hospital 5-11-13, Sugao, Ichikawa Chiba, 271-8513 Japan Tel. +81-47-322-0151 Fax: +81-47-325-4456 E-mail: ykobashi@jikei.ac.jp

Two Case Reports of Angioleiomyoma of the Finger

Angioleiomyoma represents a benign stromal tumor, which usually occurs in the subcutaneous tissue of the extremities. The angioleiomyoma in the finger is rare. We report 2 rare cases of an angioleiomyoma in finger. Case one, was a 72-year-old man with a mass on the radial side of distal phalanx of the left third finger. Case two, was a 70-year-old man with a mass on the ulnar side of interphalangeal joint of the left thumb. Both cases showed isointense to hypointense mass lesion on both T1 and T2-weighted images and were pathologically diagnosed with an angioleiomyoma. Heterogeneously isointense to hypointense on T2-weighted MR image showed two components: smooth muscle tissue punctuated with thick-walled vessles and/or hyalization on pathological finding. When much hyalization is included, it will not be enhanced on gadolinium-enhanced fat suppressed T1-weighted magnetic resonance (MR) image. Both T2-weighted and gadolinium-enhanced fat suppressed T1-weighted MR image findings should considered to predict tumor composition.

Extrapleural Solitary Fibrous Tumor of Foot: A Case Report

A 77-year-old woman was admitted to our Hospital for a mass lesion in the plantar area of the left foot. The patient referred that the mass was present for about 30 years but it had never been treated before because asymptomatic. Foot Magnetic Resonance Imaging (MRI) reviewed a low-signal-intensity tumor on both T1 weighted and T2 weighted images. Based on clinical and diagnostic imaging findings we initially suspected a fibroproliferative neoplasm like an aggressive fibromatosis. Histologically the lesion was benign fibroblastic spindle cell lesion with dense or loose collagen fibers. Cellularity was low and no mitotic figures were found. The tumor cells were positive for CD34, whereas they were negative for α smooth muscle actin, desmin, HHF35 and S100 protein. These pathological findings were consistent with an Extrapleural Solitary Fibrous Tumor (Extrapleural SFT). The Extrapleural SFT should be included in the differential diagnosis of extrapleural lesions in which MRI suggests fibrous content. These entities exhibit a dense fibrocollagenous matrix that can produce low signal intensity on T2-weighted MRI images, similar to Extrapleural SFT. However, in order to reach a proper diagnosis and treatment is essential to integrate a detailed patients’ clinical history and to perform a biopsy to collect cells for closer examination.