Radiology Commons^™

A Minimally Invasive Palliative Approach Using Radiofrequency Ablation And Cementoplasty In A Painful Metastatic Acetabular Lesion, Liliya S. Agarkov, Korinne Diss, Garrett C. Schneider

Advances in Clinical Medical Research and Healthcare Delivery

Up to 75% of patients with advanced metastatic disease experience excruciating pain that affects their daily life. We elaborate on a case of a 63-year-old male with Stage IV squamous cell lung carcinoma with advanced osseous metastatic lesions who presented with symptoms of ambulatory dysfunction due to a lesion in the right acetabulum. This case report demonstrates how radiofrequency ablation can offer pain relief through meticulous ablation of a metastatic lesion without the necessity and negative side effects of external beam radiation.

May Thurner Syndrome: Can We Stent It And Forget It ?, Sahej Arora, Asmaa Ahmed, Hafsa Jawaid, Aakriti Jain, Stephen Silver

Advances in Clinical Medical Research and Healthcare Delivery

Background: May-Thurner Syndrome (MTS) is a cause of venous obstruction and acute Deep Vein Thrombosis (DVT) in young females, due to extrinsic venous compression of left ilio-caval venous territory. It generally presents with unilateral lower limb swelling and DVT and long-term management requires endovascular stenting with anticoagulation. Little data is available on long term post-interventional outcomes. Case: A 73-year-old female with MTS, who underwent endovascular stenting of left external and common iliac vein 11 months ago, presented with recurrent symptoms. She had completed almost a year of oral anticoagulation with Eliquis approximately 45 days before presentation. She was found to …

Radiologic Findings Of A Mediastinal Mass With Pleural Fluid Cytologic Analysis: A Case Report Of Recurrent Mantle-Cell Lymphoma, Mark Cwajna, Zaain Ahmad, Evan Basha, Emily Maggioncalda, Shehbaz Ahmad, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

This case report details a 69-year-old male who presented with a right-sided pleural effusion and a mediastinal mass that was ultimately identified as recurrent mantle-cell lymphoma, occurring over 20 years after his initial diagnosis. Imaging findings discussed include chest radiograph and chest, abdomen and pelvis computed tomography depicting the mass compressing on various neighboring structures.

Integrating Clinical History, Imaging, And Serologic Testing For The Accurate Diagnosis Of Neurocysticercosis: A Case Report, Jedediah Bondy, Paul Dobria, Dillon Woody, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

Neurocysticercosis is a parasitic infection caused by the cestode Taenia solium, in which pigs serve as the definitive hosts. Humans can become accidental intermediate hosts through the ingestion of food contaminated with Taenia solium eggs via fecal-oral transmission. Once ingested, the eggs of Taenia solium hatch into larvae, which then migrate through the bloodstream and disseminate across various organs, including the central nervous system (CNS). In this case, a 40-year-old male from Mexico with a known history of seizure disorder presented to the emergency department with altered mental status. He had been told by a physician in his native …

Successful Multimodal Interventional Management Of Extensive Portal Venous System Thrombosis In A Patient With A Hypercoagulable State, Dillon Woody, Jedediah Bondy, Donnette Dabydeen, Korinne Diss, Amanda Neider Neider

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of extensive mesenteric and portal vein thrombosis in a 59-year-old male with a history of multiple thrombotic events and hypercoagulable conditions. The patient presented with abdominal pain, nausea, vomiting, and black stools, leading to the discovery of thrombosis in the portal vein, splenic vein, and superior mesenteric vein (SMV) with associated bowel ischemia. The goal of treatment was to prevent mesenteric ischemia, maintain portal vein patency, and preserve options for potential liver transplantation. The case was managed through a combination of ultrasound-guided paracentesis, portal and SMV venography, mechanical thrombectomy using the AngioJet device, and continuous thrombolytic …

Cns And Retinal Radiologic Findings Of A Young Patient With Heterozygous Prothrombin G20210a Gene Mutation, Justina Kasteri, Timothy Ehmann, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

Stroke is one of the leading causes of death and acquired long-term disability in the world.¹ In United States stroke is the 5^th leading cause of death with a mortality rate of 49.1 deaths per 100,000 people.² Strokes can be ischemic or hemorrhagic in origin, of which 85% are ischemic strokes. Approximately 10--15% of ischemic strokes occur in patients 18-50 years of age, and inherited thrombophilia may be a contributing factor through induction of a hypercoagulable state. Prothrombin G20210A mutation has an overall prevalence of approximately 2% of the general population, with an association between young patients …

Radiologic Evaluation And Management Of Metastatic Renal Cell Carcinoma With Tumor Thrombus Extension Into Right Atrium, Zaain Ahmad, Mark Cwajna, Evan Basha, Adithya Bala, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

This case report discusses the radiologic evaluation, histopathology, and management of a 67-year-old female with metastatic renal cell carcinoma (RCC) extending as a tumor thrombus into the right atrium. The patient had newly developed hematuria that was not followed up with the recommended imaging modality. Months later, the patient presented to the emergency department with progressive hematuria in addition to symptoms of dyspnea and significant weight loss. Initial CT imaging revealed a large renal mass with metastasis to the liver and lungs, along with tumor thrombus invading the inferior vena cava and right atrium. Histopathologic evaluation confirmed metastatic RCC and …

Radiologic And Histologic Findings Of Undifferentiated Sarcoma Treated With Radical Resection, Justina Kasteri, Stefan Johnson, Joseph Hatem, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Case report of an 89-year-old patient presenting with a nontraumatic painless growing mass on the right thigh. This article presents the diagnostic imaging and histologic microscopic views of the mass following a radical resection. Further discussing the key findings to diagnose undifferentiated sarcomas as well as the clinical management.

Can Anemia Be A Prognostic Indicator To Scope For Gastroesophageal Junction Adenocarcinoma?, Ryan Tam, Neha Narayanan, Evan Basha, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Gastroesophageal junction adenocarcinoma is a rapidly progressive disease that has a poor prognosis with a 5-year survival rate of 20%. It commonly presents with major symptoms of dysphagia and weight loss in addition to a long-standing history of reflux. As of now, screening for esophageal adenocarcinoma (EAC) is dependent on identifying risk factors which include a family history of Barrett’s esophagus and esophageal adenocarcinoma or patients with gastroesophageal reflux disease and at least one other risk factory for EAC such as age greater than 50 years, obesity or central adiposity, history of smoking, or male gender. Here, we present a …

Coexisting Renal Artery Stenosis And Large Angiomyolipoma In A Solitary Kidney: A Therapeutic Dilemma, Yohannes B. Tilahun, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

Title: Coexisting Renal Artery Stenosis and Large Angiomyolipoma in a Solitary Kidney: A Therapeutic Dilemma

Authors: Tilahun YB, Mentor/Attending: Sekar A

Background: Angiomyolipomas (AMLs) are the most common benign renal tumors, typically presenting as incidental findings. However, large AMLs can lead to life-threatening complications such as retroperitoneal hemorrhage, particularly in the setting of a solitary kidney. The presence of concomitant renal artery stenosis (RAS) further complicates management, posing a unique therapeutic challenge in balancing the need to prevent hemorrhage, preserve renal function, and optimize renovascular perfusion.

Case: A 77-year-old African American woman with a history of left nephrectomy for renal …

Unilateral Hearing Loss Caused By Bilateral Otosclerosis In The Context Of Prior Viral Infection - Case Report, Ryan Tam, Michael Mullinax, Timothy Ehmann, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

This is a case report of a patient who presented with left sided hearing loss. The patient was found to have mixed conductive and sensorineural hearing loss of the left ear and restrictive hearing of the right ear. Subsequent imaging demonstrated evidence of bilateral otosclerosis. Otosclerosis is characterized by progressive pathological bone remodeling in the otic capsule, resulting in hearing loss. Given the disease burden of otosclerosis and the corresponding effects on quality of life, providers must have knowledge of the disease to incorporate it into working differential diagnoses for patients presenting with hearing loss. With increasing recognition of otosclerosis …

Cardiac Arrest Following Svc Intravascular Stenting: A Case Report, Afrah Ali, Shahtaj Shah, Varun Mehta, Lubna Ziauddin, Asma Khan, Sameen Khurshid, Fawaz Ali

Advances in Clinical Medical Research and Healthcare Delivery

Superior vena cava (SVC) syndrome is a known collection of symptoms caused by obstruction of blood flow through the superior vena cava. Symptoms notably seen include difficulty breathing, coughing, hoarse voice, and swelling of the head, neck, and arm. It is most commonly seen secondary to malignancy from tumor infiltration of the vessel wall and is frequently associated with lung cancer due to anatomic location.

Treatment of SVC syndrome largely depends on severity of symptoms. While treatment of underlying cause is considered first line, intravascular stenting is also commonly considered in life threatening cases and for symptomatic relief.

We report …

An Interesting Case Of Wunderlich Syndrome And Page Kidney, Megan Worthington, Nicholaus Monsma, Raj Pyne

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of Wunderlich Syndrome and Page Kidney, a rarely reported combination. Wunderlich Syndrome, characterized by spontaneous renal hemorrhage without a history of trauma, is typically associated with Lenk’s triad of flank pain, mass, and hypovolemia. Page Kidney induced hypertension, a rare condition resulting from external renal compression associated with renin-mediated mechanisms. Our case demonstrates the importance in quick recognition and treatment as blood pressure changes can be fast and dramatic. Our case also has the added dimension of renin measurements. After the patients hypertension developed, his initial renin levels were within normal range, but they later showed …

Case Report Of Unilateral Dysphagia In The Context Of A Classical Type Of Eagle Syndrome, Ryan Tam, Stephen D. Howard, Timothy Ehmann, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

A patient presents with unilateral, right-sided dysphagia and generalized facial symptoms following past surgical history of tonsillectomy that is consistent with an underdiagnosis of Eagle Syndrome. The elongation of the styloid process likely impinged on the glossopharyngeal and vagus nerves resulting in symptoms. Given the lack of recognition of the disease, this case report describes the presentation of Eagle Syndrome to encourage physicians to consider this disease as part of a broader differential diagnosis.

Unlikely Cohabitants: A Collision Tumor Of Metastatic Small Cell Lung Carcinoma And Adrenal Adenoma, Michael Demeritt, Savanna Atwal, Stefan Johnson, Kevin Lightner, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

This case report is the second known publication of a very specific collision tumor, where small cell lung cancer metastasized to an adrenal adenoma. The focus is primarily on multimodal radiologic findings of the developing neoplasm, including CT, MRI, and FDG PET/CT. These findings are compared with established diagnostic criteria for adrenal adenomas and metastases, as identified by the literature and content expert review. Epidemiological data regarding collision tumors is discussed, as well as proposed treatment strategies. Similar topics are elucidated for small cell lung carcinoma. Reporting of this collision tumor adds to the relatively thin body of knowledge of …

A Rare Appendiceal Mucocele Of The Appendix Captured On The Ultrasound: Case Report, Vera Shulgina, Meghan Single, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Appendiceal mucocele is a rare disease which results from an accumulation of mucus in the lumen of the appendix, leading to distension and obstruction of the lumen. Clinical diagnosis is often delayed, as the presenting symptoms are usually non-specific. Even with the use of imaging, preoperative diagnosis is difficult. The treatment is surgical, with the extent determined by the surgical specimen. Definitive diagnosis is by histopathology. Our case report presents a rare case of appendiceal mucocele originally captured by ultrasound. The aim of this paper is to further understand the clinical presentation, discuss key ultrasound findings, and examine the proper …

Persistent Foci Of Infection: A Case Of Two Mycotic Aneurysms Separated In Time In A Patient With Infective E. Faecalis Endocarditis, Julia C. Stone, Joel Thompson, Joseph Hatem, Evan Basha

Advances in Clinical Medical Research and Healthcare Delivery

This is a case report of a patient who presented with mycotic aneurysms of two different blood vessels at separate hospital visits following a diagnosis of infective endocarditis.

Median Arcuate Ligament Syndrome: A Rare Cause Of Abdominal Pain That Is Difficult To Identify, Mark E. Eskander, Matthew Thrall, Joel P. Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Median arcuate ligament syndrome (MALS) is a rare disease that occurs when the celiac artery is compressed by the median arcuate ligament. Patients with MALS typically present with non-specific symptoms that overlap with more common diseases. As a result, patients may undergo extensive workup and unnecessary treatments before being properly diagnosed with MALS. In this case we present a 23-year-old female with chronic postprandial abdominal pain that persisted despite undergoing a cholecystectomy. This case highlights the symptoms and imaging findings needed to diagnose MALS and thus prevent unnecessary surgical interventions.

Radiologic And Histologic Findings Of Locally Advanced Mucoepidermoid Carcinoma Managed With Total Surgical Excision, Christopher R. Huber, Don Truong, Joseph Hatem, Joel Thompson, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

The present case report provides images from computed tomography and histology of a patient with a salivary gland neoplasm consistent with mucoepidermoid carcinoma.

Comparing Pleural Fluid Removal Volume And Oxygenation Change In Therapeutic Thoracentesis: Is There A Relationship?, Hannah Zazulak, Ryanne Burke, Andrea Bodine

Advances in Clinical Medical Research and Healthcare Delivery

Background: During therapeutic thoracentesis (TT), pleural fluid is typically drained to completion. Fluid removal improves oxygenation, and the amount of fluid removed is directly associated with the risk of serious complications. A relationship between the amount of fluid removed during TT and the change in oxygenation has not been found in the literature. A direct relationship was hypothesized in this study. Differences in the change in oxygenation between sexes, age, and pre-procedure oxygen support were secondarily hypothesized. This information would assist in the guidance of future TT protocols.

Methods: Subjects of this retrospective cohort study were males and females aged …

The Transitional Year Internship: Five Classes Of Former Interns Reflect On Their First Clinical Year, Hana L. Haver, Kush K. Patel, Robert Chow

Advances in Clinical Medical Research and Healthcare Delivery

Objective:

The clinical internship (postgraduate year-1), which precedes many advanced residency training programs, are traditionally fulfilled by a transitional year (TY) or preliminary year of training in medicine or surgery. TY programs can take place in a variety of settings, ranging from community hospitals to large academic medical centers. In the present study, we sought to evaluate if resident physicians who completed a community hospital-based TY internship felt prepared for their subsequent specialty residency training.

Methods:

A cross-sectional survey was adapted and distributed to resident physicians who completed their TY internship at a university-affiliated community hospital in Baltimore, Maryland, between …