Radiology Commons^™

Free Silicone-Induced Granulomatosis And Hypercalcemia In A Transgender Female, Brian L. Pando, Benjamin Goldsmith, Adam Lane Webb, Komal Kinger, Brian Helmly

HCA Healthcare Journal of Medicine

Introduction

Vitamin D derangements are a rare but important cause of hypercalcemia. Granulomatous disease is a primary cause of vitamin D derangements and is frequently associated with sarcoidosis, tuberculosis, and in the present case, foreign body granulomatosis. Liquid or injectable silicone is used as a filler for cosmetic body contouring. Transgender patients may seek silicone injections as part of gender affirmation surgeries. Granuloma formation is a rare but well-described complication of injectable silicone.

Case Description

A 40-year-old, assigned male at birth (AMAB) transgender female patient, with a history of HIV and chronic kidney disease (CKD) stage 3b, was admitted to …

Emerging Applications Of Contrast-Enhanced Ultrasound In Trauma, Brenda Tester, Ji-Bin Liu, John R. Eisenbrey, George Koenig

Department of Radiology Faculty Papers

The use of contrast-enhanced ultrasound (CEUS) has expanded over the past decade to include a variety of diagnostic and therapeutic applications. These include urgent clinical situations that require timely diagnosis and subsequent treatment. With the introduction of microbubble ultrasound contrast agents (UCAs), CEUS provides increased sensitivity and specificity over conventional ultrasound. Within the trauma setting, CEUS benefits include point of care imaging and an ability to monitor perfusion in real-time. Additionally, UCAs are non-nephrotoxic, and can be used when contrast enhanced CT is contraindicated. In this review, we discuss recent advancements of CEUS within trauma settings.

Role Of Lipid-Lowering Therapy In Peripheral Artery Disease, Agastya Deepak Belur, Aangi J. Shah, Salim S. Virani, Mounica Vorla, Dinesh K. Kalra

Office of the Provost

Atherosclerosis is a multifactorial, lipoprotein-driven condition that leads to plaque formation within the arterial tree, leading to subsequent arterial stenosis and thrombosis that accounts for a large burden of cardiovascular morbidity and mortality globally. Atherosclerosis of the lower extremities is called peripheral artery disease and is a major cause of loss in mobility, amputation, and critical limb ischemia. Peripheral artery disease is a common condition with a gamut of clinical manifestations that affects an estimated 10 million people in the United States of America and 200 million people worldwide. The role of apolipoprotein B-containing lipoproteins, such as LDL and remnant …

Thyrotoxic Periodic Paralysis: A Case Report And Discussion Of Clinical And Imaging Features, Kristian Quevada, Kishan Patel, Pauline Germaine

Cooper Rowan Medical Journal

Thyrotoxic Periodic Paralysis (TPP) is a rare manifestation of thyrotoxicosis, resulting in periodic episodes of acute onset muscle weakness in the setting of hypokalemia. The thyrotoxic form of Hypokalemic Periodic Paralysis (HPP) is less studied than the more well-known familial form due to fewer reported cases and smaller prevalence. This case study presents a 30-year-old African American male with multiple episodes of acute lower extremity muscle weakness, tachycardia, and a history of heat intolerance. Abnormal findings on thyroid ultrasound coupled with increased thyroid related immunoglobulins led to a diagnosis of TPP related to exacerbation of newly-found Graves’ disease. The case …

Pivotal Trial Of Mri-Guided Transurethral Ultrasound Ablation In Men With Localized Prostate Cancer: Three-Year Follow-Up, Steven S. Raman, Sandeep Arora, Katarzyna J. Macura, Aytekin Oto, Jurgen Fütterer, Robert Staruch, Temel Tirkes, David Bonekamp, Masoom Haider, Derek W. Cool, Kiran Nandalur

Conference Presentation Abstracts

Purpose: MRI-guided transurethral ultrasound ablation (TULSA) of prostate tissue is a novel directional ultrasound heating under real-time MRI thermometry feedback control. We report 3-year outcomes from the pivotal TULSA-PRO Ablation Clinical Trial. Materials and Methods: With IRB approval and HIPAA compliance, 115 men with organ-confined prostate cancer (≤T2b, PSA ≤15 ng/ml, Grade Group [GG] 1-2) across 13 centers underwent whole-gland ablation sparing the urethra, bladder neck, and urinary sphincter. Primary endpoints were safety and PSA reduction at 1 year. Secondary endpoints: prostate volume reduction, mpMRI, and 10 core biopsy at 1 year; quality of life, PSA, and salvage to 3 …

Host Gut Resistome In Gulf War Chronic Multisymptom Illness Correlates With Persistent Inflammation, Dipro Bose, Somdatta Chatterjee, Ethan Older, Ratanesh Seth, Patricia Janulewicz, Punnag Saha, Ayan Mondal, Jeffrey M Carlson, Alan W Decho, Kimberly Sullivan, Nancy Klimas, Stephen Lasley, Jie Li, Saurabh Chatterjee

Faculty, Staff and Student Publications

Chronic multisymptom illness (CMI) affects a subsection of elderly and war Veterans and is associated with systemic inflammation. Here, using a mouse model of CMI and a group of Gulf War (GW) Veterans' with CMI we show the presence of an altered host resistome. Results show that antibiotic resistance genes (ARGs) are significantly altered in the CMI group in both mice and GW Veterans when compared to control. Fecal samples from GW Veterans with persistent CMI show a significant increase of resistance to a wide class of antibiotics and exhibited an array of mobile genetic elements (MGEs) distinct from normal …

Shortness Of Breath In A Young Lady, Rare Case Report Of Thoracic Endometriosis, Willbroad Kyejo, Ally Zain Ismail, Davis Rubagumya, Rahma Bakari, Munawar Kaguta, Nancy Matillya

Family Medicine, East Africa

Introduction and importance: Endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The clinical presentation is depends on site of implantation. Complications include pneumothorax, pneumohemothorax or hemothorax.

Case presentation: A 31 year old woman with history of infertility presented with shortness of breath and was found to have a significant right sided pneumohemothorax. Drainage was done followed by chemical pleurodesis using bleomycin with resolution of symptoms on her follow up.

Clinical discussion: Thoracic endometriosis tend to present with chronic or sub-acute symptoms which are nonspecific symptoms leading to late diagnosis. Video Assisted Thoracoscopic surgery offer both …

Labrad : Vol 47, Issue 1 - June 2022, Aga Khan University, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• From the Editor’s Desk
• LABRAD Star Contributors for the Year 2021
• Clinical Relevance of Measuring Thyroid Stimulating Hormone Receptor Antibodies in Pregnancy and Newborns
• Aromatic l-amino Acid Decarboxylase (AADC) Deficiency- An Ultra-rare and Underdiagnosed Neurometabolic Disorder
• Role of Flowcytometry & Kleihauer - Betke Test in Detection and Quantification of Fetomaternal Hemorrhage
• Gestational Trophoblastic Diseases: An Overview
• Acrania-Exencephaly-Anencephaly Sequence/ Spectrum: Radiological Features on Antenatal Screening
• Minimally Invasive Tissue Sampling (MITS) A New Way to Investigate Cause of Death In Resource-constrained Countries
• Laboratory Guideline for Detection, Interpretation and Reporting of Maternal Cell Contamination (MCC) in Prenatal Analysis
• Molecular Analysis of Alpha Thalassemia …

Imaging Of Transmetallation And Chelation Phenomena Involving Radiological Contrast Agents In Mineral-Rich Fruits, Subhendra Sarkar, Zoya Vinokur, Bleidis Buitrago, Lin Mousa, Hayley Sanchez, Analia Basilicata, Jodi-Ann Douglas, Seanetta Reddock

Publications and Research

Exogenous heavy metals or non-metallic waste products, for example lanthanide or iodinated contrast media for radiological procedures, may interfere with the biochemical pools in patients and in common food sources, creating an excess buildup of exogenous compounds which may reach toxic levels. Although the mechanisms are unknown, our experiments were designed to test if this toxicity can be attributed to “transmetallation” or “chelation” reactions freeing up lanthanides or chelated transition metals in acidic fruits used as phantoms representing the biologically active and mineral-rich carbohydrate matrix. The rapid breakdown of stable contrast agents have been reported at a lower pH. The …

Financial Toxicity Tumor Board: A Multi-Disciplinary Team Activity Required In Low And Middle-Income Countries (Lmic), Ahmed Nadeem Abbasi, Sohail Rasool, Laraib Khan

Department of Radiation Oncology

No abstract provided.

Extrusion: A New Method For Rapid Formulation Of High-Yield, Monodisperse Nanobubbles, Claire Counil, Eric Abenojar, Reshani Perera, Agata A. Exner

Faculty Scholarship

Shell-stabilized gas microbubbles (MB) and nanobubbles (NB) are frequently used for biomedical ultrasound imaging and therapeutic applications. While it is widely recognized that monodisperse bubbles can be more effective in these applications, the efficient formulation of uniform bubbles at high concentrations is difficult to achieve. Here, it is demonstrated that a standard mini-extruder setup, commonly used to make vesicles or liposomes, can be used to quickly and efficiently generate monodisperse NBs with high yield. In this highly reproducible technique, the NBs obtained have an average diameter of 0.16 ± 0.05 µm and concentration of 6.2 ± 1.8 × 1010 NBs …

Aspnr Programing: Interesting Pediatric Neuroradiology Case Session (Sa-Cme): Seizures., A Krishnan

Conference Presentation Abstracts

No abstract provided.

A Rare Case Of Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy, A Dearden, J Doty, A Krishnan, J Fellows

Conference Presentation Abstracts

Purpose This is a 69-year-old male who presented with cognitive decline, hypophonia, dyspraxia, course tremor, myoclonic jerks, and gait dysfunction, all developing over 3-4 weeks. Initial head CT and MRI brain without contrast were negative. EEG demonstrated diffuse slowing. CSF analysis revealed elevated protein and elevated white blood cells (lymphocyte predominant). Given neurological worsening, MRI brain and cervical spine with contrast were performed and unique findings were identified, detailed below. The CSF autoimmune panel returned positive for Glial Fibrillary Acidic Protein (GFAP). The patient was started on steroids with rapid clinical improvement. Materials and Methods MRI brain with contrast 2 …

Benign And Malignant Cervical Lymphadenopathy: A Practical Imaging Approach To The Diagnosis Of Common And Uncommon Conditions, A Dhaliwal, J Sharma, S Noujaim

Conference Presentation Abstracts

Purpose Generally, cervical lymphadenopathy is a benign, self-limited, and reactive process that is frequently encountered, especially in the pediatric population. However, when present in the setting of a neoplastic process, cervical lymphadenopathy is an important prognostic factor that can alter patient management. Determining the etiology of cervical lymphadenopathy is as essential as its detection. Etiologies include infection, granulomatous disease, malignancy, autoimmune disorders, iatrogenic causes, and miscellaneous or unusual conditions. Careful attention to clinical history and laboratory findings and the use of appropriate radiological imaging is crucial to obtaining the correct diagnosis. A variety of cases, including benign and malignant processes, …

Spontaneous Aneurysmal Subdural Hemorrhage: A Rare Entity, M Rizk, A Khan, J Ghannam, M Waheed

Conference Presentation Abstracts

Purpose 36-year-old female who presented to our emergency department for worsening headache and new onset left sided diplopia. Physical exam confirmed a left 3rd nerve palsy. A CT of the head was obtained which showed a subdural hemorrhage which ultimately resulted in coil embolization of a ruptured aneurysm. The patient tolerated the procedure well and was closely followed for vasospasm development with routine transcranial ultrasounds which were negative. Patient remained stable and reported resolution of her headache symptoms on discharge. However, she continued to have a left 3rd nerve palsy. Materials and Methods CT of the head was obtained which …

Neuroimaging Spectrum Of Non-Compressive Non-Neoplastic Myelopathy, J Ghannam, A Dearden, R Joshi, A Wang, K Barry

Conference Presentation Abstracts

Purpose Non-compressive, non-neoplastic spinal cord lesions represent a broad range of disease processes and entities. Most commonly, spinal cord lesions demonstrate T2 signal abnormality on magnetic resonance imaging, a relatively nonspecific finding requiring a variety of differentiating factors to build an accurate differential diagnosis (1). Additionally, many disease entities have significant overlapping features on MRI, rendering it difficult to separate diagnoses and guide management (2). The combination of signal characteristics on MRI, timing of clinical presentation, degree of cord expansion, and contrast enhancement patterns can provide improved differentiation between disease entities. The purpose of this exhibit is to educate the …

The Onus On The Conus: A Neuroimaging Spectrum Of Conus Medullaris Pathologies, A Dearden, J Ghannam, A Wang, A Krishnan

Conference Presentation Abstracts

Purpose The conus medullaris is the tapered, cone-shaped end of the distal thoracic spinal cord, normally terminating near the L1-2 intervertebral disc space. As a junction between the cord and the cauda equina nerve roots, the conus can present with common cord pathologies in atypical presentations, as well as present with unique, complex pathologies found nowhere else in the cord. The conus is optimally evaluated with MRI of the lumbar spine before and after the administration of contrast medium. Accurate diagnosis of lesions within the conus is complicated by the nonspecific nature of increased intramedullary signal on T2-weighted MRI imaging, …

Vertebral Artery Pathology: A Review Of Diagnosis And Angiographic Intervention, R Joshi, A Abbas, J Wilseck

Conference Presentation Abstracts

Purpose The vertebral arteries are a critical component of the spinal and posterior intracranial circulation. Their associated pathologies are wide ranging including traumatic and congenital causes. Given the profound impact on patient management and outcomes, a careful evaluation of the vertebral artery with a firm understanding of normal anatomy is required to properly rule out pathology. This educational exhibit will provide an overview of the normal anatomy of the vertebral arteries and a case-based review of a large spectrum of their pathologies, including traumatic, spontaneous, iatrogenic, and congenital. Utilization of various imaging modalities including, CTA, MRA, angiography, and ultrasound will …

Neuroimaging Spectrum Of Compressive Non-Neoplastic Myelopathy, A Dearden, J Ghannam, A Wang, A Krishnan

Conference Presentation Abstracts

Purpose Compressive non-neoplastic spinal cord lesions represent a broad spectrum of neurologic disease processes contributing to back pain and neuropathy, including traumatic, inflammatory/infectious, degenerative, and metastatic etiologies. Compressive cord lesions are optimally evaluated with high-field strength magnet MRI with and without contrast. Differential diagnoses for cord lesions are inherently broad due to the nonspecific nature of increased intramedullary signal on T2-weighted images seen with many cord pathologies. However, differentiating features such as degree of cord expansion, enhancement characteristics, and extramedullary findings can provide additional information to refine the differential diagnosis. In this exhibit, we present representative cases of compressive non-neoplastic …

Sex Differences In The Association Between Cardiovascular Diseases And Dementia Subtypes: A Prospective Analysis Of 464,616 Uk Biobank Participants, Caiyun Dong, Chunmiao Zhou, Chunying Fu, Wenting Hao, Akihiko Ozaki, Nipun Shrestha, Salim S. Virani, Shiva Raj Mishra, Dongshan Zhu

Office of the Provost

Background: Whether the association of cardiovascular diseases (CVDs) with dementia differs by sex remains unclear, and the role of socioeconomic, lifestyle, genetic, and medical factors in their association is unknown.
Methods: We used data from the UK Biobank, a population-based cohort study of 502,649 individuals. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between CVD (coronary heart diseases (CHD), stroke, and heart failure) and incident dementia (all-cause dementia, Alzheimer's Disease (AD), and vascular dementia (VD)). The moderator roles of socioeconomic (education, income), …