Solitary plasmacytoma is an uncommon tumor. We present a case in an unusually young patient demonstrating the mini brain sign that has been published in a couple of reports as a diagnostic radiological pattern produced by plasmacytoma. Identification of “mini brain appearance” on imaging can direct the radiologist and clinicians to the diagnosis of plasmacytoma and obviate the necessity of pre-operative biopsy.
Leiomyosarcoma is a rare type of connective tissue cancer, accounting for 5–10% of all soft tissue sarcomas. We present a case of leiomyosarcoma as unusual multifocal presentation. Retroperitoneal, mediastinal, pulmonary, uterine and bony regions were all involved at the time of presentation. The liver was normal without detected lesions.
Background: A 40-year-old male presented with progressive left lower limb pain on a background of left knee surgery some 20 years prior. Examination revealed a thrill and bruit in the left popliteal fossa and diagnostic angiography confirmed a large arteriovenous fistula (AVF). Methods: Over-the-wire Fog arty catheter was used to exclude flow through the AVF and image run-off vessels. The native popliteal artery measured 6.5 mm above and below the fistula and an 8 mm × 50 mm Gore Viabahn covered stent was used to exclude the AVF with good results. The patient was started on clopidogrel and therapeutic anticoagulation with warfarin postoperatively. Results: This case illustrates the endovascular repair of a large, chronic AVF in which open surgery would have been very challenging. The majority of data on long-term primary patency of popliteal covered stents results from aneurysm treatment and is estimated to be 69.4% at 5 years. Conclusion: Treatment of chronic AV fistulas using covered stents in the popliteal region is a viable alternative to open repair.
duodenoscopy (OGD) which revealed blood in the stomach (the neo-esophagus). The patient had a cardiac arrest before finding the source of the bleeding; hence, the OGD was aborted and cardiopulmonary resuscitation (CPR) commenced. He responded to one cycle of CPR and was intubated and fluid resuscitated. When hemodynamically stable, a computed tomography aortography (CTA) was performed, which demonstrated an aortoesophageal fistula (AEF) and no other aortic abnormality. A rapid decision was made to proceed with a thoracic endovascular repair of the aorta (TEVAR) limited to that segment of aorta. The procedure was successful. He had a follow-up OGD weeks later which was normal. Four months later, he represented to hospital with hypovolemic shock secondary to massive hematemesis. Again, a diagnosis of AEF was confirmed on CTA, which was just proximal to the previous aortic stent graft. He again had emergency TEVAR covering the descending aorta from the level just below the left subclavian artery to just proximal to the celiac artery, which was again lifesaving and uncomplicated. Three months later, a repeat OGD revealed a large gastric ulcer with a visible segment of aortic stent graft in the base. At this time, he reported no symptoms and had a normal full blood count. He was then referred urgently to have definitive upper gastrointestinal and descending aorta repair. He underwent a thoracotomy, left heart bypass, repair of aorto-gastric fistula with primary stomach repair, and thoracic and abdominal aorta replacement with a Dacron graft. He made good recovery. His stent graft culture grew Candida albicans and vancomycin-resistant enterococcus.
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