SUMMARYA 62-year-old man presented with a right-sided hemichorea-hemiballismus secondary to underlying nonketotic hyperglycaemia. This condition is recognised to have a unique finding of unilateral basal ganglia lesion, which is hyperdense on CT and hyperintense on T1-weighted MRI. The clinical course of this condition is benign and has a good prognosis with early correction of the hyperglycaemia.
BACKGROUND
A 35-year-old woman with background of liver cirrhosis and portal hypertension secondary to chronic hepatitis C presented with complication of hypersplenism and thrombocytopenia. She developed severe menorrhagia requiring multiple blood transfusions. In addition, her interferon therapy was withheld owing to the underlying thrombocytopenia. Partial splenic embolisation was performed, which improved her platelet counts. Subsequently, the menorrhagia was resolved and her interferon therapy was restarted.
DESCRIPTIONWe present images of an infected and ruptured retroperitoneal teratoma in an 8-month-old baby girl, who presented with a 2-week history of lowgrade intermittent fever and failure to thrive. On arrival at the hospital, she was lethargic, febrile and mildly dehydrated. The abdomen was distended with a palpable mass occupying the central abdomen and the left lumbar region.The white cell count and C reactive protein were elevated with measurement of 20.9 mg/dL and 6.27 mg/dL, respectively, indicating an underlying infection. Both tumour markers, α-fetoprotein (7.56 ng/mL) and β-human chorionic gonadotropin (<1.2 mlU/mL), were within normal limits. A sonographic study of the abdomen showed multiple intra-abdominal collections. The subsequent urgent abdominal CT revealed a relatively large left retroperitoneal cystic lesion with fatty and calcified components within (figure 1). The anterior wall of the lesion was disrupted and irregularly associated with multiple intraperitoneal collections. The overall appearances were compatible with a ruptured retroperitoneal teratoma.The patient underwent an emergency laparotomy with excision of the ruptured retroperitoneal tumour and drainage of the interloop intraperitoneal collections (figure 2). The final histopathological result confirmed that the mass was a benign mature teratoma.Retroperitoneal mature teratoma is a rare subgroup of teratoma. Tumour rupture and infection are known but rare complications of this tumour, which may result in significant morbidity if left untreated. Imaging plays an important role in the diagnosis of a mature retroperitoneal teratoma.
Images in…Ultrasound is a low-risk modality, which is useful in paediatric population. However, the pitfalls of ultrasound are not capable of readily identifying calcifications, lack of anatomic resolution and operator dependent. 1 CT scan usually reveals complex appearance of the mature teratoma with internal debris, fat attenuation and distinct calcification. In addition, CT scan may depict the precise location of the tumour and the anatomic associations with the surrounding structures, which are important information for surgical planning.2 The disadvantages of CT are the risk of radiation, risk of intravenous contrast administration and relatively longer patient preparation.
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