Perineural (Tarlov) cysts are usually incidental findings during magnetic resonance imaging (MRI) performed for low back pain. However, in a tertiary women's hospital, they may present as incidental findings on gynecological ultrasound imaging. Approximately 40 000 pelvic scans are performed annually in our department. Tarlov cysts were identified in three women between August 2007 and September 2008. In two patients (Cases 1 and 3), these cysts were initially misdiagnosed as hydrosalpinges on ultrasound examination, the latter having a differential diagnosis of an ovarian cyst. Two patients (Cases 1 and 2) were symptomatic, although Case 2 had symptoms that could not entirely be accounted for by the location of the cyst. Although asymptomatic, Case 3 underwent laparoscopy with a view to salpingectomy/cystectomy. In these patients, confirmation of Tarlov cysts was subsequently made on either computed tomography (CT) or MRI. All three patients were managed conservatively. Here we describe their clinical presentation, the appearance of the cysts on ultrasound imaging and on CT or MRI, and their eventual outcomes. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Polypoid endometriosis, in contrast to typical (nonpolypoid) CASE REPORTA 48-year-old nulliparous Chinese woman, who had undergone subtotal hysterectomy and left salpingooophorectomy for uterine adenomyosis and left ovarian endometriotic cyst 4 years previously, presented with heavy vaginal bleeding. Clinical examination showed an enlarged cervix. A cervical (Papanicolaou) smear was performed and was normal.Ultrasound examination showed a 4.0-cm heterogeneous cervical mass with internal vascularity and irregular polypoid extension into the left parametrium and causing left hydroureter, suspicious for cervical tumor (Figure 1a). Magnetic resonance imaging (MRI) of the pelvis revealed a 4.0 × 3.5 × 5.5-cm polypoid mass in the endocervical canal, isointense on T1-weighted imaging and heterogeneously hyperintense on T2-weighted imaging, with delayed contrast enhancement (Figure 1b). Polypoid extension into the left parametrium was noted, involving the distal left ureter and resulting in severe hydronephrosis with marked thinning of the left renal cortex. There was no invasion into the rectal lumen or urinary bladder.Examination under anesthesia showed a 3.5-cm mass in the cervical canal. Tru-cut needle biopsy of the mass showed focally ulcerated polypoid endocervical mucosa with dilated glands, granulation and thick-walled vessels but no evidence of malignancy. There was also induration of the parametria, although not involving the pelvic sidewalls. Cystoscopy and sigmoidoscopy were negative for malignancy. The patient was advised to undergo removal of the endocervical mass for symptom control.At laparotomy, an enlarged cervical stump was found with a polypoid mass in the cervical canal. There were dense fibrotic adhesions to the rectum, urinary bladder and left ureter, resulting in left hydronephrosis with pyuria. After adhesionolysis, the cervical stump was excised with the endocervical polypoid mass. Left ureterolysis and antegrade stenting were performed. The patient made an uneventful recovery and was discharged in good health.The excised cervix measured 5.0 × 3.5 × 5.5 cm and contained a 4.0 × 3.0 × 5.0-cm polypoid lesion with histological features of polypoid endometriosis. The cervical stroma was expanded by irregularly distributed islands of endometrial glands and stroma involving the entire thickness of the cervical wall, extending into the left parametrium. In some of these islands, the glands were cystically dilated and some contained intraluminal polypoid masses of endometrial tissue with features resembling endometrial polyps. The stromal component was transmural and displayed 'pseudoinfiltrative' growth but the cells showed very little mitotic activity and no features of invasion were identified. On histology, samples from around the left ureter showed dense fibrous tissue with florid endometriosis. The right ovary showed features of burnt-out endometriosis.
Endovascular therapy has been performed for chronic limb ischemia for nearly 50 years. Superficial femoral artery occlusions can be managed by the retrograde contralateral ("crossover"), antegrade ipsilateral, or retrograde popliteal ("facedown") approaches. The retrograde approach was initially fraught with limitations and served as a backup option. Refinements to this technique have made it an enticing option and possibly the first choice in selected patients. We herein describe an innovative modification of this method.
Paget's disease, otherwise known as osteitis deformans, is an unusual condition in the Oriental population. We report a case of Paget's disease in a Chinese woman, incidentally diagnosed on a bone scan. This was confirmed by clinical history, biochemistry and imaging findings using other modalities. Although bone scans are commonly performed to diagnose traumatic occult fractures and bone metastases, they can also be used to diagnose metabolic bone diseases, such as osteoporotic fractures, and to evaluate Paget's disease. It can also diagnose acute fractures secondary to renal osteodystrophy and osteomalacia.
Patient: Male, 62Final Diagnosis: Superior mesenteric artery anatomic variantSymptoms: Abdominal pain • diarrhea • transcient ischemic attacksMedication: —Clinical Procedure: CT of abdomen and pelvisSpecialty: SurgeryObjective:Congenital defects/diseasesBackground:Both spontaneous SMA dissection and anatomical variants of GIT vasculature are well known entities. We present a case initially diagnosed as an SMA dissection on CT, but upon detailed review of the imaging findings was considered to be incompletely fused ventral segmental arteries – a rare anatomic variant not well described before. This finding is clinically significant, as it can mimic a vascular dissection and such a wrong diagnosis will lead to unnecessary investigation and intervention.Case Report:A 62-year-old male patient presented with abdominal pain of uncertain etiology. The initial CT revealed an abnormal appearance of the superior mesenteric artery (SMA) which was diagnosed as SMA dissection. However, the appearance of this ‘dissection’ was unusual and there was a mismatch between the clinical presentation and radiological findings. The scan was reviewed and a 3D reconstruction of the abdominal aortal and visceral arteries was performed. The abnormal appearance of the SMA was deemed to be from a congenital anatomical variant. A review of the embryological origin of gut vasculature provides a likely explanation for this appearance.Conclusions:Ours is an unusual case of a developmental variant that has not been well described hitherto. Attention to the ancillary radiological signs and understanding the embryological origin of the abdominal vasculature is important to distinguish such variants from pathology.
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