Iranian Journal of Radiology
Volume:12 Issue: 3, Jul 2015

The identification of the dorsal sector of the liver and its detailed vascular anatomy is of primary importance for surgical practice and segmental transcatheter arterial chemoembolization.. This study aimed to investigate the feeding arteries of tumors in dorsal sector of the liver..Patients and Computed tomography (CT) and digital subtraction angiography (DSA) images of eleven patients with tumors of the dorsal sector of the liver were analyzed retrospectively. The hepatic arteries that probably supplied the tumors were observed in DSA images. The case number of each hepatic artery feeding to the tumors was calculated. A scoring method was used to estimate each hepatic artery contribution to the tumor stain in DSA images. The accumulative scores were employed to evaluate the blood supply of feeding arteries of the tumors.. The data of the study revealed that right posterior hepatic artery (RPHA) (n = 9), middle hepatic artery (MHA) (n = 8), left medial hepatic artery (LMHA) (n = 6), right anterior hepatic artery (RAHA) (n = 5), and caudate hepatic artery (CaHA) (n = 3) were the feeding arteries of the tumors in dorsal sector in eleven patients. The accumulative scores of RPHA, MHA, RAHA, and LMHA were 23, 17, 11, and 7 points, respectively (χ2 = 6.827，P = 0.078, Friedman test). The total scores of right hepatic artery (RHA) branches and left hepatic artery (LHA) branches were 51 and 11 points, respectively (Z = -2.764, P = 0.006, Wilcoxon rank test).. The RPHA, MHA, RAHA, and LMHA might be the main feeding arteries of the tumors in dorsal sector of the liver..

Breast cancer is one of the most encountered cancers in women. Detection and classification of the cancer into malignant or benign is one of the challenging fields of the pathology.. Our aim was to classify the mammogram data into normal and abnormal by ensemble classification method..Patients and In this method, we first extract texture features from cancerous and normal breasts, using the Gray-Level Co-occurrence Matrices (GLCM) method. To obtain better results, we select a region of breast with high probability of cancer occurrence before feature extraction. After features extraction, we use the maximum difference method to select the features that have predominant difference between normal and abnormal data sets. Six selected features served as the classifying tool for classification purpose by the proposed ensemble supervised algorithm. For classification, the data were first classified by three supervised classifiers, and then by simple voting policy, we finalized the classification process.. After classification with the ensemble supervised algorithm, the performance of the proposed method was evaluated by perfect test method, which gaves the sensitivity and specificity of 96.66% and 97.50%, respectively.. In this study, we proposed a new computer aided diagnostic tool for the detection and classification of breast cancer. The obtained results showed that the proposed method is more reliable in diagnostic to assist the radiologists in the detection of abnormal data and to improve the diagnostic accuracy..

The teeth with undiagnosed VRFs are likely to receive endodontic treatment or retreatment, leading to frustration and inappropriate endodontic therapies. Moreover, many cases of VRFs cannot be diagnosed definitively until the extraction of tooth.. This study aimed to assess the use of different voxel resolutions of two different cone beam computerized tomography (CBCT) units in the detection of vertical root fractures (VRFs) in vitro.. The study material comprised 74 extracted human mandibular single rooted premolar teeth without root fractures that had not undergone any root-canal treatment. Images were obtained by two different CBCT units. Four image sets were obtained as follows: 1) 3D Accuitomo 170, 4 × 4 cm field of view (FOV) (0.080 mm3); 2) 3D Accuitomo 170. 6 × 6 cm FOV (0.125 mm3); 3) NewTom 3G, 6˝ (0.16 mm3) and 4) NewTom 3G, 9˝ FOV (0.25 mm3). Kappa coefficients were calculated to assess both intra- and inter-observer agreements for each image set.. No significant differences were found among observers or voxel sizes, with high average Z (Az) results being reported for all groups. Both intra- and inter-observer agreement values were relatively better for 3D Accuitomo 170 images than the images from NewTom 3G. The highest Az and kappa values were obtained with 3D Accuitomo 170, 4 × 4 cm FOV (0.080 mm3) images.. No significant differences were found among observers or voxel sizes, with high Az results reported for all groups..

Desmoplastic fibroma (DF) is a rare and locally aggressive intraosseous tumor with unknown etiology. The mandible is the common site of involvement in the maxillofacial region. However, it is believed that DF can arise in any bone of the body. A wide age distribution has been reported for DF occurrence, extending from birth to the sixth decade of life, with a peak incidence at 10 to 19 years of age. In this study, diagnostic and therapeutic management of a 6-year-old girl with a desmoplastic fibroma of the inferior orbital rim and zygomatic buttress are discussed. Cone beam computed tomography (CBCT) revealed a mixed lesion in infraorbital rim, which had ill-defined borders and a straight thick bony septum inside the lesion. It also involved the zygomatic process of maxilla and zygomatic bone. According to radiologic concepts, this rare lesion may mimic fibro-osseous, benign and especially malignant lesions. Regarding different treatment plans, identification of this lesion is essential. Furthermore, presence of coarse and irregular or straight septa along with some imaging criteria for malignant lesions such as destruction of the cortex, periosteal reaction and soft tissue invasion would be helpful to differentiate this lesion from malignant and multilocular benign lesions..

Hepatic artery aneurysms are rare but potentially life threatening. We describe a novel case of a successful endovascular coil embolization of a huge hepatic artery aneurysm. A 67-year-old woman presented with recent abdominal pain that had begun from 2 weeks before referring to our hospital. Sonographic and computerized tomographic (CT) findings revealed a huge hepatic artery aneurysm with 95 mm × 83 mm diameter. The patient underwent an endovascular technique. In aortic angiography, the celiac artery orifice and superior mesenteric artery were so narrow, so sonography was used in order to determine the exact position of the catheter in the celiac artery orifice. The aneurysm was thrombosed using coil embolization. Pulsation of the aneurysm immediately disappeared. Huge hepatic artery aneurysm can be safely treated using coil embolization..

The use of computed tomography pulmonary angiography (CTPA) has been increased during the last decade.. We studied the adherence to current diagnostic recommendations for evaluation of pulmonary embolism in a teaching hospital of Tehran University of Medical Sciences..Patients and The registered medical records (Wells scores and serum D-dimer level) of all patients whose CTPA was performed with suspicion of pulmonary thromboembolism (PTE) were studied retrospectively. Modified Wells score of each patient was determined without being aware of the CTPA results. The patients were categorized to those with a high (likely) clinical probability (score > 4) and low (unlikely) clinical probability (score ≤ 4) of PTE.. During a 6-month period, 82 patients who underwent CTPA were included. The prevalence of PTE was 62.2% in the group of subjects with a likely clinical risk. In 45 (54.8%) of those patients whose CTPA was requested, the PTE was unlikely based on modified Wells criteria. In the clinically unlikely group, serum D-dimer assay was done in 15 out of 45 (33.3%), while it was inappropriately checked in 10 out of 37 (27.0%) with a clinically likely risk. General adherence rate to diagnostic algorithm of PTE was 43.9%.. There is still excessive unjustified concern of PTE in less trained physicians leading to excessive diagnostic work-up. Loyalty to the existing guideline for management of suspected PTE in educational hospitals and supervision of attending physicians could prevent overuse of CTPA..

In orthodontic science, diagnosis of facial skeletal type (class I, II, and III) is essential to make the correct treatment plan that is usually expensive and complicated. Sometimes results from analysis of lateral cephalometry radiographies are not enough to discriminate facial skeletal types. In this situation, knowledge about the relationship between the shape and size of the sella turcica and the type of facial skeletal class can help to make a more definitive decision for treatment plan.. The present study was designed to investigate this relationship in patients referred to a dental school in Iran..Patients and In this descriptive-analytical study, cephalometric radiographies of 90 candidates for orthodontic treatment (44 females and 46 males) with an age range of 14 - 26 years and equal distribution in terms of class I, class II, and class III facial skeletal classification were selected. The shape, length, diameter, and depth of the sella turcica were determined on the radiographs. Linear dimensions were assessed by one-way analysis of variance while the correlation between the dimensions and age was investigated using Pearson’s correlation coefficient.. Sella turcica had normal morphology in 24.4% of the patients while irregularity (notching) in the posterior part of the dorsum sella was observed in 15.6%, double contour of sellar floor in 5.6%, sella turcica bridge in 23.3%, oblique anterior wall in 20% and pyramidal shape of the dorsum sella in 11.1% of the subjects. In total, 46.7% of class I patients had a normal shape of sella turcica, 23.3% of class II patients had an oblique anterior wall and a pyramidal shape of the dorsum sella, and 43.3% of class III individuals had sella turcica bridge (the greatest values). Sella turcica length was significantly greater in class III patients compared to class II and class I (P < 0.0001). However, depth and diameter of sella turcica were similar in class I, class II, and class III patients. Furthermore, age was significantly correlated to the diameter of sella turcica as greater diameters were observed in older ages (P < 0.04).. A significant relationship exists between the type of facial skeletal classification and the shape of the sella turcica; as in class III patients, sella turcica bridge was reported with a higher frequency. Also, sella turcica had a significantly higher length in these patients than in those with class I and class II facial skeletal types..

Nasopharyngeal angiofibroma is a relatively uncommon vascular tumor affecting adolescent males and it characteristically originates in the posterior lateral wall of the nasopharynx. Primary extra-nasopharyngeal angiofibroma is very rare. Here, I present a case of angiofibroma of the parapharyngeal space in a 53-year-old woman with CT and sonographic findings..

We report a 73-year-old woman with primary left atrial rhabdomyosarcoma and its 1H MR spectroscopy (MRS) findings. The tumor showed a 2.8 cm sized lesion in the posteroinferior atrial wall on MRI. 1H MR spectra were acquired using a point-resolved spectroscopy (PRESS) sequence with electrocardiographic (ECG) gating and respiratory motion. The use of 1H-MRS allowed the quantification of triglyceride (TG) peak groups at 0.9 and 1.3 ppm, and unsaturated group of lipids at 2.1 ppm, creatine (Cr) at 3.0 ppm, and choline (Cho) at 3.2 ppm. The percentages of the myocardial metabolites based on water-peak in the interventricular septum were TG 18.4%, Cr 1.6%, Cho 3.3% and unsaturated group 4.0%, whereas the rhabdomyosarcoma showed TG 118.8%, unsaturated group 5.1%, Cr 1.3%, Cho 3.5% and the olefinic components of fatty acid at 5.4 ppm 24.5%. This case demonstrates that 1H-MRS is potentially useful to diagnose the rhabdomyosarcoma by quantifying the myocardial metabolites which are important biomarkers for heart function and diseases..

Twin reversed arterial perfusion (TRAP) sequence is a syndrome with poor prognosis, seen only in monochorionic monozygotic twin pregnancies. The incidence is one in 35.000 births and one in 100 monozygotic twin pregnancies. It is characterized with a recipient fetus exhibiting lethal anomalies including acardia and a pump fetus. Mortality is usually due to heart failure or premature labor caused by polyhydramnios of pump fetus. Herein, we report a case of TRAP sequence that emphasizes the importance of gray-scale and color Doppler imaging in the diagnosis and management of TRAP sequence..

Rupture of the intracranial aneurysms is associated with a high risk of bleeding and a high incidence of mortality if left untreated.

The aim of this study is to report our experience in managing intracranial aneurysms using coil embolization and to report the 6-month follow-up outcome of the patients.

From January 2010 to December 2012, a series of 90 nonrandomized consecutive patients (mean age: 44.6 ± 14.9 years) with intracranial aneurysms underwent endovascular coil embolization in our center. We excluded patients with dissecting, blood blister-like, or false aneurysms. All patients were evaluated by four-vessel angiography to determine the shape, size, number and location of the aneurysms. We recommended a six-month follow-up control angiography. However, only 38 of them participated in this follow-up imaging. The data were analyzed by chi-square, fisher exact and t-tests and alpha was considered lower than 5%.

Immediately after the procedure, the total occlusion was seen in 76 (86.4%), subtotal occlusion in six (6.8%), and partial occlusion in six patients (6.8%). There was no significant relationship between the aneurysm size, aneurysm neck size, and location of the aneurysm with total or subtotal occlusions. Eleven patients (12.5%) experienced some complication during the procedure including two tears, three focal neurological signs, three vision disturbances, and three bleedings in the aneurysm. Major complications were significantly higher in the posterior aneurysm compared to the anterior ones (55.6% versus 44.4% of the major complications; P value = 0.015). Among patients who underwent control angiography, 34 patients (89.4%) had no change, two (5.3%) had new growth and two (5.3%) had widening of the neck after 6 months follow-up. Although aneurysms that remained unchanged after six months follow-up angiography had total occlusion after the procedure, it was 50% for aneurysms that had any changes in 6 months follow-up angiography (P value = 0.01).

Coil embolization showed successful outcomes in the treatment of intracranial aneurysms with a low complication rate.

Cervical lymphadenopathy could be seen in several pathologic processes. An accurate differentiation between these conditions is of utmost importance to select an appropriate therapy and assess the prognosis. Gray scale and Doppler are appropriate sonographic techniques for evaluating internal and external features of lymph nodes. Although, various criteria have been proposed to differentiate metastatic lymph nodes from benign ones, the most valuable and specific sonographic features are still under dispute.

The present study was designed to determine valuable sonographic features for differentiating metastasis from benign nodes using gray scale and Doppler sonography.

A prospective diagnostic study was performed on 63 patients with head and neck squamous cell carcinoma (SCC) treated and referred to surgery clinic of Hazrat Rasoul Akram hospital from November 2010 to June 2012 with complaint of palpable cervical lymph node. All patients’ necks were scanned multidirectionally by gray-scale and Doppler techniques. After sonography, lymph nodes were biopsied and investigated to find out whether they were metastatic or reactive. Finally, demographic, sonographic and pathologic data were statistically analyzed by SPSS ver. 16 software using t-test, a nonparametric test and ROC analysis. Ninety five percent confidence interval was considered for all parameters.

The study included 41 males and 22 females with a mean age of 57.56 ± 13.79 years. The number of metastatic lymph nodes was 47, while the remaining 16 were reactive. There were significant differences in length (P = 0.037), width (P = 0.001), resistance index (P < 0.001), pulsatility index (P < 0.001) and systolic velocity (P < 0.001) of metastatic and reactive lymph nodes. Cut points for resistive and pulsatility indexes and systolic velocity were calculated as 0.695, 1.35 and 16.5, respectively. The most valuable factor for defining a lymph node as metastatic was circulation pattern with accuracy, sensitivity and specificity of 94%, 85% and 93%, respectively.

Gray scale sonography in combination with Doppler sonography could be a trustworthy technique in differentiating metastatic lymph nodes from reactive ones. Although, circulation pattern had a higher diagnostic accuracy in the present study, combination of sonographic characteristics could be more beneficial in differentiating metastatic cervical nodes from reactive ones.

Diffusion-weighted imaging (DWI) is a noninvasive method for investigation of tumor histological content. It has been applied for some musculoskeletal tumors and reported to be useful.

The aim of the present study was to prospectively evaluate the apparent diffusion coefficient (ADC) values of benign and malignant soft tissue tumors and to determine if ADC can help differentiate these tumors.

DWI was performed on 25 histologically proven soft tissue masses. It was obtained with a single-shot echo-planar imaging technique using a 1.5T magnetic resonance (MR) machine. The mean ADC values were calculated. We grouped soft tissue tumors as benign cystic, benign solid or mixed, malignant cystic and malignant solid or mixed tumors and compared mean ADC values between these groups.

There was only one patient with a malignant cystic tumor and was not included in the statistical analysis. The median ADC values of benign and malignant tumors were 2.31 ± 1.29 and 0.90 ± 0.70 (median ± interquartile range), respectively. The mean ADC values were different between benign and malignant tumors (P = 0.031). Benign cystic tumors had significantly higher ADC values than benign solid or mixed tumors and malignant solid or mixed tumors (p values were < 0.001 and 0.003, respectively). Malignant solid or mixed tumors had lower ADC values than benign solid or mixed tumors (P = 0.02).

Our preliminary results have shown that although there is some overlap between benign and malignant tumors, adding DWI, MR imaging to routine soft tissue tumor protocols may improve diagnostic accuracy.

Inferior vena cava filters (IVCF) are frequently used for preventing pulmonary embolism (PE) following deep venous thromboembolism.

The present study was designed to investigate whether IVCF could prevent or impede the occurrence of bone cement implantation syndrome (BCIS), since PE is considered as the central mechanism of BCIS.

Fifteen sheep were divided into three groups: bone cement free (BCF) group, cement implantation (CI) group and IVCF group. In all the groups, an osteotomy proximal to the greater trochanter of left femur was carried out. In BCF group, the femoral canal was not reamed out or packed with any bone cement. In CI and IVCF groups, the left femoral canals were packed with bone cement, to simulate the cementing procedures carried out in hip replacement. An OptEase® filter was placed and released in inferior vena cava, prior to packing cement in the femoral canal in IVCF group, while the IVCF was not released in the CI group. The BCF group was considered as control.

Systolic blood pressure (SBP), saturation of oxygen (SaO2) and partial pressure of carbon dioxide (PaCO2) declined significantly 10 min after the bone cement packing, in CI group, compared to those in BCF group. This was accompanied by a rise in the arterial pH. However, IVCF prevented those changes in the CI group. On ultrasonography, there were dotted echoes in right atrium in the CI group, after bone cement packing, while such echoes were hardly seen in the IVCF group.

This study demonstrates that IVCF could prevent BCIS effectively, and, as a corollary, suggests that PE represents the leading cause of the constellation of BCIS symptoms.

Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information.

In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients.

For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur.

Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant.

Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient patients during lunge exercise.

It has been established that presence of lean umbilical cord with reduced Wharton’s jelly in sonographic scans is a fetal marker for risk of small for gestational age at birth. With improvement of ultrasound techniques, more studies have been investigating the alterations of the umbilical cord on pregnancy outcomes.

To determine the reference ranges of the umbilical cord area during pregnancy and to find out the association between umbilical cord morphometry and fetal anthropometric measurements.

A cross sectional study was carried out on a study population of 278 low-risk pregnant women between 15 and 41 weeks of gestational age. Fetal anthropometric measurements including biparietal diameter, abdominal circumference, and femur length were calculated. The measurements of the cross-sectional area (CSA) and circumference of the umbilical cord, vein and arteries were done on an adjacent plane to the insertion of umbilical cord into the fetus’s abdomen. The mean and standard deviation of the CSA of the umbilical cord and the 5th, 10th, 50th, 90th, 95th percentiles of it were calculated for each gestational age. Pearson correlation coefficient was used to assess the correlation between the measures of the cord and fetal anthropometric measurements. Polynomial regression analysis was performed for curves.

The values of the CSA of the umbilical cord, umbilical vein and Wharton’s jelly (WJ) increase consistently until 30 weeks of gestation, after which they reach a plateau. There was a significant correlation between anthropometric measurements and umbilical cord measurements especially with the CSA of the umbilical cord, umbilical vein and WJ. The regression equation for the umbilical cord CSA according to gestational age up to 30 weeks was y = -0.2159 x2 + 23.828x-325.59 (R2 = 0.6334) and for the WJ area according to gestational age up to 30 weeks, it was y = -0.2124 x 2 +17.613x-221.66 (R2 = 0.4979).

Reference ranges for umbilical cord CSA have been generated. The CSA of the umbilical cord and other components of it increase as a function of gestational age. These measurements correlate with fetal size.

Diffusion tensor imaging (DTI) and its different scalar values such as fractional anisotropy (FA) have recently been used for evaluation of peri-tumoral white matter (WM) involvement to help define safer surgical excision margins.

The purpose of this study is to evaluate the possibility of defining diagnostic cut-off points for differentiating four major types of peri-tumoral WM involvement using FA.

DTI was performed in 12 patients with high presumption of having brain tumors, on a 1.5 T MRI scanner. DTI data was processed by MedINRIA software. Two-hundred region of interests (ROI) were evaluated: 100 in the lesion zone and the rest in the normal WM in the contralateral hemisphere. FA value related to each ROI was measured, and the percentage of FA decrement (ΔFAs%) was calculated.

Of the 100 ROIs on the lesion side, 74 were related to high-grade lesions, 23 to low-grade ones, and three to “gliosis”. There were 54 “infiltrated”, 22 “displaced”, 15 “disrupted”, and 9 “edematous” tracts. The major type of fiber involvement, both in low-grade and high-grade tumors was “infiltrated, whereas “edematous” fibers comprised the minority. ΔFA% was more than -35 for “displaced” and “edematous” fibers, and less than -35 for the majority of “disrupted” ones, but “infiltrated” fibers had scattered distribution. Mean ΔFA% was the least for “disrupted”, followed by “infiltrated”, “edematous” and “displaced” parts.

Introducing definite diagnostic cut-points was not possible, due to overlap. Based on the fact that “disruption” is the most aggressive process, a sensitivity analysis was carried out for “disrupted” fibers for several presumptive cut-off points.

The radiologic features of intralobar pulmonary sequestration (ILPS) have been describe and include the identification of a feeding systemic artery with venous drainage through pulmonary veins. Primary sequestration associated with typical hamartoma signs is really rare and has been described only once. We describe a patient with ILPS whose radiographic findings were unusual for two reasons. First, computed tomography (CT) demonstrated a bulky mass in the pulmonary sequestration. The size of lesion and histopathology made it an unusual presentation. Final histology study demonstrated pulmonary hamartoma with predominantly adipose and cartilage differentiation, which is an unusual complication originated from ILPS. Another sign also explains the second unusual feature, intracranial cholesteatoma, occurring concurrently with ILPS.

We reported CT of a case of giant organized hematoma originating from the inferior turbinate without any paranasal sinuses involvement, with an emphasis on different patterns of enhancement of the tumor on enhanced CT scans. This case was exceptional because of unusual location and difficulties in diagnosis. Moreover, organized hematoma of nasal cavity should be considered in the differential diagnosis of a unilateral, huge and easy bleeding lesion in the nasal cavity. A high clinical suspicion based on endoscopic and radiologic findings plays an important role to make an accurate diagnosis.

Pulmonary arteriovenous malformations (AVMs) are rare vascular malformations of the lung that usually led to a notable risk of serious and life-threatening complications. There is considerable debate about the best management of strategies for the group of patients with diffuse AVMs. Several therapeutic options have been reported for management of this abnormality among which coil embolization is currently the preferred ones. This report describes our experience with the use of coiling method for treatment of multiple AVMs in an adult patient.

Developmental venous anomaly (DVA) is a common lesion formerly known as venous angioma. DVAs drain normal brain parenchyma; however, parenchymal abnormalities surrounding DVAs have been reported. Unilateral putamen and caudate calcification in the drainage territory of DVAs has so far been reported in 7 cases, all with deep venous drainage. We present two additional cases of DVAs, one with superficial and the other one with deep venous drainage, associated with basal ganglia calcifications. We emphasize that DVAs should be in the differential diagnosis of unilateral basal ganglia calcifications.

We describe a patient with an asymptomatic complete unroofed coronary sinus (CS) syndrome associated with the CS stenosis in the absence of a persistent left superior vena cava (SVC) as identified on coronary computed tomography angiography. There was a large defect between the CS and the left atrium (i.e. a large left-to-right shunt), but an unusual combination of the absence of a persistent left SVC (i.e. no risk for brain abscess due to the absence of a right-to-left shunt) and the CS stenosis (i.e. a markedly reduced degree of a left-to-right shunt), resulting in an asymptomatic presentation.

Pseudoaneurysm happens when the artery wall is injured and the blood is contained by the surrounding tissues with eventual formation of a fibrous sac communicating with the artery. We report a case of a 39-year-old man with inferior epigastric artery (IEA) pseudoaneurysm after paracentesis. The pseudoaneurysm was diagnosed by Doppler ultrasound and treated by surgical intervention regarding the patient’s underlying comorbidity. IEA false aneurysm must be included in the differential diagnosis during investigation of the cause of any swelling after paracentesis. Cirrhotic patients may be more prone to this complication because of thin rectus muscle that could not confine the hematoma.

Multiple myeloma (MM) is characterized by progressive proliferation of malignant plasma cells, usually initiating in the bone marrow. MM can affect any organ; a total of 7 - 18% of patients with MM demonstrate extramedullary involvement at diagnosis. Non-secretory multiple myeloma (NSMM) is a rare variant that accounts for 1 - 5% of all cases of multiple myeloma. The disease is characterized by the absence of monoclonal gammopathy in serum and urine electrophoresis. Our case report highlights the diagnostic challenge of a case of NSMM with extensive extramedullary involvement in a young female patient who initially presented with right shoulder pain and bilateral breasts lumps. Skeletal survey showed multiple lytic bony lesions. The initial diagnosis was primary breast carcinoma with osseous metastases. No monoclonal gammopathy was found in the serum or urine electrophoresis. Bone marrow and breast biopsies revealed marked plasmacytosis. The diagnosis was delayed for a month in view of the lack of clinical suspicion of multiple myeloma in a young patient and scant biochemical expression of non-secretory type of multiple myeloma.

Primary neoplasms in the psoas muscle including schwannoma and soft tissue sarcoma with secondary cystic degeneration are rare entities. They are difficult to distinguish from psoas abscess purely based on radiological findings. Malignant fibrous histiocytoma (MFH) in the retroperitoneum is an uncommon entity in contrast to liposarcoma and leiomyosarcoma. Psoas abscess is a common infection in the retroperitoneum, especially in regions where tuberculosis is endemic. In the current case, the patient presented with gradually progressive lower abdominal pain and raised erythrocyte sedimentation rate (ESR), lymphocyte count and sputum positive for acid fast bacilli. There was a presence of previous history of skeletal tuberculosis. Imaging revealed well-defined multilocular cystic lesion involving the left psoas muscle which along with the clinical scenario suggested psoas abscess. However, post-operative biopsy showed the lesion to be a MFH with extensive cystic degeneration. To the best of our knowledge, cystic MFH mimicking an abscess has been previously reported only once in an oncology literature.

Adult midgut volvulus is a challenging diagnosis because of its low incidence and nonspecific symptoms. Diagnostic delay and long-term complaints are frequent in this clinical scenario. We reported a patient referred to our diagnostic imaging unit with intermittent abdominal pain, bloating and episodic vomiting for several years. He underwent barium gastrointestinal transit and abdominal ultrasound, which revealed severe gastric dilatation, food retention and slow transit until a depressed duodenojejunal flexure, with malrotation of the midgut and jejunal loops being located in the right upper quadrant. Computed tomography angiography was performed, showing rotation of the small intestine around the mesentery root, suggestive of midgut malrotation. In addition, an abnormal twisted disposition of superior mesenteric artery with corkscrew appearance was seen, shaping the pole-barber sign which was evident in volume rendering three-dimensional reconstructions. The patient underwent scheduled surgical treatment without any complication and had good outcome after hospital discharge and follow-up. Computed tomography plays an important role in evaluation of adult midgut volvulus. In addition, angiographic reconstructions can help us to assess the anatomic disposition of mesenteric vascular supply. Both of these assessments are useful in preoperative management.

Iniencephaly is a rare kind of neural tube defect that is classified into two types of iniencephaly apertus and iniencephaly clausus. This anomaly could be diagnosed prenatally by obstetric ultrasonography and terminated by therapeutic abortion; however, it could be undiagnosed until birth similar to our case due to the abnormal position of the fetus or lack of experience of the sonographer. Due to abnormality of the neural tube, which causes abnormal head and neck position, all these cases will die shortly after birth. We hereby introduce the photos and imaging findings of a case of an alive neonate with iniencephaly clausus.

Ureteral stent exchange is usually performed under both fluoroscopic and cystoscopic guidance. We experienced two cases with retrograde placement of metallic ureteral stent via urethra under fluoroscopic guidance. When patients with double-J ureteral stent (DJUS)have symptom and want to change DJUS to metallic stent, fluoroscopic guided transurethral placement of ureteral metallic stent is a good option as alternative of cystoscopic procedure or percutaneous procedure through percutaneous nephrostomy tract.