1
|
Kwon K, Taub E, Dang B, Dobtsis J. Rare and common manifestation of musculoskeletal and sinonasal sarcoidosis: A case report. Radiol Case Rep 2024; 19:3579-3586. [PMID: 38957650 PMCID: PMC11217564 DOI: 10.1016/j.radcr.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 07/04/2024] Open
Abstract
Sarcoidosis is a systemic granulomatous disease that can affect multiple organ systems. Although many sarcoidosis patients are asymptomatic, the variable clinical progression of symptomatic patients and the nonspecific presentation make diagnosis difficult in certain cases. Musculoskeletal and sinonasal involvement of sarcoidosis are uncommon manifestations, and they are often only seen in patients with widespread disease. Diagnosis of osseous sarcoidosis, sarcoid arthropathy, and sarcoid rhinosinusitis are typically based on a combination of clinical history, radiological findings, and pathologic specimens. Although there are classic image findings, such as lacelike honeycomb appearance of small bones of the hands or hilar/mediastinal lymphadenopathy, sole reliance on image findings for the diagnosis of sarcoidosis is unreasonable as many findings are nonspecific. However, failure to include sarcoidosis in the differential diagnosis often leads to a delay in recognition of musculoskeletal or sinonasal involvement and results in ineffective treatment plan. Even in patients with biopsy-proven sarcoidosis, some image findings in isolation that may represent granulomatous infiltrates are disregarded as nonspecific without raising the possibility of sarcoidosis due to its rare occurrence. Here we discuss a case of multisystemic sarcoidosis in a 42-year-old female with a constellation of classic and rare findings of biopsy-proven sarcoidosis.
Collapse
Affiliation(s)
- Kihyun Kwon
- Harlem Hospital Center/Columbia University Irving Medical Center, 506 Lenox Ave, New York, NY 10037, USA
| | - Eric Taub
- Harlem Hospital Center/Columbia University Irving Medical Center, 506 Lenox Ave, New York, NY 10037, USA
| | - Brandon Dang
- Harlem Hospital Center/Columbia University Irving Medical Center, 506 Lenox Ave, New York, NY 10037, USA
| | - Joseph Dobtsis
- Harlem Hospital Center/Columbia University Irving Medical Center, 506 Lenox Ave, New York, NY 10037, USA
| |
Collapse
|
2
|
Shibuki S, Saida T, Hoshiai S, Ishiguro T, Sakai M, Amano T, Abe T, Yoshida M, Mori K, Nakajima T. Imaging findings in inflammatory disease of the genital organs. Jpn J Radiol 2024; 42:331-346. [PMID: 38165529 PMCID: PMC10980613 DOI: 10.1007/s11604-023-01518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging findings. The female section covers pelvic inflammatory disease (PID) primarily caused by sexually transmitted infections (STIs) that affect the uterus, fallopian tubes, and ovaries. Unusual causes such as actinomycosis and tuberculosis have also been explored. The male section delves into infections affecting the vas deferens, epididymis, testes, prostate, and seminal vesicles. Uncommon causes such as tuberculosis, and Zinner syndrome have also been discussed. In addition, this review highlights other conditions that mimic male genital tract infections such as vasculitis, IgG4-related diseases, and sarcoidosis. Accurate diagnosis and appropriate management of these inflammatory diseases are essential for preventing serious complications and infertility. Imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography play a crucial role in diagnosis. Understanding the diverse etiologies and imaging findings is vital for the effective management of inflammatory diseases of the genital organs.
Collapse
Affiliation(s)
- Saki Shibuki
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tsukasa Saida
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Sodai Hoshiai
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Toshitaka Ishiguro
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masafumi Sakai
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Taishi Amano
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tetsuya Abe
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Miki Yoshida
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kensaku Mori
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takahito Nakajima
- Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| |
Collapse
|
3
|
Ozer G, Ozcan HN, Gocmen R, Orhan D, Oguz B, Haliloglu M. Imaging Features of Pediatric Sarcoidosis. Radiographics 2024; 44:e230098. [PMID: 38096112 DOI: 10.1148/rg.230098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Sarcoidosis is a granulomatous inflammatory disease of uncertain cause. It occurs most commonly in young and middle-aged adults and less frequently in children; therefore, few data on pediatric sarcoidosis exist in the literature. The diagnosis and management of sarcoidosis remain challenging because of diverse and often nonspecific clinical and imaging findings. In addition, the clinical picture varies widely by age. Prepubertal and adolescent patients often present with adult-like pulmonary disease; however, early-onset sarcoidosis is typically characterized by the triad of arthritis, uveitis, and skin rash. Sarcoidosis is mostly a diagnosis of exclusion made by demonstrating noncaseating granulomas at histopathologic examination in patients with compatible clinical and radiologic findings. Although sarcoidosis often affects the lungs and thoracic lymph nodes, it can involve almost any organ in the body. The most common radiologic manifestation is pulmonary involvement, characterized by mediastinal and bilateral symmetric hilar lymphadenopathies with perilymphatic micronodules. Abdominal involvement is also common in children and often manifests as hepatomegaly, splenomegaly, and abdominal lymph node enlargement. Although neurosarcoidosis and cardiac sarcoidosis are rare, imaging is essential to the diagnosis of central nervous system and cardiac involvement because of the risky biopsy procedure and its low diagnostic yield due to focal involvement. Being familiar with the spectrum of imaging findings of sarcoidosis may aid in appropriate diagnosis and management. ©RSNA, 2023 Test Your Knowledge questions are available in the supplemental material.
Collapse
Affiliation(s)
- Gozde Ozer
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - H Nursun Ozcan
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - Rahsan Gocmen
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - Diclehan Orhan
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - Berna Oguz
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - Mithat Haliloglu
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| |
Collapse
|
4
|
Matias TB, Cordeiro RA, Duarte JA, de Jarry VM, Appenzeller S, Villarinho L, Reis F. Immune-Mediated Hypertrophic Pachymeningitis and its Mimickers: Magnetic Resonance Imaging Findings. Acad Radiol 2023; 30:2696-2706. [PMID: 36882352 DOI: 10.1016/j.acra.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 03/08/2023]
Abstract
Hypertrophic pachymeningitis (HP) is a rare and chronic inflammatory disorder presenting as localized or diffuse thickening of the dura mater. It can be idiopathic or an unusual manifestation of immune-mediated, infectious, and neoplastic conditions. Although some cases may remain asymptomatic, HP can lead to progressive headaches, cranial nerve palsies, hydrocephalus, and other neurological complications, which makes its recognition a fundamental step for prompt treatment. Regarding the diagnosis workup, enhanced MRI is the most useful imaging method to evaluate dural thickening. This article addresses the MR imaging patterns of immune-mediated HP, including immunoglobulin G4-related disease, neurosarcoidosis, granulomatosis with polyangiitis, rheumatoid pachymeningitis, and idiopathic HP. The main infectious and neoplastic mimicking entities are also discussed with reference to conventional and advanced MR sequences.
Collapse
Affiliation(s)
- Thiago Bezerra Matias
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rafael Alves Cordeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Juliana Avila Duarte
- Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Vinicius Menezes de Jarry
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Luciano Villarinho
- Department of Radiology, Rhode Island Medical Imaging, Brown University, USA
| | - Fabiano Reis
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
| |
Collapse
|
5
|
Samia AM, Fabara Pino S, Sun L. Sarcoidosis With Skeletal Involvement Masquerading as Metastatic Malignancy. Cureus 2023; 15:e44457. [PMID: 37791207 PMCID: PMC10544283 DOI: 10.7759/cureus.44457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 10/05/2023] Open
Abstract
Sarcoidosis is a systemic disorder characterized by noncaseating granuloma formation, which can affect any organ in the body; however, skeletal involvement is relatively uncommon. This case report presents a rare case of sarcoidosis primarily affecting the skeletal system in a 39-year-old man with a history of neurosarcoidosis. The patient presented with symptoms of nausea, vomiting, fatigue, weight loss, and lower back and pelvic pain, which were initially suspicious for malignancy. Computed tomography scans revealed lytic bone lesions and lymphadenopathy. However, a biopsy of a left inguinal lymph node confirmed necrotizing granulomatous lymphadenitis, which was consistent with necrotizing sarcoid granulomatosis - a rare variant of sarcoidosis. The patient was treated with systemic corticosteroids, which led to clinical improvement. The prognosis of sarcoidosis is generally good, with spontaneous remission occurring in up to two-thirds of patients; however, some patients may develop chronic and/or progressive disease. In particular, patients with a history of neurosarcoidosis may be at an increased risk for chronic or recurrent disease. This case highlights the importance of considering sarcoidosis in the differential diagnosis of patients presenting with nonspecific symptoms and lymphadenopathy, even in the absence of pulmonary involvement.
Collapse
Affiliation(s)
| | - Stephanie Fabara Pino
- Internal Medicine, University of Central Florida, School of Medicine/North Florida Hospital, Gainesville, USA
| | - Liang Sun
- Internal Medicine, University of Central Florida, School of Medicine/North Florida Hospital, Gainesville, USA
| |
Collapse
|
6
|
Sabri YY, Mahmoud NMM, Abd El–Mageed MR, Onsy MMM, Mohamed SA, Onsy MMM, Khairy MA. Mediastinal lymphadenopathy in sarcoidosis: Can diffusion MRI play a role in its evaluation? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-01000-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Sarcoidosis is a multisystem disease defined by non-caseous epithelioid cell granulomas that can affect virtually all organs. Lung, mediastinal and hilar lymph node involvement is prevalent, occurring in around 90% of the patients, and is responsible for the majority of the morbidity and mortality related to the disorder. Sarcoidosis is one of the differential diagnoses of the benign mediastinal lymphadenopathy. This research aimed to detect the diagnostic value of magnetic resonance imaging (MRI) diffusion in evaluation of mediastinal lymphadenopathy in sarcoid patients.
Results
This cross study involved a total of 30 patients known to have sarcoidosis: 6 males and 24 females aged between 18 and 50 years (with a mean age 38.97 ± 8.67); all of them presented with mediastinal lymphadenopathy. For all patients, each lymph node group was evaluated for the average size and average ADC value. The mean ADC measured was (1.76 ± 0.28) × 10−3 mm2/s. Eight patients showed concurrent activity with poor response to the treatment, and they showed different ADC values with one of them showing low ADC with pattern of diffusion restriction displaying mean ADC value of 1.28 × 10−3 mm2/s.
Conclusions
Diffusion-weighted MRI is an established imaging technique that could be utilized to evaluate mediastinal lymphadenopathy in sarcoidosis as the benign counterpart of mediastinal lymphadenopathy.
Collapse
|
7
|
Müller ML, Poller W, Skurk C, Poddubnyy D, Siegmund B, Schneider T, Landmesser U, Heidecker B. Cardiac sarcoidosis presenting with complex conduction abnormalities as the first manifestation of widespread systemic sarcoidosis: a case report. Eur Heart J Case Rep 2023; 7:ytad017. [PMID: 36733684 PMCID: PMC9887667 DOI: 10.1093/ehjcr/ytad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/11/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Background Sarcoidosis is a granulomatous multi-organ disease of unknown aetiology. Despite being relatively rare, cardiac sarcoidosis constitutes a very important manifestation of sarcoidosis, as its symptoms regularly precede or occur in isolation of more prevalent ones, and as it is the main driver of mortality in systemic sarcoidosis. Case summary We present the case of a 37-year-old woman, in which clinically isolated cardiac sarcoidosis revealed widespread systemic sarcoidosis. Apart from constitutional symptoms and strong recurrent dizziness (i.e. near-syncopes), which persisted for multiple years already, our patient initially presented with complex conduction abnormalities, including a right bundle branch block, left anterior hemi-block, and atrioventricular block °1. Following inconclusive endomyocardial biopsies, performed due to detection of focal septal scarring on cardiac magnetic resonance imaging, an 18F-FDG-PET-CT, performed upon admission to our clinic, showed distinct hypermetabolic lesions indicative of active inflammation in various organs and raised suspicion of systemic sarcoidosis. Eventually, histopathological evidence of non-caseating granulomas in affected lymph nodes, extracted by bronchoscopy, confirmed the diagnosis of systemic sarcoidosis after reasonable exclusion of other granulomatous diseases. Immediate initiation of long-term immunosuppressive therapy led to almost complete remission, as monitored by consequential 18F-FDG-PET-CT scans. Discussion Unexplained complex conduction abnormalities in young patients may be a sign of sarcoidosis, even in isolation of more prevalent symptoms. Correct interpretation and prompt initiation of a structured interdisciplinary diagnostic workup, including 18F-FDG-PET-CT as the imaging modality of choice, are essential to initiate specific treatment and obviate the major risk of mortality resulting from cardiac sarcoidosis.
Collapse
Affiliation(s)
- Maximilian L Müller
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wolfgang Poller
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Britta Siegmund
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Thomas Schneider
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Bettina Heidecker
- Corresponding author. Tel: +49 30 450 513 756, Fax: +49 30 450 7 513 984,
| |
Collapse
|
8
|
Chareonthaitawee P, Gutberlet M. Clinical Utilization of Multimodality Imaging for Myocarditis and Cardiac Sarcoidosis. Circ Cardiovasc Imaging 2023; 16:e014091. [PMID: 36649452 DOI: 10.1161/circimaging.122.014091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Myocarditis is defined as inflammation of the myocardium according to clinical, histological, biochemical, immunohistochemical, or imaging findings. Inflammation can be categorized histologically by cell type or pattern, and many causes have been implicated, including infectious, most commonly viral, systemic autoimmune diseases, vaccine-associated processes, environmental factors, toxins, and hypersensitivity to drugs. Sarcoid myocarditis is increasingly recognized as an important cause of cardiomyopathy and has important diagnostic, prognostic, and therapeutic implications in patients with systemic sarcoidosis. The clinical presentation of myocarditis may include an asymptomatic, subacute, acute, fulminant, or chronic course and may have focal or diffuse involvement of the myocardium depending on the cause and time point of the disease. For most causes of myocarditis except sarcoidosis, myocardial biopsy is the gold standard but is limited due to risk, cost, availability, and variable sensitivity. Diagnostic criteria have been established for both myocarditis and cardiac sarcoidosis and include clinical and imaging findings particularly the use of cardiac magnetic resonance and positron emission tomography. Beyond diagnosis, imaging findings may also provide prognostic value. This case-based review focuses on the current state of multimodality imaging for the diagnosis and management of myocarditis and cardiac sarcoidosis, highlighting multimodality imaging approaches with practical clinical vignettes, with a discussion of knowledge gaps and future directions.
Collapse
|
9
|
Cao L, Wu H, Liu Y. Value of CT spectral imaging in the differential diagnosis of sarcoidosis and Hodgkin's lymphoma based on mediastinal enlarged lymph node: A STARD compliant article. Medicine (Baltimore) 2022; 101:e31502. [PMID: 36451380 PMCID: PMC9704888 DOI: 10.1097/md.0000000000031502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To investigate the imaging characteristics of sarcoidosis and Hodgkin's lymphoma based on mediastinal enlarged lymph node using spectral CT and evaluate whether the quantitative information can improve the differential diagnosis of these diseases. This retrospective study was approved by the institutional review board, and written informed consent was obtained from all patients. Overall, 21 patients with sarcoidosis and 39 patients with Hodgkin's lymphoma were examined with CT spectral imaging during the arterial phase (AP) and venous phase (VP). The CT values on 40 to 140 keV monochromatic images and iodine (water) concentrations of enlarged lymph nodes were obtained in AP and VP. Iodine concentrations (ICs) were normalized to the iodine concentration in the aorta. The differences in normalized iodine concentrations (NICs) and hounsfield units (HU) curve slop (λHU) were calculated. Anatomical distribution of mediastinal lymph nodes and morphologic features were also compared. Receiver operating characteristic curves were generated to help establish threshold values for the parameters required for the significant differentiation of sarcoidosis from lymphomas. The CT values on 40 to 100 keV monochromatic images in AP and 40 to 50 keV in VP were higher in sarcoidosis than those in Hodgkin's lymphoma, the differences were statistically significant (P < .05); NICs during the AP and λHU during the AP (VP) in patients with sarcoidosis differed significantly from those in patients with Hodgkin's lymphoma. Receiver operating characteristic curves analysis showed that the monochromatic CT value on 40 keV in AP had the highest sensitivity (71.4%) and specificity (100%) in differentiating sarcoidosis from Hodgkin's lymphoma. The anatomic distribution, coalescence, calcification, compression, enhancement pattern and enhancement degree of the mediastinal enlarged lymph node differed significantly between the groups (P < .05). The combination of monochromatic CT value, NICs and λHU had higher sensitivity and specificity than did those of conventional qualitative CT image analysis during the combined phases. CT spectral imaging has promising potential for the diagnostic differentiation of Hodgkin's lymphomas and sarcoidosis. The monochromatic CT value, iodine content and λHU could be valuable parameters for differentiating Hodgkin's lymphomas and sarcoidosis based on mediastinal enlarged lymph node.
Collapse
Affiliation(s)
- Lixiu Cao
- Department of ECT, Tangshan People’s Hospital, Tangshan, Hebei Province, China
| | - Huijing Wu
- Department of ECT, Tangshan People’s Hospital, Tangshan, Hebei Province, China
| | - Yongliang Liu
- Department of Neurosurgery, Tangshan People’s Hospital, Tangshan, Hebei Province, China
- * Correspondence: Yongliang Liu, Department of Neurosurgery, Tangshan People’s Hospital, No. 65 Shengli Road, Lunan District, Tangshan 063000, Hebei province, China (e-mail: )
| |
Collapse
|
10
|
Paydar A, Jenner ZB, Simkins TJ, Chang YM, Hacein-Bey L, Ozturk A, Birkeland A, Assadsangabi R, Raslan O, Shadmani G, Apperson M, Ivanovic V. Autoimmune disease of head and neck, imaging, and clinical review. Neuroradiol J 2022; 35:545-562. [PMID: 35603923 PMCID: PMC9513912 DOI: 10.1177/19714009221100983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Autoimmune disease of the head and neck (H&N) could be primary or secondary to systemic diseases, medications, or malignancies. Immune-mediated diseases of the H&N are not common in daily practice of radiologists; the diagnosis is frequently delayed because of the non-specific initial presentation and lack of familiarity with some of the specific imaging and clinical features. In this review, we aim to provide a practical diagnostic approach based on the specific radiological findings for each disease. We hope that our review will help radiologists expand their understanding of the spectrum of the discussed disease entities, help them narrow the differential diagnosis, and avoid unnecessary tissue biopsy when appropriate based on the specific clinical scenarios.
Collapse
Affiliation(s)
| | - Zachary B Jenner
- University of California Davis
Medical Center, Sacramento, CA, USA
| | - Tyrell J Simkins
- Department of Neurology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Yu-Ming Chang
- Department of Radiology, Beth Israel Deaconess Medical
Center, Boston, MA, USA
| | | | - Arzu Ozturk
- Department of Medicine, UC Davis, Sacramento, CA, USA
| | | | - Reza Assadsangabi
- Department of Radiology, University of Southern
California, Los Angeles, CA, USA
| | - Osama Raslan
- Department of Radiology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Ghazal Shadmani
- School of Medicine in Saint Louis, Washington University, St Louis, MO, USA
| | - Michelle Apperson
- Department of Neurology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Department of Radiology, Medical College of
Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
11
|
Theodorou DJ, Theodorou SJ, Saba L, Kakitsubata Y. Skeletal Muscle Disease: Imaging Findings Simplified. Cureus 2022; 14:e29655. [DOI: 10.7759/cureus.29655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/05/2022] Open
|
12
|
Imaging More than Skin-Deep: Radiologic and Dermatologic Presentations of Systemic Disorders. Diagnostics (Basel) 2022; 12:diagnostics12082011. [PMID: 36010360 PMCID: PMC9407377 DOI: 10.3390/diagnostics12082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Cutaneous manifestations of systemic diseases are diverse and sometimes precede more serious diseases and symptomatology. Similarly, radiologic imaging plays a key role in early diagnosis and determination of the extent of systemic involvement. Simultaneous awareness of skin and imaging manifestations can help the radiologist to narrow down differential diagnosis even if imaging findings are nonspecific. Aims: To improve diagnostic accuracy and patient care, it is important that clinicians and radiologists be familiar with both cutaneous and radiologic features of various systemic disorders. This article reviews cutaneous manifestations and imaging findings of commonly encountered systemic diseases. Conclusions: Familiarity with the most disease-specific skin lesions help the radiologist pinpoint a specific diagnosis and consequently, in preventing unnecessary invasive workups and contributing to improved patient care.
Collapse
|
13
|
Shahnam A, Sayer R, Herbst U, Sharma R, Yoon WH, Dinihan T, Gao B. Growing Teratoma Syndrome in the Setting of Sarcoidosis: A Case Report and Literature Review. Curr Oncol 2022; 29:4148-4154. [PMID: 35735440 PMCID: PMC9221652 DOI: 10.3390/curroncol29060331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Growing teratoma syndrome (GTS) is rare and can mimic disease recurrence in patients with a history of immature teratoma. Benign hypermetabolic lymphadenopathy found on staging and surveillance computed tomography (CT) and positron emission tomography (PET) may lead to the presumption of metastatic malignancy. We report a case of a 38 year old with mixed mature and immature teratomas who developed new peritoneal masses after adjuvant chemotherapy despite a normalization of tumor markers. In addition to low FDG uptake observed in these peritoneal masses, a PET scan showed hypermetabolic lymphadenopathy and pulmonary and spleen lesions suggesting widespread metastases. Subsequent surgical resection confirmed a mixed pathology with GTS and sarcoidosis. We reviewed the current literature evidence of GTS and sarcoidosis as a benign cause of lymphadenopathy in cancer patients. We emphasize the importance of a tissue diagnosis before instituting therapy for presumed cancer recurrence to avoid potentially fatal diagnostic traps and management errors. A multiple disciplinary team approach is imperative in managing patients with suspected recurrent immature teratomas.
Collapse
Affiliation(s)
- Adel Shahnam
- Medical Oncology Department, Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia;
- Correspondence: (A.S.); (B.G.); Tel.: +61-288-905-200 (B.G.)
| | - Robyn Sayer
- Gynecological Oncology Department, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia;
| | - Unine Herbst
- Gynaecological Oncology Department, Westmead Hospital, Sydney, NSW 2145, Australia;
| | - Raghwa Sharma
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW 2145, Australia;
| | - Won-hee Yoon
- Medical Oncology Department, Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia;
| | - Tim Dinihan
- Respiratory and Thoracic Medicine, Blacktown Hospital, Sydney, NSW 2148, Australia;
| | - Bo Gao
- Medical Oncology Department, Blacktown and Westmead Hospitals, Sydney, NSW 2145, Australia;
- Correspondence: (A.S.); (B.G.); Tel.: +61-288-905-200 (B.G.)
| |
Collapse
|
14
|
Greggianin C, Yasufuku K, Tong LC, Dhillon G, Digby GC. Middle Mediastinal Mass Compressing the Pulmonary Trunk in a Patient With a History of Breast Cancer. Chest 2022; 161:e265-e272. [DOI: 10.1016/j.chest.2021.12.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/13/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022] Open
|
15
|
Dionisio RG, Hanna S, Smitaman E. Acute Nontraumatic Wrist Pain Due to Osseous Sarcoidosis. Am J Med 2022; 135:334-336. [PMID: 34560031 DOI: 10.1016/j.amjmed.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Robert G Dionisio
- Department of Radiology, Santa Barbara Cottage Hospital, Santa Barbara, Calif.
| | - Shirley Hanna
- Department of Radiology, Musculoskeletal Radiology, Staten Island Northwell Health, Staten Island, NY
| | - Edward Smitaman
- Department of Radiology, Musculoskeletal Radiology, University of California, San Diego, La Jolla
| |
Collapse
|
16
|
Chalard F, Hermann AL, Elmaleh-Bergès M, Ducou le Pointe H. Imaging of parotid anomalies in infants and children. Insights Imaging 2022; 13:27. [PMID: 35201515 PMCID: PMC8873326 DOI: 10.1186/s13244-022-01166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022] Open
Abstract
A wide spectrum of disorders involves the parotid glands, in infancy and childhood. Acute or chronic inflammatory/infectious diseases are predominant. The first branchial cleft anomalies are congenital lesions that typically manifest during childhood. Tumor lesions are more likely to be benign, with infantile hemangioma the most common in infancy and pleomorphic adenoma the most frequent in childhood. Malignant tumors are uncommon, with mucoepidermoid carcinoma the least rare. Infiltrative parotid diseases are rare and have some pediatric clinical specificities. These common and uncommon disorders of parotid glands during childhood and their imaging characteristics are reviewed.
Collapse
Affiliation(s)
- François Chalard
- Department of Pediatric Radiology, Hôpital Armand Trousseau, 26, Avenue du Dr. Arnold Netter, 75012, Paris, France.
| | - Anne-Laure Hermann
- Department of Pediatric Radiology, Hôpital Armand Trousseau, 26, Avenue du Dr. Arnold Netter, 75012, Paris, France
| | | | - Hubert Ducou le Pointe
- Department of Pediatric Radiology, Hôpital Armand Trousseau, 26, Avenue du Dr. Arnold Netter, 75012, Paris, France
| |
Collapse
|
17
|
Walker E, Karthik S, Chengot P, Vaidyanathan S. It's not all about the thyroid! Extrinsic and unusual pathology affecting the thyroid gland: A pictorial review. Clin Imaging 2022; 85:29-42. [DOI: 10.1016/j.clinimag.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/11/2022]
|
18
|
Vertebral sarcoidosis with associated Darier-Roussy disease manifesting as acute back pain. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
19
|
Learned BN, Nasiri-Ahad W, Davis JE, Desai AG, Chang A. Rare Association between Sarcoidosis and Smoldering Multiple Myeloma: A Case Report. Cancer Invest 2021; 39:880-884. [PMID: 34606401 DOI: 10.1080/07357907.2021.1988633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While several case reports suggest an association between sarcoidosis and multiple myeloma (MM), few cases involve smoldering MM. We report a case of sarcoidosis and smoldering MM discovered simultaneously in a patient admitted for hypercalcemia. Initial tests raised suspicion for sarcoidosis and MM, prompting invasive testing. Surgical lung biopsy revealed necrotizing granulomas, which could represent sarcoidosis in the appropriate setting. Thus, sarcoidosis was diagnosed following a negative infectious workup. Bone marrow biopsy revealed 13% plasma cells leading to subsequent diagnosis of smoldering MM. This case demonstrates the challenge of determining disease activity when other causes of CRAB symptoms are present.
Collapse
Affiliation(s)
- Brooke N Learned
- Department of Medicine, Stony Brook Medicine, Stony Brook, New York, USA
| | - Wazhma Nasiri-Ahad
- Division of Endocrinology and Metabolism, Stony Brook Medicine, Stony Brook, New York, USA
| | - James E Davis
- Department of Pathology, Stony Brook Medicine, Stony Brook, New York, USA
| | - Alpa G Desai
- Division of Pulmonary, Critical Care, and Sleep Medicine, Stony Brook Medicine, Stony Brook, New York, USA
| | - Alan Chang
- Division of Endocrinology and Metabolism, Stony Brook Medicine, Stony Brook, New York, USA
| |
Collapse
|
20
|
Houser M, Khati NJ. The Rare, the Odd, and the Atypical: A Pictorial Essay of Testicular and Paratesticular Diseases. Ultrasound Q 2021; 37:207-218. [PMID: 34478418 DOI: 10.1097/ruq.0000000000000570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Understanding a variety of scrotal diseases is essential to developing an accurate differential diagnosis and is critical in providing optimal patient care. Ultrasound is the imaging modality of choice when evaluating for scrotal pathology, with the major purpose of locating such pathology to either the testis, or epididymis, or other intrascrotal structures, as well as characterizing lesions as solid or cystic. It is generally assumed that most solid intratesticular masses are more likely malignant, whereas most extratesticular ones are benign, although some exceptions to that rule exist. This pictorial essay will focus on rare and less commonly encountered benign and malignant testicular and paratesticular pathologies, which may pose a diagnostic dilemma for interpreting radiologists and treating physicians. Knowledge of their imaging characteristics will help narrow the differential diagnosis and assist in proper patient management and care.
Collapse
Affiliation(s)
| | - Nadia J Khati
- Abdominal Imaging Section, The George Washington University Hospital, Washington, DC
| |
Collapse
|
21
|
Herrán de la Gala D, Sáenz Aldea M, Azcona Sáenz J. [Skeletal sarcoidosis as an atypical presentation of the disease]. Semergen 2021; 47:e62-e64. [PMID: 34404585 DOI: 10.1016/j.semerg.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Affiliation(s)
- D Herrán de la Gala
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - M Sáenz Aldea
- Médico Interno Residente en Medicina Familiar y Comunitaria, Centro de Salud Dávila, Santander, Cantabria, España
| | - J Azcona Sáenz
- Servicio de Radiodiagnóstico, Hospital Universitario de Donostia, San Sebastián, Guipúzcoa, España
| |
Collapse
|
22
|
Jo N, Shroff GS, Wu CC, Ahuja J, Strange CD, Marom EM, Truong MT. Imaging of the mediastinum: Mimics of malignancy. Semin Diagn Pathol 2021; 39:92-98. [PMID: 34167848 DOI: 10.1053/j.semdp.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 11/11/2022]
Abstract
In the imaging of the mediastinum, benign lesions mimicking malignancy constitute potential pitfalls in interpretation. Localization and characteristic imaging features are key to narrow the differential diagnosis and avoid potential pitfalls in interpretation. Based on certain anatomic landmarks, the mediastinal compartment model enables accurate localization. Depending on the anatomic origin, mediastinal lesions can have various etiologies. The anatomic location and structures contained within each mediastinal compartment are helpful in generating the differential diagnoses. These structures include thyroid, thymus, parathyroid, lymph nodes, pericardium, embryogenic remnants, and parts of the enteric tracts, vessels, and nerves. Imaging characteristics on computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET/CT), including attenuation (fluid, fat, calcification), contrast enhancement, and metabolic activity, aid in narrowing the differential diagnoses. Understanding the roles and limitations of various imaging modalities is helpful in the evaluation of mediastinal masses. In this review, we present potential pitfalls in the imaging of mediastinal lesions with emphasis on the mimics of malignancy.
Collapse
Affiliation(s)
- Nahyun Jo
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Girish S Shroff
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Carol C Wu
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Jitesh Ahuja
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Chad D Strange
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008
| | - Edith M Marom
- Chaim Sheba Medical Center, Department of Radiology, Tel Hashomer, Israel
| | - Mylene T Truong
- University of Texas M.D. Anderson Cancer Center, Department of Thoracic Imaging, 1515 Holcombe Blvd. Unit 1478, Houston, TX 77030-4008.
| |
Collapse
|
23
|
Sarvesvaran M, Chandramohan M. Skeletal sarcoidosis; an uncommon mimic of metastatic disease. BMJ Case Rep 2021; 14:14/4/e238493. [PMID: 33811092 PMCID: PMC8023624 DOI: 10.1136/bcr-2020-238493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 66-year-old man with pulmonary sarcoidosis was referred to the urology team for assessment of troublesome lower urinary tract symptoms. An elevated blood serum prostate-specific antigen raised concern for prostate cancer. An MRI of the prostate demonstrated a potentially aggressive prostate lesion, along with low T1 signal skeletal lesions, suggestive of metastatic disease. Subsequent bone scan and MRI whole spine demonstrated further skeletal lesions. In cases of known prostate cancer, sometimes a presumptive diagnosis of skeletal metastases is made without histological diagnosis from the skeletal lesions. However, there were certain factors in this case whereby skeletal biopsy was deemed prudent prior to further therapy. Factors included atypical MRI signal characteristics for metastatic disease, absence of a positive tissue diagnosis from the prostate and the clinical background of sarcoidosis. The biopsy confirmed skeletal sarcoid rather than metastatic disease, thereby avoiding inappropriate and potentially toxic treatment for the patient.
Collapse
|
24
|
Doan T, Nguyen NT, He J, Nguyen QD. Sarcoidosis Presenting in Breast Imaging Clinic With Unilateral Axillary Lymphadenopathy. Cureus 2021; 13:e13245. [PMID: 33728193 PMCID: PMC7948305 DOI: 10.7759/cureus.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sarcoidosis is an idiopathic systemic granulomatous disease that presents with noncaseating granulomas most commonly affecting the lungs and mediastinal lymph nodes. Patients often have nonspecific symptoms, including cough of unknown cause, fever, shortness of breath, fatigue, or weight loss. The diagnosis for sarcoidosis is relatively challenging in the sole presence of swollen lymph nodes and the absence of the aforementioned symptoms. We present a case of unilateral axillary lymphadenopathy found on routine mammography; ultimately proven to be an atypical symptom of sarcoidosis. Our goal is to highlight radiologic features that help distinguish sarcoidosis from potential malignancy.
Collapse
Affiliation(s)
- Thao Doan
- School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Nga T Nguyen
- Radiology, University of Texas Medical Branch, Galveston, USA
| | - Jing He
- Pathology, University of Texas Medical Branch, Galveston, USA
| | - Quan D Nguyen
- Radiology, University of Texas Medical Branch, Galveston, USA
| |
Collapse
|
25
|
Spectrum of [ 18F]FDG-PET/CT Findings in Benign Lymph Node Pathology. Mol Imaging Biol 2021; 23:469-480. [PMID: 33512649 PMCID: PMC8277624 DOI: 10.1007/s11307-020-01576-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/18/2023]
Abstract
Diffuse lymphadenopathy has a long differential diagnosis that includes both malignant and benign causes. As part of the lymphadenopathy work-up, many patients undergo [18F]FDG-PET/CT for purposes of ruling out malignancy. FDG-avid lymph nodes, however, are not specific for malignancy. This review will illustrate the spectrum of nodal findings on FDG-PET/CT with correlation to other cross-sectional imaging and clinical history in patients with representative infectious, inflammatory, and benign lymphoproliferative disorders. These findings are important for the nuclear medicine radiologist to understand, as they can represent common pitfalls in the work-up of lymphadenopathy. While FDG-PET/CT may be limited in ascertaining a definitive diagnosis in a disease process as the cause of lymphadenopathy, it can help to narrow this differential and rule out certain diseases in the correct clinical context.
Collapse
|
26
|
Ozawa Y, Hiroshima M, Maki H, Hara M, Shibamoto Y. Imaging findings of lesions in the middle and posterior mediastinum. Jpn J Radiol 2021; 39:15-31. [PMID: 32740793 DOI: 10.1007/s11604-020-01025-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
Lesions in the middle and posterior mediastinum are relatively rare, but there are some useful radiological clues that can be used to diagnose them precisely. It is useful to determine the affected mediastinal compartment and the locations of the main thoracic nerves on medical images for diagnosing such mediastinal lesions. Neurogenic tumors can occur in the middle mediastinum, although they generally arise as posterior mediastinal tumors. Based on the above considerations, we review various characteristic imaging findings of middle and posterior mediastinal lesions, and their differential diagnoses.
Collapse
Affiliation(s)
- Yoshiyuki Ozawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Marehiko Hiroshima
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hiroyuki Maki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8601, Japan
| | - Masaki Hara
- Department of Radiology, Nagoya City West Medical Center, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8601, Japan
| |
Collapse
|
27
|
Álvarez Vega P, Apilánez Tomás J, Jiménez Jurado I, Domínguez Iglesias F, López Suárez RY, Jiménez Jurado A. Pulmonary infiltrates and cough. An unexpected end. Rev Clin Esp 2020; 220:597-602. [PMID: 32115193 DOI: 10.1016/j.rce.2019.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 10/24/2022]
Affiliation(s)
- P Álvarez Vega
- Servicio de Neumología, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España.
| | - J Apilánez Tomás
- Servicio de Neumología, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| | - I Jiménez Jurado
- Servicio de Neumología, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| | - F Domínguez Iglesias
- Servicio de Anatomía Patológica, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| | - R Y López Suárez
- Servicio de Radiodiagnóstico, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| | - A Jiménez Jurado
- Servicio de Aparato Digestivo, Hospital Universitario de Cabueñes, Cabueñes, Gijón, España
| |
Collapse
|
28
|
Pulmonary infiltrates and cough. An unexpected end. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
29
|
Jameson A, Revels J, Wang LL, Wang DT, Wang SS. Sarcoidosis, the master mimicker. Curr Probl Diagn Radiol 2020; 51:60-72. [PMID: 33308891 DOI: 10.1067/j.cpradiol.2020.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/30/2020] [Accepted: 10/16/2020] [Indexed: 01/02/2023]
Abstract
Sarcoidosis is an idiopathic multisystem disorder characterized by noncaseating granulomas. The article focuses on the typical imaging manifestations of sarcoid and the common differentials that need to be included when appropriate. Mistaking a sarcoid-mimicking disease for sarcoid can result in increased patient morbidity and mortality. The pulmonary system is the most common system involved and is typically the best understood by the radiologist, however a deeper knowledge of the pulmonary findings and features of sarcoid in other organ systems is critical. There is a myriad of sarcoid imaging manifestations that can involve every organ system. Often a confidant diagnosis of sarcoid can be made, however a broad differential may need to be considered- differential diagnoses include primary neoplasm, metastatic disease, infectious, and inflammatory etiologies. Radiologist familiarity with the multimodality multisystem imaging findings of sarcoid can help guide clinical management and optimize patient care.
Collapse
Affiliation(s)
- Austin Jameson
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Lily L Wang
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - David T Wang
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| |
Collapse
|
30
|
Vora Z, Hemachandran N, Sharma S. Imaging of Lacrimal Gland Pathologies: A Radiological Pattern-Based Approach. Curr Probl Diagn Radiol 2020; 50:738-748. [PMID: 33077289 DOI: 10.1067/j.cpradiol.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
Despite their unassuming size, lacrimal glands can have a variety of pathologies affecting them which often poses a diagnostic challenge clinically in view of their nonspecific presentation as palpable lump in the superolateral aspect of the orbit. There are a myriad of pathological entities ranging from inflammatory to neoplastic lesions that can affect the lacrimal glands. Cross-sectional imaging is must for the detection, characterization, and mapping of these lesions. In this pictorial review, we propose a radiological pattern-based approach for various lacrimal gland lesions that provides a working algorithm for radiologists in the evaluation of lacrimal gland pathologies.
Collapse
Affiliation(s)
- Zainab Vora
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | | | - Sanjay Sharma
- Department of Radiodiagnosis, AIIMS, New Delhi, India.
| |
Collapse
|
31
|
Hu MK, Mathur A, Dempsey OJ. Pulmonary Sarcoidosis: A Clinical Update. J R Coll Physicians Edinb 2020; 50:322-329. [DOI: 10.4997/jrcpe.2020.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sarcoidosis remains difficult to diagnose, assess and treat. The last decade has brought significant diagnostic and therapeutic advances in the field of sarcoidosis including endobronchial ultrasound, 18F-fluorodeoxyglucose positron emission tomography and biologics. In this article we use clinical vignettes to discuss commonly encountered cases to illustrate and explain the application of these, and other advances.
Collapse
Affiliation(s)
- May Khei Hu
- Academic Foundation Doctor, Department of Respiratory Medicine, Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Abhinav Mathur
- Honorary Research Fellow, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, UK
| | - Owen J Dempsey
- Consultant Respiratory Physician, Department of Respiratory Medicine, Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
| |
Collapse
|
32
|
Elwazir MY, Bois JP, Abou Ezzeddine OF, Chareonthaitawee P. Imaging and Quantification of Cardiac Sarcoidosis. Semin Nucl Med 2020; 50:283-294. [PMID: 32540026 DOI: 10.1053/j.semnuclmed.2020.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiac sarcoidosis (CS) refers to the increasingly recognized cardiac involvement of an incompletely understood systemic disease entity-sarcoidosis. Endomyocardial biopsy can provide definitive diagnosis but is limited by its invasiveness and poor sensitivity. In the absence of a reliable gold standard, a combination of clinical, electrocardiographic, imaging, and histologic criteria are relied upon to provide probabilistic diagnosis. Within the last few years, societal documents have included advanced cardiovascular imaging modalities, 18F-FDG-PET/CT and cardiac magnetic resonance in their diagnostic algorithms. The current article provides a review of the imaging modalities used for screening and detection of CS, highlighting the principal findings of each with a specific focus on quantification, whenever applicable, and concluding with a proposed approach to the imaging of patients with suspected CS.
Collapse
Affiliation(s)
- Mohamed Y Elwazir
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
33
|
Kudaiberdiev T, Tukusheva E, Gaibyldaev Z, Tursunbekova G, Kadyraliev Z, Akhmedova I, Tulopbergenov N, Muraliev E. Massive pericardial effusion causing cardiac tamponade accompanied by elevated CA-125 and thoracic lymphadenopathy in sarcoidosis: a case report. Int J Surg Case Rep 2020; 72:355-360. [PMID: 32563820 PMCID: PMC7306529 DOI: 10.1016/j.ijscr.2020.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Pericardial effusion and cardiac tamponade are rare manifestations of cardiac sarcoidosis. This is a first case report that describes a patient with severe pericardial effusion and signs of cardiac tamponade with elevated carbohydrate antigen 125 (CA-125) levels, enlarged pericardial (PLN) and mediastinal lymph nodes (MLN), histologically confirmed as sarcoidosis. PRESENTATION OF CASE A 51-year-old female patient was admitted with complaints of sickness, shortness of breath on minimal exertion, swelling in lower extremities, and heaviness in right upper abdomen. Patient had diminished heart sounds, peripheral edema and hepatomegaly. She had elevated CA-125 level without gynecologic pathology. There were QRS alternation on ECG and water-bottle configuration on chest-X-ray, severe pericardial effusion, and signs of cardiac tamponade on echocardiography. CT demonstrated massive pericardial effusion, pericardial mass and enlargement of anterior MLN. The patient underwent pericardial drainage with removal of 850 mL of pericardial fluid and excision of enlarged PLN. Histological examination of PLN revealed non-caseating epithelioid cell granulomas. The diagnosis of cardiac sarcoidosis was established. Patient was discharged and 6-month follow-up was uneventful. DISCUSSION There are no reports on association of pericardial effusion, with increased CA-125 level in sarcoidosis, as we established in our patient. Our case is notable by incidental finding of enlarged PLN, mimicking pericardial mass and mediastinal lymphoadenopathy on CT, further confirmed by histological examination of PLN specimen as cardiac sarcoidosis. CONCLUSION It should be kept in mind that sarcoidosis may present as massive pericardial effusion, with signs of tamponade and pericardial lymphoadenopathy mimicking pericardial mass, mediastinal lymphoadenopathy and elevated CA-125, mimicking malignancy.
Collapse
Affiliation(s)
- Taalaibek Kudaiberdiev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan.
| | - Elmira Tukusheva
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Zhanybek Gaibyldaev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Gulnaz Tursunbekova
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Zhunus Kadyraliev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Irina Akhmedova
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Nurjan Tulopbergenov
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Emil Muraliev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| |
Collapse
|
34
|
Rajagopala S, Sankari S, Kancherla R, Ramanathan RP, Balalakshmoji D. Miliary Sarcoidosis: does it exist? A case series and systematic review of literature. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:53-65. [PMID: 33093769 PMCID: PMC7569537 DOI: 10.36141/svdld.v37i1.7837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/24/2020] [Indexed: 12/18/2022]
Abstract
Background and Objectives: Sarcoidosis typically presents with peribronchovascular and perilymphatic nodules on high-resolution computed tomography (HRCT); a miliary pattern is reported but not well described. Design, setting: We describe four patients with miliary sarcoidosis and results of a systematic review of all previously reported cases from 1985 onwards. Results: We identified only 27 cases of “miliary” sarcoidosis in the HRCT era. These patients were older (85.2% older than 40 years), had more co-morbidities (72.7%) and were symptomatic compared to “typical” sarcoidosis. Respiratory symptoms were present in 61.9% at diagnosis. Hypercalcemia was seen in 28.5%. On review of HRCT images, only 34.6% (9/26) had a “true miliary” pattern without fissural nodules. In our series, prominent perivascular granulomas were seen on histopathology in all. 44.4% (12/27) had tuberculosis preceding or concurrent to miliary sarcoidosis. Of the eight true associations, tuberculosis preceded sarcoidosis by 52 (median, IQR 36) weeks in six and occurred concurrently in another two. The diagnosis of tuberculosis was clinical in all with concurrent diagnosis of tuberculosis and sarcoidosis. Treatment with steroids had 100% response and 14.2% relapse. Conclusions: A true miliary pattern in the HRCT era is very rare in sarcoidosis and subtle perilymphatic pattern is nearly always seen; this should be labeled “pseudo-miliary”. Prominent perivascular granulomas are associated with true miliary pattern. Miliary sarcoidosis patients are older and symptomatic, needing treatment at diagnosis. “Miliary” sarcoidosis may follow treatment for tuberculosis; concurrent cases possibly indicate the difficulty in differentiating both or a “tuberculo-sarcoid” presentation. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 53-65)
Collapse
Affiliation(s)
| | | | | | | | - Devanand Balalakshmoji
- Radiodiagnosis, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, India
| |
Collapse
|
35
|
Karaosmanoglu AD, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Kraeft J, Hahn PF. Non-neoplastic hepatopancreatobiliary lesions simulating malignancy: can we differentiate? Insights Imaging 2020; 11:21. [PMID: 32040641 PMCID: PMC7010905 DOI: 10.1186/s13244-019-0813-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 01/12/2023] Open
Abstract
Despite the success of cross-sectional imaging in evaluating hepatopancreatobiliary system malignancies, several non-malignant disease processes may closely mimic malignancy. Differentiating these benign diseases from malignancy may be difficult, or even impossible, even in the hands of experienced imagers. In this manuscript, we present benign mimics involving the hepatopancreatobiliary system and try to increase awareness of these potential pitfalls.
Collapse
Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| |
Collapse
|
36
|
Reshef ER, Habib LA, Rao R, Modjtahedi BS, Eliott D, Freitag SK, Reinshagen KL, Lee NG. Clinical and radiographic features of hydrolyzed MIRAgel scleral buckles: A comparative analysis. Clin Imaging 2019; 60:10-15. [PMID: 31864194 DOI: 10.1016/j.clinimag.2019.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
The MIRAgel (hydrogel) scleral buckle, introduced in the 1980s, was a novel material to repair retinal detachments. It was later discontinued due to the frequency of long-term complications related to buckle hydrolysis and expansion. These complications included pain, limited extraocular motility, and more serious complications such as infection or scleral perforation, which ultimately necessitated surgical extraction as late as 20-30 years after placement. Prompt and proper diagnosis and treatment is often delayed as these buckle-associated complications frequently mimic other orbital pathologies such as tumors or infections. The hydrolyzed MIRAgel buckle exhibits distinct radiographic features that are helpful in arriving at the correct diagnosis, particularly in cases of ambiguous clinical presentation or history. Here, we expand on the previously described radiographic features of hydrolyzed MIRAgel and compare them to features of common, mimicking orbital pathology.
Collapse
Affiliation(s)
- Edith R Reshef
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Larissa A Habib
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Rohini Rao
- Department of Ophthalmology, School of Medicine, Boston University, Boston, MA, United States of America
| | - Bobeck S Modjtahedi
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, United States of America
| | - Dean Eliott
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Suzanne K Freitag
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Katherine L Reinshagen
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America.
| | - Nahyoung G Lee
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
37
|
Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M, Inomata T, Ishibashi-Ueda H, Eishi Y, Kitakaze M, Kusano K, Sakata Y, Shijubo N, Tsuchida A, Tsutsui H, Nakajima T, Nakatani S, Horii T, Yazaki Y, Yamaguchi E, Yamaguchi T, Ide T, Okamura H, Kato Y, Goya M, Sakakibara M, Soejima K, Nagai T, Nakamura H, Noda T, Hasegawa T, Morita H, Ohe T, Kihara Y, Saito Y, Sugiyama Y, Morimoto SI, Yamashina A. JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis - Digest Version. Circ J 2019; 83:2329-2388. [PMID: 31597819 DOI: 10.1253/circj.cj-19-0508] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fumio Terasaki
- Medical Education Center / Department of Cardiology, Osaka Medical College
| | - Arata Azuma
- Department of Pulmonary Medicine, Nippon Medical School
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nobukazu Ishizaka
- Department of Internal Medicine (III) / Department of Cardiology, Osaka Medical College
| | - Yoshio Ishida
- Department of Internal Medicine, Kaizuka City Hospital
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Takayuki Inomata
- Department of Cardiology, Kitasato University Kitasato Institute Hospital
| | | | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takatomo Nakajima
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | - Taiko Horii
- Department of Cardiovascular Surgery, Kagawa University School of Medicine
| | | | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine
| | | | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University
| | - Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Faculty of Medicine
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Tohru Ohe
- Department of Cardiology, Sakakibara Heart Institute of Okayama
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Yoshihiko Saito
- Department of Cardiorenal Medicine and Metabolic Disease, Nara Medical University
| | - Yukihiko Sugiyama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
| | | | | | | |
Collapse
|
38
|
Nepal P, Ojili V, Songmen S, Kaur N, Olsavsky T, Nagar A. "The Great Masquerader": Sonographic Pictorial Review of Testicular Tuberculosis and its Mimics. J Clin Imaging Sci 2019; 9:27. [PMID: 31448178 PMCID: PMC6702864 DOI: 10.25259/jcis-14-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 11/07/2022] Open
Abstract
Testicular tuberculosis (TB) is an uncommon presentation of extrapulmonary TB. Although rare in incidence, it is a great masquerader and should be kept in consideration while assessing focal abnormalities involving the testis. Ultrasound findings alone may be non-specific and mimic other diagnoses including infection, inflammation, tumor, infarct, and trauma. The main objective of this sonographic pictorial review is to discuss the imaging findings, specific differentiating features against each differential and use of ancillary imaging findings whenever available. Concurrent involvement of epididymis, septated hydrocele, scrotal wall edema, and calcification of tunica vaginalis provides strong evidence in an appropriate setting. Available extratesticular ancillary imaging findings must be correlated for correct diagnosis due to non-specific imaging and clinical presentation. Misdiagnosis of scrotal TB may lead to otherwise avoidable epididymo-orchiectomy.
Collapse
Affiliation(s)
- Pankaj Nepal
- Departments of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Vijayanadh Ojili
- Departments of Radiology, University of Texas Health, San Antonio, TX, USA
| | | | - Neeraj Kaur
- Departments of Radiology, University of Texas Health, San Antonio, TX, USA
| | - Thomas Olsavsky
- Departments of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Arpit Nagar
- Departments of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
39
|
Kim DI, Lock G. Bilateral extraocular muscle enlargement and proptosis associated with squamous cell carcinoma of the lung. BJR Case Rep 2019; 5:20180049. [PMID: 31131124 PMCID: PMC6519496 DOI: 10.1259/bjrcr.20180049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/14/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022] Open
Abstract
Thyroid-associated orbitopathy is characterised on cross-sectional imaging by symmetric extraocular muscle enlargement sparing the musculotendinous junction. We report a case of this imaging finding in a biochemically euthyroid patient with metastatic squamous cell carcinoma of the lung undiagnosed at time of presentation.
Collapse
Affiliation(s)
- David I Kim
- Department of Diagnostic Radiology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Gregory Lock
- Department of Diagnostic Radiology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| |
Collapse
|
40
|
George MP, Kim WG, Lee EY. Tales from the Night:: Emergency MR Imaging in Pediatric Patients after Hours. Magn Reson Imaging Clin N Am 2019; 27:409-426. [PMID: 30910105 DOI: 10.1016/j.mric.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Overnight in-house radiology has rapidly become an important part of contemporary practice models, and is increasingly the norm in pediatric radiology. MR imaging is an indispensable first-line and problem-solving tool in the pediatric population. This has led to increasingly complex MR imaging being performed "after hours" on pediatric patients. This article reviews the factors that have led to widespread overnight subspecialty radiology and the associated challenges for overnight radiologists, and provides an overview of up-to-date imaging techniques and imaging findings of the most common indications for emergent MR imaging in the pediatric population.
Collapse
Affiliation(s)
- Michael P George
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Wendy G Kim
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA
| |
Collapse
|
41
|
Riccomi G, Fornaciari G, Giuffra V. Multiple myeloma in paleopathology: A critical review. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 24:201-212. [PMID: 30530292 DOI: 10.1016/j.ijpp.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
This paper provides a critical literature review concerning paleopathological evidence of multiple myeloma discovered both in the Old and in the New World. A critical assessment of the bioarchaeological and paleopathological documentary sources permitted to identify a total of 25 ascertained cases of multiple myeloma from different geographical areas in the world ranging from Prehistoric times up to the Contemporary age. The distribution of multiple myeloma findings in past times shows that the majority of cases have been discovered in the Old World (n = 18) and extend back to the Middle Ages, while the evidences in the New World (n = 7) seems to date back to the pre-Columbian era. The demographic profile suggests a sex ratio of 1.3:1, while 91.7% of affected individuals (n = 24) are adults. This critical review also discusses the diagnostic criteria and methodological issues commonly attempted in paleo-oncological research, with particular regard to the differential diagnosis of multiple myeloma. As such, the main focus of this work is to present a comprehensive and exhaustive scrutiny of the skeletal manifestations identified as multiple myeloma in order to improve the accuracy of diagnoses within the field of paleopathology.
Collapse
Affiliation(s)
- Giulia Riccomi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
| | - Gino Fornaciari
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Valentina Giuffra
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| |
Collapse
|
42
|
Abstract
Ultrasound is the imaging modality of choice to evaluate the scrotum because of its high resolution, Doppler capabilities, availability, and lack of ionizing radiation. Acute urologic emergencies diagnosed with ultrasound include testicular torsion, testicular rupture, and Fournier gangrene. The radiologist's knowledge of sonographic features of vascular, infectious, traumatic, and benign and malignant processes that occur in the scrotum coupled with the patient's presenting symptoms, age, and physical examination allows for the correct diagnosis of a wide spectrum of scrotal pathology.
Collapse
Affiliation(s)
- Kristin Rebik
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA.
| | - Jason M Wagner
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| |
Collapse
|
43
|
Imaging of Unusual Renal Tumors. Curr Urol Rep 2019; 20:5. [PMID: 30663008 DOI: 10.1007/s11934-019-0867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Renal masses are a wide entity and a common finding in clinical practice. Detection of these masses has increased in the last years, yet mortality rates have slightly decreased. RECENT FINDINGS According to the World Health Organization classification, there are 8 types, 51 subtypes, and a lot more subsequent subclassifications of renal tumors. Histopathological analysis should always be assessed for final diagnosis of theses tumors. However, imaging can be an important diagnostic guidance. The most common diagnoses of renal tumor are clear cell carcinoma, papillary renal cell carcinoma, angiomyolipoma, and transitional cell carcinoma. Nonetheless, a considerable variety of particular tumors can arise from the kidney, challenging the expertise of radiologists and urologists on this subject. The awareness of these unusual entities is vital for professionals working at a complex medical facility with greater volume of patients. We hereby present uncommon renal tumors and its pathological and radiological features.
Collapse
|
44
|
Gray Scale Ultrasound, Color Doppler Ultrasound, and Contrast-Enhanced Ultrasound in Renal Parenchymal Diseases. Ultrasound Q 2018; 34:250-267. [DOI: 10.1097/ruq.0000000000000383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
45
|
Lavi ES, Pal A, Bleicher D, Kang K, Sidani C. MR Imaging of the Spine: Urgent and Emergent Indications. Semin Ultrasound CT MR 2018; 39:551-569. [DOI: 10.1053/j.sult.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
46
|
Lesions Without Borders: Scrotal Lesions That Involve Both the Intratesticular and Extratesticular Regions. AJR Am J Roentgenol 2018; 210:W70-W79. [PMID: 29355401 DOI: 10.2214/ajr.17.18369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Differentiation of scrotal lesions is often dictated by whether they are intraor extratesticular. However, these regions are not entirely isolated, and disease processes can span both spaces. We review a variety of lesions that can involve both regions, describe the relevant anatomy, and illustrate their imaging appearances. CONCLUSION Identification of involvement of both intra- and extratesticular regions by a single process can narrow the differential considerations and help arrive at the correct diagnosis.
Collapse
|
47
|
Ganeshan D, Menias CO, Lubner MG, Pickhardt PJ, Sandrasegaran K, Bhalla S. Sarcoidosis from Head to Toe: What the Radiologist Needs to Know. Radiographics 2018; 38:1180-1200. [PMID: 29995619 DOI: 10.1148/rg.2018170157] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disorder characterized by development of noncaseating granulomas in various organs. Although the etiology of this condition is unclear, environmental and genetic factors may be substantial in its pathogenesis. Clinical features are often nonspecific, and imaging is essential to diagnosis. Abnormalities may be seen on chest radiographs in more than 90% of patients with thoracic sarcoidosis. Symmetric hilar and mediastinal adenopathy and pulmonary micronodules in a perilymphatic distribution are characteristic features of sarcoidosis. Irreversible pulmonary fibrosis may be seen in 25% of patients with the disease. Although sarcoidosis commonly involves the lungs, it can affect virtually any organ in the body. Computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT are useful in the diagnosis of extrapulmonary sarcoidosis, but imaging features may overlap with those of other conditions. Familiarity with the spectrum of multimodality imaging findings of sarcoidosis can help to suggest the diagnosis and guide appropriate management. ©RSNA, 2018.
Collapse
Affiliation(s)
- Dhakshinamoorthy Ganeshan
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Christine O Menias
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Meghan G Lubner
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Perry J Pickhardt
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Kumaresan Sandrasegaran
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| | - Sanjeev Bhalla
- From the Department of Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (D.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.)
| |
Collapse
|
48
|
Hwang ZA, Suh KJ, Chen D, Chan WP, Wu JS. Imaging Features of Soft-Tissue Calcifications and Related Diseases: A Systematic Approach. Korean J Radiol 2018; 19:1147-1160. [PMID: 30386146 PMCID: PMC6201973 DOI: 10.3348/kjr.2018.19.6.1147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/08/2018] [Indexed: 02/05/2023] Open
Abstract
Soft-tissue calcification refers to a broad category of lesions. Calcifications are frequently identified by radiologists in daily practice. Using a simple algorithm based on the distribution pattern of the lesions and detailed clinical information, these calcified lesions can be systematically evaluated. The distribution pattern of the calcific deposits enables initial division into calcinosis circumscripta and calcinosis universalis. Using laboratory test results (serum calcium and phosphate levels) and clinical history, calcinosis circumscripta can be further categorized into four subtypes: dystrophic, iatrogenic, metastatic, and idiopathic calcification. This pictorial essay presents a systematic approach to the imaging features of soft-tissue calcifications and related diseases.
Collapse
Affiliation(s)
- Zhen-An Hwang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Kyung Jin Suh
- Department of Radiology, Dongguk University Gyeongju Hospital, Gyeongju 38067, Korea
| | - Dillon Chen
- Department of Radiology, University of California, Davis, CA 95817, USA
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| |
Collapse
|
49
|
Monmany J, Granell E, López L, Domingo P. Resolved heart tamponade and controlled exophthalmos, facial pain and diabetes insipidus due to Erdheim-Chester disease. BMJ Case Rep 2018; 2018:bcr-2018-225224. [PMID: 30337283 PMCID: PMC6254461 DOI: 10.1136/bcr-2018-225224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A 69-year-old woman suffering from exophthalmos and facial pain came to us referred for aetiological diagnosis of exophthalmos. Orbital MRI showed thinned extrinsic ocular musculature, intraconal fat infiltration, retro-ocular compression and thickening of maxillary and sphenoid sinus walls. She had been suffering from diabetes insipidus for the last 7 years. During our diagnosis process, she presented signs of cardiac tamponade. Transthoracic heart ultrasound revealed large pericardial effusion and a heterogeneous mass that compressed the right ventricle. No osteosclerotic lesions on appendicular bones were present. Pericardiocentesis temporarily controlled tamponade and corticoid therapy temporarily abated exophthalmos. Pericardiectomy definitively resolved tamponade. Histological examination of pericardial tissue was conclusive of Erdheim-Chester disease. Exophthalmos responded to pegylated interferon-alpha-2a. Facial bone pain disappeared after zoledronic acid and interferon treatment. During interferon therapy, the patient suffered from a severe generalised desquamative exanthema that slowly resolved after discontinuing interferon. Diabetes insipidus remains controlled with desmopressin.
Collapse
Affiliation(s)
- Jaume Monmany
- Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Esther Granell
- Diagnòstic per la Imatge, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura López
- Anatomia Patològica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pere Domingo
- Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
50
|
Duan J, Xu Y, Zhu H, Zhang H, Sun S, Sun H, Wang W, Xie S. Relationship between CT activity score with lung function and the serum angiotensin converting enzyme in pulmonary sarcoidosis on chest HRCT. Medicine (Baltimore) 2018; 97:e12205. [PMID: 30200130 PMCID: PMC6133449 DOI: 10.1097/md.0000000000012205] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To address the reliability of CT activity score (CTAS) and investigate the relationships between CTAS, lung function changes after treatment and the serum angiotensin-converting enzyme (SACE) levels.Fifty-seven sarcoidosis patients underwent chest high-resolution CT (HRCT) and spirometry, as well as SACE examination, were retrospectively analyzed. Follow-up spirometry in each patient was obtained about 6 months after the initial spirometry. The correlations between CTAS and pulmonary function changes were evaluated by Spearman correlation analysis. According to SACE status, patients were divided into normal and high level 2 subgroups. Comparisons of pulmonary function parameters, HRCT abnormalities extent scores between SACE normal and high 2 subgroups were performed with the Mann-Whitney U test or Independent samples t test.CTAS demonstrated significant correlations with lung function changes (Δ%VC: ρ= 0.543, P < .001; ΔFEV1.0/FVC:ρ = 0.417, P = .001; Δ%TLC: ρ = 0.309, P = .019). In addition, worse initial lung function, larger changes of lung function, and higher extent scores of HRCT were observed in SACE high-level subgroup.The findings of this study suggest that CTAS of initial HRCT is a promising index for disease activity in pulmonary sarcoidosis to some degree. Prospective studies with large cohort designed to address further verification are warranted before wide clinical practice.
Collapse
Affiliation(s)
- Jianghui Duan
- Department of Radiology, China-Japan Friendship Hospital, Beijing
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing
| | - Haixu Zhu
- Department of Radiology, The People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, China
| | - Haibo Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing
| | - Shilong Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing
| | - Wu Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing
| |
Collapse
|