Hydrocele of the canal of Nuck: a rare differential diagnosis for an inguinal hernia

Hydrocele of the canal of Nuck is a rare condition which is commonly misdiagnosed as an inguinal hernia due to the unfamiliarity of clinicians with this pathology. There are three different types of hydrocele of the canal of Nuck, with type 1 being the most common, typically presenting as a unilocular cystic lesion with no communication with the peritoneal cavity. We present a case of a two-month-old female patient with an enlarging inguinal swelling raising the suspicion for an inguinal hernia or lymphadenopathy, with sonographic imaging revealing a fluid collection in the canal of Nuck, suggestive of a hydrocele. Diagnostic radiology plays a crucial role in the initial diagnosis of a canal of Nuck hydrocele, and ultrasound is considered the modality of choice for early diagnosis differentiating it from other causes of inguinal swelling.

Pancreatic schwannoma: a rare differential diagnosis for a pancreatic mass

Pancreatic schwannomas are rare benign tumors with low malignant potential and are often difficult to diagnose due to their non-specific presenting symptoms and overlapping radiological imaging characteristics. Cross-sectional imaging plays an important role in the initial diagnosis and in delineating the extent of the lesion. However, biopsy and histopathological examination remains the gold-standard for a definite diagnosis. The management of pancreatic schwannomas includes surgical resection often yielding excellent clinical outcomes with low recurrence rates. We present a case of a 33-year-old female patient with a history of a recurrent vague upper abdominal pain where CT of the upper abdomen showed a hypodense pancreatic mass. Robotic subtotal pancreatectomy was done with histopathology showing spindled Schwann cells indicative of a pancreatic schwannoma.

Pancreatic endometrioma : a rare differential diagnosis for a pseudocyst

Pancreatic endometriosis is extremely rare with only 14 cases reported in the medical literature and its diagnosis on radiological imaging poses a great challenge. We report a case of a 31-year-old female patient with recurrent admissions for pancreatitis of unknown aetiology and no relevant previous medical history. Sectional imaging showed a cystic lesion in the tail of the pancreas and the diagnosis of a post-pancreatitis pseudocyst or a less likely pre-malignant mucinous cystadenoma was considered. On post-robotic resection of the pancreatic cyst, the histopathology analysis was positive for endometrial stroma. Pancreatic endometriosis although rare should be considered as a differential diagnosis for cystic lesions especially in patients who are known to have pelvic endometriosis. Nevertheless, the gold standard for the definite diagnosis of pancreatic endometriosis remains histopathological.

A rectosigmoid haemangioma: A rare etiology of rectal bleeding

Cavernous haemangiomas of the rectosigmoid colon are rare benign vascular neoplasms of the GI tract. Patients usually present at a younger age with various degree of rectal bleeding ranging from mild painless episodic bleeding to life-threatening hemorrhage. High index of suspicion and early diagnosis is crucial to avoid unnecessary biopsy and inappropriate management. We report a case of a 26-year-old male patient with a long history of recurrent rectal bleeding. Contrast-enhanced CT scan of the abdomen and pelvis and MRI confirmed the diagnosis of cavernous hemangioma. Further surgical treatment with rectosigmoid resection and colo-anal anastomosis represents the optimum path of management for our patient.

The role of artificial intelligence in plain chest radiographs interpretation during the Covid-19 pandemic

Artificial intelligence (AI) plays a crucial role in the future development of all healthcare sectors ranging from clinical assistance of physicians by providing accurate diagnosis, prognosis and treatment to the development of vaccinations and aiding in the combat against the Covid-19 global pandemic. AI has an important role in diagnostic radiology where the algorithms can be trained by large datasets to accurately provide a timely diagnosis of the radiological images given. This has led to the development of several AI algorithms that can be used in regions of scarcity of radiologists during the current pandemic by simply denoting the presence or absence of Covid-19 pneumonia in PCR positive patients on plain chest radiographs as well as in helping to levitate the over-burdened radiology departments by accelerating the time for report delivery. Plain chest radiography is the most common radiological study in the emergency department setting and is readily available, fast and a cheap method that can be used in triaging patients as well as being portable in the medical wards and can be used as the initial radiological examination in Covid-19 positive patients to detect pneumonic changes. Numerous studies have been done comparing several AI algorithms to that of experienced thoracic radiologists in plain chest radiograph reports measuring accuracy of each in Covid-19 patients. The majority of studies have reported performance equal or higher to that of the well-experienced thoracic radiologist in predicting the presence or absence of Covid-19 pneumonic changes in the provided chest radiographs.

Acute pancreatitis as a late complication of intra-gastric balloon insertion

Intra-gastric balloon (IGB) insertion is a safe, well-tolerated and an effective weight loss procedure. It is commonly used as a step prior to bariatric surgery in obese patients with co-morbidities and failed conservative weight-loss methods. The main side effects post-IGB placement include nausea, vomiting and abdominal pain. The reported complications of IGB include balloon over-inflation, balloon migration, esophagitis, ulceration, gastric perforation and bowel obstruction. We report a case of acute pancreatitis attributed to IGB placement, which is a rare complication of this procedure. The diagnosis of acute pancreatitis due to IGB was made after excluding other causes of acute pancreatitis by radiological imaging. The patient underwent endoscopic IGB removal with rapid post-surgical improvement of her clinical course.

A rare case of pleuropulmonary synovial sarcoma of the chest wall: A case report and a literature review

Pleuropulmonary synovial sarcoma is a subtype of synovial sarcomas that commonly arises from the chest wall, pleura, lungs and the heart. They are extremely rare, with only a few cases reported in the literature. It usually affects young and middle-aged adults with no gender predilection. Chest radiographs usually show a pleural-based mass, parenchymal consolidation, or a near complete opacification of the hemithorax. On contrast-enhanced CT, synovial sarcomas of the chest wall typically appear as a well-defined, heterogeneously enhancing mass with bone destruction and infiltration of chest wall musculature. MRI usually demonstrates a heterogeneous mass with areas of both high and low T1 signal intensities representing areas of hemorrhage and necrosis. We report a case of a 39- year old African male patient who presented to our hospital complaining of chest pain of 4 months duration. The plain chest radiograph showed complete opacification of the left hemithorax. Contrast-enhanced CT and MRI were then performed revealing a large left-sided heterogeneous mass. PET-CT demonstrated avid FDG uptake in the solid components of the mass with no evidence of distant metastasis._. An ultrasound-guided biopsy was performed, and histopathology revealed a locally advanced primary synovial sarcoma of the chest wall. Treatment consisted of neoadjuvant chemotherapy followed by surgical resection.

Periampullary duodenal schwannoma mimicking ampullary neoplasm

Schwannomas are neurogenic tumors that arise from Schwann cells in the neural sheath. Gastrointestinal schwannomas occur most often in the stomach, followed by the colon and the rectum. Duodenal schwannomas are rare amongst mesenchymal tumors of the gastrointestinal tract and only a few cases have been reported up to the current date with an incidence of approximately 2%-6%. Duodenal Schwannomas do not have characteristic imaging features thereby cannot be easily differentiated from other submucosal and adjacent extraluminal neoplasms. We present a case of a 76-year old male patient that presented to our hospital with abdominal pain and was diagnosed after an upper gastrointestinal endoscopy with an ampullary duodenal neoplasm that proved to be a periampullary duodenal Schwannoma on histopathology. Duodenal Schwannomas although rare should be considered in the differential diagnosis of ampullary neoplasms.

Metastatic pulmonary calcifications postcardiac transplant in a 15-year-old patient: A case report and review of literature

Metastatic pulmonary calcification is a metabolic lung disease that occurs due to a prolonged hypercalcemic state where calcium salts precipitate into numerous foci or nodules of fluffy calcifications in the lung apices, usually bilaterally. Calcifications can also occur in other organs such as in the stomach and the kidneys. It is often underdiagnosed and is usually associated with end stage renal failure and resultant secondary hyperparathyroidism. Nevertheless, it is rarely reported in the postcardiac surgery status and cardiac transplant patients. We present a case of a 15-year-old male patient with a recent history of cardiac transplant due to a complex congenital heart disease where findings of extensive metastatic pulmonary calcifications were seen a routine follow-up chest radiograph. Clinical manifestations of metastatic pulmonary calcifications can range from having no symptoms or mild dyspnea on exertion to fulminant respiratory failure. Therefore, early recognition of imaging features and initiation of proper management is crucial to the patient's outcome.

Acute myelitis as a neurological complication of Covid-19: A case report and MRI findings

During the recent outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 coronavirus, there is rising concerns about neurological complications of COVID-19. Fever, headache, and anosmia may occur early during the disease course. Other neurological sequalae such as encephalitis may occur in later phases. We report a case of acute myelitis in a 32-year old male COVID-19 positive patient who presented with a 2-day history of flu-like symptoms then sudden onset paraplegia and urinary retention. The incidence is not known and the pathogenesis of the disease behind this manifestation is still not fully understood. Nevertheless considering the broad differential diagnosis of acute myelitis, prompt clinical, and diagnostic work up was crucial to exclude other causes. Patients presenting with neurological symptoms such as loss of consciousness, ataxia, convulsions, status epilepticus, encephalitis, myelitis or neuritis should raise concerns for COVID-19 infection during this pandemic prompting early diagnosis and initiation of proper management.

A case of peribiliary hepatic cysts in a cirrhotic liver: A mimicker of Klatskin Tumor

Patients with end-stage liver disease may present to healthcare facilities with features of obstructive jaundice and a picture of hilar cholangiocarcinoma on radiological imaging. Careful observation and knowledge of the presence and higher prevalence of peribiliary hepatic cysts in a cirrhotic liver can aid in differentiating this benign entity from malignancy that may halt or delay the patients’ eligibility for receiving a liver transplant. We present a case of a patient with liver cirrhosis initially diagnosed as Klatskin tumor on imaging then as a simple case of multiple peribiliary hepatic cysts with the patient eventually undergoing successful liver transplantation.

Ruptured Berry Aneurysm as the initial presentation of Polycystic Kidney Disease: A case report and review of literature

Intra-cranial saccular aneurysms, also known as Berry aneurysms, have a well-known association with autosomal dominant polycystic kidney disease (ADPKD). Aneurysmal rupture can be the initial presentation of the disease. ADPKD has two types of gene mutations: PKD1 and PKD2. The latter one is of a milder form presenting later in life. Imaging plays a crucial role in the diagnosis and assessment in order to provide adequate management of these patients however, there are no official standardized guidelines established for screening of these intracranial aneurysms.

Pulmonary venous varix associated with mitral regurgitation mimicking a mediastinal mass: A case report and review of the literature

Pulmonary vein varix is an unusual cause of a mediastinal mass on a chest radiograph. It may be found as an isolated malformation or as a sequela of pulmonary venous hypertension. We encountered a case presenting with left hemiparesis and a past medical history of rheumatic heart disease. The chest radiograph revealed a well-defined mediastinal mass that turned out to be a hugely dilated pulmonary vein on contrast enhanced computed tomography of the chest. The computed tomography of the brain and upper abdomen revealed bilateral cerebral infarction and splenic infarction. In the literature, one-third of the reported cases of pulmonary vein varix are acquired secondary to mitral valve disease.