A rare case of uterine rupture in the first trimester of pregnancy: Case report and review of literature

Uterine rupture is a serious and potentially life-threatening complication. It is commonly a complication that happens in the third trimester of pregnancy. Its occurrence in early pregnancy is very rare. We report a case of a patient who presented with uterine rupture on a scarred uterus during the termination of pregnancy with misoprostol at 10 weeks' amenorrhea. In this case, we discuss the clinical warning signs, risk factors, and diagnostic methodology, and compare our approach with the literature.

Spinal metastasis of nephroblastoma: Yes it exists

Nephroblastoma or Wilms' tumor is the most common malignant tumor of the kidney in the pediatric population. Metastasis is caused by hematogenous spread. The most common localizations in decreasing order of frequency are lymph nodes, lungs, and liver. The bone is very rarely affected. According to the literature, bone metastases have been described in the iliac bone, skull, and mandible. The vertebral localization was described in 3 cases only, the first 1 in 2009, and the 2 others in 2015 . The goal of our work is to report a very rare case of metastatic vertebral localization of a Wilms' tumor in relapse after treatment; and thus to underline the potential for vertebral and intracanal involvement in nephroblastoma.

The white cerebellum sign: Classic but under recognized sign of brain injury

The white cerebellum sign is a concerning but uncommon radiological imaging result that is frequently seen in patients with severe, frequently irreversible anoxic-ischemic brain injury. Due to its frequent correlation with an unfavorable prognosis, radiologists must recognize this sign. We report the case of a 1 year old girl with history of epilepsy who presented with deterioration of conscious level and focal fits and brain computed tomography scan done on her revealed the white cerebellum sign.

Amyand's hernia in a 3-month-old infant: A case report

Amyand's hernia is a rare condition characterized by an inguinal hernia containing the appendix, which can lead to complications. It is more common in children and it can be challenging to diagnose due to its location, often being mistaken for other conditions like strangulated hernias, orchitis-epididymitis, or testicular torsion. Imaging, including computed tomography and sonography, plays an important role in diagnosis, which is usually made intraoperatively. A case concerning a 3-month-old boy with a large acute scrotum that had been evolving for 4 days was presented. Clinical examination revealed a hard inguinal mass and a large scrotum with signs of inflammation. An inguinoscrotal ultrasound found a herniated appendix, suggesting the diagnosis of Amyand's hernia, which was confirmed after surgery.

Multiseptate gallbladder in an asymptomatic child: Case report and review of the literature

Multiseptated gallbladder also known as "Honeycomb gallbladder" is a rare condition that was first described by Tandon in 1963. It is described as a congenital anomaly in most of the cases. It may be asymptomatic or may lead symptoms. We present the case of a multiseptate gallbladder in a 5 year old girl who was admitted for managament of acute appendicitis.

Mycotic Pulmonary Artery Aneurysm a Rare Complication of Ventricular Septal Defect With Infective Endocarditis: A Case Report

Introduction

Pulmonary artery aneurysms encompass a wide range of presentations and forms. Mycotic aneurysms represent a particular subset of focal dilatation of the vessel wall with high morbidity and mortality rates. Herein, we report the case of a 32 year old patient, with a prior history of ventricular septal defect presenting with a mycotic pulmonary artery aneurysm associated with infective endocarditis and septic emboli.

Case presentation

We present the case of a 32 year old male with known history of congenital ventricular septal defect presented to the emergency department with signs of sepsis and dyspnea. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. An echocardiogram found evidence of endocarditis with multiples intra cavitary vegetations. A CT angiogram demonstrated major right ventricular dilatation, multiple nodules and peripheral opacities, scattered throughout the lungs, indicative of septic emboli. Segmental saccular dilatation of the left lateral basal pulmonary artery consistent with a mycotic aneurysm formation was found. The patient was started on intravenous antibiotics and given the overall satisfactory evolution a conservative approach was pursued. The patient was discharged with antibiotics and scheduled for surgical repair of the ventricular septal defect.

Conclusion

To our knowledge, mycotic aneurysms associated to congenital heart malformation like ventricular septal wall defect remains a rare condition with few reported cases in the literature. Being aware of this entity is important for every practicing radiologist to allow for early diagnosis and treatment.

Tibia vara caused by focal fibrocartilaginous dysplasia: A rare case report

Focal fibrocartilaginous dysplasia is an uncommon benign bone condition that predominantly affects children and typically leads to varus deformities in the proximal tibia. It was first described by Bell in 1985. The etiology remains unknown and the diagnosis is radiological; biopsy is not necessary. We present a case of a 2-year-old child who presented to our department for a right limb varus deformity caused by focal fibrocartilaginous dysplasia.

Right atrial tumor revealing intravascular leiomyomatosis: about a case and literature review

Intravascular leiomyomatosis (IVL) is a very rare extension of uterine leiomyoma through the pelvic vessels. It is a benign pathology with malignant potential with a possibility of intra-cardiac extension and metastases (cerebral, pulmonary, lymph node); early diagnosis is very difficult. Prognosis depends on involvement of the inferior vena cava and extension to the right cavities. We report a case of complications of IVL, precisely the extension in the right atrium, in a 49-year-old woman. The objective of our work is to highlight the importance of imaging in the diagnosis of the vascular extension of leimyomatosis.

Unusual Case of Diffuse Neonatal Hemangiomatosis Case Report and Literature Review

Diffuse neonatal hemangiomatosis (DNH) is an infrequent condition characterized by the simultaneous occurrence of multiple cutaneous hemangiomas and the involvement of 3 or more organs. DNH is suspected when multiple hemangiomas are identified on the skin of the infant. Although it is benign in nature, DNH can lead to critical and life-threatening complications. Diagnosis primarily relies on clinical evaluation with a significant emphasis on imaging techniques. In this case report, we present an unusual pediatric case of diffuse infantile hemangioendothelioma, for which the investigative approach included ultrasound and CT scans. These imaging methods were instrumental in revealing the presence of lesions in the liver, thyroid, and brain, ultimately playing a pivotal role in making the diagnosis of DNH. A positive clinical and biological improvement was observed with corticosteroid treatment during a 3-month follow-up.

A Dental Extraction Revealing a Multisystem Burkitt's Lymphoma: A Case Report

Burkitt's lymphoma is rare but highly aggressive and very fast-growing B-cell non-Hodgkin's lymphoma (NHL). It can affect any organ such as the central nervous system, jaw, intestines, kidneys, ovaries, and other organs. It results from the malignant evolution and proliferation of B-type lymphoid cells. The diagnosis is based on a biopsy of a tumor mass or bone marrow aspiration revealing the presence of tumor cells. We report the case of a 7 year old child who was referred for a gingival swelling evolving since 1 month following a dental extraction. Imaging and anatomopathological examination after biopsy concludes to a multi systemic Burkitt's lymphoma. A chemotherapy was immediately started with spectacular complete remission.

Bilateral Nephroblastomatosis With a Unilateral Wilms Tumor: A Case Report Highlighting Imaging Characteristics

Nephrogenic rests (NRs) are foci of embryonic nephrogenic cells that persist beyond the 36th week of gestation. They are precursor lesions of Wilms tumor and are found incidentally in approximately 1% of infants. The term nephroblastomatosis (NBS) is utilized when nephrogenic rests extensively or multifocally affect the kidneys. We report a case of a left nephroblastoma with bilateral nephroblastomatosis, treated with neoadjuvant chemotherapy followed by a left nephrectomy, highlighting the imaging features of nephrogenic rests on ultrasound, CT, and MRI, and the potential possibilities of distinguishing nephroblastomas from nephrogenic rests in one hand, and the possibilities of distinguishing active nephrogenic rests from inactive ones in the other hand. We furthermore discuss the role of histology in making those distinctions, and the role of chemotherapy in reducing nephrogenic rests' size and cellularity.

Superior Mesenteric Artery Syndrome: A Misdiagnosed Disorder

The superior mesenteric artery syndrome also known as Wilkie's syndrome or Benign duodenal stasis, is a condition that occurs when the third duodenum is compressed between the superior mesenteric artery anteriorly and the abdominal aorta posteriorly following the disappearance of the perivascular fatty tissue. It can emulate the symptoms of an upper abdominal obstruction. This case involves a 9-year-old female patient experiencing food vomiting that did not improve with medication. Radiological work-up, which included an abdominal X-ray and a CT angiography, led to the diagnosis of extrinsic and incomplete obstruction of the third duodenum by the aorto-mesenteric clamp. Unfortunately, this diagnosis is rarely made. The purpose of this article is to provide a review of the etiology, clinical presentation, and imaging findings of this syndrome.

Myelin insults differentials on MRI in children: In the light of an ADEM case

Acute disseminated encephalomyelitis (ADEM) is an acute and rapidly progressive auto-immune demyelinating disorder in the central nervous system. It is a rare disease but is more frequently observed in the pediatric population. We report a case of a monophasic postvaccination ADEM, which presented with paraparesis associated with fever. It showed a favorable evolution under corticosteroids, without recurrence after 3 years of follow-up. The diagnosis was established due to the postvaccination context and the MRI abnormalities characteristics. This case prompted a general discussion about the etiologies of myelin insults in children, especially demyelinating disorders, by shedding the light on their MRI features.

Dyke-Davidoff-Masson syndrome in an 8-year-old child: Report of a case

Dyke-Davidoff-Masson syndrome (DDMS) is a rare entity. Few cases have been described in the literature. It can be symptomatic or asymptomatic. The clinical signs are very varied. Imaging is the key to diagnosis. Calvarial thickening, enlargement sinus, and cerebral hemiatrophy are suggestive signs. It is a cause of cerebral hemiatrophy and epilepsy. We report the clinical and radiological signs of this syndrome through a case of an 8-year-old male child treated for epilepsy. The importance of our article is to report a case diagnosed at an early age (8 years). Most studies report cases diagnosed in adults. MRI revealed pathognomonic signs of Dyke-Davidoff-Masson syndrome.

Clinical and Radiological Features in Poland Syndrome: Report of 3 Cases and Review of Literature

Poland syndrome is indeed a rare congenital malformation that can present with various degrees of thoracic and homolateral upper limb anomalies. The classic features of Poland syndrome include agenesis or hypoplasia of the sternocostal head of the pectoralis major muscle, hypoplasia of the nipple, absence of subcutaneous fat, multiple rib abnormalities, and sometimes Sprengel deformity (elevation of the scapula). Additionally, ipsilateral symbrachydactyly (combination of "short fingers" with cutaneous syndactyly [fused fingers]) may also be observed. However, it's important to note that not all of these findings are always present in every patient, and the combination of features can vary greatly. Surgical treatment for Poland syndrome primarily focuses on improving pulmonary functions resulting from severe thoracic deformities. However, it is frequently performed with the additional goal of enhancing cosmetic appearance. In recent times, the use of adipose-derived mesenchymal stem cells and fat transfer has shown promising results for correcting chest defects and breast augmentation. In our study, we present a series of 3 cases that were referred to our institution due to thoracic deformities associated with Poland syndrome.

Mandibular Brown Tumor Revealing Hyperparathyroidism in a Patient With Neurofibromatosis Type I: Case Report

The brown tumor is a non-neoplastic lesion resulting from an abnormality in bone metabolism in the context of primary, secondary, or tertiary hyperparathyroidism. They can affect any bone structure and be single or multiple. They are usually located on the long bones, pelvis, ribs, and collarbones. Facial localization is rare and is found in only 4.5% of brown tumors dominated by mandibular involvement. The treatment of a brown tumor depends on several elements: etiology, location, and symptomatology. It can regress or disappear after the treatment of hyperparathyroidism, thus avoiding surgical removal. Otherwise, excision of this mass is performed. We illustrate through this case a brown mandibular tumor revealing secondary hyperparathyroidism in a patient with a history of end-stage chronic renal failure on hemodialysis and associated neurofibromatosis type 1.

A rare case of Ewing's sarcoma of the maxillary sinus

Ewing's sarcoma is generally an aggressive, poorly differentiated bone and soft tissue tumor affecting children and young adults, it accounts for 4%-6% of all primary bone tumors and primary facial locations occur in only 1%-4% of all cases, primarily in the mandible and calvaria. Involvement of the paranasal sinuses is rare. Here we report the case of an 11-year-old girl with no medical, surgical, or traumatic history, who presented for 1 month and progressive evolution of swelling of the left cheek, associated with pain, nasal obstruction, rhinorrhea, and a slight weight loss not quantified. A craniofacial computed tomography (CT) scan showed a mixed lytic and condensing lesional tissue process centered on the left maxillary sinus, heterogeneously enhanced after contrast injection, lysing the walls of the sinus extended to the homolateral nasal cavity and slightly infiltrating the adjacent soft tissues. An incisional biopsy was performed and the pathological study proved that it was Ewing's sarcoma. She was put on neoadjuvant chemotherapy using 6 courses of vincristine, doxorubicin, ifosfamide, etoposide which resulted in a partial regression of the tumor size by 50%. Then the patient was put on combined chemotherapy and radiotherapy. A follow-up CT scan after 6 courses of vincristine, actinomycin, cyclophosphamide, and 17 sessions of radiotherapy showed lesion stability. Maxillary Ewing's sarcoma is a rare and aggressive tumor. Therefore, early diagnosis, combination therapy, and long-term follow-up are suggested in such cases to improve the survival rate.

Ataxic gait and dysarthria in a child: pantothenate kinase-associated neurodegeneration as a diagnosis

Pantothenate kinase-associated neurodegeneration (or previously known as Hallervorden-Spatz syndrome) is a very rare disorder that typically manifests in a child with neurological signs such as gait difficulties, dysarthria, and hyperreflexia, associated potentially with psychiatric symptoms such as cognitive decline. It demonstrates on MRI the typical 'eye of the tiger' appearance, which is due to gliosis and accumulation of iron in the globi pallidi. Other differentials can mimic this appearance on MRI, it is therefore important to search for the involvement of other basal ganglia nuclei and the cerebral cortex, and also to consider the clinical and biological context.

Posterior Reversible Encephalopathy Syndrome: A Complication of Acute Renal Failure in a Child

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity occurring during several conditions and more frequently in those associated with severe hypertension. The diagnostic approach is possible by considering the clinical context and MRI data, where white matter abnormalities are observed predominantly in the parietal and occipital territories secondary to the formation of a vasogenic edema. The evolution is characterized by a reversibility of the lesions in case of early diagnosis and management. The authors report a case of reversible posterior encephalopathy in a 12-year-old child who presented with a status epilepticus, revealing an acute renal failure.

Fetus In Fetu With Myelomeningocele

Fetus in fetu is an uncommon medical anomaly characterized by the presence of a malformed fetus within the body of a living twin. Although the retroperitoneum is the most typical location, occurrences in the sacrococcygeal and dorsolumbar regions are rare. Ongoing debates center around its embryopathogenesis, debating whether it is a highly specialized teratoma or a result of parasitic twinning in a monozygotic monochorionic diamniotic pregnancy. Notably, distinguishing factors such as vertebral bodies and limbs are pivotal in discerning FIF from teratomas. Diagnostic imaging techniques are integral for preoperative diagnosis, with histopathological examination confirming the condition's presence.

Rhinoscleroma in a 9-year old boy: Rare case report

Rhinoscleroma is a rare benign granulomatous disease in children, the pathogen of which is Klebsiella rhinoscleromatis. Rhinoscleroma almost always affects the respiratory tract, the nasal cavities are the most common site, but can also be found over the entire extent of the respiratory tree, clinically the patient often presents with nasal obstruction with other non-specific signs, Histology is the basis of the diagnosis of rhinoscleroma. Early and appropriate medical treatment improves the prognosis and prevents progression to disabling sequelae. We present the case of a 9-year-old child who presented to the pediatric emergency department with a 2-month history of nasal obstruction unresponsive to medical treatment (Oxymetazoline). This was accompanied by mild nasal swelling and intermittent episodes of epistaxis. A CT scan of the paranasal sinuses was performed, ruling out a malignant tumor in the nasal cavity due to the absence of bone lysis. A nasal cavity biopsy with histopathological examination was conducted, confirming the diagnosis of rhinoscleroma. This was supported by the presence of an infiltrate rich in histiocytes and plasma cells, along with the identification of Russell bodies during PAS (Periodic Acid Schiff) staining. The patient underwent a medical treatment regimen involving a sulfamide-based antibiotic therapy (trimethoprim/sulfamethoxazole) for 8 weeks, along with a short-term corticosteroid therapy at a dose of 1 mg/kg/24 hours. At the first follow-up after 1 month, there was a noticeable reduction in nasal swelling and an improvement in nasal obstruction. A second follow-up 3 months later showed favorable results, with complete disappearance of both the swelling and nasal obstruction. Considering the possibility of recurrence, an annual follow-up was decided upon.

A rare case of renal tumor in children: Clear cell sarcoma with an unusual presentation

Clear cell sarcoma of the kidney is the most frequently misdiagnosed renal tumor in children. We report the case of a 6-year-old boy with clear cell sarcoma of the kidney with an unusual presentation, including a primary tumor of the left kidney with metastasis in the homolateral psoas muscle. The renal tumor was revealed by abdominal mass without hematuria. In a review of the literature. Clear cell sarcoma of the kidney is most commonly associated with bone and lung metastases. Muscular metastasis at initial diagnosis has not previously been reported. This case represents an unusual metastatic pattern of clear cell sarcoma of the kidney. This also illustrates clear cell sarcoma of the kidney's ability to metastasize to other sites including the muscular. These tumors present a diagnostic challenge for the radiologist who should be aware of this entity to differentiate it from other renal tumors which are more frequent at this age. We aim to report the clinical, radiological features, and pathological presentation of this entity.

Superinfected and Ruptured Occipital Meningocele: Case Report

Meningocele is a rare congenital malformation of the central nervous system resulting from a herniation of the meninges containing cerebrospinal fluid through a bony defect in the skull. It is part of neural tube closure anomalies. The overall incidence of meningocele is 0.8 to 3 per 10 000 live births; it varies based on geographical location and race, with a predominance of occipital localization. Among diagnostic methods, computed tomography (CT) and magnetic resonance imaging (MRI) remain crucial examinations. Prenatal diagnosis of this malformation primarily relies on ultrasound and screening through maternal serum alpha-fetoprotein (AFP) levels. They typically manifest very early at birth with a highly suggestive radioclinical presentation. Surgical treatment usually allows for a definitive cure. Superinfection and rupture of the meningocele are exceptional, resulting from delayed diagnosis and management. In several developed countries, prevention through genetic counseling and the intake of folic acid during the periconceptional period, along with accurate prenatal diagnosis and the legalization of therapeutic abortion, has led to a decrease in the prevalence of meningoceles. In less developed countries, where there is a delay in diagnosis in exceptional cases, superinfection and rupture may occur. We present the case of an 8-month-old infant with a complicated occipital meningocele with superinfection and rupture.

Ollier disease: A case report and literature review

Ollier disease is an uncommon disease characterized by several enchondromas and an asymmetric distribution of cartilage lesions, which can vary significantly in size, location, age, and gender. The primary symptom of this condition is a nonossifying chondrocyte mass or hamartomatous chondrocyte growth in the metaphysis of a short or long bone. Specific cases can progress to chondrosarcoma or osteosarcoma. X-ray is the most fundamental diagnostic technique for skeletal illnesses. In this article, we present a case of Ollier disease from Mother and Child Hospital IBN SINA, Rabat, Morocco.

Mandibular Metastasis in Neuroblastoma in a 3 Year-Old Child: A Case Report

Neuroblastomas commonly metastasize to the cranium and orbit, although other facial bones were less implicated. In this report we present a 3 years old child with metastatic neuroblastoma to the mandible that presented with swollen right jaw. The first assessment of the head with computed tomography revealed soft tissue mass with permeative lytic changes of the osseous structures centered on the right mandible, as well as osteo-meningitis metastases. These masses were proven to be metastatic lesions from intra-abdominal neuroblastoma of the right adrenal gland. Over the previous several years, only 29 cases of neuroblastoma metastasis to the mandible have been reported in the literature.

Pituitary stalk interruption syndrome on MRI: Case report

Key clinical message

Pituitary stalk interruption syndrome (PSIS) is an antenatal anatomical defect characterized by pituitary insufficiency with symptomatology depending on associated hormonal deficits. Diagnosis is often delayed because many clinical findings. The gold standard for detection is pituitary MRI showing absence of pituitary stalk, anterior pituitary hypoplasia, and postpituitary ectopy. The treatment remains polyhormonal substitution.

Abstract

Pituitary stalk interruption syndrome (PSIS) is an antenatal anatomical defect. It is characterized by pituitary insufficiency with symptomatology depending on associated hormonal deficits. Diagnosis of PSIS is often delayed probably because of various clinical characteristics findings. Pituitary imaging abnormality is a specific indicator of hypopituitarism. The symptomatological triad associates a very thin or interrupted pituitary stalk, an ectopic or absent pituitary gland and hypoplasia of the anterior pituitary gland. The gold standard for detection is pituitary MRI. Some genetic factors are associated with the disease. The treatment remains polyhormonal substitution depending on the associated deficits. We reported the case of a 14-year-old child with growth retardation in whom the biological work-up and pituitary MRI concluded that the diagnosis was PSIS with growth hormone deficiency. The treatment implemented was a recombinant growth hormone treatment. The immediate outcome was marked by a regression of symptoms.

Extra-skeletal Ewing's sarcoma of the leg with multiple skeletal and pulmonary metastases: A rare pediatric case report

Being the second most common malignant bone tumor in children and young adults, Ewing's sarcoma can also occur as a primary soft-tissue tumor called extraosseous or extra-skeletal Ewing's sarcoma. It is a rare entity, especially in the pediatric population. We report the case of an adolescent who presented to our department for lower extremity magnetic resonance imaging to explore leg swelling. It revealed an extra-skeletal Ewing's sarcoma with multiple bone metastases. By reporting this case, we also review the literature on this rare abnormality.

Mesenchymal Hamartoma With Elevated Alpha-Fetoprotein: A Diagnostic Pitfall

Mesenchymal hamartoma (MH) is a benign liver tumor accounting for 3% to 8% of all liver tumors in children, commonly manifesting before 3 years of life. Distinguishing MH from hepatoblastoma and other liver tumors relies on imaging and alpha-fetoprotein (which is usually within normal range in MH), before histologic examination. We report a case of a hepatic MH associated with elevated alpha-fetoprotein, leading to a misdiagnosis of hepatoblastoma and the administration of chemotherapy. We draw the attention to the diagnostic difficulty and pitfalls related to alpha-fetoprotein elevation in the setting of a liver tumor, and we highlight the importance of imaging and histology in establishing the diagnosis.

Spinal Cord Cavernous Malformation: A Case Report

Spinal cord cavernous malformation is a rare and uncommon vascular malformation, it may remain asymptomatic for a long period or manifest as a sudden or gradual change in spinal cord functioning. The diagnosis relies essentially on magnetic resonance imaging (MRI). Surgery constitutes the majority of management with all the complications that can occur during and after surgery. We report a case of intramedullary cavernoma of a 12-year-old patient admitted for acute paraparesia with bowel and bladder dysfunction. MRI revealed 2 intramedullary cavernomas at T6-T7 and T11-T12. Through this case report, we discuss the clinical and radiological characteristics of this unusual intramedullary malformation.

The role of the radiologist in diagnosing placenta percreta: a case report and review of the literature

Placenta percreta is the most severe and least common form of placental insertion abnormalities. The increasing frequency of C-Section deliveries has led to more of these abnormalities. Ultrasound and magnetic resonance imaging (MRI) have a key role in diagnosing these abnormal adherences since it shows best transmural extension of the placental tissue. We report a case of a woman with a previous cesarean delivery who had been diagnosed with a placenta preavia on ultrasound and a suspicion of transmural extension with her MRI later showing a placenta percreta.

Transcranial sonographic measurement of the third ventricle to detect hydrocephalus in children population: Correlation to computed tomography

BACKGROUND

In neuro-intensive care, transcranial temporal ultrasound is used in adults and children to monitor brain-injured patients. It is accepted as a valuable tool for exploring brain structures. Our study aims to establish a correlation between the measurement of the third ventricle (V3) by transcranial ultrasound via temporal window and a reference method, computed tomography (CT), which could validate the method for hydrocephalus detection in the children population.

DESIGN

This is a prospective double-blind study of 34 children under 15 years. Two consultants in intensive care performed the ultrasound while a radiologist performed the CT measurements.

RESULTS

Of the 34 patients included, the V3 could be measured in 88% of cases. Among these 30 patients, there is a good correlation between CT and ultrasound measurements with a Spearman correlation coefficient of 0.773. This correlation is more important as the diameter of the V3 increases. We could determine a threshold of 3.65 mm in diameter to identify hydrocephalus on ultrasound with a detection sensitivity of 100%, and a specificity of 94.1%.

CONCLUSION

Measuring the diameter of the V3 by trans-cranial sonography remains a simple, reproducible, non-invasive tool and has a good correlation with reference examinations such as CT.

A rare presentation of a spinal diffuse midline glioma in a child: a case report

Our patient had an extremely rare type of pediatric Diffuse Midline Glioma (DMG) with modified H3 K27 that occurred in the cervical spinal cord. Due to its location in the spinal cord, slow clinical presentation with torticollis for 7 months, and the non-specific radiological appearance of this tumour, it was initially considered to be a low-grade glioma. Based on imaging findings, the neurosurgery team performed a complete surgical resection, but the pathological features were consistent with a high-grade, diffuse midline glioma. Therefore, we are reporting a case of an altered high-grade DMG H3K27 glioma, which is difficult to diagnose due to its slow clinical symptoms which caused a delay in diagnosis, non-specific imaging, and with difficulty in accessing histopathological markers in low and middle income countries (LMIC).

Tension Hydropneumothorax Caused by a Ruptured Hydatic Cyst in the Pleural Cavity: Case Report

Hydatid disease is a zoonosis caused by a larva of the tapeworm Echinococcus. All organs can be involved, but it is frequently located in liver for adults and lung for children. The clinical features are nonspecific. Imaging findings has an important place in the diagnosis and the follow-up. Rupture is the most common complication of a hydatic cyst and has a variety of imaging findings depending on the ruptured layer, the amount of air within the cyst and the type rupture. We report the case of a 10-year-old boy presenting shortness of breath and fever among other symptoms revealing by chest X-ray and thoracic CT scan, a lung ruptured hydatic cyst to the pleural cavity causing a tension hydro-pneumothorax and a superadded infection.

Primary signet ring cell carcinoma of the cervix: About an uncommon case report

BACKGROUND

Cervix mucinous adenocarcinomas have been defined by WHO classification into different subtypes: gastric, intestinal and ring signet cell. Ring signet cell subtype represent a diagnostic challenge due to the small number of cases described in the literature. We report hereby the 31st case worldwide, which is all the more exceptional as its atypical clinical presentation with mainly urological clinical signs represented a real diagnostic challenge.

CASE PRESENTATION

We present the uncommon case of a multiparous, menopausal 68 years-old-woman, who presented in our department for pelvic pain evolving for 4 months associated with dysuria. Gynecological examination showed a bulging mass on the anterior vaginal wall with mucoid urinary discharge. Perineal ultrasound and pelvic MRI showed an anterior vaginal mass arising from the anterior vaginal wall, invading the bladder, urethra and respecting vagina's upper third and the rectum associated with multiple metastatic left iliac lymph nodes. Anatomopathological analysis revealed a moderately differentiated mucinous adenocarcinoma with a signet-ring cell appearance. IHC stain for P16, marker for high-risk HPV, was strongly positive. Due to the advanced stage, the patient was not a candidate for upfront surgery and received definitive chemoradiation with palliative intent. The patient succumbed to her disease after only one month of chemotherapy.

CONCLUSIONS

Primary signet ring cell carcinoma of the cervix is rare and associated with a poor outcome. Prognosis is related to the clinical stage. Differentiate primary from metastatic signet cell carcinoma is compulsory. IHC is very helpful but not decisive and the diagnosis is often made by exclusion.

Saphenous Nerve Schwannoma: A Rare Differential Diagnosis of Knee Pain in Children

Schwannomas are uncommon benign tumors of the peripheral nerves with a low risk of malignant transformation. They rarely affect children, can affect any part of the body but rarely occur in the lower extremity and typically present with a palpable mass, pain or neurological signs. Imaging helps to orient the diagnosis and anatomopathological examination helps to confirm it. We report a case of a 12-year-old girl who presented with left knee pain with subcutaneous mass overlying the tibial tuberosity medially. Clinical examination revealed a positive Tinel's sign. Magnetic resonance imaging (MRI) of the knee was performed, which revealed an encapsulated subcutaneous soft tissue mass overlying the tibial tuberosity medially, eccentric to the course of the infrapatellar branch of the saphenous nerve. The patient was operated with total intracapsular excision of the lesion and the anatomopathological study of the surgical specimen came back in favor of a schwannoma. Postoperatively, the patient showed a good recovery with disappearance of pain and swelling.

Cerebral tuberculoma and convulsion in infants: A case report

Tuberculosis of the central nervous system is the second most common site after tuberculous meningitis. It represents 0.2% of intracranial expansive lesions in some Western countries compared to 10%-30% in developing countries. We report the case of an infant of 1 year and 2 months old who presented for 15 days with convulsions with asthenia, hypotonia, without fever. The clinical examination and laboratory workup were without abnormalities. His father had ongoing pulmonary tuberculosis, but the infant had no clinical or radiological signs of pulmonary tuberculosis. A brain MRI was showed multiple punctiform brain lesions, suggesting intracerebral tuberculomas in the first place, given the clinical and radiological appearance and the father's history of tuberculosis. The patient was put on anti-convulsant and antibacillary treatment. Through this case, we can see the clinical and radiological polymorphism of cerebral tuberculoma. The diagnosis of certainty remains anatomopathological. The prognosis is poor when it is detected late.

Granulomatous mastitis: A case report

Idiopathic granulomatous mastitis is a rare chronic benign inflammatory mastopathy occurring mainly in young women. With a non-specific imagery, it is considered as a diagnosis by exclusion and has a challenging treatment. Histologically, it is characterized by the predominance of polynuclear neutrophils and the absence of caseous necrosis. The breast carcinoma is the main differential diagnosis at the clinical stage, and imagery plays an essential role in its diagnostic approach. Its treatment combines antibiotics, anti-inflammatories, corticosteroid therapy, and surgery. We report a 42-year-old woman who presented a breast lesion diagnosis as granulomatous mastitis based on magnetic resonance imaging, ultrasound, and histology examinations. She received a treatment with different drugs (antibiotics, anti-inflammatories). The outcome treatment was successful with a good healing of breast lesions.

Primary Ewing's Sarcoma of the Spine: About a Case

Ewing's sarcoma is a primary malignant bone tumor affecting individuals in the second decade of life. Primary sarcomas of the spine are rare and the occurrence of primary Ewing's sarcoma in the spine is very rare. There are 2 types of Ewing's sarcoma of the spine, Ewing's sarcoma of the sacral spine which is very aggressive with a poor prognosis and Ewing's sarcoma of the non-sacral spine which is an extremely rare occurrence. The patient may have a neurological deficit when the tumor extends into the spinal canal, causing compression of the spinal cord. Magnetic resonance imaging (MRI) is very sensitive in diagnosing the tumor and Evaluation of the extent of the tumor. Here, we report the case of a 12-year-old boy who presented with low back pain, weakness of both lower limbs and bilateral spastic paraplegia progressively evolving since 1 month. The CT and MRI scans showed the presence of a tissue lesion process centered on the vertebral body of L1, heterogeneously enhanced after injection of Gadolinium respecting the posterior arch, without bulging of the posterior wall with epiduritis, endocanal extension and spinal cord compression. The patient underwent decompression with surgical biopsy and posterior stabilization of the spine. Histopathology and immunohistochemistry studies confirmed the diagnosis of Ewing's sarcoma and the patient was referred to an oncopediatric center for combined chemotherapy and radiotherapy, but died at home a few days later before the start of treatment.

Cherubism: a rare case report with literature review

Cherubism is an autosomal dominant disorder caused by a mutation of the gene encoding the binding protein SH3BP2. However, non-hereditary forms are observed, probably related to a de novo mutation. It is clinically manifested by an enlargement or a deformation of the jaw associated with a malposition of the teeth. In severe forms, these deformations can have a psychological impact, associated with ocular complications, as well as a reduction of the pharynx lumen and phonation disorders. The appearance of the lesions on imaging is not very specific, however it remains essential for the mapping of the lesions. We report a case of cherubism in a 12-year-old boy with no family history. This case report's objective is to identify the radiological aspect of this pathology and establish an early diagnosis to oriented therapeutic interventions.

Symptomatic congenital hemangiomatosis in a neonate: Imaging of a life-threatening presentation with multifocal liver involvement

Hemangiomas are the most common benign vascular neoplasms of infancy. Congenital hemangiomas proliferate in utero, and are fully formed at birth. They are usually solitary. Generalized forms are exceptional. The liver is the second most common site of hemangiomas after the skin. When >5 cutaneous hemangiomas are present, screening abdominal ultrasound is recommended. Based on the degree of liver parenchyma involvement, 3 hepatic hemangiomas’ subtypes are defined: focal, multifocal, and diffuse. Hepatic hemangiomas’ clinical presentation varies from asymptomatic to life-threatening. High output cardiac failure, consumptive coagulopathy, abdominal compartment syndrome, and liver dysfunction are possible complications. We report an unusual case of symptomatic congenital hemangiomatosis in a male infant born with innumerable generalized cutaneous hemangiomas whose screening abdominal ultrasound revealed multifocal hepatic hemangiomas with extensive mixed shunts. We aim to highlight this unique entity with severe associated complications and stress the role of imaging at initial presentation, for follow-up, and to guide therapeutic choices.

Bone Manifestations of Neurofibromatosis Type 1

Von Recklinghausen disease is the most common phacomatosis. It can affect many systems, including the bone system. Through these 2 cases, we illustrate the bone manifestations of this disease.

Primary umbilical endometriosis: case report and literature review of an unusual cause of catamenial umbilical pain

Endometriosis is defined by the presence of functional ectopic endometrial tissue outside the uterine cavity, excluding the myometrium. It is a benign tumor that can infiltrate and cling to other organs, mimicking a malignant tumor. Umbilical endometriosis is a rare type of endometriosis that can occur naturally or as a result of a surgical operation. We report the case of a patient who experienced catamenial umbilical discomfort and whose radiological examination revealed endometriotic involvement.

Neurological Involvement Complicating Invasive Pulmonary Aspergillosis

Cerebral aspergillosis is a fungal infection with a bad prognosis. It usually occurs in immunocompromised patients and manifests itself .Cross-sectional imaging reveals suggestive lesions.

Inoculum effect of Enterobacterales co-expressing OXA-48 and CTX-M on the susceptibility to ceftazidime/avibactam and meropenem

BACKGROUND

The treatment of infections caused by OXA-48/CTX-M-coproducing Enterobacterales may be based on new beta-lactam/beta-lactamase inhibitors, such as ceftazidime/avibactam (CZA), or on high dose of meropenem (MER). However, bacterial density at the infection site may vary widely, and the inoculum effect of such antimicrobial strategies has never been specifically investigated. To determine if CZA or MER susceptibilities are impacted by high inocula of Enterobacterales co-expressing both enzymes: OXA-48 like and CTX-M.

METHODS

Determination of an inoculum effect was performed with a standard inoculum of 10⁸ CFU/mL (0.5 McFarland) as recommended by EUCAST guidelines and compared to a twofold increase as well as a tenfold increase (1 McFarland and 5 McFarland respectively).

RESULTS

Thirty-nine isolates of ceftazidime-resistant Enterobacterales were included of which 27 (70%) co-expressed OXA-48 + CTX-M-15, 6 (15%) OXA-48 + CTX-M-14, and 6 (15%) OXA-181 + CTX-M-15. The susceptibility to the CZA combination was preserved whatever the inoculum used. Regarding MER, 24 (61.5%) of the isolates were susceptible to MER with the standard inoculum, 19 (48.7%) with a twofold increase, and only 15 (38.5%) with a tenfold increase.

CONCLUSION

We showed that in vitro inoculum effect was observed with meropenem but not with CZA for OXA-48- combined with CTX-M-producing Enterobacterales.

Child gigantomastia revealing juvenile giant fibroadenomas

Breast masses in children and adolescents are uncommon. They can be caused by tumors such as fibroadenomas and phyllode tumors. These masses can cause gigantomastia, due to their rapidly increasing size. We report the case of a 12- year-old patient admitted in our department for a rapidly growing gigantomastia evolving in a matter of 8 months. Imaging features were in favor of juvenile giant fibroadenomas and diagnosis was confirmed by biopsy. Juvenile giant fibroadenomas are rare and represent 0.5–2% of all fibroadenomas, their exact etiology is unknown. They affect children and adolescents, with a predominance in African-American females. They may cause breast enlargement and asymmetry. The rapid growth causes anxiety and is the main cause of consultation. These tumors although benign, have to be treated rapidly because they can destruct up to 80% of the surrounding normal breast tissue, and conservatory treatment cannot be done.

Acute Intestinal Intussusception: Beware of Burkitt's Lymphoma

Burkitt's lymphoma can show in a variety of ways, and it's frequently identified in children owing to the development of an abdominal tumor. This aggressive, fast growing tumor can induce either indirect symptoms due to pressure phenomena or direct involvement of the intestine lumen, resulting in intestinal obstruction or intussusception. We are reporting a case of intestinal intussusception in a patient with Burkitt's lymphoma.

Non-cardiovascular findings on chest CT angiography in children with congenital heart disease: How important are they?

Background

There are only a few publications about the non-cardiovascular findings in children with congenital heart diseases explored by chest CT angiography. The purpose of our study is to evaluate the prevalence of non-cardiovascular findings on chest CT angiographies in children with congenital heart disease and to raise awareness about their importance among the radiologists.

Methods

We retrospectively reviewed the 272 chest CT angiographies performed in our pediatric radiology department between January 2017 and march 2021 and extracted the data of the 180 patients positive for a congenital heart disease. Then from that pool, we sorted out the non-cardiovascular findings into significant and non-significant in regard of their relevance or not in the patient’s management.

Results

Non-cardiovascular lesions were found in 58% (105/180) of our patients, and 49% (88/180) of them presented at least one significant non-cardiac lesion. Lung and airways abnormalities were found in 41% (74/180) of the cases, representing the majority of the non-cardiovascular findings. Syndromic associations were found in 17% (28/180) of our patients, including 14 cases of heterotaxic syndrome.

Conclusion

Non-cardiovascular findings are common in children with congenital heart disease. Reporting these associated lesions is a requisite for an optimal therapeutic management of these children. Radiologists should never forget that a Chest CT angiography in children is first and foremost a chest CT.