Claw sign of brachial plexopathy on 18F-FDG PET/CT in neurolymphomatosis following successful treatment of lymphoma

Neurolymphomatosis is a rare neurological manifestation associated with non-Hodgkin’s lymphoma. Here we present a case of brachial plexus neurolymphomatosis in a patient with relapsed non-Hodgkin’s lymphoma exquisitely demonstrated on ¹⁸F-FDG PET/CT. It highlights the characteristic imaging features and importance of multimodality imaging in diagnosing neurolymphomatosis.

Isolated CNS relapse of medullary aggressive high-grade B-cell lymphoma on 18F-FDG-PET/CT

This is a case of high-risk, aggressive, high-grade medullary B-cell lymphoma presenting with new onset of neurological dysfunction following initial complete response to the standard chemoimmunotherapy. A whole-body re-staging PET using fluorodeoxyglucose (¹⁸F-FDG) integrated with computed tomography (¹⁸FDG-PET/CT) performed with clinical suspicion of arachnoiditis, eloquently demonstrated unequivocal multifocal FDG uptake by the spinal cord without evidence of systemic recurrence, leading to a clinical diagnosis of secondary CNS lymphoma, which is a rare complication of DLBCL with ominous prognosis. Four cycles of Modified-MATRIX protocol resulted in a halt in fulminant course of the disease and the patient experienced slight reversal of the neurological deficits, although not deemed clinically fit for a repeat ¹⁸FDG-PET/CT due to his poor general well-being. Repeat MRI was suggestive of partial recovery, however. The clinical stability was proven short-lived, and the patient experienced progressive lower limb weakness only 3 weeks after discharge following his last cycle of treatment. Isolated CNS relapse of lymphoma is a rare occurrence in the literature. The CNS recurrence is more often leptomeningeal or confined to the brain parenchyma rather than the spinal cord. The role of ¹⁸FDG-PET/CT in the diagnostic algorithm of secondary CNS lymphoma is unclear and its significance in risk stratification and assessing the response to treatment has not been evaluated. This case report illustrates the imaging findings of a more unusual form of the disease with multifocal intramedullary involvement of the spinal cord, and highlights imaging features of this rare condition with ¹⁸FDG-PET/CT and MRI to support decision making in good clinical practice.

Spurious Uptake on 68Ga-Prostate-Specific Membrane Antigen PET/CT Due to Ankylosing Spondylitis; A Rare Pitfall in Imaging of Biochemical Recurrence of Prostate Cancer

ABSTRACT

Bone is one of the most common sites of prostate cancer recurrence, and 68Ga-prostate-specific membrane antigen (PSMA) uptake by benign bone entities poses a diagnostic dilemma. We describe the case of a 60-year-old man with recurrence in a small presacral node on 68Ga-PSMA PET/CT. Of note, the images also demonstrated bilateral asymmetrical sacroiliac joint uptake. A history of ankylosing spondylitis was subsequently elicited, confirming the radiographic suspicion of sacroiliitis, therefore confirming the nonmalignant nature of 68Ga-PSMA uptake related to sacroiliitis rather than osseous recurrence from prostate carcinoma. 68Ga-PSMA uptake may indicate angioneogenesis in sacroiliitis and consequently may be helpful in assessing disease activity and therapy response.

Meningioma uptake of 68Gallium-PSMA-11 as a pitfall on positron emission tomography/computer tomography

Prostate cancer is the most common malignancy in men with high incidence of recurrence following treatment. Biochemical recurrence, as indicated by rising PSA levels following successful treatment of the primary disease, is a frequent encounter in routine clinical practice. ⁶⁸Gallium-PSMA positron emission tomography/computer tomography has been widely accepted as the modality of choice with the highest impact in management of this group of patients. Pitfalls of this diagnostic technique stem from the diversity of histological entities, other than prostate tumour cells, which can demonstrate increased uptake of the radiotracer. We present a case of intracranial uptake of PSMA by meningioma in a patient with BCR, as a pitfall in imaging of prostate cancer. Knowledge of normal distribution of the tracer is of utmost importance when reading positron emission tomography/computer tomography imaging especially given the relative novelty of usage of ⁶⁸Gallium-PSMA.

A twisted tale-radiological imaging features of COVID-19 on 18F-FDG PET/CT

The COVID-19 pandemic has had a major impact on health care systems across the globe in a short period of time. There is a growing body of evidence surrounding the findings on hybrid imaging with FDG-PET/CT, and this case highlights the importance of molecular imaging in better understanding of the biomarkers of the disease which ultimately determine the success in building a model to predict the disease severity and monitoring the response to treatment.

A Rare Cause of Obstructive Jaundice: Cecal Herniation through the Foramen of Winslow

Internal abdominal hernias are rarely reported in the literature and have a very low rate of preoperative diagnosis. It is even rarer that they present with jaundice. A 59-year-old Caucasian female presented with a short history of jaundice, dark urine, epigastric pain, vomiting, and obstipation. Her liver biochemistry profile revealed a mixed cholestatic/hepatocellular pattern with significantly elevated bilirubin. She urgently underwent abdominal imaging which provided a preoperative diagnosis of internal herniation of the cecum within the lesser sac through the foramen of Winslow. The dilated bowel was compressing the common bile duct explaining the jaundice. This was repaired intraoperatively by anchoring the mobile cecum. In this case, we highlight the importance of maintaining a high index of suspicion for internal herniation on abdominal imaging with clinical evidence of intestinal obstruction. A foramen of Winslow hernia should be further suspected in the presence of jaundice.

Twisted tail: spinal epidural lipomatosis responding to chemotherapy in a patient with non-small-cell lung cancer

Spinal epidural lipomatosis is a rare condition, described in corticoadrenal hyperactivity. It is most commonly seen in association with steroid administration and occasionally with Cushing's syndrome. This is the first case report of spinal epidural lipomatosis as presenting finding in a patient with non-small-cell lung carcinoma without any evidence of endogenous or exogenous hypercortisolism. The additional interesting feature is the paraneoplastic behaviour of this condition and even more interestingly its resolution following chemo-treatment of the primary cancer. Spinal epidural lipomatosis is a benign condition, which must be considered in the differential diagnosis of spinal cord compression in this category of patients. Its pathophysiology remains to be discovered in future.

An eye on sexually transmitted diseases: sexually transmitted diseases and their ocular manifestations

Ocular examination should be a part of the routine assessment of the patients seen at sexually transmitted diseases (STD) clinics due to the importance of these organs in the general wellbeing of patients. It is essential to keep an open eye on ocular signs and symptoms of patients with a history of exposure to common STD pathogens, to ensure prompt investigation and management of ocular complications of the STDs, which, if left unnoticed, otherwise could subject the patients to a great deal of anxiety and distress.

Spondylodiscitis due to Aerococcus viridans

Aerococcus viridans is a microaerophilic, Gram-positive, catalase-negative coccus, found singly or in tetrads. To date, no case of spondylodiscitis due to this organism has been reported. We report what we believe to be the first case of spondylodiscitis caused by A. viridans, in a patient with decompensated liver failure, and discuss the possible pathogenesis of this rather uncommon pathogen in this case.

What you can see in your patient's eyes? Review of ocular manifestations of HIV in HAART era

The early diagnosis and treatment of ocular disease to prevent morbidity and mortality of patients with human immunodeficiency virus (HIV) is of paramount importance. Since the advent of highly active antiretroviral therapy (HAART), the incidence of ocular complications of HIV has decreased and their manifestations and natural course are also modified. This has been observed in the face of emerging immune recovery, which per se has brought new difficulties in the process of diagnosing and management of the ocular disease. Conditions such as immune recovery uveitis could affect eyes with history of opportunistic disease with a potential to cause vision loss; with this regard, differentiation of the inflammatory process from infective causes is essential. The other sexually contracted diseases are also to be included in this complex picture because of their contribution to the clinical picture and also sharing common routes of transmission with HIV. There is very little doubt that visual deterioration would further deteriorate the already compromised quality of life of this group of patients. In this review, authors wish to provide evidence available in the medical literature around the visual health issues in HIV-infected patients and raise awareness towards the changing pattern of the ocular disease in the HAART era.

Neonatal herpes in herpes simplex virus type 2 and HIV-seropositive pregnant patients; the role of preventive measures in the absence of clinical disease of herpes

There is very little knowledge about how herpes simplex virus (HSV) seropositivity of HIV-positive mothers could complicate the occurrence of neonatal herpetic disease, in the absence of genital ulcers, in this group of patients. We present a case of fatal disseminated neonatal herpes infection in a baby, born to a HIV-positive patient, and wish to discuss the potential need for changes in the management of this group of patients during pregnancy. Disseminated HSV disease is a rare, yet serious condition in newborns of HSV-infected mothers, and women with HIV infection have shown to frequently shed more HSV DNA in their genital secretions, even in the absence of active herpetic ulcers. This is the first case report of this rare association and, as a result, the evidence in support of our hypothesis has been extrapolated from other studies.