Sharpeboyle1992

Synchronous primary malignancies are a rare finding which can be difficult to diagnose. We present the case of a 57-year-old patient with a high prostate specific antigen who was found to have prostate cancer on subsequent magnetic resonance imaging. A skeletal metastasis was also identified at the time, although no osteoblastic activity or sclerosis was identified on skeletal scintigraphy or computed tomography, respectively. The patient was started on hormonal therapy and follow-up imaging revealed the prostate cancer to have reduced in volume. Despite this, the skeletal metastasis appeared unchanged on magnetic resonance imaging and an F18-choline positron emission tomography study was negative. A computed tomography guided bone biopsy was organized and this demonstrated metastatic leiomyosarcoma. As a result, an F18-fluorodeoxyglucose positron emission tomography study was performed to find the primary lesion which demonstrated a large malignant tumor within the calf. Subsequently, the patient was referred to a tertiary sarcoma unit. This case highlights the challenges involved in diagnosing and managing synchronous malignancies.Anomalous origin of the right pulmonary artery from the ascending aorta (AORPA) is an extremely rare congenital cardiac malformation, commonly observed early in life. Patients with AORPA usually present with nonspecific clinical symptoms, commonly associated with other congenital cardiac anomalies and some complications as pulmonary hypertension and heart failure. A high index of clinical suspicion and noninvasive diagnostic imaging studies play an important role in diagnosis and preventing high mortality rates. We report a case of anomalous origin of the right pulmonary artery from the ascending aorta in a 15-year-old girl that was diagnosed with severe pulmonary hypertension, pulmonary hemorrhage, and small pulmonary artery aneurysm. Clinical, radiographic imaging and other investigations' findings are described. To the best of our knowledge, this is the first reported case of anomalous origin of the right pulmonary artery from the ascending aorta with large patent ductus arteriosus associated with a small pulmonary artery aneurysm.Tuberculous epididymo-orchitis is an uncommon complication after intravesical bacilli Calmette-Guerin therapy for nonmuscle invasive bladder cancer. Spread of granulomatous disease through the genitourinary tract specifically to the testes occurs in 0.4% of treated patients. The following case presents a 77-year-old man who underwent intravesical therapy after transurethral resection of bladder tumor and developed testicular discomfort and a palpable mass 2 years after initiation of therapy. After wide range of serum and urine analyses, repeated testicular ultrasonography, and an unsuccessful course of antibiotics, the patient elected to undergo orchiectomy and was confirmed to have tuberculous epididymo-orchitis. Diagnosis based on imaging and laboratory serum and urine analysis may be elusive and therefore review of this entity and associated sonographic findings is discussed.The incidence of central nervous system tuberculosis is a rare entity that accounts about 1% of all tuberculosis and remains a major health problem in developing countries. We report a case of 1-year-old baby boy who presented with a three-week history of vomiting, seizure and progressive right-sided weakness. Brain magnetic resonance imaging performed on the admission day revealed a large lesion measuring (4.3*3.5cm) involving the left thalamus with extensive perilesional edema producing enfacement of third ventricle, midline shifting and obstructive hydrocephalus.Atypical meningioma (AM) (WHO-II) has a recurrence rate of 28% after gross total resection (GTR) with limited salvage options. Transarterial therapies may provide treatment opportunities in AM patients who exhausted standard-of-care therapy. In cases where favorable tumor vasculature and particle simulation demonstrate acceptable target dose, Yttrium-90 trans-arterial radioemobilization (TARE) could theoretically provide salvage therapy. A 67-year-old man presented with recurrent AM post gross total resection with adjuvant radiotherapy in 2012, 2014, and 2016. The patient was deemed a poor candidate for additional therapies. Tumor vasculature mapping was performed to determine TARE candidacy. Super-selective angiography and contrast-enhanced cone-beam computed tomography angiosomes demonstrated predominant pial collaterals and minor supply from a middle meningeal artery branch. Particle simulation was performed by infusing 0.3 mCi of 99mTc-macroaggregated albumin (99mTc-MAA). SPECT/CT-MRI fusion demonstrated conformal activity solely within the tumor volume perfused by the middle meningeal artery branch with a lung shunt fraction of 54.7%. The patient subsequently received off-label Nivolumab (PD-1 inhibitor). Mapping angiography for AM using 99mTc-MAA is feasible. selleckchem It may identify candidates for TARE and potential AM patients with favorable blood supply. The potential for conformal intracranial vascular brachytherapy is intriguing, however, altered arterial supply in recurrent tumors is challenging.Bow Hunter's syndrome is extremely rare, which is mainly caused by mechanical vertebral artery occlusion or stenosis during head and neck rotation or hyperextension. Herein, we describe the case of a 19-year-old man without a history of trauma who presented with dizziness, binocular blackness, and disturbance of consciousness after looking up when cleaning the classroom. Subsequent imaging findings revealed the blood flow of the C2 segment of the contralateral vertebral artery was interrupted when the patient turned his head to 1 side. Such patients with normal CT angiography of the head and neck scan will show that the head and neck blood vessels are normal, which will affect the prognosis of patients. This case highlights the importance and implications of dynamic CT angiography of the head and neck in the diagnosis of Bow Hunter's syndrome.Lumps in the hand are a common presenting complaint in General Practice. We present the case of a 24-year-old male who presented to his General Practitioner with a painful lump in the dorsum of his right hand. He was referred to the sarcoma services where MRI and ultrasound examinations revealed an accessory Extensor Digitorum Brevis Manus muscle as the cause of the patient's symptoms. When patients present with a painful or discomforting lump in the dorsum of the hand during or after repetitive use, typically on flexion, a diagnosis of Extensor Digitorum Brevis Manus should be considered.