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Rizk RC, Yasrab M, Chu LC, Weisberg EM, Fishman EK. Metastatic sclerosing epithelioid fibrosarcoma. Radiol Case Rep 2024; 19:1815-1818. [PMID: 38415064 PMCID: PMC10897837 DOI: 10.1016/j.radcr.2024.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
Sclerosing epithelioid fibrosarcoma is a rare fibrosarcoma variant in which more than half of patients experience local recurrence or metastatic spread. In the current literature, there is limited and nonspecific imaging data, contributing to frequent misdiagnosis and delays in treatment intervention. Given the poor prognosis associated with this malignancy and the high probability of metastases, accurate and prompt diagnoses are critical. In this article, we report the case of a 27-year-old female diagnosed with metastatic sclerosing epithelioid fibrosarcoma following the discovery of a growing palpable mass on her right gluteus maximus muscle. We focus on the use of radiological imaging modalities in optimizing diagnosis and correlate our imaging and pathological findings.
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Affiliation(s)
- Ryan C. Rizk
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Mohammad Yasrab
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Linda C. Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Edmund M. Weisberg
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
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Rizk RC, Yasrab M, Chu LC, Weisberg EM, Fishman EK. Primary renal liposarcoma simulating angiomyolipoma. Radiol Case Rep 2024; 19:1484-1488. [PMID: 38312755 PMCID: PMC10835115 DOI: 10.1016/j.radcr.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
Liposarcomas are infrequent malignant tumors of mesenchymal origin most commonly seen in the extremities. Although infrequent, these can develop as primary lesions in the soft tissue of the kidney, making them difficult to diagnose through imaging modalities alone. Primary renal liposarcomas are associated with poor prognoses, increasing the importance of timely and accurate diagnosis. In extremely rare instances, the tumor can arise directly from the fat in the epicenter of the kidney, disguised as an angiomyolipoma. In this article, we report the case of a 54-year-old female who was diagnosed with a well-differentiated liposarcoma of the kidney and underwent radical nephrectomy. Our objective is to evaluate unique radiological imaging findings and correlate with histopathological analysis to optimize diagnosis.
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Affiliation(s)
- Ryan C. Rizk
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287, USA
| | - Mohammad Yasrab
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287, USA
| | - Linda C. Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287, USA
| | - Edmund M. Weisberg
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287, USA
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287, USA
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Yasrab M, Rizk RC, Chu LC, Fishman EK. Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem. Emerg Radiol 2024; 31:269-276. [PMID: 38236521 DOI: 10.1007/s10140-024-02204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
Non-traumatic thoracic aorta emergencies are acute conditions associated with substantial morbidity and mortality. In the emergency setting, timely detection of aortic injury through radiological imaging is crucial for prompt treatment planning and favorable patient outcomes. 3D cinematic rendering (CR), a novel rendering algorithm for computed tomography (CT) image processing, allows for life-like visualization of spatial details and contours of highly complex anatomic structures such as the thoracic aorta and its vessels, generating a photorealistic view that not just adds to diagnostic confidence, but is especially useful for non-radiologists, including surgeons and emergency medicine physicians. In this pictorial review, we demonstrate the utility of CR in the setting of non-traumatic thoracic aorta emergencies through 10 cases that were processed at a standalone 3D CR station at the time of presentation, including its role in diagnosis and management.
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Affiliation(s)
- Mohammad Yasrab
- Department of Radiology, School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287-0801, USA.
| | - Ryan C Rizk
- Department of Radiology, School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287-0801, USA
| | - Linda C Chu
- Department of Radiology, School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287-0801, USA
| | - Elliot K Fishman
- Department of Radiology, School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287-0801, USA
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Yasrab M, Thakker S, Wright MJ, Ahmed T, He J, Wolfgang CL, Chu LC, Weiss MJ, Kawamoto S, Johnson PT, Fishman EK, Javed AA. Factors associated with radiological misstaging of pancreatic ductal adenocarcinoma: A retrospective observational study. Curr Probl Diagn Radiol 2024:S0363-0188(24)00047-1. [PMID: 38522966 DOI: 10.1067/j.cpradiol.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Accurate staging of disease is vital in determining appropriate care for patients with pancreatic ductal adenocarcinoma (PDAC). It has been shown that the quality of scans and the experience of a radiologist can impact computed tomography (CT) based assessment of disease. The aim of the current study was to evaluate the impact of the rereading of outside hospital (OH) CT by an expert radiologist and a repeat pancreatic protocol CT (PPCT) on staging of disease. METHODS Patients evaluated at the our institute's pancreatic multidisciplinary clinic (2006 to 2014) with OH scan and repeat PPCT performed within 30 days were included. In-house radiologists staged disease using OH scans and repeat PPCT, and factors associated with misstaging were determined. RESULTS The study included 100 patients, with a median time between OH scan and PPCT of 19 days (IQR: 13-23 days.) Stage migration was mostly accounted for by upstaging of disease (58.8 % to 83.3 %) in all comparison groups. When OH scans were rereviewed, 21.5 % of the misstaging was due to missed metastases, however, when rereads were compared to the PPCT, occult metastases accounted for the majority of misstaged patients (62.5 %). Potential factors associated with misstaging were primarily related to imaging technique. CONCLUSION A repeat PPCT results in increased detection of metastatic disease that rereviews of OH scans may otherwise miss. Accessible insurance coverage for repeat PPCT imaging even within 30 days of an OH scan could help optimize delivery of care and alleviate burdens associated with misstaging.
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Affiliation(s)
- Mohammad Yasrab
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sameer Thakker
- Department of Surgery, New York University Langone Hospital, NYU Langone Health, New York City, NY, USA
| | - Michael J Wright
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taha Ahmed
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher L Wolfgang
- Department of Surgery, New York University Langone Hospital, NYU Langone Health, New York City, NY, USA
| | - Linda C Chu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Weiss
- Department of Surgery, Northwell Health, Lake Success, NY, USA
| | - Satomi Kawamoto
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela T Johnson
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elliot K Fishman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ammar A Javed
- Department of Surgery, New York University Langone Hospital, NYU Langone Health, New York City, NY, USA.
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Rizk RC, Yasrab M, Weisberg EM, Fishman EK. Gastrointestinal basidiobolomycosis masquerading as cancer. Radiol Case Rep 2024; 19:944-948. [PMID: 38188959 PMCID: PMC10766992 DOI: 10.1016/j.radcr.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 01/09/2024] Open
Abstract
Gastrointestinal basidiobolomycosis is an unusual fungal infection caused by Basidiobolus ranarum, a saprophytic fungus primarily found in soil and decaying vegetables. Basidiobolomycosis typically presents as a chronic subcutaneous swelling and rarely infects the gastrointestinal tract. Thus, the infrequency of gastrointestinal infections, along with nonspecific clinical symptoms, often results in misdiagnosed cases and delays in treatment. In this article, we report the case of a 68-year-old male with gastrointestinal basidiobolomycosis masquerading as metastatic cancer. We focus on the use of radiological imaging modalities and histopathological analysis to optimize the diagnosis and treatment of this rare gastrointestinal infection.
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Affiliation(s)
- Ryan C Rizk
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Mohammad Yasrab
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Edmund M Weisberg
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
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Rizk RC, Yasrab M, Weisberg EM, Fishman EK. Primary diffuse large B-cell lymphoma of the cecum. Radiol Case Rep 2024; 19:922-926. [PMID: 38188947 PMCID: PMC10767273 DOI: 10.1016/j.radcr.2023.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024] Open
Abstract
When found in the cecum or rectosigmoid junction, primary colorectal B-cell lymphoma is a rare malignant non-Hodgkin's lymphoma often associated with an unfavorable prognosis. Due to the nonspecific clinical symptoms, these uncommon tumors are often left undefined or misdiagnosed, resulting in delays in treatment and adverse patient outcomes. Contrast-enhanced computed tomography is the most commonly used medical imaging process for primary colorectal lymphoma, but due to the rarity of this disorder, accurate imaging diagnosis remains a clinical challenge. In this article, we report the case of a 70-year-old male who was diagnosed with primary B-cell lymphoma of the cecum. We focus on improving diagnosis through the utilization of radiological imaging modalities, particularly computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18-F-FDG PET/CT). While imaging modalities are important in recognizing colonic lymphomas, there are no pathognomonic imaging features for lymphoma; therefore, biopsy remains necessary for diagnostic confirmation.
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Affiliation(s)
- Ryan C. Rizk
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Mohammad Yasrab
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Edmund M. Weisberg
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
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Karim MM, Khalid AB, Sohail Z, Yasrab M. Recurrence of portosystemic encephalopathy in cirrhotic patients and its risk factors. Pak J Med Sci 2024; 40:140-144. [PMID: 38196479 PMCID: PMC10772413 DOI: 10.12669/pjms.40.1.8025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/25/2023] [Accepted: 09/18/2023] [Indexed: 01/11/2024] Open
Abstract
Objectives Recurrent episodes of Portal Systemic Encephalopathy (PSE), poses a significant burden of illness on the patients and healthcare system. The objective of this study was to assess the recurrence of PSE in cirrhotic patients after index episode of PSE and to identify various risk factors associated with it. Methods A retrospective, single-centre study was conducted at Aga Khan University Hospital over a span of one year. Patients who were admitted first time with PSE and admitted within three months of index PSE were enrolled in the study. Variables assessed were demographic data, associated comorbid conditions, aetiology of cirrhosis, Child-Turcotte-Pugh (CTP) score, Model of End-Stage Liver Disease (MELD) score, PSE grade, laboratory tests, ascites with spontaneous bacterial peritonitis (SBP), variceal bleeding. Statistical analysis was done and variables of those who developed recurrence were compared with those who did not. Results Fifty one patients were recruited. Thirty three (64.7%) were readmitted with PSE. On comparative analysis of both groups; infection, Meld score, low albumin, and raised total bilirubin showed significant P-value (<0.05). Conclusion Identification of risk factors during assessment can reduce the recurrence of PSE. We would recommend to validate result of our study on a large scale prospectively.
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Affiliation(s)
| | - Abdullah Bin Khalid
- Abdullah Bin Khalid, Lecturer, Department of Medicine, Lecturer, Dow University of Health Science, Karachi, Pakistan, Aga Khan University Hospital, Karachi, Pakistan
| | - Zahabia Sohail
- Zahabia Sohail, Resident, Post Graduate Medical Education, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Yasrab
- Mohammad Yasrab, Student, Undergraduate Medical Education, Aga Khan University, Karachi, Pakistan
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Yasrab M, Haider Naqvi SE, Ahmed F, Ahmed M, Rana S, Khushdil A. Preventing Catheter Related Bladder Discomfort (CRBD) in male patients undergoing Lower Urinary tract surgery with Bilateral Pudendal Nerve Block:A Randomized Controlled Trial. PAFMJ 2022. [DOI: 10.51253/pafmj.v72i2.7646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To compare the frequency and severity of post-operative CRBD in patients undergoing TURP and TURBT with spinal anaesthesia with pudendal nerve block against spinal anaesthesia alone.
Study Design: A randomized controlled trial (Clinical trials.gov: NCT05022160)
Place and Duration of Study: Armed Forces Institute of Urology (AFIU), Rawalpindi Pakistan, from Aug to Nov, 2021.
Methodology: The trial comprised 250 patients scheduled to have a transurethral resection of the prostate (TURP) or a transurethral resection of a bladder tumour (TURBT) under spinal anaesthesia. They were split into two groups: study (group-P) and control (group-C). After surgery, the patients in the study-group were given a bilateral pudendal nerve block. At 3, 8, 12, and 24 hours following surgery, the frequency and severity of catheter-related bladder discomfort (CRBD) were documented.
Results: CRBD frequencies were significantly lower in pudendal group at 3 hours 42 (33.8%) vs 72 (58.5%), p <0.001), 8 hours 81 (65.3%) vs 111 (90.2%), p<0.001 and 12 hours 53 (42.7%) vs 73 (59.3%), p=0.009 after the surgery. The postoperative pain score in pudendal group was lower at 3 hours (p<0.001), 8 hours (p <0.001), and 12 hours (p=0.02) but there was no statistically significant difference between the two groups at 24 hours (p=0.06).
Conclusion: When used in conjunction with spinal anaesthesia, a pudendal nerve block reduces the frequency and severity of catheter-related bladder discomfort for up to 12 hours after surgery.
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