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Khataniar H, Vellankal S. Acute Hemorrhagic Pancreatitis as a Rare Complication of Dengue Fever. ACG Case Rep J 2023; 10:e01152. [PMID: 37753103 PMCID: PMC10519561 DOI: 10.14309/crj.0000000000001152] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 09/28/2023] Open
Abstract
Dengue fever can lead to a range of symptoms, including severe manifestations such as dengue hemorrhagic fever. We report a rare case of severe dengue with hemorrhagic pancreatitis and pseudocyst formation in a 28-year-old woman. Initially presenting with fever, abdominal pain, and gastrointestinal symptoms, the patient developed worsening pain, vomiting, and an abdominal mass. Imaging revealed a pancreatic mass, and elevated amylase and lipase confirmed pancreatitis. Interventional radiology drained the hemorrhagic fluid from the suspected pseudocyst, leading to patient improvement and eventual discharge. This uncommon complication of acute hemorrhagic pancreatitis in dengue fever has not been previously documented.
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Affiliation(s)
- Himsikhar Khataniar
- Department of Internal Medicine, St. John's Medical College, Bengaluru, India
| | - Shreya Vellankal
- Department of Internal Medicine, St. John's Medical College, Bengaluru, India
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Otto W, Psomiadis JS, Kirshner B. Management of a Suspected Renal Cyst Infection With Intracystic Hemorrhage in a Patient With Autosomal Dominant Polycystic Kidney Disease. Cureus 2023; 15:e39319. [PMID: 37351251 PMCID: PMC10282502 DOI: 10.7759/cureus.39319] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/24/2023] Open
Abstract
Renal cyst infections are a serious complication in patients with autosomal dominant polycystic kidney disease (ADPKD). Cyst infections are challenging to treat and have a high incidence of complications such as sepsis and death. No guideline or evidence-based strategy for diagnosis or treatment of cyst infection currently exists. This lack of standardized guidance leads to individualized medical decision-making for each individual case, despite the high risk of morbidity and mortality associated with the infection. This case describes a 33-year-old female with a past medical history of ADPKD that presented with hematuria, increased urinary frequency, and left flank pain. On computed tomography (CT) imaging, she was found to have a large intracystic hemorrhage with an associated hematoma formation. Laboratory evaluation was remarkable for leukocytosis with left shift but normal renal function. Urinalysis displayed hematuria and the presence of protein, but the culture resulted in no growth. In the presence of clinical signs of infection, she was suspected to have an infected renal cyst that did not have glomerular communication, given the bland urinalysis and negative urine culture. Her hemoglobin stabilized, and she did not require embolization or percutaneous drainage of the cyst. Intravenous levofloxacin was initiated, and the patient clinically improved with the normalization of leukocytosis. Blood cultures remained negative, and she was discharged to home with a course of oral levofloxacin with a resolution of symptoms.
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Affiliation(s)
- Whitnee Otto
- Internal Medicine, Piedmont Macon Medical Center, Macon, USA
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Ștefan RA, Ștefan PA, Mihu CM, Csutak C, Melincovici CS, Crivii CB, Maluțan AM, Hîțu L, Lebovici A. Ultrasonography in the Differentiation of Endometriomas from Hemorrhagic Ovarian Cysts: The Role of Texture Analysis. J Pers Med 2021; 11:jpm11070611. [PMID: 34203314 PMCID: PMC8306221 DOI: 10.3390/jpm11070611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/01/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023] Open
Abstract
The ultrasonographic (US) features of endometriomas and hemorrhagic ovarian cysts (HOCs) are often overlapping. With the emergence of new computer-aided diagnosis techniques, this is the first study to investigate whether texture analysis (TA) could improve the discrimination between the two lesions in comparison with classic US evaluation. Fifty-six ovarian cysts (endometriomas, 30; HOCs, 26) were retrospectively included. Four classic US features of endometriomas (low-level internal echoes, perceptible walls, no solid components, and less than five locules) and 275 texture parameters were assessed for every lesion, and the ability to identify endometriomas was evaluated through univariate, multivariate, and receiver operating characteristics analyses. The sensitivity (Se) and specificity (Sp) were calculated with 95% confidence intervals (CIs). The texture model, consisting of seven independent predictors (five variations of difference of variance, image contrast, and the 10th percentile; 100% Se and 100% Sp), was able to outperform the ultrasound model composed of three independent features (low-level internal echoes, perceptible walls, and less than five locules; 74.19% Se and 84.62% Sp) in the diagnosis of endometriomas. The TA showed statistically significant differences between the groups and high diagnostic value, but it remains unclear if the textures reflect the intrinsic histological characteristics of the two lesions.
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Affiliation(s)
- Roxana-Adelina Ștefan
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania;
| | - Paul-Andrei Ștefan
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Victor Babes, Street, Number 8, 400012 Cluj-Napoca, Romania;
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Correspondence: or
| | - Carmen Mihaela Mihu
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street, Number 3-5, 400006 Cluj-Napoca, Romania
| | - Carmen Stanca Melincovici
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
| | - Carmen Bianca Crivii
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Victor Babes, Street, Number 8, 400012 Cluj-Napoca, Romania;
| | - Andrei Mihai Maluțan
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania;
- Obstetrics and Gynecology Clinic II, Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania
| | - Liviu Hîțu
- Doctoral School, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street, Number 3-5, 400006 Cluj-Napoca, Romania
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Watanabe K, Mitsui K, Sasaki J, Kumaki D. Subacute hemorrhagic cyst of the ligamentum flavum occurred in the lumbosacral transitional vertebra presenting as progressive lumbar nerve root compression: a case report. J Spine Surg 2021; 7:238-243. [PMID: 34296039 DOI: 10.21037/jss-20-683] [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] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/14/2021] [Indexed: 11/06/2022]
Abstract
The lumbosacral transitional vertebrae (LSVT) has been reported to be a cause of lumbar disc herniation as a result of mechanical stress, however there were no reports about relationship between LSTV and hemorrhagic intervertebral cystic lesion. We report a rare case of a hemorrhagic intravertebral cystic lesion that occurred in the LSVT of a 42-year-old man and had a subacute course of lumbar nerve root compression. He presented our hospital with complain of increasing left leg pain for one week. Contrast-enhanced MRI (Gd-T1WI) showed a heterogenous contrast-enhanced effect on the nodule at the entrance of the left pedicle root of L6. The LSTV was classified as Type IIIA using the Castellvi's classification, and the nodule was found on the ipsilateral of the lumbarization. From the imaging findings, disc cysts, ganglion cysts, synovial cysts, disc sequestration and Schwannomas were differentials of the intravertebral canal cystic lesions; however, it was suspected to be a hemorrhagic cystic lesion because of their acute progression of his symptoms, his relatively young age and imaging findings. His symptoms improved shortly after the resection of the cyst and he was diagnosed as intracystic hemorrhage of a ganglion in the ligamentum flavum. There were no features suggestive of recurrence of the cystic lesion in the follow-up MRI on 6 months after the surgery. It was speculated that in the LSTV, twisting movements act on the upper part adjacent to the transitional vertebra, causing microtrauma around the facet joint that leads to the forming a hemorrhagic cyst following damage around the joint capsule. It is difficult to make a diagnosis of hemorrhagic cyst from imaging alone. It must be suspected from the aspect of age (relatively young), gender (male), clinical course (acute to subacute) and MR imaging (various signal intensity patterns on T2WI and contrast effect on Gd enhancement).
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Affiliation(s)
- Kenya Watanabe
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Katsuhiro Mitsui
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Jun Sasaki
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Daiki Kumaki
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
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Decommer K, Feyaerts F. The T2 Dark Spot Sign in Endometrioma. J Belg Soc Radiol 2020; 104:74. [PMID: 33336145 DOI: 10.5334/jbsr.2271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Teaching Point: The T2 dark spot sign has low sensitivity but high specificity for endometrioma on MR imaging.
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Riyahi S, Dev H, Blumenfeld JD, Rennert H, Yin X, Attari H, Barash I, Chicos I, Bobb W, Donahue S, Prince MR. Hemorrhagic Cysts and Other MR Biomarkers for Predicting Renal Dysfunction Progression in Autosomal Dominant Polycystic Kidney Disease. J Magn Reson Imaging 2020; 53:564-576. [PMID: 32969110 DOI: 10.1002/jmri.27360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/12/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Screening for rapidly progressing autosomal dominant polycystic kidney disease (ADPKD) is necessary for assigning and monitoring therapies. Height-adjusted total kidney volume (ht-TKV) is an accepted biomarker for clinical prognostication, but represents only a small fraction of information on abdominal MRI. PURPOSE To investigate the utility of other MR features of ADPKD to predict progression. STUDY TYPE Single-center retrospective. POPULATION Longitudinal data from 186 ADPKD subjects with baseline serum creatinine, PKD gene testing, abdominal MRI measurements, and ≥2 follow-up serum creatinine were reviewed. FIELD STRENGTH/SEQUENCE 1.5T, T2 -weighted single-shot fast spin echo, T1 -weighted 3D spoiled gradient echo (liver accelerated volume acquisition) and 2D cine velocity encoded gradient echo (phase contrast MRA). ASSESSMENT Ht-TKV, renal blood flow (RBF), number and fraction of renal and hepatic cysts, bright T1 hemorrhagic renal cysts, and liver and spleen volumes were independently assessed by three observers blinded to estimated glomerular filtration rate (eGFR) data. STATISTICAL TESTS Linear mixed-effect models were applied to predict eGFR over time using MRI features at baseline adjusted for confounders. Validation was performed in 158 patients who had follow-up MRI using receiver operator characteristic, sensitivity, and specificity. RESULTS Hemorrhagic cysts, fraction of renal and hepatic cysts, height-adjusted liver and spleen volumes were significant independent predictors of future eGFR (final prediction model R2 = 0.88 P < 0.05). The number of hemorrhagic cysts significantly improved the prediction compared to ht-TKV in predicting future eGFR (area under the curve [AUC] = 0.94, 95% confidence interval [CI]: 0.9-0.94 vs. R2 = 0.9, 95% CI: 0.85-0.9, P = 0.045). For baseline eGFR ≥60 ml/min/1.73m2 , sensitivity for predicting eGFR<45 ml/min/1.73m2 by ht-TKV alone was 29%. Sensitivity increased to 72% with all MRI variables in the model (P < 0.05 = 0.019), whereas specificity was unchanged, 100% vs. 99%. DATA CONCLUSION Combining multiple MR features including hemorrhagic renal cysts, renal cyst fraction, liver and spleen volume, hepatic cyst fraction, and renal blood flow enhanced sensitivity for predicting eGFR decline in ADPKD compared to the standard model including only ht-TKV. Level of Evidence 2 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:564-576.
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Affiliation(s)
- Sadjad Riyahi
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Hreedi Dev
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Jon D Blumenfeld
- The Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Hanna Rennert
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Xiaorui Yin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Hanieh Attari
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Irina Barash
- The Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ines Chicos
- The Rogosin Institute, New York, New York, USA
| | - Warren Bobb
- The Rogosin Institute, New York, New York, USA
| | | | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Columbia College of Physicians and Surgeons, New York, New York, USA
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Ludwig DR, Ballard DH, Shetty AS, Siegel CL, Yano M. Apparent Diffusion Coefficient Distinguishes Malignancy in T1-Hyperintense Small Renal Masses. AJR Am J Roentgenol 2020; 214:114-21. [PMID: 31573857 DOI: 10.2214/AJR.19.21907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE. Small renal masses (< 4 cm) can be difficult to accurately classify as benign or malignant, particularly when they appear T1 hyperintense on MRI. This intrinsic signal, potentially related to intralesional hemorrhage, may limit evaluation of signal intensity on DWI. The purpose of this study was to test whether apparent diffusion coefficient (ADC) measurements may distinguish malignancy. MATERIALS AND METHODS. This single-center retrospective study identified patients with a T1-hyperintense renal mass less than 4 cm on MRI. Malignant lesions were pathologically proven; a benign mass was established by a predefined hierarchy of pathologic proof, follow-up ultrasound, or follow-up imaging showing more than 5 years of stability. T1 hyperintensity, defined as a signal intensity equivalent to or greater than the adjacent renal cortex, was confirmed by a senior abdominal radiologist. Two additional abdominal radiologists independently measured ADC of the lesion, which was normalized to the ADC of the background ipsilateral kidney and represented as ADCratio. RESULTS. The final cohort included 58 benign and 37 malignant renal lesions in 95 patients. Interrater agreement for ADC measurements was almost perfect (κ = 0.836-0.934). ADCratio was significantly lower in malignant compared with benign lesions (0.65 ± 0.29 vs 1.03 ± 0.32; p < 0.001). Malignant lesions were significantly larger than benign lesions (2.66 ± 0.86 cm vs 1.50 ± 0.65 cm; p < 0.001); however, after controlling for lesion size, ADCratio remained a significant predictor of malignancy (p < 0.001). CONCLUSION. ADCratio was highly reproducible for T1-hyperintense small renal masses and was significantly lower in malignant compared with benign renal masses.
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Kim E, Choi SW, Min D, Kim SH, Yang WI, Moon JY, Sung JH, Kim IJ, Lim SW, Cha DH, Moon B, Cho SH, Kim WJ. A case of a resected benign myxoma-like hemorrhagic cyst, which later recurred as undifferentiated pleomorphic sarcoma in the left atrium. Medicine (Baltimore) 2017; 96:e6353. [PMID: 28422827 PMCID: PMC5406043 DOI: 10.1097/md.0000000000006353] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE An intracardiac cystic mass is a rare type of mass found in the left atrium. The differential diagnosis of an intracardiac cystic mass includes hydatid cysts, bronchogenic cysts, intracardiac varices, and hemorrhages in some tumor types, including myxoma. PATIENT CONCERNS We present the case of a 68-year-old woman who presented with episodic dyspnea. DIAGNOSES-INTERVENTIONS-OUTCOMES Transthoracic echocardiography (TTE) revealed the presence of a left atrial mass mimicking myxoma. However, in postoperative findings, it was determined that the mass was actually a hemorrhagic cyst. Eighteen months later, the patient presented with recurrent exertional dyspnea and TTE revealed the recurrence of a left atrial mass. Computed tomography showed that the mass extended into the right atrium, inferior vena cava, and coronary sinus. After re-operation, the final histological diagnosis was determined to be an undifferentiated pleomorphic sarcoma in the left atrium. LESSONS An intracardiac hemorrhagic cyst was suspected during the operation of a benign-looking LA mass. As such, we recommend that other rare etiologies be considered and more biopsies be performed when possible.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Sang-Ho Cho
- Department of Pathology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Seongnam-si, Gyeonngi-do, Korea
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