Pulmonary cryptococcosis suspected due to inhalation of swallow excreta presenting with multiple infiltrative shadows

A 70-year-old woman had been treated with methotrexate for rheumatoid arthritis by a rheumatologist who opened a clinic near our hospital. In January of a certain year, she had respiratory symptoms of cough, sputum, and fever. Laboratory test results showed a white blood cell count of 8600/μL (neutrophil count of 5330/μL, lymphocyte count of 2490 μ/L), C-reactive protein (CRP) of 3.30 mg/dL. Chest radiography showed multiple infiltrative shadows in the right middle and lower lobes. Bronchoalveolar lavage fluid (BAL) lymphocyte count was increased (65.1%), and histopathological findings were consistent with numerous bowl-shaped cryptococcus cells stained black by Grocott staining. Added measurement of serum cryptococcal antigen titers was 4096-fold. Treatment with fluconazole 400 mg/day was initiated, and her symptoms resolved; the shadows of the lung fields improved. When asked in detail, the cryptococcus infection route was suspected from swallow excreta. There have been no reported cases of pulmonary cryptococcosis suspected due to inhalation of swallow excreta presenting with multiple infiltrative shadows.

Eosinophilic pneumonia developed after dupilumab administration in a patient with atopic dermatitis

A 63-year-old woman with refractory atopic dermatitis started treatment with dupilumab. She developed a cough 4 days later, sputum, and a slight fever 2 weeks later. Laboratory test results showed a blood eosinophil count of 7360/μL. Chest x-ray and computed tomography scan showed infiltrative shadows with surrounding consolidation of both upper lobes. Bronchoalveolar lavage fluid eosinophil count was increased (50.0%), and histopathological findings were consistent with numerous eosinophilic infiltrations. Treatment with prednisolone 30 mg/day (0.5 mg/kg/day) was initiated. Her symptom resolved, and the shadow of the lung fields improved. There have been no reported cases of eosinophilic pneumonia diagnosed 7 weeks after the administration of dupilumab for atopic dermatitis.

The Geriatric Nutritional Risk Index and Prognostic Nutritional Index Predict the Overall Survival of Advanced Non-Small Cell Lung Cancer Patients

We aimed to assess the prognostic and predictive significance of pretreatment Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) measurements on advanced non-small cell lung cancer (NSCLC) patients treated with first-line therapy. Patients with advanced NSCLC treated between February 2014 and August 2020 were retrospectively analyzed. The optimal cutoff points for GNRI and PNI were measured with receiver operating characteristic (ROC) curve analysis according to overall survival (OS). The predictive factors for progression-free survival (PFS) and OS were evaluated with univariate and multivariate analyses via the Cox hazards regression. A total of 160 patients were included in the study. Significant differences between the low and high-GNRI or PNI groups were found regarding ECOG-PS. The low-GNRI and low-PNI groups had significantly shorter PFS and OS than the high-GNRI and high-PNI groups. A multivariate analysis using a Cox regression model revealed that the high-GNRI group was an independent prognostic factor of OS and PFS, and the PNI group was an independent prognostic factor of OS. Pretreatment GNRI and PNI may therefore be a potential effective predictor of the survival of advanced NSCLC patients undergoing first-line treatment.

Argon plasma coagulation with atezolizumab and chemoradiation in lung pleomorphic cancer showed a remarkable response: Case report

RATIONALE

Lung pleomorphic carcinoma (LPC) is generally resistant to chemotherapy or radiotherapy. However, a combination of immune checkpoint inhibitors and radiotherapy has a remarkable efficacy against LPC.

PATIENT CONCERNS AND DIAGNOSES

Here, we report the case of a 50-year old man diagnosed with progressive LPC. The tumor invaded the carina and predominantly obstructed the right main bronchus; therefore, a combination of palliative chemoradiotherapy and atezolizumab was initiated. However the trachea was gradually obstructed.

INTERVENTION AND OUTCOME

Argon plasma coagulation (APC) was performed to prevent tumor invasion. After three APC sessions, the tumor showed a necrotic change and was easily excised using biopsy forceps.

LESSONS

A combination of chemoradiotherapy, atezolizumab, and APC showed a good efficacy, and the patient had a good response to atezolizumab maintenance therapy. Multidisciplinary treatments, such as a combination of immune checkpoint inhibitors and APC, could have synergistic efficacy in lung cancer.

Programmed cell death-1 blockade in kidney carcinoma may induce eosinophilic granulomatosis with polyangiitis: a case report

Background

Immune checkpoint inhibitors have potential applications in treating various cancers but are associated with immune-related adverse events, such as inflammation, in a wide range of organs; however, allergic inflammation caused by these agents has not been extensively studied.

Case presentation

A 65-year-old man was diagnosed with a kidney neuroendocrine carcinoma. Three months after kidney resection surgery, the tumor cells had metastasized to his liver and lymph nodes. Subsequently, the patient started chemotherapy; however, regardless of treatment, the tumor grew, and the patient experienced a series of adverse effects, such as taste disorder, anorexia, and general fatigue. Finally, he was administered a programmed cell death (PD)-1 inhibitor, nivolumab (biweekly, toal 200 mg/body), which was effective against kidney carcinoma. However, the patient had a bronchial asthma attack at 22 cycles of nivolumab treatment and chest computed tomography (CT) revealed an abnormal bilateral shadow after 37 cycles of nivolumab treatment. Bronchoscopy findings revealed eosinophil infiltration in the lungs along with severe alveolar hemorrhage. Paranasal sinus CT scanning indicated sinusitis and nerve conduction analysis indicated a decrease in his right ulnar nerve conduction velocity. Based on these findings, the patient was diagnosed with eosinophilic granulomatosis with polyangiitis; he was treated with prednisolone, which alleviated his bronchial asthma. To restart nivolumab treatment, the dose of prednisolone was gradually tapered, and the patient was administered a monthly dose of mepolizumab and biweekly dose of nivolumab. To date, there have been no bronchial attacks or CT scan abnormalities upon follow up.

Conclusions

We present a rare case in which a patient with cancer was diagnosed with eosinophilic granulomatosis with polyangiitis following treatment with a PD-1 inhibitor. Blockade of PD-1 and the programmed cell death ligand (PD-L) 1/PD-1 and PD-L2/PD-1 signaling cascade may cause allergic inflammation. Further studies are needed to identify the specific mechanisms underlying allergic inflammation after PD-1 blockade.

Good response with durvalumab after chemoradiotherapy for epidermal growth factor receptor exon 20 insertion adenocarcinoma: A case report

Epidermal growth factor receptor (EGFR) exon 20 insertion is not associated with sensitivity to EGFR tyrosine kinase inhibitors and chemotherapy. Here, we report the case of a 41-year-old man who presented a right lower lobe nodule and mediastinal lymph node enlargement diagnosed as EGFR exon 20 insertion adenocarcinoma with high-expression programmed cell death ligand 1 (PD-L1). He showed stable disease to chemoradiation treatment at the primary tumor site. However, durvalumab treatment has good response. Non-small cell lung cancer with EGFR exon 20 insertion and high PD-L1 expression may be treated with immunotherapy exposure.

[A case of spontaneous intracranial hypotension with simultaneous CSF leaks at the upper and lower thoracic levels]

We presented a patient of spontaneous intracranial hypotension (SIH), in which radionuclide cisternography demonstrated multiple CSF leaks. A 51-year-old previously healthy woman awoke with a severe headache and nausea that were almost completely relieved by lying flat (day 1). The headache was not relieved by analgesics. On day 10, she visited our clinic. Neurological examination showed no abnormalities. A lumbar puncture revealed an opening pressure of 50 mmH2O, protein level of 64 mg/dl, 21 erythrocytes 21/microliter, and 4 lymphocytes/microliter. Cranial MRI on day 11 with gadolinium infusion demonstrated diffuse thickening and enhancement of the meninges. No signs of venous sinus thrombosis were identified. There was no downward displacement of the cerebellar tonsils. Indium-111 radionuclide cisternography demonstrated early accumulation of the tracer in the urinary bladder and CSF leakage at the upper thoracic level on the left side, at the lower thoracic level on both sides, and at the lumbar level. It is noteworthy that the scintigram taken 4 hours after tracer injection demonstrated CSF leakage at the injection site but not in the upper thoracic area. The patient kept sitting for about 20 minutes just before the images were obtained. Spinal MRI did not show meningeal diverticulum and epidural fluid collection. Ten days of bed-rest and transfusion failed to relieve the headache. Epidural patching with 7 ml of autologous blood performed at the Th2/3 interspace partially relieved the headache. Five days later, a second epidural patching was performed at Th11/12, which was slightly effective. A third epidural patching at L3/4 was ineffective. On day 32, a fourth epidural patching was performed at Th1/2 while the patient was lying down on her left side. The postural headache disappeared. Repeated cranial MRI with gadolinium infusion performed on day 47 showed resolution of the abnormal findings. To our knowledge, this is the second case report of SIH with double CSF leaks. To localize multiple leaks, radionuclide cisternography should be performed with a patient in various positions just before images are obtained.

[Local staging with magnetic resonance imaging after neoadjuvant hormonal therapy for prostate cancer]

We retrospectively studied the staging accuracy of magnetic resonance (MR) imaging after neoadjuvant hormonal therapy (NAH) for 21 localized prostate cancers. MR imaging was performed using a 1.5-Tesla magnetic resonance system with a pelvic phased array coil. T2-weighted MR images were obtained on axial and coronal planes, and T1-weighted MR images using the dynamic technique with Gd-DTPA bolus enhancement were obtained in axial planes for each patient. On T2-weighted imaging, the signal intensity of the normal tissue in the peripheral zone became lower after NAH. Therefore, it was more difficult to detect residual malignant lesions in many cases than before NAH. The accuracy of T staging for prostate cancer after NAH in MRI was 71%. The accuracy, sensitivity, and specificity of the extracapsular invasion was 76%, 0% and 94%, respectively, and those of the seminal vesicular invasion 85%, 0% and 100%, respectively. While 2 of the 4 patients judged as downstaged cases in MRI showed corresponding pathological findings, 5 of the 21 cases (23.8%) were underdiagnosed. Local staging with only MRI for prostate cancer after NAH seems to have limits in applicability.

Abnormal uterine cavity: differential diagnosis with MR imaging

The objective of the study was to assess the usefulness of magnetic resonance (MR) imaging in distinguishing malignant from benign conditions in patients with an abnormal uterine cavity. Fifty-four patients that were suspected of having abnormal uterine cavities were retrospectively evaluated by using MR imaging. The diagnosis of an abnormal uterine cavity included a thickened endometrium, and/or a endometrial mass, and/or a submucosal mass. Threshold values to classify the uterine cavity as abnormal on sagittal T2-weighted images were >10 mm for premenopausal women and >5 mm for postmenopausal women. Malignancy was diagnosed when lesions invaded the myometrial/junctional zone, and/or lesion enhancement was lower than that of the adjacent myometrium. The results found that histology confirmed 18 malignant and 37 benign lesions. Twelve of 15 endometrial carcinomas and 3 malignant mixed mesodermal tumors (MMMT) were correctly characterized as malignant on enhanced T1-weighted images; whereas 6 of 15 endometrial carcinomas and 3 MMMT were correctly characterized on T2-weighted images. Thirty-four of 37 benign cases were correctly characterized as not malignant on enhanced T1-weighted images. One of 14 submucosal leiomyomas, one endometrial stromal metaplasia, and one of ten pathologically normal endometria were misdiagnosed on enhanced T1-weighted images but were correctly diagnosed on T2-weighted images. The overall sensitivity, specificity, and accuracy for distinguishing malignant from benign central uterine masses were 83%, 92%, and 89% for enhanced T1-weighted image, and 50%, 97%, and 82% for T2-weighted image, respectively. We came to the conclusion that in diagnosing patients with abnormal uterine cavity, MR imaging may help differentiate malignant from benign disorders.

Evaluation of the pancreas: a comparison of single thick-slice MR cholangiopancreatography with multiple thin-slice volume reconstruction MR cholangiopancreatography

OBJECTIVE

The purpose of this study was to assess abilities of single thick-slice MR cholangiopancreatography and multiple thin-slice multiprojection volume reconstruction (MPVR) MR cholangiopancreatography to evaluate diseases in and around the pancreas.

SUBJECTS AND METHODS

Eighty-nine patients underwent both single and MPVR MR cholangiopancreatography using a single-shot fast spin-echo technique. Image quality (five-point scale), visualization of the common bile and pancreatic ducts (three-point scale), stenotic, dilatational, or cystic changes of the pancreatic ducts, and other pathologic findings were evaluated.

RESULTS

Image quality was high for single and MPVR MR cholangiopancreatography (4.1+/-0.7 and 4.5+/-0.6, respectively). Misregistration was noted in 19 patients with MPVR MR cholangiopancreatography. Ducts on and around the greater duodenal papilla and the common bile duct were revealed better using MPVR than single MR cholangiopancreatography (p < .05). Overall sensitivity, specificity, and accuracy for detection of stenosis of the main pancreatic ducts were 83.3%, 93.6%, and 88.8%, respectively, using single MR cholangiopancreatography and 76.2%, 97.9%, 87.6%, respectively, using MPVR MR cholangiopancreatography. Dilatation of the pancreatic ducts (100%) and cystic changes (n = 17 and n = 19, respectively) were well seen using either single or MPVR MR cholangiopancreatography. Although stenotic changes of the nondilated main pancreatic ducts and their branches were difficult to evaluate using single (62.5% and 14.3%, respectively) or MPVR (43.8% and 21.4%, respectively) MR cholangiopancreatography, single MR cholangiopancreatography better depicted ductal continuity.

CONCLUSION

For evaluation of the pancreas, single and MPVR MR cholangiopancreatography provide complementary data; thus, we recommend using a combination of these two MR cholangiopancreatography techniques.

[Clinical efficacy of MRCP for diagnosis of patients with pancreatic neoplasm]

We examined the usefulness of MRCP in pancreatic cancer compared with ERCP. Moreover, it examined in the same way in focal pancreatitis, too. We compare three findings of 1) main pancreatic duct, 2) branches of the stricture part, 3) side of tail main pancreatic duct about ERCP and MRCP. As for the branches of the stricture part, MRCP was poor compared with ERCP but as for the property of the side of the tail main pancreatic duct, MRCP excelled. The study of mass forming chronic pancreatitis was a similar result and was not the one, which excels ERCP in case of qualitative diagnosis. However, we thought that it was not invasively, suitable behind the digestive operation and digestive passage fault, in case of elapse observation and moreover that MRCP is suitable for pick up the pancreatic cancer in our clinic.

MR and CT cholangiography in evaluation of the biliary tract

OBJECTIVE

To compare MR and CT cholangiography (MRC and CTC) in evaluating the anatomy of the extrahepatic biliary tract and the pathology related to the gallbladder.

MATERIAL AND METHODS

Twenty-three patients underwent MRC and CTC with a biliary contrast medium for investigation of biliary disease. 3D displays of both were also obtained. Endoscopic retrograde cholangiography was performed in 17 patients, and the pathology of all 23 was evaluated.

RESULTS

Overall, the image quality was higher with CTC than with MRC (4.7 vs 3.9, p < 0.05). The cystic duct was demonstrated better by CTC than MRC (p < 0.05). Multiplanar reformation (MPR) and source images provided additional information to that obtained from 3D MRC and CTC images. Gallstones were revealed in 6 patients by CTC and in 5 of these 6 by MRC. In 2 patients with cholecystitis, CTC demonstrated gallbladder wall thickening but MRC did not. In 3 patients with adenomyomatosis. MRC demonstrated Rokitansky-Aschoff sinuses (RAS) while CTC demonstrated focal gallbladder wall thickening in all 3 and RAS in 1 of them.

CONCLUSION

Both MRC and CTC provided anatomical and pathological information about the biliary system. With both techniques, however, either MPR or source images proved necessary in addition for evaluating the biliary system anatomy and pathology. The gallbladder wall was depicted clearly in source CTC, but MRC is recommended for the evaluation of adenomyomatosis because it depicts RAS clearly.

Evaluation of reconstructed hepatic veins with breath-hold 2D time-of-flight MR venography

PURPOSE

The purpose of this study was to assess the ability of magnetic resonance (MR) venography to evaluate the patency of reconstructed hepatic veins after surgery.

PATIENTS AND METHODS

Five normal volunteers with normal hepatic veins and eight patients who underwent reconstruction of the hepatic veins after resection of hepatic tumors were included. All subjects underwent breath-hold two-dimensional (2D) time-of-flight MR venography using a fast low angle shot (FLASH) technique with a 1.5 Tesla magnet. The initial imaging plane was coronal, and sagittal and/or transverse planes were added when necessary. Data were postprocessed with a maximum intensity projection (MIP) algorithm. In six patients, the MR findings were verified by iodinated hepatic venography.

RESULTS

The confidence level increased when patency was evaluated using a combination of MIP and source images or other imaging planes compared with the use of MIP images alone (3.0 to 3.6, p < 0.05). A signal drop near the orifice at the inferior vena cava was observed in three normal patients. The severity of stenosis was overestimated by MR venography in five patients. Obstruction was correctly suggested in one patient.

CONCLUSION

Although 2D time-of-flight MR venography overestimated stenosis of the hepatic vein at the site of connection, it might provide information on the patency of reconstructed hepatic veins especially when more than one orthogonal plane is used and both MIP and source images are evaluated.

MR angiography of the renal artery: comparison of breath-hold two-dimensional phase-contrast cine technique with the phased-array coil and breath-hold two-dimensional time-of-flight technique with the body coil

Breath-hold 2D phase-contrast (PC) cine MR angiography with a phased-array coil and 2D time-of-flight (TOF) MR angiography were performed in the renal arteries and their findings were compared. Breath-hold 2D thin slice PC and TOF MR angiography were performed in 10 normal volunteers for renal arteries. A PC technique with k-space segmentation was utilized with the phased-array coil. A PC technique provided visualization of the renal artery more distally than a TOF technique (4.8 +/- 0.5 cm vs. 3.7 +/- 0.8 cm). With cardiac triggering, distal renal arteries were well demonstrated in PC MR angiography. On PC images, up- or downward movements of the mid to distal renal arteries with aortic pulsatility were recognized. The quality of the images was better with the PC than with the TOF technique (3.4 vs. 2.7). The mid to distal portions of the renal arteries translationally move with aortic pulsatility. To consistently visualize and evaluate them on MR angiography, cardiac triggering might be required to reduce the effects of pulsatile motions of the renal artery in the use of a phased-array coil.

Anterior extension of acute pancreatitis: CT findings

OBJECTIVE

The purpose of this study is threefold: (a) to specify the pathway of the extension of pancreatitis to the anterior abdominal wall, which is clinically famous as the Cullen sign; (b) to assess if this pattern of involvement affects a patient's prognosis; and (c) to seek its association with the inflammatory processes that take place in the vicinity of the pancreatic head.

MATERIALS AND METHODS

The CT findings of 277 patients with acute pancreatitis were retrospectively reviewed.

RESULTS

Inflammatory changes involved the anterior abdominal wall in 5 of 277 cases (1.8%) with acute pancreatitis. Inflammatory processes seemed to have been delivered to the anterior abdominal wall from the pancreatic head and the hepatoduodenal ligament and along the falciform ligament. The probable triggers of acute pancreatitis in such cases were endoscopic retrograde cholangiopancreatography in two cases, alcohol intake in one case, and one case unknown. Three of five cases had proven or suspected choledocholithiasis or cholelithiasis. All five patients got well after proper treatments for acute pancreatitis.

CONCLUSION

The results of our review suggest that the anterior extension of acute pancreatitis does not directly mean extensive retroperitoneal involvement of the phlegmon or pseudocysts nor fatal prognosis either and that this style of extension might be associated with inflammatory processes that occur around the pancreatic head.

[Enhanced delineation of the pancreatic duct in MR cholangiopancreatography (MRCP) with a combined use of secretin]

Magnetic resonance cholangiopancreatography (MRCP) is a method that can depict the main pancreatic duct non-invasively; however, its tendency to overestimate ductal stenosis is being noted. The authors used secretin to stimulate the output of pancreatic juice, which increased the signal of the main pancreatic duct and consequently minimized the occurrence of pseudostenosis artifacts in MRCP. MRCP images of 54 patients suspected of having pancreatic disease were visually evaluated by two observers before and after administration of secretin (1 clinical unit/kg). Improved delineation of the main pancreatic duct (68.5-59.3%, p < 0.05) and its side branches (40.7-29.6%, p < 0.05) was obtained with good interobserver agreement (kappa = 0.71-0.68).

Torsion of the wandering spleen: CT and angiographic appearance

OBJECTIVE

To seek CT and angiographic appearances that characterize torsion of the wandering spleen.

MATERIALS AND METHODS

The CT and angiographic findings of two cases of preoperatively diagnosed torsion of the wandering spleen were reviewed, and the findings were closely compared with intraoperative and histopathological findings.

RESULTS

Characteristic CT appearance seemed to be a whirled appearance formed at the medial side of the displaced spleen. The angiographic finding that was characteristic of the disease was a tapered and abruptly twisted distal splenic artery.

CONCLUSION

These findings were useful in making the early and correct diagnosis of this rare but fulminant condition.

Occlusion of the posterior humeral circumflex artery: detection with MR angiography in healthy volunteers and in a patient with quadrilateral space syndrome

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of MR angiography in detecting occlusion of the posterior humeral circumflex artery and to determine if the finding is specific for the diagnosis of quadrilateral space syndrome.

SUBJECTS AND METHODS

Two-dimensional fast low-angle shot MR angiography was used to image both shoulders of one symptomatic patient and six asymptomatic volunteers (10 posterior humeral circumflex arteries).

RESULTS

With the arm in a neutral position, the posterior humeral circumflex arteries appeared normal on MR angiograms of all subjects. However, when the arm was in abduction, occlusion of the posterior humeral circumflex artery was seen both in the symptomatic patient and in 80% of the asymptomatic volunteers.

CONCLUSION

Our data show that occlusion of the posterior humeral circumflex artery is common in asymptomatic volunteers. Thus, MR angiography has no value in the diagnosis of quadrilateral space syndrome.

Breath-hold MR cholangiopancreatography with a long-echo-train fast spin-echo sequence and a surface coil in chronic pancreatitis

PURPOSE

To assess heavily T2-weighted breath-hold magnetic resonance cholangiopancreatography (MRCP) for imaging the pancreatic duct in patients with chronic pancreatitis.

MATERIALS AND METHODS

Thirty-nine patients with chronic pancreatitis were examined with a breath-hold fast spin-echo (FSE) sequence employing an echo train length of 32 and with a surface coil. Results were compared with those of endoscopic retrograde cholangiopancreatography (ERCP).

RESULTS

MRCP showed the head, body, and tail of the pancreatic duct well in 79%, 64%, and 53% of cases, respectively. Agreement between MRCP and ERCP was 83%-92% in cases of ductal dilatation, 70%-92% in cases of ductal narrowing, and 92%-100% in cases of filling defects. Interobserver variation was low (kappa > 0.5) for most findings.

CONCLUSION

Breath-hold MRCP with an FSE technique depicts the pancreatic duct well in patients with chronic pancreatitis and demonstrates narrowing, dilatation, and filling defects with moderate to high accuracy.

[MR cisternography using "long echo train length fast spin echo sequence" for demonstrating the inner ear]

Excellent quality of MR cisternography was acquired using "long echo train length fast spin echo sequence" (TR/TE = 2666/200, ETL = 24, 6 or 8 NEX, 3 mm thickness, 0 mm interslice gap, 19 cm FOV, 512 * 384, 2 DFT method). The inner ear anatomy such as canaliculus cochleae or lamina spiralis ossea were well visualized. The VII, VIII th nerve bundles within the internal auditory canal were detectable as 1 to 4 bundles. The vessels in the cerebellopontine angle or the internal auditory canal were also demarcated from the VII, VIII th nerve bundles because of their flow void. Signal to noise ratio seemed to be better than 3 DFT method, however limited spatial resolution in the cranio-caudal direction might require additional sagittal or coronal scan.

[Breath hold MR cholangio-pancreatography (MRCP) using long echo train length fast spin echo sequence in combination with surface coil]

To test the feasibility of MR cholangio-pancreatography (MRCP) using long echo train length (32) fast spin echo sequence in combination with shoulder surface coil, 20 patients who had had ERCP were examined. Good correlations were acquired between the findings obtained by two modalities in terms of ductal strictures, dilatations and intraductal lesions. MRCP was considered to be an examination of choice in various kinds of pathologies affecting biliary duct as well as pancreatic duct for its non-invasiveness and reasonable image quality.

Gallium-67-citrate scanning in patients with sarcoid uveitis

Gallium-67-citrate is useful for characterizing activity in patients with sarcoidosis. Gallium-67 uptake in bilateral symmetrical hilar lymphadenopathy and/or symmetrical salivary glands is typical of this clinical entity. Sarcoidosis is a systemic disease, and uveitis is considered the hallmark of ophthalmic sarcoidosis. We present two cases of ophthalmic sarcoidosis that shows uveal accumulation of 67Ga-citrate associated with clinical symptoms.

Case report: MR appearance of a retained surgical sponge

A case of a retained surgical sponge found in the retroperitoneum is presented with findings on magnetic resonance (MR) imaging, computed tomography (CT), ultrasonography (US) and angiography. Among all the performed modalities, a characteristic internal structure of the gauze granuloma was best visualized on MR imaging. If no radio-opaque marker is seen on plain radiography or CT, the folded fabric inner structure visualized on T2-weighted images can be a most important clue to the correct diagnosis of this iatrogenic mass.