18-year-old man with Down syndrome presented with multiply relapsed CD22+/CD19 negative B-cell acute lymphoblastic leukemia (B-ALL) with non-central nervous system extramedullary disease following multiple cycles of chemotherapy, hematopoietic stem cell transplantation, and blinatumomab. Medical history notable for diagnosis of myelodysplastic syndrome at age 11 years and CD19+ B-ALL. He was referred for a phase I study of CD22 CAR T cells and achieved minimal residual disease negative complete remission with clearance of extramedullary disease following grade 2 cytokine release syndrome.

Flow cytometry of bone marrow or peripheral blood from the current patient, sequential time points before CD22 CAR T-cell therapy, after first infusion, and after second infusion, assessing CD19 and CD22 expression.

A: Subfigure A of Figure 1, as shown on page 2, presents sequential flow cytometric dot plots depicting the evolution of CD19 and CD22 antigen expression on leukemic blasts from Case 1 at three time points: before CD22 CAR T-cell therapy, after the first infusion, and after the second infusion. This analysis was performed on bone marrow or peripheral blood samples to monitor antigen modulation following CD22-directed CAR T-cell immunotherapy in an 18-year-old patient with relapsed B-cell acute lymphoblastic leukemia. The figure demonstrates shifts in expression of CD19 and CD22 over the course of treatment, with no subjective interpretation provided.

Line graph of mean fluorescence intensity (MFI) for CD10, CD19, CD22, CD24, and CD34 measured by flow cytometry during immunophenotypic analysis after CD22 CAR T-cell therapy.

B: This subfigure presents a line graph showing concurrent changes in the mean fluorescence intensity (MFI) of several B cell antigens—CD10, CD19, CD22, CD24, and CD34—measured by flow cytometry as part of the immunophenotypic analysis following CD22 CAR T-cell immunotherapy, without indication of specific anatomical site or timing, and highlights variations in antigen expression over the sequential treatment course.

Flow cytometry of biopsy sample demonstrating expression of CD33, HLA-DR, CD34, and CD117, and absence of CD19 and CD22. Morphological analysis of myeloid blasts from aspirate material.

C: Immunophenotypic evaluation of concurrent myeloid sarcoma was performed using flow cytometry of the biopsy sample, demonstrating blast populations expressing myeloid markers (CD33, HLA-DR, CD34, CD117) and absent B lineage antigens (CD19, CD22), alongside morphological analysis of myeloid blasts from aspirate material.

H&E staining, MPO immunohistochemistry, and CD33 immunohistochemistry of myeloid lesion.

H&E, MPO and CD33 immunohistochemistry from the myeloid lesion showing morphological appearance and staining pattern

Secondary myeloid sarcoma with concurrent B-ALL relapse in an 18-year-old with Down syndrome

Down syndrome

Myeloid sarcoma

ALL - [acute lymphoid leukaemia] NOS


39-year-old woman presented with fever, flank pain, and tender inguinal lymphadenopathy. Symptoms began 4 weeks before admission with bilateral inguinal swelling, followed by right-sided flank pain (rated 5/10), nausea, poor appetite, and foul-smelling urine. She had immigrated from Brazil 1 year earlier and had recently returned from a 3-month visit to Brazil. Lives alone with one kitten and one full-grown cat. Medical history includes hypothyroidism, asthma, bipolar disorder, dysmenorrhea, migraines, and multiple prior urinary tract infections. Physical examination showed temperature 36.6°C, blood pressure 100/63 mm Hg, heart rate 77 beats per minute, weight 67.5 kg, BMI 24.4. Patient appeared ill with right abdominal tenderness without rebound or guarding. Bilateral tender inguinal lymph nodes were palpable, with no hepatosplenomegaly. No palpable cervical, supraclavicular, infraclavicular, or axillary lymphadenopathy.

Laboratory results: hematocrit 36%, hemoglobin 11.6 g/dl, white-cell count 10,500 per μl, platelet count 409,000 per μl, erythrocyte sedimentation rate 41 mm/hr, C-reactive protein 100.7 mg/liter, blood glucose normal, electrolytes normal, creatine kinase normal, lactate dehydrogenase normal, liver function normal, kidney function normal.

Laboratory results showed hematocrit 36%, hemoglobin 11.6 g/dl, white-cell count 10,500 per μl with normal differential, platelet count 409,000 per μl, elevated erythrocyte sedimentation rate 41 mm/hr (normal 0-20), and elevated C-reactive protein 100.7 mg/liter (normal <8). Blood glucose, electrolytes, creatine kinase, lactate dehydrogenase, liver function, and kidney function tests were normal.

(A,B) CT of the abdomen and pelvis, axial view, non-contrast. (C,D) CT of the upper abdomen, axial view.

Axial images of the abdomen and pelvis (Panels A and B), obtained without the administration of contrast material, show bilateral inguinal lymphadenopathy (Panel A, arrows), which is more prominent on the right side than on the left side, and right external iliac lymphadenopathy (Panel B, arrow) with a normal left ovary (asterisk). Axial images through the level of the upper abdomen (Panels C and D) show lymphadenopathy in the porta hepatis (Panel C, arrow) and a borderline‑enlarged lymph node in the gastrohepatic ligament (Panel D, arrow).

Biopsy Specimen of a Right Inguinal Lymph Node,(A) H&E staining. (B) H&E staining. (C) H&E staining. (D) H&E staining. (E) H&E staining. (F) H&E staining, higher magnification.

Hematoxylin and eosin staining shows marked capsular thickening and fibrosis (Panel A). At the interface of the capsule and lymphoid tissue, there are prominent small vessels associated with increased plasma cells (Panel B, arrows), which were polytypic on RNA in situ hybridization for kappa and lambda immunoglobulin light chains (not shown). Some areas of the underlying lymphoid tissue contain increased numbers of reactive follicles (Panel C, arrows) with interspersed aggregates of reactive monocytoid B cells (Panel D), and other areas contain conspicuous histiocytic infiltrates that are consistent with ill-formed granulomas (Panel E, arrows). At higher magnification, histiocytes that can be seen within the granulomas are associated with small lymphocytes and plasma cells; giant cells and neutrophils are not present, and there is no central necrosis (Panel F).

(A, B) Lymph node specimen, Warthin–Starry silver staining. (B) Higher magnification.

Warthin–Starry silver staining shows focal areas of the lymph‑node specimen that contain clumps of bacilli that appear black against a light brown counterstain and are associated with small vessels (Panels A and B, arrows). At higher magnification, the bacilli are pleomorphic and appear in small clusters (Panel B).

Bartonella henselae infection (cat scratch disease)

infection NOS

Certain infectious or parasitic diseases

Cat-scratch disease


A 31-year-old woman with seizures. The clinical examination revealed mental retardation, dysarthria, diminished tongue side-movements and mild hyperreflexia. The electroencephalogram showed waveforms compatible with idiopathic generalized epilepsy.

(A,B) Axial T2-weighted MRI. (C,D) Axial T1-weighted MRI.

Axial T2-weighted (a,b) and T1-weighted (c,d) images show thick and irregular cortex surrounding the Sylvian fissures (arrows).

(A,B) Sagittal T1-weighted MRI of the brain. (C) Coronal T1-weighted MRI of the brain.

Sagittal (a,b) and coronal (c) T1-weighted images show that polymicrogyria involves the entire perisylvian cortex (arrows) and extents posteriorly to the central sulcus (curved arrows).

Bilateral symmetrical perisylvian polymicrogyria

Bilateral perisylvian polymicrogyria


A 63-year-old Indian woman presented with fatigue and pain in the abdomen. On physical examination she had a palpable mass in the right hypochondrium region. The routine laboratory investigations revealed severe anaemia (haemoglobin 3.3gm).

Ultrasound examination.

US showing mixed echoic lesion with internal vascularity.

Axial contrast-enhanced CT.

Axial contrast enhanced CT showing well defined heterogenously enhancing mass lesion displacing duodenum laterally(arrow) and compressing IVC (asterisk).

CT, axial view, oral contrast.

Axial CT with oral contrast showing contrast filling of the ulceration and communication with the duodenum lumen.

Gross photograph of a surgical specimen, duodenum, obtained intraoperatively.

Figure 4 shows a gross photograph of a surgical specimen representing a resected gastrointestinal stromal tumour along with the “C” loop of the duodenum, as obtained intraoperatively. No imaging modality or staining procedures are involved; the anatomical site is the duodenum, and the specimen was acquired at the time of surgical resection, as depicted on page 6 of the document.

Barium meal follow through of the duodenum.

Barium meal follow through showing widened c loop of duodenum.

Histopathology and immunohistochemistry confirmed duodenal stromal tumour.

Gastrointestinal stromal tumour of duodenum


A 49-year-old man presented to us with a two-month history of weakness and epigastric pain, colicky in nature.

Upper gastrointestinal endoscopy of the 2nd part of the duodenum.

Upper GI endoscopy shows the presence of an ulcerative lesion at the medial wall of the 2nd part of the duodenum.

CT scan, axial view, duodenum.

Axial CT scan shows the presence of a prominent lesion at the medial wall of the 2nd part of the duodenum.

CT of the duodenum, axial view, magnified.

A magnified axial CT image with more evidence of the lesion of the 2nd part of the duodenum

CT scan, axial view, third part of the duodenum.

Axial CT scan reveals circumferential wall thickening of the third part of the duodenum.

CT scan, axial view.

Primary duodenal diffuse large B-cell non-Hodgkin's Lymphoma

Primary duodenal diffuse large B-cell non-Hodgkin's lymphoma

Diffuse large B-cell lymphomas


47-year-old male with 2-month history of fever, headache, myalgia, arthralgia, and malaise. History of inguinal hernia repair surgery 10 years ago and cardiac disease. On admission, body temperature was 37.3°C. Physical examination revealed aortic valve diastolic murmurs at the precordium.

Antibiotic susceptibility testing for strain LP10266.

Antibiotic susceptibility testing showed strain LP10266 was sensitive to ampicillin (MIC 1.5 μg/ml), penicillin (0.5 μg/ml), imipenem (1 μg/ml), and levofloxacin (1 μg/ml), but resistant to cefazolin (>256 μg/ml), cefuroxime (>256 μg/ml), ceftriaxone (>256 μg/ml), meropenem (16 μg/ml), and vancomycin (>256 μg/ml).

Transthoracic echocardiogram of the heart.

Transthoracic echocardiogram showed membranous ventricular septum bulged into the right ventricle.

Transthoracic echocardiogram of the aortic valve.

Transthoracic echocardiogram showed aortic valve prolapse and aortic valve excrescence formation combined with aortic valve regurgitation at moderate level.

Wright-Giemsa staining of bone marrow.

Wright-Giemsa staining of bone marrow showing infective myelogram.

Hematoxylin-Eosin staining of cardiac excrescence.

Hematoxylin-Eosin staining of cardiac excrescence showing infectious excrescence.

Infective endocarditis caused by Lactobacillus paracasei LP10266

infective endocarditis NOS


A 45-year-old female with a 3 month history of dyspareunia and urinary urgency

MRI of the pelvis, axial view, T2-weighted sequence, female urethra and periurethral region.

Figure 1 displays an axial T2-weighted MRI image of the pelvis showing a septated U-shaped hyperintense lesion along the posterior aspect of the urethra at the level of the pubic symphysis, with blue arrows indicating the lesion and a red arrow indicating the urethra; the imaging modality is magnetic resonance imaging, the anatomical site examined is the female urethra and periurethral region, and the key finding is a septated hyperintense lesion consistent with a urethral diverticulum.

(A) MRI of the pelvis, coronal view, T2-weighted sequence, acquired at the level of the pubic symphysis.

Figure 2a presents a T2-weighted MRI coronal image of the pelvis showing a hyperintense lesion surrounding the urethra (indicated by a red arrow), consistent with a cystic process in the female genital/reproductive system, acquired at the level of the pubic symphysis; the lesion’s anatomical relationship and signal characteristics are depicted without additional information on acquisition timing or further technical parameters.

MRI of the female urethra at the level of the pubic symphysis.

Figure 3a demonstrates a magnetic resonance imaging (MRI) study showing a septated cystic lesion (indicated by a blue arrow) surrounding the urethra at the level of the pubic symphysis, consistent with the appearance of a urethral diverticulum; the imaging modality is MR, the anatomical site is the female urethra, and the figure specifically highlights the lesion's septated and periurethral configuration on the image (see page 5).

Urethral diverticulum


A 47-year-old woman presented with intermittent cough, shortness of breath, fever (body temperature up to 38.5°C), accompanied by right eyelid swelling around June 17, 2017, which worsened day by day. Weight loss was about 9 kg. Physical examination included high body temperature of 39°C, right eyelid swelling, and a painless enlarged lymph node about 2 cm × 2 cm in size in the left axilla. Auscultation of lungs revealed coarse respiratory sounds with moist rale. No hepatosplenomegaly and edema in lower limbs.

Chest CT scan of the lungs performed before treatment.

Chest CT image showed interstitial exudation and mass lesions of both lungs before treatment, with left pleural effusion

(A) Clinical photograph of the right thigh. (B) Pathological biopsy of the right thigh, gross specimen.

Images showing prominent right thigh swelling and pathological biopsy revealing gray-white and gray-yellow neoplasm in intermuscular space

(A) Histopathology. (B) Immunostaining for CD8. (C) Immunostaining for granzyme B. (D) Immunostaining for T-cell intracellular antigen-1 (TIA-1). Ki-67=50%.

Histopathological findings demonstrated focal rimming of individual adipocytes by infiltrating small to medium-sized atypical lymphocytes. Immunostaining showed infiltrating lymphocytes positive for CD8, granzyme B, and T-cell intracellular antigen-1 (TIA-1), with Ki67 staining positive at 50%. (a) Focal rimming of individual adipocytes by infiltrating small to medium-sized atypical lymphocytes. (b–d) Immunostaining showed infiltrating lymphocytes positive for CD8 (b), granzyme B (c), and T-cell intracellular antigen-1(TIA)-1 (d).

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) (IIB phase, IPI scores of 2)


A 51-year-old non-smoking female hairdresser, presented to her primary care physician with a 3-4 month history of increased shortness of breath especially on exertion. Upon examination she was found to have dullness to percussion and reduced air entry to the left lung base, and oxygen saturation of 99% on air.

CT of the thorax, axial view.

Axial slice  CT Thorax  large soft tissue mass in the left hemithorax.

CT of the thorax, coronal view.

Coronal slice - CT Thorax - giant soft tissue mass in the left heme-thorax Origin Vijay Pakala, Radiology Department,Princess Royal Hospital,Telford, United Kingdom

Chest X-ray.

Chest X-ray showing opacification of left heme-thorax

A solitary fibrous tumour of the pleura was confirmed on histology

pleura tumour NOS


A 61-year-old man presented recurring episodes of wake-up confusion and hallucinations. These symptoms normalized during the day, the patient had no recollection of the episodes. He had no relevant medical background Neurological examination and electroencephalogram were normal at admission.

CT of the pelvis, axial view, non-contrast.

Figure 1 shows an axial non-contrast CT image of the pelvis depicting a well-defined retroperitoneal pelvic mass (measuring 11 x 14 x 11 cm) situated to the left of the bladder, with both the bladder and sigmoid colon displaced to the right; this image demonstrates the anatomical site and mass effect without contrast enhancement.

(A) Contrast-enhanced CT of the pelvis, axial view, arterial phase.

Figure 2 (a) on page 4 presents an axial contrast-enhanced CT image of the pelvis, showing direct vascularization of the pelvic mass by a branch of the left internal iliac artery (indicated by an arrow); the scan demonstrates the arterial phase, and the examined site is the pelvic retroperitoneal region containing the solitary fibrous tumor.

(A) Axial contrast-enhanced CT of the pelvis.

Figure 3 (a) demonstrates an axial contrast-enhanced CT image of the pelvis, showing important and heterogeneous peripheral enhancement of a well-circumscribed pelvic mass located to the left of the bladder, consistent with the hypervascular characteristics of the tumour.

Pelvic solitary fibrous tumor confirmed at pathology after complete resection

neoplasm NOS


A 56-year-old female patient presented with low-back and hip pain radiating down to her left leg for 12 months. She did not respond to initial management with conservative therapy of non-steroidal anti-inflammatory medications.

MRI of the lumbar spine, sagittal view, T2-weighted sequence.

T2-weighted sagittal MRI of the lumbar spine showing bone-based malignancy from L3 to L5 causing severe canal stenosis and infiltrating anteriorly into the retroperitoneal space.

T2-weighted axial magnetic resonance image.

T2-weighted axial magnetic resonance image shows very high signal intensity of the tumour, which infiltrating posteriorly into the paraspinal musculature and expanding into the abdomen and psoas muscles bilaterally. The tumour causes severe spinal stenosis with compression of the nerves.

Sagittal T1-weighted MRI of the vertebral bodies and retroperitoneal region.

Sagittal T1-weighted image shows a low-intensity lesion penetrating from vertebral bodies to the retroperitoneum.

Sagittal T2-SPAIR MRI.

Sagittal T2-SPAIR image shows a well-circumscribed high-intensity lesion.

T1-weighted MRI with gadolinium contrast.

T1-weighted image with gadolinium contrast demonstrates heterogenous contrast enhancement of the tumour.

Chordoma


A 57-year-old male patient with increasing abdominal pain accompanied by vomiting

(A) Small bowel histopathological section, H&E staining.

A: Figure 1a is a histopathological section of the small bowel wall stained with hematoxylin and eosin (H&E), showing marked inflammation involving all layers of the small bowel with serositis and prominent submucosal edema; the majority of inflammatory cells are eosinophils, which is characteristic of parasitic infestation, and a larva is visible outside the bowel wall (as indicated by the arrow).

CT of the small intestine, axial view.

Axial view: severe, submucosal oedema of the small intestine (arrow) with a small quantity of free peritoneal fluid, the proximal small bowel is dilated.

CT, coronal reconstruction, abdomen.

The coronal reconstruction shows wall thickening of an ileal segment in the centre of the abdomen (arrow) with small bowel distension of the proximal intestinal loops.

Acute intestinal obstruction from small-bowel anisakiasi

Obstruction of large intestine[Acute]

Anisakiasis


A 69-year-old male presented with a recent onset fever and worsening cough for 2 weeks. He had a history of chronic cough for 40 years and had been repeatedly treated for infections without any cross-sectional imaging performed earlier because of a lack of referral to a specialist center.

CT of the trachea, axial view.

Selected axial CT image showing widened and flattened tracheal lumen

CT, coronal view.

Selected coronal CT image showing tracheobronchomegaly with widened and ectatic contours of trachea and both major bronchi

Bronchoscopic image of the trachea.

Bronchoscopic image showing flattened and widened tracheal lumen

Bronchoscopic image of the left bronchus.

Bronchoscopic image through the left bronchus showing similar widening and flattening of bronchial lumen

Mounier-Kuhn syndrome

Cardiovascular and respiratory disorders


A 26-year-old woman presented with intellectual disability and refractory epilepsy.

Axial T2-weighted MRI of the brain, frontal lobes.

Axial T2W images show bilateral symmetrical cortical surface irregularity, multiple small folds, scalloped appearance of the gray matter-white matter junction and abnormally thick cerebral cortex in both frontal lobes

(A) MRI, axial and coronal T2-weighted images, parieto-occipital regions.

Axial and coronal T2W images show bilateral symmetrical multiple small folds in both parieto-occipital regions

Sagittal FLAIR MRI of the brain, frontal and parieto-occipital regions.

Sagittal FLAIR image shows irregularity of cortical surface and abnormally thick cerebral cortex in frontal and parieto-occipital regions

(A) MRI, axial view, FLAIR sequence.

Figure 4 (a) presents an axial FLAIR MRI image demonstrating a focal hyperintense area in the right centrum semiovale.

MRI of the brain, diffusion-weighted imaging.

Diffusion-weighted MRI images showed no restriction of diffusion in any region of the brain.

Bifrontal and bilateral parasagittal parieto-occipital polymicrogyria

Polymicrogyria


An ultrasound (US) examination of the left axilla was requested to evaluate a sudden appearing nodular axillary tumefaction in a 35-year-old woman in her first day of the puerperium. No other inflammatory signs were apparent and the patient denied any accompanying symptoms such as fever or local pain.

Ultrasound of the left axilla, longitudinal plane.

Longitudinal plane of the left axilla, depicting several tubular anechoic structures compatible with lactating milk ducts, with a vascularized stroma between them.

Ultrasound of the left axilla, axial plane, high frequency linear array transducer, performed on the first day of puerperium.

Figure 2 shows an axial plane ultrasound image of the left axilla, obtained with a high frequency linear array transducer on the first day of puerperium, depicting multiple tubular anechoic structures consistent with lactating milk ducts interspersed within echogenic vascularized tissue, indicative of ectopic axillary breast tissue with prominent lactational changes.

Clinical photograph of the left axillary region.

Figure 3a presents a clinical photograph of the left axillary region showing the clinically detected tumefaction with a nipple at its center, corresponding to accessory axillary breast tissue exhibiting lactational changes, as confirmed by physical examination.

Clinical photograph.

A: Clinical photograph demonstrating a supernumerary nipple located at the center of the image.

Clinical photograph of the region caudal to the left breast.

Another supernumerary nipple (caudal to the left breast) is shown, slightly indurated and tumefactive.

Lactating accessory axillary breast tissue with supernumerary nipples

breast of axilla

Supernumerary nipple


A 61-year-old female patient presented to the ER with diarrhoea, nausea, vomiting and 38.5 °C temperature Physical examination showed normal results.

(A) Longitudinal ultrasound B-mode image of the gallbladder.

(a) Longitudinal US B-mode image shows a distended gallbladder without stones (*), markedly thick wall with sonolucent intramural layers (oedema) (thin arrow) and a little fluid collection (thick arrow); compatible with acute acalculous cholecystitis.

(b) Transverse ultrasound B-mode image of the gallbladder.

(b) Transverse US B-mode image shows a distended gallbladder without stones (*), markedly thick wall with sonolucent intramural layers (oedema) (thin arrow) and a little fluid collection (thick arrow); compatible with acute acalculous cholecystitis.

(A) Longitudinal ultrasound B-mode image of the ascending colon.

(a) Longitudinal US B-mode image shows marked mucosal thickening of the ascending colon (thin arrow).

(B) Ultrasound B-mode, transverse oblique view, terminal ileum and ascending colon.

(b) Transverse Oblique US B-mode image shows marked mucosal thickening affectin the terminal ileum (thick arrow) and ascending colon (thin arrow).

Acute acalculous cholecystitis due to salmonella enterocolitis

acute acalculous cholecystitis

enterocolitis


A 15-year-old boy presented with recent onset of breathlessness, weight loss, and tiredness for two months and a crusting erythematous scalp rash for six months. The investigations revealed neutrophilia, raised C-reactive protein (CRP), and Alanine Aminotransferase (ALT). The blood urea and electrolytes, thyroid function tests, anti-nuclear antibodies, and clotting studies were normal

Chest radiograph.

Chest radiograph showing extensive bilateral reticulonodular consolidation, predominantly affecting the upper and mid zones, some with cavitation (large arrow). In addition, there are some ring shadows suggestive of cysts (small arrows)

CT of the lung apices, axial view.

Axial CT through the lung apices showing multiple coalescing nodules which demonstrate cavitation (large arrow). Few thin-walled cysts (small arrows) are also seen

CT, coronal view.

Coronal CT demonstrating involvement of the costophrenic recesses (arrows)

HRCT bone window of the sternum.

HRCT bone window demonstrating focal lytic lesion in the sternum (arrow)

Multisystem Langerhans Cell Histiocytosis with pulmonary and skeletal involvement

Langerhans cell histiocytosis

Pulmonary involvement in Langerhans Cell Histiocytosis

Adult pulmonary Langerhans cell histiocytosis

Skeletal involvement in Langerhans Cell Histiocytosis

Langerhans cell histiocytosis


A 17-year-old girl presented to the emergency department with constipation and bloodless vomiting for 3 weeks. The vomiting worsened after food ingestion. The patient was exhausted and underweight, although she did not suffer abdominal pain. At admission, the patient had unwillingly lost 10 kg over 2 years, resulting in a body mass index of 14. During this period, she started prevention medicine due to a loss of menstruation. The patient had no prior medical or surgical history. Blood tests revealed an increased sed rate (ESR) of 33 (normal range: 2-20) as the only outlier. A contrast-enhanced CT was ordered based on the acute exacerbating of vomiting and constipation, with ileus as the tentative diagnosis.

CT scan, axial plane, venous phase, performed at admission, aorto-mesenteric distance=3.3 mm.

CT scan in the venous phase showing the axial plane performed at admission highlights the decreased aorto-mesenteric distance of 3.3 mm and a distended stomach. No complications were noted

CT scan in the venous phase, sagittal plane, performed at admission, aorto-mesenteric angle=13.6°.

CT scan in the venous phase showing the sagittal plane performed at admission highlights the decreased aorto-mesenteric angle of 13.6° and a distended stomach. No complications were noted

Fluoroscopy of the stomach and duodenum, lateral plane, performed 30 minutes post-peroral administration of 200 mL contrast, examination performed during the month of admission.

Fluoroscopy of the stomach and duodenum in the lateral plane 30 minutes post-contrast. Shows a large and distended stomach. The contrast had trouble passing through to the third segment of the duodenum. The examination was performed the same month as admission. The patient was administered 200 mL of peroral contrast

CT scan in the arterial phase, axial view, performed after surgery, aorto-mesenteric distance=20.3 mm.

CT scan in the arterial phase showing the axial plane after surgery highlights the normalised aorto-mesenteric distance of 20.3 mm. No significant complications were noted

CT scan in the arterial phase, sagittal plane, performed after surgery, aorto-mesenteric angle=32.2°.

CT scan in the arterial phase showing the sagittal plane after surgery highlights the normalised aorto-mesenteric angle of 32.2°. No significant complications were noted

congenital superior mesenteric artery syndrome


A 12-year-old female presented to the Emergency Department with a 48-hour history of abdominal pain localised in the hypogastrium, which had progressively worsened in the last few hours. The patient mentioned previous episodes of less intense abdominal pain. Considering the clinical suspicion of acute appendicitis, an abdominal ultrasound was requested.

(1a) Sagittal ultrasound of the pelvis. (1b) Axial ultrasound of the pelvis.

Sagittal (1a) and axial (1b) ultrasound images of the markedly dilated vagina with abundant echogenic material in its lumen. The mass effect of the distended vagina displaces the bladder anteriorly.

(1a) Ultrasound, sagittal view, vagina. (1b) Ultrasound, axial view, vagina.

Sagittal ultrasound of the uterus and vagina.

Sagittal ultrasound image of the uterus and vagina. The uterus shows a pubertal morphology, with no dilation or content in its lumen.

Haematocolpos


A 35-year-old patient presented to A&E with complaints of sudden onset pain in scrotum extending to perineum, scrotal swelling, loss of penile erection following sexual intercourse. On examination the patient had scrotal swelling and bruising at the base of the penis and scrotum, but no penile swelling.

Coronal T1-weighted MRI of the penis (right corpus cavernosum, base).

A defect within the tunica albuginea of the right-sided corpus cavernosum close to the base of the penis - Coronal T1W

Coronal T2-weighted MRI of the base of the penis.

A defect within the tunica albuginea of the right-sided corpus cavernosum close to the base of the penis - Coronal T2W

Coronal T2-weighted MRI scan of the base of the penis.

A: Figure 3a is a coronal T2-weighted magnetic resonance imaging (MRI) scan demonstrating a soft tissue haematoma at the base of the penis.

Sagittal T2-weighted MRI.

Figure 4a demonstrates a sagittal T2-weighted MRI image showing a soft tissue haematoma extending into the right scrotal sac.

Ultrasound of the penis and scrotal region, grayscale mode.

A: Figure 5a on page 7 presents a grayscale ultrasound image of the penis, demonstrating the right testis and a region labeled as scrotal hematoma, consistent with a sonographic examination of the penile and scrotal region, with findings indicating a soft tissue hematoma in the right scrotal area.

Fractured penis

Injury, poisoning or certain other consequences of external causes

Orthopedic and connective tissue disorders


A 20-year-old woman with complaints of eructation and vomiting. She was diagnosed with autism when she was 3 years old. The patient is given probiotics, intestinal antiseptics, antibiotics, laxatives and enemas. She has followed a gluten-free diet since she was 5 years old. The patient already had episodes of such symptoms in the previous 12 years.

CT of the abdomen.

Severe air dilation of the small bowel and colon. There are no signs of pneumoperitoneum and no gas-fluid levels. The lumen of the colon in approximately 70 mm.Origin Pavlov MV, Radiology Department, The Loginov MCSC MHD, Moscow, Russia

Digital radiograph from a barium meal study of the stomach.

Figure 2 (page 5) presents a digital radiograph from a barium meal study, showing the stomach in a dilated and hypotonic state with continuous rugal patterns and fine mucosal relief visible; there is no evidence of pooling of contrast material, filling defects, or convergence of mucosal folds, and the anatomical focus is the stomach.

Fluoroscopic image from a barium meal study of the stomach.

Figure 3 presents a fluoroscopic image from a barium meal study showing the stomach, which is dilated, bent, and hypotonic, with fine mucosal relief visible and no evidence of pooling of contrast material, filling defects, or convergence of mucosal folds.

Barium meal digital radiograph of the abdomen.

Figure 4a presents a barium meal digital radiograph of the abdomen, showing the stomach displaced upward by dilated small bowel and colon and exhibiting bending in its middle third, with evidence of adequate flow of contrast material from the stomach into the small bowel.

Stomach bending and chronic intestinal pseudo-obstruction

Gastric volvulus

Chronic idiopathic intestinal pseudo-obstruction


A 47-year-old man presented to the emergency department with abdominal pain

Non-contrast CT, axial section.

Non-contrast axial CT section shows hyperdense surgical clips in the appendiceal stump (arrow).

CT, portal venous phase, axial view.

Portal venous phase contrast-enhanced axial CT section shows a dilated appendiceal remnant (arrow) and stranding of the surrounding fat.

Coronal CT, portal venous phase, abdomen.

Portal venous phase contrast-enhanced coronal CT section shows an enhancing tubular structure near the caecal pole, dilated, with wall thickening and stratification. There is a periappendiceal fluid collection and fat stranding. Surgical clips are visible.

Contrast-enhanced coronal CT of the abdomen, portal venous phase.

Portal venous phase contrast-enhanced coronal CT section evidences a wall perforation and a periappendiceal organized fluid collection (yellow circle).

CT, portal venous phase, axial section.

Portal venous phase contrast-enhanced axial CT section reveals an organized fluid collection near the caecal pole (arrow) and fat stranding.

Appendicitis


An 84-year-old woman presented with intermittent lower limb pain, sensory disturbances, and gait/balance difficulties over 1.5 years, worsening over six months. She was wheelchair-bound at presentation. The patient reported longstanding rectal incontinence but denied back pain.

Sagittal MRI of the spine, T1-weighted fast spin echo with fat saturation.

T1 FSE fat-sat sagittal MRI of the spine.

MRI, T2 FRFSE fat-sat sequence, sagittal plane, thoracic spine (Th8).

T2 FRFSE fat-sat image in the sagittal plane showcasing ventral positioning of the spinal cord at the level of Th8.

T2 FRFSE fat-sat MRI, axial plane, Th8 level.

T2 FRFSE fat-sat image in the axial plane at the level of Th8 showcasing the split cord malformation within a single dural tube, with no visible osseous spur or fibrous septum.

Split cord malformation


A 70-year-old male presents to his general practitioner with progressively worsening lower back pain and sciatica over the past four months. Previously, this patient underwent a posterior interbody fusion at L5–S1. Given his history and absence of other clinical abnormalities, the patient was referred to radiology for a CT scan of the lumbar spine.

(A) Contrast-enhanced CT, retroperitoneal region, axial view. (B) Contrast-enhanced CT, retroperitoneal region, coronal view.

Contrast-enhanced CT showing a sharply demarcated retroperitoneal mass in the right flank, predominantly fat-containing with soft tissue components on axial (1a) and coronal (1b) slices.

(A) Contrast-enhanced CT of the retroperitoneal region, axial view. (B) Contrast-enhanced CT of the retroperitoneal region, coronal view.

Abdominal ultrasound.

Abdominal ultrasound shows a hyperechoic solid lesion situated in the right flank.

Lipoma


A 75-year-old man visited the outpatient department complaining of back pain that localised to the mid-lower dorsal region. Additionally, he had a nocturnal fever of 39°C for the last month or so, accompanied by fatigue, headaches, and anorexia. Physical examination revealed localised tenderness over the pointed area in the back. Preliminary lab results elicited CRP at 39 mg/L, and Brucella agglutination test was 1/320. Hence, a blood culture was ordered, which was positive for the growth of the Brucella microorganism.

MRI of the dorsolumbar spine, sagittal view, T1-weighted sequence.

T1 sequence MRI of the dorsolumbar spine (sagittal view) shows remarkably low signal within T8 and T9 vertebral bodies due to bone marrow oedema associated with minimal erosion of the T8 inferior endplate as signs of spondylitis. The intervening disc looks relatively higher signal. Old fracture with anterior wedging of T11 also seen.

MRI of the dorsolumbar spine, sagittal view, T2-weighted sequence.

T2 sequence MRI of dorsolumbar spine (sagittal view) shows subtle increased signal within T8 and T9 vertebral bodies due to bone marrow oedema associated with minimal erosion of the T8 inferior endplate as signs of spondylitis. Not much change within the intervening disc material. Old fracture with anterior wedging of T11 also seen.

MRI of the dorsolumbar spine, sagittal view, fat-suppressed STIR sequence.

Fat suppression STIR sequence MRI of dorsolumbar spine (sagittal view) shows brightly highlighted abnormal signal within T8 and T9 vertebral bodies due to bone marrow oedema associated with minimal erosion of the T8 inferior endplate as signs of spondylitis. Not much change within the intervening disc material. Old fracture with anterior wedging of T11 also seen.

MRI of the dorsolumbar spine at T9 level, axial view, T2-weighted sequence.

T2 sequence MRI of the dorsolumbar spine at T9 level (axial view) shows confinement of the signal abnormality to the bony vertebra without extraosseous extension.

MRI of the dorsolumbar spine at T9 level, axial view, T1-weighted sequence.

T1 sequence MRI of the dorsolumbar spine at T9 level (axial view) shows confinement of the signal abnormality to the bony vertebra without extraosseous extension.

Spondylitis in brucellosis

Diseases of the musculoskeletal system or connective tissue


A 40-year-old woman presented with a palpable lump in her left superior breast. Mammography and US and biopsy performed, confirming invasive carcinoma NST Grade 2. MRI performed pre-operatively due to occult on mammography. Subsequent left breast mastectomy and reconstruction with right breast mastopexy.

Mammography at initial visit.

Ultrasound of the superior left breast.

MRI, pre-operative, fat-saturated T1-weighted sequence, post intravenous contrast, 2 minutes.

MRI pre-operative. Fat sat T1W post IV contrast 2 mins

MRI at 6 months post-operation, fat-saturated T1-weighted sequence, 2 minutes post intravenous contrast.

MRI post-operative at 6 months. Fat sat T1W post IV contrast 2 mins Orig University Foundation Trust Hospital. Cambridge, UK

(A) MRI at 18 months post-operative, non fat-saturated T1-weighted sequence. (B) MRI at 18 months post-operative, non fat-saturated T2-weighted sequence. (C) MRI at 18 months post-operative, fat-saturated T1-weighted sequence, post intravenous contrast at 2 minutes. (D) MRI at 18 months post-operative, subtracted fat-saturated T1-weighted sequence, post intravenous contrast at 2 minutes.

MRI post-operative at 18 months. A) Non fat sat T1; B) Non fat sat T2; C) Fat sat T1W post IV contrast 2 mins; D) Subtracted fat sat T1W post IV contrast 2 mins

Cutaneous suture granuloma


A 54-year-old female presented to the Emergency Department for weakness, epigastric discomfort and nausea

CT scan of the chest, axial view.

Axial view of chest CT scan showing a mass occupying the right atrium

(A) Triphasic CT scan of the abdomen, axial view, arterial phase. (B) Triphasic CT scan of the abdomen, coronal view, arterial phase.

Axial and coronal view of triphasic CT scan of the abdomen showing a mass in the VII- VIII hepatic segment (arrow) with inhomogeneous contrast enhancement in the arterial phase extending into the inferior vena cava and right atrium

(A) Triphasic CT of the abdomen, axial and coronal views, arterial phase.

CT scan of the abdomen, axial view, portal venous phase.

Axial view of triphasic CT scan of the abdomen showing portal venous phase washout of the mass (arrow) in the VIII-VIII hepatic segment of a polycystic liver

CT of the abdomen, sagittal view.

Sagittal view of abdomen CT scan showing massive thrombosis of the IVC (arrow) reaching the iliac bifurcation

Hepatocellular carcinoma with tumor thrombus into the right atrium

hepatocellular carcinoma, NOS

Divided right atrium


A 58-year-old male with worsening nausea for the past 72 hours presented to the emergency department with severe chest pain radiating to the back in the context of 4 recent episodes of non-bloody, non-bilious emesis. He was afebrile, diaphoretic, and mildly tachycardic. Cardiac workup, complete blood count, and electrolytes were normal.

Chest radiograph, posteroanterior (PA) view.

Chest radiograph PA view showing pneumococcalastinum extending to the neck (re arrows), tiny left apical pneumothorax (orange arrow), and left pleural effusion with consolidation/atelectasis (black circle).

CT of the chest, coronal view, lung window.

Coronal view CT chest (lung window) showing pneumococcalastinum extending to the neck (red arrows). Left pneumothorax at the lung base (orange arrow) not previously seen on the chest radiograph is also demonstrated.

CT of the chest, axial view, lung window.

Axial view CT chest (lung window) showing pneumococcalastinum with air around the oesophagus (red arrow), left pneumothorax (orange arrow), and bilateral pleural effusions (black arrows).

CT of the chest, axial view, soft tissue window.

Axial view CT chest (soft tissue window) showing thickened distal oesophagus (red arrow) and complex attenuating pleural effusions (black arrows).

Boerhaave syndrome


A 12-year-old Malagasy boy consulted for a fever that had been evolving for two months, with a notion of trauma and pain in the right upper quadrant as well as chronic diarrhoea. A parasitological examination of the stool found eggs of Schistosoma mansoni. An ultrasound and a CT scan were then ordered.

Ultrasound of hepatic segment VII.

Ultrasound image showing a fluid collection in the hepatic segment VII.

CT of the liver, axial view, portal phase.

Axial CT scan (portal phase) demonstrating the double target sign of liver abscesses: hypodense centres (blue arrow), hyperdense rim (green arrow) and hypodense perilesional oedema (orange arrow).

Coronal CT scan of the liver, portal phase.

Coronal CT scan (portal phase) demonstrating the double target sign of liver abscesses hypodense centres (blue arrow), hyperdense rim (green arrow) and hypodense perilesional oedema (orange arrow). There is a rupture into the Morison’s pouch and hepatosplenomegaly.

Pyogenic liver abscess


A 13-year-old boy was submitted to pelvis X-ray and MR due to left hip pain during sport activity and at rest Imaging Findings:

MRI, SE T1-weighted sequence, coronal scan.

MRI with SE T1-weighted coronal scan detects the slipping of the left capital femur epiphysis.

MRI, coronal view, T2-weighted sequence with fat suppression.

MRI with T2-weighted coronal scans with fat suppression technique shows two areas of bone marrow edema near the growth plate (arrows).

(A,B) Pelvis anteroposterior x-ray, frog lateral position.

Pelvis AP x-ray film performed in the frog lateral position shows the pathological angle between the head and the neck of the left femur (B) and the normal aspect of the controlateral femur head (A).

Epiphysiolysis


A 69-year-old female non-smoker presented with a 6-month history of progressive breathlessness. She had no relevant past medical history or drug history. Spirometry showed FEV1 32% predicted and a flow-volume loop suggesting severe small airway disease. Transthoracic echocardiogram was normal.

(A) Axial unenhanced high-resolution CT of the thorax, lung window, inspiration. (B) Axial unenhanced high-resolution CT of the thorax, lung window, expiration.

Axial unenhanced high resolution CT slices through the thorax (lung windows) in inspiration (A) and expiration (B). Mosaicism exacerbated in expiration suggests air-trapping (arrow). Vessel calibre within the hypoattenuated regions is reduced (arrow head)

CT of the thorax, axial view, mediastinal window, unenhanced.

Unenhanced axial slices through the thorax on mediastinal windows demonstrating bilateral homogenous solid soft-tissue nodules and masses (arrows)

Unenhanced CT of the thorax, axial view, high-resolution, right upper lobe, 33 mm mass.

A: Figure 3 depicts an unenhanced axial high-resolution CT slice of the thorax showing a 33 mm smoothly lobulated solid mass in the right upper lobe, which is airway-centric with a thick-walled proximal traversing airway.

Sagittal HRCT of the airway.

Sagittal HRCT shows finger-like plugging of the airway (arrow head) immediately beyond the mass (asterisk) with intermittent patency of the distal airway (arrow)

CT of the thorax, axial view, post-contrast, right upper lobe mass, non-contrast 32 HU, post-contrast 68 HU.

Axial post-contrast CT thorax demonstrates heterogeneous enhancement of the right upper lobe mass (arrow), 32 HU non-contrast, 68 HU post contrast

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) with carcinoid tumours

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

Bronchial carcinoid tumour


A 61-year-old woman presented for 3 years with a progressive visual disturbance such as difficulties in writing, reading, drawing and calculations.

Cerebral MRI, T2-weighted axial image.

Figure 1. cerebral MRI, T2-weighted axial image shows, bilateral parieto-occipital atrophy

Cerebral MRI, T1-weighted, sagittal view.

Figure 2. cerebral MRI, T1-weighted sagittal image shows, atrophy of de left parieto- occipital lobe.

Posterior cortical atrophy


A 23-year-old woman was referred to our Emergency Department with a four-day history of acute epigastric pain unresponsive to pain relief medication. She was afebrile and had unremarkable medical history and laboratory tests except for an elevated C reactive protein at 25 mg/l. The presumptive diagnosis was a perforated duodenal/gastric ulcer.

(A) Axial CT image, pre-contrast, gastro-hepatic ligament region, average density 55 Hounsfield Units, mass size 40×15 mm. (B) Axial CT image, post-contrast, portal-venous phase, gastro-hepatic ligament region, mass size 40×15 mm.

Axial CT images, before (A) and after contrast administration on a portal-venous phase (B). Well-defined mass of 40x15mm located at the level of the gastro-hepatic ligament, near the porta hepatis, slightly heterogeneous with an average non-contrast density similar to that of the liver parenchyma (55 Hounsfield Units) showing no enhancement (yellow arrows).

(A) Coronal CT before contrast administration. (B) Coronal CT after contrast administration, portal venous phase.

Reconstructed coronal CT images, before (A) and after contrast administration on a portal venous phase (B). A non-enhancing epigastric mass of 40x21 mm with the same characteristics mentioned above (yellow arrows).

(A) Contrast-enhanced CT, axial view. (B) Contrast-enhanced CT, coronal view.

Axial (A) and coronal (B) contrast-enhanced CT images. At the periphery of the anomaly, adjacent to the common hepatic artery, several serpiginous hyperattenuating structures, apparently of a vascular origin, were observed to suddenly interrupt (yellow arrows).

Intraoperative photographs of the liver and stomach region.

Figure 4 depicts intraoperative findings, showing a red-brown mass located adjacent to the lesser curvature of the stomach; surgical retraction reveals a narrow pedicle arising from the liver parenchyma, with the normal liver seen on the left side of the images and the necrotic accessory liver lobe on the right, consistent with torsion and infarction of an accessory liver lobe as visually confirmed during surgery (source: intraoperative photographs on page 6).

Torsion and infarction of an accessory liver lobe

torsion of accessory tube

Infarction of liver


Local swelling and pain in her left shin.

Anteroposterior radiograph of the left tibia.

Anteroposterior radiograph of the left tibia shows a sharply delineated expansile osteolytic lesion at the middle third of the diaphysis with reactive bone sclerosis and small satellite radiolucent foci in direct continuity with the major lesion.

Coronal and sagittal SE-T1 weighted images.

Coronal and sagittal SE-T1 weighted images demonstrate a central well-defined expansile lesion of homogeneous intermediate signal intensity (asterisk) with small satellite foci (black arrows) and decreased signal in the periphery of the lesion consistent with sclerotic changes (white arrows).

Coronal STIR MRI.

On coronal STIR image, the lesion shows homogeneous high signal intensity.

Adamantinoma


A 39-year-old male, with no prior relevant medical history, presents with atraumatic intermittent sharp pain in the lower segment of the right anterior thoracic wall. The symptoms began two months earlier when the patient started exercising (CrossFit), mostly triggered by training (especially abdominal crunches) whilst being asymptomatic in normal daily activities.

Ultrasound of the right anterior chest wall, longitudinal view, supine position.

Longitudinal view of the right anterior chest wall in supine position. The space between the 7th, 8th and 9th ribs is preserved.

Ultrasound of the right anterior chest wall, longitudinal view.

Longitudinal view of the right anterior chest wall while the patient starts performing an abdominal crunch. The 9th rib is mobile and migrates upwards towards the 8th rib.

Ultrasound of the right anterior chest wall, longitudinal view, performed during abdominal crunch.

Longitudinal view of the right anterior chest wall while the patient performs an abdominal crunch. The 9th rib is seen in close proximity to the superior rib and is pinned beneath the 8th rib.

Longitudinal ultrasound of the right anterior chest wall.

Longitudinal view of the right anterior chest wall while the patient relaxes and returns to the supine position. The 9th rib is mobile and is seen returning to its normal position.

slipping rib syndrome


A patient with known Crohn's disease presented with difficulties to pass stool, a sensation of a foreign body in the rectum and limited rectal bleeding. An endoscopy was performed as the first examination. A gallstone was found in the rectum and it was removed without complications.

MRI of the abdomen, coronal view, small bowel follow-through protocol with oral and intravenous contrast.

Figure 1 is a coronal MRI image of the abdomen, acquired as a small bowel follow-through with oral and intravenous contrast, demonstrating a fistulous tract between the gallbladder and the hepatic flexure of the colon; the image specifically highlights the anatomical connection characteristic of a cholecystocolonic fistula.

Coronal MR image of the abdomen, small bowel follow-through with oral and intravenous contrast.

This figure presents a coronal MR image of the abdomen acquired as a small bowel follow-through with oral and intravenous contrast, in which the fistulous tract is clearly visualized connecting the gallbladder and the colon, specifically between the gallbladder and the hepatic flexure, as indicated by the arrow.

Cholecystocolonic fistula


10-year-old male patient presented with an 18 month history of pain and swelling of the left tibia

Plain radiograph of the left leg.

Plain radiographs of the left leg demonstrating an expansile lytic lesion of the tibia diaphysis. Note the ill-defined margins and involvement of the central medullary cavity.

(A) Coronal FLAIR MRI and T1-weighted MRI pre- and post-gadolinium of the medullary cavity.

Coronal FLAIR, T1-W pre and post gadolinium demonstrates homogeneously enhancing solitary lesion with complete invasion of the medullary cavity, a feature more commonly seen in adamantinomas.

Axial MRI of both legs, pre- and post-gadolinium.

Pre and post gadolinium axial MRI images of both legs, once again clearly demonstrates the lesion on the left. Note the expansile nature of the lesion with diffuse cortical thinning, in comparison to the right.

Adamantinoma


A 13-year-old male presented with pain in the right hypochondrium and loss of appetite for 1 month. There was no history of fever. The patient has a history of a successfully treated abdominal tuberculosis, for which he had taken anti-tubercular treatment for 1 year.

(1a) Contrast-enhanced CT of the abdomen, axial view. (1b) Contrast-enhanced CT of the abdomen, coronal view.

Axial (1a) and coronal (1b) contrast-enhanced CT images of the abdomen showing an accessory lobe of liver inferior to segment IV, reaching till the porta posteriorly (asterisk).

(A) Contrast-enhanced CT of the abdomen, axial view. (B) Contrast-enhanced CT of the abdomen, coronal view.

CT of the abdomen, axial view, contrast-enhanced maximum intensity projection.

Axial contrast-enhanced maximum intensity projection CT image of the abdomen showing the lobe being supplied by a branch of the left hepatic artery (arrow).

Coronal contrast-enhanced CT of the abdomen.

Coronal contrast-enhanced CT image of the abdomen showing dilatation of central and peripheral intrahepatic bile ducts (arrows).

Coronal contrast-enhanced CT image of the abdomen showing attenuated calibre of the left branch of the portal vein (arrow) as compared to the right.

Accessory hepatic duct


A 40-year-old woman with a 2-year history of progressive dysphagia and dyspnoea.

CT angiography of the thoracic region, axial view, contrast-enhanced, posterior mediastinum.

Figure 1 shows an axial contrast-enhanced CT angiography image of the thoracic region, depicting an aberrant right subclavian artery (ARSA) compressing the oesophagus, with the anatomical focus on the posterior mediastinum.

Axial contrast-enhanced CT angiography of the chest, mediastinum at the level of the aortic arch.

Figure 2 presents an axial contrast-enhanced CT angiography image of the chest showing an aberrant right subclavian artery (ARSA) compressing the oesophagus (labeled "E"), with the trachea ("T") and aortic arch ("Arcus Ao") also identified; the anatomical site examined is the mediastinum at the level of the aortic arch, and the key finding is the posterior course of the ARSA resulting in oesophageal compression.

CT angiography scan, sagittal plane, anatomical region: right subclavian artery and oesophagus.

Figure 3a demonstrates a CT angiography scan in the sagittal plane, showing the aberrant right subclavian artery (ARSA) compressing the oesophagus (E) as it takes a posterior course, indicated by a white arrow; the image highlights the anatomical relationship between the aberrant vessel and the oesophagus, acquired from the radiology department.

arteria lusoria


A 4-month history of a slowly enlarging subcutaneous mass in the left thigh. Clinical examination revealed a soft, well-defined, smooth mass subcutaneously in the anterior surface of the left thigh.

Axial T1-weighted MRI of the thigh (TR/TE: 640/17).

Axial T1-weighted image (TR/TE:640/17) shows a low to isointense well-delineated subcutaneous mass in the anterior part of the thigh. Note the areas of high signal intensity with mostly peripheral distribution (arrows) as well as the incomplete hypointense rim surounding the posterior border of the lesion (arrowhead). The mass compresses the adjacent muscles and superficial fascia without any sign of invasion.

Axial MRI, T2-weighted image (TR/TE: 3000/25).

Axial IR T2-weighted image (TR/TE: 3000/25) shows a high signal intensity mass with low signal internal areas (arrows).

Axial T1-weighted MRI after administration of paramagnetic agent.

Axial T1-weighted image after the administration of paramagnetic agent shows that the lesion remains unenhanced.

MRI, sagittal view, T1-weighted sequence (TR/TE: 30/13).

Sagittal T1-weighted image (TR/TE: 30/13) shows the craniocaudal extension of the lesion.

Microscopic examination, H&E staining, 40× magnification.

Microscopic examination (HE x40) shows a cyst lined by stratified squamous epithelium with a granular layer surrounding laminated keratin.

Epidermal cyst


A 45-year-old female with a 3 month history of dyspareunia and urinary urgency

Axial T2-weighted MRI of the female pelvis.

Figure 1 presents an axial T2-weighted MRI image of the female pelvis demonstrating a septated U-shaped hyperintense lesion along the posterior aspect of the urethra, consistent with a urethral diverticulum, as indicated by blue arrows, with the urethra itself marked by a red arrow.

Coronal T2-weighted MRI of the pelvis, female urethra and periurethral region.

Figure 2a on page 4 presents a coronal T2-weighted MRI image of the pelvis demonstrating a T2 hyperintense lesion surrounding the urethra, as indicated by a red arrow; the anatomical site examined is the female urethra and periurethral region, with the image acquired for the assessment of a suspected urethral diverticulum, but without specification of the precise timing relative to symptoms or procedures.

MRI of the pelvis at the level of the pubic symphysis.

Figure 3a presents a magnetic resonance imaging (MRI) scan demonstrating a septated cystic lesion (indicated by a blue arrow) surrounding the urethra at the level of the pubic symphysis; the image is from the Department of Radiology, Clínica Ricardo Palma, Lima, Perú, and depicts the anatomical relationship between the cystic lesion and the urethra, consistent with the features of urethral diverticulum observed on MR imaging.

Urethral diverticulum


A 48-year-old female patient with slow-growing, unilateral, right-side retroareolar breast lump was referred to undergo mammography. She complained of right breast progressively enlarging lump for the last years. No history of pain or discharge.

Right mammography, craniocaudal (CC) view.

Right CC view: Multiple, well-defined, rounded, radio-opaque structures in the right retroareolar region with surrounding low attenuating hallow. No focal calcification in the vicinity. No evidence of skin thickening or nipple retraction.

Right mammogram, mediolateral oblique (MLO) view.

Right MLO view: Multiple, well-defined, rounded, radio-opaque structures in the right retroareolar region with surrounding low attenuating hallow.

Ultrasound of the ducts.

Ultrasound: A well-defined, echogenic, solid-appearing lesion in the dilated duct. Adjacent dilated ducts are also noted.

Ultrasound of dilated ducts.

Ultrasound: Multiple echogenic, solid lesion in dilated ducts.

Intraductal papillary mucinous neoplasm of pancreas


A 31-year-old female, G3P2, came in with 5-day history of severe menorrhagia. She was treated medically and discharged. She was readmitted 2 days later with menorrhagia and anaemia (haemoglobin of 77). The patient had suffered a spontaneous miscarriage a few months earlier.

CT of the pelvis, arterial phase, axial view.

Arterial phase axial CT of the pelvis demonstrating abnormal myometrial enhancer arrows) thought to represent the AVM with contrast blush of extravasation

Selective angiography of the right uterine artery.

Selective angiographic images over the right uterine artery confirmed tortuous and multiple arteriovenous malformation with active extravasation into the uterine cavity. 325 - 500 micron particles used to selectively embolise the malformation branches and stop further extravasation. The right uterine artery itself is preserved

Uterine arteriovenous malformations


A multitrauma patient was admitted to the intensive care unit (ICU) due to an intrahepatic hematoma. On the 7th day of ICU hospitalization, he presented fever. Laboratory blood tests showed leucocytosis and elevated liver function values.

Ultrasonography of the gallbladder performed on day 7 of intensive care unit hospitalization. Gallbladder wall thickness=5.9 mm.

Ultrasonography of the gallbladder performed on the 7th day of intensive care unit hospitalization demonstrates marked thickening of the gallbladder wall (5.9 mm), associated with sludge formation and a significant amount of pericholecystic fluid, findings indicative of acute acalculous cholecystitis in a critically ill patient.

Acute acalculous cholecystitis in a critically ill patient.

acute acalculous cholecystitis


A 46 year old HIV positive Portuguese man, presented with a 10 day history of shortness of breath, dry cough, fever and a sore throat. There was no history of recent foreign travel.

Chest radiograph.

Chest radiograph showing right upper lobe consolidation and illdefined right postero basal medial shadowing

HRCT of the thorax.

HRCT thorax showing a right upper lobar distribution of ground glass opacification containing several areas of cystic change that raise the suspicion of PCP.

HRCT of the thorax, basal areas.

HRCT thorax through the basal areas showing a smaller region of ground glass opacification also containing areas of cystic change in the posteromedial segment of the right lower lobe.

BAL microscopy.

Figure 4 shows BAL (bronchoalveolar lavage) microscopy demonstrating an adult Strongyloides worm surrounded by an inflammatory infiltrate.

Pulmonary strongyloidiasis in an HIV infected patient

HIV infection

Strongyloidiasis


At the age of 30 months, the patient began presenting an evolving framework of severe cognitive and neurological impairment, with tetraparesis and mixed spastic-dystonic features, language delay and deafness. Moreover, she has coarse facial features, presenting a high forehead and hypertelorism; her tongue is protruding due to macroglossia.

MRI, T2-weighted sequence, brain, periventricular region.

Diffuse periventricular hyperintensities in T2 as diffuse poor myelination.

MRI, T2-weighted sequence, globus pallidus.

Bilateral T2 hypo-intensity at the medial and lateral segments of the globus pallidus, separated by a thin hyperintense band on T2.

MRI, brain, axial view, T1-weighted sequence, without contrast.

Fucosidosis

Endocrine, nutritional or metabolic diseases


34-year-old male patient presented with wrist pain after being struck by a car while cycling

Radiograph, anteroposterior view, initial examination.

Initial AP radiograph. No acute fracture seen. In particular, the hamate appears normal. Positive ulnar variance is demonstrated.

CT of the left wrist, sagittal view.

Sagittal CT images of the left wrist show a minimally displaced fracture through the hook of the hamate. The remainder of the carpal bones were normal in appearance.

CT of the left wrist, transaxial images.

Transaxial CT images of the left wrist show a minimally displaced fracture through the hook of the hamate. The remainder of the carpal bones were normal in appearance.

CT of the wrist, coronal view.

Coronal CT of the wrist show positive ulnar variance and contour irregularity of the ulnar fovea. Mild sclerosis of the adjacent lunate and triquetrum suggests ulnarcarpal impaction.

hand fracture NOS[Hook of hamate]


Asymptomatic 64-year-old male patient. Routine chest X-ray is performed.

Abdominal X-ray.

Abdominal X-ray showed diffuse sclerosis of the lumbar vertebrae, sacrum, iliac and femoral heads.

CT scan.

CT scan shows the same findings already noted previously at the plain radiographic studies: diffuse bone sclerosis.

CT scan, sagittal view, multiplanar reformation (MPR).

Sagittal CT scan MPR reformation showing diffuse vertebral sclerosis.

CT scan of the spine, sagittal multiplanar reformation (MPR).

Figure 4 presents a sagittal CT scan multiplanar reformation (MPR) of the spine, demonstrating diffuse vertebral sclerosis.

Systemic mastocytosis


The patient was admitted with suspected stroke. There was a history of changed mental behaviour and after admission she further focal seizures.

FLAIR MRI of the brain.

FLAIR sequence - diffuse signal enhancement in the right hemisphere with space occupying effect to the right ventricle.

T2-weighted MRI.

T2-weighted image corresponding to Fig. 1.

MRI, T1-weighted sequence with IV gadolinium administration.

On T1-weighting after administration of IV gadolinium no contrast enhancement is seen

fibrillary astrocytoma of unspecified site


A 20-year-old male patient with autoimmune hepatitis presented with worsening jaundice and pruritus. A MRCP was performed, which was compared with the previous 7-month-old MRCP scan. Lab parameters revealed elevated anti- nuclear antibodies along with raised s. bilirubin (8mg/dl) and ALP 305 IU/L.

MRCP of the liver obtained seven months prior to follow-up.

Figure 1 presents a magnetic resonance cholangiopancreatography (MRCP) image of the liver obtained seven months prior to follow-up, demonstrating normal appearance of the central intrahepatic and extrahepatic bile ducts, with only a very subtle beaded appearance of the peripheral intrahepatic biliary radicles (IHBR), without overt dilatation or strictures.

MRCP, follow-up examination.

Followup MRCP reveals obvious beading and dilatation of the peripheral IHBR with suggestion of stricture of the right posterior sectoral duct near its ostium with upstream dilatation.

MRCP, axial view.

Axial MRCP obvious beading and dilatation of the peripheral biliary radicles with dilated right posterior sectoral duct.

Autoimmune hepatitis / sclerosing cholangitis overlap syndrome

Autoimmune hepatitis

sclerosing cholangitis

Barrett syndrome[Overlapping sites of oesophagus]


A 78-year-old male patient presented with worsening exertional dyspnea. Echocardiogram revealed signs of right ventricle dysfunction and elevation of pulmonary artery systolic pressure (PASP) to 81 mmHg (41 mmHg the year before), suggesting severe pulmonary hypertension (PH). Moderate tricuspid regurgitation was also noted. The patient underwent CT for further evaluation.

(A–C) Axial CT pulmonary angiography (CTPA) of the chest.

Axial CTPA images in a patient with CTEPH: a large eccentric thrombus in the right pulmonary artery (arrow on A) and multiple bilateral partial filling defects in lobar and segmental arteries with linear and web-like morphology, corresponding to intraluminal bands and webs (arrowhead on B and circles on C). These findings indicate organised residual thrombotic material in the pulmonary vascular bed.

(A) CT pulmonary angiography, axial oblique view, pulmonary trunk. (B) CT pulmonary angiography, axial maximum intensity projection. (C) CT pulmonary angiography, sagittal oblique maximum intensity projection.

CTPA reconstructed images depicting signs of PH. A) Axial oblique image showing an enlarged pulmonary trunk. B) Axial maximum intensity projection (MIP) image reveals marked reduction in size of the right lower lobe arteries in comparison with contralateral arteries. C) Sagittal oblique MIP image shows an enlarged and tortuous bronchial artery (arrow).

(A) ECG-gated CT pulmonary angiography, axial view. (B) ECG-gated CT pulmonary angiography, axial maximum intensity projection (MIP). (C) ECG-gated CT pulmonary angiography, axial view, diastolic phase. (D) ECG-gated CT pulmonary angiography, right ventricular outflow view, diastolic phase.

ECG-gated CTPA images showing right-sided heart abnormalities secondary to CTEPH. A) Axial image with dilatation of right cardiac chambers. B) Axial MIP image at a lower level showing opacilitation of hepatic veins due to retrograde flow of contrast material. C) and D) Images of axial and right ventricular outflow view, respectively, in diastolic phase reveal right ventricle hypertrophy and prominent trabecular pattern (arrows).

(A) Lung ventilation scintigraphy. (B) Lung perfusion scintigraphy. (C) V/Q quotient imaging. (D) Coronal CT pulmonary angiography (CTPA), minimum intensity projection (MinIP).

Lung V/Q scintigraphy revealing mismatched segmental perfusion defects in the right lower lobe, which has normal ventilation (A, ventilation; B, perfusion; C, V/Q quotient). D) Coronal CTPA minimum intensity projection (MinIP) image with correspondent decreased lung attenuation in the affected segments (circle).

Chronic thromboembolic pulmonary hypertension


A 10-year-old boy presenting with knee pain. Plain radiographs were performed

Plain radiograph (X-ray) of the knee, lateral view.

Figure 1 shows a plain radiograph of the knee demonstrating fragmentation at the inferior pole of the patella, indicative of osteochondrosis. The imaging modality is conventional radiography (X-ray) in the lateral view, examining the knee joint with specific focus on the inferior patellar pole, which corresponds to the site of pain and clinical findings at presentation in a 10-year-old boy.

Sinding-Larsen-Johansson disease


A 27-year-old male patient presented with complaints of exertional dyspnea and dry cough for a duration of 2 weeks. History of loss of weight was present.

Chest X-ray, mediastinum (anterior compartment).

Figure 1 consists of a scout chest radiograph demonstrating a right anterior mediastinal mass lesion with mild displacement of the mediastinum to the left. The imaging modality is a plain chest X-ray (scout film), the anatomical site examined is the mediastinum, specifically the anterior compartment, and the key finding is a right anterior mediastinal mass causing mild shift of mediastinal structures toward the left. No acquisition timing beyond the initial work-up is specified, and no special views, staining, or magnification are applicable to this modality.

CT of the mediastinum, axial view.

Plain axial CT image shows right anterior mediastinal soft tissue density lesion with heterodense areas.

Contrast-enhanced CT, axial view, right anterior mediastinum.

Contrast-enhanced CT axial image shows heterogenous enhancement of soft tissue density lesion in right anterior mediastinum

Contrast-enhanced CT of the anterior mediastinum, axial view.

Contrast-enhanced CT axial image shows heterogenously enhancing soft tissue density lesion in right anterior mediastinum with displacement of mediastinal structures.

Contrast-enhanced CT of the right anterior mediastinum, axial view.

Contrast-enhanced CT axial image shows heterogenously enhancing soft tissue density lesion in right anterior mediastinum with mild compression of superior vena cava.

Mediastinal extra skeletal Ewing's sarcom

Extraosseous Ewing sarcoma


A 16-year-old girl known for unsteadiness, recurrent falls, cognitive decline and visual problems was referred for a brain MRI. Her mother has a history of balance problems associated with retinopathy since the age of 30 and her maternal grandmother also developed balance difficulties later in life.

Noncontrast sagittal brain MRI.

Figure 1 demonstrates a noncontrast sagittal brain MRI showing marked atrophy of the pons and inferior cerebellar vermis, as well as moderate atrophy of the midbrain and medulla oblongata, with no signs of atrophy in the cerebrum.

CT or MRI of the posterior fossa, showing the inferior cerebellar vermis.

Slice through the posterior fossa shows atrophy of the inferior cerebellar vermis. The cerebrum and cerebellar hemispheres show no signs of atrophy.

Axial brain MRI.

Figure 3 presents an axial brain MRI demonstrating significant atrophy of the pons and middle cerebellar peduncles.

MRI of the brain, coronal view, T1-weighted sequence, posterior fossa region.

Figure 4a presents a coronal T1-weighted MRI image of the brain demonstrating symmetrical atrophy of the superior cerebellar peduncles. This image focuses on the posterior fossa region, and illustrates the involvement of the superior cerebellar peduncles without evidence of additional abnormalities or specific findings outside this structure.

MRI of the posterior fossa, slice through the pons.

Slice through the posterior fossa shows a small hyperintensity in the pons due to degeneration of transverse pontine fibres.

Spinocerebellar ataxia


The patient was a 53 year old male with a previous stroke.

CT of the mid-lung, trans-axial view, lung window.

Trans-axial mid-lung CT image as seen on the lung window.

CT of the lung, trans-axial view, soft tissue window.

Trans-axial mid-lung CT image as seen on soft tissue window.

Lipoid pneumonia


The first patient, a 3-month-old girl baby presented with recurrent episodes of abnormal tonic posturing, frothing, and abnormal blinking of eyes since the 22nd day of her life. Clinical examination demonstrated abnormal facial morphological features like prominent premaxilla and sparse lateral eyebrows.

MRI, midsagittal view, T2-weighted sequence, brain.

Midsagittal T2-weighted MR image shows agenesis of the corpus callosum with a high- riding third ventricle and a large dorsal interhemispheric cyst. The cingulate gyrus and sulcus are absent, with a sunburst appearance of radiating gyri. The tectum is normal in size.

Axial T2-weighted MRI of the brain.

Axial T2-weighted MR image shows a large T2 hyperintense bilobed interhemispheric cyst with a thin internal septation. Nodular areas with grey matter signal intensity are noted in the subependymal region of the left lateral ventricular body, indicating sub-ependymal heterotopia. Polymicrogyria markedly noted in the left frontal lobe.

3D T2-weighted FSE coronal reformatted MRI of the brain.

3D T2-weighted FSE coronal reformatted MR image displays the left cerebral hemi- atrophy with features of polymicrogyria. It shows a classical “Viking helmet” sign suggestive of corpus callosal agenesis. An unilobulated T2 hyperintense inter-hemispheric cyst is noted.

Axial T2-weighted MRI of the left posterior globe.

Axial T2-weighted MRI image shows a focal defect in the left posterior globe with a well- defined T2 hyperintense retro-bulbar cystic focus, abutting the optic nerve, causing mild proptosis (coloboma).

Axial T2-weighted MRI of the brain.

Axial T2-weighted MR image displays left cerebral hemi-atrophy with sub-cortical grey matter heterotopia and callosal agenesis with colpocephaly.

Aicardi syndrome


Patient is a 2 month-old male, full-term infant, with severe malnutrition and failure to thrive, admitted to the intensive care unit, with long term feeding difficulties. The study was performed initially to rule out malrotation.

Upper GI series radiograph of the duodenum.

Spot images from an upper GI series demonstrate abrupt caliber change at the junction of the second and the third portion of the duodenum, with the second portion markedly dilated. There is a rather prominent tubular impression at this transition point, which is the impression made by the superior mesenteric artery. Note that the ligament of Treitz is in its normal location, ruling out malrotation.


A 23-year-old female presented with a complaint of intermittent dyspnea (New York Heart Association NYHA grade, II), which aggravates on exertion and mild chest pain. No past significant medical and surgical history was given by the patient. On clinical examination, bruit was heard on auscultation in the left mid-zone.

Chest X-ray.

CT pulmonary angiography, axial maximum intensity projection.

CT pulmonary angiography, coronal maximum intensity projection.

CT volume rendering multiplanar reformatted image of the pulmonary vessels.

Figure 4 presents a volume rendering multiplanar reformatted image obtained by CT, demonstrating the vascular anatomy of a pulmonary arteriovenous malformation in the lung, with clear visualization of the vascular communications including the origin and termination of the lesion, thereby confirming the diagnosis of pulmonary arteriovenous malformation; the anatomical focus is the pulmonary vessels, and the image was acquired as part of a multimodality chest imaging assessment at the Department of Radiodiagnosis, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, with no specific mention of the timing beyond its role in diagnostic confirmation.

Pulmonary arteriovenous malformation


52-year-old female with AML and persistent fevers on chemotherapy. Patient presented to the emergency room with fever.

Chest radiograph, frontal view.

Frontal view of the chest demonstrates diffuse bilateral patchy air space opacities. Pleural effusions are not evident on this image. A right-sided tunneled catheter is present.

adult respiratory distress syndrome


45 year old hispanic male with a 3 month history of progressively worsening pain in the right shoulder.

Frontal radiograph of the right shoulder, internal rotation.

Frontal radiograph of the right shoulder in internal rotation showing several flocculent calcific densities lateral and posterior to the right humeral head.

tumoural calcinosis


50 y/o female with three month history of weight loss and early satiety.

Upper GI series, AP view.

CT, axial view, with contrast enhancement.


Follow up radiographs for multiple osteochondromas.

Frontal radiograph of both knees.

Frontal radiograph of both knees demonstrates multiple osteochondromas projecting away from the knee joint. These metaphyseal lesions are seen on the distal femur and proximal tibia and fibula. The cortex and medullary space of the parent bone are continuous with that of the osteochondroma.

Frontal radiograph of the wrist.

Frontal radiograph of wrist demonstrates multiple osteochondromas projecting away from the wrist joint. Lesions are seen on the metaphyses of the distal radius and ulna. The cortex and medullary space of the parent bone are continuous with that of the osteocondroma. There is associated shortening of the ulna.

Multiple congenital exostoses


Weight loss and abdominal pain/vomiting after eating

Supine upper gastrointestinal fluoroscopic image.

Supine fluoroscopic image from upper GI demontrates dilation of the second portion of the duodenum and abrubt vertically oriented linear filling defect in the third portion with no passage of contrast

Prone abdominal radiograph after ten minute delay.

Prone image after ten minute delay demonstrates persistent dilation of the second portion of the duodenum and abrupt vertically oriented filling defect in the third portion with no distal passage of contrast.


A 12 year old girl with congenital aqueductal stenosis presented with nausea, vomiting and headache and neck pain. Imaging Findings:

MRI of the brain, coronal view, T2-weighted sequence, posterior fossa.

Figure 1 depicts a coronal T2-weighted MRI image of the brain demonstrating continuous transverse folia of the cerebellum, indicative of rhombencephalosynapsis, with the anatomical site being the posterior fossa; the image highlights the fusion of cerebellar hemispheres and absence of the vermian separation, but does not specify scan timing or further acquisition parameters.

Axial T2-weighted MRI of the posterior fossa.

Figure 2 shows an axial T2-weighted MRI image of the posterior fossa demonstrating absence of the cerebellar vermis, a box-shaped fourth ventricle, fusion of dentate nuclei as indicated by black arrows, and fusion of the cerebellar hemispheres.

Sagittal T2-weighted MRI of the brain.

Figure 3a on page 5 is a sagittal T2-weighted MRI of the brain demonstrating that the fastigial recess of the fourth ventricle (indicated by a black arrow) is round in shape, whereas it is normally sharp, and also showing the presence of tonsillar herniation.

MRI of the brain, midsagittal view, T1-weighted.

Figure 4 depicts a midsagittal T1-weighted MRI image of the brain, demonstrating hypoplasia of the corpus callosum and cerebellar tonsillar herniation.

Rhombencephalosynapsis


A 29-year-old woman with no significant medical history presented with a rapidly growing and painful left breast mass.

Colour-Doppler ultrasound.

On colour-doppler US the solid components of the lesion were vascularised.

Ultrasound of a cystic mass.

Ultrasound showed a large complex cystic mass with circumscribed, partially microlobulated margins.

Mammography of the left breast, craniocaudal (CC) and oblique mediolateral (OML) views.

CC and OML mammograms revealed a large, round, high density mass in the upper outer quadrant of the left breast, mostly circumscribed with partially ill defined margins and without microcalcifications.

MRI, T2-weighted sequence.

On T2-WI the lesion was round, lobulated and heterogeneous with central hyperintense necrotic component and a peripheral irregular solid component, measuring 7.5 x 6.5 cm2.

(A) Contrast-enhanced imaging, early phase. (B) Contrast-enhanced imaging, delayed phase.

The peripheral solid component of the mass revealed rapid and heterogeneous enhancement at early phase after intravenous contrast administration (A) with wash-out in the delayed phase (B).

Metaplastic breast carcinoma with squamous cell carcinoma differentiation

Metaplastic carcinoma of breast

Breast carcinoma NOS


Two-day history of nausea, anorexia, and abdominal pain.

Grayscale ultrasound of the right lower quadrant.

Grayscale sonographic image of the right lower quadrant, which demonstrates a blind-ended tubular structure.

(A) Grayscale sonographic image of the appendix, transverse plane, with compression. (B) Grayscale sonographic image of the appendix, transverse plane, without compression.

Grayscale sonographic images with and without compression of the appendix in transverse plane demonstrating lack of compressibility.

Sonographic imaging of the appendix, grayscale mode, width=8 mm.

Grayscale sonographic image through the appendix demonstrating width of 8mm and loss of central echogenicity.

Acute appendicitis


23 yo soldier (OIF) s/p multiple IED blasts without clear evidence of LOC.

Axial PET scan of the brain with scalp muscles, F18-FDG.

Axial PET images of brain with the scalp muscles demonstrating F18-FDG metabolism that is more intense than the gray matter.

traumatic brain injury NOS


A male 2nd world war veteran had a head CT after a motor vehicle accident

CT of the head.

Head CT: Bilateral partially calcified auricular cartilages.

Auricular cartilage calcification


77 year-old man with right upper quadrant pain and microhematuria.

CT of the abdomen, axial view.

Axial CT of abdomen shows a markedly thickened (>3 mm) and gallbladder wall. The known calculus at the gallbladder neck is not visualized.

CT with contrast, axial view, gallbladder wall thickness >3 mm.

Axial CT with contrast shows a markedly thickened (>3 mm) and enhancing gallbladder wall.

Ultrasound of the right upper quadrant.

Longitudinal ultrasound of right upper quadrant shows the gall bladder with thickened wall and a biliary calculus with acoustic shadowing within the gallbladder neck.

biliary calculus with acute cholecystitis


Sagittal T1-weighted MRI of the knee.

Sag T1 image demonstrates complete disruption of the ACL. No normal low signal intensity fibers are seen. Moderate to large joint effusion.

Sagittal T2 fat-saturated MRI of the knee.

Sag T2 fat sat image demonstrates complete disruption of the ACL. Increased signal intensity within the disrupted fibers of ACL is present. Moderate to large joint effusion.

tear of ACL - [anterior cruciate ligament]


Acute onset of stomach and back pain. Previously healthy female.

Frontal radiograph of the abdomen.

Fronatal radiograph shows multiple radiopaque stones in the expected region of the gallbladder.

Ultrasound of the gallbladder.

US shows multiple echogenic stones with posterior shadowing in the gallbladder. The gallbladder wall is thickened.

Ultrasound of the gallbladder.


12 year-old boy presents with acute right lower quadrant pain.

Ultrasound of the right lower quadrant, longitudinal view, diameter of tubular structure measured at 8 mm.

Gray-scale longitundal sonographic image through the right lower quadrant shows an inflamed appendix. This dilated, fluid-filled, noncompressible, blind-ending tubular structure measured 8 mm in diameter, with increased periappendieal echogenicity representing infiltration of mesenteric fat.

Transverse sonographic image of the right lower quadrant.

Gray-scale transverse sonographic image through the right lower quadrant shows an inflamed appendix. This dilated, fluid-filled, noncompressible, blind-ending tubular structure measured 8 mm in diameter, with increased periappendieal echogenicity representing infiltration of mesenteric fat. Additionally, note the target appearance caused by a fluid-filled lumen and an intact echogenic submucosal layer.

Longitudinal color Doppler ultrasound of the appendix.

Color Doppler longitudinal sonographic image through the inflamed appendix reveals marked hyperemia along the periphery.

Acute appendicitis


PA chest radiograph.

Fig 1: On PA chest radiograph, a large, well-marginated, expansile mass with sclerotic border originating from the right 8th rib was demonstrated.

(A) MRI, axial view, FSE T2-weighted sequence. (B) MRI, coronal view, FSE T2-weighted sequence.

Fig 2a,b: Axial and coronal FSE T2-weighted MR images show heterogeneous high signal intensity lesion that caused cortical thinning.

Axial T1-weighted MRI, fast field echo sequence.

Fig 3: Axial fast field echo T1-weighted MR image shows largely isointense with areas of hypointensity lesion to the skeletal muscle which is expansile and medullary located.

Contrast-enhanced T1-weighted MRI, transverse view.

Fig 4: Heterogeneous central and peripheral rim enhancement was shown on contrast- enhanced T1-weighted transverse MR image.

fibrous dysplasia, site unspecified


A 32 year-old male presented to his primary care provider with unremitting neck pain. He denied any history of trauma. The patient was unresponsive to conservative therapy and plain-film radiographic evaluation was negative. Patient was subsequently referred for a cervical spine MR for further evaluation.

Sagittal T1-weighted MRI of the cervical spine.

Sagittal T1WI of the cervical spine demonstrates a multilobulated mass in the inferior aspect of the fourth ventricle. The lesion is isointense to gray matter.

MRI of the cervical spine, sagittal view, T2-weighted imaging.

Sagittal T2WI of the cervical spine demonstrates a multilobulated mass in the inferior aspect of the fourth ventricle. The lesion is of mixed iso/hypointensity when compared to gray matter. There are some small areas of low signal intensity suggestive of calcifications.

Brain MRI, axial view, T2-weighted imaging.

Axial T2WI of the brain demonstrates a multilobulated mass in the fourth ventricle. The lesion is of mixed iso/hypointensity when compared to gray matter and demonstrates a small focus of very low signal intensity consistent with an intralesional calcification.

Coronal contrast-enhanced T1-weighted MRI of the brain.

Coronal contrast enhanced T1WI of the brain demonstrates a multilobulated mass in the fourth ventricle. The lesion shows scattered areas of enhancement.

Ependymoma


22 year old G1P1 presents with hemoptysis and shortness of breath for 1 day. She is 8 days post induced labor and delivery at 36 weeks due to pre-eclampsia and was discharged 2 days ago on beta blocker and clonidine patch.

CT of the chest, enhanced.

Enhanced CT chest demonstrates cardiac enlargement with dilated left ventricle.

CT of the chest with contrast.

Enhanced CT chest demonstrates cardiac enlargement with dilated left ventricle and small bilateral pleural effusions.

CT of the chest, lung windows.

Enhanced CT chest with lung windows demonstrates patchy areas of airspace consolidation bilaterally, compatible with diffuse alveolar hemorrhage.

Chest radiograph.

Chest radiograph demonstrates cardiac enlargement and vascular prominence and opacity of the right lower lung.

Cardiomyopathy


A male full-term neonate was admitted to the hospital 4 hours after birth for ecchymosis and petechiae. The infant was delivered by cesarean section at 40+5 weeks gestation due to failed induction, with birth weight 4000g and Apgar scores of 10. Physical examination revealed stable vital signs, weight 3850g, length 52cm, head circumference 35cm. The infant was alert and responsive with no special facial features. Skin examination showed large areas of ecchymosis on the chest, back, and upper limbs, with ecchymosis at the hepatitis B vaccine and vitamin K1 injection sites, and scattered pinpoint hemorrhages on the buttocks and lower limbs. The umbilical cord ligation site showed no bleeding, and cardiac, pulmonary, abdominal, and neurological examinations were normal.

Genetic analysis, next-generation sequencing, vWF gene exon 28 c.3946G>A (p.Val1316Met).

Next-generation sequencing results showing vWF gene exon 28 c.3946G>A (p.Val1316Met) heterozygous missense mutation in the patient, with both parents negative for this variant at the same locus

Von Willebrand disease type 2B

Diseases of the blood or blood-forming organs


A 34-year-old woman with a history of chronic urinary infections

CT scan of the pelvis, axial view, urinary bladder.

Figure 1 presents an axial CT scan of the pelvis demonstrating hyperdensity and thickening of the urinary bladder wall, features which simulate a neoformation; the imaging specifically depicts the bladder as the anatomical site, with no details on scan timing beyond its use in the initial patient assessment for urinary symptoms, and the key finding is wall thickening with increased density suggestive of possible neoplastic infiltration.

A: Figure 2a presents a histopathological section showing the histologic findings of the bladder lesion, although specific details such as staining technique and magnification are not provided in the caption on page 4; the image suggests a high-power field, likely stained with hematoxylin and eosin, revealing clusters of large cells with abundant cytoplasm and eccentric nuclei, characteristic of malakoplakia, but precise identification of microscopic features is limited by the available text.

Malakoplakia of bladder


This case is a 26-year-old Chinese female patient who presented with a 2-year history of progressive weakness of lower limbs and scissors gait that began at age 24. As her gait abnormality progressed, she developed dysphagia and severe cognitive impairment with a mini-mental state examination (MMSE) score of 16/30. The spasticity was severe in the lower extremities and mild in the upper extremities. Physical examination revealed patellar clonus on the left side. Her birth history and developmental milestones were normal. She was initially classified as sporadic HSP, though genetic testing later revealed she had compound heterozygous mutations indicating autosomal recessive inheritance.

(A) Brain MRI acquired after symptom onset, axial, coronal, and sagittal views, T2-weighted sequence.

A: Figure 3 (A) shows axial, coronal, and sagittal brain MRI images of case 1 acquired after symptom onset, displaying T2-weighted sequences with red arrows indicating characteristic radiological findings. The images reveal the 'ears of the lynx' appearance and thinning of the corpus callosum, which are hallmark features associated with SPG11-related hereditary spastic paraplegia, but there is no mention of other brain regions being abnormal. The MRI modality, anatomical site (brain), and sequence (T2-weighted), as well as the specific findings (ears of the lynx appearance and corpus callosum thinning), are explicitly provided in the figure caption and body text (see page 7, figure and caption; clinical context in results section page 6).

pedigree diagram, current patient marked as II. 2. It shows mutational status for SPG11 mutations (p.M245fs and p.F2343fs), "+" symbols indicate mutation carriers

A: Figure 2 (A) presents the pedigree of Family 1 with hereditary spastic paraplegia, depicting the family members’ relationships, gender, and mutational status for SPG11 mutations (p.M245fs and p.F2343fs), where black symbols indicate affected individuals, "+" symbols indicate mutation carriers, and arrows designate the proband; this is a schematic genealogical diagram used for genetic segregation analysis rather than a clinical image, and it does not describe imaging, anatomical sites, or acquisition timing.

Table presenting clinical data and genetic findings of hereditary spastic paraplegia patients with mutations in HSP-related genes.

Table 2 presents the clinical data of hereditary spastic paraplegia (HSP) patients with mutations in HSP-related genes identified in this study, including details on sex, age at onset, disease duration, inheritance pattern, specific genes and variants (distinguishing known and novel mutations), variant type (homozygous or heterozygous), HSP phenotype (pure or complex), presence of neuropathy, upper and lower limb hyperreflexia, lower limb weakness, ankle clonus, Babinski sign, and additional clinical features such as dysarthria, mental retardation, tremor, visual impairment, depression, anxiety, Hoffmann sign, and nystagmus; this table systematically summarizes the genotype-phenotype correlations for eight cases, with each entry specifying the technical and clinical descriptors relevant to the individual mutations detected.

Complex hereditary spastic paraplegia (HSP) due to compound heterozygous pathogenic mutations in SPG11 gene (p.M245fs and p.F2343fs)

Autosomal recessive complex hereditary spastic paraplegia


A female patient, 50 years old, non-Portuguese-speaking Eastern Europe immigrant, was referred to our institution because of a low stature (1.37 meters), with foreshortened skull base, short wide face and coarse dry skin. The laboratory analysis showed elevated TSH and low T4 levels with normal T3 levels suggesting primary hypothyroidism with residual hormonal production.

CE-CT of the base of tongue, axial view.

CE-CT axial view: Slightly heterogeneously enhancing 2 cm nodule lying over the base of the tongue corresponding to ectopic thyroid tissue.

CE-CT of the base of the tongue, axial view.

CE-CT, coronal view.

CE-CT coronal view: This reconstruction helps to better understand the anatomic relations of the enhancing ectopic thyroid and the base of the tongue.

Contrast-enhanced computed tomography, sagittal plane.

A: Contrast-enhanced computed tomography (CE-CT) in the sagittal plane demonstrates the presence of ectopic thyroid tissue located between the base of the tongue and the epiglottis.

CE-CT, sagittal view.

CE-CT sagital view: The ectopic thyroid can be located between the base of the tongue and the epiglottis.

Congenital hypothyroidism with cretinism and ectopic lingual thyroid tissue

Congenital hypothyroidism

cretinism

Thyroid ectopia


10-year-old white female, competitive ice skater, presented with right knee pain in January 2010. Pain progressed to limit walking. In July 2010 after falling on right knee, presented to ER with severely swollen knee. No constitutional symptoms reported.

MRI of the knee, osseous and soft tissue mass measuring 5.9 × 4.8 × 4.9 cm centered in the patella with marrow extension, and three additional subcutaneous lesions around the knee.

MRI showed 5.9 x 4.8 x 4.9 cm osseous and soft tissue mass centered in patella with marrow extension and three similar subcutaneous lesions around knee

(A) Biopsy specimen. (B) Biopsy specimen, immunohistochemistry for P63.

Biopsy showed: (A) multinucleated osteoclast giant cells with large numbers of nuclei scattered among mononuclear tumor cells; (B) mononuclear tumor cells with nuclear reactivity for P63

CT scan of the chest, axial view, performed at diagnosis.

Figure 3 presents an axial computed tomography (CT) scan of the chest performed at diagnosis, demonstrating innumerable, well-circumscribed pulmonary nodules consistent with metastatic dissemination of giant-cell tumor of bone.

Intraoperative pathological section

Figure 4 shows a histopathological section of metastatic giant-cell tumor of bone (GCTB) involving the lung; the image displays metastatic GCTB tissue in the lower right portion adjacent to normal lung parenchyma in the upper left, as described in the case report on page 1 and visualized on page 2. The slide type and staining are not explicitly stated for this figure, but the appearance and context indicate a routine light microscopy preparation of resected pulmonary tissue confirming metastatic GCTB.

Metastatic Giant-Cell Tumor of Bone (GCTB)

Giant cell tumour of bone unknown behaviour of unspecified site

bone metastasis


A 32-year-old woman presented to the clinic in June 2013 with complaints of easy fatigability, muscle cramps, and myoglobulinuria. Her family history was unremarkable. She recalled experiencing easy fatigability, muscle cramps, and contractures after intense exercise during physical education classes since early adolescence. She had several episodes of dark urine following intense exercise such as long-distance running, with symptoms of exercise intolerance aggravated one year prior to presentation. She reported marked improvement in exercise tolerance after about 20 minutes, described as the 'second-wind phenomenon', with improvement in excessive fatigue, breathlessness, and tachycardia. Physical examination showed no fixed muscle weakness or muscle atrophy, with all sensory modalities and tendon reflexes intact. Laboratory studies revealed a serum creatine kinase level of 1,161 IU/L at rest (normal < 215 IU/L). Nerve conduction study and needle electromyography showed no abnormalities at rest. Motor nerve conduction study on the ulnar nerve after voluntary maximal contraction for two minutes and 50 Hz nerve stimulations for one second showed no decrease in compound muscle action potential amplitudes, and EMG did not show silent electrical activities during muscle cramps.

pedigree chart, current patient marked as II. 3

A: Figure 1 (A) presents a pedigree chart depicting a family affected by glycogen storage disease type V (GSD-V), with the proband indicated by an arrow and filled symbols denoting affected individuals; this figure illustrates the inheritance pattern but does not involve imaging, pathology, or laboratory modalities, anatomical site, or procedural timing.

Non-ischemic forearm exercise test, venous lactate and ammonia levels.

Non-ischemic forearm exercise test showed no increase in venous lactate level with a normal increase in ammonia.

Genetic analysis of PYGM gene.

Sequencing chromatograms revealed compound heterozygous PYGM mutations: one allele had a frameshift mutation of c.1531delG (p.D510fs) in exon 13 and the other allele had a deletion mutation of c.2128_2130delTTC (p.F710del) in exon 17.

Glycogen storage disease


A male neonate, born at 36+1 weeks gestation via cesarean section due to scarred uterus and fetal heart rate deceleration, weighing 2700g with Apgar scores of 2-8-9. The infant experienced severe asphyxia at birth requiring intubation and chest compressions. After resuscitation, he presented with respiratory distress and difficulty breathing. Following extubation from mechanical ventilation on day 6, the patient developed recurrent inspiratory dyspnea and stridor. The infant had no relevant family history and no history of laryngeal or thoracic surgery.

Fiberoptic bronchoscopy performed on day 20 of life.

Fiberoptic bronchoscopy performed on day 20 of life showing: epiglottis elevated well, arytenoid tissue hypertrophic, collapsing toward the subglottis during inspiration, aryepiglottic folds opening and closing well, membranous adhesion visible on both sides anterior to the vocal cords, vocal cord movement restricted, trachea patent with smooth mucosa, no fistula observed; carina normal with smooth mucosa, bilateral main bronchi openings normal, bilateral segmental bronchi openings normal with smooth and hyperemic mucosa, small amount of thin secretions observed and improved after saline lavage.

Laryngoscopy at 1 month and 7 days of life.

Laryngoscopy performed at 1 month and 7 days of life showing: bilateral nasal cavity and nasopharynx with good ventilation and drainage, larynx with normal epiglottis, aryepiglottic folds, pyriform sinuses and ventricular folds morphology, no excess mucosal folds causing obstruction, bilateral vocal cords remained in midline position and fixed during crying, anterior-middle-posterior glottic gap present, posterior commissure width approximately 2-3mm, complete exclusion of glottic web type.

Paralysis of vocal cords or larynx[Bilateral]