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We describe the usefulness of n -butyl-cyanoacrylate (nBCA)-assisted retrograde transvenous obliteration (NARTO) for gastric varices in 3 consecutive patients. In all patients, balloon catheters were inserted into the gastrorenal shunt via the left renal vein. After injecting sclerosant into the gastric varix under balloon occlusion, nBCA was injected to the proximal side of the shunt, to completely embolize the shunt. NARTO is a simple technique to achieve stagnation of the injected sclerosant in gastric varices and to occlude a gastrorenal shunt. This procedure is also cost-effective, and may improve procedure time compared with original or modified balloon-occluded retrograde transvenous obliteration., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Air emboli represent rare but severe complications of computed tomography (CT)-guided lung biopsy (CTLB). No reports exist regarding the behavior of air during the early stages of air emboli. We present a case of air emboli following CTLB, evaluated by intermittent CT over a 2-hour period, spanning from onset to resolution. A man in his 60s underwent CTLB for diagnosis of a slowly enlarging pulmonary nodule in the right lower lobe. Immediately post-biopsy, chest CT revealed air emboli in the right coronary artery and apex of the ascending aorta. The patient was in the head-down position on the CT table, and intermittent CT scans were performed over a 2-hour period until the air emboli resolved. Subsequently, the patient was discharged without any complications., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Ectopic pituitary neuroendocrine tumors (PitNETs) are uncommon conditions that develop outside of the sella turcica. The sphenoid sinus is the most common site for ectopic PitNET, followed by the suprasellar region, clivus, and cavernous sinus. PitNETs, regardless of whether inside or outside sella, may display avid 18F-fluorodeoxyglucose (FDG) uptake and masquerade as malignant tumors. Herein, we report a case of ectopic PitNET arising in the sphenoid sinus, which was found as an FDG-avid mass during cancer screening. On magnetic resonance imaging, the tumor showed heterogeneous and intermediate signal intensity areas on T1- and T2-weighted images with cystic components, which was consistent with PitNET. The localization and the presence of empty sella were suggestive of ectopic PitNET, and the diagnosis of ectopic PitNET (prolactinoma) was confirmed by endoscopic biopsy. Ectopic PitNET should be considered in a mass similar in nature to an orthogonal PitNET in areas near the sella turcica especially in patients with empty sella., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Intravascular lymphoma (IVL) is difficult to diagnose because its clinical presentation and laboratory and imaging findings are nonspecific. Herein, we report a case of IVL presenting as a lesion in the splenium of the corpus callosum. A 52-year-old man attended the emergency department with a 2-week history of progressively worsening abnormal behavior and gait disturbance. Magnetic resonance imaging on admission revealed an oval lesion in the splenium of the corpus callosum. The follow-up magnetic resonance imaging performed 2 months after disease onset revealed multiple high-signal areas in the bilateral cerebral white matter on T2-weighted images and diffusion-weighted images. The blood test results showed an elevated level of lactate dehydrogenase and serum-soluble interleukin-2 receptor. These findings were compatible with the diagnosis of IVL. IVL is often difficult to diagnose due to a wide variety of clinical presentations and imaging findings., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Hepatic venous outflow complication is one of the crucial vascular complications after liver transplantation. We describe successful use of the pull-through technique for hepatic vein angioplasty in a patient with stenosis of the middle and left hepatic veins (MHV and LHV) after living-donor liver transplantation. It was difficult to select the stenotic MHV with a femoral approach. However, the guidewire was unexpectedly inserted into a small collateral vein and selective angiography showed the MHV through the collaterals. Because the guidewire proceeded to the MHV via the collateral and finally into the inferior vena cava, we advanced a catheter from the inferior vena cava to the MHV using the pull-through technique and performed balloon angioplasty., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Pulmonary artery aneurysms (PAAs) occurring in the distal branch of the pulmonary artery are rare, and there are only a few reports of transcatheter embolization of unruptured idiopathic peripheral PAAs. We report a case of a 66-year-old woman with a history of surgery for pulmonary arteriovenous malformations who presented with an idiopathic peripheral PAA of A10 confirmed by contrast-enhanced computed tomography and pulmonary artery angiography. Transcatheter embolization was performed to prevent rupture, and the aneurysm was successfully embolized. Although there is no consensus on the indications and treatment for unruptured idiopathic peripheral PAAs, transcatheter embolization may be a favorable treatment option., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

A displaced left upper bronchus is a rare anomaly. We report the case of a 45-year-old man with a displaced bronchus, branching from the left main bronchus and bifurcating into the apicoposterior and anterior segment bronchi of the left upper lobe. The displaced bronchus passed behind the left pulmonary artery. To our knowledge, 12 similar cases of displaced bronchi have been reported to date. Displaced bronchi are difficult to detect prospectively on computed tomography. However, evaluating the accessory fissures may help establish an accurate diagnosis., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Acupuncture is an alternative treatment for a variety of diseases, and serious complications are rare. We report a case of transcatheter arterial embolization performed in a patient with a massive hemothorax after acupuncture treatment. A 36-year-old woman with no previous medical history was admitted to our hospital with left back pain and respiratory distress after acupuncture treatment. Contrast-enhanced computed tomography showed a left hemothorax and leakage of contrast medium, which was considered to result from an injury to the second intercostal artery, caused by acupuncture treatment. Transcatheter arterial embolization successfully stopped the bleeding, and the hematoma was thoracoscopically removed. No rebleeding was observed 6 months after treatment., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Post-traumatic facial nerve paralysis is a common disease, but intracranial facial nerve injury after blunt injury has rarely been reported. We report a case of facial nerve avulsion at the cerebellopontine angle. A 23-year-old female with incomplete right-sided facial nerve palsy and facial spasms presented to our hospital. She had a history of traumatic injury, having fallen off a table and hit her head at the age of 2 years. After the accident, she developed complete right-sided facial nerve palsy and underwent conservative treatment with steroids. A magnetic resonance imaging examination performed 21 years later showed avulsion of the facial nerve at the cerebellopontine angle. Magnetic resonance imaging targeting the facial nerves might provide additional information to computed tomography in cases with poor recovery with conservative treatment., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

ACTA2-related vasculopathy is an autosomal dominant genetic disorder characterized by aortic aneurysms and dissection, and limb artery lesions are rare. We report a case of transcatheter arterial embolization for a pseudoaneurysm of a deep femoral artery in a patient with presumptive ACTA2-related vasculopathy. A 58-year-old woman was presumed to have an ACTA2 mutation based on her history of aortic diseases and family history of ACTA2 mutations. During follow-up, contrast-enhanced computed tomography for aortic diseases revealed occlusion and vessel wall abnormalities of the bilateral deep femoral arteries. Two weeks later, she complained of acute right inguinal pain without any triggering factors, and contrast-enhanced computed tomography revealed a pseudoaneurysm of the right deep femoral artery. Vascular fragility due to ACTA2 mutation was believed to be the cause of the pseudoaneurysm. Transcatheter arterial embolization was successfully performed and no rebleeding occurred during 1.5 years after the transcatheter arterial embolization., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Blastic plasmacytoid dendritic cell neoplasm is a rare aggressive myeloid malignancy thought to be derived from precursor plasmacytoid dendritic cells. Rapid progression and poor prognosis have been known. We herein present a case of BPDCN in a previously healthy man who presented with suddenly developed multiple deep purple skin rashes, with sequential computed tomography examinations. The follow-up computed tomography demonstrated that multiple skin nodules observed in the initial MRI fused, resulting in a thickening of the entire skin, with some surface erosions and crusting. Blastic plasmacytoid dendritic cell neoplasm should be considered in the differentials in patients with a sudden onset and rapidly progressing skin rash or thickening., Competing Interests: None., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Endometrial stromal sarcoma is a rare uterine mesenchymal neoplasm, and extrauterine endometrial stromal sarcoma is even rarer, with a limited number of case reports. In the present report, we present a case of low-grade extrauterine endometrial stromal sarcoma originating from the mesentery in a 49-year-old woman, without endometrial stromal sarcoma in the uterus or evidence of endometriosis. The tumor was diagnosed using recombination of the JAZF1 gene by fluorescence in situ hybridization. Computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed a 13 cm, primarily polycystic, mass containing a contrast-enhancing solid component with restricted diffusion and mild 18F-fluorodeoxyglucose uptake. A large cystic component may be a characteristic feature of extrauterine endometrial stromal sarcoma, given the low pressure from the surrounding tissues., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Postmortem computed tomography (CT) is currently a well-known procedure and helps in postmortem investigations. In this case report, we report a unique postmortem CT finding: delayed cerebral enhancement associated with the antemortem infusion of contrast medium. A 72-year-old female lost consciousness at a restaurant and was taken to a hospital in an ambulance. Despite resuscitation efforts, she died of hypoxic-ischemic encephalopathy caused by cardiac arrest. About 6 h before her death, she underwent enhanced antemortem CT of the head. No abnormal enhancement was observed in the cerebral parenchyma. Then, 11 h after her death, she underwent unenhanced postmortem CT, which showed bilateral hyperdense caudate nucleus and putamina, due to residual iodinated contrast medium, in addition to other characteristic findings of hypoxic-ischemic encephalopathy. The mechanism underlying this phenomenon could be the destruction of the blood-brain barrier, and/or selective vulnerability, due to hypoxic-ischemic changes in the gray matter. Enhancement of basal ganglia on postmortem CT due to antemortem infusion of iodinated contrast medium might suggest hypoxic-ischemic encephalopathy, which should be noted in postmortem CT interpretations., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Fat-forming variant of solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm. Here we report the case of a 33-year-old woman who developed pain and muscle weakness from the posterior aspect of the right hip to lower extremity. Imaging examinations revealed a mass with fatty components and hypervascular solid components filling the sacral spinal canal and sacral foramen. The sacral mass was resected and histological examination of the specimens revealed patternless proliferation of short spindle-shaped cells with staghorn blood vessels. A number of mature adipocyte-like cells were also observed. The tumor cells were positive for STAT6 and the nuclei of the adipocytes were also positive, which was diagnostic for fat-forming SFT., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Penile metastasis of malignant tumors is a very rare condition, often occurring as a part of systemic metastases, and is therefore associated with a poor prognosis. Although there have been reports of magnetic resonance imaging findings of penile metastasis, longitudinal imaging changes have not been presented previously. We report a case of a 80-year-old male patient with penile metastasis from prostate adenocarcinoma. First magnetic resonance imaging demonstrated multiple penile nodules in the left corpus cavernosum corpora cavernosa, and these nodules were fused and across the septum of the penis, forming an enlarged, diffusely spreading mass on the follow-up exam 5 years later. In this case, a longitudinal evaluation of magnetic resonance imaging demonstrated the course of the extension of the rare penile metastasis., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Antibiotic ointments are often used to treat or prevent infections in surgical wounds. However, due to a dearth of reports on adverse effects, the complications of the use of such ointments, especially possible long-term effects, are largely unknown. We experienced a unique case of a cystic lesion that developed after surgical site infection treated with gentamicin ointment in a 62-year-old man who underwent subtotal glossectomy for tongue cancer. The antibiotic ointment that was applied following abscess drainage remained there, replacing the abscess cavity and forming an oval mass. The lesion was found incidentally on follow-up MR examination to monitor cancer recurrence. On both T1- and T2-weighted images, it showed high-intensity reflecting oily base material, constituting the ointment, which appeared to be a fat-containing tumor such as a lipoma that had arisen at the surgical site. Echo-guided drainage extracted the ointment, which was seemingly unaltered from the time it was applied 11 months before. We describe the clinical course and imaging findings to acknowledge this potential adverse effect associated with topical antibiotic treatment for surgical site infection., (© 2019 The Authors.)