Search

• Think about the epiploic appendagitis more frequently when dealing with an obese patient with predispositions. • Understand the importance of imagery that avoids unnecessary surgery in case of uncomplicated epiploic appendagitis and make it possible to do a radiological drainage. • Always make the necessary differential diagnoses before evoking appendagitis. Epiploic appendagitis is a torsion of fatty appendages of ligamentum trees (1), it's a rare cause of abdominal pain that usually manifests by right or left iliac fossa pain, reminding of appendicitis, diverticulitis or ischemia of the omentum. We report the case of a 56 years old male patient admitted for an epigastric pain and a right-upper quadrant abdominal pain, for whom he underwent an abdominal ultrasound and a CT-scan who shown an abscessed mass under colic transverse to the unusual seat. CT scan is still the key modality for diagnosis, avoiding unnecessary surgery. Complications of primary epiploic appendagitis have rarely been described in the literature (Hwang et al., 2013; Hasbahceci et al., 2012). Another more rare complication is appendagitis with associated abscess, in this condition, we must also think about complicated diverticulitis. The treatment of uncomplicated forms is generally conservative, however, some authors have suggested a surgical method (Saad et al., 2014). For therapeutic management of its complication, there has been much interest in the use of minimally invasive techniques such as percutaneous drainage to minimize the morbidity and mortality that is associated with surgery (Evidence National Guideline Centre (UK), 2019). The diagnosis of epiploic appendagitis is still uncommon, CT scan can eliminate other diagnosis of acute abdominal pain such as diverticulitis and appendicitis. It also allows the diagnosis of the rare complicated forms such as abscesses associated with epiploic appendagitis. The treatment of typical forms is usually conservative, while the complicated form requires surgery because of the potential associated pathology. [ABSTRACT FROM AUTHOR]

Intraorbital cavernous hemangiomas are the most common benign vascular tumors of the orbit in adults. The clinical presentation consists of a slowly progressive intraorbital mass syndrome, often causing late exophthalmos of varying grades. It may be accompanied by reduced visual acuity or ocular motility disorder. CT and MRI scans allow a precise diagnosis to be made in the vast majority of cases, while pathology confirms the diagnosis. Treatment is not always indicated, and when it is, it is exclusively surgical. The vital and functional prognosis is generally good, and the recurrence is almost exceptional. We report the case of a 49-year-old patient who presented with a decrease in visual acuity of his right eye caused by cavernous hemangioma of the orbit.

Lepidic adenocarcinoma is a cancer with atypical radiological presentation making its diagnosis difficult and late. Here,we report the case of a 64-year-old man, who presented with respiratory distress his thoracic CT showed ground glass areas and diffuse condensations with blood hypereosinophilia. He was diagnosed to have eosinophilic lung and was placed on corticosteroid therapy but he did not show any improvement. A CT-guided biopsy showed lepidic adenocarcinoma. [ABSTRACT FROM AUTHOR]

L'anévrysme de l'ampoule de Galien est une malformation vasculaire congénitale rare et complexe de la ligne médiane dont le pronostic est grave, le plus souvent lié à un tableau d´insuffisance cardiaque réfractaire. Cette affection se révèle essentiellement au cours de la période néonatale et chez le nourrisson et est caractérisée par un polymorphisme clinique en fonction de l'âge de découverte. Le diagnostic est radiologique notamment grâce à l'angiographie cérébrale qui joue un rôle diagnostic et thérapeutique. A l´heure actuelle, le traitement de choix repose sur l´embolisation endovasculaire qui a amélioré le taux de survie. Nous rapportons un cas d´une malformation anévrysmale de l´ampoule de Galien chez un petit enfant de 3 ans révélée par des crises convulsives.

Le kyste hydatique orbitaire est une forme rare d´hydatidose. La localisation isolée orbitaire sans la participation à d´autres organes est rare, elle représente moins de 1% de l´ensemble des localisations. La plupart d'entre eux sont situés dans les angles superolatéral et super-médial de l'orbite. Le traitement de choix du kyste hydatique orbitaire reste son ablation chirurgicale. Cependant, elle expose à un redoutable risque de dissémination par rupture du kyste pendant la chirurgie. Le diagnostic préopératoire est important pour éviter la rupture du kyste et empêcher la propagation de la maladie parasitaire. Nous rapportons un cas de kyste hydatique orbitaire révélé par une exophtalmie d´évolution progressive. Ce cas a été considéré comme une primo-infection, car il n´y avait aucun antécédent de maladie hydatique ou d´autre localisation notamment hépatique ou pulmonaire aux examens radiologiques.

La torsion ovarienne est une cause rare de douleur abdominale aiguë chez l´enfant, elle constitue une véritable urgence diagnostique et thérapeutique. Le tableau clinique ainsi que la présentation radiologique est non spécifique. Le but de cet article est de comprendre la physiopathologie et de passer en revue les différents aspects radiologiques de la torsion ovarienne chez la jeune fille. Il s´agit d´une série rétrospective menée au Service de Radiologie Mère-Enfant du CHU Hassan II de Fès sur une période de trois (3) ans, allant de janvier 2016 à décembre 2018 portant sur 8 observations de torsions ovariennes portées sur leurs aspects clinico-radiologiques et prouvées chirurgicalement. L´âge des patientes était compris entre 6 et 16 ans avec une moyenne de 12 ans. Le maitre symptôme était la douleur abdominale localisée au site de la torsion. Toutes nos patientes ont été explorées en première intention par une échographie pelvienne, couplée au doppler couleur. Le scanner abdominal a été réalisé dans 4 cas et l´IRM pelvienne dans 2 cas en complément de l´échographie pelvienne. L´aspect radiologique la plus courante de la torsion ovarienne était l'élargissement unilatéral de l´ovaire, la localisation périphérique des follicules ovariens et la position médiane de l'ovaire. La torsion touchait un ovaire sain dans 5 cas (62,5%), était secondaire à un tératome ovarien dans 2 cas (25%) et à un kyste ovarien dans 1 seul cas soit 12,5% des cas. Le traitement a consisté à une détorsion dans 4 cas ; une annexectomie dans cas 3 cas ; une détorsion associée kystectomie dans un cas.

Le lipome du corps calleux est une lésion congénitale bénigne très rare, qui peut être isolée ou associée à des degrés divers de dysgénésie du corps calleux. Il peut être asymptomatique ou se révélé par des signes non spécifiques tels que des crises épileptiques, des céphalées, de déficit neurologique ou de démences. L´imagerie en coupe fait le diagnostic aisément. Nous rapportons le cas d´un adolescent de 18 ans qui a présenté une crise convulsive chez qui l´imagerie a révélé un lipome du corps calleux.

La néphrolithotomie percutanée s´accompagne d´un risque de complications en particulier hémorragiques, qui en fait une technique potentiellement invasive. Nous rapportons le cas d´une patiente de 70 ans, traité auparavant pour néphrolithotomie percutanée d´une lithiase sur un rein unique gauche. Une hématurie persistante de moyenne abondance est apparue il y a 2 mois et demi, et qui a motivé à la réalisation d´une tomodensitométrie découvrant un faux anévrisme intra rénal polaire inférieur, d´origine iatrogène. Il a nécessité une embolisation sélective efficace à la colle biologique.

Inflammatory myofibroblastic tumors (IMT) are an uncommon mesenchymal solid tumor commonly documented in children and young adults (Kim et al., 2012 [1]). Cecum is a rare location of this entity, may simulating a malignant tumor process. A 71 year old patient was admitted for pain in the right iliac fossa with chronic constipation evolving for two months associated with weight loss. As a diagnosic step, an abdominal computed tomography (CT) scan was performed showing a thickening of the cecal wall. There was no regional or distant metastasis. During a colonoscopy, many biopsies have been returned to a non-specific chronic colitis; as a result, the IMT of the cecum was confirmed pathologically after ilio-coecal resection. IMT is difined as a solid mesenchymal tumor basically affects the soft parts as well as the visceral organs. The litterature show that frequent localisations are pulmonary and intra-orbital (Krzysztof Siemion et al., 23 February 2022); therefore, the cecal location is very rare may mimic a malignant tumor (Mauricio Gonzalez-Urquijo et al., January 20, 2020), It is worth recalling that the imaging outcomes are polymorphic and inconclusive; in addition, Surgical excision is the treatment of choice for IMT (Alireza Mirshemirani et al., Dec 2011) and the histopathology is still required for the final diagnosis. Radiologic features of IMT present a diagnostic challenge to the radiologist; also, mimic malignancy may lead to unnecessary investigations. • Inflammatory myofibroblastic tumors (IMTs) are an unusual solid tumor derived from mesenchymal origin and grouped into a mix of fibroinflammatory disorders. • Clinical manifestations are not specific, dependent on the location of the tumor, an inflammatory syndrome may be associated. • Their radiological appearance is polymorphic and not conclusive. • The final diagnostic is based on histopathology. • Surgical treatment is the preferred treatment; complete excision with negative margin has a lower risk of recurrence. [ABSTRACT FROM AUTHOR]

Le mésentère commun complet est une anomalie rare de rotation du tube digestif. Sa découverte est exceptionnelle à âgé adulte; à cette période, il demeure très souvent asymptomatique et donc non diagnostiquée. Le mésentère commun complet peut être découvert de façon fortuite, lors d'un syndrome appendiculaire ectopique, comme ce fut le cas de notre observation. Il s'agissait d'un patient âgé de 42 ans, qui à présenté un tableau inflammatoire clinico-biologique aiguë pelvien. La TDM a permis de poser le diagnostic d'une appendicite aigue sur un mésentère commun complet. Le traitement par laparotomie a confirmé le diagnostic d'une appendicite aiguë perforée sur la malrotation intestinale. Les suites post appendicectomies étaient favorables.

Il s'agit d'une patiente de 81 ans, admise au service des urgences pour prise en charge d'une colique hépatique associée à un ictère cutanéo-muqueux, quelques épisodes de vomissement et une hyperthermie. A l'examen physique, la patiente avait une sensibilité de l'hypochondre droit avec palpation d'une masse mobile douloureuse du flanc homolatéral arrivant jusqu'au niveau de la fosse iliaque droite. Un bilan biologique a montré une hyperleucocytose à polynucléaire neutrophile 12000/uL, une C Réactive Protéine à 144 mg/l avec perturbation du bilan hépatique de cholestase montre (élevation de la bilirubine et des transaminases à X fois la normale (pas besoin des chiffres exacts). Une échographie réalisée en urgence a montré une vésicule biliaire très distendue (14x07cm), lithiasiques à paroi épaissie, étendue en bas jusqu'au niveau du carrefour ilio caecal avec ectasie des voies biliaires (voie biliaire principale = 26mm). Une TDM abdominale a objectivé les mêmes résultats décrits à l'échographie, avec dilatation kystique du cholédoque, le conduit pancréatique principal était de calibre normal. Une CPRE réalisée avec sphinctorotomie a confirmé la dilatation kystique de la VBP. Le diagnostic de cholécystite aigue associé à une dilatation kystique de la VBP de type I de tadoni est retenu. Après antibiothérapie le patient a bénéficié d'un traitement chirurgical qui a consisté en une cholécystectomie avec exérèse en bloc de la voie biliaire dilatée, suivie d'une dérivation bilio-digestive sur anse en Y. Les suites opératoires étaient simples.

Purpose: To propose an intelligent, non-invasive, highly precise, and rapid method to predict the mutation status of the Epidermal Growth Factor Receptor (EGFR) to accelerate treatment with Tyrosine Kinase Inhibitor (TKI) for patients with untreated adenocarcinoma Non-Small Cell Lung Cancer., Materials and Methods: Real-world data from 521 patients with adenocarcinoma NSCLC who performed a CT scan and underwent surgery or pathological biopsy to determine EGFR gene mutation between January 2021 and July 2022, is collected. Solutions to the problems that prevent the model from achieving very high precision, namely: human errors made during the annotation of the database and the low precision of the output decision of the model, are proposed. Thus, among the 521 analyzed cases, only 40 were selected as patients with EGFR gene mutation and 98 cases with wild-type EGFR., Results: The proposed model is trained, validated, and tested on 12,040 2D images extracted from the 138 CT scans images where patients were randomly partitioned into training (80 %) and test (20 %) sets. The performance obtained for EGFR gene mutation prediction was 95.22 % for accuracy, 960.2 for F1_score, 95.89 % for precision, 96.92 % for sensitivity, 94.01 % for Cohen kappa, and 98 % for AUC., Conclusion: An EGFR gene mutation status prediction method, with high-performance thanks to an intelligent prediction model entrained by highly accurate annotated data is proposed. The outcome of this project will facilitate rapid decision-making when applying a TKI as an initial treatment., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (© 2024 The Authors. Published by Elsevier Ltd.)

Peribiliary cysts are an incidental finding in patients with advanced liver disease. They were found to be common in fibrocystic disorders such as autosomal dominant polycystic kidney disease and polycystic liver disease, as well as cirrhotic livers. They result from obstruction-induced cystic dilatation of the peribiliary glands. We report in this article the case of 2 patients, aged 41 and 71, smokers and chronic alcoholics, admitted for febrile cholestatic jaundice, for which MRI revealed the presence of peribiliary cysts., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Epidermal growth factor receptor ( EGFR ) mutation screening in non-small cell lung cancer (NSCLC) is now used to guide treatment decisions to identify patients with EGFR positive mutations that predict response to EGFR tyrosine kinase inhibitors. This study aimed to explore with a prospective study the current testing practices and the predictive value of EGFR mutations in a series of 261 patients with NSCLC. EGFR mutation testing was conducted using 2 different assays: bidirectional Sanger sequencing of polymerase chain reaction (PCR) and real-time PCR on the Rotor-Gene Q instrument. Epidermal growth factor receptor mutation testing was performed for 261 patients with lung cancer. Exons 18 to 21 were successfully analyzed in 113 tumors by Direct sequencing and in 148 tumors by real-time PCR. The prevalence of positive EGFR -mutations in each method was 22.1% (N = 25) and 24.3% (N = 36), respectively ( P  = .3). In total, EGFR mutations were detected in 59 patients among 261 patients with NSCLC. A statistically significant association between female sex, nonsmoking history, nonsolid major pattern, and a higher EGFR mutation frequency. In this study, we investigated clinicopathological differences between tumors harboring exon 19del and those harboring L858R. We did not find any significant differences between the 2 mutations and gender or smoking features, interestingly, the prevalence of patients aged >60 years was significantly higher in the L858R group than in the exon 19del group (81.8% vs 55.8%, P  = .05). A significant association was observed between exon 19 deletions and the papillary major pattern, but no correlation was detected between exon 21 mutation and any histological pattern. This prospective study documented the real-world clinical testing of EGFR mutation in Moroccan NSCLC patients. Our experience confirms the need to develop standards-based guidelines for the routine performance and evaluation of EGFR testing to improve clinical care for this subset of lung cancer. On the other hand, our study demonstrated that tumors with exon 19 deletions and L858R harbor specific clinicopathological features in NSCLC., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A 46-year-old farmer living in a rural area, who sustained an injury to his left foot 10 years ago, consulted due to progressive swelling of the same foot. An MRI revealed the "dot-in-circle" sign, suggestive of mycetoma of the foot, also known as Madura foot. This condition primarily affects soft tissues and bones and can occasionally lead to potentially severe visceral complications. Foot involvement is predominant, observed in 80% of cases., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

A rare disorder called congenital infiltrating lipomatosis of the face is characterized by a diffuse fatty infiltration of the soft tissues of the face. Muscle involvement and related bony hyperplasia may coexist. This particular form of lipomatous tumor is rare and typically appears in childhood. It is congenital in nature. Collections of mature, nonencapsulated lipocytes that infiltrate local tissues and frequently recur following surgery define congenital infiltrating lipomatosis, a unique clinicopathologic condition. The best modalities are, CT scan and MRI since they can determine the extent of the lesions and reveal their fat content. The treatment of this disease is surgical as soon as possible to restrict their infiltrative growth and improve the appearance of the face. We describe a case of massive facial invading lipoma that was investigated using MRI., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Central nervous system (CNS) tuberculosis is a postprimary form of tuberculosis with high mortality and morbidity rates, even with early diagnosis and treatment. Focal tuberculous cerebritis is extremely rare, typically occurring in patients without AIDS, and often associated with tuberculous meningitis. In endemic regions, it should be a primary consideration when encountering cerebral anomalies suggestive of granulomatous conditions. Its meningeal pseudo-tumor form poses a significant diagnostic challenge. We present the case of a 26-year-old man who arrived at the emergency room with cerebellar and pyramidal syndrome. Cerebral magnetic resonance imaging (MRI) revealed an expansive lesion in the right hemicerebellum with glove-finger edema and leptomeningeal thickening. Given the MRI findings and associated lung involvement, the diagnosis of tuberculosis was strongly suggested in our epidemiological context. Due to contraindications for lumbar puncture, high surgical risk, and strong clinical and radiological suspicion, antituberculous treatment was initiated in collaboration with neurologists and infectious disease specialists. The clinical and radiologic manifestations of CNS tuberculosis can mimic other infectious and noninfectious neurological conditions, as seen in our patient. Thus, familiarity with the imaging presentations of CNS tuberculosis among infectious disease specialists and radiologists is crucial for prompt and accurate diagnosis., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

The case presented illustrates a very rare chronic granulomatous disease called the Madura foot or also called mycetoma. It is a chronic granulomatous disease, caused by a contained infection that penetrates the subcutaneous tissues and spreads to the nearby bone by damaging the affected area's vascularization. Early diagnosis is greatly aided by clinical history and imaging, especially if the "dot-in-circle" sign-a pathognomonic marker of mycetoma-is seen on the MRI. Compared to ordinary radiographs, computed tomography offers a more accurate study of changes in the bone. In order to apply the appropriate course of treatment, it is critical to identify the causal species, which can be caused by either a true fungus (eumycetoma) or a bacterium Actinomyces (Actinomycetoma). Treatment can be extremely challenging and can even result in amputation, particularly if the diagnosis is delayed., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Pilonidal sinus disease is a frequent and recurrent pathology in young adults, with a male predominance, while malignant transformation of the pilonidal sinus is a rare complication, it occurs in 0.1% of patients, with a poor prognosis. Early surgical removal of the primary lesion remains the best treatment. We report a case of malignant transformation of pilonidal disease into squamous cell carcinoma., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Complete cerebellar agenesis is an extremely rare condition characterized by the complete absence of cerebellar tissue. Only a small number of cases have been reported, with varying motor and cognitive deficits. We describe a case of an 11-month-old baby with developmental delay, whose CT scan evaluation showed the complete absence of the cerebellum with no other associated cerebral malformation., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

In this study, we present findings from an analysis of 17 patients diagnosed with eosinophilic lung disease, with a majority (64.70%) being male. The average age of the patients was 54 ± 13.22 years. A history of uncontrolled asthma was noted in nine cases. The clinical picture was characterized by persistent dyspnea and cough. Blood hypereosinophilia was present in all cases, with a median of 1770 cells/ul. Two patients had a pulmonary eosinophilia greater than 25%. Radiological findings were consistent with diffuse bilateral ground-glass opacities or areas of consolidation in the majority of cases. The main etiologies identified were chronic eosinophilic pneumonia (12 cases), followed by eosinophilic granulomatosis with polyangiitis (3 cases), idiopathic hypereosinophilic syndrome (1 case) and drug-induced hypereosinophilia (1 case). All patients were treated with systemic corticosteroids, with the addition of immunosuppressive therapy necessary in three cases. Notably, five relapses were recorded after corticosteroid therapy was stopped., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bouhamdi et al.)

Exostosis, or osteochondroma, represents the most prevalent primary benign bone tumor, often viewed as a developmental anomaly rather than a true neoplasm. This article presents 2 cases illustrating complications associated with tibial osteochondroma. The first case involves a 25-year-old patient with recurrent medial knee pain attributed to pes anserine bursitis secondary to tibial osteochondroma, managed successfully with surgical excision. The second case features a 15-year-old with similar symptoms and unsuccessful conservative management, highlighting the diagnostic challenges and therapeutic options for this condition. Discussion encompasses the clinical presentation, diagnostic modalities including MRI and ultrasound, and management strategies such as conservative measures, corticosteroid injections, and surgical excision. Recognizing and promptly managing complications like pes anserine bursitis in tibial osteochondroma is crucial to prevent chronic pain and functional impairment, emphasizing the importance of a multidisciplinary approach involving orthopedic surgeons, radiologists, and physical therapists., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Intussusception is a rare condition in adults, unlike in children, with a variety of etiologies. In most cases, it is secondary to tumors. acute intussusception on lipoma is very exceptional. We report a case of 68-year-old female patient, diagnosed with intestinal intussusception on lipoma., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: Non-small cell lung cancer (NSCLC) remains a significant global health concern, with EGFR mutations playing a pivotal role in guiding treatment decisions. This prospective study investigated the prevalence and clinical implications of EGFR mutations in Moroccan NSCLC patients., Methods: A cohort of 302 NSCLC patients was analyzed for EGFR mutations using multiple techniques. Demographic, clinical, and pathological characteristics were assessed, and overall survival (OS) outcomes were compared among different EGFR mutation subtypes., Results: EGFR mutations were present in 23.5% of patients, with common mutations (81.69%) dominating. Common mutations showed strong associations with female gender and non-smoking status, while rare mutations were associated with a positive smoking history. Patients with EGFR mutations receiving tyrosine kinase inhibitors (TKIs) had significantly improved OS compared to wild-type EGFR patients. Notably, patients with common EGFR mutations had the highest OS, while those with rare mutations had a shorter survival period, albeit not statistically significant., Conclusion: This study highlights the relevance of EGFR mutation status in NSCLC patients, particularly in therapeutic decision-making. The association between smoking history and rare mutations suggests the need for tailored approaches. The survival advantage for patients with common EGFR mutations underscores the significance of personalized treatment strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Boukansa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)