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Tuberculoma is a rare but known complication of tuberculosis. It rarely occurs in the mastoid bone. When it occurs in the middle ear cleft, it can lead to intracranial complications if there is a delay in the diagnosis and management.A rare case of tuberculosis of the middle ear cleft which presented as tuberculoma of the mastoid bone with infranuclear facial palsy is described. The tuberculoma was removed and a canal wall down tympanomastoidectomy was performed. Post-operatively the patient was kept on antituberculous therapy. The various problems encountered in the diagnosis and management of this case are discussed.

Spontaneous regression of hepatocellular carcinoma is extremely rare, and the exact pathogenesis leading to this remarkable phenomenon remains unclear. We describe a case of spontaneous regression of an incidentally discovered hepatocellular carcinoma in a 63-year-old man with hepatitis C cirrhosis. The regression followed a series of events, in particular, an upper gastrointestinal haemorrhage. Ischaemic insult may be a major pathway leading to tumour regression. As limited data is available in the literature, knowledge and recognition of this rare event will have implications for patient management and may alter treatment. Further, data may be useful to assess if these patients have an altered prognosis with improved survival.

Various disorders of sex development (DSD) result in abnormal development of genitalia, which may be recognized at prenatal ultrasonography, immediately after birth, or later in life. Current methods for diagnosing DSD include a thorough physical examination, laboratory tests to determine hormone levels and identify chromosomal abnormalities, and radiologic imaging of the genitourinary tract and adjacent organs. Because of the complex nature of DSD, the participation of a multidisciplinary team is required to address the patient's medical needs as well as any psychosocial issues that the patient or the family may encounter after the diagnosis. The first step in the management of DSD is sex assignment, which is based on factors such as the genotype; the presence, location, and appearance of reproductive organs; the potential for fertility; and the cultural background and beliefs of the patient's family. The primary goal of sex assignment is to achieve the greatest possible consistency between the patient's assigned sex and his or her gender identity. Once the sex is assigned, the next step in management might be surgery, hormone therapy, or no intervention at all. Patients with ovotesticular DSD and gonadal dysgenesis may require a gonadectomy, followed by reconstructive surgery. Some patients may need hormone replacement therapy during puberty. An understanding of the immediacy of families' need for sex assignment and clinicians' need for reliable diagnostic imaging results will help radiologists participate effectively in the prenatal and postnatal assessment of patients with DSD.

Increasing use of smartphones and handheld computers is accompanied by a rapid growth in the other related industries. Electronic books have revolutionized the centuries-old conventional books and magazines markets and have simplified publishing by reducing the cost and processing time required to create and distribute any given book. We are now able to read, review, store, and share various types of documents via several electronic tools, many of which are available free of charge. Additionally, this electronic revolution has resulted in an explosion of readily available Internet-based educational resources for the residents and has paved the path for educators to reach out to a larger and more diverse student population.

To the best of our knowledge, a portal vein aneurysm presenting with obstructive jaundice has not been reported in the literature. The preferred treatment for these aneurysms is surgical and a shunting procedure should be considered in cases with portal hypertension to preserve portal vein flow when portal hypertension is present or is secondary to the aneurysm itself. In our case, due to patient's advanced age and co-morbidities, an endoscopic biliary stent was placed which led to successful resolution of symptoms of obstructive jaundice.

We are in the midst of an evolving educational revolution. Use of digital devices such as smart phones and tablet computers is rapidly increasing among radiologists who now regularly use them for medical, technical, and administrative tasks. These electronic tools provide a wide array of new tools to the radiologists allowing for faster, more simplified, and widespread distribution of educational material. The utility, future potential, and limitations of some these powerful tools are discussed in this article.

Purpose To compare safety and imaging response with 100–300 μm and 300–500 μm doxorubicin drug-eluting bead (DEBs) to determine optimal particle size for chemoembolization of hepatocellular carcinoma (HCC). Materials and Methods DEB chemoembolization using 100–300 μm (n = 39) or 300–500 μm (n = 22) LC beads loaded with 50 mg of doxorubicin was performed in 61 patients with HCC. Patient age, sex, etiology of liver disease, degree of underlying liver disease, tumor burden, and performance status were similar between the groups. All treatments were performed in a single session and represented the patient's first treatment. Toxicities and imaging response in a single index tumor were analyzed using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) criteria. Results There was a significantly lower incidence of postembolization syndrome and fatigue after treatment in the 100–300 μm group (8% and 36%) versus the 300–500 μm group (40% and 70%) (100–300 μm group, P = .011; 300–500 μm group, P = .025). Mean change in tumor size was similar between the two groups based on WHO and EASL criteria and similar rates of objective response, but there was a trend toward a higher incidence of EASL complete response with 100–300 μm beads versus 300–500 μm beads (59% vs 36%; P = .114). Conclusions In DEB chemoembolization for treatment of HCC, 100–300 μm doxorubicin DEBs are favored over 300–500 μm doxorubicin DEBs because of lower rates of toxicity after treatment and a trend toward more complete imaging response at initial follow-up.

There is a diverse group of rare, primary benign and malignant ovarian tumors that show characteristic histomorphology and natural history. Some of these tumors may demonstrate typical imaging features. However, due to the rarity of these tumors, imaging characteristics of these diverse lesions are not well described in the literature. Knowledge of these select ovarian entities is essential and facilitates optimal management of patients who often manifest with nonspecific symptoms.

Clinical symptoms and signs of ovarian torsion are often nonspecific, and imaging studies have a crucial role in making an accurate timely diagnosis. Ultrasound with color Doppler is often the initial investigation. However, as illustrated in our case, a normal Doppler study cannot exclude the diagnosis of ovarian torsion, and MRI should be performed if a high degree of concern for ovarian torsion persists. We report a case of a case of an 18-year-old female who was diagnosed with ovarian torsion on MRI. To the best of our knowledge, "whirlpool sign on MRI" has not been reported previously. If this sign is present, a specific diagnosis of ovarian torsion can be made.

We report a case of a solitary fibrous tumor of prostate presenting with urinary retention and a large prostate mass. We describe the clinical presentation, magnetic resonance imaging findings, and histopathology of this rare, benign tumor. Although clinical and radiologic appearances embrace various differential diagnoses including sarcoma, this mass was confirmed by histologic analysis following surgical resection. We report this rare, benign tumor to help the radiologist suggest the diagnosis when presented with a similar case.

Uterine didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare congenital anomaly of the Müllerian duct system referred to as Herlyn-Werner-Wunderlich syndrome. Because of its rare occurrence, a high level of suspicion is often required for diagnosis. Clinically, these patients usually present after menarche with pelvic pain, dysmenorrhea, and a palpable pelvic mass. We present a case of a 31-year-old female patient with infertility. Imaging findings were consistent with Herlyn-Werner-Wunderlich syndrome, with a congenital defect in the longitudinal vaginal septum resulting in partial spontaneous decompression of right-sided hematocolpos.

A 75-year-old male presented to the emergencydepartment with severe chest pain. The patient hadnever smoked and had a long-standing skin disorder.Physical examination revealed multiple small skin-coloured papules on his face, chest and back.A CT angiogram was performed, which ex-cluded aortic dissection and pulmonary embolus.However, incidental pulmonary findings were found(Figure 1).Based on these images, what is your differentialdiagnosis?What is your best diagnosis given the clinical historyand physical exam findings?Given this diagnosis, what other organ might beabnormal?

Sclerosing cholangitis can be idiopathic (primary) or secondary to an identifiable cause. Irrespective of cause, sclerosing cholangitis usually progresses to end-stage liver disease and warrants orthotopic liver transplantation. Recent studies provide new insights into the etiopathogenesis, natural history, diagnosis, and management of these different entities.

A 44-year-old man was involved in a motorcycle crash. His left lower extremity was impacted between the motorcycle and a car. He suffered left-sided rib fractures, capsular injury to his left fifth proximal interphalangeal joint and had a large haematoma in the medial aspect of the left thigh. Ultrasound of the left thigh was performed 1 week after the accident (Figure 1). The subsequent clinical course was characterised by a persistent fluid collection in the medial aspect of the left thigh that was painful and bothersome. Further evaluation with MRI of the left thigh was performed 2 months after the time of injury (​(​FigureFigure 2, 3 and 4). Laboratory findings revealed a normal coagulation panel. Figure 1 Longitudinal greyscale ultrasound image of the left upper thigh shows a subcutaneous fluid collection containing avascular fat lobules (arrow). Figure 2 T1 weighted axial MRI of the left upper thigh shows a subcutaneous fluid collection containing globular hyperintense fat lobules (arrows) and hypointense capsule. Figure 3 Short tau inversion-recovery (STIR) coronal MRI of the left upper thigh confirms the subcutaneous location of the fluid collection. Note the typical ovoid margins and hypointense capsule. Figure 4 T2 weighted axial MRI of the left upper thigh shows a subcutaneous fluid collection containing multiple fluid–fluid levels. What are the characteristics of the fluid collection on ultrasound? What observations can you make from the MRI? What is your diagnosis?

We present a pictorial essay on pediatric intestinal transplantation that describes the indications for pediatric intestinal transplantation, surgical technique, and the role of imaging in the pre-transplant work-up and detection of post-transplant complications. We illustrate the normal post-transplant imaging appearance and common complications, including rejection, infection, post-transplant lymphoproliferative disease (PTLD), mechanical dysfunction and vascular complications. We conclude with an imaging algorithm for suspected post-transplant complications based on clinical scenarios.

Scapulothoracic dissociation may be underreported due to the high associated mortality rate; a well-centered chest radiograph revealing a laterally displaced scapula in the acute setting should prompt immediate vascular imaging work-up.

Hepatic steatosis is often seen in patients with hepatitis on screening ultrasound as generalized increased liver echogenecity. However, its nodular form can present as multiple echogenic masses, which can mimic hepatocellular carcinoma or metastasis by ultrasound and computed tomography. Small hepatocellular carcinomas are often hyperechoic and have a trend towards lower alpha-fetoprotein levels. Magnetic resonance imaging can accurately identify microscopic fat within the lesions and demonstrate lack of associated enhancing soft tissue. If this entity is not appropriately characterized using magnetic resonance imaging, it can lead to additional imaging workup and unnecessary biopsy.

stomach and simulating a large, recently ingested meal (Fig. 1). CT revealed a mixed air and soft-tissue density intraluminal gastric mass, confirming the diagnosis of a gastric bezoar (Fig. 2). Subsequently, our patient admitted to habitually ingesting foam and hair. Patient’s IQ was normal. Up to 90% of trichobezoars occur in girls younger than 20 years. Common associations are mental retardation, pica, and trichotillomania [1]. Gastric bezoars often present with acute symptoms and sometimes respond to conservative or endoscopic therapy [2]. In our patient, the bezoar was removed via open surgery forming a cast of the stomach (Supplementary materials available with this article online).

Prediction of the steady state flying height and attitude of air-bearing sliders in hard disk drives via simulations is the basis of their design process. Over the past few years air-bearing surfaces have become increasingly complex incorporating deep etches and steep wall profiles. In this paper we present a novel method of solving the inverse problem for air-bearing sliders in hard disk drives that works well for such new designs. We also present a new method for calculating the static air-bearing stiffness by solving three linear systems of equations. The formulation is implemented, and convergence studies are carried out for the method. Mesh refinements based on flux jumps and pressure gradients are found to work better than those based on other criteria.

Background and Objectives: Myofascial Pain Dysfunction Syndrome (MPDS) has been recognized as the most common, nontooth-related chronic orofacial pain condition that confronts dentists. A variety of therapies has been described in literature for its management. The present study is a prospective study carried out to evaluate the efficacy of occlusal splint therapy and compare it with pharmacotherapy (using analgesics and muscle relaxants) in the management of Myofascial Pain Dysfunction Syndrome. Materials and Methods: Forty patients in the age range of 17-55 years were included in the study and randomly assigned to one of two equally sized groups, A and B. Group A patients received a combination of muscle relaxants and analgesics while Group B patients received soft occlusal splint therapy. All the patients were evaluated for GPI, VAS, maximum comfortable mouth opening, TMJ clicking and tenderness during rest and movement as well as for the number of tender muscles at the time of diagnosis, after the 1 st week of initiation of therapy and every month for three months of follow-up. Results: There was a progressive decrease in GPI scores, number of tender muscles, TMJ clicking and tenderness with various jaw movements and significant improvement in mouth opening in patients on occlusal splint therapy during the follow-up period as compared to the pharmacotherapy group. Conclusion: Occlusal splint therapy has better long-term results in reducing the symptoms of MPDS. It has better patient compliance, fewer side effects, and is more cost-effective than pharmacotherapy; hence, it can be chosen for the treatment of patients with MPDS.

A 6-week-old boy with progressively increasing non-bilious emesis was referred for evaluation of suspected pyloric stenosis. US revealed thickening and elongation of the pylorus, classic for pyloric stenosis, with reverberation artefact from the gastric wall. Echogenic foci compatible with portal venous gas were noted in appropriate distribution within the imaged liver (Fig. 1). Abdominal plain films confirmed gastric pneumatosis as the cause of portal venous gas (Fig. 2). Gas in the bowel wall in infants is an alarming finding, raising concerns for gut ischemia and necrotizing enterocolitis. Gastric pneumatosis in the absence of ischemia has been reported in gastric outlet obstruction, including that from

Bell's palsy is the most common facial nerve disease and has a sudden onset. It is an acute unilateral paralysis of the seventh cranial nerve of unknown etiology. Patients with Bell's palsy present with facial weakness, inability to keep an eye closed, inability to keep food in the buccal vestibule, impairment of taste and lacrimation. Untreated Bell's palsy leaves some patients with major facial dysfunction and a reduced quality of life. In most of the cases there is partial to complete recovery which occurs spontaneously in 4 to 6 months. We present here a systematic review of two cases with manifestation of Bell's palsy which includes clinical features, differential diagnosis, treatment and referrals to neurosurgeon if required.

Background: Vitiligo prevails to be a skin disease with endless possibilities but no promises. Despite substantial research in pathogenesis and therapeutic modalities, the literature is deplete with technologies to predict the probabilities for repigmentation with or without therapy in the common generalized vitiligo. Aim: To correlate pretreatment melanin index in skin patches of nonsegmental vitiligo to probable extent of repigmentation following 6 months of monotherapy with a topical corticosteroid. Methods: A prospective study was conducted including thirty patients of vitiligo and their melanin index (melanin value; pigmentation index) in representative skin lesion was determined using Mexameter® MX 18. Patients were studied under three groups (A, B, and C) based on the obtained melanin indices. The extent of repigmentation following 6 months of topical therapy with mometasone furoate 0.1% cream was correlated with pretreatment melanin indices. Results: Repigmentation in Group C (mean melanin index >200) was significantly higher in terms of number of patients (P = 0.000) and area of patch coverage (P = 0.00) as against the other two groups with lower melanin indices. Conclusion: Melanin index in depigmented lesions is a useful indicator in the management of nonsegmental vitiligo to predict the repigmentation and to choose the appropriate treatment option. Mexameter is a simple, noninvasive, low cost staging, and monitoring device to estimate the melanin reservoir in vitiligo.

Gardner's syndrome is a hereditary autosomal dominant disorder with complete penetrance and variable expression. The disease is characterized by multiple intestinal polyps, osteomas and supernumerary teeth. Gardner's syndrome is linked to mutations on the long arm of chromosome 5 (5q21-q22) referred to as the adenomatous polyposis locus. It has 100% potential for malignant change. Increase in loss of heterozygosity percentages of chromosome 18q21 have suggested that 'Deleted in Colon Cancer' (DCC) gene may be involved in the progression of benign adenomas to malignant carcinomas. We report a case of Gardner's syndrome with similar findings along with presence of multiple epidermal inclusion cysts. The patient's father had died of intestinal cancer. An oral physician may be the first person diagnosing the condition based on orofacial manifestation. Early recognition of this disease can be lifesaving to the patient.

Background: Sexually transmitted infections (STIs) increase the risk of transmission of Human Immunodeficiency Virus (HIV) infection causing immense need to understand the patterns of STIs prevailing in the regions of a country for proper planning and implementation of STI control strategies. Due to the lack of adequate laboratory infrastructure in the country, information regarding the profile of STIs relies essentially on syndromic diagnosis. Aims and Objectives: To study the pattern of common STIs and the prevalence of HIV infection in patients attending the STI clinic of a tertiary care hospital in northern part of India using a syndromic approach. Materials and Methods: A retrospective analysis of data collected from the clinical records of 2700 patients over a period of 21 months (July 2012 to March 2014) was carried out at the Skin and VD Department of SMS Hospital, Jaipur. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were tested for HIV by ELISA and rapid plasma reagin. STIs were categorized in different syndromes as depicted by National AIDS Control Organization in the syndromic management of STIs. The data collected was analyzed statistically. The proportions were calculated for various syndromes and disease prevalence. Results: The overall most common STI was balanoposthitis, followed by genital herpes, vaginal/cervical discharge, molluscum contagiosum, genital warts, nonherpetic genital ulcer disease, lower abdominal pain, and urethral discharge in decreasing order. Among the study population, 2.55% were found to be HIV-positive. Conclusion: Viral STIs such as molluscum contagiosum, herpes genitalis, and condylomata acuminata are on the rise among STI/RTI clinic attendees.

Tophaceous gout of the symphysis pubis is an exceedingly rare event, with only four other cases reported in the literature [1–4]. Gout is the oldest recognized arthropathy and results from the deposition of monosodium urate crystals [5]. Gouty tophi are a consequence of prolonged hyperuricemia and can be found in soft tissues, tendon sheaths, joints, and bony prominences [3]. Calcium may precipitate with the urate crystals to varying degrees, making tophi more apparent on radiographs. Gout most often afflicts the feet, ankles, knees, hands, and elbows, in decreasing order of frequency [5]. This case is exceptional because it demonstrates the hallmark imaging characteristics of tophaceous gout in spite of its uncharacteristic location. The symphyseal joint space is preserved. The erosions on either side of the joint are well-demarcated with sclerotic margins. These erosions have been described as “punched-out,” resembling “mousebites,” with overhanging edges that are typical of gout. The association of these erosions with the hyperdense calcified tophus is a reflection of the indolence of this arthropathy [5]. This case diagnosis may be achieved from the images and information provided. Following the patient’s initial presentation, a skeletal survey and laboratory workup were performed. The serum uric acid level was elevated, in keeping with the suspected diagnosis. Skeletal survey was notable in that the first tarsometatarsal (TMT) joint was unaffected. However, other sites, including the ulnar styloid process, displayed erosions with sclerotic margins and overhanging edges (Fig. 1). The combination of imaging findings, history and laboratory evaluation led to this patient’s diagnosis of tophaceous gout involving the symphysis pubis. Synovial fluid analysis of this joint was deferred. Other conditions that may afflict the symphysis pubis include metastasis, plasmacytoma, primary osseous neoplasm such as chondrosarcoma, septic arthritis, osteoarthritis in isolation or in association with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, and amyloidosis. Neoplasms, both primary and secondary, and infection are much less likely given the well-defined pattern of osteolysis with sclerotic margins. Preservation of the joint space and lack of periosteal elevation further mitigate against these diagnoses on imaging alone. Septic joint is unlikely in an afebrile patient with normal white blood cell count. This patient had no systemic symptoms such as weight loss and generalized malaise to suspect malignancy. Erosions are typical of osteoarthritis involving the symphysis pubis, as in the temporomandibular, acromioThe case presentation can be found at doi:10.1007/s00256-010-0898-0

Rotator cuff tears following shoulder dislocation are the most common cause of prolonged shoulder pain. However, 9 to 18% of patients who have anterior dislocation actually suffer from prolonged pain due to axillary nerve injury [1]. The axillary nerve (C5, C6) is a branch of the posterior cord of the brachial plexus and exits the axilla to enter the quadrilateral space. This space is bounded by the teres minor muscle superiorly, the teres major muscle inferiorly, the long head of the triceps muscle medially, and the surgical neck of the humerus laterally. The anterior branch of the axillary nerve supplies the anterior deltoid muscle and overlying skin, while the posterior branch supplies the teres minor muscle, the posterior deltoid muscle, the skin overlying the distal deltoid muscle, and proximal triceps [2]. In an anterior shoulder dislocation, axillary nerve injury presumably occurs because of inferior displacement of the humeral head causing compression of the quadrilateral space [1]. Clinical symptoms of axillary nerve injury include vague shoulder pain, decreased strength on abduction, and abnormal sensation in the cutaneous distribution of the axillary nerve. The definitive diagnostic test used to confirm the clinical diagnosis of axillary nerve injury is electromyography (EMG). However, EMG is painful and operatordependent. MR imaging, on the other hand, is a noninvasive technique that can help provide a diagnosis, especially when other diagnoses besides axillary nerve injury are being considered [3]. Anatomical distribution of the signal changes on MR distinguishes nerve injury from direct traumatic injury of muscles. With axillary nerve injury, some or all of the muscles supplied by the axillary nerve will be affected, depending on the location of the injury along the path of the axillary nerve [1]. MR signal from acute denervation within the first 24 h may manifest as increased short tau inversion recovery (STIR) signal and as increased apparent diffusion coefficient (ADC) [4, 5]. Absence of edema of overlying soft tissues allows distinction of acute denervation from acute traumatic muscle injury. Subacute muscle denervation causes uniform muscle edema in approximately 2–4 weeks. Shifting of water from the intracellular to the extracellular space causes increased MR signal in the fluid-sensitive The case presentation can be found at doi:10.1007/s00256-009-0846-z.

Punch grafting was performed in 15 patients using punches varying in size from 2 to 3 mm in diameter. Silicone gel sheets were used as a post-operative dressing. Removal of the dressings after 7 days revealed no lifting of grafts in 13 patients. A minimally raised surface seen in two patients flattened after 6 to 8 weeks of continuous use of the dressing. At two months of follow-up, no cobblestoning or any other untoward effect was evident. Firm pressure provided by silicone gel sheets probably prevents cobblestoning by counteracting forces which tend to lift the grafts. Additionally, the sheets act as a brace preventing graft dislocation, provide a sterile atmosphere underneath the grafts, facilitate periodic observation due to their transparency, and are easily removed at the time of follow-up.

Ossifying fibromas are benign fibro-osseous tumors of mesenchymal origin. Although ossifying fibromas have principally been found in the jaw, they have also been reported in the frontal, ethmoid, sphenoid, and temporal bones, as well as the orbit and anterior cranial fossa. Ossifying fibromas affecting the jaw exhibit variable behaviors ranging from slow growth to occasionally aggressive local destruction. In the present article, we discuss a differential diagnosis considered for maxillary swellings and report a rare case of ossifying fibroma occurring in the maxilla.

Adult intussusception (AI) is relatively rare and can be a difficult clinical diagnosis, often requiring cross-sectional imaging for confirmation. Unfortunately, intussusceptions in the setting of indwelling long enteral feeding tubes have been predominantly characterized in the pediatric population with minimal investigation in adults. We report three cases of AI in patients with long feeding catheters serving as anatomic lead points leading to intussusception diagnosed on cross-sectional imaging. We highlight the limited utility of the supine plain films for detection of AI, and it behooves the radiologist to hold a high index of suspicion if the patient has a long enteral catheter. Since the majority of these patients tend to be fairly ill and unable to stand for upright abdominal radiographs, in the setting of percutaneous feeding tubes, decubitus abdominal radiographs should always be obtained. These cases also highlight the importance of having a high clinical suspicion of intussusceptions in a patient presenting with abdominal pain in the setting of an enteral feeding tube. In post-operative patients, other factors can predispose the patient to intussusception, including adhesions. Another interesting feature in tube related AI is the reverse intussusception that may be seen with indwelling enteral tubes. Reverse intussusception is where the distal bowel telescopes into the proximal segment over the tube.

The use of computed tomography (CT) for evaluation of liver disease has increased dramatically at our tertiary care center due to increased hepatology referrals. We sought to decrease the radiation dose associated with multiphase liver CT studies while maintaining a high degree of diagnostic accuracy. We found that by eliminating the nonenhanced acquisition and adjusting the imaging field of view to include the liver-containing abdomen only—simply by manipulation of patient-specific imaging parameters—we achieved a 30% reduction in dose.

A case report can foster one’s career by acting as a segue into more advanced scientific writing and provide an avenue for mentorship. However, before a case report can be added to the literature, its authors and contributors must be decided. While organizations such as the International Committee of Medical Journal Editors have determined authorship rules for manuscripts, there is a relative paucity of information in the literature regarding the proprietary rules and protocol for generating a case report. Therefore, we ask, ‘Whose case is it, anyway’? In this editorial, we aim to describe the complex milieu in which case reports often originate and propose some ground rules for determining their authorship.

Case reports remain an invaluable resource in the literature, and they continue to serve an equally important role in scientific advancement. They record discoveries, report the unexpected, and spark further research. Preparation of a case report can be a great learning experience, especially for medical students, residents, and young physicians. It serves as an excellent introduction to academic writing, familiarizing them with all aspects of publishing, from a structured case presentation and literature review to submitting and revising a manuscript. It can also stimulate an interest in a specific topic and gradually lead to more involved and complex academic endeavors.

We report two adult patients with varied urologic symptoms who were found to have inflammatory pseudotumor on histopathology. The first patient had a large, solid, enhancing retroperitoneal mass lesion and presented with increased frequency of urination and recurrent urinary tract infections. The second patient had an obstructing left distal ureteric stricture and presented with painless hematuria. Though preoperative radiological diagnosis of this entity is not feasible, the present article illustrates the imaging findings in this unusual disease entity with review of the relevant literature.

A 63-year-old man presented with a long-standing history of sinusitis and 3 weeks of frontal headache. The physical examination was unremarkable. The alkaline phosphatase level was elevated at 434 IU per liter (upper limit of the normal range, 129). The serum calcium level was within normal limits. Radiography of the skull (Panel A) showed thickening of the outer and inner tables of the cranial bones, widening of the diploe, and a “cotton wool” appearance caused by irregular areas of sclerosis (arrows). Computed tomography of the skull (Panel B) confirmed bony expansion, cortical bone thickening, and irregular areas of sclerosis (arrows). . . .

mass (arrow) inferior to the hyoid bone and anterior to the normal thyroid gland. Thyroglossal duct cysts are the most common cause of midline neck masses. These can be found at any level from the base of the tongue to the isthmus of the thyroid gland. Most (65%) are infrahyoid in location [1]. Initial treatment consists of antibiotics. Following control of the underlying infection, elective surgery (Sistrunk operation) is usually performed to remove the cyst to prevent recurrence [2].

Accessory spleens are common, usually asymptomatic, incidentally discovered congenital foci of splenic tissue. They occur most commonly near the splenic hilum, with almost 20% in or near the pancreatic tail. On contrast-enhanced computed tomography (CT), differentiation of an intrapancreatic accessory splenule (IPAS) from other pancreatic tail lesions such as islet cell tumors and metastatic disease can present a diagnostic challenge. A high index of suspicion on the part of the radiologist, based on the classic location with typical imaging features and a combination of cross-sectional imaging studies such as ultrasound, computed tomograph (CT), or magnetic resonance imaging (MRI) with nuclear medicine examinations, can confirm the diagnosis of intrapancreatic accessory splenule and prevent unnecessary biopsy and/or surgery.