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Concurrent radiotherapy with Transcatheter Arterial Infusion (TAI) chemotherapy is reportedly effective in curing locally advanced head and neck cancer. However, the effectiveness and safety of using TAI with palliative or salvage intent after radiotherapy combined with systemic intravenous chemotherapy (IV-CRT) is not well known. Herein, we describe two cases using TAI palliatively for locally advanced residual tongue cancer after IV-CRT, where tumor reduction or tumor progress inhibition could be achieved, thereby improving or maintaining the patients’ quality of life without severe toxicities. These cases indicate the effectiveness and safety of using TAI palliatively for locally advanced tongue cancer. Further, we have combined a literature review with the description of these cases. Keywords: tongue cancer; transcatheter arterial infusion; palliative interventional radiology

Lymphangioma of the mesocolon is very rare. We report two cases of surgically resected and histologically proven mesocolic lymphangioma in adults. In both cases, ultrasound revealed a large cystic mass with multiple thin septa in the lower abdomen. A peculiar finding was the large craniocaudal sliding movement of the mass synchronized with the patient's respiration, which was a clue to the diagnosis of mesenteric lymphangioma. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:78-81, 2018.

Objective In children, lateral sinus thrombosis (LST) following minor head injury (MHI) has occasionally been reported because of neuroimaging techniques. However, the condition is rare, and its pathophysiology remains unknown. We aimed to identify the factors associated with its etiology and severity to provide information to guide the diagnosis, management, and prognosis. Methods We retrospectively reviewed all patients aged 1–15 years with craniofacial trauma presenting to our emergency department between 2011 and 2015. In total, 4 patients with LST following MHI were identified. We also performed a comprehensive literature review to identify relevant cases in studies published between 1990 and 2015, and this yielded 17 studies with 24 patients. We analyzed the data for these 24 patients with our 4 cases (n = 28). Results The mean age of the 28 cases was 7.0 years, and the male-to-female ratio was 1.2:1. Nausea/vomiting and headache were the most common symptoms, but signs and symptoms of increased intracranial pressure were present in 5 patients. The sigmoid sinus was most commonly affected. A total of 20 patients were treated conservatively, and the remaining 8 patients received anticoagulation. All patients had good outcomes, with no major complications. Radiological follow up showed complete recanalization in 14 patients and partial recanalization in 3 patients. Conclusions Although LST following MHI is still rare in children, our findings indicate that it might be much more common than previously thought. Thankfully, though, most patients appear to have an excellent prognosis. A high degree of suspicion should be maintained when assessing patients with MHI, because the non-specific symptoms make diagnosis difficult. Neuroimaging by magnetic resonance venography or computed tomography venography is crucial for both diagnosis and follow up. Hypercoagulation disorders should be excluded, and anticoagulation therapy should be given to patients with these disorders, or to those with persistent or progressive LST. Conservative therapy is recommended, although anti-edema drugs or intermittent lumbar puncture may be beneficial.

We report three cases of traumatic microbleeds evaluated by sequential observation. Hypo-intensities on T2* gradient echo imaging (T2*GEI) appeared just 2-3 h after the injury (the hyper-acute period). However, these hypo-intensities on T2*GEI disappeared or became obscure 2-6 days after the injury (the subacute period). A follow-up MRI again revealed clear hypo-intensities on T2*GEI 1-3 months after the injury (the chronic period). Our cases indicate that hypo-intensities on T2*GEI might change dynamically from the hyper-acute to the chronic period. The differences of susceptibility effects by hematoma age might be the cause of this dynamic change.

Splenic artery pseudoaneurysm (SAPA) is a relatively infrequently encountered but clinically important vascular change, because it carries a high risk of rupture that warrants prompt treatment regardless of its size. Thus, sufficient knowledge is indispensable when seeing chronic pancreatitis patients or post-traumatic patients. Here, we report two such cases. The first case was a 52-year-old woman known to have chronic pancreatitis who presented with hematemesis and hemodynamic instability in which X-ray computed tomography (CT) and color Doppler sonography (CDS) had difficulty visualizing slow blood flow in SAPA, but superb microvascular imaging (SMI) clearly demonstrated the slow blood flow in SAPA, prompting our therapeutic decision to perform rapid embolization. The second case was a 51-year-old woman with post-traumatic SAPA in which 3D SMI enabled us to understand more clearly the topographic relationship between multiple SAPAs as compared with conventional US, leading to a decision to provide immediate surgical treatment. SMI was thought to provide a new insight into the US diagnosis of SAPA. When examining patients suspected of having a SAPA, SMI is an indispensable diagnostic tool at present.

We report the case of a patient with advanced colon cancer receiving oxaliplatin-based chemotherapy that was able to continue systemic chemotherapy by performing mild partial splenic embolization (PSE) for thrombocytopenia caused by splenomegaly due to oxaliplatin. Mild PSE may be useful for thrombocytopenia due to splenomegaly in cancer patients because it provides more treatment opportunities.

A 49-year-old man presented with fever and pain, redness, swelling, and difficulty in walking. The serum C-reactive protein (CRP), creatin kinase (CK), and endotoxin levels were elevated. A blood culture revealed Edwardsiella tarda(E. tarda). Computed tomography (CT) showed subfascial and subcutaneous low-density areas in the lower legs, suggesting focal abscesses and edema. The patient was likely to have necrotizing fasciitis or cellulitis. He was successfully treated with several antibiotics and discharged after 43 days. Because E. tarda causes sepsis and fulminating necrotizing fasciitis with a high mortality rate in patients with an underlying illness, it should be considered a potentially important pathogen. The lack of an underlying illness may be a factor for a good outcome in this case.

The aim of the present study was to consider the safety and efficacy of concurrent use of strontium-89 (Sr-89) with external beam radiotherapy (EBRT) for multiple bone metastases, including lesions that require urgent therapy. A retrospective review was performed of a consecutive series of patients who received Sr-89 for multiple bone metastases. Forty-five patients with multiple bone metastases received Sr-89 injection. Since 17 of the 45 patients had osteolytic bone lesions requiring emergent EBRT, they underwent concurrent use of Sr-89 with EBRT (concurrent group). The remaining 28 patients, none of whom had osteolytic lesions requiring urgent EBRT, were given Sr-89 injection only (singularity group). The injection of Sr-89 was to be given during EBRT, or on the day before the first day of EBRT. The dose of EBRT was 30 Gy in 10 fractions or 40 Gy in 20 fractions. Adverse events were evaluated according to hematological toxicity as measured by the Common Terminology Criteria for Adverse Events (V4.0). To assess efficacy, we checked changes in the pain scale and analgesic drug dosages, and the presence or absence of serious complications from bone metastases. Fifteen of 17 patients (88.2 %) in the concurrent group and 17 of 28 patients (60.7 %) in the singularity group reported bone pain relief. A statistically significant difference was found between the two groups, and severe complications (spinal cord compression and pathological fracture) from bone metastases could be prevented in all patients in the concurrent group. Severe hematological toxicity (grade 3 or higher) was not observed in the two groups. There was no statistical difference between the two groups. No one required additional intervention. The adverse events were tolerable. The results of our study suggest that concurrent use of Sr-89 with EBRT for multiple bone metastases can be performed safely if it is carried out with care, and that it may be an effective therapy in cases requiring emergency treatment.

Splenic inflammatory pseudotumor is a rare pathology, and the literature stresses the difficulty of preoperative diagnosis. There are no previous reports of contrast-enhanced ultrasound findings for this tumor in the literature. Our case appears to be the first to be examined using this technique. In our case, contrast-enhanced ultrasound showed the mass to be homogeneously and less enhanced than the surrounding parenchyma in all phases, and it included fine enhanced spots. We also briefly review the literature.

We report the case of a patient with chronic pancreatitis that was complicated by the rare occurrence of a pseudoaneurysm of the gastroduodenal artery that ruptured into the superior mesenteric vein. The patient, a 65-year-old alcoholic man, suddenly experienced hematemesis. Gastroesophagoscopy revealed bleeding from esophageal varices; the hemorrhaging was controlled with sclerotherapy. Sonography identified a 2-cm round anechoic mass at the pancreatic head, and color Doppler imaging revealed turbulent arterial flow within the mass, leading us to the diagnosis of the pseudoaneurysm. CT and angiographic findings generally corresponded with those of sonography and confirmed our diagnosis. The pseudoaneurysm was treated successfully with embolization, and the patient was discharged 10 days after therapy. Follow-up sonography performed 2 months later confirmed the absence of blood flow within the lesion. Color Doppler sonography was very useful for diagnosing the pseudoaneurysm and planning its treatment, and we recommend its routine use in patients with chronic pancreatitis to avoid delays in diagnosing and treating such vascular complications.

A 78-year-old man was transferred to our hospital for detailed examination and treatment of sudden-onset and rapidly increasing general edema. Routine blood counts and laboratory test results were normal. His medical history included chronic heart failure over a very long period under medical treatment and a sigmoidectomy for 4-cm sigmoid colon cancer carried out 3 years previously. At that time, an isolated small (about 2 cm) liver metastasis (segment 4) was also detected. Simultaneous segmentectomy and sigmoidectomy was initially considered, but the patient’s cardiac problem prevented it, and ultrasound (US)-guided radio-frequency ablation (RFA) was selected as the most appropriate treatment for the hepatic metastasis. During the following three years, the patient visited the outpatient clinic regularly, and several whole-body computed tomography (CT) studies at intervals of 6 months showed no abnormalities. They also showed the treated hepatic metastasis to be completely necrosed (Fig. 1). The patient was symptom-free for a long time, but very recently he suddenly became edematous. Abdominal US performed in our hospital using a Toshiba Aplio XG unit (Tokyo, Japan) revealed an approximately 6 9 5-cm irregular and ill-margined slightly hypoechoic tumor in S4, which extended posteriorly and directly invaded the left, middle, and right hepatic veins. The left and middle hepatic veins were completely occluded and were not recognized on B-mode US, and the right hepatic venous lumen was partially recognized. The tumor extended towards the right atrium, and a huge tumor thrombus was found there (Fig. 2). The intrahepatic and extrahepatic portal system was normal, but a large amount of ascites was also present throughout the whole abdominal cavity. Contrast-enhanced US using Sonazoid solution (GE Health Care), performed to observe blood flow in the liver, provided more detailed information about the hemodynamics of the lesion and the surrounding hepatic veins (mechanical index *0.25). Soon R. Satoyoshi (&) H. Kotanagi Department of Surgery, Akita Red Cross Hospital, 222-1 Kamikitade Saruta, Nawashirosawa, Akita 010-1495, Japan e-mail: rika-s@alto.ocn.ne.jp

The purpose of this study was to define the role of three-dimensional (3D) computed tomography (CT) in the head and neck diseases with bony abnormalities. Thirty-two patients were examined with a low dose radiation technique. Three-dimensional CT clearly delineated bony lesions in 27 of 32 patients. Three-dimensional CT could not demonstrate subtle bony erosions infiltrated by tumor, a temporal bone fracture, and a blow-out fracture, although two-dimensional (2D) images obtained before the 3D reconstructions clearly depicted those lesions. These two kinds of CT technique were thought to be complimentary.

Cell wall formation, particularly deposition of polysaccharides, of compression wood in Todo fir (Abies sacharinensis) was examined by either fluorescence and ultraviolet microscopy or by transmission electron microscopy coupled with cytochemical staining.

Hepatic hemangiomas are usually asymptomatic and very rarely produce abdominal symptoms. We report a painful 10 × 9 cm hemangioma situated at the hepatic surface of segment 6. The lesion showed a heterogeneous internal structure, composed irregularly of hyperechoic and hypoechoic areas, and it also showed weak posterior echo enhancement. Contrast-enhanced US showed the so-called fill-in pattern, leading to the diagnosis of hepatic hemangioma. The patient’s abdomen showed no other abnormal findings, which stressed the relationship between the hemangioma and the patient’s symptoms. When the diagnosis of hepatic hemangioma is conclusive, surgical therapy is indicated only in patients with severe symptoms. Our patient was considered to be a candidate for enucleation of the lesion. Histopathologically, the lesion included no areas of hemorrhage or necrosis, and the patient’s abdominal pain was likely due to distension of the liver capsule. After surgery, the patient was completely free of symptoms, and enucleation was considered to be appropriate.

An 80-year-old man who had undergone total gastrectomy and splenectomy for gastric cancer 13 years ago presented with headache, drowsiness, and high fever 1 month after a traffic accident. Brain CT scans revealed bilateral subdural fluid collections. Diffusion-weighted imaging (DWI) showed mixed high and low signal intensities in the left subdural fluid, and contrast-enhanced MR imaging revealed capsule enhancement of the left subdural fluid collection. The patient was diagnosed with left subdural empyema, and 2 burr-holes were drilled for drainage and irrigation. Operative findings revealed a neomembrane underneath the dura mater. Old hematoma and yellowish-white purulent fluid were present within the neomembrane. This confirmed the diagnosis of infected subdural hematoma (ISH). Abscess culture results were positive for Escherichia coli. The patient's symptoms resolved postoperatively with subsequent antibiotic therapy. However, 4 months after the operation, he suddenly died of severe sepsis and disseminated intravascular coagulation following cholecystitis, which was possibly associated with splenectomy. The clinical presentation, diagnosis, and treatment of an unusual case of ISH have been discussed. We emphasize that DWI and enhanced MR imaging may be useful for diagnosing ISH, and serial DWI evaluations may help in monitoring the therapeutic response in ISH.

Small lesions are frequently detected in the lung with computed tomography (CT) in clinical practice. It is important to know the CT features of small-sized periphearal small cell lung cancer (SCLC) for early-stage diagnosis. We reviewed the CT findings of SCLC that presented as a solitary peripheral nodule without associated lymphadenopathy. This study included 12 patients (11 men and 1 woman; mean age, 68.5 years) with peripheral SCLC of diameters ranging from 9 - 28 mm (mean, 15.4 mm). We evaluated the findings with thin-section CT for each peripheral tumor; emphasis was laid on the predominant internal characteristics (whether the mass is solid), tumor-lung interface characteristics (whether the mass is well-defined with a smooth surface or with lobulation or spiculation), and surrounding structures (the presence or absence of perivascular thickening adjacent to the tumor). In all patients, most portions of the tumor consisted of a non-calcified solid mass. Contrast enhancement in varying degrees was observed in the tumors of all 8 patients, who were evaluated with enhanced CT. The tumor-lung interface characteristics observed on the CT images included a well-defined mass with a smooth surface (n = 5), a well-defined mass with lobulation (n = 3), and a mass with spiculation (n = 4). An irregular perivascular thickening adjacent to the tumor was observed in 4 patients. We conclude that peripheral SCLC without associated lymphadenopathy manifests as a non-calcified solid mass and is occasionally characterized by perivascular thickening.

A primary intracranial germinoma that involves the midbrain is rare. We describe an unusual case of primary cystic germinoma originating from the midbrain. A 29-year-old man presented with diplopia, and his MRI showed a cystic, ring-like enhanced lesion in the thalamo-mesencephalic junction. Open biopsy was performed and the diagnosis of germinoma was based upon the histopathological findings. Following chemotherapy and radiotherapy, the symptoms improved and the tumor disappeared. We propose that primary intracranial germinoma should be included in the differential diagnosis of midbrain tumors, because early diagnosis and appropriate treatment for midbrain germinoma improves clinical outcome.

Spontaneous regression of hepatocellular carcinoma (HCC) is a rare phenomenon. Some reports have described cases of spontaneous regression of HCC, but there have been few cases with spontaneous regression of only metastatic lesions from HCC. We report a case of a 70-year-old woman with multiple lung metastases from HCC that regressed spontaneously following regression of HCC after transcatheter arterial embolization (TAE). To our knowledge, this is the first reported case that multiple lung metastases regressed spontaneously following TAE for HCC. Numerous mechanisms for spontaneous regression of HCC have been suggested such as subintimal damage, blood transfusion, alcohol withdrawal, infection, hemorrhagic shock, hepatic artery occlusion and herbal medicine. Our case, however, had no connection with any such symptom and medication. Our case suggests that the mechanisms leading to spontaneous regression in remote organs may be associated with activation of host immune response involving cytokines.

Portal gas is relatively rare, and its relationship to ischemic bowel diseases has been emphasized. We report the case of a 70-year-old woman with acute obstructive cholangitis in whom portal gas was detected by ultrasonography (US) but not by computed tomography (CT). The former showed multiple echo spots moving in the portal vein. Doppler signals confirmed them to be bidirectional and spiky, which immediately led to the diagnosis of portal gas. Immediate appropriate antibiotic treatment and biliary drainage yielded the disappearance of the portal gas. We stress the usefulness of US and Doppler US for detecting and diagnosing portal gas. Our observation suggests that when portal gas is detected by US, the possibility of cholangitis should be included in the differential diagnosis.

Despite the semi-routine use of color Doppler sonography for evaluating portal circulation abnormalities, there is a relative paucity of information on portal-systemic (P-S) shunt through the right renal vein (P-SR shunt). We report such a case. The patient was a 60-year-old woman with hepatocellular carcinoma on liver cirrhosis. Serial sonography showed an aggravation in findings; an increase in the size of the tumor was followed by formation of a portal tumor thrombus, and then occurrence of a P-SR shunt. We present this case, with a comparison between the patient's clinical course and the color Doppler results. To our knowledge, this is the first report to make such a comparison in a P-SR shunt case. We also briefly review the literature.

We report the case of a 82-year-old man with primary carcinoid tumor of the liver. Abdominal ultrasonography (US) showed 2 well-demarcated, round tumors in the right lobe (4 x 4 cm and 1 x 1 cm). The lesions were both markedly echogenic with many small cystic areas. Contrast-enhanced US showed the whole tumor to be quickly and highly enhanced, suggesting the highly vascular nature of the lesion, and the findings corresponded well with hepatic angiographic results. The patient underwent a US-guided needle biopsy, which yielded histological results consistent with a carcinoid tumor. Considering his age, we selected radiofrequency ablation (RFA) for treatment. After treatment, contrast-enhanced US demonstrated complete disappearance of blood flow signals, indicating satisfactory treatment. Our case showed that US and contrast-enhanced US findings can lead to a high suspicion of carcinoid tumor.

We describe the case of a patient with cavernous angioma (CA). A 44-year-old woman complained of numbness on the left side of the body as an initial symptom of the disease. The initial magnetic resonance (MR) imaging revealed a cystic mass with a fluid-fluid level without perifocal edema in the right thalamus on the T 2-weighted image (T 2WI) and T2*-weighted image (T2*WI). Her symptoms were self-controllable; therefore we decided to observe her natural course only with serial MR imaging. The cystic mass was not enhanced by gadolinium on T1-weighted images, although, we suspected the tumor was complicated by vascular malformation. Therefore, we performed cranial angiography to eliminate the possibility of bleeding from the vascular malformation. Angiography did not demonstrate tumor staining nor vascular malformation. Longitudinally, the tumor demonstrated mosaic signal intensities on each sequence with perifocal edema. Moreover, the tumor exhibited hypointensities on T2* WIs without perifocal edema. The natural history of the tumor on MR imaging exhibited a typical case of CA. Some previous reports described cystic CA with perifocal edema and vascular malformation. In our present case, we clinically diagnosed CA on the basis of the final MR imaging together with previous reports. An intra-axial fluid-fluid level is a very rare finding of MR imaging. Here, we report the case of a patient with cystic CA accompanied by a fluid-fluid level. This finding is not a pathognomonic sign of CA; although, we consider that it is very important to follow up carefully the natural history of such cases.

We report the case of a patient with chronic pancreatitis that was complicated by the rare occurrence of a pseudoaneurysm of the gastroduodenal artery that ruptured into the superior mesenteric vein. The patient, a 65-year-old alcoholic man, suddenly experienced hematemesis. Gastroesophagoscopy revealed bleeding from esophageal varices; the hemorrhaging was controlled with sclerotherapy. Sonography identified a 2-cm round anechoic mass at the pancreatic head, and color Doppler imaging revealed turbulent arterial flow within the mass, leading us to the diagnosis of the pseudoaneurysm. CT and angiographic findings generally corresponded with those of sonography and confirmed our diagnosis. The pseudoaneurysm was treated successfully with embolization, and the patient was discharged 10 days after therapy. Follow-up sonography performed 2 months later confirmed the absence of blood flow within the lesion. Color Doppler sonography was very useful for diagnosing the pseudoaneurysm and planning its treatment, and we recommend its routine use in patients with chronic pancreatitis to avoid delays in diagnosing and treating such vascular complications.

A case of bladder cancer producing granulocyte colony-stimulating factor (G-CSF) is reported. A 76-year-old male was admitted to our hospital with gross hematuria and leukocytosis. He was diagnosed with advanced bladder cancer. His white blood cell (WBC) count and serum granulocyte colony-stimulating factor (G-CSF) level were elevated (peak WBC 22,010/microliter, peak G-CSF 351 pg/ml), which immediately normalized after cystectomy. The histopathological diagnosis was transitional cell carcinoma, grade 3, pT4, pN1. Immunohistochemical examination was positive for G-CSF and G-CSF receptor. There has been no recurrence of cancer for more than 23 months since the operation without any additional therapy.

We report a case of tumor regression of multiple bone metastases from breast carcinoma after administration of strontium-89 chloride. This case suggests that strontium-89 chloride can not only relieve bone metastases pain not responsive to analgesics, but may also have a tumoricidal effect on bone metastases.