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  More Than You Can Swallow: Mycotic Aneurysm, An Uncommon Etiology of Dyspepsia

  Hussein Bazzy, Katharine Glover, Steven Jones, James Aldridge, Michael Potes, and Katie Sumnicht

  Publication Date: 5-4-2023

  Dyspepsia is defined as predominant epigastric pain lasting greater than one month.

  ▪ Common etiologies of dyspepsia include peptic ulcer disease, medications, and gastroesophageal reflux.

  ▪ We present a rare case of dyspepsia caused by a mycotic aneurysm due to accidental foreign body ingestion leading to emergent inpatient intervention.

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  Varicella-Zoster Encephalitis Presenting with Trigeminal Neuralgia, Complicated by Vasculopathy

  Amy Ishbia, Katherine Ross, Dillon Yaldo, Jacob Conroy, and Andrea Stoner

  Publication Date: 5-4-2023

  VZV is a herpesvirus that causes chickenpox before laying dormant and having the potential to reactivate to cause myelitis, encephalitis, or vasculopathy [1,4]. ▪ Encephalitis occurs in less than 0.1% of cases; however accounts for 90% of neurologic complications from VZV [2].

  Vasculopathy is a rare complication of VZV encephalitis characterized by vessel wall damage and transmural inflammation with multinucleated giant cells and/or epithelioid macrophages.

  Vasculopathy has significant morbidity/mortality due to ischemic/hemorrhagic stroke, spinal cord infarction, temporal artery inflammation, ischemic cranial neuropathies and cerebral venous thrombosis [2].

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  Impact of Structured Reporting Template on the Quality of HRCT Radiology Reports for Interstitial Lung Disease

  Han G. Ngo, Girish B. Nair, and Sayf Al-Katib

  Publication Date: 5-2023

  This QI study compared the completeness of HRCT radiology reports before and after the implementation of a disease-specific structured reporting template for suspected cases of interstitial lung disease (ILD).

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  Complex Removal of Heterogenous Soft Tissue Mass in Patient with Prior History of Malignancy

  Yumna Siddiqui and Randy Semma

  Publication Date: 5-4-2023

  There is a variety of pathologies seen in the foot and ankle. One of the more challenging pathologies involves the ability to obtain the correct diagnosis and therapeutic treatment for a soft tissue mass of unknown etiology. With both benign and malignant tumors found in the lower extremities, most malignancy presenting in the foot and ankle is primary in nature. However, in patients with history of malignancy elsewhere in the body, a possible secondary metastatic tumor should always be a differential. Therefore, early diagnosis and treatment is of upmost importance. We present a case study of a patient with prior history of uterine cancer, presenting with an enlarging heterogenous soft tissue mass on her ankle.

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  Invasive Lobular Carcinoma of the Breast Presenting as Pneumoperitoneum with Omental and Retroperitoneal Metastasis A Case Report

  Logan Smith; Christian , Przeslawski; Katie Sarraf; Steven Jones; and Raimundo Pastor

  Publication Date: 5-5-2023

  A 65 year old female presenting with abdominal pain and imaging findings of pneumoperitoneum was brought to the operating room and found to have a retroperitoneal mass and omental caking secondary to metastatic breast lobular carcinoma. Intra abdominal metastasis is rare however lobular carcinoma is more likely to spread here than other types of breast cancer [1]. This is the first case of pneumoperitoneum from metastatic lobular carcinoma in the literature.

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  Imaging-Based Modules for Musculoskeletal Anatomy & Pathology in Preclinical Medical Education

  Ameen Suhrawardy, Tarek Almsaddi, Sarah Fried, Sayf Al-katib, Drew Moore, and Malli Barremkala

  Publication Date: 5-2023

  Many medical students report a lack of adequate orthopedic and musculoskeletal (MSK) teaching in the preclinical medical curriculum. As gross anatomy is emphasized in pre-clinical education, students may feel a disconnect from clinical anatomy proficiency. This project assesses the efficacy of a preclinical image-based module to teach MSK anatomy and pathology concepts to preclinical medical students.

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  Comparing Radiological characteristics of Neck Pain in Younger versus Older Patients: A retrospective analysis

  Jnana Aditya Challa, Abdul Majid Khan, and Varna Taranikanti

  Publication Date: 5-2-2022

  INTRODUCTION
  Neck pain commonly occurs during the fifth or sixth decade of life due to degenerative changes in the spine. With increased usage of digital technology from a very young age we hypothesized an earlier age of onset of these degenerative changes. There have been no recent epidemiologic studies that investigated difference in radiological changes seen in older versus younger patients presenting with neck pain. Hence, this study is undertaken to analyze the variability in radiological changes seen in the cervical vertebrae between older (>50) versus younger (≤50) patients presenting with the chief complaint of neck pain.

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  Pre and Postnatal Magnetic Resonance Imaging of Ventriculomegaly

  Ryan Kelsch, Megan Moore, and Anant Krishnan

  Publication Date: 4-2022

  Purpose or Case Report: The purpose of this research was to analyze our institution’s large database of fetal magnetic resonance (MR) for cases of ventriculomegaly in order to understand trends in pre and postnatal MR.
  Methods & Materials: In this retrospective study, 316 individual fetal MR exams from the past 10 years at our institution were reviewed. Of those, 86 patients had fetal MRs with findings of either ventriculomegaly or an ordering indication of ventriculomegaly. Our inclusion criteria of a diagnosis of ventriculomegaly (lateral ventricle measured at the trigone on coronal imaging of over 10mm) on fetal MR with a corresponding postnatal MR for that patient yielded 21 patients. Information extracted included degree of ventriculomegaly, and cause as determined by imaging. Correlation was performed via chart review to understand each patient's clinical outcome. Poor outcome was defined as permanent neurological deficits including seizures and developmental delay. The majority of the clinical outcome information was collected from the first few years of life.
  Results: Of the 21 patients with ventriculomegaly with pre and postnatal MR imaging, the cause for ventriculomegaly was determined by prenatal imaging in 10 patients, by postnatal imaging in 4, while in 7 patients, a definite cause was not determined by the combination of prenatal and post-natal imaging. On prenatal imaging 7 fetuses had mild ventriculomegaly (10-12mm), 6 fetuses had moderate ventriculomegaly (>12-15mm) and 6 fetuses had severe ventriculomegaly (>15mm). Of the patients with mild ventriculomegaly, 5/7 had a normal neurological outcome while 2/7 have thus far had a poor neurological outcome. Of the patients with moderate ventriculomegaly, all 6, and similarly of the severe ventriculomegaly, 4/5 have thus far had a poor neurological outcome, with one patient not having enough clinical information thus far to determine outcome.
  Conclusions: Our study demonstrates the utility of fetal MR in characterizing ventriculomegaly, with 48% (10/21) of patients receiving an etiology for the ventriculomegaly based on fetal MR findings. Our study also confirms previously reported studies that fetuses with mild ventriculomegaly more often have a normal neurological outcome (71%, 5/7) when compared to those with moderate to severe ventriculomegaly.

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  Irreversible Electroporation for Recurrent Pelvic Metastases: Case Series and Literature Review

  Duncan A. Stevens, Jeffrey H. Savin, Brett J. Friedman, and Michael A. Savin

  Publication Date: 5-2-2022

  INTRODUCTION
  Irreversible electroporation (IRE) is a nonthermal ablative technique that has potential safety advantages over thermal ablation in the treatment of tumors near critical structures. It creates an electrical field which forms permanent nanopores in the membranes of cells and triggers apoptosis. This case series reviews three patients with pelvic metastases from colorectal cancer treated with IRE.

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  Irreversible Electroporation for Recurrent Pelvic Metastases: Case Series and Literature Review

  Duncan A. Stevens, Jeffrey H. Savin, Brett J. Friedman, and Michael A. Savin

  Publication Date: 9-23-2022

  Purpose: Irreversible electroporation (IRE) is a nonthermal ablative technique that has potential safety advantages over thermal ablation in the treatment of patients with tumors near critical structures. It creates an electrical field that forms permanent nanopores in the membranes of cells and triggers apoptosis. This case series reviews three patients with pelvic metastases from colorectal cancer treated with IRE.

  Materials and Methods: Two patients had rectal cancer, and one had sigmoid colon cancer. The mean age was 55 years, and there were two men and one woman. Thermal ablation was contraindicated because of proximity to the ureter, bladder, bowel, or sciatic or lumbosacral nerves. Every patient was referred to interventional radiology because of progression after primary tumor resection, FOLFOX (folinic acid, fluorouracil, and oxaliplatin) chemotherapy, and pelvic radiation. All patients were treated with NanoKnife IRE (AngioDynamics).

  Results: To reduce IRE risk, hydrodissection was performed. In each case, either four or five IRE probes were used with up to two pull-back treatments. The probe exposure length was either 1.5 cm or 1 cm. One patient had no recurrence after the last follow-up at 23 months. Two patients had recurrence, one after 6 months (retreated with IRE) and the other after 17 months. Complications included partially reversible lower extremity sensory and motor deficits, contained colon perforation, and ureteral injury requiring stent placement.

  Conclusions: IRE is a promising tool for local treatment of recurrent pelvic metastases when other local treatments are contraindicated. IRE leaves supporting tissue largely unaffected so that blood vessels and the intestines are relatively preserved, and damaged axons may regenerate. This is important in the pelvis, where sensitive structures include the bladder, ureters, bowel, lumbar and sacral nerve roots, and sciatic nerve. For these patients, IRE was selected over thermal ablation because of a decreased risk of complications. Complete ablation is possible for smaller lesions, but symptom control should be the focus for patients with larger lesions.