Search Results (333)

Cardiac sarcoidosis (CS) is an inflammatory cardiomyopathy with heterogeneous presentation and potentially life-threatening complications, including ventricular arrhythmia, atrioventricular block, and heart failure. Early diagnosis is challenging and a multidisciplinary approach is pivotal for optimal treatment and better outcome. We report the case of a 47-year-old man with newly diagnosed systemic sarcoidosis who rapidly developed heart failure and therapy-refractory ventricular arrhythmias despite combined immunosuppressive and antiarrhythmic therapy. Within eight months from the first diagnosis of CS, the patient required four hospitalizations, ICD implantation, ventricular tachycardia ablation, and ultimately orthotopic heart transplantation. Histological examination of the explanted heart revealed extensive myocardial fibrosis without residual granulomas or inflammation, consistent with end-stage, burned-out CS—highlighting the irreversibility of myocardial damage once the fibrotic phase has developed. This case illustrates the potentially devastating course of CS despite aggressive immunosuppressive therapy, emphasizing that the overall prognosis of sarcoidosis disease is largely influenced by cardiac manifestation. Indeed, complete metabolic remission based on a serial FDG-PET/CT scan did not prevent progressive functional deterioration—underscoring that irreversible myocardial fibrosis may progress beyond maximal medical therapy, including anti-inflammatory, immunosuppressive and neuro-humoral treatment. Therefore, prompt screening for CS is essential, and once cardiac involvement is suspected and respectively confirmed, the therapy window may become particularly narrow in the case of rapidly progressive CS. Full article

Atmospheric icing is one of the most critical meteorological hazards for unmanned aerial vehicles (UAV), whose operation under adverse conditions—high latitudes, elevated altitudes, long-endurance missions without pilot intervention—particularly exposes them to ice accumulation on aerodynamic surfaces and propellers. Unlike manned aviation, where this phenomenon has been extensively studied and regulated, a significant knowledge gap exists in the UAV domain that limits the development of effective protection systems adapted to energy constraints. This article provides an integrative review—conducted with a systematic search strategy following PRISMA reporting guidelines—of atmospheric ice formation mechanisms, their specific effects on UAV propellers, and the two most promising mitigation approaches: electrothermal modelling for the optimisation of electric heating systems and the development of functional surface materials including superhydrophobic coatings (SHC); composites with conductive nanofillers (graphene, carbon nanotubes); and piezoelectric actuators. The analysis demonstrates that hybrid systems combining passive and active strategies managed by intelligent control represent the most viable solution for extending UAV operational envelopes under known icing conditions, with a projected reduction in anti-icing system energy consumption of at least 40% relative to conventional continuous heating. This estimate is based on the most conservative published evidence: pulsed electrothermal de-icing achieves 40–60% savings versus continuous anti-icingSHC-assisted hybrid heating reduces IPS power by more than 80% on static aerofoils; and rotary-wing pulsed systems reduce mean consumption by 60–75% relative to continuous operation. Key research gaps are identified, and a prioritised future research agenda is proposed to support the development of certifiable anti-icing systems for rotary-wing UAV platforms. Full article

Isolated cortical vein thrombosis is a rare subtype of cerebral venous thrombosis with highly variable clinical and radiologic manifestations that frequently delay diagnosis. Bilateral thrombosis of the veins of Trolard is exceptionally uncommon, with only a few cases reported in the literature. We report a 64-year-old right-handed man who presented after being found unresponsive with suspected seizure. Although his neurological examination was normal at evaluation (NIHSS 0), noncontrast CT demonstrated subtle bilateral cortical vein hyperdensities (cord sign). Subsequent MRI and MR venography confirmed bilateral thrombosis of the veins of Trolard with associated venous congestion and a small sulcal subarachnoid hemorrhage. The patient was treated with therapeutic anticoagulation and levetiracetam. The patient achieved an excellent functional outcome (modified Rankin Scale score of 0). At 3-month follow-up, he remained neurologically intact without recurrent seizures. Follow-up MRI demonstrated improvement of the cortical FLAIR abnormality, and MR venography showed significant interval improvement in the bilateral vein of Trolard thromboses with residual short-segment nonocclusive filling defects, consistent with partial venous recanalization. This case expands the recognized clinical spectrum of the bilateral vein of Trolard thrombosis by demonstrating that extensive bilateral cortical venous involvement may present predominantly with seizure despite a normal neurological examination (NIHSS 0). Early recognition of subtle CT findings, confirmation with dedicated venous imaging, and prompt anticoagulation can result in excellent clinical recovery and favorable radiographic evolution. Full article

Background and Clinical Significance: Proliferative fasciitis (PF) is an infrequent benign fibroblastic/myofibroblastic proliferation that may closely resemble a soft tissue sarcoma, creating a diagnostic dilemma out of proportion to its biological behaviour. Because no single clinical, histological or immunohistochemical feature is diagnostic, accurate classification depends on the integration of complementary findings. We describe a challenging case of PF involving the lower leg and present a practical clinicopathological approach to its evaluation. Case Presentation: A 34-year-old man presented with a painless subcutaneous nodule on the lateral aspect of the left lower leg, discovered incidentally. Clinical examination suggested a benign superficial soft-tissue lesion, and because no features raised suspicion for malignancy, complete excision was performed without preoperative imaging. Gross examination revealed a 1.9 × 1.6 × 0.7 cm fascial-based lesion composed of spindle cells and scattered ganglion-like cells within a variably myxoid stroma. Focal nuclear pleomorphism, typical mitotic activity (2 mitoses/10 high-power fields), and limited extension into adjacent adipose tissue broadened the differential diagnosis. Immunohistochemistry demonstrated focal SMA positivity, weak focal desmin and S100 expression, absence of CD31 and CD34 staining, and a low Ki-67 proliferative index (approximately 2–3%). Negative surgical margins, together with integration of the clinical presentation, gross findings, histomorphology, and immunophenotype, supported the diagnosis of proliferative fasciitis. The patient remains free of local recurrence four months after surgery. Conclusions: PF should be considered in the differential diagnosis of superficial spindle-cell proliferations showing deceptively aggressive histological features. Careful clinicopathological correlation remains the cornerstone of diagnosis and helps distinguish this benign entity from its malignant mimics. The clinicopathological framework proposed in this report may assist pathologists in the systematic evaluation of similar diagnostically challenging lesions. Full article

Cerebral venous sinus thrombosis (CVST) is an uncommon cerebrovascular disorder with heterogeneous manifestations and may occasionally precede the diagnosis of an underlying malignancy. We report the case of a 24-year-old man who presented with recurrent fever, headache, pharyngodynia, and systemic inflammation initially attributed to a sinonasal or odontogenic infectious process. He subsequently developed binocular horizontal diplopia, left abducens nerve palsy, papilledema, severe headache, and nausea. Neuroimaging demonstrated extensive CVST involving the left internal jugular vein, bilateral transverse sinuses, and superior sagittal sinus, without ischemic, hemorrhagic, or tumoral brain parenchymal lesions. Thrombophilia testing identified heterozygous prothrombin G20210A as the only established inherited thrombophilic factor. Despite initial neurological stabilization, the patient developed a rapidly recurrent frontal calvarial, epicranial, and cranio-dural lesion extending toward the superior sagittal sinus, without brain parenchymal involvement or imaging evidence of leptomeningeal disease. Initial morphological assessment suggested Langerhans cell histiocytosis. However, comprehensive histopathological and immunohistochemical reassessment demonstrated diffuse strong CD30 expression, nuclear and cytoplasmic ALK positivity, CD43 expression, and focal epithelial membrane antigen and granzyme B positivity, while CD1a and S100 were negative. These findings established the diagnosis of systemic ALK-positive anaplastic large cell lymphoma with secondary extra-axial cranio-dural involvement. Systemic staging demonstrated disseminated nodal disease and a noncontiguous cranio-dural extranodal lesion, consistent with stage IV disease. Treatment with anticoagulation and six cycles of brentuximab vedotin combined with cyclophosphamide, doxorubicin, and prednisone resulted in a favorable neurological and oncological outcome, with no metabolically active or residual enhancing disease on follow-up imaging. This case emphasizes the importance of continued etiological investigation in young patients with extensive CVST and an atypical clinical course, even when plausible infectious and inherited thrombotic risk factors coexist. Full article

Background and Clinical Significance: Pulmonary disease caused by nontuberculous mycobacteria (NTM) represents an important diagnostic challenge in tuberculosis-endemic settings because its clinical, radiological, and microbiological features may overlap with those of pulmonary tuberculosis (TB). Accurate distinction between these conditions is essential to avoid diagnostic delay and inappropriate treatment. Case Presentation: We present two cases that illustrate the heterogeneity of imaging patterns associated with NTM disease. The first case involved a 55-year-old woman with previously treated pulmonary tuberculosis who presented with chronic productive cough, recurrent mild hemoptysis, and progressive nodular-bronchiectatic and cavitary abnormalities. Mycobacterium avium was repeatedly isolated from independently collected respiratory specimens and identified using a line probe assay (LPA). The second case involved a 65-year-old man with severe chronic obstructive pulmonary disease (COPD), bronchiectasis, previous tuberculosis, and extensive bilateral fibrocavitary lung disease. Respiratory specimens were acid-fast bacilli-positive, whereas GeneXpert MTB/RIF repeatedly failed to detect the Mycobacterium tuberculosis complex. Repeated cultures identified Mycobacterium xenopi, including isolates from two sputum specimens and one bronchial aspirate. Treatment was subsequently adapted according to species identification and multidisciplinary assessment. These cases illustrate two major phenotypes of pulmonary NTM disease: nodular-bronchiectatic disease caused by M. avium and fibrocavitary disease caused by M. xenopi. They emphasize that persistent acid-fast bacilli (AFB) positivity with negative GeneXpert MTB/RIF results should prompt consideration of NTM alongside other differential diagnoses, followed by mycobacterial culture and species-level identification. Conclusions: The diagnosis of pulmonary NTM disease requires integration of clinical manifestations, radiological evolution, and repeated microbiological confirmation. Early species identification, multidisciplinary treatment selection, and close follow-up may reduce diagnostic delays and support appropriate individualized management. Full article

Background/Objectives: Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, is increasingly used for glycemic control and weight reduction and has a generally favorable hepatic safety profile. However, rare cases of clinically significant drug-induced liver injury have been reported. We report a case of severe hepatocellular injury during tirzepatide therapy and compare it with previously reported cases. Case Presentation: A 36-year-old man developed gastrointestinal symptoms, dark urine, and severe hepatocellular injury approximately 5 weeks after starting tirzepatide for weight reduction, shortly after dose escalation from 2.5 mg to 5 mg weekly and amid rapid weight loss of approximately 10 kg. Extensive evaluation excluded viral, autoimmune, metabolic, biliary, and structural causes, with no competing medication or supplement exposure identified. Tirzepatide was discontinued, and clinical and biochemical status improved rapidly. The Roussel Uclaf Causality Assessment Method (RUCAM) score was 7, indicating probable drug-induced liver injury. Discussion: Previously reported cases demonstrate heterogeneous biochemical patterns and severity, ranging from mild hepatocellular injury to mixed or cholestatic presentations and acute liver failure requiring transplantation. The mechanism remains uncertain. An idiosyncratic drug reaction is the most plausible explanation, while rapid weight loss, dose escalation, and hepatic steatosis may represent susceptibility modifiers rather than established causes. Conclusions: Tirzepatide-associated liver injury appears rare but can be clinically severe. Clinicians should remain alert to the possibility of drug-induced liver injury when unexplained hepatic symptoms or liver biochemical abnormalities arise during treatment. Full article

Background: Resistant hypertension poses a significant therapeutic challenge, often leading to severe polypharmacy. Renal denervation (RDN) has re-emerged as a valuable adjunctive intervention for blood pressure control. Case Presentation: We report the case of a 64-year-old man (body mass index [BMI] 34 kg/m²) with long-standing resistant hypertension (RH), after previous percutaneous coronary intervention (PCI) to the left anterior descending artery, heart failure with preserved ejection fraction (HFpEF), and prior nephron-sparing surgery for clear cell renal carcinoma. Despite treatment with an extensive antihypertensive regimen encompassing nine pharmacological classes including diuretic therapy (angiotensin-converting enzyme inhibitor; calcium channel blocker, thiazide diuretic, β-blocker, α1-blocker, central α2-agonist, mineralocorticoid receptor antagonist, loop diuretic, long-acting nitrates), blood pressure remained severely uncontrolled on both home and office measurements. Persistent hypertension was accompanied by exertional dyspnoea and episodes of exertional chest discomfort. Following comprehensive evaluation and exclusion of secondary causes of hypertension, the patient underwent catheter-based renal denervation using the SymplicitySpyral™ (Medtronic) multi-electrode radiofrequency system. The procedure was associated with substantial and sustained improvement in blood pressure control, with mean 24 h ambulatory blood pressure measurements decreasing to 130/80 mmHg at six-month follow-up. Importantly, successful blood pressure reduction enabled major simplification of pharmacotherapy, including complete discontinuation of clonidine, loop diuretic therapy, and long-acting nitrates, together with marked dose reduction in doxazosin. Conclusions: This case illustrates the potential clinical utility of renal denervation in carefully selected patients with true resistant hypertension and pronounced sympathetic overactivity. Beyond achieving satisfactory blood pressure control, RDN may facilitate meaningful reduction in medication burden, potentially improving treatment adherence, quality of life, and long-term cardiovascular risk. Written informed consent was obtained from the patient for both the procedure and the publication of this case report. Full article

Background and Clinical Significance: Iatrogenic aorto-ostial dissection is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), most commonly involving the right coronary artery. Although ostial stenting is generally considered the standard bailout strategy, failure of initial sealing may occur in selected anatomical settings and remains poorly understood. A focused narrative review of the literature was conducted through PubMed/MEDLINE, Scopus and Web of Science to identify reports of PCI-related aorto-coronary dissection with particular attention to dissection morphology, propagation mechanisms, bailout strategies, and outcomes after ostial stenting; Case Presentation: A 76-year-old man presented with non-ST-elevation myocardial infarction. Coronary angiography showed severe ostial right coronary artery (RCA) disease and significant left anterior descending artery stenosis. Following drug-eluting stent implantation in the RCA, extensive aorto-ostial dissection with retrograde extension into the sinus of Valsalva occurred. Initial ostial stenting failed to seal the dissection and was complicated by hyperacute stent thrombosis. After successful rewiring of the true lumen, a second overlapping drug-eluting stent was implanted using a stent-in-stent technique, followed by prolonged balloon inflation, achieving complete sealing and stabilization. Serial computed tomography angiography confirmed stability, and staged PCI of the LAD was successfully performed five days later; Conclusions: Failure of primary sealing may depend not only on procedural factors but also on dissection morphology. Transverse dissections with wide entry tears may be less effectively sealed by a single ostial stent, whereas overlapping stenting with prolonged balloon inflation may represent a more effective bailout strategy. Full article

Background/Objectives: Sellar solitary fibrous tumors (SFTs) are exceptionally rare mesenchymal neoplasms that frequently mimic non-functioning pituitary adenomas (PAs) because of overlapping clinical manifestations and nonspecific radiological findings. Consequently, preoperative diagnosis remains challenging and definitive diagnosis relies on histopathological and immunohistochemical evaluation. Methods: We report a sellar SFT initially diagnosed as a PA and analyze the diagnostic features of previously reported cases to identify recurring diagnostic pitfalls. Clinical, endocrinological, radiological, intraoperative, histopathological, and immunohistochemical findings from a patient with a sellar SFT were retrospectively reviewed. A structured literature review of previously reported sellar SFTs was performed to compare presenting symptoms, endocrine abnormalities, imaging characteristics, pathological findings, and diagnostic features. Results: A 65-year-old man presented with headache, progressive visual impairment, fatigue, and anterior hypopituitarism. Magnetic resonance imaging demonstrated a heterogeneously enhancing sellar lesion with suprasellar extension and cavernous sinus involvement, leading to an initial diagnosis of non-functioning PA. Endoscopic transsphenoidal surgery revealed an unexpectedly hypervascular and firm tumor. Histopathological examination demonstrated a spindle-cell neoplasm with a hemangiopericytoma-like vascular pattern, six mitoses per 10 high-power fields, absence of necrosis, and diffuse nuclear STAT6 positivity, establishing the diagnosis of CNS WHO grade 2 solitary fibrous tumor according to the 2021 WHO classification. Review of the literature demonstrated that most sellar SFTs share similar clinical and radiological features with PAs and are diagnosed only after surgical resection. Conclusions: Sellar SFT should be considered in the differential diagnosis of atypical sellar masses despite the absence of characteristic imaging findings. Recognition of intraoperative features, together with appropriate immunohistochemical evaluation, particularly STAT6 staining, is essential for accurate diagnosis. Current evidence remains insufficient to define the optimal postoperative management of completely resected sellar SFTs, emphasizing the importance of individualized treatment decisions and long-term surveillance. Full article

Under the background of global warming, high-tide floods pose growing threats to China’s coastal ecosystems, infrastructure and freshwater supplies. Although the occurrence of high-tide flooding events is widely recognized as being related to relative sea-level rise, tides, and residuals, the analysis and attribution of individual events remain relatively scarce. Based on tide-gauge data and numerical simulations, this study conducted a quantitative analysis of the high-tide flooding events along China’s southern coast around 19 November 2024 and provides mitigation recommendations. Results indicate that coastal sea levels south of the Yangtze River Estuary in November 2024 hit the third-highest November value on record. Sea levels south of the Taiwan Strait were 26 cm above those of normal years, with the highest monthly level since that recorded in 1980. Around 19 November, the coastal area levels coincided with the astronomical spring tide period, with the astronomical high water levels in Shanwei (Guangdong), Dongfang (Hainan), and Beihai (Guangxi) reaching 116 cm, 186 cm, and 292 cm above local mean sea level, respectively. Additionally, influenced by the outer circulation of the tropical cyclone Man-Yi and a cold-air process, an extensive coastal surge occurred, with 30~80 cm surges persisting for nearly 30 h. The combined effects of high sea levels, spring tides, and abnormal surges triggered extreme sea levels that broke historical records, with multiple stations reaching once-in-20-year levels. The contributions of astronomical tides to the extreme sea levels in Shanwei, Dongfang and Beihai were 49.5%, 69.3%, and 77.8%, respectively, while the contributions of surges were 23.6%, 6.4%, and 4.6%. This high-tide flooding event affected multiple coastal areas in Guangdong, Guangxi, and Hainan. Developing a comprehensive adaptation strategy encompassing emergency observation and early warning, risk assessment and zoning, coastal protection, coastal adaptive planning, and freshwater resources management is crucial for effectively addressing the risks of high-tide flooding events. Full article

Background: Cervical dumbbell-shaped neurogenic tumors occurring at two noncontiguous levels are rare, and postoperative cerebrospinal fluid (CSF) collection causing cord compression is an uncommon but serious complication after intradural tumor resection. Case Presentation: A 30-year-old man presented with a 3-month history of progressive gait disturbance. Neurological examination revealed grade 3 paraparesis with upper motor neuron signs. Magnetic resonance imaging (MRI) demonstrated two discrete dumbbell-shaped neurogenic tumors located at the C1-2 and C7-T1 levels. The lesions were simultaneously resected. Complete removal of the C1-2 tumor required total sacrifice of the left C2 nerve root, while the C7-T1 lesion was excised through a T-shaped dural incision. The dura was closed primarily with watertight sutures reinforced with dural sealant, and no CSF leakage was observed during intraoperative Valsalva testing. Two months postoperatively, the patient developed worsening upper back and trapezial pain with severe scapular swelling. MRI revealed a large CSF collection extending from C6 to T5, causing moderate cord compression. Urgent revision surgery was performed. Controlled drainage was attempted to prevent intracranial hypotension, but significant CSF egress occurred. The dural defect was repaired using an autologous muscle plug reinforced with fibrin glue. The patient recovered uneventfully after revision surgery and was discharged without recurrence or complications. Conclusions: This case highlights that delayed, extensive postoperative CSF collection can occur despite apparently watertight primary closure and negative intraoperative Valsalva testing. Clinical vigilance for this complication is essential when patients present with new axial pain or localized swelling following cervical intradural surgery, even in the absence of classic low-pressure headaches. Full article

Background: Drop finger may occur in patients with C7 and/or C8 cervical radiculopathy caused by cervical spondylosis. Although surgical decompression of the affected nerve roots is performed in patients with drop finger refractory to conservative treatment, postoperative recovery of drop finger is often unsatisfactory. Furthermore, no effective rehabilitation strategy for improving drop finger has yet been established. Methods: Here, we report a patient with drop finger who underwent a novel postoperative rehabilitation program. A 64-year-old man presented with drop finger of the left hand caused by left C7 and C8 radiculopathy and underwent cervical foraminotomy. For postoperative rehabilitation, we applied the single-joint Hybrid Assistive Limb (HAL), a wearable robotic suit. The patient underwent a total of 21 sessions of metacarpophalangeal HAL training, which assisted voluntary flexion and extension movements of the metacarpophalangeal joints, and 6 sessions of wrist abduction HAL training, which assisted ulnar-direction wrist abduction movements. Results: As a result, improvement in the left-sided drop finger was achieved. In this case, the use of HAL enabled voluntary motor training within the normal range of motion of the fingers and wrist even during the early postoperative phase, when sufficient neurological recovery had not yet been achieved. Conclusions: This successful motor experience may have facilitated the reacquisition of normal movement patterns, thereby contributing to improvement in drop finger. Full article

Background and Clinical Significance: Cardiac and mediastinal angiosarcomas are rare, aggressive malignancies that often present with nonspecific symptoms and pose significant diagnostic challenges. Tumor heterogeneity and necrosis may lead to false-negative biopsy results; Case Presentation: We report a 64-year-old man who initially presented with cardiac tamponade of unclear etiology. Despite an extensive workup, the patient remained asymptomatic for five months before re-presenting with dyspnea and a large mediastinal mass compressing the right heart, along with a lytic rib lesion. Initial ultrasound-guided biopsy of the rib lesion demonstrated a benign vascular proliferation consistent with Masson tumor (intravascular papillary endothelial hyperplasia), which was discordant with aggressive imaging findings. Further evaluation with positron emission tomography–computed tomography (PET-CT) revealed peripheral metabolic activity, and cardiac magnetic resonance imaging (MRI) demonstrated a heterogeneous mass with central necrosis and peripheral enhancement. A repeat CT-guided biopsy targeting the metabolically active region confirmed angiosarcoma, with immunohistochemical staining demonstrating diffuse positivity for ERG, CD31, and CD34. The patient was treated with palliative radiation and paclitaxel-based chemotherapy but experienced rapid clinical decline and transitioned to comfort-focused care; Conclusions: This case highlights the importance of correlating imaging with pathology and emphasizes the risk of sampling error in necrotic tumors. PET-guided biopsy targeting viable tumor regions is essential in cases with discordant findings. Full article

Background/Objectives: Type II endoleaks (T2ELs) remain one of the most frequent causes of aneurysm sac enlargement following endovascular abdominal aortic aneurysm repair (EVAR). While embolization may be effective in typical T2ELs with a clearly identifiable feeding vessel, management becomes more challenging when no visible communication with a side branch can be demonstrated. Emerging evidence suggests that hypertrophic vasa vasorum may contribute to aneurysm sac expansion in these atypical cases. We present a case of refractory atypical T2EL treated by open conversion and discuss the potential role of the vasa vasorum network in its pathophysiology. Case Presentation: A 77-year-old man presented with lumbar pain ten years after EVAR for a symptomatic abdominal aortic aneurysm. Computed tomography angiography demonstrated progressive aneurysm sac enlargement to 8.5 cm despite three previous translumbar embolization procedures. Multiple areas of contrast pooling were identified within the aneurysm sac, but no clear communication with a feeding side branch was observed. Owing to persistent sac expansion and symptoms, open conversion was performed with partial endograft explantation and reconstruction using a bifurcated PTFE graft. Results: After opening the aneurysm sac and evacuating the thrombus, diffuse bleeding was observed from numerous small vascular orifices distributed throughout the inner sac surface. These findings were considered consistent with a prominent vasa vasorum network. Hemostasis was achieved using a combination of figure-of-eight sutures and electrocautery. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Follow-up imaging demonstrated normal graft patency without complications. Conclusions: This case supports the hypothesis that an extensive vasa vasorum network may contribute to aneurysm sac expansion in atypical T2ELs and possibly endotension after EVAR. In patients with refractory sac enlargement, open conversion remains a definitive treatment option. Further research is needed to clarify the underlying mechanisms and to explore targeted therapeutic strategies aimed at modulating angiogenesis and vascular remodeling. Full article