Search Results (110)

Background/Objectives: Lipoid pneumonia (LP) is a rare and frequently underdiagnosed pulmonary condition with a broad spectrum of radiological manifestations that can closely mimic infectious, inflammatory, and neoplastic lung diseases. Despite its clinical relevance, no standardized imaging-based diagnostic pathway exists. For this reason, this pictorial narrative review aims to provide a structured, imaging-centred synthesis of LP, to characterise the full spectrum of high-resolution CT (HRCT) and magnetic resonance imaging (MRI) findings, and to propose a pragmatic diagnostic workflow. Methods: A systematic literature search was performed in PubMed, MEDLINE, Embase, and the Cochrane Library from January 1950 to February 2025. Search terms combined “lipoid pneumonia” with imaging-related keywords including “HRCT,” “computed tomography,” “MRI,” and “fat attenuation.” After screening 891 deduplicated records, 60 studies were included in the narrative synthesis. Eight illustrative institutional cases with imaging–pathology correlation were additionally selected to demonstrate key imaging phenotypes. Results: HRCT is the cornerstone modality, demonstrating intralesional fat attenuation (typically −30 to −150 HU) in 40–80% of cases depending on series and disease chronicity. Additional patterns include ground-glass opacity, crazy paving, centrilobular nodules, and mass-like consolidation mimicking malignancy. Fat attenuation is absent in up to 60% of cases when inflammatory exudate or fibrosis masks lipid content. MRI, particularly chemical shift imaging, serves as a problem-solving adjunct in pseudotumoral or densitometrically equivocal presentations. A pragmatic diagnostic workflow is proposed, integrating HRCT findings, exposure history, fat-sensitive MRI in selected cases, BAL cytology, and histopathological confirmation when required. Conclusions: A pattern-based radiological approach, anchored on HRCT and integrated with clinical exposure history, BAL cytology, and selective use of fat-sensitive MRI, enables accurate diagnosis of LP in most cases and can prevent unnecessary invasive procedures including surgical resection performed under suspicion of malignancy. Full article

Pulmonary disease caused by nontuberculous mycobacteria represents an important diagnostic challenge, particularly in immunocompromised patients, in whom clinical and radiologic findings may mimic malignancy. We report the case of a 70-year-old woman with myelofibrosis treated with ruxolitinib who developed a tumor-like lesion in the left upper lobe on computed tomography, highly suggestive of lung cancer. Despite broad-spectrum antibiotic therapy, the lesion persisted; bronchoscopy did not yield diagnostic findings, and CT-guided transthoracic biopsy demonstrated necrotizing granulomatous inflammation without evidence of malignancy. Microbiological analysis subsequently identified Mycobacterium avium, and targeted antimycobacterial therapy led to clinical and radiologic improvement. This case highlights that pulmonary nontuberculous mycobacterial infection may present as a pseudotumoral lesion and should be considered in the differential diagnosis of mass-like pulmonary opacities, particularly in patients receiving Janus kinase inhibitor therapy. Full article

Background and Clinical Significance: Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory disorder that can mimic infection or malignancy. Spinal involvement is exceedingly rare and usually limited to pachymeningitis or epidural pseudotumors. True vertebral bone destruction has been reported only sporadically. Case Presentation: A 54-year-old man presented to our emergency department with severe neck pain after a fall. CT and MRI revealed extensive osteolysis of the C1 posterior arch and odontoid process with atlantoaxial subluxation. Following a second inpatient fall, he developed acute tetraparesis. Emergency posterior occipitocervical fusion (C0–C4) with C1–C2 laminectomy and foramen magnum decompression was performed. Histopathology demonstrated dense lymphoplasmacytic infiltration and fibrosis with up to 36 IgG4⁺ plasma cells per high-power field and an IgG4⁺/IgG ratio > 40%, confirming IgG4-RD. The patient recovered substantial motor function postoperatively and regained independent ambulation after neurological rehabilitation. Conclusions: IgG4-RD can rarely present as destructive craniovertebral osteolysis with neurological compromise. Unexplained C1–C2 osteolytic lesions should prompt evaluation for IgG4-RD, a rare but treatable cause of cervical instability. Full article

Cardiologists consider degenerative or infectious causes when evaluating valvular heart disease. However, the role of autoimmune disorders, though less frequent, remains clinically significant. This report describes a young male patient presenting with persistent coronary disease and a suspected valvular cusp perforation initially attributed to infective endocarditis, which ultimately proved to be a manifestation of IgG4-related disease. IgG4-related disease is a rare condition, more prevalent in Asian populations, that typically affects the pancreas, salivary glands, lacrimal glands, and the retroperitoneum. Cardiac involvement, although uncommon, can present in various ways, including pericarditis, pulmonary arterial hypertension, valve dysfunction, cardiac pseudotumor, and coronary disease. Diagnosing and managing IgG4-related cardiac involvement requires heightened clinical suspicion, serological and histopathological assessment, and prompt interdisciplinary collaboration. Notably, involving rheumatologists in the management of these rare yet impactful autoimmune cardiac diseases is essential. Full article

Background: Gossypiboma is an uncommon postoperative complication caused by the retention of surgical materials, most frequently sponges, and is associated with substantial morbidity and medicolegal consequences. Despite a reduction in reported incidence, diagnosis remains challenging due to its nonspecific clinical presentation. Case Presentation: We present the case of a 36-year-old woman who presented with a one-week history of throbbing abdominal pain in the umbilical and left lumbar regions, associated with fetid leukorrhea. Her medical history included an appendectomy, a recent cesarean section performed two months prior, and pregnancy-induced hypertension. Initial computed tomography revealed bilateral subcutaneous and intra-abdominal collections with air bubbles and hyperdense linear structures, raising suspicion of abdominal abscesses. Gynecological evaluation excluded pelvic inflammatory pathology. Exploratory laparotomy identified bilateral pseudotumoral masses with complex adhesions involving intestinal loops and omentum, without evidence of gynecologic infection, prompting transfer to a tertiary care center. Repeat imaging confirmed bilateral flank abscesses. Surgical reintervention revealed retained surgical sponges within both abscess cavities, which were successfully removed, followed by evacuation, lavage, and drainage. Postoperative evolution was favorable under broad-spectrum antibiotic therapy, with complete clinical and biological recovery. Conclusions: This case highlights the diagnostic challenge of gossypiboma, particularly when mimicking intra-abdominal abscesses or adhesion syndromes. A high index of suspicion is required in patients with prior surgical history and atypical postoperative presentations, as early recognition and prompt surgical management are essential to reduce morbidity and medicolegal consequences. Full article

Background: Plasma cell granuloma is generally considered a pseudotumor formed by reactive, polyclonal plasma cells. Although most cases can show polyclonal gammaglobulin production, quite a minority may exhibit monoclonal gammopathy, which mimics plasma cell neoplasms such as multiple myeloma or plasmacytoma. Because of this overlap, distinguishing reactive monoclonal proliferation from true malignancy is clinically essential. Case report: A 79-year-old man was presented with an anterior chest wall mass that had grown during investigation for fever of unknown origin. ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed a sternal bone mass (SUVmax 9.04), aortic uptake of bifurcation (SUVmax 7.08), and Th7/8 soft tissue mass (SUVmax 5.32). Results from the FDG-PET revealed infectious reactions. A chest wall biopsy revealed high degree proliferation of plasma cells. Hematologists suspected plasmacytoma. The pathologist did not diagnose plasmacytoma; thus, there remains a possibility of reactive granuloma lesion. Lastly, the patient’s vertebral soft tissue mass culture yielded Staphylococcus aureus. The patient was treated with antimicrobials and responded well. Discussion: In the presented case, FDG-PET revealed an aortic mass with an aortic aneurysm, a sternal mass, and a vertebral mass, as multiple lesions. The abscess lesions that initially resembled multiple plasmacytomas were identified as plasma cell granuloma. The final diagnosis required demonstrating biopsy and definitive monoclonality. Light-chain restriction or monoclonal protein should be considered in the clinical context. Ultimately, this case highlights the diagnostic value of FDG-PET and the importance of differentiating reactive plasma cell granuloma from true plasma cell neoplasm to guide appropriate management. In conclusion, a reactive plasma cell granuloma associated with infectious aortitis can exhibit monoclonal gammopathy, mimicking plasma cell neoplasm. Careful pathological and clinical evaluation is essential to avoid misdiagnosis and ensure proper treatment. Full article

This study presents the first documented case of a disease syndrome in cultured largefin longbarbel catfish (Hemibagrus macropterus). The condition is characterized by massive abdominal pseudotumor formation, severe cachexia, and functional gonadal arrest. Comprehensive pathological investigation revealed that the pseudotumor was encapsulated by fibroblasts and primarily composed of host-derived, poorly differentiated hyperplastic cells, interspersed with invasive, basophilic Type III cells. These cells and associated inflammatory–fibrotic lesions were also disseminated in the gill, kidney and spleen. Systematic diagnostic approaches, including microbiology and transmission electron microscopy, found no evidence of conventional bacterial or viral pathogens. Metagenomic analysis further supported these findings and suggested a link to infection by an as-yet-unidentified eukaryotic parasite, with Microsporidia or Ichthyosporea being the primary candidates. Functional (KEGG) profiling of the pseudotumor tissue further revealed a molecular signature consistent with active cellular proliferation and metabolism. We propose that the pseudotumor acts as a metabolically active “nutrient sink,” driving the systemic catabolism that underlies the severe cachexia and reproductive arrest. This work provides the first case of a eukaryotic parasite-induced pseudotumorous syndrome in fish, which represents an emerging threat to conservation aquaculture and offering novel insights into parasite-mediated host metabolic hijacking and tumor-mimicry. Full article

Background/Objectives: To examine longitudinal changes in total retinal nerve fiber layer thickness (RNFLT) as the primary outcome measure in newly diagnosed pediatric idiopathic intracranial hypertension (IIH) patients using Spectral-Domain Optical Coherence Tomography (SD-OCT) at one-year follow-up. Methods: This is a prospective observational cohort study with cross-sectional control-group comparison. We included children with clinically definite IIH (IIH group) and children without papilledema and a normal neurological exam as a control group. Optic nerve parameters, including the primary outcome measure RNFLT and secondary outcome measures such as total retinal thickness (TRT) and optic disk area (ODA), were evaluated using SD-OCT (3D OCT-2000, Topcon, Topcon Corporation, Tokyo, Japan). Evaluations took place at presentation and, for the IIH group, before lumbar puncture (LP), at 1-day post-LP and at 1-, 3-, 6-, and 12-month follow-ups. Results: A total of 44 children aged 7–17 years were recruited (IIH group: N = 19, control group: N = 25). The mean baseline RNFLT was 133.1 ± 18.5 µm and 113.1 ± 8.7 µm for the IIH and control groups (p < 0.001), respectively. The IIH group showed a significant decline in RNFLT at the third-month follow-up. Between 3-month to one-year follow-up, mean total RNFLT showed an insignificant decline of 6 µm and did not differ from the RNFLT of the control group; however, segmental analysis of RNFLT showed a significant decline in the thickness of the nasal segments. At the one-year follow-up, two children had significant thinning of RNFLT at the superior quadrant. Intracranial pressure measured in the IIH group was directly correlated with RNFLT at the superior segment. Conclusions: SD-OCT is a useful non-invasive adjunct tool for the diagnosis and follow-up of IIH in children from primary school age onward. RNFL thickening resolved in most children at 3 months from IIH diagnosis. The study is constrained by specific methodological limitations, including a small sample size and non-contemporaneous evaluation of the control group compared with the IIH group. The significance of the segmental RNFL changes observed after one year should be further investigated with regard to long-term development, if possible with a larger prospective study that also considers the ganglion cell layer to explore for permanent axonal damage to the optic nerve. Full article

Sjögren’s syndrome is a chronic autoimmune disease marked by lymphocytic infiltration of the exocrine glands and the development of sicca symptoms, yet some patients also develop extraglandular involvement. Imaging has become relevant for describing these systemic features and supporting clinical assessment. This review discusses the roles of ultrasonography, elastography, computed tomography, and magnetic resonance imaging in evaluating multisystem disease associated with Sjögren’s syndrome. Ultrasonography and elastography help assess muscular involvement by showing changes in echogenicity and stiffness that reflect inflammation and later tissue remodeling. In joints, ultrasound can detect synovitis, tenosynovitis, and early erosive changes, including abnormalities not yet evident on examination. Pulmonary disease, most often with interstitial lung involvement, is best evaluated with high-resolution computed tomography, which remains the most reliable imaging modality for distinguishing interstitial patterns. Magnetic resonance imaging is valuable in assessing neurological complications. It can reveal ischemic and demyelinating lesions, neuromyelitis optica spectrum features, or pseudotumoral appearances. Imaging is also essential for detecting lymphoproliferative complications, for which ultrasound and magnetic resonance imaging can reveal characteristic structural and diffusion-weighted imaging findings. When combined with clinical and laboratory information, these imaging methods improve early recognition of systemic involvement and support accurate monitoring of disease progression in Sjögren’s syndrome. Full article

Background: Epstein–Barr virus (EBV)-related primary splenic tumors are exceptionally rare and encompass a heterogeneous group of entities, including inflammatory pseudotumor (IPT), IPT-like follicular dendritic cell (FDC) tumors or sarcomas, and EBV-positive diffuse large B-cell lymphoma (DLBCL). Because clinical presentation and imaging findings are often nonspecific, establishing a definitive diagnosis remains challenging and frequently necessitates splenectomy for histopathologic confirmation. Methods: We retrospectively reviewed patients who underwent laparoscopic splenectomy for suspected primary splenic lesions at a single tertiary institution between June 2014 and August 2025. Among 67 patients, five consecutive patients were pathologically confirmed as EBV-related primary splenic tumors. Clinical characteristics, imaging features, histopathologic and immunophenotypic findings, EBV in situ hybridization results, treatment, and follow-up outcomes were analyzed. Results: This case series comprised four spindle cell–predominant EBV-related tumors (IPT or IPT-like FDC tumors/sarcomas) and one EBV-positive DLBCL. All patients presented with splenic masses that could not be definitively characterized by preoperative imaging alone and therefore required splenectomy. EBV in situ hybridization was positive in tumor cells in all cases. Patients with non-lymphomatous tumors achieved durable disease control following splenectomy alone, with disease-free survival of up to five years. In contrast, the patient with EBV-positive DLBCL required postoperative systemic immunochemotherapy. Conclusions: EBV-related primary splenic tumors represent a diagnostically challenging and clinically diverse disease spectrum. This case series highlights the pivotal role of splenectomy in establishing definitive diagnosis and guiding subsequent management, particularly for isolated splenic lesions with indeterminate imaging findings. Full article

Background: Idiopathic intracranial hypertension (IIH), also known as primary pseudotumor cerebri, is characterized by increased intracranial pressure (ICP) without an identifiable cause. It can lead to significant morbidity, including permanent vision loss, especially in younger children. The exact cause of IIH is still unclear, but excess adiposity seems to be a key risk factor. Current treatment options are unsatisfactory, but research is exploring novel therapies targeting obesity-related mechanisms. Methods: Narrative review of the literature aimed at summarizing current knowledge regarding the epidemiology, pathophysiology, clinical features, treatment options and long-term outcomes for pediatric IIH, with a particular focus on the link with obesity. Results: The incidence of IIH is rising, mirroring the obesity epidemic. Excess adiposity, predominantly visceral, might cause IIH through several factors such as decreased venous return, hormone dysregulation, inflammation, obstructive sleep apnea, and dysfunction of the glymphatic system. The extent of weight loss required and the most appropriate strategy to achieve it are still uncertain. Given the difficulty in achieving and maintaining weight loss with dietary strategies, bariatric surgery and weight loss medications are emerging as effective options for long-term remission of both obesity and IIH. Conclusions: IIH is a rare and poorly understood disease. At present, weight loss represents the only treatment that addresses the pathophysiology of IIH. The role and potential as standalone or synergistic therapies of weight loss drugs and bariatric surgery for IIH in adolescents require future research. Full article

The study reports a diagnostic challenge involving an inflammatory lesion mimicking a brown tumor. A 23-year-old male patient was referred for treatment of a cystic lesion in the left frontal process of the maxilla and ethmoid region. The leading symptoms were hemoptysis and chronic sinus inflammation. Endoscopic surgery was performed under general anesthesia, including curettage and drainage of the lesion into the middle nasal meatus. Histopathological examination revealed chronic inflammatory and fibrotic changes with hemosiderin deposits and CD68(+) histiocytes, findings that could suggest a brown tumor. However, subsequent laboratory investigations excluded this diagnosis. Postoperative healing was uneventful, with complete resolution of symptoms. This report highlights the importance of distinguishing inflammatory from metabolic bone lesions in the paranasal sinuses and underscores the critical role of histopathological evaluation in differentiating true neoplasms from inflammatory pseudotumors. Full article

Hemophilic pseudotumor (HP) is a rare but severe complication of hemophilia, characterized by progressive bleeding in the muscles, joints, and bone tissue, which can lead to lytic lesions. Its prevalence is approximately 1–2% among patients with hemophilia. This report presents a male patient with mild hemophilia A who developed an intraosseous lesion in the posterior region of the right maxilla, with a prior history of endodontic treatment in the area. Surgical excision was performed and, following clinicopathological correlation, the lesion was diagnosed as HP. Background/Objectives: This review aims to identify previously reported cases of HP located in the maxilla. Methods: The study protocol followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The databases PubMed, Scopus, and ScienceDirect were searched, and Google Scholar was used to identify gray literature. The Joanna Briggs Institute (JBI) tool was employed to assess the risk of bias and the quality of the included reports and case series. Results: A total of 1487 publications were identified using specific keywords. After removing duplicates and non-relevant titles/abstracts, 42 full-text articles were reviewed. Of these, 10 met the inclusion criteria: 7 case reports and 3 case series, comprising 13 cases of HP in the maxilla, including the case presented here. Although rare in the maxillofacial region, when it does occur, it is more commonly seen in the mandible and is often linked to prior trauma. In this case, endodontic treatment may have triggered lesion development. Conclusions: This report highlights that, although uncommon, HP can manifest with involvement of the maxilla, and that specific dental interventions may represent potential triggering events. Full article

A 75-year-old patient was transferred to the oncology department due to the discovery of a large pelvic tumor compressing the femoral neurovascular bundle suspected to be of malignant origin. Further investigation revealed a rare complication related to a 27-year-old total hip arthroplasty (THA). The final diagnosis was a severe adverse local tissue reaction (ALTR) resulting from excessive implant wear—first from a metal-on-metal (MoM) bearing and later exacerbated by a revision to a metal-on-polyethylene (MoP) articulation. The clinical course was further complicated by periprosthetic joint infection (PJI). The patient underwent extensive tumor-like mass resection followed by two-stage revision arthroplasty. Despite these interventions, infection persisted, ultimately necessitating joint resection. This case highlights the rare but serious convergence of dreaded orthopedic complications (ALTR and PJI). It underscores the diagnostic challenge posed by wear-induced pseudotumors, which are rare even among arthroplasty specialists and are often unfamiliar to oncologists. This case illustrates the importance of early orthopedic evaluation, maintaining a high index of suspicion in atypical presentations, and invites further discussion about the interplay between ALTRs and infection risk in arthroplasty patients. Full article

Hepatic actinomycosis (HA) and IgG4-related inflammatory pseudotumors are rare and often overlooked causes of liver mass, which can easily be misdiagnosed as primary liver cancer or metastasis. Diagnosis is arduous due to unspecified clinical and radiological features and the fact that histology is not always conclusive. In cases of actinomycosis, the use of molecular diagnostic techniques—such as polymerase chain reaction (PCR) for bacterial DNA—can aid in establishing a definitive diagnosis, especially when conventional cultures are non-diagnostic. We present a case report of one of our patients who was incidentally diagnosed with a hepatic lesion presenting aspecific radiological features. Since radiological imaging was inconclusive, a biopsy was performed, and a diagnosis of IgG4 related hepatic inflammatory pseudotumor was then made. Because of the disease progression, during immunosuppressive therapy, our diagnosis was questioned and a new liver biopsy was carried out. At the end, it took three consequent biopsies to finally find out the presence of an actinomyces infection. Full article