Images in radiology

Case 1 A1-year-old girl who had a k/c/o seizure disorder was brought with complaints of abnormal body movement for 1 day lasting 1½ h which was tonic–clonic type, focal involving left UL and LL associated with uprolling of eyeballs and deviation of mouth to the right side and loss of consciousness. On examination, the child had a port wine stain on the right side of the face. Noncontrast computed tomography (CT) brain showed tram track subcortical and gyral calcification in the right frontal lobe. Pial subcortical vessels appear calcified along the right frontal cortex and atrophy of the right frontal cortex [Figure 1].Figure 1: Struge–Weber syndrome. Noncontrast computed tomography head of a 1-year-old female showing (a) frontal lobe atrophy and tram track subcortical calcification (b) calcified pial vessel Final diagnosis - Sturge–Weber Syndrome Sturge–Weber syndrome (SWS) is a neurocutaneous syndrome marked by angiomas affecting the face, choroid, and leptomeninges. The facial capillary malformation, commonly referred to as a “port-wine stain” or “nevus flammeus,” typically appears in the distribution of the trigeminal nerve. SWS is a sporadic developmental disorder caused by somatic mosaic mutations in the GNAQ gene, located on the long arm of chromosome 9.[1] The most frequent clinical manifestation of SWS is seizures, which occur in 71%–89% of cases[2] and are often resistant to medical treatment. These seizures typically begin in early childhood and are commonly associated with developmental delays and hemispheric symptoms, such as hemiplegia/hemiparesis and hemianopsia. Diagnosis of SWS primarily depends on imaging studies. Findings may include cortical and subcortical calcifications (known as the “tram-track sign”), associated parenchymal volume loss, calvarial and regional sinus enlargement, and potentially orbital choroidal hemangiomas. Case 2 A 17-year-old female presented with pain and swelling over the left calcaneum for 1 year. The swelling was insidious in onset and gradually progressive. There was tenderness at the lateral aspect of ankle joint. On CT, a well-defined, multiloculated, multiseptated lytic expansile lesion in the calcaneum was noted, and on magnetic resonance imaging (MRI), a well-defined, T1 isointense, T2 hyperintense, multiloculated, multiseptated expansile lesion was noted in the calcaneum showing multiple blood fluid levels within [Figures 2 and 3].Figure 2: Aneurysmal bone cyst. Computed tomography of ankle in 17 year old female shows (a) well defined lytic expansile lesion (b) with multiple septations Figure 3: Aneurysmal bone cyst. Magnetic resonance imaging of ankle joint in 17 year old female shows (a) T1 isointense and (b) T2 hyperintense well defined lesion with multiple septations in calcaneum (c) with blood fluid levels On histopathology, benign bony tissue with hemorrhage and fibrosis were noted. Final diagnosis - Aneurysmal bone cyst Aneurysmal bone cysts (ABCs) constitute about 1% of primary bone tumors and are more common in women than in men.[3] They predominantly affect individuals under 20 years of age, with very few cases occurring in those under 5 or over 50 years of age.[4] ABCs are benign, vascular lesions that may arise either as a primary condition (65%) or secondary (35%) to existing benign or malignant lesions, such as giant cell tumors, osteoblastomas, angiomas, and often chondroblastomas of the calcaneus. Although ABCs have been reported in nearly every bone, they are most commonly found in the metaphyses of the long bones, particularly the distal femur, proximal tibia, and vertebrae. The calcaneus is an uncommon site for ABCs, representing only 1.6% of cases.[5] On imaging, ABC shows multiloculated, multiseptated lytic expansile lesion and shows blood fluid levels on MRI. Case 3 A 12-year-old female presented with abdominal distension with intermittent pain for 3 months. On examination, the abdomen was massively distended and lumpy nodular mass was felt all over the abdomen. On ultrasonography, multiple thin-walled cysts of varying sizes were noted in the liver, spleen, and throughout the peritoneal cavity. On contrast-enhanced CT abdomen, multiple peripherally enhancing well-defined cystic lesions with few of them showing internal membrane-like structures and calcific foci were seen in the liver, spleen, and diffusely within the peritoneal cavity [Figure 4].Figure 4: Disseminated intraperitoneal hydatid cyst with cyst in liver, spleen and peritoneum. contrast-enhanced computed tomogrpahy abdomen of a 12 year old female shows (a) multiple well defined peripherally enhancing cystic lesions with (b) calcific foci and (c) internal membrane like structure On serology, Echinococcus IgG was present. Final diagnosis - disseminated intraperitoneal hydatid cyst with cyst in the liver, spleen, and peritoneum Peritoneal hydatidosis (PH) is a parasitic condition caused by the seeding of the peritoneal serosa with Echinococcus granulosus larvae, typically resulting from the rupture or fissuring of hepatic hydatid cysts. Although rare, PH accounts for approximately 5%–16% of all hydatid cyst cases.[6] Diagnosis primarily relies on biological and, in particular, radiological examination techniques.[7] On imaging, numerous cysts of varying sizes can be seen throughout the peritoneal cavity, and many display multiple internal septations and daughter cysts and focal calcification also can be seen. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.