We report the case of a 48-year-old man with a right fusiform internal jugular venous aneurysm, presenting as a unilateral painless neck swelling on coughing or laughing. This is a rare condition, more commonly seen in the paediatric population and can be diagnosed using non-invasive modalities such as Doppler ultrasound and contrast-enhanced CT. This anomaly is frequently misdiagnosed or overlooked, and our case highlights the importance of considering venous aneurysm as a differential to prevent invasive imaging and inappropriate management.
Fear of Falling (FoF) is the most commonly reported fear among older adults (up to 50%) and can result in the avoidance of physical and social activities, potentially leading to loss of confidence, social isolation, increasing dependency, depression and decreased quality of life. To develop a psychological intervention to address FoF, we investigated how older people make sense of and accommodate fear of falling in their everyday lives.
Hydroxyapatite crystal deposition disease (HADD) around the hip is typically described involving the gluteal tendons. However, HADD can occur in any location and result in varied clinical presentations. Even with small deposits, symptoms can be significant and imaging findings may appear aggressive, mimicking infection and malignancy particularly when in an atypical location. We illustrate cases of both common and rare locations of HADD around the hip, in particular presenting as greater trochanteric pain syndrome, piriformis syndrome and ischiofemoral impingement. The latter two manifestations have not been previously described in the literature. Low signal deposits were identified on MRI at the greater trochanter (gluteus medius tendon), proximal piriformis (adjacent to the sciatic nerve), and quadratus femoris (in the ischiofemoral space), respectively. Associated inflammatory changes with tendinopathy, bursitis and oedema were also demonstrated. The patient with piriformis syndrome underwent steroid injections and shockwave therapy with significant symptom improvement. HADD should be within the differential diagnosis for hip pain and nerve compression syndromes. Knowledge of tendon anatomy and correlation with radiographs or CT, even after MRI, is crucial in recognising unusual manifestations and preventing unnecessary investigation. Therefore, we review the spectrum of imaging features of HADD, as well as the current evidence on its management, to confidently diagnose this condition.
To evaluate the diagnostic performance of MRI compared with CT in differentiating neoplastic from infectious/inflammatory causes of complete unilateral maxillary sinus opacification (UMSO). Although MRI is increasingly used, no studies validate its utility compared to CT or nasal endoscopy in this context.A retrospective analysis of 49 patients presenting with complete UMSO to a tertiary referral centre was performed, investigated with both CT and MRI. Two head and neck radiologists independently reviewed each imaging modality and recorded both a final diagnosis and Likert-scale diagnostic certainty score. A consensus radiological diagnosis was determined, stratified into potentially neoplastic or infectious/inflammatory aetiology, and compared with nasal endoscopy and final diagnosis. Diagnostic performance and interoperator agreement for predicting neoplasia were calculated.Both CT and MRI demonstrated high sensitivity and negative predictive value for neoplasm, although MRI was more specific (79%; 95% CI: 60-92%) than CT (14%; 95% CI: 4-32%), with a higher positive predictive value. MRI was more accurate (88%; 95% CI: 75-95%) than CT (49%; 95% CI: 34-64%) in diagnosing neoplasia. MRI had significantly higher diagnostic certainty Likert scores than CT (p < 0.0001 for both observers). Interobserver agreement was fair for CT (kappa coefficient = 0.327) and excellent for MRI (kappa coefficient = 0.918).MRI is more specific than CT in characterising UMSO, with greater diagnostic certainty and reproducibility. The additive diagnostic value of MRI complements CT, potentially reducing diagnostic delays in some cases and the need for diagnostic endoscopic sinus surgery in others. We recommend MRI incorporation into the diagnostic pathway for patients with UMSO.
A 59-year-old man presented to our surgical clinic with a long-standing history of heart burn, and upper abdominal pain. Gastroscopy showed a large sliding hiatus hernia associated with severe reflux oesophagitis. Oesophageal pH manometry revealed a high DeMeester score of 36.03. A computed tomography (CT) scan was performed for preoperative hiatal hernia repair planning. This showed the incidental finding of an accessory left hepatic artery (ALHA) and an aneurysm of this accessory artery. The aneurysm occurred at the point where the ALHA traversed the diaphragmatic crus and was only present in association with the hiatus hernia. These observations suggest that the aetiology of the aneurysm was due to traction during development of the hiatus hernia. The patient went onto have a laparoscopic hiatus hernia repair and Toupet fundoplication with ligation of the accessory left hepatic artery and made an excellent recovery. ALHAs are not uncommon, occurring in around 15% of the general population, with aneurysms of the hepatic arteries accounting for about 20% of cases of visceral artery aneurysms. The case presented herein highlights the importance of performing an arterial phase CT when planning surgery for large hiatus hernias to detect more cases like this one. This would allow early detection and concurrent treatment of an associated aneurysm with repair of the hiatus hernia, to prevent aneurysmal complications later on.
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