This study aimed to examine the imaging characteristics and clinical implications of atypical pleural lesions that mimic bone tumors and form along the inner margins of consecutive ribs. This retrospective analysis included 45 atypical pleural lesions arising from 13 patients who underwent chest computed tomography (CT) between April 2021 and March 2023. The clinical features, CT findings, and radiologic diagnoses prior to pathologic identification were examined. Pathological findings were reviewed in the surgically resected case. Subgroup analysis was performed based on the presence of concurrent typical pleural plaques. The mean age of the patients was 69.3±8.4 years with a predominance of males (76.9%). The lesions primarily exhibited unilateral involvement (84.6%), being most frequently located in the right mid-level posterior region. Calcification was present in 75.6% of cases, typically seen continuously along the ribs (82.4%). Adjacent rib changes were observed in 28.9% of cases. These lesions were frequently misdiagnosed as osteochondromas or bony spurs (55.6%) by thoracic radiologists. No significant growth was observed during follow-up (n=11, 47±41 months), and the pathological findings were consistent with pleural plaques. Patients with concurrent typical pleural plaques had more atypical pleural lesions without statistical significance (P=0.071) and showed a more even distribution (P=0.039). In conclusion, atypical pleural lesions resembling bone tumors along consecutive ribs represent a distinct subset of pleural plaques. Their unique distribution and morphology should be recognized by radiologists to avoid misinterpretation and unnecessary interventions.

UNASSIGNED: Endodermal sinus tumors are rare, especially extragonadal endodermal sinus tumors, which often occur in the midline of the brain, neck, chest, and abdomen.
UNASSIGNED: We present the case of a 37-year-old woman with a mass on the right edge of the liver. Color Doppler ultrasound, computed tomography, and magnetic resonance imaging examinations were performed before the operation. Given these results and the elevation of alpha-fetoprotein, the diagnosis of hepatocellular carcinoma was made. Postoperative pathological examination indicated an endodermal sinus tumor on the abdominal wall near the right liver. The causes of misdiagnosis were analyzed, and the related literature was reviewed.
UNASSIGNED: Primary endodermal sinus tumors on the abdominal wall near the right liver are easily misdiagnosed as hepatocellular carcinoma due to liver compression and elevated alpha-fetoprotein. The key point of differentiation is the wide basal connection between the tumor and the abdominal wall near the liver. In addition, the enhancement mode of endodermal sinus tumors is different from the enhancement pattern of hepatocellular carcinoma.
UNASSIGNED: Extragonadal endodermal sinus tumors often occur in the midline of the body. Here, we present a case of a primary endodermal sinus tumor on the abdominal wall near the right liver for the first time.

The falciform ligament is a peritoneal double layer that anatomically divides the right and left hepatic lobes. Abnormality of the falciform ligament is rare - less than 20 cases of torsion of the falciform ligament have been reported to date in adults. The pathophysiology of these entities is similar to intra-abdominal focal fat infarction. The clinical of the patient with torsion of the falciform ligament is abdominal pain of sudden onset and focal location. Laboratory tests can lead to diagnostic confusion with cholecystitis. Ultrasonography is usually the initial evaluation test, but the gold standard diagnosis is computed tomography. We report the case of a 30-year-old female patient reporting sudden abdominal pain that radiates to the dorsal region associated with nausea and vomiting diagnosed with torsion of the falciform ligament with ultrasonography and confirmed with computed tomography. She was treated conservatively without the need for surgical treatment, being discharged after one week hospitalization.

Eagle syndrome consists of an elongation of the styloid processes with calcification of the stylohyoid ligaments, unilaterally or bilaterally. Characteristically, it produces a temporal or retroauricular headache, which is exacerbated by speaking and chewing, with pain on palpation of the tonsillar pillars. Knowing its form of clinical and semiological presentation allows requesting the appropriate complementary tests that avoid delays in diagnosis and thus guide the correct treatment.
El síndrome de Eagle consiste en una elongación de los procesos estiloides con una calcificación de los ligamentos estilohioideos, uni o bilateral. Característicamente produce una cefalea de localización temporal o retroauricular, que se exacerba con el habla y la masticación, con dolor a la palpación de los pilares amigdalinos. Conocer su forma de presentación clínica y semiológica permite solicitar las pruebas complementarias adecuadas que eviten demoras en el diagnóstico y orientar así el tratamiento correcto.

Computed tomography coronary angiography (CTCA) is a non-invasive diagnostic modality that provides a comprehensive anatomical assessment of the coronary arteries and coronary atherosclerosis, including plaque burden, composition and morphology. The past decade has witnessed an increase in the role of CTCA for evaluating patients with both stable and acute chest pain, and recent international guidelines have provided increasing support for a first line CTCA diagnostic strategy in select patients. CTCA offers some advantages over current functional tests in the detection of obstructive and non-obstructive coronary artery disease, as well as for ruling out obstructive coronary artery disease. Recent randomised trials have also shown that CTCA improves prognostication and guides the use of guideline-directed preventive therapies, leading to improved clinical outcomes. CTCA technology advances such as fractional flow reserve, plaque quantification and perivascular fat inflammation potentially allow for more personalised risk assessment and targeted therapies. Further studies evaluating demand, supply, and cost-effectiveness of CTCA for evaluating chest pain are required in Australia. This discussion paper revisits the evidence supporting the use of CTCA, provides an overview of its implications and limitations, and considers its potential role for chest pain evaluation pathways in Australia.

UNASSIGNED: To determine whether gross tumor volume (GTV) of adenocarcinoma of esophagogastric junction (AEG) corresponding to cT and cN stages measured on CT could help quantitatively determine resectability.
UNASSIGNED: 343 consecutive patients with AEG, including 279 and 64 randomly enrolled in training cohort (TC) and validation cohort (VC), respectively, underwent preoperative contrast-enhanced CT. Univariate and multivariate analyses for TC were performed to determine factors associated with resectability. Receiver operating characteristic (ROC) analyses were to determine if GTV corresponding to cT and cN stages could help determine resectability. For VC, Cohen\'s Kappa tests were to assess performances of the ROC models.
UNASSIGNED: cT stage, cN stage and GTV were independently associated with resectability of AEG with odds ratios of 4.715, 4.534 and 1.107, respectively. For differentiating resectable and unresectable AEG, ROC analyses showed that cutoff GTV of 32.77 cm3 in stage cT1-4N0-3 with an area under the ROC curve (AUC) of 0.901. Particularly, cutoffs of 27.67 and 32.77 cm3 in stages cT3 and cT4 obtained AUC values of 0.860 and 0.890, respectively; and cutoffs of 27.09, 33.32 and 37.39 cm3 in stages cN1, cN2 and cN3 obtained AUC values of 0.852, 0.821 and 0.902, respectively. In VC, Cohen\'s Kappa tests verified that the ROC models had good performance in distinguishing between resectable and unresectable AEG (all Cohen\'s K values > 0.72).
UNASSIGNED: GTV, cT and cN stages could be independent determinants of resectability of AEG. And GTV corresponding to cT and cN stages can help quantitatively determine resectability.

UNASSIGNED: To develop and validate a quantitative model based on gross tumor volume (GTV) of gastric adenocarcinoma (GA) corresponding to N-stage measured at multidetector computed tomography (CT) for preoperative determination of resectability.
UNASSIGNED: 493 consecutive patients with confirmed GA undergoing contrast-enhanced CT two weeks before treatments were randomly enrolled into the training cohort (TC, n = 271), internal validation cohort (IVC, n = 107) and external validation cohort (EVC, n = 115). GTV was measured on CT by multiplying sums of all tumor areas by section thickness. In TC, univariate and multivariate analyses were performed to select factors associated with resectability. Receiver operating characteristic (ROC) analysis was to determine if N-stage based GTV could identify resectability. In IVC and EVC, unweighted Cohen\'s Kappa tests were to evaluate performances of the ROC models.
UNASSIGNED: According to univariate analysis, age, cT stage, cN stage and GTV were related to resectability in TC (all P-values < 0.05), and multivariate analysis suggested that cN stage and GTV were independent risk factors with odds ratios of 1.594 (95% confidence interval [CI]: 1.105-2.301) and 1.055 (95%CI: 1.035-1.076), respectively. ROC analysis in TC revealed the cutoffs of 21.81, 21.70 and 36.93 cm3 to differentiate between resectable and unresectable cancers in stages cN0-3, cN2 and cN3 with areas under the curves of more than 0.8, respectively, which was validated in IVC and EVC with average Cohen k-values of more than 0.72.
UNASSIGNED: GTV and cN stage can be independent risk factors of unresectable GA, and N-stage based GTV can help determine resectability.

UNASSIGNED: Late pulmonary autograft dilatation is observed in 10-20 % of patients after the Ross procedure, more often during the second decade of follow-up. Composite aortic root replacement with a valved conduit is the most common redo procedure. An aortic valve-sparing root replacement does not require lifelong anticoagulation and may significantly decrease the risk of complications, associated with a valve prosthesis.
METHODS: We report a case of late pulmonary autograft dilatation developed after the Ross procedure. The annual transthoracic echocardiography after 20 years revealed severe dilatation of the pulmonary autograft, measuring 60 mm in diameter. The patient underwent a successful elective redo valve-sparing aortic root replacement (David I procedure). The aortic cross-clamp time was 144 min, and the CPB time was 181 min. The patient had an uneventful midterm postoperative course.
UNASSIGNED: Late pulmonary autograft failure after the Ross procedure is a relatively rare condition, leading to repeat operation. Late autograft failure can contribute to aortic regurgitation, heart failure, and death due to ascending aortic dissection and rupture. Several research groups reported good early and midterm results of redo valve-sparing root replacement in such cases. In a reoperative valve-sparing root replacement after the Ross procedure, the portion of the native aorta with the adjacent part of the autograft may complicate the aortic root proper sizing.
CONCLUSIONS: Redo valve-sparing root replacement (David I procedure) is a viable option in pulmonary autograft dilatation with unaffected valve leaflets.

BACKGROUND: Clear cell sarcoma (CCS) is a rare and highly malignant soft tissue tumor, usually occurring in the deep soft tissues of the distal tendons and aponeurosis of the extremities, especially the feet and knees. CCS originating in the head and neck is extremely rare. The clinical manifestations of CCS in the head and neck are not typical, and the imaging manifestations have certain characteristics, but the diagnosis still depends on pathological examination and genetic testing.
METHODS: A 33-year-old male patient had paroxysmal headache for more than 4 years, accompanied by nausea and vomiting, which could be relieved after rest. Computed tomography angiography showed a left paraspinal soft tissue mass. Contrast-enhanced imaging showed obvious uneven enhancement with adjacent bone lytic destruction. Magnetic resonance imaging examination showed isosignal on T1-weighted images, slightly high signal on T2-weighted images (T2WI), high signal on Tirm fat suppression sequence, significantly high signal on diffusion weighted imaging, and obvious and uneven enhancement. The lesion invaded the anterior medulla oblongata through the left atlantoaxial foramen and compressed the cervical spinal cord on T2WI. Primary CCS of soft tissue was diagnosed by pathology and genetic examination.
CONCLUSIONS: CCS should be considered in the differential diagnosis of soft tissue tumors of the head and neck, and their diagnosis depends on pathological examination and genetic testing.

UNASSIGNED: Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is a rare subtype of follicular dendritic cell sarcoma (FDCS) that is mainly located in the liver and spleen (1). Splenic IPT-like FDCS is a rare low-grade malignancy with non-specific clinical manifestations and laboratory findings. Herein, we reported the pathological and imaging features of a case with splenic IPT-like FDCS.
UNASSIGNED: A 57-year-old woman was found to have a mass in the spleen during a physical examination and was hospitalized for further treatment. Her laboratory results were within the normal range. Unenhanced and contrast-enhanced computed tomography scans of the whole abdomen showed a round mass in the spleen, with a diameter of about 5 cm. After further examination with enhanced MRI, a provisional diagnosis of splenic hemangioma or splenic hamartoma was made. The patient underwent splenectomy, and the pathological diagnosis was splenic IPT-like FDCS. No tumor recurrence or metastasis was found during the 1-year follow-up after the operation.
UNASSIGNED: Herein, we reported a case of splenic IPT-like FDCS. Although the clinical examination and laboratory examination lack specificity, the imaging of this case showed that the lesion was a solid mass with progressive enhancement, and the central scar showed the characteristics of delayed enhancement, which facilitated the diagnosis.