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Type 1 Autoimmune Pancreatitis: When a “Sausage-Shaped Pancreas” Mimics Pancreatic Cancer

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A 60-Year-Old Man With Persistent Postprandial Upper Abdominal Pain A 60-year-old man presented with approximately one month of persistent upper abdominal pain, particularly after meals. At first glance, postprandial abdominal pain may suggest common gastrointestinal disorders such as gastritis, gallstone disease, or functional dyspepsia. However, the clinical picture becomes considerably more important when persistent abdominal pain is accompanied by abnormal hepatobiliary enzymes and pancreatic enlargement on contrast-enhanced CT. In this case, the pancreas was diffusely enlarged and had a characteristic rounded, thickened “sausage-like” appearance . A low-attenuation capsule-like rim surrounded the pancreas. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated distal bile duct narrowing, while serum IgG4 was elevated. Histologic examination demonstrated lymphoplasmacytic infiltration, fibrosis, and chronic inflammation without evidence of malignancy. Following glucoco...
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Quadricuspid Pulmonary Valve on CT: A Rare Incidental Finding in a 43-Year-Old Woman With Sudden Epigastric Pain

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A radiologist’s approach to quadricuspid pulmonary valve: CT diagnosis, four-cusp morphology, differential diagnosis, pulmonary regurgitation, pulmonary artery aneurysm, multimodality imaging, management, and prognosis. By Hwunjae Lee, MD, PhD Introduction A 43-year-old woman presented with sudden epigastric pain radiating to the back . That clinical description immediately raises an important diagnostic concern. Sudden severe upper abdominal or epigastric pain extending toward the back can represent acute aortic syndrome (AAS) , including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or aortic rupture. In an emergency setting, these potentially fatal conditions must be excluded rapidly. CT angiography was therefore performed. The aorta was unremarkable for an acute aortic catastrophe. There was no convincing aortic dissection, penetrating atherosclerotic ulcer, intramural hematoma, rupture, or pericardial effusion. However, the examination contained an une...
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Primary Breast Lymphoma in a Young Woman with a Painless Breast Mass

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Multimodality Imaging with Ultrasound, MRI, and FDG PET/CT Clinical Overview A painless breast mass in a young woman is often considered likely to represent a benign lesion such as fibroadenoma. However, when a mass demonstrates rapid growth, marked vascularity, atypical enhancement, or increased FDG uptake , a broader differential diagnosis should be considered. Primary breast lymphoma (PBL) is a rare extranodal non-Hodgkin lymphoma involving the breast. Although uncommon, it can mimic both benign breast tumors and primary breast carcinoma on imaging. This case is particularly noteworthy because of the combination of: Young age Immunosuppressive therapy Painless breast mass Hypervascular hypoechoic mass on ultrasound Tubular enhancement and washout kinetics on MRI Increased FDG uptake on PET/CT Final diagnosis of primary breast lymphoma, marginal zone lymphoma The case emphasizes the importance of integrating clinical history with multimodality breast imaging rather than relying on a...
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Moyamoya Syndrome Presenting as Migraine-Like Headache: MRI, MRA, DSA Imaging Clues and the Clinical Significance of Cerebrovascular Reserve

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  Subtitle A radiologist’s approach to a 47-year-old man with recurrent headache, photophobia, phonophobia, and nausea, with emphasis on abnormal collateral vessels, severe proximal M1 stenosis, multimodal neurovascular imaging, differential diagnosis, revascularization, and the emerging role of AI. Executive Clinical Summary A 47-year-old man presented with recurrent headaches accompanied by photophobia, phonophobia, and nausea. Each episode lasted approximately 2–3 hours and occurred about four times per month. Neurologic examination did not reveal a definite abnormality. Clinically, the presentation could easily be interpreted as migraine. The imaging findings, however, changed the diagnostic perspective. Brain MRI demonstrated multiple abnormal vascular flow-void structures along the left Sylvian fissure. TOF-MRA demonstrated severe stenosis of the proximal left M1 segment with reduced visualization of the distal MCA branches. The combination of major intracranial arteri...
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