Patient: Male, 26-year-old Final Diagnosis: Hypoperfusion/devascularization of the thyroid gland Symptoms: Base of neck gunshot wound Medication:— Clinical Procedure: — Specialty: Radiology Objective: Rare disease Background: The thyroid gland is rarely injured in cases of penetrating neck trauma. Computed tomography (CT) plays a central role in prompt evaluation of the extent of penetrating neck trauma and can demonstrate thyroid gland injury. The current literature on thyroid gland injury is limited mostly to blunt trauma, with little emphasis on findings seen on CT imaging. In the present case report, we focus on CT imaging findings of thyroid gland hypoperfusion/devascularization in a patient who had a gunshot wound injury through the base of his neck. Case Report: A 26-year-old man was transferred to our trauma center after experiencing multiple gunshot wounds, including one through the base of the neck. The bullet path through his neck was associated with enlargement/edema involving the right thyroid lobe, with an asymmetric decrease in enhancement involving the mid and superior aspects of the right thyroid lobe. Maximum-intensity-projection angiographic images of the vascular supply of the thyroid gland suggested an abrupt decrease in caliber close to the origin of the posterior glandular branch of the right superior thyroid artery. The findings favored vasospasm rather than an arterial injury, which led to hypoperfusion/devascularization of the upper pole of the right thyroid lobe. Conclusions: Thyroid gland hypoperfusion/devascularization after a penetrating neck injury is rare. Recognition of CT imaging findings that favor post-traumatic organ hypoperfusion/devascularization is crucial for prompt management and to decrease morbidity in such cases.

Patient: Male, 72-year-old Final Diagnosis: Air embolism • stroke Symptoms: Altered mental status Medication:— Clinical Procedure: Endoscopy • esophagogastroduodenoscopy • hyperbaric oxygen treatment • variceal banding Specialty: Neurology • Radiology Objective: Rare disease Background: Cerebral air embolism is a rare iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. The symptoms of cerebral air embolism are nonspecific and may be attributed to sedation-related complications and central nervous system insults. Having awareness of this rare iatrogenic event and deciding on immediate imaging when it is suspected are essential for prompt diagnosis and treatment. Case Report: A 72-year-old man with a past medical history of alcoholic liver cirrhosis with associated portal hypertension underwent an outpatient esophago-gastroduodenoscopy for surveillance of esophageal varices. During the procedure, the patient retched several times and developed a mucosal tear, which was repaired using endoscopic clips. After the procedure, the patient remained sedated for a prolonged time and was subsequently unresponsive. Nonenhanced CT of the head showed several foci of gas throughout the subarachnoid spaces. Follow-up nonenhanced brain magnetic resonance imaging demonstrated ischemic changes, which were more prominent along the right cerebral hemisphere. Conclusions: Cerebral air embolism is an iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. It must be included in the differential diagnosis of a patient presenting with altered mental status and neurological deficits after an endoscopic procedure. Diagnostic imaging can be useful in identifying key features of this iatrogenic event. Timely diagnosis and treatment can improve patient outcomes.