Teaching point: The scalpel sign is pathognomonic for a dorsal arachnoid web, a rare clinical-radiologic entity that can cause myelopathy.

A retro-odontoid pseudotumor is an uncommon non-neoplastic mass. They are mostly associated with rheumatoid arthritis and atlanto-axial subluxation. The pathogenesis is degeneration of the transverse ligament due to chronic mechanical stress. In this case report, an atlanto-occipital assimilation altered the biomechanics of the cervical spine, causing chronic mechanical stress on the transverse ligament and subsequently the development of a retro-odontoid pseudotumor. This is in accordance with previous studies that have attributed the development of retro-odontoid pseudotumor to a loss of mobility of the cervical spine, in cases without associated rheumatoid arthritis or atlanto-axial subluxation.

Background and Aim: Patients with thoracic aortic aneurysm had higher incidence of renal cyst (30 to 60%); on the contrary the incidence of aortic aneurysm in patients with renal cyst is not well understood. Aim of our study is to explore whether presence and characteristic of renal cyst influence the incidence of ascending aorta aneurysm. Methods: Among 4487 patient who had a chest and abdomen CT scan between 2006 and 2016, 604 were diagnosed with one or more renal cysts. Primary outcome was ascending aorta dilatation (AAD) was defined as maximal diameter ≥ 45 mm. Multivariate linear regression was used to identify the parameters influencing ascending aorta diameter. Results: Mean age was 74.1 years and 65.4% were male. Mean number of renal cyst was 5.9 and the mean maximal-cyst diameter was 30.5 mm. Prevalence of AAD was 6.1%. Mean ascending, arch and descending aorta diameters were 35.7 ± 4.9 mm, 30.4 ± 3.9 mm and 27.7 ± 3.8 mm respectively. Regression analysis identified abdominal aorta atherosclerosis or previous treatment, major diameter of the renal cyst, male, familiarity and age as predictors of ascending aorta diameter. Conclusions: Patients with renal cyst have a higher incidence of ascending aneurysm and their maximal diameter influence its diameter. This information could be the base to set a prospective screening program to early detect patients with ascending aorta aneurysm.

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