A 40-year-old Asian female with heavily treated relapsed Hodgkin's lymphoma showed complete remission (CR) after receiving 8 cycles of brentuximab vedotin (BV) in combination with gemcitabine as 4th line treatment. The patient remained in CR at the 18-month post-treatment follow-up. She developed severe hypotension (50/36 mm Hg) with upper and lower limb petechiae and edema after the addition of gemcitabine on the 6th cycle of BV. This adverse event resolved after 3 days of treatment with vasopressor and high-dose corticosteroid. The addition of dexamethasone for the subsequent 2 cycles successfully prevented this adverse event from recurring.
Gastrointestinal lymphoma accounts for up to 20% of all extranodal lymphoma cases. Among them, the ileum is the second most commonly affected site after the stomach. The majority of gastrointestinal lymphoma originates from the B cell lineage. We report the case of 60-year-old male with persistent anemia, hematochezia, and poor performance status (PS). After thorough workup, imaging, and pathological study, the patient was diagnosed with diffuse large B-cell lymphoma of the terminal ileum. He was treated with R-CHOP based chemotherapy with dose tailoring to accommodate his poor PS. His symptoms promptly subsided after the first chemotherapy cycle. After eight cycles of chemotherapy, terminal ileum wall thickening was gone and the patient was disease-free for 6 months. This case report shows that chemotherapy can be beneficial in patients with gastrointestinal lymphoma despite poor PS. Therefore, it should be given when possible with proper dose tailoring.
Adrenal Incidentaloma lesions are commonly detected by Computed Tomography and Magnetic Resonance Imaging. Lesion characterization is essential to predict the prognosis of the primary disease, to assess staging, and direct therapy. Imaging plays a critical role in the characterization of adrenal incidentaloma lesions. Imaging modalities have been developed forr accurately differentiating lesions by using anatomic and physiologic imaging principles and major adrenal imaging techniques currently available which include newly developed promising techniques. An imaging algorithm is provided to guide radiologists in recognizing, reporting, and managing adrenal lesions, so it leads to the appropriate test to make correct diagnosis. The purpose of this article is to discuss the principles, techniques and imaging algorithms in characterizing adrenal lesions.
Urolithiasis is a common disease with a reported prevalence between 4% and 20% in the worldwide. Determination of urinary calculi composition is a key factor in preoperative evaluation, treatment, and recurrence prevention. Dual-energy computed tomography (DECT) is available methods for determining urinary stone composition were only available after stone extraction, and thereby unable to aid in optimized stone management prior to intervention. DECT utilizes the attenuation difference produced by two different x-ray energy spectra to quantify urinary calculi composition while still providing the information attained with a conventional CT. Knowledge of DECT imaging pitfalls and stone mimics is important, as the added benefit of dual-energy analysis is the determination of stone composition, which in turn affects all aspects of stone management.
This article describes DECT principles, scanner types and acquisition protocols for the evaluation of urinary calculi as they relate to imaging pitfalls (inconsistent characterization of small stones, small DECT field of view, and mischaracterization from surrounding material) and stone mimics (drainage devices) that may adversely impact clinical decisions.
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