Intracranial hemangiopericytomas (HPCs) are rare tumors that closely mimic meningiomas. However, in contrast to meningiomas, HPCs have a relatively high incidence of local recurrence and distant metastases, manifesting the need for sensitive noninvasive methods of detection that efficiently image the entire body. We present a rare case of a right optic nerve sheath HPC in which we identified a previously unknown distant metastasis in the thoracic spine on an 111In-pentetreotide scan. We detail the radiologic characteristics seen with somatostatin receptor imaging, FDG PET, and MRI and discuss how to exploit these findings to detect recurrence and metastatic disease in HPC.

Mental nerve neuropathy (numb chin/lip syndrome) is a sensory neuropathy presenting with numbness in the distribution of the inferior alveolar nerve/mental nerve (chin and lower lip). This is typically unilateral and can be secondary to dental disease or malignancy. When caused by malignancy, these symptoms can be either an initial presentation of an unsuspected tumor or progressive metastatic disease, both of which would indicate poor prognosis. We describe a 48-year-old female patient with a history of breast cancer who presented with left chin numbness and manifested a metastatic lesion involving the left mandibular foramen on PET/CT and subsequent MRI.

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tests showed a random sugar level of 2.3 g/L and creatinine of 14 mg/L. Abdominal ultrasonography showed a malrotated pelvic left kidney and gross hydronephrosis with internal debris. A diagnosis of pyonephrosis of the malrotated left kidney was made, based on the presentation and the ultrasonography findings. The patient was referred for PCN drainage. CT showed a horizontally lying kidney in the midline at the level of the L4/5 vertebral body, with the renal pelvis directed antero-superiorly and to the right. There was a grossly distended pelvicalyceal system and thinning of renal parenchyma suggestive of PUJ obstruction (Fig. 1). There was no evidence of calculi. However, there was no suitable access to reach the left kidney because of the descending colon anteriorly and the left iliac bone posteriorly. It was planned to displace the descending colon anteriorly by a retrocolonic saline instillation and to obtain an access for PCN.The procedure was done under local anaesthesia and sedation, with the patient in the right lateral position. Axial CT sections were obtained and a suitable level (shortest distance, transrenal parenchymal, retroperitoneal approach) selected (Fig. 2). With strict aseptic precautions, a 7-cm, 21 G needle was placed horizontally from the left side behind the distal descending colon and in front of the left iliac bone (Fig. 3). Then ª 120 mL of normal saline was instilled in the retroperitoneal space after confirming the needle position by CT fluoroscopy. Check CT showed anterior displacement of the descending colon by > 2 cm (Fig. 4a,b). A 15-cm, 21 G needle was passed along this track into the renal pelvis through the upper pole calyceal region, and pus was aspirated. A 0.9 mm guidewire was initially passed and subsequently changed for a 0.9 mm Amplatz wire using an Accustick dilator system. A 10 F pigtail drainage catheter was placed and connected to a urine bag for dependent drainage (Fig. 5).Sample culture showed Gram-negative bacilli and the patient was kept on antibiotics with supportive therapy. She showed a significant clinical improvement within a few days and underwent elective left nephrectomy 2 months later. COMPARISON WITH OTHER METHODSPUJ obstruction with pyonephrosis can be managed by PCN or surgery. PCN is the preferred initial option as it constitutes a life- INDICATIONSPercutaneous nephrostomy (PCN), a well established and safe method for rapid decompression of an infected and obstructed pelvicalyceal system, may be a life-saving procedure in patients with acute pyelonephritis and with features of septicaemia. In one series, PCN decreased mortality from Gram-negative septicaemia from 40% to 8% in patients with urinary obstruction complicated by infection [1]. Difficulties arise when there is variation in the anatomy, e.g. ectopic kidney, horseshoe kidney and crossed-fused kidneys. Here we describe a case of pelvic kidney with pyonephrosis that was successfully and safely drained by creating an access using a retrocolonic saline injection. METHODA 44-year-old diabetic wo...

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