Coexisting pituitary lesions may range from clinically non-functioning adenomas to hormonally active tumors such as prolactinomas and growth hormone (GH) or thyrotropin (TSH)-secreting adenomas. A 22-year-old male presented with a two-month history of generalized tonic-clonic seizures, accompanied by signs of intracranial hypertension, including intermittent frontal headaches resistant to analgesics and a sudden decrease in visual acuity. He also reported a 20 kg weight gain and an increase in shoe size from 40 to 44 over a seven-month period, without any decline in libido. Clinical examination revealed normal blood pressure and heart rate, and no dysmorphic features, particularly no acromegaloid characteristics. The patient had moderate obesity (BMI: 34 kg/m²), bilateral gynecomastia, mild violaceous striae, no galactorrhea, and was classified as Tanner stage G5P5. Hormonal evaluation showed hyperprolactinemia at 278 ng/mL, central hypothyroidism (TSH: 0.6 mIU/L; free T4: 8 pmol/L), and central hypogonadism (FSH: 1.37 IU/L; LH: 1.1 IU/L; total testosterone: 1.80 ng/mL). IGF-1 was within the normal range (275.8 ng/mL; reference: 120–338). Morning cortisol was 15 µg/dL, with an appropriate suppression after a 1 mg overnight dexamethasone test (0.7 µg/dL). A 24-hour urinary free cortisol measurement was also normal (75 µg/24h). HbA1c was 5.5%. Ophthalmologic examination revealed a normal fundus, but visual field testing showed nasal isopter narrowing. Pituitary MRI demonstrated a well-defined intra- and suprasellar lesion measuring 19 × 16 × 19 mm, consistent with a pituitary macroadenoma. Additionally, an infiltrative cortical and subcortical lesion in the fronto-cingulate region (36 × 24 × 47 mm) suggested a low-grade glioma. The patient was started on cabergoline 0.5 mg twice weekly and levothyroxine 25 µg daily. Neurosurgical intervention for the glioma was performed with gross total resection. Histopathological analysis confirmed a low-grade glial proliferation. Postoperative clinical and biochemical follow-up showed favorable outcomes. This case highlights the need for comprehensive neuroimaging in patients diagnosed with pituitary adenomas who present with atypical neurological symptoms, such as seizures.

Background: Cholangiocarcinoma is a malignant tumor of the biliary epithelium with poor prognosis due to late presentation. Histopathology is the gold standard for diagnosis but is invasive and limited in assessing tumor extent. Triphasic multidetector computed tomography (MDCT) offers a non-invasive alternative for evaluation. Objective: To assess the diagnostic role of triphasic MDCT in characterizing cholangiocarcinoma and to correlate imaging findings with histopathology. Methods: This cross-sectional study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, from September 2022 to August 2024. A total of 33 patients with suspected cholangiocarcinoma underwent triphasic MDCT. Imaging findings regarding lesion characteristics, location, growth pattern, vascular invasion, lymph node involvement, and enhancement patterns were analyzed. Histopathology was used as the reference standard. Diagnostic performance was calculated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results: The mean age was 65.6 ± 7.51 years, with 66.7% males. Most tumors were perihilar (63.64%) and periductal infiltrating (60.6%). Ill-defined margins (69.7%) and delayed enhancement (81.82%) were common findings. Vascular invasion and lymph node involvement were seen in 27.3% and 39.39% of cases, respectively. MDCT showed a sensitivity of 89.66%, specificity of 75%, accuracy of 87.88%, PPV of 96.3%, and NPV of 50%, with a significant correlation with histopathology (p = 0.01). Conclusion: Triphasic MDCT is a reliable, non-invasive modality with high diagnostic accuracy for cholangiocarcinoma and is valuable for tumor characterization and staging.

Isolated dissection of the celiac trunk is a rare vascular condition that is often discovered incidentally on contrast-enhanced computed tomography (CT). We report the case of a 72-year-old male who presented to the emergency department with acute biliary pancreatitis. Contrast-enhanced abdominal CT revealed biliary obstruction and an incidental aneurysmal dilatation of the celiac trunk associated with two distinct dissection planes extending toward the splenic artery without vascular occlusion or organ ischemia. As the vascular lesion was asymptomatic, conservative management with clinical and imaging follow-up was recommended. This case highlights the importance of systematic evaluation of vascular structures during emergency CT examinations, even when imaging is performed for non-vascular indications.

Smartphone applications have significant benefits in various specialties. The medical field is no exception to this trend, but more research is needed on the use of smartphone medical imaging apps among Saudi Arabian students. This study aimed to evaluate the awareness of mobile radiology applications (Apps), and the effectiveness of mobile applications. The findings of the study are important to enhance the integration of mobile technological resources in the teaching-learning process of radiology which is still an unexplored issue. A descriptive, cross-sectional survey was conducted during January and February 2025. four hundred ninety participants, including undergraduate medical imaging students from governmental and private institutions across Saudi Arabia, participated in the study. Most of the undergraduate students agreed (40.7%) and strongly agreed (28.6%) that the mobile medical imaging Apps were easy, quick, well organized, and gained the confidence of the users. 50.5% of the participants used mobile apps during their daily clinical practice, and 42.9% agreed that mobile apps improved their practical skills. 33% of the participants reported that mobile medical imaging Apps were more effective than logbooks or pocketbooks, while 40.7% showed supplement logbooks or pocketbooks were more effective. The study found that participants who installed medical imaging apps had better knowledge and skills, particularly in practical skills (p-value = .017), radiographic positioning (p-value = .030), x-ray collimation (p-value < .001), radiographic anatomy (p-value < .001), and evaluating x-ray image criteria (p-value < .001), compared to those who did not install the apps. The findings of this study indicate that mobile medical imaging apps can enhance the practical skills and knowledge of radiology students. The positive outcomes observed suggest that these applications should be integrated into radiology curricula to provide students with accessible, efficient learning tools. Future research should investigate the long-term effects of mobile apps on clinical practice, as well as explore how their integration can be optimized across different educational settings.

Hepato-Adrenal Syndrome is an underdiagnosed condition that is still incompletely understood but appear multifactorial. His prevalence can reach 72% in series of hospitalized patients for cirrhosis. change in protein homeostasis imposed by hypoalbuminemia induced by cirrhosis and the decrease in all globulin binding outside of SHBG tends to cause diagnostic doubts. We report the case of a patient with a viral cirrhosis at the stage of decompensation in whom we diagnosed a hepato-adrenal syndrome suggested by evocative clinical symptoms and associated to a refractory hyponatremia. The spectacular evolution under hydrocortisone led us to reiterate our diagnosis even before performing the adrenal stimulation test. We propose a review of literature that highlights the epidemiological, pathophysiological and diagnostic aspects of this pathological entity.

Adipsic diabetes insipidus (ADI) is a rare form of central diabetes insipidus characterized by hypotonic polyuria associated with absent or impaired thirst, causing a devastating disorder of water balance with significant associated morbidity and mortality. Adipsic diabetes insipidus results from injury to osmosensitive neuroreceptors, mainly located in the paraventricular and supraoptic nuclei, which leads to reduced synthesis and secretion of arginine vasopressin. Key neural circuits governing thirst perception and drive are anatomically colocalized with arginine vasopressin-producing centers and are therefore affected by the same injury, leading to impaired thirst and severe water balance dysregulation. In most patients, the disease arises from destruction of the hypothalamus due to a variety of underlying causes. Adipsic diabetes insipidus has most frequently been linked to surgical clipping of anterior communicating artery aneurysms after subarachnoid hemorrhage, as well as to craniopharyngioma and certain congenital disorders. Meanwhile, suprasellar arachnoid cysts are an uncommon cause. In this case, the suprasellar arachnoid cyst was responsible for hypothalamic-pituitary compression. Diagnosis relies on clinical suspicion, biochemical findings, and imaging. Adipsic diabetes insipidus is a rare but serious condition requiring early recognition. Although often asymptomatic, suprasellar arachnoid cysts can lead to this complication. Management is based on combining hormonal therapy such as arginine vasopressin replacement, careful fluid management, and etiological treatment. Furthermore, keeping serum sodium levels within the normal range is often difficult in these patients, and marked fluctuations in sodium levels frequently lead to recurrent hospitalizations. Thus, a multidisciplinary approach is essential to prevent severe complications and improve outcomes.(Kothari et al., 2021a) (Blevins & Wand, 1992)