Acute aortic dissection usually presents with abrupt chest or back pain, but neurological symptoms may dominate the presentation and mimic acute ischemic stroke. We report a case of a 50-year-old woman who presented with recurrent transient left-sided weakness. The initial episode persisted during early hospital assessment and resolved as brain magnetic resonance imaging was initiated. A second episode occurred during subsequent aortic computed tomography angiography and lasted approximately 20 minutes. Brain computed tomography and diffusion-weighted magnetic resonance imaging showed no acute abnormality, while magnetic resonance angiography of the head and neck showed no large-vessel occlusion or cervical arterial involvement. A marked inter-arm blood pressure difference prompted computed tomography angiography of the chest, abdomen, and pelvis, which demonstrated an acute Stanford type B aortic dissection extending from the proximal descending thoracic aorta to the infrarenal abdominal aorta. The dissection occurred in a Type I right-sided aortic arch with mirror-image branching, consisting of a left brachiocephalic trunk followed by the right common carotid and right subclavian arteries. The dissected descending thoracic aorta measured up to 6.7 × 5.4 cm. The patent false lumen supplied the right renal artery, with delayed right renal enhancement suggesting impaired perfusion despite preserved serum creatinine. These high-risk imaging findings supported early intervention after multidisciplinary evaluation. On hospital day 3, the patient underwent a single-session hybrid repair consisting of bilateral carotid-subclavian bypasses, proximal embolization of both subclavian arteries, and thoracic endovascular aortic repair using two overlapping stent grafts. Completion angiography showed exclusion of antegrade false-lumen flow through the treated proximal entry region and preserved right renal perfusion through distal false-lumen re-entry. Cerebrospinal fluid drainage and perioperative pressure augmentation were used for spinal cord protection. The patient was discharged without neurological deficit or major postoperative complication. Clinical evaluation and surveillance computed tomography angiography were planned at the one-month post-repair interval. Completion angiography documented immediate procedural success, while durable technical success remained to be confirmed by surveillance computed tomography angiography because of the residual focal graft malapposition and continued false-lumen-dependent right renal perfusion. This case highlights the importance of considering acute aortic disease in patients with recurrent focal neurological deficits, normal cerebral imaging, and marked inter-arm blood pressure asymmetry, even in the absence of typical thoracic pain. It also illustrates how Type I right-sided aortic arch anatomy and severe arch angulation can complicate proximal landing-zone planning and require an individualized hybrid repair strategy.

Metaiodobenzylguanidine (MIBG) scintigraphy is an established imaging modality for evaluating neuroendocrine tumors, particularly pheochromocytoma and neuroblastoma; however, false-positive uptake remains a significant diagnostic challenge. This systematic review aimed to summarize reported pitfalls in MIBG scintigraphy, focusing on false-positive findings. PubMed and Scopus were searched for studies published between 1980 and November 2024 that reported false-positive MIBG uptake, including case reports, case series, and observational studies. Study selection followed predefined criteria, with additional articles identified through reference screening. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool for diagnostic accuracy studies and the CAse REport (CARE) checklist for case reports and case series. Ninety-one studies were included, comprising 170 documented false-positive cases. False-positive uptake most frequently involved the abdomen and pelvis (57.6%), followed by soft tissues and the skeletal system (31.8%), chest (7.1%), and head and neck regions (3.5%). Reported etiologies included non-tumoral conditions, benign and malignant tumors, and physiological or variant uptake patterns. The adrenal glands were the most common site of false-positive uptake, substantially complicating the diagnosis of pheochromocytoma. Awareness of these pitfalls, combined with careful clinical correlation, hybrid imaging, and complementary diagnostic modalities, is essential to improve diagnostic accuracy and reduce misinterpretation.

Spontaneous dissection of the renal pelvis and ureter is a rare urinary system disease characterized by separation between the muscularis and mucosal layers or within the muscularis of the pyeloureteral wall, with urine extravasation into the false lumen causing renal colic and hydronephrosis. We report a 30-year-old woman with no prior kidney stone history who presented with paroxysmal colic, nausea, and a 1-month history of abdominal pain that had exacerbated over 1 day; urinalysis showed multiple abnormalities. Non-contrast computed tomography (CT) revealed pyeloureteral dilation without calculi. Further computed tomography urography (CTU) demonstrated a double-lumen sign in the right renal pelvis and upper ureter, with significantly lower CT values on the dissected side suggesting urinary obstruction. The patient underwent ureteral stenting with prompt symptom relief. This case highlights that CTU reliably diagnoses spontaneous dissection of the renal pelvis and ureter, and early interventional treatment resulted in symptom relief and short-term favorable outcome in this patient, providing a valuable clinical reference for managing this rare disease.

Artificial Intelligence (AI)-based opportunistic risk stratification solutions can help to counter rising fragility fracture rates. Existing tools estimate bone mineral density (BMD) alone, while the present study incorporates trabecular bone score (TBS), a surrogate of bone microarchitecture, more closely mirroring fracture pathophysiology. We aimed to evaluate the performance of an AI tool that estimates bone fragility directly from standard radiographs to identify individuals at highest risk of fracture.