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We present a case of a man who experienced recurrent ischaemic stroke secondary to an elongated styloid process compressing the cervical carotid artery.

A 36-year-old woman presented with a subacute, relapsing myelitis, manifesting as bilateral ascending lower limb paraesthesia, partially responsive to steroids. Imaging demonstrated a longitudinal spinal cord lesion, with a unique and characteristic sign (the ‘trident sign’) on axial views, which is specific to a diagnosis of neurosarcoidosis. This case highlights the importance of using this feature to distinguish a longitudinal cord lesion of sarcoidosis from other differentials.

Verruciform xanthomas occur primarily in the mouth, but sometimes in the anogenital region, which may cause clinical confusion with genital warts. We present a case where a 70-year-old man presented with an asymptomatic warty lesion on the scrotum and verruciform xanthoma was confirmed by histopathological results.

Sarcoidosis is a multisystem granulomatous disease that preferentially affects the lungs and intrathoracic lymph nodes. Oral involvement is quite rare and usually appears in patients with known systemic sarcoidosis but it may also be the initial finding of a systemic disease. Herein, we report a case of asyptomatic pulmonary sarcoidosis with cutaneous and oral involvement. Recognising oral sarcoidosis may be difficult but it is important not to miss an asymptomatic pulmonary sarcoidosis. Patients with oral lesions of sarcoidosis should be screened for systemic disease.

We present a case of black pleural fluid following thoracic trauma. The unusual dark colour most strikingly resembled soy sauce as independently commented upon by multiple treating physicians. The black colouration could not be fully accounted for by haemothorax or cholethorax, so other differential diagnoses were investigated, including Aspergillus niger infection and malignant melanoma. The cause, however, was thought to be due to staining of the fluid with carbon deposited in the pleural space from the non-volatilised impurities from smoking crack cocaine. A novel use of a point-of-care urine toxicology assay confirmed the presence of cocaine in the pleural fluid. Considering a broad range of differential diagnoses is needed to avoid missing important causes of unusual pleural effusions.

KEYWORDS: pulmonary artery pseudoaneurysm, chest imaging, pulmonary metastases, interventional radiology, uterine leiomyosarcoma Case presentation A 46-year-old woman presented to the emergency department with a 2-day history of progressively worsening chest pain and shortness of breath. Following an initial chest X-ray, a contrast-enhanced CT pulmonary angiography (CTPA) was performed to rule out recurrent pulmonary embolism. Discussion Pulmonary artery pseudoaneurysm is a rare life-threatening entity that arises due to disruption of the pulmonary artery wall leading to contained rupture.1,2 The most common cause of PAP is infection, but cases of PAP secondary to neoplastic aetiology where the tumour is thought to directly invade the vessel wall have also been rarely reported.

Laboratory tests indicated physical infections with white blood cell counts at 2.88x109/L and neutrophils counts at 1.58x109/L, but multiple blood cultures did not reveal bacterial, fungi or mycobacterial growth. In order to find the cause of the disease, we performed a percutaneous liver needle biopsy and the histopathology revealed considerable neutrophil infiltration, which were consistent with inflammation in the liver tissue (Fig 2). Discussion A salmonicida is a member of vibrio family and is a rare multi-host pathogen which can infect immunocompromised individuals, mainly resulting in gastroenteritis and sepsis.1 Human liver infection of A salmonicida has rarely been reported, so its characteristic image performance is not clear.2 MGS is a type of DNA sequencing technology which mainly targets a person's genome for exceptional genetic disorders and detects rare pathogen infection when traditional tests are negative or quicker result judgement could increase patients' survival rate.3,4 However, the high sensitivity of MGS sometimes results in false-positive results, which requires the clinician to accurately judge the detection report according to the clinical diagnosis pathway for specific disease.5 It is reasonable that an AIDS patient with fever of unknown origin and liver low-signal lesions are conventionally suspected as having liver infection even if no pathogen diagnosis evidence.