Clin Imaging

Acute mesenteric ischemia. CT and plain radiographic analysis of 26 cases.

Yamada K. Saeki M. Yamaguchi T. Taira M. Ohyama Y. Ashida H. Sakuyama K. Ishikawa T.
Department of Radiology, St. Marianna University School of Medicine, Kanagawa, Japan.
The purpose of this study was to assess the computed tomography (CT) and plain radiographic findings of acute mesenteric ischemia, in an effort to elucidate its poor prognostic signs. The study group consisted of 26 cases with pathologically or angiographically proven mesenteric ischemia. The pathologically proven longitudinal extent of the bowel ischemia was graded using six degrees, and correlated with the radiographic findings. The mortality of the patients depended primarily on the extent of infarctions and the age of the patient. Patients with bowel dilation or abnormal gas in the bowel wall or portal system were prone to have wider extents of ischemia.

Ileus secondary to pancreatic pseudocyst.

Buyukberber S. Mahmutyazicioglu K. Ertas E. Sencan O. Sahin M. Orakci V.
Department of Internal Medicine, Inonu University, School of Medicine, Malatya/Turkey.
Intra-or extrapancreatic pseudocyst is a common local complication in pancreatitis. Pathological involvement of the colon secondary to acute and chronic pancreatitis is a rare complication of major clinical interest. Contiguity with the tail of the pancreas and certain anatomical relationships, particularly at the level of the peritoneal reflections, explain the involvement of, particularly, the left flexure of the colon and the adjacent part of the transverse colon. We report a patient, presenting with ileus resulting from pressure of a giant pseudocyst secondary to acute pancreatitis, to share the diagnostic and chronologic follow-up computed tomography (CT) scanning findings of this rare complication.

Contracted gallbladder in hepatitis. Value of postprandial examination.

Loberant N. Jerushalmi J. Herskovits M. Mor A.
Department of Radiology, Western Galilee Hospital, Nahariya, Israel.
A completely contracted gallbladder is occasionally seen in patients with acute hepatitis. We have observed that postprandial examination in these patients shows the gallbladder filling with bile to a degree that permits an adequate diagnostic examination. This simple procedure may prevent having to recall the patient for follow-up examination.

Dilatation of the inferior vena cava in patients with cirrhotic portal hypertension. Causes and imaging findings.

Wachsberg RH. Levine CD. Maldjian PD. Simmons MZ.
Department of Radiology, University Hospital, Newark, NJ 07103, USA.
Dilatation of the inferior vena cava is a frequent finding in patients with cirrhosis and portal hypertension, and may be produced by various mechanisms. In this article we illustrate the spectrum of causes and appearances of inferior vena caval dilatation in patients with cirrhosis and portal hypertension.

Pancreaticopleural fistula. An unusual cause of persistent unilateral pleural effusion.

Year 1998
Miller JA. Maldjian P. Seeff J.
Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark 07103, USA.
There are a myriad of causes of a large persistent pleural effusion. Pancreaticopleural fistula is a rare entity seldomly included in the above differential. As it usually presents with thoracic rather than abdominal symptoms, a combination of imaging modalities, including chest radiography (CXR), computerized tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) is essential in obtaining the diagnosis.

Arterio-esophageal communication from a ruptured aberrant right subclavian artery aneurysm. CT diagnosis.

Year 1998
Singha NK. Hale SJ. Kuhlman JE.
Department of Radiology, University of Wisconsin Medical School, Madison, USA.
We report the computed tomography (CT) findings of an arterio-esophageal communication from an aberrant right subclavian artery aneurysm which had eroded into the esophagus. Pathologic correlation is provided. To our knowledge, this is the first CT demonstration of an aberrant right subclavian aneurysm causing a communication to the esophagus reported in the literature. Previously, one CT case of a left aberrant subclavian artery aneurysm that had ruptured into the esophagus, had been described. The characteristic location of the aberrant vessel with aneurysmal dilation and the presence of abnormal air identified within the wall of the aneurysm on CT, helped establish the diagnosis antemortem.

Castleman disease mimicking a hepatic neoplasm.

Year 1998
Cirillo RL Jr. Vitellas KM. Deyoung BR. Bennett WF.
Department of Diagnostic Radiology, Ohio State University, University Medical Center, Columbus, USA.
Castleman disease, or angiofollicullar hyperplasia, is a rare cause of lymph node enlargement. This most commonly occurs within the thorax, although rare extrathoracic presentations have been described. Only two cases with hepatic localization have been reported. We present a case of Castleman disease within the porta hepatis masquerading as a hepatic neoplasm.

MRI findings in adenosquamous carcinoma of the gallbladder.

Year 1998
Wagreich JM. Shapiro RS. Glajchen N. Seijo L.
Department of Radiology, Mount Sinai Medical Center, City University of New York 10029-6574, USA.
In this report, we present the MRI findings of adenosquamous carcinoma of the gallbladder, a rare type of gallbladder malignancy. MRI examination not only helped established the diagnosis but also accurately depicted the extent of involvement of the adjacent liver. The ability to image in multiple planes was also useful in assessing the anatomic location of the tumor and in determining that the patient could be treated with surgical resection.

Differential diagnosis of hepatic tumors with delayed enhancement at gadolinium-enhanced MRI: a pictorial essay.

Year 1998
Awaya H. Ito K. Honjo K. Fujita T. Matsumoto T. Matsunaga N.
Department of Radiology, Yamaguchi University School of Medicine, Japan.
Hepatic lesions with delayed enhancement are sometimes encountered on gadolinium-enhanced MRI of the liver. This study illustrates the varied appearances of several pathologic entities with delayed enhancement, including hepatic hemangioma, hepatic metastases, intrahepatic cholangiocarcinoma, focal nodular hyperplasia, hepatic abscess, hepatocellular carcinoma, and hepatocellular carcinoma after transcatheter arterial chemoembolization, and presents the utility of arterial-phase dynamic MRI in the differential diagnosis of these lesions. Possible causes of these delayed enhancements are also discussed.

Direct duodenal invasion of hepatocellular carcinoma. Intestinal hemorrhage treated by transcatheter arterial embolization.

Year 1998
Yamada K. Tohyama H. Shizawa Y. Kohno M. Fukunishi Y. Tomoe M.
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan.
This report describes a case of direct duodenal invasion of hepatocellular carcinoma with massive intermittent gastrointestinal (GI) bleeding. Progressive anemia was intractable by supportive therapy alone, and repeated blood transfusion was necessary. Transcatheter arterial embolization was finally carried out, which dramatically reduced the amount of transfusion. Owing to severe blood loss, patients with GI tract involvement generally have a poor prognosis.

Differentiation between hepatic cavernous hemangioma and malignant tumor with T2-weighted MRI: comparison of fast spin-echo and breathhold fast spin-echo pulse sequences.

Year 1998
Soyer P. Dufresne AC. Somveille E. Lenormand S. Scherrer A. Rymer R.
Department of Radiology of Hopital Foch, Suresnes, France.
PURPOSE: The goal of our study was to compare a T2-weighted breathhold fast spin-echo (BHFSE) technique with T2-weighted nonbreathhold fast spin-echo (FSE) technique for characterizing cavernous hemangioma of the liver and differentiating this entity from malignant tumor. MATERIALS AND METHODS: Eighteen patients with cavernous hemangiomas and 18 patients with malignant hepatic tumors were studied with T2-weighted MRI with a nonbreathhold FSE technique with and without fat suppression and with a BHFSE technique without fat suppression. Hepatic lesions were analyzed quantitatively using signal intensity (SI) and contrast-to-noise (C/N) ratio. In addition, images were qualitatively compared for accuracy in characterizing hepatic lesion. RESULTS: Quantitatively, hemangioma had significantly higher SI and C/N ratios than did the malignant tumor on every pulse sequence (P < 0.01). Qualitatively, all malignant tumors were correctly categorized; differentiation between cavernous hemangioma and malignant tumor was impossible in three cases of cavernous hemangioma with the three pulse sequences (92% accuracy, 100% sensitivity, and 83% specificity). CONCLUSION: T2-weighted FSE and BHFSE MRI shows comparable levels of accuracy for differentiating between hepatic cavernous hemangioma and malignant tumor. Because overlap may exist using quantitative measurement, morphologic patterns must be carefully analyzed, supporting that quantitative analysis and morphologic evaluation are complementary.

Hepatic adenoma and focal nodular hyperplasia: MR findings with superparamagnetic iron oxide-enhanced MRI.

Year 1998
Beets-Tan RG. Van Engelshoven JM. Greve JW.
Department of Radiology, University Hospital Maastricht, The Netherlands.
Two cases are presented in which the MRI findings following superparamagnetic iron oxide (SPIO) enhancement of hepatic adenoma and focal nodular hyperplasia (FNH) are described. Benign liver lesions show uptake of iron oxide particles, which allows differentiation from malignant liver lesions and tumors of other cell origin. There have been several publications in the literature, but the SPIO-enhanced MR findings of hemorrhage in a hepatic adenoma have not been previously described. To illustrate the role of SPIO-enhanced MRI in the differential diagnosis of adenoma from FNH, the SPIO-enhanced MR features of FNH are presented.