RESUMO
Pancreatic ductal adenocarcinoma (PDA) is one of the most aggressive cancers. It has a poor 5-year survival rate of 12%, partly because most cases are diagnosed at advanced stages, precluding curative surgical resection. Early-stage PDA has significantly better prognoses due to increased potential for curative interventions, making early detection of PDA critically important to improved patient outcomes. We examine current and evolving early detection concepts, screening strategies, diagnostic yields among high-risk individuals, controversies, and limitations of standard-of-care imaging.
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Carcinoid tumors are the most common form of gut neuroendocrine tumors, however, they rarely present with small bowel obstruction. We present a case of a 65-year-old woman without prior abdominal operations who presented with symptoms of small bowel obstruction. Computed tomography (CT) showed multiple air fluid levels and a transition point in the left mesentery with two soft tissue densities at the same level. The patient was taken to the operating room for surgical exploration, which showed two intramural masses in the mid and distal jejunum, which surgical pathology showed to be stage IIIB carcinoid tumor.
Assuntos
Tumor Carcinoide/diagnóstico por imagem , Neoplasias Intestinais/diagnóstico por imagem , Obstrução Intestinal/etiologia , Neoplasias do Jejuno/diagnóstico por imagem , Idoso , Tumor Carcinoide/cirurgia , Feminino , Humanos , Neoplasias Intestinais/cirurgia , Obstrução Intestinal/cirurgia , Neoplasias do Jejuno/cirurgia , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios X/métodosRESUMO
The descending duodenum is a structure with distinct pathologic processes and anatomic relationships that requires a systematic approach to the differential diagnosis. Because of its tubular shape and fixed position in the retroperitoneum, both intrinsic duodenal and juxtaduodenal diseases are capable of producing luminal narrowing and obstruction. Duodenal lesions may be located in the mucosa or submucosa. Extraduodenal lesions may originate in adjacent structures--such as the pancreas, liver, gallbladder, colon, and lymph nodes--or from other retroperitoneal structures. Causes of duodenal obstruction include intraluminal masses, such as bezoars; duodenal inflammation, such as as peptic ulcers and Crohn disease; hematomas; and benign or malignant mucosal and intramural tumors. Pancreatic inflammation; tumors; and extrinsic compression caused by gallbladder processes, hepatic masses, retroperitoneal fluid collections, and tumors, including lymphoma, may produce duodenal obstruction. Abdominal radiography, barium studies, multidetector computed tomography, magnetic resonance imaging, and positron emission tomography may be used to depict and characterize duodenal strictures. Integration of imaging, clinical, laboratory, and endoscopic findings plays a major role in establishing a diagnosis of obstructive duodenal strictures.
Assuntos
Diagnóstico por Imagem , Duodenopatias/diagnóstico , Algoritmos , Obstrução Duodenal/diagnóstico , Humanos , Atresia IntestinalRESUMO
OBJECTIVE: Congenital urinary anomalies may be symptomatic or encountered during imaging for other clinical indications. The array of abnormalities is related to the embryologic stage at the time of the developmental insult, and these abnormalities result in a spectrum of conditions ranging from insignificant to incompatible with life. CONCLUSION: Understanding the implications of common congenital urinary anomalies is the key to detecting associated anomalies, initiating therapy, and avoiding both complications and unnecessary intervention.
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Diagnóstico por Imagem , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/terapia , Diagnóstico Diferencial , Humanos , Sistema Urogenital/embriologiaRESUMO
The delineation and characterization of splenic lesions and other abnormalities can be challenging on computed tomography. Many splenic lesions are incidentally found, imaging features tend to overlap, and without the appropriate clinical context, differentials can range from benign to malignant. Radiologists should be familiar with the wide variety of pathologies seen on computed tomography as it is often the first imaging modality a splenic lesion is seen. The purpose of this MDCT-focused review is to understand normal splenic anatomy and its variants, to illustrate and describe typical and atypical imaging patters of inflammatory, infectious, vascular, traumatic, benign, and malignant tumors of the spleen and provide clues in reaching the appropriate differential diagnosis and management.
Assuntos
Esplenopatias , Diagnóstico Diferencial , Humanos , Esplenopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Nonatherosclerotic etiologies of arterial insufficiency are uncommon but important causes of chronic lower extremity ischemia. We report a patient with multiple hereditary exostoses (MHE) presenting with lifestyle-limiting lower extremity claudication and popliteal artery occlusion secondary to a large osteochondroma. The presence of MHE with associated osteochondroma resulting in arterial occlusion is a rare condition. Management strategies for treating large osteochondromas adjacent to or with vessel involvement in asymptomatic patients remain undefined.
Assuntos
Arteriopatias Oclusivas/genética , Exostose Múltipla Hereditária/genética , Claudicação Intermitente/genética , Isquemia/genética , Extremidade Inferior/irrigação sanguínea , Artéria Poplítea , Tíbia/patologia , Angiografia Digital , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/cirurgia , Constrição Patológica , Exostose Múltipla Hereditária/complicações , Exostose Múltipla Hereditária/patologia , Feminino , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/cirurgia , Isquemia/diagnóstico , Isquemia/cirurgia , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Veia Safena/transplante , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Procedimentos Cirúrgicos VascularesRESUMO
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive gastrointestinal malignancy with a poor 5-year survival rate. Accurate staging of PDAC is an important initial step in the development of a stage-specific treatment plan. Different staging systems/consensus statements convened by different societies and academic practices are currently used. The most recent version of the American Joint Committee on Cancer (AJCC) tumor/node/metastases (TNM) staging system for PDAC has shifted its focus from guiding management to assessing prognosis. In order to preoperatively define the resectability of PDAC and to guide management, additional classification systems have been developed. The National Comprehensive Cancer Network (NCCN) guidelines, one of the most commonly used systems, provide recommendations on the management and the determination of resectability for PDAC. The NCCN divides PDAC into three categories of resectability based on tumor-vessel relationship: 'resectable,' 'borderline resectable,' and 'unresectable'. Among these, the borderline disease category is of special interest given its evolution over time and the resulting variations in the definition and the associated recommendations for management between different societies. It is important to be familiar with the evolving criteria, and treatment and follow-up recommendations for PDAC. In this article, the most current AJCC staging (8th edition), NCCN guidelines (version 2.2019-April 9, 2019), and challenges and controversies in borderline resectable PDAC are reviewed.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Carcinoma Ductal Pancreático/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Humanos , Estadiamento de Neoplasias , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the United States and is projected to be the second by 2030. Systemic combination chemotherapy is considered an essential first-line treatment for the majority of patients with PDA, in both the neoadjuvant and palliative settings. In addition, a number of novel therapies are being tested in clinical trials for patients with advanced PDA. In all cases, accurate and timely assessment of treatment response is critical to guide therapy, reduce drug toxicities and cost from a failing therapy, and aid adaptive clinical trials. Conventional morphological imaging has significant limitations, especially in the context of determining primary tumor response and resectability following neoadjuvant therapies. In this article, we provide an overview of current therapy options for PDA, highlight several morphological imaging findings that may be helpful to reduce over-staging following neoadjuvant therapy, and discuss a number of emerging imaging, and non-imaging, tools that have shown promise in providing a more precise quantification of disease burden and treatment response in PDA.
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Adenocarcinoma , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Radiologia , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/terapia , Humanos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/tratamento farmacológico , Radiografia AbdominalRESUMO
A broad spectrum of pathology affects the rectum, anus, and perineum and understanding of its relevant anatomy is important in accurate reporting, particularly in rectal cancer. In this pictorial essay, correlative imaging, endoscopic, pathologic, and operative images are presented to illustrate normal anorectal anatomy and neoplastic conditions that affect the anus and rectum. A particular case-based focus is given to rectal adenocarcinoma with pelvic MR and surgical histopathology. Additionally, carcinoid tumor, gastrointestinal stromal tumor, condylomata acuminata, squamous cell carcinoma, melanoma, and metastatic disease about the rectum and anus are reviewed.
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Neoplasias Retais/patologia , Colonoscopia , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Imagem Multimodal , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgiaRESUMO
A broad spectrum of pathology affects the rectum, anus, and perineum, and multiple imaging modalities are complementary to physical examination for assessment and treatment planning. In this pictorial essay, correlative imaging, endoscopic, pathologic, and operative images are presented for a range of rectal, perirectal, and perineal disease processes, including infectious/inflammatory, traumatic, congenital/developmental, vascular, and miscellaneous conditions. Key anatomic and surgical concepts are discussed, including radiological information pertinent for surgical planning, and current operative approaches of these anatomic spaces to assist radiologists in comprehensive reporting for gastroenterologists and surgeons.
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Colonoscopia , Procedimentos Cirúrgicos do Sistema Digestório , Imagem Multimodal , Doenças Retais/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Humanos , Doenças Retais/congênito , Doenças Retais/microbiologia , Doenças Retais/cirurgia , Reto/irrigação sanguínea , Reto/diagnóstico por imagem , Reto/lesões , Doenças Vasculares/congênito , Doenças Vasculares/cirurgiaRESUMO
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare malignant hepatic tumor that occurs primarily in children. Only a limited number of cases have been reported in the literature due to low incidence of one per million, and reports of metastatic lesion of UESL are even rarer. We hereby describe the case of a 13-year-old male who presented with a palpable mass with imaging findings suggestive of a large complex tumor in the right lobe of the liver. He underwent extended right hepatectomy followed by adjuvant chemotherapy. The tumor was confirmed to be UESL by postoperative pathology and immunohistochemical staining analysis. Four years later, surveillance imaging revealed a small lung nodule in the left lower lobe. Complete removal of the lung tumor by wedge resection was performed, and a histological diagnosis of metastatic UESL was made. The patient also received postoperative adjuvant chemotherapy and is currently in a good general condition and tumor-free in the present eight-month period. This case is presented with emphasis on clinicopathological and immunohistochemical findings of the primary UESL and lung metastases with the aim of collecting more data and expanding our understanding of this rare malignancy.
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Abscess-fistula complexes and enterocutaneous fistulae are due to postoperative, spontaneous, and inflammatory etiologies. Conservative, percutaneous, endoscopic, and surgical treatment options are available options. Interventional radiologists have an array of different treatment strategies, often starting with percutaneous drainage of associated intra-abdominal abscesses. This review article details different percutaneous management strategies, focusing on percutaneous catheter strategies for abscess-fistula complexes along with tract closures strategies for enterocutaneous fistulae.
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Positron emission tomography (PET) with 2-fluoro-deoxyglucose (FDG) has become an established imaging modality that can accurately and noninvasively differentiate malignant neoplasms from benign masses. It is increasingly being used to grade malignant neoplasms as well and has almost replaced other studies like gallium 67-citrate scans for metabolic imaging. We describe an interesting case of 3 synchronous liposarcomas with different radio-opacifications on computed tomography (CT). The more aggressive lesion with more opacity on CT showed intense FDG activity and was found to be a high-grade liposarcoma on pathology. The well-differentiated lesion with more fat content appearing less radio-opaque on CT showed almost no FDG activity and an intermediate grade lesion with intermediate radio-opacity on CT showed mildly increased FDG activity. Dual modality imaging with integrated PET/CT systems have strengthened the confidence of classifying these lesions even before knowing the pathology as depicted in this case.
Assuntos
Fluordesoxiglucose F18 , Lipossarcoma/diagnóstico por imagem , Segunda Neoplasia Primária/diagnóstico por imagem , Compostos Radiofarmacêuticos , Neoplasias Retroperitoneais/diagnóstico por imagem , Biomarcadores Tumorais , Transformação Celular Neoplásica , Meios de Contraste , Fluordesoxiglucose F18/farmacocinética , Humanos , Interpretação de Imagem Assistida por Computador , Lipossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/farmacocinética , Neoplasias Retroperitoneais/patologia , Tomografia Computadorizada por Raios XRESUMO
Most renal lesions replace the renal parenchyma as a focal space-occupying mass with borders distinguishing the mass from normal parenchyma. However, some renal lesions exhibit interstitial infiltration-a process that permeates the renal parenchyma by using the normal renal architecture for growth. These infiltrative lesions frequently show nonspecific patterns that lead to little or no contour deformity and have ill-defined borders on CT, making detection and diagnosis challenging. The purpose of this pictorial essay is to describe the CT imaging findings of various conditions that may manifest as infiltrative renal lesions.
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Nefropatias/diagnóstico por imagem , Nefropatias/patologia , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , HumanosRESUMO
BACKGROUND: Hepatic artery aneurysms (HAAs) constitute 14% to 20% of visceral artery aneurysms. Most HAAs are asymptomatic. Although rare, obstructive jaundice due to external bile duct compression or rupture of the HAA into the biliary tree with occlusion of the lumen from blood clots has been reported. CASE PRESENTATION: A 56-year-old white man presented to an outside hospital with symptoms of obstructive jaundice, including abdominal pain and yellowing of the skin. Imaging showed a large HAA. Patient was transferred to our hospital where an endoscopic retrograde cholangiopancreatography with biliary stenting was performed. This was followed by coil embolization of the HAA with improvement in symptoms and liver chemistries. CONCLUSIONS: Most clinicians agree that management of HAA is highly variable and depends on clinical presentation and anatomic location. Biliary stenting provides temporary relief for patients with obstructive jaundice. Definitive options include open aneurysmal repair versus endovascular therapy. Hepatic artery aneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.
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The retroperitoneum is a large space where primary and metastatic tumors grow silently before clinical signs appear. Neoplastic retroperitoneal diseases may be solid or cystic, primary or secondary and range from benign to aggressive in behavior. Retroperitoneal neoplasms are notable for their widely disparate histologies. The solid primary retroperitoneal neoplasms are extremely uncommon and can be classified based on their tissue of origin into three main categories: mesodermal tumors, neurogenic tumors, and extragonadal germ cell tumors. These tumors can grow to a large size before clinical symptoms occur or become palpable. When symptoms do occur, they are nonspecific. The majority of these masses are malignant and imaging plays a pivotal role in the detection, staging, and pre-operative planning. Benign and malignant masses should be distinguished whenever possible to avoid unnecessary surgical procedures. Macroscopic fat, calcification, necrosis, vascularity, and neural foraminal widening are common imaging features helping for tumor differentiation. Meticulous cross-sectional imaging can triage the patient to the most appropriate therapy. Tumor morphology dictates imaging character, and biologic activity is reflected by positron emission tomography (PET). Complete surgical excision with tumor free margins is essential for long-term survival. Biopsy should be performed in consultation with surgical oncology to avoid complicating curative surgery. This pictorial essay illustrates the spectrum of multidetector computed tomography (MDCT) imaging findings in common and uncommon primary retroperitoneal masses, with an emphasis on cross-sectional imaging features for an adequate tumor characterization and staging.
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Imagem Multimodal , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Biópsia , HumanosAssuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Úmero , Adulto , Idoso , Neoplasias Ósseas/cirurgia , Neoplasias da Mama/cirurgia , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Resultado do TratamentoAssuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Laríngeas/patologia , Recidiva Local de Neoplasia/patologia , Inoculação de Neoplasia , Terapia de Salvação , Adulto , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Intervalo Livre de Doença , Epiglote/patologia , Feminino , Humanos , Neoplasias Laríngeas/tratamento farmacológico , Neoplasias Laríngeas/radioterapia , Laringectomia/efeitos adversos , Metástase Linfática , Esvaziamento Cervical , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/radioterapia , Estadiamento de NeoplasiasRESUMO
Hepatic cirrhosis is the clinical and pathologic result of a multifactorial chronic liver injury. It is well known that cirrhosis is the origin of multiple extrahepatic abdominal complications and a markedly increased risk of hepatocellular carcinoma (HCC). This tumor is the sixth most common malignancy worldwide and the third most common cause of cancer related death. With the rising incidence of HCC worldwide, awareness of the evolution of cirrhotic nodules into malignancy is critical for an early detection and treatment. Adequate imaging protocol selection with dynamic multiphase Multidetector Computed Tomography (MDCT) and reformatted images is crucial to differentiate and categorize the hepatic nodular dysplasia. Knowledge of the typical and less common extrahepatic abdominal manifestations is essential for accurately assessing patients with known or suspected hepatic disease. The objective of this paper is to illustrate the imaging spectrum of intra- and extrahepatic abdominal manifestations of hepatic cirrhosis seen on MDCT.