Hepatobiliary infection after transjugular intrahepatic portosystemic shunt creation in patients with prior biliary intervention: A multi-institution retrospective study.

PURPOSE: To estimate the risk of hepatobiliary infection, including endoTIPSitis, liver abscesses, and cholangitis, after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with prior biliary intervention. MATERIALS AND METHODS: This multi-institution, retrospective study identified 76 patients (n=48 males; mean age 54.9; mean model for end stage liver disease score=13.2; n=45 for ascites and n=23 for varices; n=31 with prior liver transplantation) among 2,130 undergoing TIPS (3.6%) who had prior biliary intervention (n=19 bilioenteric anastomoses, n=35 sphincterotomies, n=28 internal plastic stents, n=4 internal metal stents, and n=6 percutaneous biliary drains). The baseline risk of post-TIPS hepatobiliary infection was estimated from a control group of 1,202 TIPS procedures in patients without prior biliary intervention. RESULTS: Eleven of 76 patients (14.5%) developed hepatobiliary infection after TIPS, including 7 with endoTIPSitis, 4 with hepatic abscesses, and 2 with cholangitis. The 30-day risk of infection was 10.9% (95% CI=3.5-17.8%), significantly higher than the 0.4% risk (95% CI=0.1-0.8%) observed in patients without prior biliary intervention (hazard ratio (HR)=25.56, 95% CI=8.36-78.13, p<0.001). All types of biliary intervention were associated with increased risk of infection, with bilioenteric anastomoses conferring the highest risk. Paradoxically, among patients with prior biliary intervention, use of post-procedural antibiotic prophylaxis was associated with an increased infection risk (HR=19.85; 95% CI=2.44-161.50; p=0.005). Microbial culture data showed high rates of Enterococcus, Klebsiella, and Candida species. CONCLUSIONS: Prior biliary intervention was associated with a 10.9% risk of hepatobiliary infection, including endoTIPSitis, liver abscess, and cholangitis, within 30 days after TIPS creation.

Radiopathologic findings of multifocal nodular hepatic steatosis.

Multifocal nodular hepatic steatosis (MFNHS) is a rare benign clinical entity mimicking metastatic disease. This study is designed to describe the imaging and histopathologic findings and clinical course of patients with MFNHS. In this retrospective study during 2005 and 2023, 10 patients with an imaging and pathologic diagnosis of MFNHS were included. The imaging and histopathology findings were reviewed in each case. The follow-up images were reviewed to assess the clinical course of the disease. The mean age was 50.0 ± 10.5 years, and the male-to-female ratio was 4:6. Three patients had a past medical history of cancer. All patients were found to have lesions suspicious of malignancy on either ultrasound (US) or computed tomography (CT) requiring further workup. Six patients underwent magnetic resonance imaging (MRI), and 4 patients underwent an image-guided biopsy which resulted in hepatic steatosis. During the follow-up period, the majority of patients (71.5%) remained unchanged or improved, while 2 patients (28.5%) progressed. MRI is a reliable modality in detecting and characterizing MFNHS and should be considered to further assess multiple hepatic lesions in cases where the clinical suspicion is not high for metastasis.

Totally percutaneous rendezvous technique for the treatment of complete biliary obstruction after liver transplant.

Biliary complications, including biliary stricture and obstruction, remain a major cause of morbidity and mortality after living donor liver transplantation. In these patients the biliary system may not be accessible by endoscopic approach due to Roux-en-Y hepaticojejunostomy, and a percutaneous approach may be considered to avoid surgical interventions. When there is complete biliary obstruction, the conventional percutaneous approaches may not be successful to cross the hepaticojejunostomy anastomosis. In this study, a totally percutaneous rendezvous technique was used to create a neo-biliary-enteric tract using a trans-biliary Rosch-Uchida needle in a patient with complete biliary obstruction and Roux-en-Y anastomosis after a split liver transplant. A biodegradable stent was placed after recanalization with long-term patency on follow up.

Retroperitoneal abscess caused by dropped renal stones.

Staghorn calculi account for about 4% of presenting renal stones in developed countries, are source of recurrent urinary tract infection, and may be eventually treated by surgical stone removal. A 55-year-old female with a history of staghorn renal calculi and recurrent urinary tract infections presented with a left flank and lower abdominal pain following recent left robotic partial nephrectomy and nephrolithotomy. Contrast-enhanced computed tomography (CT) of the abdomen demonstrated a large left-sided retroperitoneal fluid collection with a few dropped renal stones in the dependent portion of the collection. The patient treated with early percutaneous drainage of the collection and antibiotic treatment and responded well clinically. The clinical and imaging presentation of a rare case of retroperitoneal abscess formation caused by dropped renal stones is described in this study. Imaging, particularly ultrasound and CT, plays a key role in detecting the dropped renal stones and can help with differential diagnosis and treatment plans.

Uterine Carcinosarcoma: A Case Report and Literature Review.

Uterine carcinosarcomas are rare and extremely aggressive undifferentiated carcinomas which include both carcinomatous and sarcomatous elements. A 52-year-old female presented with heavy irregular menstrual bleeding for several years and new right elbow pain and swelling. Ultrasound and computed tomography showed a large uterine mass with regional and distant metastatic lymphadenopathy and suspicious findings of osseous metastasis to the right elbow. A biopsy confirmed uterine carcinosarcoma, and the patient underwent chemotherapy and then surgical resection of the uterine mass with palliative radiotherapy of the right elbow. The postoperative imaging showed new metastasis, and the patient was scheduled to start on immunotherapy. Considering the highly invasive nature of uterine carcinosarcomas, timely detection of this cancer using characteristic imaging and pathology findings is of extreme importance to improve the patient's survival.

Corrigendum to "Enchondroma protuberans of the hand: A case report" [Radiology Case Reports 15 (2020) 943-946].

[This corrects the article DOI: 10.1016/j.radcr.2020.04.026.].

Posttransplant Intrarenal Lymphangiectasia.

Renal lymphangiectasia is an extremely rare benign condition in the setting of transplanted kidneys. We describe a 50-year-old female with a past medical history of lupus nephritis and renal transplants who presented with right lower quadrant pain and was found to have intrarenal lymphangiectasia on imaging and laboratory tests. The patient was treated with percutaneous drainage initially and then wide peritoneal fenestration and omentoplasty. An extremely rare adult case with intrarenal lymphangiectasia thirteen months after kidney transplant was described in this study. Imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), plays a key role in the diagnosis of renal lymphangiectasia.