Abdominal complications of chemotherapy in pediatric malignancies: imaging findings.

OBJECTIVE: To describe the imaging findings of abdominal complications caused by chemotherapy in pediatric cancer patients. SUBJECTS AND METHODS: Radiology studies of 243 patients treated in our Children Cancer Center were reviewed, 164 of whom had abdominal studies. Medical records of 54 patients with abnormal imaging findings were studied. RESULTS: Ultrasound and/or CT findings showed the following complications: (1) gallbladder sludge/crystals (n=13), gallstones (n=8), cholecystitis (n=3); (2) liver steatosis (n=23), siderosis (n=1), veno-occlusive disease (n=2); (3) pancreatitis (n=7); (4) typhlitis (n=12), esophagitis (n=2). CONCLUSION: Awareness of these complications is essential for appropriate management, decreasing their mortality and morbidity.

Abdominal manifestations of multiple myeloma: a retrospective radiologic overview.

BACKGROUND: Abdominal manifestations of multiple myeloma (MM) are rare. Herein, the authors study the radiologic characteristics of such involvement because these findings are usually missed by the radiologist and oncologist. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 202 patients with MM treated at our institution. A total of 192 patients underwent > or = 1 abdominal imaging studies (ultrasound, computed tomography, magnetic resonance imaging), which were correlated with histopathology, when available. RESULTS: Eleven patients (5.72%) had lesions within 13 abdominal sites: liver (n = 4); pancreas (n = 3); peritoneum (n = 2); kidney, stomach, adrenal gland, and retroperitoneum (n = 1), respectively. Cytopathologic diagnosis was available in 5 cases. The remaining cases were considered to have myeloma deposits as a result of previous normal studies and the absence of other primary disease. The imaging findings were nonspecific. CONCLUSION: Myeloma deposits within the abdomen are rare. Although the imaging findings are nonspecific, oncologists and radiologists should be aware of their common characteristics.

Generalized dysplasia epiphysealis hemimelica with contralateral sacro-iliac joint involvement.

Dysplasia epiphysealis hemimelica (or Trevor's disease) is a rare developmental bone dysplasia characterized by benign osteocartilaginous overgrowth involving one or multiple epiphyses, usually of a single lower extremity. It is classified as localized form, classical form (most common), and generalized form. In this report we describe a case of generalized form of dysplasia epiphysealis hemimelica with involvement of the contralateral sacroiliac joint, which is an extremely rare presentation.

Left-sided cervical aortic arch associated with pseudocoarctation, aneurysm formation, and anomalous left brachiocephalic vein: appearance on MDCT and MR angiography.

Cervical aortic arch (CAA) is a rare congenital aortic anomaly. It can be associated with several cardiovascular abnormalities including aortic aneurysm, valvular disease, and pseudocoarctation. In this report, we present a case of CAA with combined association of both aneurysm formation and pseudocoarctation. This combination of anomalies is extremely uncommon, described in only 4 cases in the literature. In addition, our patient had an anomalous subaortic left brachiocephalic vein that, to our knowledge, was not previously described in the literature to be associated with CAA. The radiographic, multidetector computed tomography scan, and magnetic resonance angiography imaging findings are presented.

Imaging findings of familial Mediterranean fever.

PURPOSE: The aim of this study was to study the imaging findings of familial Mediterranean fever (FMF). MATERIALS AND METHODS: We performed a retrospective review of the medical records and imaging studies of 38 patients with proven FMF, diagnosed between 1992 and 2002. RESULTS: The most common clinical manifestation was recurrent peritoneal attacks with abdominal pain (76.3%) and fever (42.1%). Abdominal imaging findings included ileus (n=12), splenomegaly (n=5), hepatomegaly (n=2), ascitis (n=2), focal peritonitis (n=2), mesenteric streaking (n=1), and enlarged mesenteric lymph node (n=1). One patient developed fatal peritoneal mesothelioma, and 13.1% of the patients developed amyloidosis with sonographic findings of renal parenchymal disease or cardiomyopathy. Arthritis was second in frequency, occurring in 34.2% of patients; radiographs were normal (n=4) or showed joint effusion and periarticular soft tissue swelling (n=4) due to synovitis. One patient developed seronegative destructive arthropathy. Skin lesions were noted in 23.6% of patients. Pleuritis was encountered in 13.1% and pericarditis in 5.2%. Polyarteritis nodosa (PAN) was present in two patients, multiple sclerosis in one, and autoimmune hemolytic anemia in one patient. CONCLUSION: FMF predominantly involves abdominal viscera but can affect other organs. The majority of patients have nonspecific imaging findings, and the radiologic diagnosis is rarely considered. Amyloidosis, mesothelioma, and destructive arthropathy are potential serious complications of FMF. PAN, multiple sclerosis, and autoimmune hemolytic anemia are probably rare associations or rather than coincident with FMF.

Heterozygous prothrombin 20210G/A mutation, associated with hyperhomocysteinemia, and homozygous methylenetetrahydrofolate reductase 677C/T mutation, in a patient with portal and mesenteric venous thrombosis.

We herein report a 34-year-old man who was investigated for severe abdominal pain. Portal vein thrombosis (PVT) and mesenteric vein thrombosis (MVT) were diagnosed. An association with two predisposing factors for thrombosis was noted: (1) heterozygous factor II 20210G/A mutation and (2) homozygous methylenetetrahydrofolate reductase (MTHFR) 677C/T mutation with hyperhomocysteinemia. Our case is of particular interest because the patient reported herein, is homozygote for the MTHFR 677C/T mutation, while the only two other cases reported in the literature with similar gene mutations, were heterozygotes for the mutation.

Imaging of hepatic cystic lesions.

Cystic lesions of the liver are a common finding and the differential diagnosis is wider than often considered. Awareness of the radiologic key features allows a correct presumptive diagnosis in a lot of cases. Diagnostic accuracy is increased when combining the characteristic radiologic features to the clinical history and laboratory findings as summarized in Table I. Further useful information can be obtained in the most difficult cases with atypical findings by means of fine needle aspiration performed under imaging guidance. In endemic regions, hepatic echinococcal cyst should be always kept in mind and excluded from the differential diagnosis of HCL.

Imaging of common benign solid liver tumors.

The imaging modalities currently used for radiologic detection and characterization of hepatic neoplasms include color Doppler sonography, helical computed tomography (plain, biphasic enhanced CT), magnetic resonance imaging (plain, gadolinium enhanced MR), radionuclide scintigraphy (Technetium RBC, sulfur-colloid, IDA scan), angiography, and image-guided percutaneous needle biopsy. MR imaging is probably better at characterizing lesions than CT scan, but the latter remains the modality of choice at many institutions due to the speed of acquisition and good contrast resolution inherent in the technique. Each of these modalities is useful, but accurate lesion detection and specific radiologic diagnosis is most often made in many patients with typical imaging features using a combination of examinations rather than with a single modality. In the remaining patients with atypical features, a definitive diagnosis is usually obtained by a needle biopsy. Table I summarizes the typical clinical and imaging findings of common benign solid liver tumors, with suggested further work-up and management. Future developments will focus on the use of special contrast agents in sonography and MRI for further evaluation and characterization of focal hepatic lesions. Emerging clinical applications of these special contrast agents have shown a promising future role for contrast-enhanced sonography and MRI as problem-solving examinations after inconclusive ultrasound and helical CT.

Biliary fascioliasis: case report and review of the literature.

Hepatobiliary parasitic diseases are rare in Lebanon. We recently encountered biliary fascioliasis in a Lebanese native. The clinical and laboratory findings were nonspecific. The biliary parasite (Fasciola hepatica) was identified by sonography and confirmed at ERCP that has retrieved the parasite from the common bile duct.