Cystic dystrophy of the duodenal wall in heterotopic pancreas: an atypical case in non-alcoholic female.

Cystic dystrophy of the duodenal wall in heterotopic pancreas, recently described as paraduodenal pancreatitis, is a rare condition characterized by multiple cysts or pseudocysts located in the submucosa or muscularis propria of a thickened duodenal wall. They result from multiple episodes of obstruction of the small ducts in aberrant pancreatic islets. Cystic dystrophy of the duodenal wall in heterotopic pancreas usually affects alcoholic males, but here we present the case of a female without a history of alcohol abuse who was referred to our emergency department with abdominal pain and vomiting. She was treated by a pancreas-preserving surgical approach, thanks to a proper pre-operative differential diagnosis. Even though differentiating this benign condition from pancreatic cancer is a challenge, some characteristic findings on multidetector CT scan and MRI/MR cholangiopancreatography, such as a thickened duodenal wall containing cysts and sheet-like tissues in the pancreaticoduodenal groove, could lead to the correct diagnosis.

Diagnostic imaging in a case of a cystic lesion of the pancreas.

The case of a patient admitted to hospital for symptoms characterized by upper abdominal pain of pancreatic type associated with vomiting, is discussed. MRI was performed. It documented a focal fluid lesion apparently in communication with the dilated main pancreatic duct showing filling defects. Based on previous radiologic examinations performed elsewhere and MRI findings the diagnostic suspicion was of a cystic lesion. MRI was performed again for re-evaluation and lithotripsy was done; the patient was discharged with the diagnosis of chronic pancreatitis from alcohol abuse.

Evolution of digital angiography systems.

The innovations introduced by digital subtraction angiography in digital radiography are briefly illustrated with the description of its components and functioning. The pros and cons of digital subtraction angiography are analyzed in light of present and future imaging technologies. In particular, among advantages there are: automatic exposure, digital image subtraction, digital post-processing, high number of images per second, possible changes in density and contrast. Among disadvantages there are: small round field of view, geometric distortion at the image periphery, high sensitivity to patient movements, not very high spatial resolution. At present, flat panel detectors represent the most suitable substitutes for digital subtraction angiography, with the introduction of novel solutions for those artifacts which for years have hindered its diagnostic validity. The concept of temporal artifact, reset light and possible future evolutions of this technology that may afford both diagnostic and protectionist advantages, are analyzed.

Soft-tissue mineralization in Werner syndrome.

Werner syndrome is a rare autosomal recessive disorder characterized by clinical signs of premature aging, short stature, scleroderma-like skin changes, endocrine abnormalities, cataracts, and an increased incidence of malignancies. We report on a 48-year-old woman with Werner syndrome associated with intracranial meningiomas who had extensive musculoskeletal manifestations including osteoporosis of the extremities, extensive tendinopathy about the ankles, osteomyelitis of the phalanges of the first left toe, abundant soft-tissue calcification, and two dense ossified soft-tissue masses, with cortical bone and trabeculae arising from the posterosuperior aspect of the calcanei and extending into Kager fat pads. A review of previous descriptions of the radiological abnormalities of Werner syndrome indicates that the presence of soft-tissue calcifications has either not been noted or been mentioned only briefly. Moreover, there is no mention of bony masses associated with Werner syndrome in the world literature, and this would appear to be the first report of this kind.