Obstructive icterus directly related to visceral artery aneurysm in a CAPD patient.

Visceral artery aneurysms (VAA) are uncommon pathologies. We report a case of the first CAPD patient with obstructive jaundice directly related to VAA. A 25-year-old man with a four-year history of hemodialysis followed by two years of CAPD was admitted due to jaundice. He had two episodes of peritonitis. An abdominal ultrasonogram and a selective common hepatic arteriogram confirmed the presence of a 5 cm saccular aneurysm supplied from the gastroduodenal artery and a 4 cm fusiform aneurysm supplied from the proximal part of the common hepatic artery. The gastroduodenal artery was responsible for the impression of the common bile duct. In the operation, the gastroduodenal artery aneurysm was completely excised after its proximal and distal ends were ligated. The proximal and distal ends of the hepatic artery were also ligated. A prosthetic graft (PTFE), which extended from the splenic artery to the distal portion of the hepatic artery, was placed. In this way, the arterial blood flow of the liver was re-established. Patients with VAAs present with a constellation of symptoms including abdominal pain, jaundice and shock (due to rupture of aneurysm). Pancreatitis, and atherosclerosis have been reported to be the most common causes of VAAs. In conclusion, when CAPD patients present with jaundice or hemorrhagic shock with abdominal pain, VAA should be considered in differential diagnosis, especially if patients have a history of frequent pancreatitis episodes, and severe risk factors for atherosclerosis.

A rare cause of peripheral arterial embolism: ruptured cardiac hydatid cyst.

One of the important unfavorable events that occur during the course of the cardiac hydatid cyst is rupture of the cyst and embolism of the germinative membrane. Peripheral arterial embolism of this germinative membrane is uncommon but is a potential risk due to the nature of the disease. Ruptured cardiac hydatid cyst should be suspected in young patients who have a peripheral arterial embolism and come from sheep-raising areas and/or if they have a suspected embolectomy material resembling germinative membrane. Following the embolectomy and reconstruction of the circulation in the involved extremity, ruptured cardiac hydatid cyst should be diagnosed immediately and excision of the cardiac cyst should be performed as quickly as possible. In this case report, we present two patients who had lower extremity embolism originating from the ruptured cardiac hydatid cyst and were operated on for cardiac cyst excision.

Characterization of hepatocellular carcinomas with triphasic CT and correlation with histopathologic findings.

PURPOSE: To determine the utility of triphasic CT in the characterization of hepatocellular carcinomas (HCCs) and correlations with histopathologic findings. MATERIAL AND METHODS: Thirty patients with hepatocellular carcinomas were included in the study and triphasic CT examinations were performed. The CT protocol included hepatic arterial, portal venous and late phases. A histopathologic examination was carried out in all but 3 patients, and the diagnosis and degrees of differentiation were determined. RESULTS: Hepatocellular carcinomas were hyperattenuated in 17 (57%) and hypoattenuated in 13 (43%) of the 30 patients in arterial phase images. The lesions were hypoattenuated in 26 (87%) and hyperattenuated in 4 (13%) patients in portal venous phase images. These hyperattenuated tumors were well-differentiated in the histopathologic examinations (P < or = 0.05). Portal vein invasion was seen in 50% of the patients and this relationship was significant in patients whose lesions was greater than 10 cm (P < 0.05). Capsule formation, abnormal internal vessels and necrosis were detected in 57%, 53% and 40% of the patients, respectively. CONCLUSION: Triphasic CT can aid in the histopathologic differentiation of HCCs, in addition to their characterization. Hyperattenuation in PVP images was found to be associated with well-differentiated HCCs and portal vein invasion was more frequent in tumors larger than 10 cm.

Childhood Guillain-Barré syndrome. MR imaging in diagnosis and follow-up.

PURPOSE: To evaluate the value of serially obtained spinal MR images in the diagnosis and clinical follow-up of childhood Guillain-Barré syndrome (GBS), and the time period for resolution of contrast enhancement during the course of illness. MATERIAL AND METHODS: Contrast-enhanced spinal MR images of 11 pediatric patients with GBS were reviewed prospectively. In the first group of 6 patients, follow-up MR was performed three times after the 1st, 3rd and 6th months after onset of the disease. In the second group (the other 5 patients) who had not accepted serial MR examinations, control MR was repeated once after 1 year. Patients were graded clinically into five categories according to their initial clinical signs and symptoms and three grades (mild, moderate and severe) according to level of contrast enhancement on T1-weighted images to correlate the severity of enhancement with clinical findings and recovery. RESULTS: Ten of the 11 patients revealed contrast enhancement in varying degrees in the spinal nerve roots surrounding the conus medullaris and extending the length of the cauda equina. One patient showed no contrast enhancement. Anterior nerve roots enhanced more intensely than the posterior roots in 3 patients. Follow-up MR images in all patients revealed diminishing or resolving contrast enhancement in the nerve roots as the clinical symptoms improved. CONCLUSION: We suggest contrast-enhanced spinal MR imaging as a supplementary diagnostic modality in diagnosing GBS, especially when the clinical and electrophysiological findings are equivocal. Follow-up images may play a role in predicting the clinical course of the disease.

Alveolar echinococcosis of the liver: correlative color Doppler US, CT, and MRI study.

PURPOSE: To determine and compare the imaging features of hepatic alveolar Echinococcosis using color Doppler US, CT, and MRI. MATERIAL AND METHODS: Abdominal CT and MRI with and without contrast agents and color Doppler US were performed on seven patients with hepatic alveolar Echinococcosis. The lesions were evaluated for location, features of echogenicity, intensity and density, calcification, and vascular, hilar, and perihepatic involvement. The diagnosis was confirmed histopathologically in all patients. RESULTS: Six patients had solitary lesions, and one displayed multiple lesions. The lesions were generally seen as heterogeneous and hyper- or hypoechoic when imaged with color Doppler US, hypodense with CT, and hypointense with MRI, in comparison with the liver parenchyma. Calcification, central necrosis, and small peripheral cysts were observed in six, seven, and four patients, respectively. Vascular flow or contrast enhancement was not observed in any of the cases. A look at the respective advantages of each method reveals that calcification was best rendered visible via CT, small peripheral cysts with T2-weighted MRI, central necrosis with CT and MRI, and perihepatic invasion with multiplanar MRI. Vascular involvement was revealed by all methods. CONCLUSION: Color Doppler US, CT, and MR imaging function extremely well as complementary methods in the diagnosis of HAE. Color Doppler US should be performed in these patients owing to its ability to efficiently detect the disease. Knowledge of imaging characteristics makes it possible to radiologically ascertain an early diagnosis.

Color Doppler ultrasonography findings of bladder tumors: correlation with stage and histopathologic grade.

PURPOSE: To describe color Doppler ultrasonography findings of bladder tumors and to investigate the correlation between these findings with stage and histopathological grade. MATERIAL AND METHODS: Twenty-four patients with bladder tumors were assessed with color Doppler ultrasonography for tumor size, presence of vascularity, vascular pattern, and spectral properties. All patients underwent surgery. Stage and histopathological grades of tumors were determined and compared with color Doppler ultrasonography findings. RESULTS: Presence of vascularity was related to tumor size (P<0.05) and color Doppler signal was detected when tumors reached 24 mm in size. There was no statistically significant relationship between tumor stage and histopathological grade with tumor size, presence and pattern of vascularity, and spectral color Doppler ultrasonography findings (P>0.05). CONCLUSION: The evaluation of vascularity in bladder tumors by color Doppler ultrasonography is not helpful in predicting tumor stage and histopathological grade before surgery.

Gastrointestinal wall thickening in patients with cirrhosis: frequency and patterns at contrast-enhanced CT.

PURPOSE: To determine the frequency and patterns of gastrointestinal wall thickening at contrast material-enhanced computed tomography (CT) in patients with cirrhosis. MATERIALS AND METHODS: Three radiologists retrospectively assessed the contrast-enhanced abdominal CT scans of 77 patients with cirrhosis and 100 patients without cirrhosis for gastrointestinal wall thickening from the stomach through the descending colon. The frequencies of wall thickening were determined in the cirrhosis and in the control groups and were compared by using the Fisher exact test. The segmental distribution, symmetry, and enhancement pattern were evaluated in all patients with cirrhosis and gastrointestinal wall thickening. RESULTS: Gastrointestinal wall thickening was seen in 49 (64%) patients with cirrhosis and in seven (7%) control subjects (P <.005). The jejunum and ascending colon were the most common sites of gastrointestinal wall thickening; each was involved in 32 (42%; 95% CI: 30%, 53%) patients. The scans of 30 (61%; 95% CI: 47%, 75%) patients with gastrointestinal wall thickening showed multisegmental distribution. Gastrointestinal wall thickening was concentric and homogeneous in all patients with cirrhosis. CONCLUSION: Gastrointestinal wall thickening is common on contrast-enhanced abdominal CT scans in patients with cirrhosis. It frequently involves multiple segments. The jejunum and ascending colon are the most common sites of involvement.

Continuous ambulatory peritoneal dialysis.

PURPOSE: To assess complications of continuous ambulatory peritoneal dialysis (CAPD) in uremic patients with and without clinical symptoms by CT peritoneography. MATERIAL AND METHODS: A total of 64 patients with end-stage renal disease and on continuous CAPD were investigated. Twenty-eight had some clinical symptoms, which might be related to the complications of CAPD. Thirty-six patients had no complaints or symptoms due to the dialysis treatment. RESULTS: CT peritoneography revealed various complications including hernias (50%), dialysate leakage (46%), localized fluid collection (4%) and peritoneal adhesions (4%) in the patients who had clinical symptoms that might be related to the dialysis treatment. Moreover, similar complications were found in the asymptomatic patients at a lower rate: hernia (3%), dialysate leakage (17%), peritoneal adhesions (3%) and abdominal wall laxity (3%). Complication detection rate by CT peritoneography was 68% (n=19) in the symptomatic patients and 22% (n=8) in the asymptomatic patients. The number of complications found in each group was significant. CONCLUSION: CT peritoneography was an effective modality in detecting complications from CAPD in patients with and without clinical symptoms.

Tumor recurrence after radiofrequency thermal ablation of hepatic tumors: spectrum of findings on dual-phase contrast-enhanced CT.

OBJECTIVE: We conducted this study to determine the spectrum of CT findings of tumor recurrence after radiofrequency ablation of primary and secondary malignant hepatic tumors. MATERIALS AND METHODS: Twenty-five patients, 10 with hepatocellular carcinoma (HCC) and 15 patients with metastases who developed tumor recurrence after radiofrequency ablation of hepatic neoplasms, formed the study population. Three observers reviewed the CT scans of these patients and evaluated the location (local intrahepatic, remote intrahepatic, or extrahepatic) of all recurrent lesions and the morphology and enhancement characteristics of local intrahepatic recurrences. RESULTS: Local intrahepatic recurrences were seen in nine patients (90%) and 11 patients (73%); remote intrahepatic recurrences, in five patients (50%) and seven patients (45%); and extrahepatic recurrences, in zero and six patients (40%) with recurrent HCC and recurrent metastases, respectively. Of the 12 nodules of local intrahepatic recurrences in HCC and the 24 in metastases, the patterns of local intrahepatic recurrences were of nodular, halo, and gross enlargement types in eight (67%) and nine (38%), four (33%) and six (38%), and zero and nine (37%) nodules in HCC and hepatic metastases, respectively. The number of local intrahepatic recurrent lesions enhancing in the arterial phase was significantly greater in HCC. CONCLUSION: Tumor recurrences occurred at intra- and extrahepatic sites after radiofrequency ablation of hepatic neoplasms. The local intrahepatic recurrences appeared in three patterns: nodular, halo, or gross enlargement. The sites of recurrence and the morphologic patterns of local intrahepatic tumor recurrence differed between primary and secondary hepatic neoplasms.

Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough.

Six existing minimally invasive techniques for the treatment of primary and secondary malignant hepatic tumors--radio-frequency ablation, microwave ablation, laser ablation, cryoablation, ethanol ablation, and chemoembolization--are reviewed and debated by noted authorities from six institutions from around the world. All of the authors currently believe that surgery remains the treatment of choice for patients with resectable hepatic tumors. However, the clinical results of each of the minimally invasive techniques presented have exceeded those obtained with conventional chemotherapy or radiation therapy. Thus, for nonsurgical patients, these techniques are becoming standard independent or adjuvant therapies. In addition, with continued improvement in technology and increasing clinical experience, one or more of these minimally invasive techniques may soon challenge surgical resection as the treatment of choice for patients with limited hepatic tumor.