The choice of region of interest after spinal procedures alters bone mineral density measurements.

PURPOSE: Vertebrae affected by artifacts, such as metallic implants or bone cement, should be excluded when measuring the spine bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA). Exclusion may be performed using two methods: first, the affected vertebrae are included in the region of interest (ROI) and subsequently excluded from the analysis; second, the affected vertebrae are completely excluded from the ROI. This study aimed to investigate the influence of metallic implants and bone cement on BMD with and without the inclusion of artifact-affected vertebrae in the ROI. METHODS: DXA images of 285 patients, including 144 with spinal metallic implants and 141 who had undergone spinal vertebroplasty from 2018 to 2021, were retrospectively reviewed. Spine BMD measurements were performed when the images were evaluated using two different ROIs for each patient during the same examination. In the first measurement, the affected vertebrae were included in the ROI; however, the affected vertebrae were excluded from the BMD analysis. In the second measurement, the affected vertebrae were excluded from the ROI. Differences between the two measurements were evaluated using a paired t-test. RESULTS: Among 285 patients (average age, 73 years; 218 women), spinal metallic implants led to an overestimation of bone mass in 40 of 144 patients, whereas bone cement resulted in an underestimation of bone mass in 30 of 141 patients when the first measurement was compared with the second measurement. The opposite effect occurred in 5 and 7 patients, respectively. Differences in results between the inclusion and exclusion of the affected vertebrae in the ROI were statistically significant (p<0.001). Spinal implants or cemented vertebrae included in the ROI might significantly alter BMD measurements. Additionally, different materials were associated with varying modifications in BMD. CONCLUSION: The inclusion of affected vertebrae in the ROI may notably alter BMD measurements, even when they are excluded from the analysis. This study suggests that the vertebrae affected by spinal metallic implants or bone cement should be excluded from the ROI.

Volunteer participation differentially moderates the association between insomnia and poor subjective well-being in community-dwelling older adults: the Yilan study, Taiwan.

OBJECTIVES: We aimed to elucidate the moderating effect of volunteer participation on the association between insomnia and subjective well-being. METHODS: This was a community-based, cross-sectional study that targeted community-dwelling older adults aged ≥ 65 years in Yilan city, Taiwan. Whether individuals had volunteered in the past month was asked. Insomnia was measured using the Athens Insomnia Scale-5. Subjective well-being was evaluated using self-rated health, self-rated happiness, the physical component summary (PCS), and the mental component summary (MCS) of Short-form 12. Interaction terms between volunteer participation and insomnia were examined to test the moderating effect of volunteer participation on subjective well-being. RESULTS: In total, 3,875 participants were included in the study. After controlling for confounders, older adults with insomnia were more likely to have poor subjective well-being, except with respect to PCS. By contrast, volunteering was associated with a low risk of association between self-rated health and happiness. The interaction terms for volunteering with self-rated happiness (p = 0.03) and the MCS (p = 0.02) were significant. The association between insomnia and poor self-rated happiness among volunteers (odds ratio [OR] = 3.91, 95% confidence interval [CI] = 1.85-8.28) was significantly stronger than that in non-volunteers (OR = 1.48, 95% CI = 1.18-1.86). However, insomnia was linked with poor MCS in non-volunteers (OR = 1.53, 95% CI = 1.21-1.94), but not in volunteers (OR = 0.64, 95% CI = 0.27-1.50). DISCUSSION: Volunteer participation moderated the association between insomnia and subjective well-being; specifically, volunteering strengthened the association between insomnia and poor self-rated happiness but mitigated the relationship between insomnia and poor MCS.

Association of possible sarcopenic obesity with osteoporosis and fragility fractures in postmenopausal women.

Possible sarcopenic obese women had a decreased likelihood of osteoporosis but an increased likelihood of fragility fractures compared with non-sarcopenic non-obese and sarcopenia-only women. Furthermore, possible sarcopenic obese women had lower values of trabecular bone score than non-sarcopenic non-obese and sarcopenia-only women. PURPOSE: The coexistence of possible sarcopenia and obesity may have opposing effects on osteoporosis. This study aimed to investigate whether possible sarcopenic obesity is associated with osteoporosis or fragility fracture. METHODS: In this cross-sectional study of 1007 postmenopausal women from Taiwan, bone mineral density of the spine and hips was evaluated using dual-energy X-ray absorptiometry (DXA), and bone microarchitecture was evaluated using the trabecular bone score (TBS) derived from a lumbar spine image acquired by DXA. According to the definition of sarcopenia by the 2019 Asian Working Group for Sarcopenia, possible sarcopenia was defined by either low muscle strength or reduced physical performance. Obesity was defined as a body mass index of ≥ 27 kg/m2. Based on the presence of possible sarcopenia and obesity, study participants were classified as follows: control (non-sarcopenic non-obese), sarcopenic (non-obese), obese (non-sarcopenic), and sarcopenic obese. Prevalent fragility fractures were determined by retrospectively reviewing medical records. RESULTS: In this study, 10.1% of participants were classified as sarcopenic obese, 9.1% as obese, 35.2% as sarcopenic, and 45.6% as control. Relative to the control group, the sarcopenic obese group (OR, 0.28; 95% CI 0.18, 0.46) and obese group (OR, 0.38; 95% CI 0.23, 0.61) had a decreased likelihood of osteoporosis. However, the sarcopenic obese group (OR, 2.29; 95% CI 1.31, 4.00) and obese group (OR, 1.94; 95% CI 1.04, 3.62) had an increased likelihood of fragility fractures than with the control group. In addition, the sarcopenic obese group had a higher likelihood of fragility fractures than the sarcopenic group. Possible sarcopenic obese women also had significantly lower TBS values than those in the control and sarcopenic groups. CONCLUSIONS: Possible sarcopenic obese women had a lower likelihood of osteoporosis but a higher likelihood of fragility fractures than non-sarcopenic non-obese and sarcopenia-only women. Furthermore, possible sarcopenic obese individuals had lower values of TBS than non-sarcopenic non-obese and sarcopenia-only women.

Depression and anxiety correlate differentially with dissatisfaction with healthcare services in older adults: The Yilan Study, Taiwan.

BACKGROUND/PURPOSE: Previous studies have seldom investigated the psychological factors that are associated with dissatisfaction with healthcare services. We therefore examined the associations of depression and anxiety with service dissatisfaction among older adults. METHODS: A community-based health survey was conducted from 2012 to 2016. Residents aged ≥65 years were randomly recruited from Yilan City, Taiwan. Besides overall dissatisfaction, we assessed dissatisfaction with physicians' ability, physicians' attitude, and waiting time. The Hospital Anxiety and Depression Scale was used to detect depressive and anxiety symptoms with optimal cut-off points of 3 for the anxiety subscale and 6 for the depression subscales. RESULTS: Of the 3480 residents included in this study, the overall dissatisfaction rate was 7.9%. After controlling for covariates, depressive and anxiety symptoms were consistently correlated with the various dimensions of dissatisfaction. More specifically, depressive symptoms were associated with overall dissatisfaction and dissatisfaction with physicians' ability and attitude. Conversely, anxiety was uniquely associated with dissatisfaction with waiting time. CONCLUSION: Psychological symptoms were consistent correlates of dissatisfaction with healthcare services among older adults, although the specific symptoms had different associations with the various dimensions of dissatisfaction.

Using hand grip strength to detect slow walking speed in older adults: the Yilan study.

BACKGROUND: Walking speed is an important health indicator in older adults, although its measurement can be challenging because of the functional decline due to aging and limited environment. The aim of this study was to examine whether hand grip strength can be a useful proxy for detecting slow walking speed in this population. METHODS: A cross-sectional study was conducted using the cohort from the Yilan Study in Taiwan. Community-dwelling older adults aged 65 years and older were included. Slow walking speed was defined as a 6-meter walking speed < 1.0 m/s, according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Stepwise multiple linear regression was used to determine the most significant variables associated with walking speed. Receiver operating characteristic analysis was used to determine the optimal cutoff values for hand grip strength in detecting slow walking speed. RESULTS: A total of 301 participants with an average age of 73.9 ± 6.8 years were included; 55.1 % participants were women. In stepwise multiple linear regression analysis that included various variables, hand grip strength was found to be the most explainable factor associated with walking speed among all participants and among participants of each sex. The optimal cutoff values for hand grip strength in the detection of slow walking speed were 19.73 kg for all participants (sensitivity: 55 %, specificity: 83 %, area under the curve: 0.74, accuracy: 66.9 %), 35.10 kg for men (sensitivity: 92 %, specificity: 42 %, area under the curve: 0.70, accuracy: 66.4 %), and 17.93 kg for women (sensitivity: 62 %, specificity: 80 %, area under the curve: 0.76, accuracy: 67.9 %). CONCLUSIONS: Hand grip strength was found to be a useful proxy for the identification of slow walking speed in older adults.

The Impact of the "Osteo" Component of Osteosarcopenia on Fragility Fractures in Post-Menopausal Women.

Osteosarcopenia, the coexistence of bone and muscle loss, is common in older adults, but its definition lacks international consensus. This cross-sectional study (n = 1199 post-menopausal women) aimed to determine the association between osteosarcopenia and fragility fractures and to investigate the impact of the definition of the "osteo" component. Bone mineral density and bone microarchitecture were measured by dual-energy X-ray absorptiometry and the trabecular bone score (TBS), respectively. The "osteo" component of osteosarcopenia was classified as osteoporosis (T-score ≤ -2.5 SD), osteopenia/osteoporosis (T-score < -1 SD), and high-fracture-risk osteopenia (-2.5 SD < T-score < -1 SD)/osteoporosis (T-score ≤ -2.5 SD). The Fracture Risk Assessment Tool was used to identify high-fracture-risk osteopenia. Altogether, 30.3%, 32.2%, 14.4%, and 23.1% of participants had osteosarcopenia, osteoporosis alone, sarcopenia alone, and neither condition, respectively. The odds ratios between osteosarcopenia and fragility fractures were 3.70 (95% CI: 1.94-7.04) for osteosarcopenia, 2.48 (95% CI: 1.30-4.71) for osteoporosis alone, and 1.87 (95% CI: 0.84-4.14) for sarcopenia alone. Women with osteosarcopenia also had lower TBS, indicating worse bone microarchitecture. In conclusion, women with osteosarcopenia were more likely to have previously sustained a fracture compared to those without osteosarcopenia, with sarcopenia alone, and with osteoporosis alone. The relationship between osteosarcopenia and fracture risk may be best identified when considering high-fracture-risk osteopenia and osteoporosis.

Hand grip strength in predicting the risk of osteoporosis in Asian adults.

INTRODUCTION: There is a need for a cost-effective method to identify individuals with a high risk of osteoporosis. This study aimed to investigate the suitability of hand grip strength in predicting the risk of osteoporosis in Asian adults. MATERIALS AND METHODS: In this cross-sectional, hospital-based study of 1007 participants, the bone mineral density of the spine and hips was evaluated using dual-energy X-ray absorptiometry according to the 2019 International Society for Clinical Densitometry official positions. Bone microarchitecture was evaluated using the trabecular bone score, and hand grip strength was measured in the dominant hand using a hand digital dynamometer. RESULTS: Hand grip strength was significantly related to bone density and bone microarchitecture. Moreover, hand grip strength was a significant predictor of osteoporosis in both women and men. For osteoporosis prediction in women, a threshold of 21.9 kg of hand grip strength had a sensitivity of 59%, specificity of 59%, and area under the curve (AUC) of 0.61. In men, a threshold of 28.7 kg had a sensitivity of 66%, specificity of 78%, and AUC of 0.75. The optimal cutoff strengths for osteoporosis depended on age and sex. CONCLUSION: The measurement of hand grip strength is a simple, cost-effective and an easy assessment method for identifying individuals at a high risk of osteoporosis. The cutoff strength for evaluating osteoporosis in adults is age and sex specific.

Comparing self-assessment, functional, and anthropometric techniques in predicting osteoporosis.

The osteoporosis self-assessment tool was more accurate than hand grip strength, gait speed, and calf circumference in predicting osteoporosis in women. Hand grip strength was more accurate than the osteoporosis self-assessment tool, gait speed, and calf circumference in predicting osteoporosis in men. PURPOSE: The osteoporosis self-assessment tool, functional assessment, and anthropometric measurement are different techniques to identify those at risk of osteoporosis. This study aimed to compare the performance of these techniques in predicting osteoporosis. METHODS: In this cross-sectional, hospital-based study including 1109 participants, the bone mineral density of the spine and hips was evaluated using the dual-energy X-ray absorptiometry. The Osteoporosis Self-Assessment Tool was used as a simple clinical risk assessment tool to screen for osteoporosis. Gait speed and hand grip strength were used as functional assessments to predict osteoporosis. Calf circumference was used as an anthropometric measurement to predict osteoporosis risk. RESULTS: In women, the Osteoporosis Self-Assessment Tool was better than hand grip strength, gait speed, and calf circumference in predicting osteoporosis. In contrast, in men, hand grip strength was better than the Osteoporosis Self-Assessment Tool, gait speed, and calf circumference. CONCLUSION: The application of simple, cost-effective techniques for the identification of osteoporosis risk will be beneficial for both screening and patient care when dual-energy X-ray absorptiometry is not available. We suggest that the Osteoporosis Self-Assessment Tool can be used to identify the risk of osteoporosis in women and hand grip strength measurement can be used for men.

Validation of Global Self-Rated Health and Happiness Measures Among Older People in the Yilan Study, Taiwan.

Background: Single-item measures of physical and mental health are feasible for older adults, but their validity for that age group is unclear. This study tested validity of a global self-rated health and a global self-rated happiness measure in a large sample of community-dwelling older adults in Taiwan. Methods: A cross-sectional sample of 3,982 men and women aged 65 or older in Yilan, Taiwan, provided data on global self-rated health and happiness using 100-point numerical scales. The Physical Component Summary of the 12-Item Short Form Health Survey (version 2) and the Groningen Activity Restriction Scale were used to test the validity of the self-rated health item. The Mental Component of that 12-item scale and the Hospital Anxiety and Depression Scale were validators regarding the self-rated happiness item. Criterion validity was tested using the 12-Item Short Form Health Survey (version 2). Results: The correlations between the self-rated health and happiness measures and the 12-Item Short Form Health Survey (version 2) validators were positive and statistically significant, supporting convergent validity. Sufficient divergent validity was demonstrated through the negative and significant relationship between the self-rated health item and the Groningen Activity Restriction Scale scores and the negative and significant relationship between the self-rated happiness item and the Hospital Anxiety and Depression Scale. Optimal cut-off scores for physical and mental health states depended on age and gender. Conclusion: The global self-rated health and happiness measures were validated. Cut-off scores for evaluating older adults' physical and mental health should be age- and gender-specific.

Computed Tomography of Spontaneous Perforated Meckel's Diverticulum in an Elderly Adult: A Case Report.

Spontaneous perforated Meckel's diverticulum is a rare complication and mimics appendicitis or diverticulitis in elderly adults. We report the case of a 51-year-old man who presented to the emergency department with abdominal pain that had progressively increased over the previous two hours. The provisional diagnosis was appendicitis or diverticulitis, and we recommended computed tomography for further evaluation. Computed tomography of the abdomen showed an outpouching, blind-ending, fluidfilled structure in continuity with the distal ileum that depicted wall perforation and extraluminal air bubbles, consistent with perforated Meckel's diverticulum. In this case report, computed tomography provided a clear imaging diagnosis of perforated Meckel's diverticulum preoperatively. Thus, in patients with acute abdomen, complicated Meckel's diverticulum should be included in the differential diagnosis.

Lifestyles and Mortality in Taiwan: An 11-Year Follow-up Study.

The associations of modifiable lifestyle-related factors with cardiovascular and all-cause mortality were examined in a population-based sample of older Taiwanese people. A total of 4176 individuals aged 50 years and older, with 11 years of follow-up, were analyzed. Current and former smokers had a higher risk of all-cause mortality compared with never smokers ([HR = 1.33; 95% CI = 1.12, 1.58], [HR = 1.39; 95% CI = 1.16, 1.68]). Low intake of vegetables and fruits was associated with a significantly higher risk of 1.43 (95% CI = 1.13, 1.81) for cardiovascular mortality and 1.22 (95% CI = 1.09, 1.38) for all-cause mortality. The low physical activity group at baseline who became part of the low, moderate, and high physical activity groups during follow-up had the following risks of cardiovascular mortality: ([HR = 2.89; 95% CI = 1.91, 4.36], [HR = 2.17; 95% CI = 1.29, 3.63], [HR = 1.59; 95% CI = 0.90, 2.82]). Similarly, the moderate physical activity group at baseline who became part of the low, moderate, and high physical activity groups during follow-up had the following risks of cardiovascular mortality: ([HR = 3.52; 95% CI = 2.14, 5.80], [HR = 2.25; 95% CI = 1.34, 3.80], [HR = 1.44; 95% CI = 0.78, 2.66]). The same tendencies were found in all-cause mortality. Smoking, diet, and physical activity were significantly modifiable lifestyle-related factors for mortality.Besides, individuals who decreased their physical activity had a significantly higher risk, whereas those who increased their physical activity had a significantly lower risk.

Smoking behavioral changes and subsequent mortality during a 18-year follow-up in Kinmen, Taiwan.

BACKGROUND: The aim of this study was to examine the changes in smoking behavior over 6 years and to relate these changes to mortality risk during 18 years' follow-up. METHODS: We followed a cohort for 6 years (1991-1997) to assess changes in smoking behavior and then for an additional 12 years (1997-2008) to relate these findings to mortality in 4986 Chinese individuals. Participants were classified as never smokers, long-term quitters, new smokers, new quitters, and continuing smokers. Mortality was ascertained by linkage with the nationwide death registry. RESULTS: Compared with never smokers, continuing smokers had the highest risk of 1.84 [95% confidence interval (CI): 1.38, 2.45] for all-cause mortality, new quitters had a risk of 1.49 (95% CI: 1.04, 2.15), new smokers had a risk of 1.26 (95% CI: 0.59, 2.68), and long-term quitters had a risk of 1.11 (95% CI: 0.64, 1.91). There was a significant 19% risk reduction in all-cause mortality for new quitters. CONCLUSION: Smoking cessation was associated with a significant reduction in mortality risk within approximately 6 years, while no significantly increased risk was observed for long-term quitters.

Management of rotator cuff calcific tendinosis guided by ultrasound elastography.

BACKGROUND: Ultrasound (US) elastography can provide information about the hardness of calcification and might help decide treatment strategy. The purpose of this study was to evaluate the hardness of the calcific area within rotator cuffs by US elastography as an aid for the selection of aspiration or fine-needle repeated puncture for the treatment of rotator cuff calcific tendinosis. METHODS: This prospective study included 39 patients (32 males, 7 females; mean age, 52.9 years) who received US elastography and gray-scale ultrasonography before US-guided treatment for rotator cuff calcific tendinosis. The morphology of the calcifications was classified as arc, fragmented, nodular, and cystic types. US elastography using virtual touch imaging (acoustic radiation force impulse) technique was performed to examine the calcified region to obtain an elastogram that was graded dark, intermediate, or bright. The hardness of the calcifications were recorded, and graded as hard, sand-like, or fluid-like tactile patterns during the US-guided treatment, and the tactile patterns were compared with the results of US elastography and gray-scale ultrasonography. RESULTS: Though the morphologies of the calcifications were significantly related to the tactile pattern of the needle punctures (p < 0.001), gray-scale US could not accurately demonstrate the hardness of the calcifications. With the aid of elastography, the fluid-like tactile pattern could be predicted well as a nondark pattern by elastography (p < 0.001). CONCLUSION: Ultrasound elastography is a useful modality for evaluation of rotator cuff calcific tendinosis, and as an aid to guide management. If elastography shows the calcified area as a non-dark pattern, then fine-needle aspiration should be performed.

Comparison of the analgesic effect of xylocaine only with xylocaine and corticosteroid injection after ultrasonographically-guided percutaneous treatment for rotator cuff calcific tendonosis.

BACKGROUND: The analgesic effect of xylocaine alone versus xylocaine with corticosteroid injection after ultrasonographically (US)-guided treatment of rotator cuff calcific tendonosis has not been described in English literature. The aim of this study was to compare the analgesic effect of xylocaine only with xylocaine and corticosteroid following US-guided percutaneous treatment of rotator cuff calcific tendonosis. METHODS: This prospective study enrolled 88 patients who were given different analgesic treatments [xylocaine only, n = 23; xylocaine with corticosteroid, n = 44; control (no xylocaine or corticosteroid), n = 21]. The assessment of a patient's painful symptoms was recorded before treatment, and 1 day, 1 week, 1 month and 3 months after treatment using the visual analogue scale (VAS). RESULTS: There were no significant differences in age, sex, calcification size before and after treatment, and amount of calcification decrease after treatment, but there was a significant difference in calcification morphology among the groups (p = 0.010). General linear model analysis indicated that the three groups had no difference in pain prior to treatment. After treatment, the xylocaine only and the xylocaine with corticosteroid groups had less pain than the control group at 1 day, 1 week, and 1 month after treatment. At 3 months after treatment, the xylocaine only group had less pain than the control group (p = 0.039), and the xylocaine with corticosteroid and control groups had similar levels of pain. CONCLUSION: Injection of xylocaine alone after US-guided treatment of rotator cuff calcific tendonosis provided a longer pain relief period than that of a mixture of xylocaine with corticosteroid.

Color Doppler ultrasonography evaluation for chemotherapy treatment response of osteogenic sarcoma.

The aim of this study was to evaluate the vascular parameters of the proximal peripheral arteries of limbs by color Doppler ultrasonography (CDUS) in individuals with osteogenic sarcoma (OGS) after neoadjuvant chemotherapy and their relation to the tumor necrosis rate. We recruited 50 individuals with osteogenic sarcoma who were scheduled for neoadjuvant chemotherapy before elective surgery from 2003 to 2010. Once enrolled, we evaluated these 50 subjects using color Doppler sonography to identify vascular parameters of tumor vessels before and after neoadjuvant therapy. The vascular parameters of the proximal peripheral arteries of limbs (peak systolic velocity [PSV], end-diastolic velocity [EDV], resistive index [RI]) and tumor neovascularity were compared before and after neoadjuvant chemotherapy using CDUS. Before chemotherapy, the PSV, EDV and RI differed significantly between the diseased and contralateral normal limbs (p < 0.001). Among the factors relating to the tumor necrosis rate before chemotherapy, the EDV of the diseased limb (p = 0.047) and tumor neovascularity (p = 0.027) showed significant differences. After chemotherapy, the PSV of the diseased limb (p = 0.022) and the difference in PSV between the diseased and contralateral limbs (p = 0.003) showed significant differences. The vascular parameters of the proximal peripheral arteries of limbs owing to tumor burden differ significantly between the diseased and contralateral normal limbs. For individuals with osteogenic sarcoma who still have a higher difference in PSV between the diseased and contralateral limbs after chemotherapy, another course of chemotherapy after surgery and close follow-up should be considered.

Radiofrequency ablation for recurrent hepatocellular carcinoma in postresectional patients: prognostic factors analysis.

BACKGROUND: Percutaneous ablation therapies can be used for recurrent hepatocellular carcinoma (HCC) in postresectional patients not eligible for repeat surgery. AIMS: To determine prognostic factors affecting the disease-free survival of postresectional patients after percutaneous ultrasound-guided radiofrequency ablation (RFA) for recurrent HCC. METHODS: From August 2003 to December 2009, patients who had received previous hepatectomy because of HCC and suffered from tumor recurrence were included. Among them, 82 patients who received initial percutaneous ultrasound-guided RFA were included. Various host, treatment, and therapeutic-related factors were analyzed. RESULTS: Eighty-two patients (64 men, mean age 64.27 years) were included. Sex (P=0.495), age (P=0.840), hepatitis marker (P=0.083), and Child-Pugh score (P=0.809) were not related to prognosis. Preresectional tumor number (P=0.502), recurrent tumor location (P=0.795), recurrent tumor number (P=0.533), pathology proved cirrhosis (P=0.889), and OKUDA stage of the primitive disease (P=0.865) were not related to prognosis, either. Survival rates were significantly related to the preresectional tumor size (P=0.008), microscopic portal vein invasion (P=0.001), recurrent tumor size (P<0.001), and preablation α-fetoprotein serum level (P=0.006). Ablation needle (P=0.373), ablation time (P=0.387), and postablation temperature (P=0.444) were not related to prognosis. Multivariate analysis revealed that microscopic portal vein invasion was the only factor that had a significant effect on patient survival. CONCLUSION: In patients with postresectional HCC treated with percutaneous ultrasound-guided RFA for recurrent disease, those without microscopic portal vein invasion had a significantly higher probability of disease-free survival.

Right hepatic artery pseudoaneurysm ruptured into the gallbladder demonstrated by magnetic resonance angiography.

Rupture of a right hepatic artery pseudoaneurysm into the gallbladder is very rare. We demonstrated a 20-mm dumbbell-shaped pseudoaneurysm in the gallbladder lumen by using contrast-enhanced magnetic resonance angiography in a 73-year-old man with acute right upper abdominal pain. Inflammation of the gallbladder caused by calculous cholecystitis, which leads to biliary leakage and erodes the right hepatic artery, could have been the cause.