[Rupture of renal cyst secondary to blunt trauma: case report and review of the literature].

Rupture of a renal cyst can be spontaneous, iatrogenic or consequent to a trauma even of minor entity, especially in predisposing conditions such as cysts, tumors or hydronephrosis. Kidneys are, in fact, involved in about 25% of abdominal traumas. The grading system of the American Association for the Surgery of Trauma (AAST) classifies renal injuries into five categories based on renal involvement and abnormalities detected on contrast-enhanced CT, modality of choice in the evaluation of abdominal trauma with suspicion of intraperitoneal hemorrhage. Hematuria and/or flank pain are the most frequent presenting symptoms, although some patients may be also asymptomatic. Treatment is usually conservative, but sometimes nephrectomy may be necessary. In our manuscript we describe the case of a patient who comes to our observation with left side pain reporting a minor accidental fall occurred the day before. Ultrasound examination and CT with contrast medium revealed hemoretroperitoneum resulting from rupture of a hemorrhagic renal cyst. We will describe the imaging characteristics and therapeutic choices below.

The role of unhenanced CT in a ruptured parathyroid adenoma: A case report.

Acute bleeding is a rare and potentially life-threatening complication of a Parathyroid Adenoma described in just a few cases in literature. We describe the case of a healthy 53-years-old female patient without prior history of parathyroid pathology who presented with acute onset of neck and mediastinal hemorrhage. Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) combined with laboratory tests led to the diagnosis of a bleeding Parathyroid adenoma. This case is presented to sensitize both Radiologists and Clinicians about this rare presentation that should be put into differential diagnosis of acute neck swelling and pain.

Percutaneous "Y" biliary stent placement in palliative treatment of type 4 malignant hilar stricture.

BACKGROUND: This study evaluated the technical and clinical efficacy of percutaneous bilateral biliary stent-in-stent (SIS) deployment technique with a "Y" configuration using open-cell-design stents in type 4 Klatskin tumor patients. METHODS: Retrospective evaluation ten patients with type IV Bismuth malignant hilar stricture (MHS) treated with percutaneous bilateral "Y" SIS deployment technique placement followed in our institution between March of 2012 and November of 2014. RESULTS: Bilateral SIS deployment was technically successful in all patients. One patient (10%) had major complications (episode of cholangitis); one patient (10%) had minor complications, including self-limiting hemobilia. Successful internal drainage was achieved in nine (90%) patients. Stent occlusion by tumor overgrowth and sludge formation occurred in two patient (20%). The median survival and stent patency time were 298 and 315 days respectively. CONCLUSIONS: Percutaneous bilateral metal stenting using a Y-stent is a valid option for the palliative treatment of type 4 Bismuth MHS, improving quality patient' life.

Alpha-fetoprotein and ultrasonography screening for hepatocellular carcinoma.

Although there is no definitive evidence that hepatocellular carcinoma (HCC) screening in high-risk groups improves survival, many physicians screen high-risk populations with various strategies. alpha-fetoprotein (AFP) and liver ultrasonography (US) are the most widely used tools. AFP sensitivity and specificity depend on the cut-off value chosen. In cirrhotic patients, using a cut-off level of 20 ng/mL, sensitivity is only around 60% and positive predictive value ranges from 9% to 50%, depending on HCC prevalence. Sensitivity and specificity are much higher (94.1% and 99.9%, respectively) in hepatitis B carriers, but positive predictive value is only 5%. The performance of US as a screening tool varies widely depending on the experience of the examiner and the technology used. Recent studies generally indicate a 60% sensitivity or higher, a specificity greater than 90%, and a positive predictive value of 70%. The cost effectiveness of screening strategies using AFP, US, or both have been estimated retrospectively or using decision models. In general, HCC screening using both AFP and US appears to be of borderline cost effectiveness or not cost effective at all. Based on the estimated HCC doubling time, the recommended screening interval is 6 months, although a 1-year interval seems as effective. Currently, HCC screening with AFP only is not recommended except when US is either not available or of poor quality. US seems more efficient as a screening tool. Pathology assessment of liver explants in living-donor transplantation programs will provide more precise and reliable information regarding the value of AFP and US as HCC screening tools.