Contribution of boars to reproductive performance and paternity after homospermic and heterospermic artificial insemination.

Heterospermic AI is commonly used in swine despite preventing precise evaluation of individual boar fertility. The present study compared the contribution of four boars (A, B, C and D) for reproductive performance and for paternity using homospermic and heterospermic (AB, AC, AD, BC, BD and CD) AI (n=204 for homospermic AI; n=307 for heterospermic AI). Blood samples from the four boars, from all sows inseminated with heterospermic doses and from the umbilical cords of their piglets, as well as tissue smears from mummified fetuses, were genotyped using single nucleotide polymorphisms (SNPs). Differences among boars were detected for the in vitro oocyte penetration rate and for the number of spermatozoa per oocyte (P<0.05), but not for sperm motility, mitochondrial functionality and integrity of the membrane, acrosome and DNA (P>0.05). Homospermic and heterospermic AI resulted in similar (P>0.05) farrowing rates (90.5% and 89.9%, respectively) and total litter size (12.4±0.4 and 12.7±0.7, respectively). Farrowing rate was lower for Boar B than for Boar C (P<0.05), but no other differences in reproductive performance among boars were observed with homospermic AI. The SNPs determined the paternity of 94.2% of the piglets sired by heterospermic AI. In the AC pool, paternity contribution per boar was similar (P>0.05), but differences between boars occurred in all other pools (P<0.05). Boar D achieved the greatest paternity contribution in all pools and parity categories (nearly 60%), whereas Boar B sired the fewest piglets (at most 40%). Reproductive performance was similar with homospermic and heterospermic AI, but differences in performance among boars undetected with homospermic AI were only evident after genotyping the piglets sired through heterospermic AI.

Intra-arterial thrombolysis of acute hand ischaemia with or without microcatheter: preliminary experience and comparison with the literature.

PURPOSE: This paper evaluates the indications, techniques, results, and complications of intra-arterial thrombolysis with or without a multihole microcatheter in three cases of acute hand ischaemia in comparison with the literature. MATERIALS AND METHODS: Three men (mean age 39 years) with symptoms and signs of acute hand ischaemia (i.e. pain, pallor, cyanosis, decreased motor or sensory function) were studied with Doppler ultrasound and selective arteriography, which demonstrated acute clotting of wrist and/or hand arteries. They therefore underwent intra-arterial thrombolysis with the administration of urokinase and vasodilators and heparin if necessary, with (n=2) or without (n=1) multihole microcatheters. RESULTS: In all three cases, partial or complete recanalisation of the occluded arteries was achieved, with almost complete remission of clinical symptoms and good recovery of hand function. CONCLUSIONS: Percutaneous intra-arterial thrombolysis is an effective therapeutic approach in cases of acute hand ischaemia and is a valid alternative to surgical thrombectomy. Multihole microcatheters allow the thrombolytic agent to be distributed more evenly into the clot and may help to reduce reactive arterial spasm.

Role of echocardiography and cardiac MRI in depicting morphological and functional imaging findings useful for diagnosing hypertrophic cardiomyopathy.

PURPOSE: Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterised by primary hypertrophy of the left and/or right ventricle. The reference standard for imaging diagnosis is echocardiography. The aim of our study was to prospectively compare the diagnostic accuracy of echocardiography and cardiac magnetic resonance (MR) imaging in patients with HCM. MATERIALS AND METHODS: Twenty-two consecutive patients with a known diagnosis of HCM were prospectively evaluated, with echocardiography and cardiac MR imaging performed within 2 weeks of each other (mean interval 7 days, range 2-14 days). Two experienced radiologists blinded to the previous clinical and imaging findings separately reviewed the images. The following parameters were calculated for both techniques: myocardial mass, wall thickness, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), systolic anterior motion (SAM) of the mitral valve and degree of myocardial fibrosis (based on the ultrasonic reflectivity at echocardiography and degree of late enhancement at cardiac MR imaging). The statistical correlation was calculated with Student's t test, Spearman coefficient and Fisher's exact test. A value of p<0.05 was considered significant. RESULTS: The diagnosis of HCM was confirmed in all patients with both techniques, with absolute agreement in terms of the site of disease. The mean value of myocardial mass presented a statistically significant difference between the two techniques (114 g, p<0.001). In contrast, a nonsignificant difference between echocardiography and cardiac MR imaging was found for EDV (102 ml vs 111 ml; p=0.31), ESV (30 ml vs 38 ml; p=0.1), EF (74% vs 68%, p=0.5), SAM (p=0.1) and myocardial fibrosis (p=0.15). CONCLUSIONS: Cardiac MR imaging correlates well with echocardiography in defining the morphological and functional parameters useful for the imaging diagnosis of HCM and therefore, in selected cases (poor acoustic window, doubtful echocardiography findings), it may be a valid alternative to echocardiography.

Bleeding control by radiofrequency in penetrating trauma of the liver.

Termocoagulation by radiofrequency (RF) is widely used for ablation of liver neoplasms. Recently, innovative uses of RF were proposed, as to assist liver resection, to help partial splenectomy, or to treat ruptured hepatocellular carcinoma. A 21 years old man was admitted for massive haemorrhage from a right thoraco-abdominal knife wound. Massive haemothorax was drained but arterial bleeding was caused by a deep penetrating wound on liver segment VIII. During operation, considering the difficult exposure of the source of bleeding, it was taught to stop haemorrhage using RF termocoagulation, under ultrasonographic guidance. Termocoagulation of the pedicle of the liver segment VIII was performed. In this patient with haemorrhagic shock the RF method for bleeding control was very easy and effective, and avoided risks of morbidity due to a major procedure.

High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients.

PURPOSE: The objective of this study was to demonstrate that nontuberculous mycobacteria (NTM) pulmonary infections are not so infrequent and that the diagnosis may be suggested on the basis of the high-resolution computed tomography (HRCT) pattern alone. MATERIALS AND METHODS: We retrospectively reviewed HRCT scans of 29 patients (9 men, 18 women; mean age 63 years, range 38-88 years) with positive culture from bronchial wash. Mycobacterium avium complex (MAC) was present in all (with the exception of one in whom the NTM was indistinct). In six patients, MAC was associated with M. chelonae, M. kansasii, M. fortuitum or M. xenopi. In one of these patients, MAC was associated with both M. fortuitum and M. chelonae. All patients had had nonspecific symptoms of pulmonary infection for a time ranging from 6 months to 12 years. Previous tuberculous infection was present in five patients (18.5%). Eleven patients had other pulmonary diseases (40.8%), and 12 had associated systemic diseases (44.4%). RESULTS: HRCT findings were apical fibrotic scarring (n=8; 29.6%), consolidations (n=16; 59.2%), single/multiple nodules >1 cm (n=8, multiple; 29.6%), cavitations (n=7; 25.9%), ground glass appearance (n=3; 11.1%), reticular/reticulonodular pattern (n=6; 22.2%), bronchiectasis (n=25; 92.5%), centrilobular nodules (tree in bud) (n=24; 88.8%), air trapping (n=8; 29.6%), lymphadenopathy >1 cm, also with calcification (n=13, 3 with calcification; 48.1%) and pleural effusion (n=2; 7.4%). In 3/7 patients with nodules >1 cm and with cavitations, the "feeding bronchus sign" (a patent bronchus running into a cavitation) was present. Lesions were in the upper lobes in 23 (85.1%), middle lobe/lingula in 25 (92.5%) and lower lobes in 18 (66.6%) patients. The findings were diffuse in 13 (48.1%) cases and patchy in 17 (62.9%). CONCLUSIONS: HRCT findings are essential for the diagnosis of NTM pulmonary infection. The presence of bronchiectasis, cavitary nodules with feeding bronchus sign and tree-in-bud nodules in the middle lobe and lingula are suggestive of NTM infection, thus assisting the physician in the diagnostic workup of these patients.

MR imaging findings of elastofibroma dorsi in correlation with pathological features: our experience.

PURPOSE: This paper describes the role of magnetic resonance (MR) imaging for characterising elastofibroma dorsi in correlation with pathological findings. MATERIALS AND METHODS: Over a period of 9 years, 1,233 MR examinations of the periscapular region assessed for the presence of elastofibroma dorsi with superconductive 1.5-T MR scanners at three different radiology institutes were retrospectively reviewed. RESULTS: Our study population included 15 patients (12 women, three men; mean age 58 years, range 28-82 years) presenting with 17 lesions. Two patients had bilateral elastofibroma dorsi. Thirteen of 15 patients underwent MR examination for clinical suspicion of a lesion located in the periscapular region, whereas in 2/15 cases it was an incidental finding during MR examination performed for other diseases. Diagnosis of elastofibroma dorsi was confirmed by histopathology in 11/17 cases. The remaining lesions were considered benign, as their size and morphology did not change over a mean follow-up period of 1.5 years. CONCLUSIONS: MR imaging with its multiplanar capabilities and high-contrast resolution has a high level of accuracy in characterising elastofibroma dorsi and may avoid the need for biopsy or surgical operation.

Strangulated traumatic hernia of the diaphragm. A report of two cases.

The herniation of abdominal viscera in the thorax can immediately follow diaphragmatic rupture or be delayed even years after the injury. The herniated viscera can strangulate; this consequence may lead to a dangerous misdiagnosis which could be lethal for the patient. Radiological procedures, serial chest X-ray studies, CT and MRI scans are mandatory to confirm diagnosis. The insertion of a naso-gastric tube is a very helpful method in ruling out hypertensive pneumothorax in the presence of an air-fluid level in the thorax. We report 2 cases of strangulated traumatic hernia of the diaphragm occurring just a few hours (case 1) and 18 months (case 2) after the trauma. During thoracotomy, a rupture of the left diaphragmatic cupola was demonstrated with herniation of the stomach in case 1, the stomach, spleen and transverse colon in case 2. No postoperative mortality or morbidity were detected.

Role of magnetic resonance in characterising extrahepatic cholangiocarcinomas.

PURPOSE: The purpose of this study was to evaluate the accuracy of magnetic resonance (MR) in correctly locating and characterising biliary strictures in patients affected by extrahepatic cholangiocarcinoma, identify findings suggestive of the disease, identify lesions with similar MR features and possible criteria for differential diagnosis and establish prospective MR accuracy in diagnosis of malignant obstruction of extrahepatic bile ducts. MATERIALS AND METHODS: We retrospectively reviewed the MR examinations of 39 patients affected by extrahepatic cholangiocarcinoma confirmed by histology or cytology. The studies were evaluated for the following parameters: site of obstruction (hilar, proximal or distal), presence of intra- or extrahepatic dilation of bile ducts, morphology of ductal stenosis (gradual tapering or abrupt ending), morphology of the lesion (mass like or circumferential), dimension, signal intensity before contrast medium administration and lesion enhancement after administration of contrast medium. Finally, we assessed the most useful sequence for the diagnosis. In order to evaluate MR accuracy in the diagnosis of malignant obstruction of extrahepatic bile ducts, we prospectively reviewed MR examinations of 74 patients affected by obstructive jaundice (55 malignant lesions and 19 inflammatory lesions). MR diagnosis was compared with histology or cytology considered as the gold standard. RESULTS: MR allowed identification and localisation of 41/41 extrahepatic cholangiocarcinomas. Fifty-four percent of the lesions showed gradual duct tapering; the remaining lesions showed an abrupt ending. Fifty-six percent of the lesions appeared as a circumferential thickening (infiltrative growth); the remaining lesions had a mass-like appearance (expansile growth). Most lesions were hypo- (49%) or isointense (49%) in T1-weighted sequences and hyper- (49%) or isointense (51%) in T2-weighted sequences. Ninety-five percent of the lesions did not enhance significantly in the arterial phase while 98% showed late enhancement (10 min). The most diagnostic sequence (in 76% of cases) was the late-phase gradient-echo (GRE) T1 fat-saturated sequence. MR had good sensitivity (91%) but poor specificity (47%) in characterising stenosis as malignant, given the large number (10/19) of benign lesions evaluated as neoplastic lesions. CONCLUSIONS: MR almost always identified the cause of stenosis and suggested its neoplastic nature if it exhibited a mass-like appearance (extraductal or growing into the choledochus). On the other hand, lesions with parietal thickening, particularly if smaller than 1 cm, require endoscopic cytology or histology because of the high risk of unnecessary procedures for benign lesions.

Doppler ultrasound and contrast-enhanced magnetic resonance angiography in assessing carotid artery stenosis.

PURPOSE: This study prospectively compares Doppler ultrasound (Doppler US) and contrast-enhanced magnetic resonance angiography (CE-MRA) with digital subtraction angiography (DSA) and endarterectomy findings to determine the accuracy in assessing carotid artery stenosis. MATERIALS AND METHODS: Thirty-two patients underwent carotid endarterectomy, 21 studied with Doppler US, CE-MRA and DSA and 11 with Doppler US and CE-MRA. In 41 carotid arteries, the degree of stenosis was analysed with Doppler US and CE-MRA and compared with DSA by using the Spearman rank correlation coefficient. Nine out of 32 endarterectomies were done using the eversion technique, and it was possible to compare Doppler US, CE-MRA and DSA with the specimen measurement. Twenty-three out of 32 endarterectomies were done using the standard technique, and the presence of ulcers was documented. RESULTS: There was a significant Doppler US/DSA (Rs=0.86; p<0.001) and CE-MRA/DSA (Rs=0.81; p<0.001) correlation for the degree of stenosis. The diagnostic accuracy of the three methods was the same (89%). Ulcers were most frequently seen at CE-MRA, with a diagnostic accuracy of 85%. CONCLUSIONS: These data suggest that endarterectomy on the basis of Doppler US and CE-MRA can be considered appropriate. CEMRA was the best noninvasive imaging modality to detect plaque ulceration.

Metabisulfite oral challenge: incidence of adverse responses in chronic childhood asthma and its relationship with bronchial hyperreactivity.

Fifty-six children with chronic asthma, 6 to 14 years of age, were studied to evaluate bronchoconstrictive airway responses after ingestion of varying doses of potassium bisulfite administered in one occasion in capsule and in another occasion in solution. With methacholine challenge before and after metabisulfite (MBS) provocation, the relationship of bronchoconstrictive responses and bronchial hyperreactivity was evaluated. Positive bronchoconstrictive responses were observed in only four children after the ingestion of a maximum dose of MBS in capsule and in two children after the ingestion of different doses of MBS solution. A high reactivity to methacholine challenge was present in all the reactive children. After MBS challenge, no additional changes in bronchial reactivity were observed either in the reactors or nonreactors.

Pelvic endometriosis: US and MRI features.

Endometriosis represents a common and important clinical problem of women of childbearing age. It is a disabling disorder manifesting with pain and infertility. The exact pathogenesis of the disease remains unclear, despite the different theories that have been formulated. The literature on endometriosis is extensive, but often in regard to classic endometrioma. It is surprising that, to the best of our knowledge, the many radiologic features of extraovarian endometriosis have not been well documented thus far. Although ultrasound (US) remains the imaging modality of choice in the radiologic evaluation of female patients with pelvic pain, the role of magnetic resonance imaging (MRI) in the evaluation of abdominal pain is expanding. In the young patient, MRI may be performed if a gynecologic disorder is not suspected at first, especially if US findings are equivocal or the abnormality extends beyond the field of view of the sonographic probe. Moreover, MRI is useful whenever further characterization of pelvic disorder is required. In fact, many causes of pelvic disorders and of endometriosis in particular demonstrate characteristic MRI findings. For these reasons, in this work we describe the protean US and MRI appearances of endometrial foci as encountered in daily experience.

Intraductal papillary mucinous tumors of the pancreas: spectrum of CT and MR findings with pathologic correlation.

The reports of intraductal papillary mucinous tumors (IPMT) of the pancreas are increasingly more frequent in the literature. The diagnosis by means of cross-sectional imaging of these tumors is not easy, especially in the early stages, when they can mimic an inflammatory disease of the pancreas. Prompt identification of the disease is nevertheless extremely important, especially in the case of tumors originating from the collateral branches, since its recognition can modify the management of the patient, in some cases obviating recourse to surgery.

Duodenal duplication cyst identified with MRCP.

We report a case of a stalked cystic duodenal duplication. The lesion, hyperintense on T2-weighted GRE images, maintained the signal intensity after oral administration of a negative contrast agent (Lumirem, Guerbet, Aulnay-Sous-Bois, France), confirming its independence from the duodenal lumen. To our knowledge, this is the first demonstration of duodenal duplication by means of MR cholangiopancreatography.

[Imaging of bronchogenic cysts]. / L'imaging delle cisti broncogene.

Bronchogenic cysts, unlike the other mediastinal cysts, exhibit a high incidence of complications, which makes their resection advisable even if no symptoms are present. The correct diagnosis should thus be made with the available imaging modalities. We reviewed our series of 11 bronchogenic cysts, all of them studied with conventional radiology (CR), as well as with such newer imaging modalities as CT and/or MRI. All mediastinal lesions had fluid density at CT and were homogeneously hyperintense on T2-weighted MR images. On the contrary, on T1-weighted images, some lesions were hypointense and some hyperintense, probably because of their rich protein content. In contrast, hilar or pulmonary lesions had air inside, except for one case--characterized by multiple localizations--in which the hilar lesion exhibited the same fluid density as the mediastinal lesions. The CT or MR finding of a lesion with fluid content below the carina permits a nearly unquestionable diagnosis of bronchogenic cyst since the other cystic lesions involve this region very rarely. In all the other cases, other types of mediastinal or hilar-pulmonary lesions cannot be ruled out. In particular, in case of cysts in paraesophageal site, no imaging modality permits to differentiate bronchogenic from enteric cysts; in some cases, the differential diagnosis may be impossible even with histology of the resected specimen.

Intraductal papillary mucinous tumor of the pancreas: a pictorial essay.

Intraductal papillary mucinous tumor (IPMT) of the pancreas was identified and classified only recently. IPMT has a primarily intraductal, papillomatous growth pattern, which is associated with excessive mucin secretion and results in progressive ductal dilatation or cyst formation. The tumor occurs in four forms: segmental or diffuse involvement of the main pancreatic duct and macrocystic or microcystic involvement of a branch duct. In the past, many IPMTs may have been misdiagnosed as chronic pancreatitis because of their generally benign behavior. The correct diagnosis, once achieved only with endoscopic retrograde cholangiopancreatography (ERCP), can now be made with noninvasive imaging modalities, particularly computed tomography (CT) and magnetic resonance (MR) imaging. ERCP remains the imaging modality of choice for diagnosis of IPMT. With ERCP, the communication between the cystically dilated ductal segment or branch duct and the main pancreatic duct is easily demonstrated. However, reflux of contrast material due to an excess of mucin or an enlarged papillary orifice hinders filling of the ductal tree. Filling defects due to mucin globs or mural nodules are also important clues to the diagnosis. Bulging of the papilla into the duodenal lumen is virtually pathognomonic of IPMT and is well demonstrated with CT or MR imaging.

Nonfunctioning endocrine tumors of the pancreas: possibilities of spiral CT characterization.

The aim of this study was to assess the ability of spiral CT to adequately characterize the nonfunctioning endocrine tumors (NFETs) of the pancreas, distinguishing this lesion from the other pancreatic tumors. The spiral CT examinations of 21 cases of histologically proven NFETs, along with those of 29 cases of other pancreatic tumors and tumor-like lesions, were retrospectively reviewed in a blinded fashion by two radiologists, in order to correctly classify the lesions, highlighting the typical signs reported in the literature. Discordant cases were further analyzed in the presence of a third radiologist. The final diagnosis was acquired by means of a majority or overall consensus. The histopathologic examination was considered the gold standard. The sensitivity, specificity, and positive and negative predictive values of CT were calculated. After the consensus evaluation, the correct diagnosis was reached in 72% of cases, with 10% of nonspecific diagnoses of solid pancreatic tumor and 18% of wrong diagnoses. The sensitivity and specificity of spiral CT in identifying NFETs were 66.6 and 82.7%, respectively. The positive and negative predictive values were 73.7 and 77.4%, respectively. In up to 70% of cases the NFET demonstrates a typical aspect of a mass hyperdense in the arterial contrastographic phase eventually associated with hyperdense hepatic metastases in more than half of the patients. This finding does allow the diagnosis of NFET but without certainty indeed, since other tumors can show a similar densitometric behavior and among them particularly the ductal adenocarcinoma. On the other hand, both the solid, hypovascularized NFETs, and the cystic form, cannot be differentiated from the other solid and cystic tumors of the pancreas.

CT features of malignant mucinous cystic tumors of the pancreas.

This study is aimed at evaluating which pre-operative findings at CT are prevailingly associated with histologically malignant appearance of mucinous cystic tumor (MCT) of the pancreas. The CT examinations of 52 female patients affected with pathologically proved MCT were retrospectively evaluated by two radiologists, blinded to the histopathological assessment of the biologic behavior (either benign or malignant). A multivariate logistic regression analysis was performed in order to identify the most important features associated with the malignant nature of MCT. Calcifications in the wall and/or in the septa, thick wall, and septations resulted in the most important features associated with malignancy. The simultaneous presence of all these radiological signs constitutes an almost "certain" marker of malignancy, being the risk equal to 0.95, whereas the simultaneous presence of at least two of them entails a risk of malignancy ranging from 0.56 to 0.74, according to the type of morphological features. On the other hand, the absence of the mentioned radiological features entails a negligible risk of malignancy (0.02). Mucinous cystic tumors characterized by multilocular macrocystic architecture, with thick wall and calcifications in the wall and/or the septa, present the highest risk of malignancy, and advocate prompt surgical intervention. When those signs are absent, the probability of malignancy is lower. In this case a non-operative management is possible.

Cystic pancreatic masses: cross-sectional imaging observations and serial follow-up.

BACKGROUND: We retrospectively reviewed the imaging features of a series of patients with cystic pancreatic masses, the majority of whom underwent imaging surveillance. METHODS: Imaging data from 30 patients with known cystic pancreatic masses were reviewed. Nine patients had surgical and/or cytologic classification. Of the 21 who were not operated on, all underwent serial imaging surveillance. Of these, five had corroborative endoscopic retrograde cholangiopancreatography and 16 were followed by only computed tomography and/or magnetic resonance imaging. RESULTS: In the nonoperated group, mean follow-up time was 30 months (3-144 months). Two patients demonstrated growth, and the remainder remain stable. In the patients who underwent surgery, invasive carcinoma was found in those with lesions larger than 4 cm, involvement of the main pancreatic duct, or visible solid components on the imaging study. Smaller lesions were benign. CONCLUSION: In patients with suspected cystic pancreatic neoplasms, surveillance might be possible if lesions are smaller than 2.5 cm, spare the main pancreatic duct, and demonstrate no solid components.

Serous cystadenoma of the pancreas: report of 30 cases with emphasis on the imaging findings.

PURPOSE: Our goal was to evaluate retrospectively 30 cases of serous cystadenoma (SCA) to determine its main imaging features as well as to discuss the differential diagnosis problems versus the other cystic lesions of the pancreas. METHOD: Thirty SCAs were analyzed; they were all benign lesions, proven at surgery. Twenty-three tumors were evaluated with US, 26 with CT, and 5 with MRI. RESULTS: Three different morphostructural patterns were identified: microlacunar (n = 19), mixed (n = 6), and macrolacunar (n = 5). The diagnosis of SCA, possible in either the microlacunar or the mixed patterns, was achieved in 74% of cases with US (17/23) and in 61.5% with CT (16/26). Among the 19 patients evaluated with both modalities, the joint information allowed a correct diagnosis in 16 cases (84%). The five macrolacunar tumors were undistinguishable from other cystic masses of the pancreas. CONCLUSION: The diagnosis of SCA can be considered certain in the microlacunar, likely in the mixed, and not possible in the macrolacunar type.

Blunt pancreatic trauma. Role of CT.

PURPOSE: To define the evolution patterns of blunt pancreatic trauma, and to point out the CT features most significant for the diagnosis. MATERIAL AND METHODS: Ten cases of pancreatic trauma, observed over a period of about 10 years, were analyzed in retrospect. The cases were divided into 3 groups according to the time that had elapsed between trauma and first CT: early phase (within 72 h: n=3/10); late phase (after 10 days: n=3/10); and following pancreatic drainage (n=4/10). RESULTS: In the early phase, one case showed a blood collection surrounding the pancreatic head and duodenum, and displacing the mesenteric vessels to the left. In the 2 other cases it was possible to demonstrate a tear in the pancreas at the neck, perpendicular to the main pancreatic axis. In the late phase in all 3 cases, one cystic lesion was present at the site of the tear, either surrounding the gland or embedded - more or less deeply - within the parenchyma. One of the lesions subsided spontaneously; the 2 others required surgery. In the postoperative phase, an external fistula was demonstrated in 2 cases following percutaneous drainage of pancreatic cysts; the fistula was fed by a cystic lesion in the pancreatic neck. In the 2 other cases a pseudocyst developed. CONCLUSION: Early demonstration of a parenchymal tear was difficult. At a later stage the diagnosis was easier owing to the demonstration of cystic lesions within the parenchyma at the site of the tear. The surgical drainage of this lesion does not usually lead to healing since an external fistula or a pseudocyst may develop.