Indeterminate liver lesions on gadoxetic acid-enhanced magnetic resonance imaging of the liver: Case-based radiologic-pathologic review.

Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology. It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently, but also certain benign lesions have differing management. These lesions are increasingly being detected due to rapid growth of use of cross-sectional imaging as well as improvement in image quality and new imaging techniques. Contrast enhanced magnetic resonance imaging (MRI) is considered the gold standard technique in characterising focal liver lesions. Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities. Classic imaging characteristics of common liver lesions, including their behaviour on gadoxetic acid enhanced MRI, have been described in literature over recent years. It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis. In this article, we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting, namely hepatocellular adenoma, focal nodular hyperplasia, hepatic angiomyolipoma, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.

Intra-peritoneal mature benign cystic teratoma deposits: an unusual complication from previous surgical resection of an ovarian mature benign cystic teratoma.

In this case, we describe multiple unusual intra-peritoneal lesions containing fat, soft tissue and calcification. These were found radiologically and histologically to be in keeping with mature benign cystic teratoma intra-peritoneal deposits, also described as dermoid cysts. These were presumed to be due to seeding from surgical resection of ovarian mature benign cystic teratoma 5 years previously. This surgical complication has not been well documented thus far in the literature.

Sigmoid-gluteal fistula: a rare complication of fistulating diverticular disease.

A rare complication of diverticular disease is the formation of fistulas, most commonly either colo-vesical or colo-vaginal. We present the unusual case of a perforated sigmoid diverticulum forming a colo-gluteal fistula and presenting initially as a gluteal abscess in an otherwise asymptomatic patient. After drainage of the gluteal abscess, the patient re-presented with faecal loss from the abscess drainage site. Imaging revealed fistulous communication between the sigmoid and the left obturator internus muscle, tracking to the gluteus maximus with associated abscess and cutaneous communication to the site of previous drainage. The patient underwent an emergency Hartmann's procedure with lay open/abscess drainage of the gluteal cavity. Post-operatively the patient experienced continuing discharge from the gluteal fistula despite repeated drainage and debridement causing considerable morbidity, inconvenience and misery. Clinicians should maintain a high index of suspicion when presented with a gluteal abscess and should consider the possibility of an intra-abdominal source.