ABSTRACT
An exponential rise in the use of cross-sectional imaging has led to an increase in the incidental identification of pancreatic cystic lesions (PCL); however, with many subtypes defined to date and heterogeneous morphology with often absent defining radiological features, PCLs present a diagnostic challenge. Computed tomography (CT) and/or magnetic resonance imaging (MRI) alone are frequently not sufficient to provide accurate characterisation. Endoscopic ultrasound (EUS) has an important role in the evaluation and classification of PCLs through its ability to define the internal architecture, which is further enhanced by the use of contrast medium. It is also used widely for the surveillance of larger cysts (>2 cm), which are associated with a greater malignant potential. The aim of this review is to demonstrate the role of contrast-enhanced (CE)-EUS in the diagnosis and risk stratification of PCLs. The features of the main non-neoplastic and neoplastic PCLs observed on CE-EUS are provided. When used in combination with other imaging techniques and patient characteristics, CE-EUS offers a more accurate assessment of PCLs and aids risk stratification. Additionally, CE-EUS enables assessment of parenchymal perfusion improving the precision of cyst characterisation and targeted biopsy of worrisome components. The International Consensus Guidelines recommend regular follow up for patients with mucinous or indeterminate PCLs that are fit enough for surgery. With the growing range of tools available to assess PCLs including CE-EUS, it is hoped that patients can be steered towards surgery, surveillance, or discharge with increasing accuracy.
Subject(s)
Pancreatic Cyst , Pancreatic Neoplasms , Endosonography , Humans , Pancreas/diagnostic imaging , Pancreas/pathology , Pancreatic Cyst/diagnostic imaging , Pancreatic Cyst/pathology , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Synovial chondromatosis (SC) is a rare condition with a very variable clinical presentation, thus making the diagnosis not immediate. We report a case of massive primary SC of the knee, properly evaluated with X-rays, ultrasonography and magnetic resonance imaging and successfully treated with an arthroscopic approach.
Subject(s)
Chondromatosis, Synovial/diagnostic imaging , Knee Joint/diagnostic imaging , Adult , Humans , Male , RadiographyABSTRACT
We report a case of unilateral Keros type III variant of the cribriform plate (olfactory fossa >7 mm deep) that caused non-traumatic pneumocephalus. A 61-year-old male patient presented to the emergency room complaining of acute-onset headache after blowing his nose. Computed tomographic (CT) examination showed a massive pneumocephalus; a CT scan from three months before showed a Keros type III variant. The defect was repaired endoscopically with mucoperichondrial and mucoperiostal grafts. Pneumocephalus that has developed in a Keros type III variant has been theorised about, but never reported to our knowledge. Radiologists should be familiar with the Keros classification so that they can identify patients who are at increased risk of fractures of the cribriform plate.
Subject(s)
Ethmoid Bone , Fractures, Bone , Pneumocephalus , Ethmoid Bone/injuries , Fractures, Bone/complications , Fractures, Bone/etiology , Humans , Male , Middle Aged , Nose , Pneumocephalus/etiology , Tomography, X-Ray ComputedABSTRACT
La pancreatitis autoinmune (PAI) es una forma distinta de pancreatitis crónica, que se caracteriza por un mecanismo patogénico autoinmune. Su frecuencia es levemente mayor en los pacientes de sexo masculino (60%) y la edad promedio de presentación oscila entre los 40 y 60 años, aunque el rango etario es mucho más amplio (de 14 a 80 años). Desde el punto de vista histológico, la PAI se presenta con un infiltrado inflamatorio denso, de extensión variable, que puede ser focal o comprometer difusamente todo el páncreas. Su presentación clínica en la mayoría de los casos es inespecífica: dolor abdominal leve y rara vez síntomas de pancreatitis aguda, pérdida de peso o ictericia. Varios estudios han descrito un compromiso multiorgánico por el proceso autoinmune, indicando la naturaleza sistémica de la enfermedad. En 2011 el Consenso Internacional de Criterios Diagnósticos de la Pancreatitis Autoinmune (ICDC, por sus siglas en inglés) establecieron las directrices o guías diagnósticas, estipulando que la resonancia magnética (RM) y la colangiopancreatografía por RM (CPRM) constituyen las técnicas diagnósticas cardinales. En este trabajo presentamos las características imagenológicas de la PAI, sus diagnósticos diferenciales y hallazgos en imágenes luego del tratamiento y seguimiento. Adicionalmente, comunicamos nuestra experiencia en esta enfermedad problemática y poco frecuente.
Autoimmune pancreatitis (AIP) is a distinct form of chronic pancreatitis caused by an autoimmune pathogenetic mechanism. It affects males (60%) slightly more frequently, and generally occurs between 40 to 60 years, although the possible range is much wider (14-80 years). Histologically AIP is characterised by the presence of a dense inflammatory infíltrate, with variable extensión. It can be focal or diffuse throughout the whole páncreas. Clinical presentation in most cases is non-specific, with patients presenting with mild abdominal pain, rarely, acute pancreatitis symptoms, weight loss, and jaundice. Several studies reported múltiple organ involvement due to the autoimmune process, suggesting a systemic nature of the disease. In 2011 the International Consensus Diagnostic Criteria for autoimmune pancreatitis (ICDC) defined the guidelines, and magnetic resonance imaging (MRI) and MR-cholangiopancreatography (MRCP) became the reference diagnostic technique in the diagnosis of the disease. This paper will review the imaging characteristics, the differential diagnosis, and the imaging features after treatment and follow up. Furthermore, our experience in this uncommon and challenging disease is reviewed.