An appraisal of the computed axial tomographic appearance of the human mesentery based on mesenteric contiguity from the duodenojejunal flexure to the mesorectal level.

OBJECTIVE: The human mesentery is now regarded as contiguous from the duodenojejunal (DJ) to anorectal level. This interpretation prompts re-appraisal of computed tomography (CT) images of the mesentery. METHODS: A digital model and reference atlas of the mesentery were generated using the full-colour data set of the Visible Human Project (VHP). Seventy one normal abdominal CT images were examined to identify mesenteric regions. CT appearances were correlated with cadaveric and histological appearances at corresponding levels. RESULTS: Ascending, descending and sigmoid mesocolons were identifiable in 75%, 86% and 88% of the CTs, respectively. Flexural contiguity was evident in 66%, 68%, 71% and 80% for the ileocaecal, hepatic, splenic and rectosigmoid flexures, respectively. A posterior mesocolic boundary corresponding to the anterior renal fascia was evident in 40% and 54% of cases on the right and left, respectively. The anterior pararenal space (in front of the boundary) corresponded to the mesocolon. CONCLUSIONS: Using the VHP, a mesenteric digital model and reference atlas were developed. This enabled re-appraisal of CT images of the mesentery, in which contiguous flexural and non-flexural mesenteric regions were repeatedly identifiable. The anterior pararenal space corresponded to the mesocolon. KEY POINTS: The Visible Human Project (VHP) allows direct identification of mesenteric structures. Correlating CT and VHP allows identification of flexural and non-flexural mesenteric components. Radiologic appearance of intraperitoneal structures is assessed, starting from a mesenteric platform.

Osteopoikilosis masquerading as osseous metastases in breast cancer.

Osteopoikilosis (OPK) is a rare, congenital bone disorder characterised by multiple round or ovoid radio densities appearing throughout the axial and appendicular skeleton. It is usually an asymptomatic condition diagnosed incidentally on radiological imaging, and may mimic other bone disorders, including osseous metastases. In this case report, we present a patient with lobular breast cancer whose computed tomography findings were thought to be consistent with osseous cancer metastases. Radionuclide bone scintigraphy plays a key role in distinguishing OPK from osteoblastic bone metastases. This case demonstrates the importance of a clinical awareness of OPK to ensure that patients with potentially curable disease are properly diagnosed.

Isolated pharmacomechanical thrombolysis plus primary stenting in a single procedure to treat acute thrombotic superior vena cava syndrome.

PURPOSE: To report a combined procedure that opens the acutely thrombosed superior vena cava (SVC) to rapidly alleviate symptoms in seriously ill patients with SVC syndrome. CASE REPORTS: Four patients aged 54 to 63 years old with underlying malignancies were referred for treatment of SVC syndrome. All received isolated pharmacomechanical thrombolysis (IPMT) with tissue plasminogen activator delivered in a Trellis Peripheral Infusion System that removed obstructive clot in minutes versus the 24 to 48 hours required for traditional catheter-directed thrombolysis. In each case, stents were inserted immediately following IPMT in a combined procedure lasting <1 hour. Patients exhibited near-immediate relief of debilitating symptoms; completion venography demonstrated patent vessels with excellent blood flow. CONCLUSION: Combining IPMT with immediate stenting during the same session is an effective method for managing acute thrombotic SVC syndrome and limiting the exposure time and number of interventions performed on seriously ill patients.

Isolated limb infusion: technique description and clinical application.

Isolated limb infusion (ILI) is a recently described minimally invasive technique indicated in the management of regionally advanced cancers refractory to systemic therapy and surgery. The present report describes the initial single-center experience of three patients with regionally advanced peripheral melanoma and one with lower-extremity cutaneous T-cell lymphoma treated over a period of 1 year. It is feasible to perform the complete ILI procedure in a single 60-100-minute session, solely in the interventional radiology suite, without a requirement for patient transfer to the operating room or extra waiting time between catheter insertion and chemotherapy infusion treatment.