Excavated mass and doubletracking in the sigmoid colon due to colocolic fistula complicating diverticulitis.

We report on a patient admitted for work up of prostatic carcinoma in which CT study showed an excavated mass involving the sigmoid colon and the bladder dome. Barium enema showed a double track pattern associated with diverticular disease. By surgery the mass was separated from the urinary bladder and the sigmoid resected. On pathological exam diverticulitis was evident as well as an organised colocolic fistula in the thickened fibrotic subserosal fat.The usefulness of opacifying the colon is highlighted.

Carcinoid tumor of the small intestine: MDCT findings with pathologic correlation.

BACKGROUND: MDCT currently frequently represents the first choice modality for imaging in acute or subacute abdominal conditions implicating the small bowel. As a consequence, the MDCT features of intestinal carcinoid tumors and of their peculiar metastatic spread have to be known by abdominal radiologists. PATIENTS AND METHODS: These features are described and illustrated in the retrospective review of seven proven cases of small intestine carcinoids diagnosed and treated in our institution. The findings are described and correlated with gross anatomy specimens. RESULTS: The primary tumour clearly appeared as a contrast-enhancing intraluminal lesion in all cases except in one case in which the primary lesion remained unlocalized and in another in which the primary tumour finally appeared infracted at gross anatomy. The maximal tumoral enhancement was obtained in 3 patients imaged during the acute arterial phase. The diameter of the primary tumour ranged from 1 to 3 cm and all masses were ileal comprising one lesion in the proximal ileum, two in the medium ileum and three in the distal ileum. 6/7 patients had multiple prominent mesenteric nodal metastases, all also appearing as hypervascularised enhancing masses. In 4/7 patients the nodal metastases represented the major finding being much prominent and larger than the primary tumour. Signs of retractile mesenteritis with soft tissue stranding, retraction and stellate pattern of the mesentery were found around the mesenteric metastases in 5/7 patients and direct incarceration of vessels were found in 3 cases. CONCLUSION: The analysis of the arterial phase of MDCT study appears primordial to detect the sometimes very small but intensively enhancing primary tumor and to delineate encasement or direct obstruction of mesenteric vessels frequently caused by enhancing nodal metastases which volume often exceeds that of the primary tumor. Secondary retractile mesenteritis, deformation or ischemia of bowel loops, and hypervascular hepatic metastases are typical associated findings.

The whirl sign in caecal volvulus: a decisive diagnostic clue.

The case of a 35-year-old woman with acute right flank pain, right iliac fossa pain, nausea and vomiting for 6 hours is presented. Plain abdominal radiography and CT scan were performed to find the etiology. These exams showed no signs of colonic obstruction but thickened non-enhancing wall of caecum with ascites was suggestive for ischemia. The whirl sign depicted on CT was the decisive feature for the diagnosis of caecal volvulus.

[Pictorial essay. Infarction of the greater omentum: can US and CT findings help to avoid surgery?]. / Infarctus du grand tablier epiploïque: quels signes echo-graphiques et tomodensitometriques permettent d'eviter la chirurgie?

Infarction with or without torsion of the greater omentum is an uncommon but well recognised acute abdominal condition which was seldom diagnosed preoperatively before the widespread clinical use of US and CT. The aetiology is unknown and speculative. In most cases the pathology is right sided and clinical presentation consists of an acute or subacute flank pain with mild peritonism usually evoking appendicitis or cholecystitis. Recently, US and CT have proved to provide sufficiently typical, consistent and well-recognizable features to avoid unnecessary surgery. We report on six typical -five right sided and one left sided- cases investigated with CT and US. Two patients underwent surgical treatment, one because the usually spontaneous regression of the entity was ignored and the other because of extremely severe clinical symptoms. In the other four patients, conservative medical management was preferred and successful. Even though US may be efficient if performed by a well-trained echographist, CT appears to be the procedure of choice as it is operator independent and reliable for excluding mimicking surgical conditions or associated pathology.

Epiploic appendagitis: color Doppler sonographic findings.

The aim of this study was to analyze the color Doppler sonographic findings in primary epiploic appendagitis. Color Doppler sonographic findings of ten patients with primary epiploic appendagitis were reviewed. The following sonographic features were analyzed: identification of a mass adjacent to the colonic wall; identification of spotty color areas with arterial flow in this mass and detection of abnormalities of the colonic wall adjacent to the infiltrated fatty tissue. A well-delineated hyperechoic mass adjacent to the colonic wall was detected in each patient with sonography. No colonic wall abnormalities were observed nor color Doppler signal in and around the hyperechoic area. Absence of flow at color Doppler sonography is an additional feature of epiploic appendagitis.