Sporadic giant intra-abdominal desmoid tumor: A radiological case report.

Desmoid tumor (DT) is a locally invasive form of fibromatosis, comprising only 0.03% of all tumors. DTs occur more frequently in patients with familial adenomatous polyposis and Gardner's syndrome, as intra-abdominal or anterior abdominal wall tumors, whereas sporadic DTs are more likely to be extra-abdominal (only 5% of sporadic DTs are intra-abdominal). There is also an association of DTs with prior trauma, surgery, estrogen exposure and childbirth. Imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI) are used for preoperative diagnosis and for the planning of the surgery. Following surgery, CT and MRI are used to detect recurrence and to monitor the tumor's response to radiotherapy or medical therapy for unresectable or recurrent tumors. We herein report a rare case of a sporadic giant intra-abdominal DT in a 28-year-old female patient without any predisposing factors, and highlight the importance of including DT in the differential diagnosis of huge intra-abdominal masses.

Transcatheter ovarian vein embolisation without renal vein stenting for pelvic venous congestion and nutcracker anatomy.

The diagnosis of a nutcracker syndrome can be aggravated by overlap of a nutcracker phenomenon with other pathologies. In patients with nutcracker anatomy and predominantly pelvic congestion symptoms, ovarian vein embolization without left renal vein stenting could be considered a first line therapy.

Safety of Radiographic Imaging in Pregnancy

There are many false assumptions, both in the general population and among physicians, regarding the influence of radiation on pregnant patients and the fetus during diagnostic procedures, in spite of scientific facts based on studies. These false assumptions are mostly based on the idea that every diagnostic procedure using ionizing radiation is a cause for serious concern and that artificial abortion as a possible solution might be considered. We analyzed data from counseling of pregnant patients exposed to ionizing radiation during diagnostic procedures in the Merkur University Hospital during a 4-year period. In this period, 26 patients presented for counseling after exposure to diagnostic ionizing radiation during pregnancy. Results showed most of these patients to have been exposed to radiation between the 2nd and 3rd week of gestation (36%), between the 4th and 5th week 32%, before the 2nd week 24%, and after the 6th week of gestation less than 8%. To provide reasonable estimate of fetal doses, Report No. 174 from the National Council on Radiation Protection and Measurements (NCRP) was used. Data from the Report include estimate of the fetal dose from direct and indirect exposures. Th e mean doses were up to 0.01 cGy in 46.2%, 0.01-0.15 cGy in 19.2%, 0.2-1 cGy in 26.9% and 1 cGy or more in 7.7% of patients. None of the counseled patients had medical indication for abortion, even though in a small percentage of patients abortion was a personal subjective decision. Considering that there are no Croatian guidelines for counseling patients exposed to ionizing radiation during pregnancy, it is recommended to use the International Commission on Radiological Protection guidelines in the management of pregnant patients exposed to ionizing radiation.

[ULTRASOUND GUIDED PERCUTANEOUS SCLEROTHERAPY OF SIMPLE RENAL CYSTS: PRIMARY SUCCESS AND PROCEDURE SAFETY]. / PERKUTANA SKLEROTERAPIJA JEDNOSTAVNIH CISTA BUBREGA VODENA ULTRAZVUKOM: PRIMARNI USPJEH I SIGURNOST PROCEDURE.

OBJECTIVE: To evaluate primary (technical) success and procedure safety in ultrasound (US)-guided percutaneous sclerotherapy of simple renal cysts, using 96% ethanol. PATIENTS: 17 patients with symptomatic simple renal cysts referred by nephrologists or urologists. METHODS: US-guided percutaneous puncture of the cyst with an 18G (gauge) needle and a "pigtail" 5F (French) catheter, drainage and inspection of the cyst content, and injection of ethanol. RESULTS: Puncture was rejected in two referred patients because of Bosniak II cyst and renal hilum proximity. 15 patients underwent puncture and drainage of the cyst content. In 4 patients ethanol was not injected because: thick or bloody cyst, proximity of renal hilum and severe pain during injection of ethanol. 11 patients underwent sclerotherapy of the cyst. The average size of sclerosed cyst was 8 cm (range 6-12 cm). There were no significant complications. CONCLUSION: US-guided percutaneous sclerotherapy of simple renal cysts is easy to perform and safe procedure, with the previous good selection of cysts that are suitable for the sclerotherapy.

Unexpected outcome in a treated XY reversal syndrome patient.

Hormone replacement therapy is mandatory to maintain quality of life and bone mineralization status in patients with gonadal dysgenesis. Occasionally, these patients need higher than recommended estrogen dosage to prevent signs and symptoms of hypoestrogenic state. Our 18-year-old female patient with XY sex reversal syndrome was gonadectomized and administered conventional hormone replacement therapy. Gonadoblastoma was found in the excised streak gonad. Five years after continuous replacement therapy, the patient reported unexpectedly hot flushes and amenorrhea in spite of regular hormone intake. Severe osteopenia was also detected. Unconventionally high estrogen dose was given with additional daily vitamin D and calcium supplement. Dual energy x-ray absorptiometry revealed lesser but evident osteopenia and the patient reported repeated bleeding without hot flushes on the new hormone regimen. Individualized dosage of estrogen is essential for these patients according to their bone status and subjective symptoms. Early therapy initiation along with continuous and frequent evaluation of bone status and quality of life is advised.

The possibilities and limitations of direct digital radiography, ultrasound and computed tomography in diagnosing pleural mesotelioma.

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4%), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2%), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found.