To biopsy or not to biopsy: an 82-year-old patient with a retroperitoneal mass and severe low back pain.

An 82-year-old patient was admitted to our ward due to disabling severe low back pain. Computed tomography of the spine revealed a retroperitoneal space-occupying lesion encroaching on two adjacent lumbar vertebrae and causing destruction of the cortex of their anterior aspect. The patient was scheduled for a biopsy of the mass. Magnetic resonance (MR) of the lumbar spine, however, suggested that the mass was most probably an aortic aneurysm. The biopsy was cancelled and the patient was referred for surgical intervention. MR is indicated in the evaluation of a solid mass causing vertebral destruction in order to achieve an accurate preoperative diagnosis and prevent a hazardous invasive procedure.

Gas in the kidney: CT findings.

Gas in the renal parenchyma is a rare finding seen best with computed tomography (CT). It can be encountered in a wide range of clinical conditions, some of them life-threatening like emphysematous pyelonephritis, whereas in others, it may represent a postoperative or procedure outcome. The latter are not usually a clinical emergency (for example, after nephrostomy insertion or in a urinary intestinal connection). Due to the increasing use of abdominal CT examinations, radiologists, especially in emergency setting, should be aware of this rare finding and be familiar with its differential diagnosis.

Wandering spleen--the challenge of ultrasound diagnosis: report of 7 cases.

PURPOSE: To summarize our experience with sonographic diagnosis of wandering spleen in children and assess for the typical sonographic findings of wandering spleen, complications, and possible diagnostic pitfalls. METHODS: We identified all pediatric patients from 1998-2003 with a surgically confirmed diagnosis of wandering spleen. All sonographic examinations were reviewed for splenic position, size, echotexture, and parenchymal blood flow. RESULTS: Seven children were identified with a mean age of 9.7 years (range 4.2-15.3 years). All presented with abdominal pain. Abdominal sonography, performed in all children demonstrated a low position of the spleen (n = 6), splenomegaly (n = 4), and absence of parenchymal flow in the three patients with splenic torsion and infarction. The diagnosis was made preoperatively via sonography in five children; three required repeated hospital admissions before the correct diagnosis was established. Complications occurred in five patients (gastric obstruction [n = 1], splenic infarction [n = 3], and recurrent pancreatitis [n = 1]). CONCLUSION: The most specific sonographic finding for wandering spleen is low position of the spleen. However, if the spleen regains its normal or near-normal position, the diagnosis may be missed and the condition may recur, and result in complications.