Guillermo Sangster

Multiple hereditary exostoses as a rare nonatherosclerotic etiology of chronic lower extremity ischemia

Nonatherosclerotic etiologies of arterial insufficiency are uncommon but important causes of chronic lower extremity ischemia. We report a patient with multiple hereditary exostoses (MHE) presenting with lifestyle-limiting lower extremity claudication and popliteal artery occlusion secondary to a large osteochondroma. The presence of MHE with associated osteochondroma resulting in arterial occlusion is a rare condition. Management strategies for treating large osteochondromas adjacent to or with vessel involvement in asymptomatic patients remain undefined.

MDCT Imaging Findings of Liver Cirrhosis: Spectrum of Hepatic and Extrahepatic Abdominal Complications

Hepatic cirrhosis is the clinical and pathologic result of a multifactorial chronic liver injury. It is well known that cirrhosis is the origin of multiple extrahepatic abdominal complications and a markedly increased risk of hepatocellular carcinoma (HCC). This tumor is the sixth most common malignancy worldwide and the third most common cause of cancer related death. With the rising incidence of HCC worldwide, awareness of the evolution of cirrhotic nodules into malignancy is critical for an early detection and treatment. Adequate imaging protocol selection with dynamic multiphase Multidetector Computed Tomography (MDCT) and reformatted images is crucial to differentiate and categorize the hepatic nodular dysplasia. Knowledge of the typical and less common extrahepatic abdominal manifestations is essential for accurately assessing patients with known or suspected hepatic disease. The objective of this paper is to illustrate the imaging spectrum of intra- and extrahepatic abdominal manifestations of hepatic cirrhosis seen on MDCT.

Genitourinary imaging: part 1, congenital urinary anomalies and their management.

OBJECTIVE Congenital urinary anomalies may be symptomatic or encountered during imaging for other clinical indications. The array of abnormalities is related to the embryologic stage at the time of the developmental insult, and these abnormalities result in a spectrum of conditions ranging from insignificant to incompatible with life. CONCLUSION Understanding the implications of common congenital urinary anomalies is the key to detecting associated anomalies, initiating therapy, and avoiding both complications and unnecessary intervention.

Delayed Splenic Rupture; Normal Appearing Spleen on the Initial Multidetector Computed Tomography (MDCT) Can Sometimes Be Misleading

Introduction Delayed splenic rupture (DSR) is an unusual outcome following blunt abdominal trauma. Although DSR is defined as bleeding more than 48 hours after blunt trauma in a previously hemodynamically stable patient, a review of the reported cases in the literature shows that in almost all of the cases the initial CT imaging revealed some form of damage to the spleen. Case Presentation Here we describe an extremely rare condition in a case that presented with a DSR following blunt trauma and had a normal appearing spleen in the initial post trauma MDCT scan. Conclusions DSR is a serious consequence of trauma and is associated with a significantly higher mortality rate compared with the overall mortality for acute splenic injuries. A High index of suspicion along with the liberal serial utilization of the imaging studies are the essential elements for early detection of DSR. We propose that DSR be considered as a differential diagnosis in patients presenting with hemodynamic instability late post trauma, even when the immediate post trauma MDCT scan has shown a normal appearing spleen. We suggest that every patient with a high impact injury or injuries to peri-splenic organs should have a repeat MDCT scan 2 - 3 days post trauma or before the patients is discharged from hospital.

Acquired constricting and restricting lesions of the descending duodenum.

The descending duodenum is a structure with distinct pathologic processes and anatomic relationships that requires a systematic approach to the differential diagnosis. Because of its tubular shape and fixed position in the retroperitoneum, both intrinsic duodenal and juxtaduodenal diseases are capable of producing luminal narrowing and obstruction. Duodenal lesions may be located in the mucosa or submucosa. Extraduodenal lesions may originate in adjacent structures--such as the pancreas, liver, gallbladder, colon, and lymph nodes--or from other retroperitoneal structures. Causes of duodenal obstruction include intraluminal masses, such as bezoars; duodenal inflammation, such as as peptic ulcers and Crohn disease; hematomas; and benign or malignant mucosal and intramural tumors. Pancreatic inflammation; tumors; and extrinsic compression caused by gallbladder processes, hepatic masses, retroperitoneal fluid collections, and tumors, including lymphoma, may produce duodenal obstruction. Abdominal radiography, barium studies, multidetector computed tomography, magnetic resonance imaging, and positron emission tomography may be used to depict and characterize duodenal strictures. Integration of imaging, clinical, laboratory, and endoscopic findings plays a major role in establishing a diagnosis of obstructive duodenal strictures.

Head and neck cancer with lower neck nodal metastases: Management of 23 cases and review of the literature

To investigate the patient outcomes associated with the applied modes of therapy in head and neck cancer with lower neck nodal metastases. The medical records of 23 consecutive individuals who were managed by intent to treat for head and neck cancer with metastatic disease in the lower neck nodes over a 19-year period were reviewed. The mean age was 53.5 years, and the larynx was the most frequently affected primary site (57%). Overall, locoregional tumor control was achieved in the majority (75%) of the cases and the 2-year survival rate was 48%. The 2-year survival rates of people managed by surgery and postoperative radiotherapy, chemoradiation or single modality therapy were 63%, 56% and 17%, respectively, (p=0.04). Aggressive therapy resulted in five (22%) long-term (>5 years) survivors. The combination of treatment modalities proved to be effective management for head and neck cancer with lower neck nodal metastases and should be further investigated in prospective trials.

Parasitic leiomyoma presenting as an inguinal hernia in a postmenopausal woman

Uterine leiomyomas are one of the most common tumors affecting reproductive-age women. Leiomyomas can present as an intrauterine mass or rarely as an extrauterine tumor. Depending on its location, the diagnosis of extrauterine leiomyoma can be challenging, and multiple imaging modalities may be needed for correct identification and differentiation from malignant entities. We report the case of a 48-year-old-postmenopausal female who presented with a painful left inguinal mass, which was clinically diagnosed as inguinal hernia. Ultrasound, computed tomography, magnetic resonance imaging, and percutaneous biopsy were used to characterize the mass. Surgical resection and histopathological analysis revealed the mass to be a parasitic leiomyoma, a very rare cause of inguinal hernia, especially in a postmenopausal woman.

A Multimodality Review of Adrenal Tumors

Adrenal tumors are very commonly encountered in the practice of radiology. They may arise from the adrenal gland itself, either the cortex or the medulla, or they could be secondary lesions. They may be benign or malignant. The functioning adrenal tumors lead to hypersecretion of adrenal hormones leading to clinical syndromes. Computed tomography is the most common imaging modality used for the initial evaluation of adrenal tumors. Magnetic resonance imaging and functional scintigraphic techniques are frequently used for atypical presentations or further evaluation. We present a multimodality review of common and uncommon adrenal tumors. We highlight their characteristic and specific imaging features which help us in making a diagnosis and suggesting an appropriate follow up for further management. The spectrum of adrenal tumors is wide with varying appearances on different imaging modalities. Imaging techniques used for adrenal tumor imaging have their own strengths and weaknesses as it relates to the final diagnosis. It is important to be familiar with imaging characteristics of adrenal tumors for appropriate diagnosis and management. Differentiation of benign (leave alone) tumors from malignant (surgical) ones along with appropriate disposition of incidentalomas are some of the challenges facing the radiologist.

Multimodality Imaging Review of Anorectal and Perirectal Diseases with Clinical, Histologic, Endoscopic, and Operative Correlation, Part II: Infectious, Inflammatory, Congenital, and Vascular Conditions

A broad spectrum of pathology affects the rectum, anus, and perineum, and multiple imaging modalities are complementary to physical examination for assessment and treatment planning. In this pictorial essay, correlative imaging, endoscopic, pathologic, and operative images are presented for a range of rectal, perirectal, and perineal disease processes, including infectious/inflammatory, traumatic, congenital/developmental, vascular, and miscellaneous conditions. Key anatomic and surgical concepts are discussed, including radiological information pertinent for surgical planning, and current operative approaches of these anatomic spaces to assist radiologists in comprehensive reporting for gastroenterologists and surgeons.

Multimodality Imaging Review of Anorectal and Perirectal Diseases With Histological, Endoscopic, and Operative Correlation, Part I: Anatomy and Neoplasms

A broad spectrum of pathology affects the rectum, anus, and perineum and understanding of its relevant anatomy is important in accurate reporting, particularly in rectal cancer. In this pictorial essay, correlative imaging, endoscopic, pathologic, and operative images are presented to illustrate normal anorectal anatomy and neoplastic conditions that affect the anus and rectum. A particular case-based focus is given to rectal adenocarcinoma with pelvic MR and surgical histopathology. Additionally, carcinoid tumor, gastrointestinal stromal tumor, condylomata acuminata, squamous cell carcinoma, melanoma, and metastatic disease about the rectum and anus are reviewed.