Ilaria Sansoni

Herlyn-werner-wunderlich syndrome: MRI findings, radiological guide (two cases and literature review), and differential diagnosis

BackgroundHerlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures, and it is characterized by the triad of didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis. It generally occurs at puberty and exhibits non-specific and variable symptoms with acute or pelvic pain shortly following menarche, causing a delay in the diagnosis. Moreover, the diagnosis is complicated by the infrequency of this syndrome, because Müllerian duct anomalies (MDA) are infrequently encountered in a routine clinical setting.Cases presentationtwo cases of HWW syndrome in adolescents and a differential diagnosis for one case of a different MDA, and the impact of magnetic resonance (MR) imaging technology to achieve the correct diagnosis.ConclusionsMR imaging is a very suitable diagnostic tool in order to perform the correct diagnosis of HWW syndrome.

Tu1134 Layered Pattern of Enhancement and Retrodilation At Magnetic Resonance Enterography Predict the Outcome of Anti-TNF Alpha Therapy in Patients With Moderate-to-Severe Ileal Crohn's Disease

of 1-31. New/worse inflammation was found in 43.8% of CTs while any new/worse finding was found in 57.4%. PA+ occurred in 16.8% of CTs. Univariate analysis shows that younger and female patients were less likely to have I but not PA+. Steroid use did predict a higher probability of PA+ (OR 1.58, 95%CI 1.01-2.47) but not I (OR 1.01, 95%CI 0.70-1.44). Biologic agents and other immunosuppression did not predict either outcome. Among the labs, CRP was a good predictor of I and PA+ while ESR only predicted PA+. Higher absolute neutrophil count and lymphocyte count predicted both outcomes. The multivariable model for I had a c statistic of 0.68; a cutoff of 16% has a sensitivity of 99.6% and negative predictive value of 92.3%. The model for PA+ had better performance characteristics with a c statistic of 0.80; a cutoff of 5% has a sensitivity of 94.9% and a negative predictive value of 97.7%. Conclusions: Patients with CD are exposed to radiation frequently but have significant new/worse findings less than 60% of the time. Models with good negative predictive values predicting I and PA+ were identified. Automated use of these models could aid ER physicians in the decision to avoid CT scans in patients with low likelihood of a positive scan. Prospective studies are needed to validate these models and their utility in clinical practice.

Portomesenteric Venous System Gas after CT Colonography: A Case Report

Portomesenteric vein gas can occur owing to a variety of interraleted factors such as loss of mucosal integrity and intraluminal overpressure, and the most common and serious cause is bowel ischemia, which requires urgent laparotomy. Nevertheless, when portal venous gas is caused by nonischemic causes, surgery is not required and it can be treated conservatively. So, its features should be carefully evaluated at CT scan, together with clinical findings. The authors report a case of an old male with portomesenteric venous system gas after CT colonography, without evidence of pneumatosis intestinalis or colonic perforation. A CT scan without enema was required after 24 hours in absence of worsened patient conditions, revealing the disappearance of gas in mesenteric vein and in the portal venous system.