Naama Bogot

Radiologic Imaging and Intervention for Gastrointestinal and Hepatic Complications of Hematopoietic Stem Cell Transplantation

Hematopoietic stem cell transplantation (HSCT) is an increasingly available treatment option for patients with various oncologic, hematologic, and immunologic diseases. Although HSCT can be curative for some diseases, complications associated with this treatment limit its success and applicability. Gastrointestinal graft-versus-host disease (GVHD) and hepatic veno-occlusive disease are unique and deadly complications of HSCT. These diseases can mimic other HSCT complications, such as infection, hemorrhage, and hepatotoxicity with cholestasis, but GVHD and veno-occlusive disease require specific treatment. Early treatment improves the probability of treatment success. For these reasons, timely and accurate diagnosis is essential. Abdominal imaging and intervention play an important role in the early, minimally invasive diagnosis and treatment of GVHD and veno-occlusive disease. Imaging findings tend to be nonspecific, but common findings that may guide further management or establish a diagnosis in the clinical setting have been defined. In cases where the diagnosis is unclear and liver biopsy is required, image-guided transvenous liver biopsy may be a safer and more practical option than the transcutaneous approach. Image-guided interventions, including intraarterial steroid-injection therapy in severe, systemic steroid-refractory GVHD and transjugular intrahepatic portosystemic shunt placement in veno-occlusive disease with portal hypertension, have shown some promise in small, uncontrolled series. Larger, controlled studies are needed to define the role of these invasive procedures in this patient population.

SEMI-INVASIVE AND INVASIVE PROCEDURES FOR THE DIAGNOSIS AND STAGING OF LUNG CANCER II: Bronchoscopic and Surgical Procedures

Each of the various techniques used for the diagnosis and staging of lung cancer has its advantages and limitations (Table 1). Imaging has a major role in guiding these procedures and deciding which of them is most appropriate in a given clinical setting. A CT examination by which the size and location of the parenchymal lesion and the presence and location of enlarged lymph nodes can be determined is a prerequisite for all sampling procedures. As a general rule, when attempting to diagnose a solitary pulmonary nodule or mass, central lesions are more easily approached by the bronchoscopic route, whereas a transthoracic route is preferred for peripheral lesions. Bronchoscopy is often performed using fluoroscopic guidance, and the recently developed CT fluoroscopy and endoscopic ultrasound have the potential to facilitate transbronchial needle aspiration. A recent advent in imaging of lung cancer has been the introduction of positron emission tomography to the diagnostic work-up of lung cancer. Although this technique has been shown to be highly accurate in determining the malignant or benign nature of lesions, it does not enable histologic diagnosis. In each case, the most appropriate diagnostic procedure should be tailored to suit the specific requirements determined by the characteristics of the disease process, institutional availability of the various diagnostic procedures, and patient preferences, when possible.

Leukocyte telomere length and coronary artery calcification in Palestinians

OBJECTIVEnShorter leukocyte telomere length (LTL) is associated with higher incidence of coronary heart disease (CHD) and increased mortality. We examined the association of LTL with coronary artery calcification (CAC), which reflects the cumulative burden of coronary atherosclerosis, in an urban Arab sample of Palestinians, a population at high risk of CHD.nnnMETHODSnUsing a cross-sectional design, a random sample of East Jerusalem residents, comprising 250 men aged 45-77 and women aged 55-76 and free of CHD or past stroke, was drawn from the Israel national population register. LTL was measured by Southern blots. CAC was determined by 16-slice multidetector helical CT scanning using Agatston scoring. We applied multivariable logistic modeling to examine the association between sex-specific tertiles of LTL and CAC (comparing scores >100 vs. <100, and the upper third vs. the lower 2 thirds), controlling for age, sex, education and coronary risk factors.nnnRESULTSnCAC, evident in 65% of men and 52% of women, was strongly associated with age (sex-adjusted Spearmans rho 0.495). The multivariable-adjusted odds ratios for CAC >100 (found in 30% of men and 29% of women) were 2.92 (95% CI 1.28-6.68) and 2.29 (0.99-5.30) for the lower and mid-tertiles of LTL vs. the upper tertile, respectively (Ptrend = 0.008). Findings were similar for CAC scores in the upper tertile (Ptrend = 0.006), and persisted after the exclusion of patients with diabetes or receiving statins.nnnCONCLUSIONSnShorter LTL was associated with a greater prevalence of asymptomatic coronary atherosclerosis in an urban Arab population-based sample. Mechanisms underlying this association should be sought.

Ectopic pancreatic pseudocyst and cyst presenting as a cervical and mediastinal mass - case report and review of the literature

Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass. The CT scan revealed a cystic lesion in the anterior mediastinum. The patient underwent surgical resection by cervical approach. A Cystic mass with pseudocysts, cysts and complete pancreatic tissue were found in pathology. There were no signs of pancreatitis or malignancy. No recurrence was observed after a follow up of four years. We reviewed the case reports describing this rare condition in the medical literature.We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility. Surgery is probably needed for the diagnosis and treatment. Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis. In those cases surgery is not recommended. Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1849369005957671

Dual‐energy computed tomography as a diagnostic tool for gout during intercritical periods

The aim of this study is to evaluate the diagnostic yield of dual‐energy computed tomography (DECT) in detection of uric acid accumulation in joints or periarticular structures in patients suspected of having gout, in their intercritical period.

Spontaneous Regression of Metastatic Papillary Renal Cell Cancer After Cessation of Treatment With Sorafenib

Introduction Spontaneous regression of renal cell cancer is a rare phenomenon, with an estimated incidence 1%. Most cases had been observed fter a surgical resection of the primary tumor, but regression can also ccur in association with radiofrequency ablation, radiation, or emolization of the primary tumor. The site of the regression was most commonly in the lung. Here, we report the a case of spontaneous regression after cessation of treatment with sorafenib that occurred in a patient with papillary renal cell cancer.

Bronchial perforation with aortic pseudo-aneurysm due to aspirated foreign body

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Extremely high Agatston calcium score without significant coronary artery stenoses

Severe coronary calcification (Agatston score >1000) is associated with advanced obstructive coronary disease.nn### Case 1nnA 48-year-old woman, presented with long-standing Type II diabetes mellitus, hypertension, renal failure, peripheral vascular disease with prior bilateral above knee amputation, had atypical chest pain and T-wave inversion in the antero-lateral ECG leads. Non-enhanced cardiac CT (CCT) …