Paramanand Maharaj

Is Same-Day Sonography of the Gallbladder Feasible After Intravenous Urography or Contrast-Enhanced Computed Tomography?

Objective. To determine whether same‐day sonographic evaluation of the gallbladder is possible after the use of oral or intravenous iodinated contrast agents during intravenous urography or computed tomography. Methods. One hundred fifty‐three patients involved in this prospective study received low‐osmolar or conventional contrast material. Each preparation contained 300 mg/mL iodine. Sixty‐six patients received contrast agents intravenously, and 87 received them orally. Gallbladder volume was estimated sonographically, and the precontrast volume was used to calculate the volume after contraction at 30‐minute intervals up to 2 hours after contrast agent administration. Results. Gallbladder volume returned to precontrast values at 2 hours irrespective of the type of contrast agent or route of administration. The mean volume after contraction at 0.5 hour was 71% after intravenous contrast agent administration and 76% after oral contrast agent administration. Both changes were statistically significantly different from precontrast values (P < .01, null hypothesis) and were unaffected by the osmolarity of the contrast agent. Conclusions. Gallbladder volume was restored to precontrast values 2 hours after contrast agent administration. Thus any strategy involving simultaneous same‐day sonographic or computed tomographic assessment of the gallbladder after contrast agent administration can be confidently undertaken after this period. This finding may have cost‐saving implications.

Multi-organ benign and malignant tumors: recognizing Cowden syndrome: a case report and review of the literature.

BackgroundCowden syndrome is an autosomal dominant disorder with a predisposition to multiple benign and malignant tumors. In our patient, in addition to breast and endometrial malignancies as well as facial trichilemmomas, she was noted to have multiple meningiomas, pancreatic lipomas and lung cysts. These latter lesions have been noted in previous Cowden syndrome case reports, but are not included in the diagnostic criteria at this time. To our knowledge, this is the first case of multiple meningiomas in this syndrome. Further studies are therefore warranted to assess the significance of these findings in Cowden syndrome.Case presentationA middle-aged Afro-Caribbean known endometrial carcinoma patient (post surgery and adjuvant radiotherapy), presented with a locally advanced breast carcinoma. She received neoadjuvant chemotherapy followed by a modified radical mastectomy and axillary lymph node clearance. Her past medical history included a sphenoid wing meningioma for which she received definitive external beam radiotherapy. She was also known to have a multinodular goiter, anal polyp and longstanding mucocutaneous lesions. Further workup revealed additional smaller meningiomas, a parotid arteriovenous malformation, a lung cyst and pancreatic lipomas. Overall, consortium criteria were met for the diagnosis of Cowden syndrome. Furthermore, genetic testing identified a pathogenic mutation in the PTEN gene. She will be closely followed with annual clinical examination, dermatologic assessment and screening colonoscopies. She will perform interval whole body contrast enhanced CT for continued surveillance for metastatic disease.ConclusionCowden syndrome is likely to be an under diagnosed condition, but critically important to identify due to its cancer predisposition. When encountering multi-organ tumors, diagnostic criteria for Cowden syndrome should be sought in order to increase the diagnostic rates. Cancer surveillance for carcinoma detection in the early and curative stages remains the most critical aspect of management.

Cholangiocarcinoma in Association With Caroli's Disease The Role of Ultrasound and Other Imaging Modalities

Carolis disease is a rare congenital disorder characterized by focal or diffuse dilatation of the intrahepatic bile ducts. If asymptomatic, this condition may remain undetected for several years. We present a case of focal Carolis disease, first suspected on sonography, with a coexisting bile duct carcinoma. Both computed tomography (CT) imaging and percutaneous transhepatic cholangiography (PTC) supported a diagnosis of Carolis disease but did not detect the presence of an associated mass, which was histologically proved to be a bile duct carcinoma. The advantages and disadvantages of different modalities in evaluating Carolis disease are discussed.

Abdominal Imaging Findings in Neurocutaneous Syndromes: Looking Below the Diaphragm

OBJECTIVE Neurocutaneous syndromes are a heterogeneous group of multisystemic disorders. We review the multimodality imaging findings in the disorders with a propensity for intraabdominal disease. We highlight more recently recognized disease patterns and discuss imaging surveillance optimization. CONCLUSION Knowledge of varied intraabdominal phenotypic expressions can increase diagnostic rates. Limitation of radiation dose must be considered in screening this tumor-prone population. Early detection of neoplastic findings is critical for morbidity and mortality reduction.

Right sided spleen laying retro-duodenal: A case report and review of the literature

Highlights • This is the first reported right accessory spleen laying retro-duodenal reported.• This is the second largest accessory spleen reported.• Accessory spleen is a possibility in a retroperitoneal tumor differential diagnosis.• We present a literature review of the other right accessory spleen cases.