S. El Mouhadi

Chemoembolization and the arcuate ligament: how to manage it?

Three patients with hepatocellular carcinoma following cirrhosis were referred for chemoembolization after a primary liver tumor multidisciplinary team meeting. A pre-treatment CT on each patient showed tight stenosis at the origin of the celiac axis, with no calcification, and dilatation of the anterior and posterior duodenopancreatic arcades (Fig. 1). Primary catheterization of the celiac axis was attempted in each case and was impossible despite using different catheters and microcatheters, and in a second stage the superior mesenteric artery was catheterized. Contrast injection into this artery in each case showed two hypertrophic duodenopancreatic arcades and opacification of the hepatic artery (Fig. 2a). A guide catheter was then introduced into the superior mesenteric artery, then enabling the duodenopancreatic, gastroduodenal and main hepatic artery branches to be catheterized with a microcatheter (Fig. 2b).

Cavoportal shunt in superior vena cava obstruction

54-year-old woman with history of clear cell ovarian adeocarcinoma presented with cough, chest discomfort and ight arm swelling. After bilateral ovariectomy and hysterectomy, systemic hemotherapy with cisplatin and epirubicin was adminstrated by central venous catheter placed within right ubclavian vein. Physical examination confirmed edema of the face and rms. O2 saturation was 96,6% at room air. Spiral CT was erformed to rule out pulmonary emboli. Superior vena cava was obstructed (arrow) at the level f the aortic arch. Prominent azygos vein was demonstrated arrowhead) (Fig. 1a). On lower level, a wedge-shaped yperenhancement (arrows) of segment IV of the liver was emonstrated (Fig. 1b). Prominent collateral vessels (small

A hepatic and renal presentation of B-cell non-Hodgkin lymphoma.

A 37-year-old male attended a consultation due to the progressive appearance of jaundice and pruritus. He had no known medical history and no risk factors for chronic liver disease. He remained in good general health. Laboratory tests showed cholestasis with conjugated bilirubin changes (total bilirubin = 450 moles/L), negative viral serology and a normal complete blood count. An abdominal sonogram demonstrated a single mass of the left liver, extending to the hepatic hilum, leading to dilated intrahepatic bile ducts. An MRI scan of the liver was carried out, which showed a left liver mass with slightly high signal intensity on T2-weighted images (Fig. 1a), low signal intensity on T1-weighted images (Fig. 1b), no enhancement with a Gadolinium contrast agent irrespective of the time since the injection (Fig. 1c) and even with delayed phase acquisition, and a nondysmorphic liver. The intrahepatic bile ducts were noted to be dilated and there was left liver atrophy.

Ileal diverticulitis complicated by portal-mesenteric pylephlebitis and pulmonary septic foci.

a Service de radiologie, hôpital Saint-Antoine, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, Assistance publique—Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France b Service de réanimation médicale, hôpital Saint-Antoine, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, Assistance publique—Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France