T.-Y. Lee

CT findings at lupus mesenteric vasculitis

Purpose: To describe the spectrum of early CT findings of lupus mesenteric vasculitis (LMV) and to assess the utility of CT in the management of this uncommon entity. Methods: Abdominal CT was performed within 1–4 days (average 2.2 days) of the onset of severe abdominal pain and tenderness in 15 women with systemic lupus erythematosus. Prompt high-dose i.v. corticosteroid was administered in 11 patients after the CT diagnosis of LMV was made. CT was performed after abdominal symptoms subsided. Results: Eleven cases revealed CT features suggestive of LMV including conspicuous prominence of mesenteric vessels with palisade pattern or comb-like appearance (CT comb sign) supplying focal or diffuse dilated bowel loops (n=11), ascites with slightly increased peritoneal enhancement (n=11), small bowel wall thickening (n=10) with double halo or target sign (n=8). Follow-up CT before high-dose steroid therapy revealed complete or marked resolution of the abnormal CT findings. Conclusion: CT is helpful for confirming the diagnosis of LMV, especially the comb sign which may be an early sign. Bowel ischemia due to LMV is less ominous than previously expected, and the abnormal CT findings were reversible when early diagnosis and prompt i.v. steroid therapy could be achieved.

Small bowel obstruction due to phytobezoar: CT diagnosis

Abstract. We report two cases of small bowel obstruction (SBO) due to phytobezoar impaction. In both cases, computed tomography (CT) demonstrated a well-defined, ovoid intraluminal mass with mottled gas pattern within the dilated small bowel at the site of obstruction and an abruptly collapsed lumen beyond the lesion. Recognition of these CT findings allows specific preoperative diagnosis of SBO owing to this uncommon lesion.n

Renal squamous cell carcinoma: CT findings and clinical significance

Abstract.Background: To study the biological behavior of renal squamous cell carcinoma (RSCC).n Methods: Fifteen cases of RSCC were retrospectively studied. These cases were classified as central (eight cases) and peripheral (seven cases) types by the tumor location. The clinical data and computed tomographic findings were analyzed and compared.n Results: High incidence (87%) of urolithiasis was observed. The prognosis of RSCC was very poor, with a median survival time of 3.5 months. The infectious symptoms, central location, and modified stage IV of the tumor were the poor prognostic factors of RSCC. Two types of RSCC were different in the presenting symptoms, lymph node metastasis, modified tumor staging, and survival time.n Conclusion: The central and peripheral types of RSCC were different biologically. High index of suspicion should be maintained when identifying the subtle clues of malignancy in patients with urolithiasis.

Ductal dilatation and stenting make routine hepatectomy unnecessary for left hepatolithiasis with intrahepatic biliary stricture.

BACKGROUNDnHepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Hepatic resection has recently been advocated as one of the treatment modalities for hepatolithiasis; however, this procedure is not without risk. This study was designed to achieve complete clearance of the stones, eliminate bile stasis, and avoid the potential risks of hepatic resection in the patient with hepatolithiasis and intrahepatic biliary stricture.nnnMETHODSnIn this prospective clinical trial 13 patients with retained left hepatolithiasis and intrahepatic biliary strictures were included. All the patients met the following criteria: (1) initial surgical procedure for hepatolithiasis, (2) normal gross findings of the left liver, and (3) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma. After the operation they underwent matured T-tube tract ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting. Choledochoscopic electrohydraulic lithotripsy was used in five patients after dilatation when impacted or large stones were encountered.nnnRESULTSnComplete clearance of the stones was achieved in these 13 patients. One patient had fevers develop after ductal dilatation, and another patient had mild hemobilia after electrohydraulic lithotripsy. Both recovered uneventfully with conservative treatment. These successfully treated patients remain well, with a mean follow-up period of 20 months.nnnCONCLUSIONSnPostoperative matured T-tube tract ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe alternative to hepatic resection for selected left hepatolithiasis with intrahepatic biliary stricture.

The management of complicated hepatolithiasis with intrahepatic biliary stricture by the combination of T-tube tract dilation and endoscopic electrohydraulic lithotripsy.

Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Retention of stones behind strictures after surgery is a frequent and troublesome complication. Post-operative duct dilation with percutaneous transhepatic cholangioscopy tube stenting through a matured T-tube tract was performed in 15 patients. Choledochoscopic electrohydraulic lithotripsy was applied in six patients when impacted or large stones were encountered. Complete clearance of stones was achieved in 12 patients (80%). Two patients had fevers develop after ductal dilation and recovered after conservative treatment. These 12 successfully treated patients remain well, with a mean follow-up of 18 months. Post-operative T-tube tract dilation, selectively combined with endoscopic electrohydraulic lithotripsy, is an effective and safe method for complicated hepatolithiasis with biliary strictures.

Unusual liver MR findings of Wilson's disease in an asymptomatic 2-year-old girl.

We describe the unusual magnetic resonance (MR) findings of a case of Wilsons disease (WD) in an asymptomatic 2-year-old girl. Preenhanced computed tomography revealed multiple hyperdense areas in the liver. These lesions were hyperintense on T1-weighted and hypointense on T2-weighted MR images, results that might be ascribed to the paramagnetism of copper deposited in liver at a relatively early stage of the disease before severe liver cirrhosis had evolved.

Unusual imaging presentations in renal transitional cell carcinoma

Purpose: to report on unusual imaging presentations in renal transitional cell carcinoma (TCC) Material and Methods: Imaging studies of 140 cases of pathologically proven renal TCC were retrospectively studied with the focus on unusual presentations Results: Unusual imaging manifestations were found in 20 cases (14.3%). These findings were classified into 5 categories: perirenal abscesses or perirenal hematomas in 6 cases; parenchymal masses in 5; undue thickening of the hydronephrotic wall in 4; “tuberculoid” pyelograms in 3; and tumors with massive necrosis in 2 Conclusion: Deceptive imaging presentations may occur in renal TCC. Recognition of these presentations may help to prevent delay in diagnosis

Treatment of postoperative residual hepatolithiasis after progressive sleeting of associated bile duct strictures through the T-tube tract

AbstractPurpose: The authors report their experience with the treatment of intrahepatic bile duct strictures associated with hepatolithiasis.n Methods: Eighty patients had multiple postoperative retained intrahepatic duct stones trapped behind intrahepatic biliary strictures. Before stone extraction, the strictures were opened gradually by semirigid dilators, followed by stent placement to create enough patency for stone removal. All procedures were carried out through the T-tube tracts and were aided by cholangioscopy and electrohydraulic lithotripsy.n Results: Complete clearance of stones was achieved in 69 patients. Failure to dilate the strictures was due to acute and multiple ductal angulations. These included the right posterior inferior intrahepatic duct at its junction with the left intrahepatic ducts when it was more than 2 cm distal to the hepatic bifurcation, when the angle between the T-tube tract and the common bile duct was smaller than 90°, and when stones were located in peripheral intrahepatic ducts with more than five angulations.n Conclusion: This technique is considered safe and effective for complicated hepatolithiasis with intrahepatic biliary strictures

Primary gas-containing mediastinal abscess in a diabetic patient

A case of primary gas-containing mediastinal abscess is reported. Mediastinal widening was seen on the chest radiograph of a diabetic patient who presented with nonspecific symptoms of shortness of breath and abdominal pain of 3 days duration. The diagnosis of primary gas-containing mediastinal abscess was established by the characteristic findings of computed tomography and exclusion of all the etiological possibilities. The patient was treated by closed chest tube drainage and antibiotic therapy with an uneventful outcome. Primary gas-containing mediastinal abscess should be included in the differential diagnosis when treating a diabetic patient with mediastinal widening.

Posttraumatic gluteal epidermal cyst with ischiorectal and presacral extension

An unusual case of rapid-growing posttraumatic gluteal epidermal cyst with ischiorectal and presacral extension is reported. Pertinent clinical history and magnetic resonance imaging allowed accurate preoperative diagnosis. Cautious complate excision was important to prevent recurrence. To our knowledge, posttraumatic gluteal epidermal cyst with this unusual clinical presentation has not been described previously.