scholarly journals Rare Hepatic Arterial Anatomic Variants in Patients Requiring Pancreatoduodenectomy and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Smita Ramanadham ◽  
Seth M. Toomay ◽  
Adam C. Yopp ◽  
Glen C. Balch ◽  
Rohit Sharma ◽  
...  
Keyword(s):  
Uncinate Process ◽  
Arterial System ◽  
Cross Sectional ◽  
Replaced Right Hepatic Artery ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Head Of The Pancreas ◽  
Anatomic Variants ◽  
Hepatobiliary And Pancreatic Surgery ◽  
Arterial Anatomy

Normal hepatic arterial anatomy occurs in approximately 50–80% of cases; for the remaining cases, multiple variations have been described. Knowledge of these anomalies is especially important in hepatobiliary and pancreatic surgery in order to avoid unnecessary complications. We describe two cases of patients undergoing pancreatoduodenectomy for abnormalities in the head of the pancreas. Preoperative contrast-enhanced cross-sectional imaging demonstrated relevant, rare hepatic arterial variants: (1) a completely replaced hepatic arterial system with a gastroduodenal artery (GDA) arising directly from the celiac axis and (2) a replaced right hepatic artery originating from the superior mesenteric artery and traveling anterior to the pancreatic uncinate process and head. These findings were confirmed during pancreatoduodenectomy. Both of these variants have been rarely described with an incidence of <1.0%. In the present paper, we describe the hepatic arterial anomalies commonly encountered and clarify the important details associated with these variants as they pertain to pancreatoduodenectomy.

Intraductal Papillary Mucinous Neoplasm of the Pancreas

2021 ◽  
Vol 8 (28) ◽  
pp. 2562-2566
Author(s):  
Jayalatha Nethagani ◽  
Priyanka Govula ◽  
Revathi Chandu ◽  
Pravin Raj T
Keyword(s):  
Epigastric Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Uncinate Process ◽  
Cystic Lesions ◽  
Chronic Alcoholic ◽  
Contrast Enhanced ◽  
History Of ◽  
Head Of The Pancreas ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

A 36-year-old non-smoker, chronic alcoholic female presented with recurrent episodes of epigastric pain and vomiting in the last 10 days. H/o similar episodes of pain 3 times, with last episode was noted 2 months back. She also had history of vomiting (3 episodes). Jaundice/melena/steatorrheas was not observed. Subsequently, contrast-enhanced computed tomography (CECT) of the patient was done and it showed well defined multiple cystic lesions with peripheral wall enhancement involving head and body of pancreas, largest measuring 24 X 22 X 22 mm in the head of the pancreas, the lesion was seen abutting antro-pyloric region anteriorly. Main pancreatic is mildly dilated measuring 4 mm in diameter. A well-defined heterogeneously hypodense (necrotic) para duodenal lesion, was noted inferior to uncinate process, m/s 22 X 20 X 20 mm, which is indicative of lymph nodal deposit. On magnetic resonance cholangiopancreatography (MRCP): few cystic lesions were seen scattered in the pancreatic parenchyma, with one of the cysts showing communication with main pancreatic duct (MPD) ab.

scholarly journals Imaging of the adrenal gland lesions

2014 ◽  
Vol 47 (4) ◽  
pp. 228-239 ◽  
Author(s):  
Keith Herr ◽  
Valdair F. Muglia ◽  
Walter José Koff ◽  
Antonio Carlos Westphalen
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Adrenal Gland ◽  
Photon Emission ◽  
Resonance Imaging ◽  
Cross Sectional ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Contrast Enhanced Ultrasonography ◽  
Photon Emission Tomography

With the steep increase in the use of cross-sectional imaging in recent years, the incidentally detected adrenal lesion, or "incidentaloma", has become an increasingly common diagnostic problem for the radiologist, and a need for an approach to classifying these lesions as benign, malignant or indeterminate with imaging has spurred an explosion of research. While most incidentalomas represent benign disease, typically an adenoma, the possibility of malignant involvement of the adrenal gland necessitates a reliance on imaging to inform management decisions. In this article, we review the literature on adrenal gland imaging, with particular emphasis on computed tomography, magnetic resonance imaging, and photon-emission tomography, and discuss how these findings relate to clinical practice. Emerging technologies, such as contrast-enhanced ultrasonography, dual-energy computed tomography, and magnetic resonance spectroscopic imaging will also be briefly addressed.

scholarly journals Advanced Fusion Imaging and Contrast-Enhanced Imaging (CT/MRI–CEUS) in Oncology

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2821 ◽  
Author(s):  
Vincent Schwarze ◽  
Johannes Rübenthaler ◽  
Constantin Marschner ◽  
Matthias Philipp Fabritius ◽  
Johannes Rueckel ◽  
...  
Keyword(s):  
Fusion Imaging ◽  
Resonance Imaging ◽  
Renal Surgery ◽  
Cross Sectional ◽  
Renal Lesions ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Excellent Safety Profile ◽  
Hepatic Lesions

Fusion imaging depicts an innovative technique that facilitates combining assets and reducing restrictions of advanced ultrasound and cross-sectional imaging. The purpose of the present retrospective study was to evaluate the role of fusion imaging for assessing hepatic and renal lesions. Between 02/2011–08/2020, 92 patients in total were included in the study, of which 32 patients had hepatic lesions, 60 patients had renal lesions. Fusion imaging was technically successful in all patients. No adverse side effects upon intravenous (i.v.) application of SonoVue® (Bracco, Milan, Italy) were registered. Fusion imaging could clarify all 11 (100%) initially as indeterminate described hepatic lesions by computed tomography/magnetic resonance imaging (CT/MRI). Moreover, 5/14 (36%) initially suspicious hepatic lesions could be validated by fusion imaging, whereas in 8/14 (57%), malignant morphology was disproved. Moreover, fusion imaging allowed for the clarification of 29/30 (97%) renal lesions initially characterized as suspicious by CT/MRI, of which 19/30 (63%) underwent renal surgery, histopathology revealed malignancy in 16/19 (84%), and benignity in 3/19 (16%). Indeterminate findings could be elucidated by fusion imaging in 20/20 (100%) renal lesions. Its accessibility and repeatability, even during pregnancy and in childhood, its cost-effectiveness, and its excellent safety profile, make fusion imaging a promising instrument for the thorough evaluation of hepatic and renal lesions in the future.

Point-of-care contrast enhanced lung ultrasound and COVID-19

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110479
Author(s):  
Alice Tee ◽  
Gibran Timothy Yusuf ◽  
Adrian Wong ◽  
Deepak Rao ◽  
Sa Tran ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Contrast Enhanced Ultrasound ◽  
Cross Sectional ◽  
Patient Demographics ◽  
Pulmonary Angiogram ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Ct Pulmonary Angiogram

Objectives Bedside lung ultrasound has been indispensable during the coronavirus disease 2019 (COVID-19) pandemic, allowing us to rapidly assess critically unwell patients. We demonstrate the unique application of contrast-enhanced ultrasound with the aim of further understanding this disease. Methods Patient demographics were recorded alongside recent cross-sectional imaging and inflammatory markers. Ultrasound was conducted by experienced operators in a portable setting. Conventional six-point lung ultrasound method was used to evaluate B-lines, small (subpleural) consolidation and the pleura. Areas of small consolidation were targeted after intravenous administration of ultrasound contrast. Results The areas of small consolidations, a potential sign of pneumonia on B-mode lung ultrasound, usually enhance on contrast-enhanced ultrasound. Our study revealed these areas to be avascular, indicating an underlying thrombotic/infarction process. Findings were present in 100% of the patients we examined. We have also shown that the degree of infarction correlates with CT severity (r = 0.4) and inflammatory markers, and that these areas improve as patients recover. Conclusions We confirmed the theory of immune thrombus by identifying the presence of microthrombi in the lungs of 100% of our patients, despite 79% having had a recent negative CT pulmonary angiogram study. contrast-enhanced ultrasound can be utilised to add confidence to an uncertain COVID-19 diagnosis and for prognosticating and monitoring progress in confirmed COVID-19 patients. Contrast-enhanced ultrasound is clearly very different to CT, the gold standard, and while there are specific pathologies that can only be detected on CT, contrast-enhanced ultrasound has many advantages, most notability the ability to pick up microthrombi at the periphery of the lungs.

Miscellaneous Lesions of the Mediastinum

Chest Imaging ◽  
2019 ◽  
pp. 505-510
Author(s):  
Brett W. Carter
Keyword(s):  
Clinical History ◽  
Extramedullary Hematopoiesis ◽  
Vascular Lesions ◽  
Esophageal Hiatus ◽  
Malignant Neoplasms ◽  
Cross Sectional ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Enhanced Computed Tomography ◽  
Omental Fat

A group of several miscellaneous lesions may arise within one or more of the mediastinal compartments that are distinct from benign or malignant neoplasms, cysts, lymphadenopathy, and vascular lesions. Such entities cannot be classified as one specific disease type, and include extramedullary hematopoiesis and multiple types of herniations, specifically hiatal, paraesophageal and Morgagni hernias. Extramedullary hematopoiesis typically manifests as paravertebral masses that may exhibit fat attenuation or signal. Hiatal and paraesophageal hernias are common abnormalities in which the stomach herniates into the thorax through the esophageal hiatus. Morgagni hernias occur through an anterior diaphragmatic defect and typically contain omental fat but may also contain liver and bowel. As with other abnormalities of the mediastinum, these lesions may first be identified on chest radiography. However, correlation with pertinent clinical history and cross-sectional imaging, typically contrast-enhanced computed tomography, is necessary for definitive diagnosis.

Endoscopic Ultrasound Features Associated with Malignancy and Aggressiveness of Nonhypovascular Solid Pancreatic Lesions: Results from a Prospective Observational Study

2019 ◽  
Author(s):  
Stefano Francesco Crinó ◽  
Alessandro Brandolese ◽  
Filippo Vieceli ◽  
Salvatore Paiella ◽  
Maria Cristina Conti Bellocchi ◽  
...  
Keyword(s):  
Observational Study ◽  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Prospective Observational Study ◽  
Distant Metastases ◽  
Cross Sectional ◽  
Surgical Specimen ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Tissue Acquisition

Abstract Background and Study Aims On contrast-enhanced imaging studies, nonhypovascular (i. e., isovascular and hypervascular) patterns can be observed in solid pancreatic lesions (SPLs) of different nature, prognosis, and management. We aimed to identify endoscopic ultrasound (EUS) features of nonhypovascular SPLs associated with malignancy/aggressiveness. The secondary aims were EUS tissue acquisition (EUS-TA) outcome and safety in this setting of patients. Patients and Methods This prospective observational study included patients with nonhypovascular SPLs detected on cross-sectional imaging and referred for EUS-TA. Lesion features (size, site, margins, echotexture, vascular pattern, and upstream dilation of the main pancreatic duct) were recorded. Malignancy/aggressiveness was determined by evidence of carcinoma at biopsy/surgical pathology, signs of aggressiveness (perineural invasion, lymphovascular invasion, and/or microscopic tumor extension/infiltration or evidence of metastatic lymph nodes) in the surgical specimen, radiologic detection of lymph nodes or distant metastases, and/or tumor growth > 5 mm/6 months. Uni- and multivariate analyses were performed to assess the primary aim. Results A total of 154 patients with 161 SPLs were enrolled. 40 (24.8 %) lesions were defined as malignant/aggressive. Irregular margins and size > 20 mm were independent factors associated with malignancy/aggressiveness (p < 0.001, OR = 5.2 and p = 0.003, OR = 2.1, respectively). However, size > 20 mm was not significant in the subgroup of other-than-neuroendocrine tumor (NET) lesions. The EUS-TA accuracy was 92 %, and the rate of adverse events was 4 %. Conclusion Irregular margins on EUS are associated with malignancy/aggressiveness of nonhypovascular SPLs. Size > 20 mm should be considered a malignancy-related feature only in NET patients. EUS-TA is safe and highly accurate for differential diagnosis in this group of patients.

scholarly journals Evaluation of genitourinary fistulas in pelvic malignancies with etiopathologic correlation: role of cross sectional imaging in detection and management

2020 ◽  
Vol 93 (1111) ◽  
pp. 20200049 ◽  
Author(s):  
Anitha Mandava ◽  
Veeraiah Koppula ◽  
Gaurav Sharma ◽  
Meghana Kandati ◽  
K.V.V.N. Raju ◽  
...  
Keyword(s):  
Imaging Findings ◽  
Cross Sectional ◽  
Pelvic Malignancies ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Ct And Mri

Objective: Genitourinary fistulas in pelvic malignancies are abnormal communications occurring due to either locally advanced tumours invading the surrounding organs or post-therapeutic complications of malignancies. In this article we review and describe the role of cross-sectional imaging findings in the management of genitourinary fistulas in pelvic malignancies. Methods: A retrospective study, for the period January 2012 to December 2018, was undertaken in patients with pelvic malignancies having genitourinary fistulas. The cross-sectional (CT and MRI) imaging findings in various types of fistulas were reviewed and correlated with the primary malignancy and the underlying etiopathology. Results: Genitourinary fistulas were observed in 71 patients (6 males, 65 females). 11 types of fistulas were identified in carcinomas of cervix, rectum, ovary, urinary bladder, sigmoid colon, vault, endometrium and prostate. The commonest were rectovaginal and vesicovaginal fistulas. 13 patients had multiple fistulas. The sensitivity, specificity, positive and negative predictive values of CT and MRI are 98%, 100%, 66%, 98% and 95%, 25%, 88% and 50% respectively. Contrast-enhanced CT with oral and rectal contrast is more sensitive and specific than MRI in the evaluation of genitourinary fistulas. Conclusion: Imaging findings significantly influence the management and outcome of genitourinary fistulas in pelvic malignancies. Contrast-enhanced CT is the imaging modality of choice in the evaluation of pelvic fistulas associated with malignancies and MRI is complimentary to it. Advances in knowledge: To our knowledge, this study is the first of its kind wherein the mean duration of occurrence of fistulas in pelvic malignancies is correlated with the underlying etiopathology.

Introduction to Mediastinal Abnormalities

Chest Imaging ◽  
2019 ◽  
pp. 471-473
Author(s):  
Melissa L. Rosado-de-Christenson
Keyword(s):  
Chest Radiograph ◽  
Chest Ct ◽  
Cross Sectional ◽  
Thoracic Inlet ◽  
Skeletal Involvement ◽  
Invasive Behavior ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Lateral Chest

The mediastinum is the space between the pleura and lungs, extends from the thoracic inlet to the diaphragm, and contains various organs and structures that may be affected by a variety of disease processes including neoplasms, other acquired conditions and congenital anomalies. The abnormal mediastinum is typically initially identified on chest radiography because of a mediastinal contour abnormality or mass. The radiologist must assess the frontal chest radiograph to determine whether the lesion manifests as a focal, diffuse or multifocal mediastinal abnormality. The lesion must then be localized to a specific mediastinal compartment using the lateral chest radiograph. This allows the formulation of a focused differential diagnosis and recommendations for further evaluation and management that often involve contrast-enhanced chest CT and less frequently MRI. These studies allow further characterization of the lesion and identification of associated findings such as lymphadenopathy, skeletal involvement and locally invasive behavior. Cross-sectional imaging usually allows categorization of mediastinal abnormalities as vascular, surgical or non-surgical lesions. Benign pathognomonic conditions that do not require further treatment may also be confidently diagnosed.

Contrast-enhanced ultrasound (CEUS) reliably rules out neoplasm in developmental renal pseudotumor

2020 ◽  
pp. 028418512093929
Author(s):  
Paul Spiesecke ◽  
Thomas Fischer ◽  
Andreas Maxeiner ◽  
Bernd Hamm ◽  
Markus H Lerchbaumer
Keyword(s):  
Predictive Value ◽  
Fast Method ◽  
Contrast Enhanced Ultrasound ◽  
Cross Sectional ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Renal Pseudotumor ◽  
Sectional Imaging ◽  
Rule Out

Background Renal pseudotumors appear as benign cortical hypertrophies and are typically assessed by contrast-enhanced computed tomography or magnetic resonance imaging to rule out malignancy. Purpose To investigate whether contrast-enhanced ultrasound (CEUS) can rule out renal neoplasm and thus potentially reduce cross-sectional imaging and further follow-up in these patients. Material and Methods Thirty-two patients with presumption of developmental renal pseudotumor on CEUS between June 2011 and July 2019 were retrospectively analyzed. All patients were examined with a standardized renal US protocol including B-mode, color-coded duplex sonography (CCDS), and CEUS by an experienced radiologist (EFSUMB level 3). Images were retrospectively interpreted in consensus by two highly experienced radiologists. Histopathological reports, cross-sectional imaging findings, and clinical course (treatment response, long-term imaging follow-up) were defined as standard of reference. Results CEUS correctly identified 8/9 neoplastic lesions and missed one oncocytoma within the 32 included patients. Irregular vessel structure (88.9% vs. 13.0%, P = 0.007) and hyperenhancement (66.6% vs. 17.4%, P = 0.031) on CEUS were more common in neoplasm compared to developmental pseudotumors reaching statistical significance. Compared with the standard of reference, CEUS had 89% sensitivity (95% confidence interval [CI] 57–98), 96% specificity (95% CI 80–99), a positive predictive value of 89% (95% CI 57–98), and a negative predictive value of 96% (95% CI 79–99) for ruling out renal malignancy in developmental pseudotumors. Conclusion CEUS is a safe and fast method to rule out neoplasm in the diagnostic work-up of renal pseudotumors. In conjunction with B-mode and CCDS, CEUS has the potential to reduce further (invasive) diagnostic procedures.

Sign in / Sign up

Export Citation Format

Share Document