scholarly journals Bile Duct Strictures Caused by Solid Masses: MR in Differential Diagnosis and as a Prognostic Tool to Plan the Endoscopic Treatment

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Tomasz Gorycki ◽  
Michał Studniarek
Keyword(s):  
Differential Diagnosis ◽  
Bile Duct ◽  
Endoscopic Treatment ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Duct ◽  
Linear Measurements ◽  
Diagnosis And Prognosis ◽  
Signal Characteristics ◽  
Malignant Lesions ◽  
Solid Lesions

The aim of the study was to assess how realiable is differential diagnosis and prognosis for endoscopic treatment with MR signal characteristics as the qualitative parameter and magnetic resonance cholangiopancreatography (MRCP) images in cases of bile duct obstructions caused by solid masses.Material and Methods. Retrospective study of MR and MRCP images in 80 patients (mean age 58 ys) was conducted. Mean signal intensity ratio (SIR) from planar MR images and MRCP linear measurements were compared between benign and malignant lesions and in groups including the size and number of stents placed during ERCP (< 10 F <) in 51 cases in which ERCP was performed.Results. Significantly higher SIR values were encountered in malignant lesions in T2W images () and STIR T2W images (). Malignant lesions were characterised by longer strictures () and greater proximal biliary duct dilatation (). High significance for predicting ERCP conditions was found with mean SIR in STIR T2W images and stricture length.Conclusion. Probability of malignancy of solid lesions obstructing biliary duct increased with higher SIR in T2W images and with longer strictures. Passing the stricture during ERCP treatment was easier and more probable in cases of shorter strictures caused by lesions with higher SIR in STIR T2W images.

scholarly journals Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

2019 ◽  
Vol 9 ◽  
pp. 23
Author(s):  
Giulia Frauenfelder ◽  
Annamaria Maraziti ◽  
Vincenzo Ciccone ◽  
Giuliano Maraziti ◽  
Oliviero Caleo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Abdominal Pain ◽  
Imaging Modality ◽  
Biliary Duct ◽  
History Of ◽  
The Common ◽  
Solid Lesions

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.

Novel immunohistochemical markers differentiate intrahepatic cholangiocarcinoma from benign bile duct lesions

2016 ◽  
Vol 69 (7) ◽  
pp. 619-626 ◽  
Author(s):  
Stefanie Bertram ◽  
Juliet Padden ◽  
Julia Kälsch ◽  
Maike Ahrens ◽  
Leona Pott ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Bile Duct ◽  
Intrahepatic Cholangiocarcinoma ◽  
Immunohistochemical Markers ◽  
Hsp 27 ◽  
Malignant Lesions ◽  
The Difference ◽  
Bile Duct Lesions ◽  
Cluster Of Differentiation ◽  
Bile Duct Adenoma

AimsThe distinction between intrahepatic cholangiocarcinoma (ICC) and benign bile duct lesions can be challenging. Using our previously identified potential biomarkers for ICC, we examined whether these are useful for the differential diagnosis of ICC, bile duct adenoma and reactive bile duct proliferations in an immunohistochemical approach and identified a diagnostic marker panel including known biomarkers.MethodsSubjects included samples from 77 patients with ICC, 33 patients with bile duct adenoma and 47 patients with ductular reactions in liver cirrhosis. Our previously identified biomarkers (stress-induced phosphoprotein 1 (STIP1), SerpinH1, 14-3-3Sigma) were tested immunohistochemically following comparison with candidates from the literature (cluster of differentiation 56, heat shock protein (HSP)27, HSP70, B-cell-lymphoma2, p53, ki67).ResultsThe expression of SerpinH1 and 14-3-3Sigma was significantly higher in ICC than in bile duct adenomas and ductular reactions (p<0.05), whereas STIP1 expression was significantly higher (p<0.05) in ICC than in ductular reactions, but the difference to the bile duct adenoma group was not significant. A panel of the biomarker SerpinH1, 14-3-3Sigma and ki67 (≥2 marker positive) showed a high diagnostic accuracy (sensitivity 87.8%, specificity 95.9%, accuracy 91.8%) in the differential diagnosis of ICC versus non-malignant bile duct lesions.ConclusionsThis suggests that 14-3-3Sigma and SerpinH1 may be useful in the differential diagnosis of malignant, benign and reactive bile duct lesions in addition to ki67 where a cut-off of >5% might be used for the distinction of malignant and non-malignant lesions.

scholarly journals A case report of spontaneous biliary peritonitis with accessory liver lobe: rare presentation of a rare pathology

2021 ◽  
Vol 8 (10) ◽  
pp. 3224
Author(s):  
Bhuban M. Das ◽  
Suraj Ethiraj ◽  
Sujit K. Mohanty ◽  
Ramapada Mohapatra
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Rare Condition ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Duct ◽  
Liver Lobe ◽  
Rare Presentation ◽  
Distal Common Bile Duct ◽  
Accessory Liver ◽  
Accessory Liver Lobe

Spontaneous intrahepatic bile duct perforation with associated accessory liver lobe is an exceedingly rare condition with very few cases reported in the literature. Here we report a case of 76 years old man presenting with severe pain, abdominal distension since 3 days having jaundice and signs of peritonitis. Having undergone an exploratory laparotomy, 1 liter of bilious peritoneal fluid was seen with a perforation of left intra hepatic bile duct with a presence of an accessory lobe of liver. The gall bladder was contracted with multiple stones. Extrahepatic biliary duct was found normal intraoperatively. A cholecystectomy with resection of the accessory liver lobe was done. Post operatively patient had persistence of jaundice for which a magnetic resonance cholangiopancreatography was done, revealing a distal common bile duct calculus. Patient underwent endoscopic retrograde cholangiopancreatography with stone extraction on post operative day 10 relieving the symptoms. Patient is on regular follow up with no further complications. Awareness of such unusual occurrences is necessary for early diagnosis and instituting the appropriate treatment thereby reducing the mortality.  

scholarly journals Cardiac magnetic resonance imaging in differential diagnosis of cardiac masses

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
EC D"angelo ◽  
P Paolisso ◽  
L Bergamaschi ◽  
A Foa ◽  
I Magnani ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Pericardial Effusion ◽  
Tissue Characterization ◽  
Descriptive Analysis ◽  
Gadolinium Enhancement ◽  
Malignant Lesions ◽  
T1 And T2 ◽  
Cardiac Masses

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): S. Orsola Hospital Background  Differential diagnosis of cardiac masses represents a challenging issue with important implications for therapeutic management and patient’s prognosis. Cardiac Magnetic Resonance (CMR) is a non-invasive imaging technique used to characterize morphologic and functional features of masses. Integration of these information can lead an accurate diagnosis. Purpose  To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. Methods : Ninety-three patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certainty. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion. Tissue characterization resulted from an estimation of contrast enhancement - early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) sequences - and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours.  Results  The descriptive analysis of the morphologic features showed that diameter &gt; 50mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p &lt; 0.001). As for tissue characteristics, heterogeneous signal intensity - independently from T1 and T2 weighted acquisitions - and EGE were more common in malignant lesions (p &lt;0.001). When analysing the four subgroups, CMR features did not discriminate between primitive malignant masses and metastasis. Conversely, hyperintensity signal and EGE were able to distinguish benign primitive lesions from pseudotumors (p = 0.002).  Furthermore, using classification and regression tree (CART) analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes was a common characteristic of malignancy and identifies itself malignant tumors. In the absence of invasive features, gadolinium enhancement was evaluated: the lack of contrast uptake was able to exclude a pseudotumor diagnosis and reduced the probability of a primary benign tumor.  Conclusions Cardiac magnetic resonance is a very powerful diagnostic tool for differential diagnosis of cardiac masses as it correctly addresses malignancy. Furthermore, an accurate evaluation of the several CMR features, may discriminate primary benign masses and pseudotumours. Abstract Figure. Benign and malignant cardiac masses

Claudins as biomarkers of differential diagnosis and prognosis of tumors

2021 ◽  
Author(s):  
Olga P. Popova ◽  
Alla V. Kuznetsova ◽  
Svetlana Yu Bogomazova ◽  
Alexey A. Ivanov
Keyword(s):  
Differential Diagnosis ◽  
Diagnosis And Prognosis

scholarly journals An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings

2013 ◽  
Vol 47 (2) ◽  
pp. 125-127
Author(s):  
Hakan Önder ◽  
Faysal Ekici ◽  
Emin Adin ◽  
Suzan Kuday ◽  
Hatice Gümüş ◽  
...  
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Magnetic Resonance ◽  
Biliary Obstruction ◽  
Fasciola Hepatica ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Clinical Findings ◽  
Imaging Studies ◽  
Laboratory Findings ◽  
Acoustic Shadow

Background. Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. Case report. We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. Conclusions. Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.

Endoscopic Treatment of Patients with Bile Duct Stricture After Cholecystectomy: Factors Predicting Recurrence in the Long Term

2015 ◽  
Vol 60 (6) ◽  
pp. 1778-1786 ◽  
Author(s):  
Erkan Parlak ◽  
Selçuk Dişibeyaz ◽  
Bülent Ödemiş ◽  
Aydın Şeref Köksal ◽  
Fahrettin Küçükay ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Treatment ◽  
Bile Duct Stricture ◽  
Duct Stricture

Indicial response functions of growth and remodeling of common bile duct postobstruction

2004 ◽  
Vol 286 (3) ◽  
pp. G420-G427 ◽  
Author(s):  
Quang Dang ◽  
Hans Gregersen ◽  
Birgitte Duch ◽  
Ghassan S. Kassab
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Wall Thickness ◽  
Time Course ◽  
Quantitative Description ◽  
Biliary Duct ◽  
Stress And Strain ◽  
Response Functions ◽  
Mechanical Remodeling ◽  
Scheduled Time

Biliary duct obstruction is an important clinical condition that stems from cholelithiasis, the neoplasm in the wall or, most commonly, gallbladder stones. The objective of this study is to understand the structural and mechanical remodeling of the common bile duct (CBD) postobstruction. Porcine CBD was ligated near the duodenum that increased the duct's pressure from 6.4 to 18.3 cmH2O in the first 12 h and to 30.7 cmH2O after 32 days. The remodeling process was studied after 3 h, 12 h, 2 days, 8 days, and 32 days ( n = 5 in each group) after obstruction. One additional animal in each group was sham operated. At each scheduled time, the time course of change of morphometry (diameter, length, wall thickness, etc.) and mechanical properties (stress, strain, etc.) was documented. It was found that the diameter increased by about threefold and the wall thickness of the CBD doubled in the 32-day group compared with the sham group ( P < 0.001). The stress and strain increased initially with increase in pressure but recovered to near the control values by day 32 due to the structural and mechanical adaptations. Hence, the net effect of the structural and mechanical remodeling is to restore the stress and strain to their homeostatic values. Furthermore, the strain recovers more rapidly and more completely than stress. Finally, the remodeling data were expressed mathematically in terms of indicial response functions (IRF), i.e., change of a particular feature of a CBD in response to a unit step change of the pressure. The IRF approach provides a quantitative description of the remodeling process in the CBD.

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