Real-time CEUS-guided biopsy revealing a littoral cell angioma of the spleen after inconclusive CT and MRI findings

The aim of this case report is to present real-time CEUS-guided biopsy for diagnosing rare benign splenic pathologies after inconclusive findings on cross-sectional imaging. We present the case of a 50-year-old male patient who received a contrast-enhanced computed tomography scan of the thorax during the evaluation for lung transplant due to lung fibrosis, with incidental finding of disseminated hypodense splenic lesions. During follow-up imaging, the patient did not tolerate a complete MRI examination, and two acquired pulse sequences did not confirm the final diagnosis. While CT-guided biopsy revealed no results, CEUS-guided target biopsy with repeated contrast injections showed a benign littoral cell angioma of the spleen. The use of real-time CEUS-guided target biopsy during lesion washout may be a useful tool to improve the accuracy of biopsy and accelerate the diagnosis in patients with parenchymal lesions after inconclusive cross-sectional imaging findings which may pose a challenge for CT-guided biopsy.

Anthropogenic Impact on Beach Heterogeneity within a Littoral Cell (Northern Tuscany, Italy)

In this paper the evolution of the Northern Tuscany littoral cell is documented through a detailed analysis of the increasing anthropogenic pressure since the beginning of the 20th century. This sector of the Tuscany coast has been experiencing strong erosion effects that resulted in the loss of large volumes of sandy beaches. The anthropogenic impact on natural processes have been intensified by the construction of two ports in the early decades of the 20th century. Competent authorities reacted by building hard protection structures that tried to fix the position of the shoreline but offset the erosion drive downdrift. Therefore, in the last 20 years a regional Plan was undertaken to gradually replace the hard defense schemes with a softer approach, which involved a massive use of sediment redistribution activities. Many nourishments have been done ever since, using both sand and gravel. All these hard and soft protection operations have been archived in a geodatabase, and visualized in maps that clearly show the progressive change from hard to soft defense. This database may improve the approach to any future analysis of the littoral cell both in terms of research and management, while providing a practical example that may be easily replicated elsewhere.