Discrimination of papillary renal cell carcinoma from benign proteinaceous cyst based on iodine and water content on rapid kV-switching dual-energy CT

PURPOSEWe aimed to evaluate whether rapid kV-switching dual energy CT (rsDECT) can discriminate between papillary renal cell carcinoma (RCC) and benign proteinaceous cysts (BPCs) based on iodine and water content.METHODSTwenty-four patients with histopathologically proven papillary RCC and 38 patients with 41 BPCs were retrospectively included. Patients with BPCs were eligible for inclusion when the cysts were stable in size and appearance for at least 2 years or proved to be a cyst on ultrasound or MRI. All patients underwent delayed phase (70–90 s) rsDECT. Iodine and water content of each lesion was measured on the workstation.RESULTSOf papillary RCC patients, 4 (16%) were female and 20 (84%) were male. Mean tumor size was 39±20 mm. Mean iodine and water content was 2.08±0.7 mg/mL and 1021±14 mg/mL, respectively. Of BPC patients, 9 were female and 29 were male. Mean cyst size was 20±7 mm. Mean iodine and water content was 0.82±0.4 mg/mL and 1012±14 mg/mL, respectively. There were significant differences between iodine and water contents of papillary RCCs and BPCs (P < 0.001). The best cutoff of iodine content for differentiating papillary RCC from BPC was 1.21 mg/mL (area under the curve [AUC]=0.97, P < 0.001, sensitivity 96%, specificity 88%, positive predictive value [PPV] 82%, negative predictive value [NPV] 97%, accuracy 91%,); the best cutoff of water content was 1015.5 mg/mL (AUC=0.68, P = 0.016, sensitivity 83%, specificity 56%, PPV 52%, NPV 85%, accuracy 66%).CONCLUSIONAn iodine content threshold of 1.21 mg/mL accurately differentiates papillary RCC from BPCs on a single postcontrast rsDECT. Despite having a high sensitivity, water content has inferior diagnostic accuracy

A Rare Mimicker of an Adrenal Carcinoma: Co-occurrence of Hemorrhagic Pseudocyst and Myelolipoma

Adrenal collision tumors are rare tumors composed of two different benign or malignant tumors in the adrenal gland. Radiological features are very helpful in the diagnosis, however it is not always possible to make a definite diagnosis with imaging findings alone because the coexisting masses contain different tissue components. In this paper, we report the imaging findings of an adrenal lesion with pseudocyst and myelolipoma mimicking an adrenocortical carcinoma in a 42-year-old female patient. To the best of our knowledge, this is the first reported case of an adrenal lesion containing myelolipoma and hemorrhagic pseudocyst mimicking an adrenal carcinoma in the literature

A Rare Cause of Adrenal Mass: Adrenocortical Oncocytoma

WOS: 000501997300013Adrenocortical oncocytomas are extremely rare, usually incidentally detected tumors that are thought to have low malignant potential. The number of reported cases in the literature is below 200. These tumors are frequently non-functional and do not secrete hormones, but cases of oncocytoma causing hypertension, Cushing syndrome, and virilization have also been reported. Imaging methods are insufficient for diagnosis, and a definitive diagnosis can only be made after a histopathological examination of the adrenalectomy specimen. Here, we present the imaging and histopathological features of an adrenal mass in a 46-year-old woman who presented with left renal colic

Comparison of intrahepatic vein-to-liver parenchyma and intercostal muscle-to-liver parenchyma strain ratios in the assessment of liver fibrosis: which one should we use?

WOS: 000351697000006PubMed: 25408430The aims of this study were to investigate whether there is a difference in diagnostic value between vein to parenchyma strain ratio (VPSR) and muscle to parenchyma strain ratio (MPSR). VPSR and MPSR were calculated via sonoelastography, and were recorded for comparison with histopathology. ROC analysis, the Mann-Whitney U test, the Kruskal-Wallis test, and Spearman's rank correlation test were used for statistical analysis. The study included 59 cases of individuals who underwent biopsy (29 women, 30 men). When the threshold value for VPSR was set at 3.23, the sensitivity was 96.2% and the specificity was 83.3% (p < 0.001, F a parts per thousand yen 1). When the threshold value was set at 3.01 for MPR, the sensitivity was 88.7% and the specificity was 83.3% (p < 0.001, F a parts per thousand yen 1). The areas under the curve values were VPSR 0.95 and MPSR 0.92 for F a parts per thousand yen 1, VPSR 0.94 and MPSR 0.92 for F a parts per thousand yen 2, and VPSR 1.00 and MPSR 0.76 for F = 3 (p < 0.001). The Spearman's correlation coefficient was 0.75, and a high positive concordance was found between VPSR and MPSR (p < 0.001). In this study, a high positive correlation was observed between two strain ratios, and VPSR was found to be more reliable than MPSR in determining liver fibrosis

Cholangiocarcinoma Arising from a Type VI Biliary Cyst: A Case Report and Review of the Literature

Cystic dilatations of the cystic duct which are suggested as type VI biliary cysts are very rare and many of them go unrecognized or are confused with other cysts until the operation although they are obvious on imaging studies. They can present with fusiform or saccular dilatations and can be accompanied by common bile duct dilatations. It is important to identify these cysts as they share the same characteristics as the other biliary cyst types and can be complicated with malignancy. We herein present a very unusual case of a cholangiocarcinoma arising from a type VI biliary cyst in a 58-year-old female patient and review the literature. The patient presented with jaundice, weight loss, and abdominal pain. On imaging, the cystic duct and common bile duct were fusiformly dilated and had a wide communication. There was a mass filling the distal parts of both ducts. The patient was urgently operated on after perforation following ERCP. Histopathology was compatible with a type VI biliary cyst and an associated cholangiocarcinoma

A rare cause of acute abdomen in the ED: Chemotherapy-induced pneumatosis intestinalis

WOS: 000424190600008PubMed: 29464220Pneumatosis intestinalis (PI) and portomesenteric venous gas (PVG) refers to the presence of air within the intestinal wall and portomesenteric vessels. Most of the time, it is associated with mesenteric ischemia that requires immediate surgical intervention as it has high mortality rate. It may also be seen secondary to various conditions, including infections, surgeries, and some chemotherapeutic drugs. A 61-year old-male was admitted to our emergency department complaining of abdominal pain after chemotherapy. Radiological evaluation of the patient demonstrated massive PVG and PI. Patient underwent urgent surgery due to the possibility of intestinal ischemia and infarction, but no necrosis was identified Chemotherapeutic drug-induced PI and PVG was the final diagnosis. Although PI and PVG are signs of mesenteric ischemia and intestinal necrosis most the of time, chemotherapeutic drugs may also cause PI and PVG rarely. Recent history of chemotheraphy and absence of any mesenteric vascular occlusion may be the diagnostic clue. Copyright (C) 2017 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license

A Rare Complication of Blunt Traumatic Injury: Posttraumatic Intrasplenic Arteriovenous Fistula and Treatment by Superselective Coil Embolization

Posttraumatic intrasplenic arteriovenous fistula is a very rare complication of blunt traumatic injury. Computed tomography angiography is a useful and noninvasive technique to follow up nonsurgically managed patients with posttraumatic splenic injury and has a vital role detecting delayed complications such as arteriovenous fistula. Endovascular treatment of a vascular complication prevents risk of surgery and splenectomy complications. We present a case of posttraumatic arteriovenous fistula in 39-year-old male which was diagnosed by computed tomography angiography and successfully treated by transcatheter coil embolization. [Med-Science 2015; 4(3.000): 2536-42