Pylephlebitis complicating peridiverticulitis without hepatic abscess: early detection with contrast-enhanced CT of the abdomen

Pylephlebitis is a very rare and dangerous complication of inflammatory abdominal processes, mainly appendicitis (1) and diverticulitis (2). We describe a case of peridiverticular inflammation leading to a extensive phlebitis of the adjacent sigmoid vein, extending to the inferior mesenteric vein up to the proximal portal vein, with distal embolus into the left portal vein. Contrast CT and multiplanar reconstructions allowed early diagnosis, and with antibiotic and anticoagulation therapy, no liver abscess developed

Spontaneous transhepatic rupture of the gallbladder with massive hemoperitoneum.

Perforation of the gallbladder has an incidence of 1.6 to 2.8% in gallbladder disease. Among these cases trans hepatic rupture is a very rare event. We report a case associated with secondary massive hemoperitoneum, free gallstone spillage, partial portal vein thrombosis and secondary pulmonary embolis

Extensive propagation of a pancreatic pseudocyst along the lower limb through the sciatic foramen.

The extremely rare extensive propagation of a giant retroperitoneal pancreatic pseudocyst into the posterior compartment of the lower limb as far as the knee is reported. The extension was found producing through the sciatic foramen and the full diagnosis was made by MDCT. A complete healing was progressively obtained in the 78-year old female after a six months period of sequential multidisciplinary therapeutic approach comprising combined medical and surgical intra-abdominal and external drainage

The spine in Paget’s disease

Paget’s disease (PD) is a chronic metabolically active bone disease, characterized by a disturbance in bone modelling and remodelling due to an increase in osteoblastic and osteoclastic activity. The vertebra is the second most commonly affected site. This article reviews the various spinal pathomechanisms and osseous dynamics involved in producing the varied imaging appearances and their clinical relevance. Advanced imaging of osseous, articular and bone marrow manifestations of PD in all the vertebral components are presented. Pagetic changes often result in clinical symptoms including back pain, spinal stenosis and neural dysfunction. Various pathological complications due to PD involvement result in these clinical symptoms. Recognition of the imaging manifestations of spinal PD and the potential complications that cause the clinical symptoms enables accurate assessment of patients prior to appropriate management

Ileal Inflammatory Fibroid Polyp Causing Ileocolic Intussusception

Inflammatory Fibroid Polyp (IFP) is an extremely rare tumour involving the gastrointestinal tract (GI) and especially the stomach and small bowel. It presents either as a solitary large or sessile lesion arising from the submucosa and despite a large size and sometimes infiltrating growth, the tumour is always benign and has a good prognosis. Histogenesis remains unknown and controversial. We report an ileal case presenting classically and typically with ileocolic intussusception. Diagnosis was made preoperatively with abdominal mdCT The polyp itself does not have noteworthy radiological signs but must be included in the large essentially histological differential diagnosis of GI tumours

Hepatic angiosarcoma occurring 65 years after thorium dioxide (Thorostrast) exposure: imaging, surgical and histopathologic findings of a historical case

We report the CT, surgical and histopathologic findings of a rare case of Hepatic Angiosarcoma (HAS) diagnosed in a 85-year old women 65 years after Thorotrast (Th²³²) exposure for angiography. At the early arterial phase of dynamic MDCT, peripheral curvilinear and central nodular puddling of contrast produced in the 8 cm tumor. Then progressive contrast filling of the tumor was observed on the delayed scans. Associated pathognomonic signs related to previous Th²³² exposure were also found comprising diffuse intrahepatic reticular bands of calcifications, numerous calcified epigastric lymph nodes and a calcified shrunken spleen. Emergency laparotomy was performed because of associated hemoperitoneum. With a delay of 65 years after Thorotrast exposure, this historical case probably represents, to our knowledge, the most delayed presentation of Th²³² related HAS ever published

Carcinoid Tumor of the Small Intestine: Mdct Findings With Pathologic Correlation

Background. MDCT currently frequently represents the first choice modality for imaging in acute or subacute abdominal conditions implicating the small bowel. As a consequence, the MDCT features of intestinal carcinoid tumors and of their peculiar metastatic spread have to be known by abdominal radiologists. Patients and methods:These features are described and illustrated in the retrospective review of seven proven cases of small intestine carcinoids diagnosed and treated in our institution. The findings are described and correlated with gross anatomy specimens. Results:The primary tumour clearly appeared as a contrast-enhancing intraluminal lesion in all cases except in one case in which the primary lesion remained unlocalized and in another in which the primary tumour finally appeared infracted at gross anatomy. The maximal tumoral enhancement was obtained in 3 patients imaged during the acute arterial phase. The diameter of the primary tumour ranged from 1 to 3 cm and all masses were ileal comprising one lesion in the proximal ileum, two in the medium ileum and three in the distal ileum. 6/7 patients had multiple prominent mesenteric nodal metastases, all also appearing as hypervascularised enhancing masses. In 4/7 patients the nodal metastases represented the major finding being much prominent and larger than the primary tumour. Signs of retractile mesenteritis with soft tissue stranding, retraction and stellate pattern of the mesentery were found around the mesenteric metastases in 5/7 patients and direct incarceration of vessels were found in 3 cases. Conclusion: The analysis of the arterial phase of MDCT study appears primordial to detect the sometimes very small but intensively enhancing primary tumor and to delineate encasement or direct obstruction of mesenteric vessels frequently caused by enhancing nodal metastases which volume often exceeds that of the primary tumor. Secondary retractile mesenteritis, deformation or ischemia of bowel loops, and hypervascular hepatic metastases are typical associated findings