S. Sen, A. Gehani, P. Ghosh, Anurima Patra, Sumit Mukhopadhyay, Aditi Chandra, D. Lingegowda, J. Khoda, A. Chatterjee
Abstract Hepatocellular carcinoma (HCC) is the most prevalent form of liver cancer with major risk factors being chronic liver disease (CLD) including chronic liver inflammation, steatohepatitis and certain viral infections (Hepatitis B and C). Due to the poor prognosis, early detection is key for effective management. Imaging of HCC has developed over the years with specificity as high as 95%. The Liver Imaging Reporting and Data System (LI-RADS) provides a standardized reporting format that can be followed by radiologists and clinicians alike. This article focuses on the pathological basis of imaging observations described in the LI-RADS lexicon. A clear understanding of the pathological basis of imaging will help the radiologist to be more confident to resolve unequivocal observations apart from achieving a high degree of specificity in the diagnosis of HCC.
{"title":"Pathological Basis of Imaging in Hepatocellular Carcinoma","authors":"S. Sen, A. Gehani, P. Ghosh, Anurima Patra, Sumit Mukhopadhyay, Aditi Chandra, D. Lingegowda, J. Khoda, A. Chatterjee","doi":"10.1055/s-0043-1764310","DOIUrl":"https://doi.org/10.1055/s-0043-1764310","url":null,"abstract":"Abstract Hepatocellular carcinoma (HCC) is the most prevalent form of liver cancer with major risk factors being chronic liver disease (CLD) including chronic liver inflammation, steatohepatitis and certain viral infections (Hepatitis B and C). Due to the poor prognosis, early detection is key for effective management. Imaging of HCC has developed over the years with specificity as high as 95%. The Liver Imaging Reporting and Data System (LI-RADS) provides a standardized reporting format that can be followed by radiologists and clinicians alike. This article focuses on the pathological basis of imaging observations described in the LI-RADS lexicon. A clear understanding of the pathological basis of imaging will help the radiologist to be more confident to resolve unequivocal observations apart from achieving a high degree of specificity in the diagnosis of HCC.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"1 1","pages":"160 - 172"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88455634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Hepatic lesions are commonly encountered in radiology practice. Lesions with classic imaging findings such as hepatocellular carcinoma, cholangiocarcinoma, hemangiomas, focal nodular hyperplasia, and adenomas are well described in literature and easily diagnosed by most experienced radiologists. In the appropriate context, metastases, which are one of the most common lesions encountered by radiologists who practice in predominantly cancer care settings, are also easily diagnosed. However, one may encounter rarer neoplasms which may be challenging to diagnose and manage. Often, these lesions have overlapping imaging features with those of the common lesions mentioned above. Diagnosis of these rarer tumors would require not only interpreting the images in the context of patient's demographics and clinical presentation but also recognizing the unique imaging features of these tumors. The literature is sparse in describing the radiological appearances of these tumors. Diagnosis based solely on imaging criteria is not advised in these instances. Histological confirmation or other prudent follow-up strategies are necessary for confirmation of imaging findings and interpretation. In this article, we will describe known imaging features of a few rarer primary malignant and benign neoplasms in the liver.
{"title":"Imaging Features of Rare Hepatic Tumors","authors":"R. Vikram, A. Sarna, Nir Stanietzky","doi":"10.1055/s-0043-1764402","DOIUrl":"https://doi.org/10.1055/s-0043-1764402","url":null,"abstract":"Abstract Hepatic lesions are commonly encountered in radiology practice. Lesions with classic imaging findings such as hepatocellular carcinoma, cholangiocarcinoma, hemangiomas, focal nodular hyperplasia, and adenomas are well described in literature and easily diagnosed by most experienced radiologists. In the appropriate context, metastases, which are one of the most common lesions encountered by radiologists who practice in predominantly cancer care settings, are also easily diagnosed. However, one may encounter rarer neoplasms which may be challenging to diagnose and manage. Often, these lesions have overlapping imaging features with those of the common lesions mentioned above. Diagnosis of these rarer tumors would require not only interpreting the images in the context of patient's demographics and clinical presentation but also recognizing the unique imaging features of these tumors. The literature is sparse in describing the radiological appearances of these tumors. Diagnosis based solely on imaging criteria is not advised in these instances. Histological confirmation or other prudent follow-up strategies are necessary for confirmation of imaging findings and interpretation. In this article, we will describe known imaging features of a few rarer primary malignant and benign neoplasms in the liver.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"4 1","pages":"227 - 237"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87891465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Adult intussusception is a rare phenomenon and often provides a unique diagnostic challenge, typically involving extensive investigation to rule out sinister pathology. We present the case of a healthy 28-year-old male, who presented with symptoms suggestive of small bowel obstruction. Computed tomography displayed evidence of a small bowel intussusception; however, thorough investigation was unremarkable, besides a marked polycythemia. The patient represented several months later with another bowel obstruction, at which time he disclosed the regular use of androgenous anabolic steroids (AAS), which are recognized to induce polycythemia. AAS increase the risk of thromboembolic events and have more recently been implicated as a risk factor for intussusception. This case aims to highlight the increasing prevalence of AAS use, and the importance of its consideration in diagnostic dilemmas, particularly in otherwise healthy adults presenting with intussusception.
{"title":"Multiple Small Bowel Intussusceptions in the setting of Anabolic Steroid Use","authors":"A. Davies, Michael Sangiorgio, Ashwin Patwardhan","doi":"10.1055/s-0043-1763482","DOIUrl":"https://doi.org/10.1055/s-0043-1763482","url":null,"abstract":"Abstract Adult intussusception is a rare phenomenon and often provides a unique diagnostic challenge, typically involving extensive investigation to rule out sinister pathology. We present the case of a healthy 28-year-old male, who presented with symptoms suggestive of small bowel obstruction. Computed tomography displayed evidence of a small bowel intussusception; however, thorough investigation was unremarkable, besides a marked polycythemia. The patient represented several months later with another bowel obstruction, at which time he disclosed the regular use of androgenous anabolic steroids (AAS), which are recognized to induce polycythemia. AAS increase the risk of thromboembolic events and have more recently been implicated as a risk factor for intussusception. This case aims to highlight the increasing prevalence of AAS use, and the importance of its consideration in diagnostic dilemmas, particularly in otherwise healthy adults presenting with intussusception.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"238 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86082063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Rajesh, V. Arunachalam, Gopinath Periaswamy, Gobi Kalyan, Rupa Renganathan, Gowtham Sm, M. Cherian
Abstract Background and Objectives The purpose of this study is to evaluate and establish the accuracy of noninvasive methods, including third-generation dual-source dual-energy computed tomography (DECT) and proton density fat (PDF) fraction on magnetic resonance imaging (MRI) using three-dimensional multiecho multipoint chemical shift-encoded spoiled gradient echo (q-Dixon) sequence in the quantification of hepatic steatosis; with H1-MR spectroscopy (MRS) as the reference standard. Materials and Methods A total of 47 patients were included in this prospective study. We studied the accuracy of fatty liver detection using third-generation DECT using mixed set images (MSIs), virtual monochromatic images (VMIs), and MRI q-Dixon. The results were compared with H1-MRS. Data were analyzed using linear regression for each technique compared with MRS. Results Our study's correlation and linear regression analysis showed a good correlation between PDF values obtained by H1-MRS and MR q-Dixon methods ( r = 0.821, r 2 = 0.674, p < 0.001). On MSI, H1-MRS showed a low correlation with average liver attenuation ( r 2 = 0.379, p < 0.001) and a moderate correlation with liver attenuation index ( r 2 = 0.508, p < 0.001) noted. There was a moderate correlation between H1-MRS and average liver attenuation and liver attenuation index on VMI at 80 to 120 keV with r 2 = 0.434, p < 0.001, and r 2 = 0.485, p < 0.001, respectively. Conclusion MRI q-Dixon is the method of choice for evaluating fat quantification in the absence of H1 MRS. Among DECT images, VMI is valuable in the evaluation of hepatic fat as compared with the mixed set of images.
背景与目的本研究的目的是评估和建立无创方法的准确性，包括第三代双源双能计算机断层扫描(DECT)和磁共振成像(MRI)上的质子密度脂肪(PDF)分数，利用三维多回波多点化学位移编码的破坏梯度回波(q-Dixon)序列定量肝脏脂肪变性;以H1-MR光谱(MRS)为参比标准。材料与方法本前瞻性研究共纳入47例患者。我们研究了第三代DECT使用混合集图像(msi)、虚拟单色图像(vmi)和MRI q-Dixon检测脂肪肝的准确性。结果与H1-MRS比较。结果本研究的相关分析和线性回归分析显示，H1-MRS法与MR q-Dixon法测定的PDF值具有良好的相关性(r = 0.821, r 2 = 0.674, p < 0.001)。在MSI上，H1-MRS与肝脏平均衰减呈低相关性(r 2 = 0.379, p < 0.001)，与肝脏衰减指数呈中等相关性(r 2 = 0.508, p < 0.001)。80 ~ 120 keV时，H1-MRS与VMI平均肝衰减和肝衰减指数有中度相关性，r2 = 0.434, p < 0.001; r2 = 0.485, p < 0.001。结论MRI q-Dixon是在没有H1 mrs的情况下评估脂肪定量的首选方法。在DECT图像中，与混合图像集相比，VMI在评估肝脏脂肪方面更有价值。
{"title":"Accuracy of Evaluation of Fatty Liver with Third-Generation Unenhanced Dual-Energy CT and MRI: Prospective Comparison with MR Spectroscopy","authors":"S. Rajesh, V. Arunachalam, Gopinath Periaswamy, Gobi Kalyan, Rupa Renganathan, Gowtham Sm, M. Cherian","doi":"10.1055/s-0043-1763483","DOIUrl":"https://doi.org/10.1055/s-0043-1763483","url":null,"abstract":"Abstract Background and Objectives The purpose of this study is to evaluate and establish the accuracy of noninvasive methods, including third-generation dual-source dual-energy computed tomography (DECT) and proton density fat (PDF) fraction on magnetic resonance imaging (MRI) using three-dimensional multiecho multipoint chemical shift-encoded spoiled gradient echo (q-Dixon) sequence in the quantification of hepatic steatosis; with H1-MR spectroscopy (MRS) as the reference standard. Materials and Methods A total of 47 patients were included in this prospective study. We studied the accuracy of fatty liver detection using third-generation DECT using mixed set images (MSIs), virtual monochromatic images (VMIs), and MRI q-Dixon. The results were compared with H1-MRS. Data were analyzed using linear regression for each technique compared with MRS. Results Our study's correlation and linear regression analysis showed a good correlation between PDF values obtained by H1-MRS and MR q-Dixon methods ( r = 0.821, r 2 = 0.674, p < 0.001). On MSI, H1-MRS showed a low correlation with average liver attenuation ( r 2 = 0.379, p < 0.001) and a moderate correlation with liver attenuation index ( r 2 = 0.508, p < 0.001) noted. There was a moderate correlation between H1-MRS and average liver attenuation and liver attenuation index on VMI at 80 to 120 keV with r 2 = 0.434, p < 0.001, and r 2 = 0.485, p < 0.001, respectively. Conclusion MRI q-Dixon is the method of choice for evaluating fat quantification in the absence of H1 MRS. Among DECT images, VMI is valuable in the evaluation of hepatic fat as compared with the mixed set of images.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"14 1","pages":"079 - 088"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74034412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Juvaina, KT Aleena, A. Riyaz, E. Devarajan, P. Ranjit, ER Rani Jyothi
Abstract Choledochal cyst (CDC) is a rare surgical cause of cholestatic jaundice in infants. Spontaneous rupture is an unusual presentation of a previously undiagnosed CDC and is also a rare cause of biliary peritonitis in children. Here, we report a case of a 1-year-old boy who was evaluated for progressive abdominal distension. Ultrasonogram showed gross ascites with echogenic particles, dilated common bile duct (CBD), common hepatic duct (CHD), and upstream intra hepatic biliary radicle dilatation (IHBRD). CECT sections of the abdomen showed gross ascites and IHBRD with disproportionate dilatation of CHD and CBD. At laparotomy, a type 1 CDC with rupture of the anterior wall was found. The cyst was excised followed by hepaticojejunostomy. In a sick child with abdominal pain, cholestatic jaundice and biliary ascites, a high index of suspicion during imaging will help in the correct diagnosis and surgery for a potentially fatal ruptured CDC.
{"title":"Spontaneous Rupture of Choledochal Cyst: A Rare Presentation","authors":"P. Juvaina, KT Aleena, A. Riyaz, E. Devarajan, P. Ranjit, ER Rani Jyothi","doi":"10.1055/s-0042-1759682","DOIUrl":"https://doi.org/10.1055/s-0042-1759682","url":null,"abstract":"Abstract Choledochal cyst (CDC) is a rare surgical cause of cholestatic jaundice in infants. Spontaneous rupture is an unusual presentation of a previously undiagnosed CDC and is also a rare cause of biliary peritonitis in children. Here, we report a case of a 1-year-old boy who was evaluated for progressive abdominal distension. Ultrasonogram showed gross ascites with echogenic particles, dilated common bile duct (CBD), common hepatic duct (CHD), and upstream intra hepatic biliary radicle dilatation (IHBRD). CECT sections of the abdomen showed gross ascites and IHBRD with disproportionate dilatation of CHD and CBD. At laparotomy, a type 1 CDC with rupture of the anterior wall was found. The cyst was excised followed by hepaticojejunostomy. In a sick child with abdominal pain, cholestatic jaundice and biliary ascites, a high index of suspicion during imaging will help in the correct diagnosis and surgery for a potentially fatal ruptured CDC.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"2 1","pages":"154 - 157"},"PeriodicalIF":0.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88014148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Fistulas are abnormal communication between two epithelialized surfaces. Gastrointestinal fistulas are communication between the gut and another epithelialized surface. Fistulas are classified according to anatomic (internal or external), physiologic (output volume), and etiologic characteristics. In the case of clinical suspicion of a fistula, a multidisciplinary approach helps in diagnosing and management. Multidetector computed tomography (MDCT) has an advantage over other imaging modalities due to its ability to reconstruct high-resolution images in seconds, which limits motion or peristalsis artifacts, and is ideal for patients who are uncooperative or who are seriously ill. Aim Evaluation of MDCT as an initial tool in the diagnosis and characterization of gastrointestinal fistulas. Methods During this prospective observational study, MDCT was used to assess patients with clinical suspicion of gastrointestinal fistulas. When necessary, contrast agents were used to identify the enteric fistulous tract. The etiology and characterization of the fistulas were determined. Further, the gastrointestinal fistulas were confirmed via endoscopy, cystoscopy, or surgery. Results The most common type of gastrointestinal fistula is enterocutaneous fistula (ECF) (39%) and the most common cause of gastrointestinal fistulas is postoperative (47%). ECFs were classified according to their etiology, anatomy, and favorable characteristics (85% favorable) along with complexity (64% complex) to aid in the management process. In addition to pancreaticopleural fistulas (22%), biliary (11%), esophageal (8%), and pelvic fistulas (19%) were also observed. There were 19% of fistulas (esophageal and biliary) that were asymptomatic. Endoscopy confirmed such asymptomatic fistulas that were not convincingly detected on CT. Conclusion In this study, we concluded that with the appropriate clinical history, MDCT can accurately depict enteric fistulas. In addition to characterizing fistulas, MDCT is equally useful for detecting secondary complications like inflammation, obstruction, or abscesses.
{"title":"Role of Multidetector Computed Tomography in Diagnosis of Acquired Gastrointestinal Fistulas","authors":"Gitanjali Arora, P. Badhe","doi":"10.1055/s-0042-1758124","DOIUrl":"https://doi.org/10.1055/s-0042-1758124","url":null,"abstract":"Abstract Introduction Fistulas are abnormal communication between two epithelialized surfaces. Gastrointestinal fistulas are communication between the gut and another epithelialized surface. Fistulas are classified according to anatomic (internal or external), physiologic (output volume), and etiologic characteristics. In the case of clinical suspicion of a fistula, a multidisciplinary approach helps in diagnosing and management. Multidetector computed tomography (MDCT) has an advantage over other imaging modalities due to its ability to reconstruct high-resolution images in seconds, which limits motion or peristalsis artifacts, and is ideal for patients who are uncooperative or who are seriously ill. Aim Evaluation of MDCT as an initial tool in the diagnosis and characterization of gastrointestinal fistulas. Methods During this prospective observational study, MDCT was used to assess patients with clinical suspicion of gastrointestinal fistulas. When necessary, contrast agents were used to identify the enteric fistulous tract. The etiology and characterization of the fistulas were determined. Further, the gastrointestinal fistulas were confirmed via endoscopy, cystoscopy, or surgery. Results The most common type of gastrointestinal fistula is enterocutaneous fistula (ECF) (39%) and the most common cause of gastrointestinal fistulas is postoperative (47%). ECFs were classified according to their etiology, anatomy, and favorable characteristics (85% favorable) along with complexity (64% complex) to aid in the management process. In addition to pancreaticopleural fistulas (22%), biliary (11%), esophageal (8%), and pelvic fistulas (19%) were also observed. There were 19% of fistulas (esophageal and biliary) that were asymptomatic. Endoscopy confirmed such asymptomatic fistulas that were not convincingly detected on CT. Conclusion In this study, we concluded that with the appropriate clinical history, MDCT can accurately depict enteric fistulas. In addition to characterizing fistulas, MDCT is equally useful for detecting secondary complications like inflammation, obstruction, or abscesses.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"80 1","pages":"015 - 020"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86833445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Splenosis is a benign and rare condition that is usually caused by trauma or splenectomy or other procedures involving splenic tissue. The patient is usually asymptomatic and often diagnosed incidentally especially when presents as intrahepatic lesion, can be misdiagnosed as neoplasm. Here, we present case report of a 56-year-old male patient, who was incidentally detected to have focal liver lesion on routine ultrasound check up. He was further evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) and the lesion was indistinguishable from neoplastic lesions and misdiagnosed to be hepatic adenoma. Retrospectively analyzing, the patient had history of splenectomy following road traffic accident 10 years before the present presentation. Following laparotomy, the liver lesion was resected and histopathology confirmed the diagnosis of hepatic splenosis. In this case report and review, we present the diagnostic features and the criteria that help in the diagnosis of splenosis which is a great mimicker.
{"title":"Hepatic Splenosis: A Rare Entity and Great Mimicker","authors":"Shruthi Kb, Hanan Pk","doi":"10.1055/s-0042-1758123","DOIUrl":"https://doi.org/10.1055/s-0042-1758123","url":null,"abstract":"Abstract Splenosis is a benign and rare condition that is usually caused by trauma or splenectomy or other procedures involving splenic tissue. The patient is usually asymptomatic and often diagnosed incidentally especially when presents as intrahepatic lesion, can be misdiagnosed as neoplasm. Here, we present case report of a 56-year-old male patient, who was incidentally detected to have focal liver lesion on routine ultrasound check up. He was further evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) and the lesion was indistinguishable from neoplastic lesions and misdiagnosed to be hepatic adenoma. Retrospectively analyzing, the patient had history of splenectomy following road traffic accident 10 years before the present presentation. Following laparotomy, the liver lesion was resected and histopathology confirmed the diagnosis of hepatic splenosis. In this case report and review, we present the diagnostic features and the criteria that help in the diagnosis of splenosis which is a great mimicker.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"9 1","pages":"067 - 070"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76170396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Papillary thyroid cancer (PTC) is the most common endocrine malignancy, accounting for 85% of differentiated thyroid cancers. A small percentage of PTC variants are considered more aggressive, such as the tall cell variant associated with the V600E mutation in the BRAF gene and the rarer columnar variant, which is described in only 0.2% of cases and has a poor prognosis. Although locoregional metastases to neck lymph nodes are common, distant metastases of PTC are rare at presentation with only 5 to 7% reported in the literature. We present a very rare case of columnar cell variant PTC with synchronous metastasis to the lungs and indolent focus in the pancreas at initial diagnosis, which has never been reported in the literature. Our patient presented with non-radioactive iodine (RAI) responsive PTC with diffuse metastases to the lungs and one synchronous focal metastatic lesion in the pancreas. After multidisciplinary discussions, pancreatectomy/metastasectomy was deferred due to the disseminated PTC with multiple metastases to the lungs, lack of pancreas-related symptoms in the patient, and inherent complication risks. The patient was treated with systemic therapy using a tyrosine kinase inhibitor (lenvatinib), which is the standard of care for non-RAI responsive PTC and showed a complete radiologic resolution of the pancreatic lesion, however, with partial yet nonprogressive metastatic disease in the lungs.
{"title":"Rare Columnar Cell Variant Papillary Thyroid Carcinoma with Metastasis to Pancreas and Lungs at Initial Presentation: A Case Report and Review of Literature","authors":"A. Gjeluci, Joseph Clark, A. Jawahar","doi":"10.1055/s-0042-1758122","DOIUrl":"https://doi.org/10.1055/s-0042-1758122","url":null,"abstract":"Abstract Papillary thyroid cancer (PTC) is the most common endocrine malignancy, accounting for 85% of differentiated thyroid cancers. A small percentage of PTC variants are considered more aggressive, such as the tall cell variant associated with the V600E mutation in the BRAF gene and the rarer columnar variant, which is described in only 0.2% of cases and has a poor prognosis. Although locoregional metastases to neck lymph nodes are common, distant metastases of PTC are rare at presentation with only 5 to 7% reported in the literature. We present a very rare case of columnar cell variant PTC with synchronous metastasis to the lungs and indolent focus in the pancreas at initial diagnosis, which has never been reported in the literature. Our patient presented with non-radioactive iodine (RAI) responsive PTC with diffuse metastases to the lungs and one synchronous focal metastatic lesion in the pancreas. After multidisciplinary discussions, pancreatectomy/metastasectomy was deferred due to the disseminated PTC with multiple metastases to the lungs, lack of pancreas-related symptoms in the patient, and inherent complication risks. The patient was treated with systemic therapy using a tyrosine kinase inhibitor (lenvatinib), which is the standard of care for non-RAI responsive PTC and showed a complete radiologic resolution of the pancreatic lesion, however, with partial yet nonprogressive metastatic disease in the lungs.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"35 1","pages":"062 - 066"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79794860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Poojary Shweta Raviraj, Venkataswamy Chandana, Hagalahalli Nagarajegowda Pradeep, C. Nanjaraj
Abstract Wide array of anatomical variations and pathologies affect the inferior vena cava (IVC). Multidetector computed tomography remains the most important modality to diagnose and evaluate the extent of involvement. The congenital variations such as duplication, anomalous course of renal veins, azygos continuation of IVC, etc., remain clinically indolent and are detected incidentally in abdominal imaging. This article describes the various congenital variants which include abnormalities in drainage, failure of development, and regression of the IVC. This article also highlights the important pathological conditions such as Budd–Chiari syndrome, primary and secondary neoplasms of the IVC, bland thrombosis, and retrograde opacification of the IVC.
{"title":"Inferior Vena Cava Anomalies and Pathologies","authors":"Poojary Shweta Raviraj, Venkataswamy Chandana, Hagalahalli Nagarajegowda Pradeep, C. Nanjaraj","doi":"10.1055/s-0042-1758129","DOIUrl":"https://doi.org/10.1055/s-0042-1758129","url":null,"abstract":"Abstract Wide array of anatomical variations and pathologies affect the inferior vena cava (IVC). Multidetector computed tomography remains the most important modality to diagnose and evaluate the extent of involvement. The congenital variations such as duplication, anomalous course of renal veins, azygos continuation of IVC, etc., remain clinically indolent and are detected incidentally in abdominal imaging. This article describes the various congenital variants which include abnormalities in drainage, failure of development, and regression of the IVC. This article also highlights the important pathological conditions such as Budd–Chiari syndrome, primary and secondary neoplasms of the IVC, bland thrombosis, and retrograde opacification of the IVC.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"258 1","pages":"021 - 031"},"PeriodicalIF":0.0,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78396075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Gallstone ileus is an uncommon presentation in patients with acute abdomen. Its diagnosis and treatment are often delayed due to its nonspecific clinical presentation. Presence of gallstone in ileum can be difficult to detect on computed tomography (CT) as mostly they are lucent. We report the case of a 66-year-old man with a 1-day history of vomiting and abdominal bloating. Initial CT could not identify the obstructing gall stone. On the follow-up CT, there was a distal shift of obstruction site in the intestine raising suspicion of a gallstone. We discuss the imaging findings on CT and the clues to diagnosing gallstone ileus.
{"title":"Gallstone Ileus—Lessons from a Missed Diagnosis","authors":"Animesh Ajit Sathe, Rajat Bhargava","doi":"10.1055/s-0042-1754327","DOIUrl":"https://doi.org/10.1055/s-0042-1754327","url":null,"abstract":"Abstract Gallstone ileus is an uncommon presentation in patients with acute abdomen. Its diagnosis and treatment are often delayed due to its nonspecific clinical presentation. Presence of gallstone in ileum can be difficult to detect on computed tomography (CT) as mostly they are lucent. We report the case of a 66-year-old man with a 1-day history of vomiting and abdominal bloating. Initial CT could not identify the obstructing gall stone. On the follow-up CT, there was a distal shift of obstruction site in the intestine raising suspicion of a gallstone. We discuss the imaging findings on CT and the clues to diagnosing gallstone ileus.","PeriodicalId":52666,"journal":{"name":"Journal of Gastrointestinal and Abdominal Radiology","volume":"11 1","pages":"032 - 036"},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84967930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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