Perihepatitis with pelvic inflammatory disease (PID) on MDCT: characteristic findings and relevance to PID.

BACKGROUND: To evaluate the prevalence and image characteristics of perihepatitis, as well as the relationship with some computed tomography (CT) manifestations of pelvic inflammatory disease (PID). METHODS: Between January 2006 and December 2007, 93 consecutive patients examined with three-phase abdominal CT scans and clinically diagnosed and treated for PID were included. Three radiologists retrospectively reviewed CT scans with consensus, and examined the location (12 areas) and thickness (four grades) of enhancement of the hepatic surface. Several CT manifestations of PID were also evaluated and statistical analysis was performed to determine the relationship of these findings. RESULTS: Out of the 93 patients, 55 (59%) showed enhancement of the hepatic surface. The right anteroinferior hepatic surface was the most common site (89%) and lower hepatic division showed thicker parenchymal enhancement. Oophoritis (P = 0.020) and extension of mesenteric infiltration (P < 0.001) were revealed as statistically significant factors associated with the presence of perihepatitis in PID. CONCLUSIONS: Perihepatits commonly occurs in PID; 59% of PID patients in this study had perihepatitis. The predominant site was the right anteroinferior hepatic surface. Perihepatitis seems not to be associated with various CT findings of PID reflecting disease severity, except oophoritis and upper extension of mesenteric infiltration.

Screening-detected and symptomatic ductal carcinoma in situ: differences in the sonographic and pathologic features.

OBJECTIVE: The purpose of our study was to retrospectively compare the sonographic and pathologic features of screening-detected and symptomatic ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Of 5,790 cases diagnosed as breast cancer at our institution between January 1998 and December 2005, 528 (9.1%) cases were DCIS. We found 106 screening-detected and 125 symptomatic DCIS lesions in 226 patients (age range, 20-77 years; mean age, 47.8 years) who underwent preoperative whole-breast sonography and mammography. Three radiologists reviewed the sonographic features of these 231 cases of DCIS by consensus according to Breast Imaging Reporting and Data System (BI-RADS). The pathologic features were also reviewed. Statistical comparisons were performed using the chi-square test, the Fisher's exact test, and the Mann-Whitney U test. RESULTS: On sonography, masses (p < 0.001) and associated ductal change (p = 0.019) were more common in symptomatic than in asymptomatic patients. Associated microcalcifications and posterior shadowing were more frequently found in screening-detected than in symptomatic DCIS (p < 0.001). On mammography, microcalcifications were more common in screening-detected than in symptomatic DCIS, and masses were more common in symptomatic than in screening-detected DCIS (p < 0.001). No significant differences were seen in the pathologic features of the two groups. CONCLUSION: Our results showed that differences exist in the sonographic features of screening-detected and symptomatic DCIS. Recognition of the many and varied sonographic appearances of DCIS might be helpful to decrease the false-negative rate of bilateral whole-breast sonography and to detect symptomatic mammographically occult DCIS when we use sonography to supplement mammography.

Heterotopic ossification developing in surgical incisions of the abdomen: analysis of its incidence and possible factors associated with its development.

OBJECTIVE: To analyze the incidence of heterotopic ossification (HO) development in incision scars after abdominal surgery and to search for factors relating with its development. METHODS: We retrospectively analyzed the postoperative computed tomographic scans of 152 consecutive patients who underwent abdominal incisions, recording the presence of ossification and its characteristics, the type of surgery and incision, and characteristics of the xiphoid process. The change in size upon follow-up was also evaluated. RESULTS: Heterotopic ossifications were identified in 39 patients (25.7%). They were most commonly located in the linea alba (n = 29 [74.4%]) and associated with upper midline incisions (n = 30 [76.9%]). Twenty-four of the 29 patients who underwent postoperative computed tomography twice at least demonstrated changes in size, with decreases in 21 patients. The HO had completely disappeared in 2 patients. CONCLUSIONS: The development of HOs in abdominal incisions is a common finding and may be self-limiting. The upper midline incision seems to affect its incidence not uniquely.

Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors.

PURPOSE: To evaluate the pattern and risks for intrahepatic recurrence after percutaneous radiofrequency (RF) ablation for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: We studied 62 patients with 72 HCCs (< or =4 cm) who were treated with percutaneous RF ablation. The mean follow-up period was 19.1 months (6.0-49.1). We assessed the incidence and cumulative disease-free survival of local tumor progression (LTP) and intrahepatic distant recurrence (IDR). To analyze the risk factors, we examined the following, for the LTP: (1) tumor diameter, (2) contact with vessels, (3) degree of approximation to hepatic hilum, (4) contact with hepatic capsule, (5) presence of ablative safety margin, (6) degree of benign periablational enhancement and (7) serum alpha-fetoprotein; for the IDR: (1) severity of hepatic disease, (2) presence of HBsAg, (3) serum alpha-fetoprotein, (4) whether RF ablation was the initial treatment and (5) multiplicity of tumor for IDR. RESULTS: The incidence of overall recurrence, LTP and IDR was 62.9%, 26.4% and 53.2%, respectively. The cumulative disease-free survival rates were 52%, 82% and 56% at 1 year, 26%, 63% and 30% at 2 years, respectively. Univariate analysis showed that the significant risk factors for LTP were: a tumor with a diameter >3 cm, contact of HCC with a vessel and an insufficient safety margin (p<0.05). A multivariate stepwise Cox hazard model showed that the measurement of a tumor diameter >3 cm and insufficient safety margin were independent factors. Only the increased serum alpha-fetoprotein was a significant risk factor for IDR (p<0.05). CONCLUSION: Intrahepatic recurrence after percutaneous RF ablation is common. Large HCC (>3 cm) with high serum alpha-fetoprotein should be treated more aggressively because of higher risk for recurrence.

Bronchobiliary fistula after radiofrequency thermal ablation of hepatic tumor.

A broad spectrum of complications can occur after radiofrequency (RF) ablation of hepatic tumors, even though it has been accepted as a safe and effective technique for unresectable hepatic tumors. Recently, the rare complication of brochobiliary fistula was encountered after RF ablation in a patient with a metastatic tumor from stomach cancer. It was assumed to have developed from collateral damage to the adjacent diaphragm and lung base as well as biloma formation at the ablation zone. Symptomatic improvement was achieved by conservative management with an external drainage catheter, but the fistula was still persistent on a 2-month follow-up image.

Extrapelvic and extraperitoneal spread of recurrent stomach cancer: two case reports.

We report two cases of unusual combined extrapelvic and extraperitoneal extension of recurrent gastric adenocarcinoma and describe the imaging findings of the preferential anatomic pathway of disease spread. Extrapelvic and extraperitoneal extension of recurrent gastric adenocarcinoma is rare, and its symptoms may be vague and nonspecific. If patients with a surgical history of gastrointestinal neoplasm present with diffuse abdominal pain or painful swelling of the lower extremities, disease spread to the extrapelvic and extraperitoneal spaces should be suspected.

Primary retroperitoneal synovial sarcoma: a case report.

A case of a 36-yr-old woman with retroperitoneal synovial sarcoma is described. Her presenting symptom was epigastric pain that radiating to the back. On radiologic study, bulky retropancreatic soft tissue mass was detected which showed cystic and solid components. At operation, complete resection of the tumor was not possible because of the adhesion to the vena cava and the liver. During the follow-up, extensive tumor recurrence and liver metastasis were revealed. Primary retroperitoneal synovial sarcoma is a very rare malignant tumor with high mortality and recurrence rates. Retroperitoneal synovial sarcoma usually appears as a nonspecific soft tissue mass that do not have specific imaging features differentiating it from other mesenchymal tumors. However general radiologic findings and anatomic location of the tumor may help the diagnosis. In addition, synovial sarcoma should be included in the differential diagnosis of retroperitoneal soft tissue mass detected in young adults.

Segmental colonic involvement of plexiform neurofibroma in neurofibromatosis type 1.

In a 36-year-old man with neurofibromatosis type 1, rare colonic involvement of plexiform neurofibroma is presented. The diagnosis was confirmed by operation. Radiologic findings consisted of marked concentric thickening of the colonic wall with variable attenuation, namely, a "multilayer appearance," as well as clusters of multiple soft tissue nodules in the mesentery.