Colonic Hemostatic Clip Causing Perforated Acute Appendicitis.

Teaching Point: The advantages of CT over other imaging techniques for the diagnosis of acute appendicitis in adults include the ability to identify foreign bodies that may be involved.

Asymptomatic left isomerism with preduodenal portal vein: computed tomography appearance.

Left isomerism (polysplenia), one of the two major variants of heterotaxia with right isomerism (asplenia), may be rarely diagnosed in adulthood. Most cases are nevertheless asymptomatic and incidentally detected during imaging or surgery performed for unrelated conditions. We hereby report a case of left isomerism fortuitously diagnosed in a 55-year-old man with unrelated tachy-cardiomyopathy. Thoraco-abdominal computed tomography revealed a typical preduodenal portal vein (PDPV) associated with a large series of other occult anatomic variations comprising: polysplenia, agenesis of both pancreatic body and tail, complete non-rotation of the bowel and finally azygous continuation of the inferior vena cava. Subtle but highly specific thoracic features of left isomerism were also found with a bilobed right lung and bilateral long hyparterial main bronchi. The features of adult left isomerism are remembered with special attention to the PDPV.

Computed tomographic angiography (CTA) diagnosis of a rare meandering right pulmonary vein (MRPV).

Meandering right pulmonary vein (MRPV) is an exceedingly rare congenital pulmonary vascular variant with less than 20 reported cases. MPVR is a tortuous aberrant venous drainage of the right pulmonary upper lobe anastomosing with the right lower pulmonary vein instead of directly joining the left atrium. The variant is benign with an orthotopic venous drainage without any kind of shunting. The differential diagnosis mostly comprises the scimitar syndrome but also primary varix, arteriovenous malformations, and pulmonary sequestration. We report a case of MRPV fortuitously diagnosed in a 70-year-old patient. Multi-detector computed tomographic angiography (CTA) with MPR, MIP, and 3D reconstructions allowed the diagnosis obviating the need for invasive procedures.

A case of reversed intestinal rotation revealed by volvulus in adult: anatomo-radiological correlations.

We report a case of reversed rotation (RR) of the midgut, the rarest form of intestinal malrotation (IMR), revealed by a chronic volvulus, in a 42-year-old woman presenting with episodes of abdominal pain occurring after heavy meals. The complete preoperative diagnosis was obtained by contrast-enhanced computed tomography (CT). Classical signs of volvulus were associated with typical findings of RR comprising an unusual position of the third duodenum in front of the mesenteric vessels and a very unusual location of the transverse colon behind these vessels. Complete absence of fixation of the right colon allowed secondary volvulus. A detailed reminder of the embryology of IMR and RR is presented.

Hepatic "hot-spot" on angio-computed tomography: the role of inferior Sappey's and ensiform veins.

Hepatic "hot spots" in anterior paraumbilical hepatic segments of patients suffering from superior vena cava syndrome may be revealed by angio-computed tomography. They may be due to a collateralizing system, the epigastric-paraumbilical venous system (EPVS), which enters the liver as a "third inflow". We report a typical case emphasizing the role of the ensiform and inferior Sappey's veins which constitute typical anatomic components of the EPVS.

Morphologic variants of the Cerebral Arterial Circle on computed tomographic angiography (CTA): a large retrospective study.

PURPOSE: To confirm and illustrate the great variability of morphology of the Cerebral Arterial Circle (CAC)-also commonly called "Circle of Willis"-in current clinical Computed Tomography Angiography (CTA) practice. METHODS: Computed Tomographic Angiographic 3D Volume Rendering reconstructions of the CAC performed in a series of 511 patients were retrospectively reviewed and classified following their anatomic configuration. RESULTS: An amount of 27 CAC configurations were listed. Complete and "nearly complete" (1 missing segment) CACs were found in 115 (22.58%) and 157 (28.6%) patients. The posterior arch was much more frequently incomplete (374 patients = 73.18%) than the anterior arch (96 patients = 18.4%). The main cause was a high prevalence of missing posterior communicating arteries (PCoAs). The left or right PCoA were unilaterally lacking in 156 patients (30.53%) and both PCoAs were lacking in 179 patients (35.02%). Cases with 2 and 3 missing segments were observed in 184 (36%) and 44 patients (8.6%). Precarious situations were also identified including 7 cases (1.4%) of complete isolation of the middle cerebral artery (MCA), 11 cases (2.15%) of absence of interhemispheric supply, 205 cases (40.1%) of full separation of the carotid and vertebra-basilar (VB) territories and 44 cases (8.6%) of full separation of the three main arterial axes (both ICAs and VB). The prevalence of Fetal Posterior Cerebral Arteries (FPCA) variants was also reported. A "Full" FPCA was found unilaterally in 48 (9.4%) and bilaterally in 13 (2.54%) of patients. Apart from agenesis and hypoplasia reported in our study, various other variations of the anterior complex of the CAC (ACoA and A2 segments of the ACA) were also noted. CONCLUSION: CTA with 3D Volume Rendering may powerfully assess the numerous variations of the CAC. This assessment is of prime importance for the evaluation of patients presenting with risk factors or in whom neurosurgery, cardiac surgery, interventional radiology or carotid endarterectomy (CEA) are being considered.

Inferior vena cava reconstruction with a superficial femoral vein graft after resection of a venous leiomyosarcoma.

Leiomyosarcoma is a rare malign neoplasm, representing about 5-7% of all tissue sarcomas while inferior vena cava leiomyosarcomas accounts for only 1%. This paper presents the case of a 74 years old patient that was diagnosed with an abdominal venous leiomyosarcoma involving the inter-renal segment of the inferior vena cava. Tumor was treated by complete in bloc resection. Reconstruction of the vascular axis was performed with an autologous venous tube graft achieved with segments of the right superficial femoral vein. Recurrent free survival and freedom from local or systemic recurrence was observed at 2 years after the intervention thanks to the aggressive radical surgical management.

Massive Benign Pneumatosis Intestinalis.

Teaching point: CT may help distinguishing benign from life-threatening pneumatosis intestinalis.

Acute Volvulus of the Cecum.

Teaching Point: Abnormal embryological cecal fixation may lead to volvulus, which accounts for approximately 1 to 3 percent of all colic obstructions. A pack of suggestive CT features can make the diagnosis.

Intravesical Protrusion of a Pedunculated Colonic Polyp through a Sigmoido-Vesical Fistula Caused by Diverticulitis.

Teaching Point: Sigmoid diverticulitis may cause colo-vesical fistula from which intravesical protrusion of a pedunculated colonic polyp is an exceptional event that should not be regarded as a bladder cancer.

The Typical "Cracked Dry Mud" Ultrasound Pattern of Proliferative Myositis.

Teaching point: The typical "cracked dry mud" pattern on ultrasound may help avoiding biopsy for proliferative myositis which is a self-resolving benign process.