Spontaneous hepatic rupture in a normotensive monoamniotic twin pregnancy: case report and review of the literature.

BACKGROUND: Spontaneous liver rupture during pregnancy is extremely rare, and often associated with hypertensive disorders. Maternal outcomes are poor and morbidity is high. CASE: A 27-year-old women (G1P0), pregnant with monochorionic-monoamniotic twins, developed extensive abdominal pain while she was electively admitted at 32 weeks for fetal pulmonary maturation. Diagnosed with preterm labor, a caesarean section was performed. Postoperatively, our patient deteriorated and a second laparotomy revealed an extensive liver rupture. There was no evidence of hypertensive disorders or hepatic tumors. After perihepatic packing and embolization, our patient required long-term treatment in our intensive care unit. She survived, and both mother and children are healthy after 6 months. CONCLUSION: Despite being rare, spontaneous liver rupture in absence of hypertensive disorders during pregnancy is associated with high maternal morbidity and mortality. Adequate treatment requires a multidisciplinary approach.

Isolated noncompaction of ventricular myocardium. Diagnosis with multidetector computed tomography.

Noncompaction of the ventricular myocardium is a cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium. Non-compaction presents as an isolated form or in association with other congenital anomalies, such as obstruction of the right or left ventricular outflow tracts, complex cyanotic congenital heart disease and coronary artery anomalies. Contrast-enhanced CT is capable of showing the abnormal architecture of the left ventricular wall in non-compaction but is also able to evaluate the coronary arteries to exclude anomalies or significant stenosis, which is usually not possible with MRI or echocardiography.

Small bowel obstruction during pregnancy.

The authors report the case of a 28-year old pregnant woman with abdominal pain and contractions at 37 weeks of gestation. After labour and delivery, abdominal pain persisted and laparoscopy was performed. A bowel obstruction was diagnosed and surgically corrected. The authors discuss the clinical and therapeutic consequences of bowel obstruction during pregnancy.

Contrast-enhanced MR imaging of breast lesions and effect on treatment.

PURPOSE: To assess the value of local staging with preoperative magnetic resonance imaging (MRI) in patients with suspect breast lesions and the effect on therapeutic approach. MATERIALS AND METHODS: Two hundred and four consecutive women with suspect breast lesions on clinical examination (CE) and/or mammography (MX) and/or ultrasound (US) underwent preoperative contrast-enhanced MRI. Detection of multifocal, multicentric and bilateral breast cancer by all three imaging modalities was evaluated. Results of preoperative breast MRI were discussed with the treating surgeons. The type of therapeutic change after preoperative MRI was marked on a questionnaire (none, additional fine needle aspiration, core biopsy, open biopsy, wider excision, mastectomy) and considered 'necessary' or 'unnecessary' using final histopathological results as gold standard. RESULTS: In 170 patients, breast cancer was diagnosed. MRI detected 96% of multifocal disease and 95% of multicentric disease, whereas MX depicted 37 and 18%, and US 41 and 9% of them, respectively. All bilateral breast cancers were seen on MRI; both MX and US detected 56%. Findings of more extensive disease and unsuspected multiple breast cancer foci identified on MRI only, changed the therapeutic approach correctly in 30.6% of breast cancer patients. Nine unnecessary wider excisions and three unnecessary FNA/core biopsies were performed because MRI overestimated the number or size of malignant lesions. CONCLUSION: Preoperative breast MRI is an important adjunct to conventional imaging in the loco-regional staging of breast cancer and a useful tool in treatment planning.

Preoperative breast MRI in patients with invasive lobular breast cancer.

To investigate the use of MRI in preoperative characterization of invasive lobular breast cancer (ILC) and in detection of multifocal/multicentric disease. We retrospectively reviewed T1-weighted FLASH 3D precontrast and postcontrast MR images together with subtraction images of 26 women with histopathologically proven invasive lobular cancer. Two experienced radiologists described tumor patterns of ILC independently. MR findings of unifocal, multifocal, single quadrant and multiquadrant disease were correlated with results of other imaging techniques and compared with histopathological findings as gold standard. Most ILC presented on MRI as a single spiculated/irregular, inhomogeneous mass (pattern 1, n=12) or as a dominant lesion surrounded by multiple small enhancing foci (pattern 2, n=8). Multiple small enhancing foci with interconnecting enhancing strands (pattern 3) and an architectural distortion (pattern 4) were both described in three cases. There was one case of a focal area of inhomogeneous enhancement (pattern 5) and one normal MR examination (pattern 6). Unifocal and multifocal lesions were identified on MRI in four patients with normal conventional imaging. In nine women, multiple additional lesions or more extensive multiquadrant disease were correctly identified only on MRI. MRI may play an important role in the evaluation of patients with ILC, which is often difficult to diagnose on clinical examination and conventional imaging and more likely occur in multiple sites and in both breasts. However, false-negative MR findings do occur in a small percentage of ILC.

Endoscopic treatment of a perforated duodenal diverticulum.

We describe a case of a perforated duodenal diverticulum, which was managed by a combined percutaneous and endoscopic approach. In combination with conservative treatment, this technique can be a challenging alternative to surgery.

Heterotopic gastric mucosa presenting as gallbladder polyps.

The authors report the case of a 16-year-old man with recurrent abdominal pain. Ultrasonography showed two gallbladder polyps, one of them larger than 10 mm. Laparoscopic cholecystectomy was performed. Histologic examination revealed gastric heterotopia. The authors discuss the clinical, pathophysiologic and histologic features of the present case and those reported in the literature.

Ultrasonography and computed tomography of afferent loop obstruction.

The US and CT findings in a case of afferent loop obstruction after total gastrectomy are reported. A U-shaped fluid filled tubular structure crossing the midline between the abdominal aorta and the superior mesenteric artery (SMA) is a characteristic US and CT image of an afferent loop obstruction. CT is helpful to recognize the bowel wall and to demonstrate its relationship with the biliary system. Its vague clinical picture and confusing laboratory findings may mimic pseudocysts.

Common hepatic artery aneurysm: diagnosis with duplex sonography and color Doppler.

Hepatic artery aneurysms are uncommon lesions, often with a nonspecific clinical presentation and difficult to diagnose before rupture. The authors report a case which was correctly diagnosed with non-invasive procedures (duplex sonography and color Doppler).

Spontaneous retroperitoneal renal hemorrhage: imaging and angiographic findings in five patients.

The authors describe one case and report four other of pathologically proven spontaneous retroperitoneal renal hemorrhage due to a ruptured hemorrhagic cyst (2 cases), a renal cell carcinoma, an angiomyolipoma, and a tubular adenoma. The contribution of US, CT, and angiography to the diagnosis is discussed and the recent literature is reviewed.

Occult prostatic abscess detected by transrectal sonography and computed tomography. Case report.

The authors report a case of prostatic abscess in a patient without significant clinical manifestation. Transrectal ultrasonography and computed tomography demonstrated a lesion suggestive of an abscess which was finally confirmed by transurethral resection revealing pus.

Ultrasound and CT of multifocal liver abscesses caused by Yersinia enterocolitica.

We present a patient with idiopathic liver hemochromatosis and mild secondary cirrhosis complicated by Yersinia sepsis and miliary liver abscesses proven by echography and CT.

Computed tomography of acute jejunogastric intussusception.

A case of acute retrograde jejunogastric intussusception occurred 31 years after a Billroth II partial gastrectomy. Gastroscopy was nondiagnostic. The CT features allowed a correct diagnosis.