Perforated Meckel's Diverticulum in an Adult.

Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract. Its complications have an extensive variety of clinical and imaging manifestations, extending from benign and indolent findings to acute life-threatening conditions. Complicated Meckel's diverticulum often constitutes a challenging diagnosis for both the clinician and the radiologist. Therefore, imaging techniques play an important role in this condition in evaluating its complications, determining decision making. We describe a case of a 49-year-old man suffering from right abdominal pain with fever and constipation, during the past 5 days. Laboratory data revealed C-reactive protein of 306 mg/L and leukocytosis. Contrast-enhanced CT features were highly suggestive of perforated Meckel's diverticulum. The purpose of this article is to emphasize that besides its rarity, Meckel's diverticulum complications can occur in adult patients.

O divertículo de Meckel é a anomalia congénita mais comum do tracto gastrointestinal. As suas complicações variam num amplo espectro, desde achados benignos e indolentes até condições potencialmente graves, e constituem frequentemente um desafio diagnóstico tanto para o clinico como para o médico radiologista. Neste sentido, os métodos de diagnóstico por imagem desempenham um papel importante na avaliação e extensão das suas complicações, determinando muitas vezes a tomada de decisões. Descrevemos um caso de um paciente de 49 anos, que apresenta dor abdominal lateralizada à direita, febre e obstipação, durante um período de 5 dias. Analiticamente apresenta valores de proteína C reactiva de 306 mg/L e leucocitose. O estudo TC contrastado foi muito sugestivo de divertículo de Meckel perfurado. O objectivo deste artigo é enfatizar que, apesar da sua raridade, as complicações do divertículo de Meckel podem ocorrer em pacientes em idade adulta.

Ultrasound requested by general practitioners or for symptoms unrelated to the thyroid gland may explain higher prevalence of thyroid nodules in females.

BACKGROUND: A higher prevalence of thyroid nodules/carcinoma in females is well-known from the literature. The reasons for this difference are not fully explained. We intended to assess gender variation in the referral for ultrasound-guided fine needle aspiration (FNA) of thyroid nodules, to study reasons for gender referral differences, and to assess differences in nodules characteristics between genders. METHODS: Included were 272 consecutive patients, with 290 nodules submitted to FNA. Patients were questioned on the reason why ultrasound (US) examination was required. Electronic medical records were reviewed. Nodules' ultrasound/cytological characteristics were assessed. Variables studied: referral cause; referral pattern (hospital-specialist versus general-practitioner); number of nodules; age, thyroid function; nodule size, TIRADS classification, resistive index, Doppler pattern, Bethesda categorisation. Variables were compared between males and females referred for FNA. Significant variables were assessed with logistic regression. RESULTS: Of the 272 patients, 215(79%) were women with a female:male referral ratio for FNA of 3.8:1. Non-parametric statistically significant differences (p < 0.05) were found between genders in: thyroid function, nodule size, referral pattern and referral cause. Nodule size and thyroid function tests became non-significant in logistic regression. Cause and referral pattern remained significantly associated with gender. Referral by a general-practitioner was associated with a 2.6-fold increase in odds of referring a female. Causes unrelated to the thyroid were associated with a 3.2-fold increase in odds of female reference. CONCLUSIONS: A referral bias might be responsible for the higher rate of thyroid nodules in female patients, both due to referral by general practitioners and due to causes indirectly related to the thyroid gland.

Post-treated prostate cancer: normal findings and signs of local relapse on multiparametric magnetic resonance imaging.

The use of multiparametric magnetic resonance imaging (mp-MRI) for prostate cancer has increased over recent years, mainly for detection, staging, and active surveillance. However, suspicion of recurrence in the set of biochemical failure is becoming a significant reason for clinicians to request mp-MRI. Radiologists should be able to recognize the normal post-treatment MRI findings. Fibrosis and atrophic remnant seminal vesicles after prostatectomy are often found and must be differentiated from local relapse. Moreover, brachytherapy, external beam radiotherapy, cryosurgery, and hormonal therapy tend to diffusely decrease the signal intensity of the peripheral zone on T2-weighted images (T2WI) due to the loss of water content, consequently mimicking tumor and hemorrhage. The combination of T2WI and functional studies like diffusion-weighted imaging and dynamic contrast-enhanced improves the identification of local relapse. Tumor recurrence tends to restrict on diffusion images and avidly enhances after contrast administration either within or outside the gland. The authors provide a pictorial review of the normal findings and the signs of local tumor relapse after radical prostatectomy, external beam radiotherapy, brachytherapy, cryosurgery, and hormonal therapy.