Ectopic gastric mucosa presenting as a polypoid mass within a Meckel's diverticulum.

A 32-year-old man presented with severe abdominal pain located in the mesogastrium and right hemi-abdomen. A barium transit study showed a tubular structure of 6 cm arising from a bowel loop in the distal ileum, with an intraluminal polypoid mass near the bottom. Diagnosis of a benign lesion within a Meckel's diverticulum was made. Anatomopathology confirmed a Meckel's diverticulum and demonstrated that the polypoid mass was caused by an unusual great ectopic island of gastric mucosa.

Colitis cystica profunda.

A 39-year-old woman with inflammatory bowel disease was admitted to the hospital because of cramping abdominal pain and diarrhea. Ultrasound of the abdomen revealed thickening of the wall of the descending colon. At endoscopy mucosa-covered nodules with substenosis were seen. A double-contrast examination showed narrowing in the transition zone between the descending colon and sigmoid with mucosal nodularities and barium spots in between. Examination of the resection specimen revealed colitis cystica profunda. After surgical treatment the history of the patient was uneventful.

Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging.

The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.

Radiologic investigations and pathologic results of experimental chronic pancreatitis in cats.

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate a variety of methods to induce chronic pancreatitis and its radiologic expression by experimentally inducing this condition in cats. MATERIALS AND METHODS: Chronic inflammatory and fibrosing pancreatitis was produced in cats by intraductal injection of 1.5 mL of 94% ethanol in one group or by a combination of intraductal and intraparenchymal injection of ethanol together with partial obstruction of the main pancreatic duct to 70% of its original lumen by fixation of a small catheter in the papilla. For comparison, other cats underwent total obstruction of the main pancreatic duct. All groups, as well as untreated control cats (n = 3), underwent repeat laparotomy to obtain biopsy specimens. RESULTS: Cats with total obstruction showed progressing fibrosis with dilatation of ductules occasionally infiltrated with granulocytes. From 26 weeks on, acini and islets of Lnagerhans became atrophic. Radiographs showed progressive but diffuse dilatation of ducts, ductules, and side branches. Cats from the other two groups had interlobular inflammation and fibrosis with flattened and irregular ductular epithelium. Later, ductular proliferation occurred, interstitial inflammation subsided, and fibrosis increased. Radiographs showed very irregular ducts and ductules with stenosis and dilatation. From 26 weeks on, no substantial differences were observed between the cats who received only intraductal injection of ethanol and the cats who underwent the combination of procedures. CONCLUSION: The histopathologic and radiographic alterations that evolved from damage to the ductal epithelium in the cat resembled the features of chronic pancreatitis in humans and differed from those caused by total obstruction of the main pancreatic duct in cats.

Ischemic jejunitis caused by primary small bowel volvulus.

A case of ischemic jejunitis caused by primary small bowel volvulus is presented. The radiological signs of ischemia persisted after detorsion. Contrast examinations of the small intestine demonstrated severe jejunitis with ulcerations, segmental narrowing and fistulas. This last sign is a rather uncommon event in ischemic disorders. The radiological signs of acute ischemia of the small intestine are discussed.

Healing of severe recurrent ileitis with azathioprine therapy in patients with Crohn's disease.

BACKGROUND & AIMS: Standard corticosteroid therapy for Crohn's ileitis induces symptom relief without improvement of endoscopically visible lesions. In this study, the effect of azathioprine therapy on the inflammatory lesions in the neoterminal ileum of patients with severe postoperative Crohn's recurrence was examined. METHODS: Macroscopic ileal lesions were studied endoscopically or radiologically after at least 6 months of azathioprine therapy after complete weaning of corticosteroids. All patients who underwent an ileocecal resection for Crohn's disease at our institution between January 1989 and December 1993 and who subsequently developed severe recurrent ileitis treated with azathioprine were included. RESULTS: Of the 19 patients treated with azathioprine for recurrent ileitis, 15 could be reevaluated by endoscopy or radiological examination. The therapy resulted in induction and maintenance of clinical remission in all 15 patients, at least 6 months after complete weaning of the corticosteroids. Complete macroscopic healing of the neoterminal ileum was observed in 6 of 15 patients, near-complete healing with only superficial erosions remaining in 5 of 15 patients, partial healing in 3 of 15 patients, and unchanged inflammatory lesions in 1 patient. CONCLUSIONS: It is concluded that azathioprine leads to mucosal healing in severe recurrent Crohn's ileitis and may be the treatment of choice in this indication.

Mechanisms involved in postdeglutition retention in the elderly.

This study examines possible quantifiable causes of postdeglutition pharyngeal retention in the elderly. Manofluorography and computer processing of video images are performed. Retention in the valleculae and in the piriform sinuses is associated with a markedly reduced pharyngeal shortening, a low tongue driving force (TDF), and a diminished amplitude of the pharyngeal contraction. There is no relationship with the hypopharyngeal suction pump (HSP). Retention limited to the valleculae is associated with a low TDF, and retention restricted to the piriform sinuses is accompanied by a reduced pharyngeal shortening.

Imaging of gallbladder and biliary tract before laparoscopic cholecystectomy: comparison of intravenous cholangiography and the combined use of HASTE and single-shot RARE MR imaging.

To compare intravenous cholangiography (i.v.c.) and magnetic resonance imaging (MRI) as preoperative imaging techniques in patients scheduled for laparoscopic cholecystectomy. Twenty patients underwent i.v.c. and MRI, 40 axial 'localizer' images were first obtained with a half-Fourier single-shot turbo spin echo (HASTE) sequence. Next, an extremely high T2-weighted rapid acquisition relaxation enhancement (RARE) acquisition (TE = 1100 msec) was used for MR cholangiography. All images obtained with i.v.c. and MRI were independently analyzed by two observers. The relative visibility of the (normal or abnormal) gallbladder (GB), cystic duct (CD), and bile ducts (BD) on both types of images was scored as follows: 1 = MRI better than i.v.c.; 2 = no difference; 3 = i.v.c. better than MRI. We observed 3 anatomic variants: 1 of the cystic duct and 2 of the intrahepatic bile ducts; 15 patients had gallstones; one had cholecystitis. Magnetic resonance images were considered more informative than i.v.c.-images for visualization of GB in 11 patients (55%), for CD in 9 patients (45%), and in 8 patients (40%) for visualization of the CBD. Intravenous cholangiography outperformed MRI in the evaluation of the CBD and CD in one patient (5%). The combined use of half-Fourier single-shot RARE and high T2-weighted RARE MR imaging is a valuable alternative to i.v.c. in the preoperative evaluation of gallbladder and biliary tract.

Esophageal tuberculosis mimicking malignancy.

A case of pulmonary and esophageal tuberculosis in an 82-year-old female is presented. Esophageal tuberculosis is very rarely seen in Europe and the United States, but the disease is still endemic in India. The major differential diagnosis is esophageal malignancy. Findings that can suggest the diagnosis are tracheo-esophageal fistula formation, enlarged, centrally necrotizing lymph nodes, and a micronodular lung pattern.

The evolution of radioprotection.

In comparison with the first half of this century the frequency of X-ray induced lesions diminished spectacularly both in patients and in radiologists in the second half; this was due to more and more rigorous radioprotection. The present measures of radioprotection may be divided into two groups according to their appliance to the patient or the operator. Prevention of irradiation of an unknown pregnancy is the responsibility of the clinician (application of the 10 days rule) but equally of the radiologist (warning poster in the radiological department, query of possible pregnancy). The sensitivity of the imaging material has been raised by adaptation of film, intensifying screens, grids and the use of image intensifier with TV-chain and photofluorography. The quantity of X-rays to the patient may be directly lowered by reducing the time and dose of fluoroscopy, the number of radiographs, by using a diaphragm, by covering some organs with lead shields and by choosing different examination modalities. Dose reduction to the patient may also be achieved by modifications of the quality of the X-ray beam (filter, KV/MA) and by proper indication of the examination. Patient's dose can be calculated by phantom simulation and by chromosomal blood study. The operator is never allowed to put his unprotected hand in the X-ray beam. The amount of scattering radiation to the operator will be lowered by several of the above mentioned measures reducing the patient's dose and by choosing the most favourable direction of the axis X-ray tube-image intensifier. Direct protection of the operator is achieved by lead-glass screens, lead flaps around the patient, lead gloves, apron and glasses and by raising the distance between the operator and the X-ray tube. Early detection of unusual radiation is possible by systematic dosimetry.

[The history of gallbladder and bile duct diagnosis]. / Geschiedenis van de galblaas- en galweg-diagnostiek.

In the first period (1896-1910), investigation was made through plain abdominal film with description and differential diagnosis of the different calcifications in the right hypochondrium. Second period (1911-1924): indirect signs of liver and gallbladder pathology were described. Via pneumoperitoneum and gastro-intestinal opacification the pathology in the right hypochondrium was delineated and interpreted. Third period (1924 until now): due to the development of contrast agents for the gallbladder and biliary tree, these organs could be directly visualized either by intravenous injection, or by peroral administration; sometimes direct injection of contrast in the bile ducts was used.

Intermittent subobstruction and cholestasis as complications of duodenal amyloid tumours.

Amyloidosis confined to the duodenum is uncommon. In the present report the history of an 83-year old patient, admitted for vomiting and heavy epigastric pain, is described. Radiographic and endoscopic investigation revealed two polypoid lesions in the duodenum (D2). Biopsies showed diffuse amyloid deposition in the lamina propria, muscularis mucosae and submucosa of the duodenum as well as vascular deposits. No other localisations were documented. Amyloid tumours of the gastrointestinal tract are rare but may lead to serious symptoms.

Esophageal metastasis from breast carcinoma.

A case of esophageal metastasis from a breast carcinoma is presented. Location was, as usual, midesophageal. The interval of time between breast carcinoma and the onset of esophageal symptoms was rather long. Barium swallow examination enabled correct diagnosis, whereas several series of superficial endoscopical biopsies were negative. Diagnosis was confirmed by deep endoscopical biopsy.

Three cases of non-tumoural tight stenosis of the bifurcation of the hilar bile ducts.

Stenosis of the bifurcation of the hepatic bile duct is usually caused by malignant lesion. We report on three different causes of benign stenosis of the hepatic confluence with a similar radiological pattern on direct cholangiography. The first case is considered a spontaneous neuroma, the second a periductal abscess, and the third case a postoperative stricture Bismuth type 4.

CT findings in nonmucosal eosinophilic gastroenteritis.

A 22-year-old patient with eosinophilic gastroenteritis with predominantly submucosal and muscular involvement is presented. The benefits of CT, using water as an orally administered contrast agent, are stressed, because CT enabled the authors to suggest a full thickness biopsy, after mucosal biopsies had remained repeatedly negative.

Imaging of polypoid endoluminal growing bile duct tumors.

We reviewed the radiological documents and protocols of 196 cases of bile duct tumors examined over a period of 12 years: 20 of them (10.2%) presented with a polypoid endoluminal growth. The aim of this study was to provide a better knowledge about the radiological features of this less frequent kind of tumor. In these 20 cases, the correct diagnosis of bile duct lesion was provided in 100% by E.R.C.P., P.T.C., U.S. as well as C.T., and in 42% by arteriography. The correct diagnosis of tumor was made by E.R.C.P. in 86%, by P.T.C. in 88%, by U.S. in 61%, by C.T. in 63%, and by arteriography in 25%. A correct diagnosis of tumor could be reached in all cases by combination of several examination techniques. The anatomopathological diagnosis was: bile duct adenocarcinoma (7 cases), adenocarcinoma of the ampulla of Vater (4), villous adenoma of Vater's ampulla (2), cystadenoma (1), cystadenocarcinoma (1), hepatocellular carcinoma (1), apudoma (1), and metastases (3).