Extramedullary hematopoiesis presenting as a focal splenic mass: a case report.

We report the ultrasound, computed tomographic, and magnetic resonance imaging findings in a case of extramedullary hematopoiesis presenting as a focal splenic mass in a patient with myelodysplastic syndrome. Ultrasound demonstrated a well-circumscribed hyperechoic mass, whereas computed tomography showed a heterogeneous mass better visualized after administration of intravenous contrast. On magnetic resonance imaging, the lesion was hypointense to the spleen on T1-weighted images, with increased signal on T2-weighted images, and demonstrated enhancement after intravenous contrast administration. Extramedullary hematopoiesis should be considered in the differential diagnosis for a splenic mass in any patient with a hematologic disorder.

Dilatation of the inferior vena cava in patients with cirrhotic portal hypertension. Causes and imaging findings.

Dilatation of the inferior vena cava is a frequent finding in patients with cirrhosis and portal hypertension, and may be produced by various mechanisms. In this article we illustrate the spectrum of causes and appearances of inferior vena caval dilatation in patients with cirrhosis and portal hypertension.

Cholangiographic demonstration of the cholecystohepatic duct of Luschka.

The cholecystohepatic duct of Luschka is demonstrated. This anomaly directly connects the gallbladder to the bile ducts, draining a portion of the right lobe of the liver. The pertinent embryology is reviewed. When accidentally severed, it may cause a bile leak leading to biloma formation. It should be recognized before surgery to alert the surgeon.

Sarcoid myopathy: imaging findings.

Sarcoidosis is a granulomatous multisystem disorder that may uncommonly involve muscle. Muscular sarcoid may be nodular, atrophic myopathic, or acute myositic. We illustrate a case of the myopathic type of muscular sarcoid that is unusual because the abdominal wall muscles, rather than the extremity muscles, were involved. Muscular involvement by sarcoid should be considered in the differential diagnosis of focal muscle disease, especially in a patient with a known history of sarcoid. The presence of typical bilateral hilar adenopathy on a chest radiograph as well as the presence of abdominal findings (hepatosplenomegaly and retroperitoneal adenopathy) may help establish the diagnosis. Otherwise, sonographically guided biopsy may be necessary for definitive diagnosis.

Benign extraovarian mimics of ovarian cancer. Distinction with imaging studies.

Imaging of the pelvis via computed tomography (CT), ultrasound, or magnetic resonance (MR) provides excellent anatomical detail and superb resolution. Despite this, radiologists often have difficulty reaching a specific diagnosis in evaluating adnexal masses. A wide spectrum of benign extraovarian pathology may closely resemble ovarian cancer. Fallopian tube disease such as hydrosalpinx, tuboovarian abscess, and chronic ectopic pregnancy may mimic cystic or solid ovarian neoplasm. Pedunculated uterine leiomyomas may imitate ovarian lesions. Gastrointestinal causes of adnexal masses include mucocele, abscess, and hematoma. These entities may appear similar to ovarian lesions, thus requiring close attention to specific anatomical detail in order to help differentiate them. Similarly, peritoneal disease including tuberculous peritonitis and peritoneal pseudocyst may simulate ovarian tumor. While ultrasound represents the initial imaging modality in the evaluation of most pelvic disease, MR's multiplanar capability and improved tissue characterization make it a valuable modality in many circumstances.

Wedge-shaped intrahepatic cholangiocarcinoma: MRI-pathologic correlation.

On magnetic resonance imaging (MRI) studies, wedge-shaped areas of signal abnormality noted in association with liver lesions have been attributed to secondary phenomena and are said to be substantially larger than the actual tumor. We describe the MRI and pathological appearance of a wedge-shaped cholangiocarcinoma. In cases where therapy might be affected, biopsy of wedge-shaped MRI abnormalities associated with hepatic malignancy should be considered for accurate tumor staging.

Transient arteriovenous fistulae after transrectal prostate biopsy: diagnosis with color Doppler ultrasonography.

To assess the prevalence and significance of arteriovenous fistulae after prostate biopsy, we performed color Doppler ultrasonography immediately after 136 consecutive transrectal prostate needle biopsies. Pathologic results were correlated with color Doppler ultrasonographic findings. Arteriovenous fistulae developed after 17 biopsies (13%), all closed spontaneously within 18 minutes, and none were associated with unusual bleeding. Carcinoma was noted in 25 biopsy specimens (18%), 10 (40%) of which were followed by arteriovenous fistula. The correlation between malignancy and postbiopsy arteriovenous fistula was statistically significant (P < 0.0004), consistent with hypervascularity known to be present in many prostate cancers.

CT in patients with blunt abdominal trauma: clinical significance of intraperitoneal fluid detected on a scan with otherwise normal findings.

OBJECTIVE: The purpose of this study was to determine the clinical significance of intraperitoneal fluid seen on CT scans with otherwise normal findings in patients with blunt abdominal trauma. MATERIALS AND METHODS: We retrospectively analyzed the CT scans of 60 patients with blunt abdominal trauma who had scans showing normal findings except for the presence of intraperitoneal fluid. The location of the fluid was determined (pouch of Douglas, pelvis, paracolic gutters, mesentery, Morison's pouch, perihepatic or perisplenic spaces). The amount of fluid in each location was categorized as minimal, moderate, or marked. The total volume of fluid in each patient was estimated as small (+1), intermediate (+2), or large (+3) on the basis of the sum of the amount of fluid in the individual peritoneal locations. The amount and location of fluid were compared between patients who required exploratory laparotomy and those who were managed conservatively. RESULTS: In most patients, the total fluid volume was small (44 patients, 73%) as opposed to intermediate (11 patients, 18%) or marked (five patients, 8%). Thirty-seven patients had fluid in one location, 12 patients had fluid in two locations, and 11 patients had fluid in three or more locations. Intraperitoneal fluid tended to accumulate in the pouch of Douglas (67%) and Morison's pouch (33%). Patients requiring laparotomy had a higher total fluid volume score compared with the patients managed conservatively (2.2 versus 1.3, p < .002) and had larger amounts of fluid in the upper abdomen. Laparotomy was required in only one patient (2%) who had a small amount of fluid compared with three patients (27%) with intermediate and two patients (40%) with marked amounts. Mesenteric and/or bowel injuries were noted in all six patients at laparotomy. One patient had a small superficial liver laceration that was not diagnosed with CT. No other injuries to the solid viscera were missed on the scans. Two of the four patients with mesenteric fluid seen on the CT scan had mesenteric lacerations found during surgery, and the remaining two did well with conservative management. CONCLUSION: Patients with blunt abdominal trauma who have small amounts of intraperitoneal fluid as the sole abnormality shown by CT may generally be treated conservatively. However, patients with even a small quantity of mesenteric fluid may benefit from peritoneal lavage to help exclude bowel or mesenteric injury. Intermediate and large amounts of fluid are less common as the sole CT abnormality but have a higher likelihood of being associated with bowel or mesenteric injury.

Cardiophrenic varices in portal hypertension: evaluation with CT.

PURPOSE: To determine the prevalence and appearance of cardiophrenic angle (CPA) varices at computed tomography (CT) in patients with portal hypertension (PHT). MATERIALS AND METHODS: A retrospective review was performed of 148 consecutive contrast material--enhanced abdominal CT scans of patients with PHT. The paracardiac region was assessed for tubular structures suggestive of varices. Variceal diameter and CT attenuation relative to adjacent liver were noted. RESULTS: Tubular structures consistent with CPA varices were noted in 29 cases and were more common on the right side than on the left. Mean CPA variceal diameter was 2.6 mm. In three cases, right CPA varices measured 10-13 mm in diameter, but no variceal enhancement was noted on initial dynamic CT images. Delayed CT demonstrated contrast enhancement that reflected delayed enhancement of the portal venous system. CONCLUSION: CPA varices, particularly on the right side, are not uncommon in patients with PHT. Varices should be considered and excluded as a cause of CPA masses, particularly before percutaneous biopsy. Delayed CT may be necessary to correctly delineate CPA varices.

Imaging of percutaneous tube gastrostomies: spectrum of normal and abnormal findings.

Enteral alimentation is a crucial component of care for the malnourished patient who cannot eat. Until recently, long-term alimentation was delivered through nasogastric tubes or gastrostomy tubes placed at surgery. In the past few years, percutaneous endoscopic gastrostomy (PEG) has almost completely supplanted these traditional methods. PEG is a safer and better-tolerated procedure. The advantages of PEG over nasogastric tubes include greater social acceptance and improved cosmetic appearance, increased ease of feedings, and decreased nasal alar deformities and gastroesophageal reflux. Complications are less common with PEG than with open gastrostomy but still occur in as many as 15% of cases [1-3]. Percutaneous gastrostomies performed using fluoroscopic guidance have complications in approximately 10% of cases [4]. Despite a rapid increase in the use of percutaneous gastrostomies and their placement by radiologists [4], few published reports have described imaging findings after the placement of such tubes. This pictorial essay illustrates a spectrum of normal and abnormal imaging findings observed with the use of PEG tubes, including tube migration and misplacement, infection, tumor seeding along the PEG tube track, and a variety of gastric wall defects and pseudomasses.

Inflammatory fibroid polyp of the esophagus in an HIV-infected individual: case study.

We report an unusual case of a large esophageal inflammatory fibroid polyp in a man infected with the human immunodeficiency virus complaining of dysphagia. Barium studies and computed tomography demonstrated a long, submucosal-appearing, distal esophageal mass which extended into a hiatal hernia. Inflammatory fibroid polyps should be considered in the differential diagnosis of submucosal and polypoid esophageal masses, although distinctive radiographic features are not found.

Coronary vein diameter and flow direction in patients with portal hypertension: evaluation with duplex sonography and correlation with variceal bleeding.

OBJECTIVE: The purpose of this study was to compare the diameter of the coronary vein and the direction of flow within it between patients with portal hypertension and control subjects. SUBJECTS AND METHODS: We used pulsed Doppler sonography to measure the diameter of the coronary vein and to determine the direction of flow within it in 50 control subjects and 50 patients with portal hypertension. The sonographic findings were correlated with the presence of esophageal varices seen at endoscopy and with history of variceal hemorrhage. RESULTS: In control subjects, the diameter of the coronary vein measured up to 6 mm. In patients with portal hypertension, dilatation of the coronary vein (diameter > 6 mm) was seen in only 13 (26%). Hepatofugal flow in the coronary vein was seen in 39 patients (78%) with portal hypertension, 29 (74%) of whom did not have hepatofugal flow in other major veins of the portal system. None of the patients with portal hypertension and hepatopetal flow in the coronary vein had a history of variceal hemorrhage, whereas 40% of those with hepatofugal flow had had variceal hemorrhage. CONCLUSION: The diameter of the coronary vein may measure up to 6 mm on sonograms of normal subjects. Dilatation of the coronary vein (diameter > 6 mm) does not occur in most patients with portal hypertension, and need not be present for variceal hemorrhage to occur. Hepatofugal flow in the coronary vein is a common and useful Doppler sonographic sign of portal hypertension. Preservation of hepatopetal flow in the coronary vein in patients with portal hypertension may be associated with a low risk of variceal hemorrhage.