Intrapancreatic accessory spleen: evaluation by CT arteriography.

BACKGROUND: Intrapancreatic accessory spleens are frequently confused with primary pancreatic tumors, and differentiation from neoplastic lesions is important to avoid an unnecessary laparotomy. We present three cases of intrapancreatic accessory spleen evaluated by computed tomographic arteriography (CTA) and discuss the characteristic findings. METHODS: CTA was performed, followed by digital subtraction angiography, with an injection of contrast material through a 4-F catheter placed in the celiac artery. Single-level dynamic CTA was also performed in two patients with a 30-s continuous scan in one breath-hold. RESULTS: CTA clearly demonstrated early inhomogeneous enhancement of the lesion, similar to the splenic parenchyma. On single-level dynamic CTA, inhomogeneous enhancement of the lesion in the early phase was diminished in the late phase. Multiplanar reformatted images obtained in two cases showed the deep cleft between the lesion and the pancreas, which suggested that the lesion was originally extrapancreatic. CONCLUSIONS: These two findings on CTA, inhomogeneous enhancement of the lesion and the deep cleft between the lesion and the pancreas, may help to confirm the diagnosis of an intrapancreatic accessory spleen.

Hepatocellular carcinoma with blood supply from omental branches: treatment with transcatheter arterial embolization.

PURPOSE: To evaluate the usefulness of transcatheter arterial embolization (TAE) through the omental branch in the treatment of hepatocellular carcinoma (HCC) with blood supply from the omental branch. MATERIALS AND METHODS: Fifteen patients with HCC fed by the omental branch underwent TAE. All but one had previously undergone several therapies for HCC, including TAE. Three patients had intraperitoneal hemorrhage caused by ruptured HCC fed by the omental branch, and two necessitated emergency TAE. The technical success rate, therapeutic effect, and safety of TAE via the omental branch were evaluated. RESULTS: Twenty-six omental branches that fed HCC were observed angiographically. Attenuation or occlusion of the hepatic artery was observed in 80%. Nineteen omental branches (73%) could be successfully embolized. Hepatic hemostasis was achieved in all patients with ruptured HCC. Tumor recurred in 80% of patients who underwent successful TAE of the omental branch, and additional therapy was performed in six patients. Ten patients died after 2-26 months (mean, 8 mo). Five patients were alive for 3-13 months (mean, 7 mo). Severe complications were not observed in any patient. CONCLUSION: TAE of the omental branch is safe and has become technically feasible in almost all patients, but tumors frequently recur.

Use of a catheter with a large side hole for selective catheterization of the inferior phrenic artery.

The authors report the use of a catheter with a large side hole in the catheterization of the right inferior phrenic artery (IPA) arising from the proximal portion of the celiac trunk. A 5-F catheter with a side hole on either the top or the right side of the superior portion near the tip was used in five patients with hepatocellular carcinoma fed by the right IPA, which could not be selected by a conventional coaxial technique. In all patients, a 3-F microcatheter was successfully advanced into the right IPA through the side hole of this catheter introduced into the celiac artery or the common hepatic artery.

Histological influence on contrast-enhanced CT of pancreatic ductal adenocarcinoma.

PURPOSE: The purpose of our study was to examine the influence of the histology of pancreatic ductal adenocarcinoma on its appearance with contrast-enhanced CT. METHOD: Early-phase and late-phase dynamic CT images were obtained in 34 patients who underwent pancreaticoduodenostomy. The attenuating areas of the tumors (n = 58) on early- and late-phase images were classified as hyperattenuated, isoattenuated, hypoattenuated, or unenhanced. The histologic findings of these lesions were compared to the CT appearances. RESULTS: The isoattenuated areas on both early- and late-phase images histologically showed increasing cellularity of tumor cells (n = 1) or coexisting acinar tissues and tumor cells (n = 2) within the tumor. Hypoattenuated areas on early-phase images and isoattenuated or hyperattenuated areas on late-phase images (n = 27) showed dense fibrosis except in one tumor with an abscess. Hypoattenuated areas on early- and late-phase images and unenhanced areas (n = 28) showed mucin and/or necrosis within the tumor. CONCLUSION: The contrast-enhanced CT appearance of pancreatic ductal adenocarcinoma is influenced by the histologic features associated with tumor cells.