Ectopic gastric pancreatitis: unusual cause of epigastric pain.

Ectopic pancreatic tissue has the same characteristics than normal pancreatic tissue.Therefore it may be affected by the same diseases. We report a rare cause of epigastric pain due to gastric heterotopic pancreatitis.The rare diagnosis was suspected by ultrasound and CT and definitively confirmed by echo-endoscopic guided biopsies.

MRI findings of hepatobiliairy fascioliasis.

Hepatobiliary fascioliasis is an uncommon disease. Depending on the stage of the disease it can present with a wide variability of clinical symptoms. Knowledge of the specific radiological findings of the disease is crucial to shorten the time to final diagnosis, which is usually long. We report a case of hepatobiliary fascioliasis in a 26-year-old woman with intermittent abdominal discomfort showing non specific findings at computed tomography and ultrasound. A hypothesis of an infectious disorder was formulated based on MRI findings and a recent history of travelling. Final diagnosis was confirmed by subsequent serology testing.

Acute calcific prevertebral tendinitis.

Acute calcific prevertebral tendinitis, also known as retropharyngeal calcific tendinitis and longus colli tendinitis, is an uncommon benign condition presenting as acute neck pain.Typical characteristics of this entity are calcifications at the superior insertion of the longus colli tendons at C1-C2 level and a fluid collection in the retropharyngeal space. Differential diagnosis consists of retropharyngeal abscess, traumatic injury or infectious spondylitis. Knowledge of the clinical and imaging findings can prevent misdiagnosis with inappropriate attempts at surgical drainage.

Primary cardiac lymphoma.

Primary cardiac lymphoma is rare. It can present with a wide variability of clinical symptoms frequently leading to a delay in diagnosis. We report a case of a primary cardiac lymphoma in a 85 year old woman. The MRI showed a large mass in the right atrio-ventricular groove and infiltration of the interventricular septum and left ventricular wall with subtle contrast enhancement, isointense aspect on T1 weighted and hyperintense aspect on T2 weighted sequences. Mostly the radiological signs are non specific. Calcification, hemorrhage, a diffuse infiltrative pattern with infiltration of the valves and coronary arteries and a left atrial localization can suggest the diagnosis.

Epithelioid hemangioendothelioma of the liver: radiologic-pathologic correlation.

Epithelioid hemangioendothelioma of the liver is a rare vascular tumor with intermediate malignant potential. On imaging studies, the lesion has a solid appearance and may mimic metastatic disease. We present a case in which the morphologic features (multifocal aspect, peripheral location, and capsular retraction) and the clinical history aided in including this entity in the differential diagnosis.

Endovascular treatment of the descending thoracic aorta.

OBJECTIVES: to report our initial experience with endovascular stent graft repair of a variety of thoracic aortic pathology. DESIGN: retrospective single center study. MATERIAL AND METHODS: between February 2000 and January 2002, endovascular stent graft repair was performed in 26 patients: traumatic aortic isthmus rupture (n=3), Type B dissection (n=11) and descending thoracic aortic aneurysm (n=12). The deployed stent graft systems were AneuRx-Medtronic (n=1), Talent-Medtronic (n=13) and Excluder-Gore (n=12). RESULTS: successful deployment of the stent grafts in the intended position was achieved in all patients. No hospital mortality neither paraplegia were observed. Late, non procedure related, death occurred in four patients (15%). Access artery complications with rupture of the iliac artery occurred in two patients and were managed by iliac-femoral bypass. The left subclavian artery was overstented in seven patients (27%). Only the first patient received a carotido-subclavian bypass. The mean maximal aortic diameter decreased significantly in patients treated for descending thoracic aneurysm. Only one patient had an endoleak type II after 6 months without enlargement of the aneurysm. Complete thrombosis of the thoracic false lumen occurred in all but one patient treated for Type B dissection 6 months postoperatively. Two patients underwent a consecutive stent graft placement, due to a large re-entry tear distal to the first stent graft. CONCLUSIONS: endovascular stent graft repair for Type B dissection, descending thoracic aneurysm and aortic isthmus rupture is a promising less-invasive alternative to surgical repair. Further studies are mandatory to determine its long-term efficacy.

On-line haemodiafiltration. Remarkable removal of beta2-microglobulin. Long-term clinical observations.

BACKGROUND: The accumulation of beta2-microglobulin (beta2-M) in long-term dialysis patients may lead to dialysis amyloidosis. In this respect, the removal with different modes of on-line haemodiafiltration (HDF) of beta2-M was studied. Long-term clinical observations in patients with more than 10 years of dialysis, treated mainly with biocompatible and highly permeable membranes and in the last years with on-line HDF are also reported. METHODS: In the first part of this report, the reduction ratios and clearances of beta2-M, blood urea nitrogen, creatinine and phosphorus (P) of on-line HDF with 40 to 120 ml/min replacement fluid are compared with bicarbonate haemodialysis (HD). In the second part, we investigated 16 patients with more than 10 years of dialysis treatment. The prevalence of dialysis amyloidosis and the mean values for serum albumin, serum total cholesterol, HDL and LDL cholesterol and parathyroid hormone are reported, as well as the mean dose of erythropoietin. RESULTS: In the first part with on-line HDF, starting from HDF 60 ml/min a significantly higher beta2-M reduction ratio and clearance vs HD is noted. In HDF100 (i.e. with 241 replacement volume per 4-h treatment) vs HD, a beta2-M reduction ratio of 72.7% vs 49.7% (P= 0.0000) and a beta2-M clearance of 116.8 vs 63.8 ml/min (P=0.0000) was obtained. Comparing HDF120 with HDF100, there is a significantly higher beta2-M clearance with the former (P<0.005), although the beta2-M reduction ratio was not significantly better. In the HDF120 session the amount of beta2-M in the total dialysate was 292 mg per session. If one adds the known 17% adsorption on the polysulfone membrane, a total of 341.6 mg beta2-M per session is removed, which adds up to 1024.8 mg a week. Concerning the small molecules, our results with HDF100 also show a higher creatinine and especially P clearance vs HD. In the second part with 16 patients with more than 10 years of dialysis treatment (mean 14 years 1 month), the mean time on HDF amounted to 39.5% of the total treatment time. In four patients only biocompatible and highly permeable membranes were used, AN69 and mainly polysulfone, and in four other patients these membranes were used for more than 95% of the treatment time. Therefore, it is not surprising that the prevalence of carpal tunnel syndrome was only 12.5% in the patients after 10 years of dialysis. Twenty-five percent of these patients met the criteria for diagnosis of beta2-M bone-amyloidosis, proposed by van Ypersele de Strihou et al., but without a retrospective X-ray analysis. The mean predialysis beta2-M value was 29.6 mg/l. The mean values for serum albumin, serum total cholesterol, HDL and LDL cholesterol were within normal limits. For the parathyroid hormone a mean of 287.5 pg/ml was found. Subtotal parathyroidectomy was performed in five patients. The mean dose of 43 U erythropoietin/kg per session is comparable with those reported in the literature. Conclusions. Like Canaud, in our renal unit, treatment with on-line HDF with a highly permeable and biocompatible membrane has proven to be an efficient, well-tolerated and safe technique. Furthermore it leads to a low prevalence of dialysis amyloidosis and a superior P clearance. However, continuous attention must be paid to an on-line sterile and apyrogenic dialysate. Although on-line HDF is undoubtedly a more optimal approach of chronic dialytic treatment, it also carries a higher cost, which is currently evaluated to be nearly US$11 per session.

Herniation of the left atrial appendage due to partial congenital absence of the left pericardium.

Partial congenital absence of the left pericardium is a rare abnormality which may provoke serious complications. We report the case of a young adult, suffering from chest pain due to incarceration of atrial tissue. Based on this case report the clinical, pathophysiological and diagnostic features of this condition are described.

Endoscopic drainage of pancreatic pseudocysts.

Endoscopic drainage is a recent method in the management of pancreatic pseudocysts. It has been developed as an alternative to surgical treatment in high risk patients. Our experience with this technique is illustrated by a well documented case report which is followed by a brief review of the literature.

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.

Rectal stenosis following the use of suppositories containing paracetamol and acetylsalicylic acid.

The authors report the case of a 74-year-old woman presenting a rectal stenosis that arose after the prolonged use of suppositories containing an association of paracetamol and acetylsalicylic acid (Perdolan). On the basis of a review of the literature, the clinical, histological, and radiological features are discussed.

Familial occurrence of paragangliomas.

The occurrence of paragangliomas in three members of the same family is reported. It concerned a left carotid body tumor in one patient, a left carotid body tumor in her older sister, and a concomitant jugulotympanic and vagal body tumor in their younger brother. The radiological diagnosis in these patients was based on the typical hypervascular character in specific locations both on angiography and computed tomography. The familial occurrence of these lesions should be kept in mind whenever a chemodectoma is found, even in the absence of clinical symptoms in the direct relatives of the patients.