Washout of hepatocellular carcinoma on portal venous phase of multidetector computed tomography in a pre-transplant population.

INTRODUCTION: Washout is an important diagnostic imaging feature of hepatocellular carcinoma (HCC) on computed tomography (CT). The primary aim of this study is to evaluate the prevalence and the interobserver variation in the detection of portal venous phase (PVP) washout of HCCs using CT in a transplant population. The secondary aim is to evaluate factors influencing the detection of PVP washout. METHODS: Forty-five patients who underwent CT liver imaging within the 60 days before transplantation had viable HCCs confirmed on pathology. Two radiologists retrospectively reviewed the images for HCCs including features of arterial enhancement and PVP washout. Clinical data, peak kilovoltage, imaging features of portal hypertension, region of interest attenuation measurements of the individual lesions, background liver parenchyma and portal vein were obtained. Liver to lesion attenuation ratio was also calculated. Statistical analysis was performed. RESULTS: The two readers identified 50 arterially enhancing HCCs in 45 patients. In consensus, the two readers identified washout in 60% of the HCCs with a substantial interobserver agreement (kappa = 0.633). PVP washout was associated with larger lesion size, increased background liver parenchyma attenuation, increased liver to lesion attenuation ratio, increased portal vein attenuation and hepatitis B viral status (P = 0.027, 0.008, 0.014, 0.017 and 0.037 respectively). CONCLUSION: In our transplant population, portal venous phase washout was seen in 60% of the hypervascular HCCs. Factors influencing the presence of PVP washout include lesion size as well as the liver and portal vein attenuation reflective of the portal haemodynamics.

Imaging of hepatocellular carcinoma recurrence post liver resection: a pictorial essay.

This pictorial essay presents and discusses the imaging findings of patients with hepatocellular carcinoma recurrence post liver resection. A broad range of recurrence patterns is reviewed including intrahepatic and extrahepatic recurrences.

Concurrent thrombosed aneurysmal sciatic artery and anomalous aortic arch.

A persistent sciatic artery is a rare developmental anomaly which may predispose to a range of vascular complications. We report a 60-year-old woman presenting with right lower limb ischemia. Computed tomography angiography revealed an aneurysmal right-sided sciatic artery occluded by thrombus. An aberrant right subclavian artery and anomalous common carotid origins were also incidentally discovered. It is unknown whether an association exists between a persistent sciatic artery and other congenital arterial abnormalities. This is the first case report, so far as we are aware, describing both such arterial anomalies coexisting in a patient.

Scintigraphic features of Morquio's syndrome: a case report.

INTRODUCTION: To the best of our knowledge, we present for the first time the bone scintigraphy findings of a patient with Morquio's syndrome. CASE PRESENTATION: A 46-year-old Caucasian man with Morquio's syndrome presented with lower back pain six weeks after a left total hip replacement. A whole body bone scan demonstrated an anthropomorphic skeletal pattern consistent with a mucopolysaccharide storage disease, thereby showing the cause of the patient's pain. CONCLUSIONS: To the best of our knowledge, the bone scintigraphy findings of a case of Morquio's syndrome have never before been published. We present our case report to add to the knowledge we have of this rare disease.

Resolution of hepatopulmonary syndrome after methadone withdrawal as demonstrated by right to left shunt study.

We present the right to left shunt study findings of a 50-year-old male patient with hepatitis C cirrhosis, who complained of worsening dyspnea on exertion. Follow-up images showed resolution of hepatopulmonary syndrome following methadone withdrawal although there had been no improvement in his liver disease. This was unusual and may have been due to the effect of opiate receptors on nitric oxide signaling in the pulmonary vasculature.

Stent-assisted coil embolization of a wide-necked renal artery aneurysm.

We present a case of stent-assisted coil embolization of a wide-necked renal artery aneurysm performed at our institution. The technique involved a stent being delivered over the neck of the aneurysm. Subsequently a catheter was placed into the aneurysm through the stent mesh and the aneurysm was then filled with detachable coils. Complete aneurysm occlusion was obtained and there was no evidence to suggest renal infarction on a follow-up contrast CT scan 6 months later. Our preliminary experience suggests that stent-assisted coil embolization of wide-necked renal artery aneurysms is a technically challenging but potentially effective renal-sparing endovascular approach.

Abdominal angina in occlusive mesenteric vascular disease: a case report.

INTRODUCTION: Abdominal angina is a descriptive term for abdominal pain that can occur postprandially in patients with occlusive mesenteric vascular disease due to insufficient increase in blood flow. CASE PRESENTATION: In this case a 60-year-old Caucasian woman with a 2 year history of abdominal angina presented to hospital for elective mesenteric revascularization surgery. Postoperative recovery was complicated by graft occlusion resulting in hepatic ischemia as well as splenic and small bowel infarction. CONCLUSION: This case highlights the importance of keeping this differential diagnosis in mind when dealing with patients who have a long history of abdominal pain and discusses some of the complications that may occur after surgical treatment.

Hepatobiliary scintigraphy in vasculitis of the gallbladder as a manifestation of polyarteritis nodosa: a case report.

INTRODUCTION: Polyarteritis nodosa can on rare occasions manifest itself as vasculitis of the gallbladder. Patients typically present with right upper quadrant pain and are initially worked up for cholecystitis. The definitive diagnosis is then usually based on surgical and histopathological findings. CASE PRESENTATION: In this case a 23-year-old Caucasian female presented with a 3 week history of right upper quadrant pain and fevers. CONCLUSION: The clinical pathway and imaging findings of a rare case of gallbladder vasculitis as a manifestation of polyarteritis nodosa are demonstrated.

The role of CT imaging in the congenital absence of a cervical spine pedicle: a case report and review of the literature.

The congenital absence of a cervical spine pedicle is a rare clinical condition which is usually picked up as an incidental finding on imaging studies performed on patients complaining of neck pain following trauma. It is important to recognize that the finding is not traumatic in origin as this has implications regarding the treatment. We report a case of congenital absence of a cervical spine pedicle and present a review of the literature.

Fish bone ingestion mimicking aortic dissection: a case report.

INTRODUCTION: The lodgement of fish bones during ingestion is a common complaint and can mimic other medical conditions such as aortic dissection. CASE PRESENTATION: In this case a non-English speaking 63-year-old Chinese man presented to the emergency department with chest pain and hypotension. Subsequent spiral computed tomography angiography ruled out aortic dissection but demonstrated a lodged fish bone tenting the oesophagus in the non-contrast phase. CONCLUSION: This case highlights the importance of this imaging modality as well as the role of a good history in establishing an early diagnosis.

Cardiac lipoma in a patient with a history of malignant tumours: a case report.

Cardiac tumours are relatively rare. Most of them do not cause clinical symptoms so that prior to the introduction of modern methods of investigation they were predominately incidental findings during autopsies or open heart surgery.We present the case of a 63-year-old German man with a past history of malignant melanoma and renal cell carcinoma who presented with a right atrial lipoma and a suspicious lesion in the right lower lobe of the lung. Surgical excision of the cardiac lipoma was performed and a biopsy of the lung mass was done which diagnosed a moderately differentiated adenocarcinoma.