Case 213: primary splenic angiosarcoma.

History A 75-year-old woman with a medical history of gastroesophageal reflux disease and type II diabetes presented to the hospital with a 3-month history of gradually worsening headaches, vague upper abdominal pain, and lower back pain. The patient denied fevers, night sweats, contact with sick individuals, occupational exposure to infection, bleeding, immunodeficiency, intravenous drug use, alcohol or tobacco abuse, history of malignancy, family history of genetic disorders, and international travel. Physical examination revealed a skin-colored mass protruding from the right side of her forehead, but there were no other notable abnormalities. Her diabetes was managed with diet, and the only prescription medication she was taking was esomeprazole. She was not taking anticoagulants. Initial laboratory work-up revealed anemia and profound thrombocytopenia (hemoglobin level, 9.4 g/dL; platelet count, 16 × 10(9)/L); these were refractory to aggressive treatment, including plasmapheresis, immunosuppression with prednisolone, and numerous transfusions. Contrast material-enhanced magnetic resonance (MR) imaging of the head was performed at admission to further evaluate the patient's headache and the mass on the patient's forehead. Ultrasonography (US) of the abdomen was performed to evaluate the cause of abdominal pain. The discovery of liver lesions at US led us to perform contrast-enhanced computed tomography (CT) of the chest, abdomen, and pelvis. Contrast-enhanced MR imaging of the abdomen was performed to narrow the diagnostic considerations for the lesions identified at CT. Bone marrow biopsy revealed no evidence of infectious or neoplastic processes. Endoscopy and colonoscopy were performed; however, they revealed no abnormalities. Further laboratory work-up included extensive testing for parasites, fungi, bacteria, and viruses, including the human immunodeficiency virus (HIV). All of the results were negative. On the 17th day of admission, the patient became acutely unresponsive, her condition deteriorated rapidly, and she died. Unenhanced head CT was performed at the time of the patient's acute decompensation.

Transient, marked flattening of the abdominal aorta, iliac arteries, and venous structures during active vomiting: report of a case demonstrated by MDCT.

In recent years, intra-abdominal hypertension has gained greater recognition both clinically and radiologically. Its most clinically significant form occurs when intra-abdominal pressure (IAP) is sustained at high pressures for long periods of time. This is known as abdominal compartment syndrome (ACS), which is a surgical emergency with high morbidity and mortality rates even when treated appropriately and its imaging characteristics are well described in the literature. However, it is known that IAP reaches far higher pressures transiently during certain maneuvers, such as Valsalva maneuvers like coughing and vomiting. The effect of the severely, markedly increased IAP on imaging findings during Valsalva maneuvers has rarely been visually depicted since cross-sectional imaging is typically not performed during these episodes and older CT scanners acquired images too slowly to capture these brief moments. We report a case with unique arterial findings related to the massively increased IAP generated by vomiting during MDCT acquisition that differentiates intense Valsalva maneuvers, such as vomiting, from ACS radiologically.