Diverticulum of common hepatic duct leading to obstructive jaundice, a case report.

Choledochal cyst is a dilation of the intrahepatic and/or extrahepatic biliary tree. The pathogenesis is unknown and potentially is multifactorial. In 1977, Todani classified the cysts under five different types according to their morphology, number and distribution along the biliary tree. Presenting symptoms of Choledocal cysts which include upper abdominal pain, acute cholangitis and jaundice, although often they are clinically silent and discovered as an incidental finding. Biliary complications include cholangitis, biliary stones, pancreatitis, portal hypertension and cholangiocarcinoma. We describe a case of a rare Type II Todani cyst located on the right side of the common hepatic duct characterised by a clinical presentation similar to that observed in Mirizzi Syndrome. The treatment of a Type II choledochal cyst consists in cystic excision.

Preliminary Indoor Radon Measurements Near Faults Crossing Urban Areas of Mt. Etna Volcano (Italy).

The slopes of Etna are crossed by numerous active faults that traverse various towns and villages. These faults pose a two-fold problem for the local people: on one hand, they cause frequent damage to houses and breakage of roads, while on the other they constitute a preferential route for the rising of crustal and sub-crustal gases, including radon, toward the surface. Various recent studies on the volcano confirm a high level of radon degassing measured both in the soil (> 10,000 Bq/m3), and inside homes (> 2,000 Bq/m3). For this reason, we felt the need to deepen our knowledge on the radon present in the Etnean area, focusing in particular on indoor radon pollution that, as widely recognized, is among the main causes of cancer largely (but not exclusively) of the respiratory system. Firstly, since 2005 we made a broad surface survey that revealed very high radon emissions from soils near active faults on Etna. Typical background soil activity on Etna were <1,000 Bq/m3, whereas in areas of stronger soil degassing, activity values up to ~60,000 Bq/m3 were measured. Furthermore, since late 2015 we have performed continuous indoor radon monitoring inside seven houses, some of which located close to degassing faults on the eastern, southern and south-western flanks of the volcano. Indoor radon concentration varied according to the season of the year, but above all, they changed according to the geology and tectonic setting of the substratum of the monitored houses. In one case, indoor radon concentration reached 3,549 Bq/m3 and remained > 1,000 Bq/m3 for several consecutive months, highlighting a potential health problem for those living in such environments. In other cases, the construction features of the houses and/or the materials used seemed to play an important role in the mitigation of indoor radon accumulation, even in the presence of intensely degassing soils. These preliminary data demonstrate the need to deepen the studies, extending indoor radon measurements to other urban areas, in order to monitor the health hazard for the Etna population, amounting to about one million people.

Duplex collecting system in a pelvic kidney - an unusual combination.

Pelvic kidney is a relatively common renal malformation as well as duplex kidney; however, the unilateral coexistence of these abnormalities is not frequently found. We present a case of a young woman with a history of hypertension in whom a pelvic and dysmorphic left kidney was discovered during ultrasound examination performed for the study of the renal arteries. Magnetic resonance imaging and computed tomography imaging revealed a duplex pelvic kidney. This combination is very rare; we have not found a similar case reported in the literature.

MR-arthrography in superior instability of the shoulder: correlation with arthroscopy.

PURPOSE: This study was undertaken to evaluate magnetic resonance (MR) arthrography in the detection and classification of lesions that may cause superior instability. MATERIALS AND METHODS: Forty-two consecutive patients with clinical signs of chronic superior instability of the shoulder underwent MR arthrography followed by arthroscopic surgery. For each patient we retrospectively reviewed the MR arthrography and surgical findings. RESULTS: We detected 31 superior labral anterior posterior (SLAP) lesions, all confirmed on arthroscopy with three cases of underestimation: in the detection of SLAP lesions, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MR arthrography were 100%; in the evaluation of the type of SLAP lesion, sensitivity was 100%, specificity was 78.5%, accuracy was 92.8%, PPV was 71.7% and NPV was 100%. All cases of capsular laxity (13/42) and biceps tendon lesions (3/42) were confirmed on arthroscopy with sensitivity, specificity, accuracy, PPV and NPV of 100%. Eleven cuff lesions were detected on MR arthrography, 10 of which confirmed at arthroscopy: sensitivity was 100%, specificity was 96.8%, accuracy was 97.6%, PPV was 90.9% and NPV was 100%. Associated lesions were found in 38/42 patients. CONCLUSIONS: Superior instability is frequently associated with different anatomical variants or pathological conditions, such as SLAP lesions. The role of MR arthrography is to describe the key features of lesions affecting the superior portion of the shoulder, including location, morphology, extent, and associated injuries and leanatomical variants and to correlate these features with clinical symptoms.

Matrix-induced autologous chondrocyte implantation of the knee: mid-term and long-term follow-up by MR arthrography.

OBJECTIVE: To define magnetic resonance (MR) arthrography imaging findings of matrix-induced autologous chondrocyte implantation (MACI) grafts of the knee in order to describe implant behaviour and to compare findings with validated clinical scores 30 and 60 months after MACI implant. MATERIALS AND METHODS: Thirteen patients were recruited (10 male, 3 female) with a total number of 15 chondral lesions. Each patient underwent an MACI procedure and MR arthrography 30 and 60 months after surgery. MR arthrography was performed using a dedicated coil with a 1.5-Tesla unit. The status of the chondral implant was evaluated with the modified MOCART scoring scale. The lining of the implant, the integration to the border zone, the surface and structure of the repaired tissue were assessed, and the presence of bone marrow oedema and effusion was evaluated. For clinical assessment, the Cincinnati score was used. RESULTS: At 60 months, the abnormality showed worsening in 1 out of 15 cases. Integration showed improvement in 3 out of 15 cases, and worsening in 3 out of 15 cases. Two surfaces of the implant showed further deterioration at 60 months, and 1 afflicted implant fully recovered after the same time interval. Implant contrast enhancement at 30 months was seen in 2 out of 15 cases, 1 of which recovered at 60 months. According to the MOCART score, 4 cases were rated 68.4 out of 75 at 30 months and 65 out of 75 at 60 months. The mean clinical score decreased from 8.6 out of 10 at 30 months to 8.1 out of 10 at 60 months. CONCLUSION: Magnetic resonance arthrography improved the evaluation of implants and facilitated the characterisation of MACI integration with contiguous tissues. The follow-up showed significant changes in MACI, even at 60 months, allowing for useful long-term MR evaluations.

Ultrasound-guided removal of foreign bodies: personal experience.

Foreign bodies (FBs) retained in the soft tissues are a common reason for medical consultation, and usually consist of wooden or metal splinters or glass shards. Failure to remove foreign bodies is likely to give rise to acute or late complications, such as allergies, inflammation or infection, that may be severe. The surgical removal of an FB is invasive, costly and technically challenging. The procedure may fail in some cases and carries the risk of complications. Our study describes a technique for the ultrasound-guided removal of an FB, devised from our experience, and demonstrates its advantages over the standard surgical procedure. Sixty-two patients (43 males and 19 females aged from 9 to 65 years, median age 31 years) presented at our institution between October 2005 and June 2008 with suspected foreign bodies retained in the soft tissues of various body districts. Radiographic and/or ultrasound diagnosis was established by a radiologist expert in musculoskeletal sonography. The same radiologist helped by a nurse subsequently undertook the ultrasound-guided removal in the outpatient's clinic according to the technique described in the paper. ATL 5000 and PHILIPS iu22 ultrasound systems were used with high-frequency linear-array probes, sterile material, local anaesthetic (lidocaine 2%), scapels and surgical forceps. Antibiotic prophylaxis with amoxicillin and clavulanic acid were prescribed to all patients for 7 days after the procedure. Ninety-five FBs (39 glass, 35 metal, 17 vegetable, 2 plastic, 2 stone) were successfully removed under ultrasound guidance in all patients and the procedure took between 15 and 30 min. No complications arose either during or after the procedure. Seventy-five skin incisions were made and the wounds closed with Steri-Strips in 73/75 cases, whereas skin sutures were used in 2/75 cases. No complications arose either during or after the procedure. Ultrasound-guided removal of an FB retained in the soft tissues is a good alternative to surgery as is its relatively straightforward, inexpensive, repeatable and carries a low risk of complications. In addition, failure to remove an FB does not preclude traditional surgical removal. The advantages of this real-time procedure and the use of small instruments minimize bleeding time and avoid injury to surrounding structures. Patient compliance is enhanced by the fact that the procedure has little or no aesthetic impact. These encouraging results suggest ultrasound-guided removal as a first-choice procedure for the extraction of foreign bodies.

Combined percutaneous thrombin injection and endovascular treatment of gastroduodenal artery pseudoaneurysm (PAGD): case report.

A 69-year-old man with a history of acute pancreatitis developed a huge pseudoaneurysm of the gastroduodenal artery (PAGD), as diagnosed by CT scan. The PAGD was treated by percutaneous thrombin injection (2,000 IU) under ultrasound guidance and selective embolization of gastroduodenal artery with microcoils with its complete exclusion. The 6-month follow-up confirmed the complete exclusion of the PAGD sac.