Management algorithm of acute cholecystitis after percutaneous cholecystostomy catheter placement based on outcomes from 377 patients.

PURPOSE: To report outcomes of percutaneous cholecystostomy (PC) catheter placement in patients with acute cholecystitis (AC) and propose management algorithm of AC after PC catheter placement based on the outcomes. METHOD AND MATERIALS: Retrospective study was performed. 419 patients who underwent PC between July 2010 and September 2016 were included. Patients who underwent PC for indication other than AC were excluded. The primary outcome was definitive treatment of AC following PC, including cholecystectomy or percutaneous cholecystolithotomy. Secondary outcomes include removal of drainage catheter without further management or death with catheter in place. Based on outcomes, we proposed management algorithm of AC after PC catheter placement. RESULTS: 377 of 419 patients underwent PC for treatment of AC (median age, 66 years; range 18-100 years). Technical success rate was 100% with 2.4% major complications rate and 1.6% minor complications rate. Following PC, 118 patients (31%) underwent definitive treatment with cholecystectomy. Sixty-one patients (16%) underwent definitive treatment with percutaneous cholecystolithotomy with removal of catheters. Seventy-four patients (20%) had their catheters removed upon resolution of cholecystitis without undergoing surgery or stone removal. Fifty patients (13%) died with catheters in place due to other comorbidities. Five patients (1%) still had their catheters in place at the end of the study. CONCLUSION: PC remains a viable option for treatment of AC with low complication rate and can be used as bridge to definitive therapy. Our proposed management algorithm can be a guideline for the management of AC after PC catheter placement.

Renal lymphangiomatosis: a rare cause of bilateral nephromegaly.

We report the ultrasound, excretory urography and MR findings in a young child with renal lymphangiomatosis who presented with gradually progressive bilateral flank swelling but who was otherwise asymptomatic. The typical perirenal and parapelvic cysts are visualized as hypoechoic lesions on sonography and hyperintense on T2-weighted HASTE images. T1-weighted image could not delineate the cysts clearly. The renal parenchyma was hyperechoic on sonography, and MRI showed reversal of the normal corticomedullary signal intensity, and confirmed the diagnosis by suggesting the non-parenchymal origin of the cysts.

Successful treatment of pulmonary artery aneurysms secondary to possible Behçet's disease.

Pulmonary artery aneurysm (PAA) secondary to Behçet's disease (BD) is a rare condition. The commonest presentation is hemoptysis, which can be fatal. Though the classical triad of recurrent oral and genital ulcers and relapsing iritis is present in most patients of BD, isolated pulmonary artery involvement termed as incomplete BD has been reported. Prompt diagnosis and immunosuppressive therapy can cause regression of aneurysm and prevent fatal hemoptysis. We report a case of PAA due to BD who presented with hemoptysis and responded to steroid therapy.

Cerebrospinal fluid pseudocyst of the breast.

Cerebrospinal fluid pseudocyst of the breast is a rare complication of ventriculoperitoneal shunt placement. Two cases of cerebrospinal pseudocyst of the breast are reported here. The mammography and ultrasound findings in these two cases are described.

Extracranial head and neck circulation aneurysms in a case of polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a rare systemic necrotising medium vessel vasculitis. The hallmark of this condition is aneurysms which are seen in visceral arteries. Aneurysms of extracranial neck and head vessels are rare. We describe a case of PAN who had such aneurysms together with characteristic aneurysms in the mesenteric circulation.

Sonographic diagnosis of a solitary intramuscular cysticercal cyst.

We present a rare case of a solitary cysticercal cyst that involved the anterior abdominal wall musculature and was diagnosed with sonography. Sonograms revealed a small, well-defined, elliptical cystic lesion with an eccentric hyperechoic area within it. An eccentric, echogenic, pedunculated structure was seen within the cystic area of the lesion. No calcification was apparent. The lesion was surrounded by inflammation in the muscle. Hypervascularity in the surrounding muscle was noted on color Doppler imaging. If lesions with similar morphologic characteristics are encountered in the musculature or subcutaneous tissues during sonographic examination for another condition, one should suspect cysticercosis.

Two-phase dynamic contrast-enhanced computed tomography with water-filling method for staging of gastric carcinoma.

The objective of the study was to evaluate the usefulness of two-phase incremental contrast-enhanced computed tomography (CT) with water-filling method in the preoperative assessment of stomach carcinoma. Dynamic CT was done in 20 patients with biopsy-proven gastric cancers and the findings were compared with surgery. A 150-ml ionic contrast medium was administered intravenously at a flow rate of 3.5 ml/s. CT scanning was done at 45 s (early phase) and 3 min (equilibrium phase) after the start of intravenous injection. Primary tumors were detected in all the cases. The overall accuracies of dynamic CT in determining depth of tumor invasion, pancreatic invasion, adjacent liver infiltration, and lymph node metastasis were 85% (17/20), 90% (18/20), 85% (17/20), and 69% (13/19), respectively. The early phase of dynamic CT is highly accurate in determining the depth of tumor invasion of advanced gastric cancers but has low sensitivity in the detection of nodal metastasis. The delayed phase scans do not add any additional information and hence, should not be routinely used for staging.

MRI findings of retrobulbar myxoma-- a case report.

Myxomas are benign soft tissue neoplasms, which usually involve the heart, skin and subcutaneous tissues, and rarely the ocular adnexa. We present a rare case of orbital myxoma with magnetic resonance imaging (MRI) findings and a review of the literature.