CT imaging features of bile duct stent complications.

Biliary stents have been widely used to treat both malignant and benign biliary obstruction. Biliary stenting serves as a temporary measure to maintain ductal patency and promote bile drainage. Biliary decompression can help relieve clinical symptoms of pain, obstructive jaundice, pruritis, fat malabsorption, and failure to thrive and prevent disease progression, such as secondary biliary cirrhosis and end-stage liver failure. Endoscopic placement of biliary endoprosthesis is a minimally invasive procedure well tolerated by most patients but is not without problems. Multiple early and late complications have been reported in the literature and Computed Tomography (CT) is the most used modality to assess normal positions and evaluate patients suspected of stent complications. The aim of this article is to provide a review various of biliary stent related complications, as seen on CT. Current literature on risk factors, diagnosis and management is also discussed.

Multimodality imaging approach in identifying invasive hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the 5th most common neoplasm and the 3rd leading cause of cancer related mortality worldwide. Early stages of the neoplasm may be treated curatively with liver resection or orthotopic liver transplant. However, HCC has a high propensity for vascular and locoregional invasion, which can preclude these treatment options. The portal vein is the most invaded structure, while other regional structures affected include the hepatic vein, inferior vena cava, gallbladder, peritoneum, diaphragm, and the gastrointestinal tract. Management of invasive and advanced stages of HCC includes modalities such as transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and systemic chemotherapy, which are non-curative and focus on relieving tumor burden and slowing progression. A multimodality imaging approach is effective in identifying areas of tumor invasion and distinguishing between bland and tumor thrombi. Due to implications in prognosis and management, it is imperative for radiologists to accurately identify imaging patterns of regional invasion by HCC and to distinguish between bland and tumor thrombus in cases of potential vascular invasion.

Peritoneal vaginal fistula and contrast extravasation during MRI.

Gynecological malignancies including primary cervical cancers are frequently treated with chemotherapy and radiation. Fistulas affecting the gynecological organs and surrounding cavities are a known consequence of radiotherapy due to focal necrosis of the regional mucosa. In this report, we will demonstrate a rare case of a posterior vaginal wall rupture with resulting fistulization into the peritoneal cavity in a 50-year-old female patient with squamous cell carcinoma of the cervix status postchemoradiotherapy. Magnetic resonance imaging (MRI) showed a discontinuity in the posterior vaginal wall near the fornix with extravasation of ultrasound gel used as contrast into the intraperitoneal compartment. Patient later presented with peritonitis like signs and symptoms and was treated successfully with antibiotics. Vaginal gel should be used with caution in patients with prior history of radiation due to the possibility of vaginal rupture which may lead to peritoneal vaginal fistula and contrast extravasation.

Pseudoangiomatous stromal hyperplasia in a healthy young adult male.

This case report describes the occurrence of a rapidly enlarging pseudoangiomatous stromal hyperplasia (PASH) tumor in a 20-year-old male patient. The diagnosis was made via tomosynthesis and ultrasound-guided biopsy with pathological correlation consistent with PASH. The patient's case was discussed, and he was recommended to undergo surgical resection of the mass to alleviate symptoms due to its large size. Surgical pathology confirmed the original diagnosis and the patient had an uncomplicated postoperative course. Here, we exhibit our imaging findings; review classic presentations of PASH on mammography, ultrasound, and MRI; and discuss histological characteristics of this benign entity.

Coexistence of superior mesenteric artery syndrome and nutcracker phenomenon.

Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction. Nutcracker syndrome occurs as the result of external compression of the left renal vein. Although they share a similar pathophysiology, SMA and nutcracker syndrome occurring simultaneously is rare. In this case report, we discuss the pathophysiology and unique computed tomography findings in a 25-year-old female patient diagnosed with SMA syndrome who was also incidentally found to have a coexisting nutcracker phenomenon. Due to similar pathogenesis, radiologists should consider the possibility of coexistence of these rare syndromes in appropriate patients.

Corrigendum to 'Pulmonary vein occlusion: A delayed complication following radio frequency ablation for atrial fibrillation' [Radiology Case Reports 16 (2021) 3666-3671].

[This corrects the article DOI: 10.1016/j.radcr.2021.09.015.].

"Target sign" from dropped gallstones after laparoscopic cholecystectomy.

Isolated case reports and small series in radiologic and surgical literature relay the different modes of clinical presentation that arise secondary to spillage of gallstones during surgery. We report a case of a 70-year-old female who presented with a 2-week history of right-sided abdominal pain. CT (computerized tomography) imaging findings demonstrated multiple peripherally enhancing hypoattenuating lesions in the right subphrenic space abutting the hepatic dome, concerning for abscesses. The lesions were found to have a characteristic central hyperattenuating focus (Target Sign) consistent with gallstones, as identified on a pre-cholecystectomy CT, resulting in the early diagnosis and treatment of dropped gallstones from prior laparoscopic cholecystectomy approximately 1 year prior to presentation.

Pulmonary vein occlusion: A delayed complication following radiofrequency ablation for atrial fibrillation.

This case reports demonstrates the rare but potentially serious complication of pulmonary vein stenosis and subsequent thrombosis diagnosed two years after radiofrequency ablation of the pulmonary veins for atrial fibrillation. Pulmonary vein stenosis can remain asymptomatic until significant occlusion occurs, after which it can present with a variety of symptoms, mimicking a myriad of cardiovascular and pulmonic pathologies. Early diagnosis and treatment rely on consistent follow up using appropriate diagnostic imaging modalities and is paramount in preventing severe complications.

Stromal Fibrosis of the Breast and the Associated Radiological Findings.

This case report follows a 42-year-old female patient who underwent a routine screening mammogram. The patient was found to have a 50 mm benign subareolar mass in the right breast. However, because benign imaging findings do not preclude malignancy, the patient was recommended to undergo a biopsy for confirmation. Subsequent imaging and core needle biopsy established a benign lesion consistent with stromal fibrosis with underlying fibroadenomatous changes. The benign imaging and histological findings of the breast mass were concordant. The patient was recommended yearly mammograms and continued observation. This case report highlights the importance of radiopathological concordance in patients found to have benign imaging findings on screening mammograms.

Metastatic Cecal Adenocarcinoma presenting as acute appendicitis.

This case report details the findings of metastatic colon cancer in an older male patient who initially presented with signs and symptoms of acute appendicitis. The patient underwent routine CT (Computed Tomography) imaging for diagnostic evaluation of appendicitis. Subsequently, the patient was found to have findings consistent with acute appendicitis secondary to obstruction from a cecal mass with evidence of hepatic and pulmonary metastases. This case report demonstrates the radiological findings of acute appendicitis secondary to metastatic colorectal disease and highlights the importance of considering underlying malignancy in cases of appendicitis occurring in older individuals.

Giant nabothian cysts: A rare incidental diagnosis on MRI.

This case report follows a 52-year-old female patient undergoing routine screening for hepatocellular carcinoma. Incidentally, the patient was found to have a cystic pelvic mass on initial imaging via CT. Subsequent imaging with MR confirmed findings of two giant nabothian cysts. This case outlines the rare, asymptomatic nature of giant nabothian cysts and emphasizes the efficacy of MR as a tool for diagnosis of pelvic masses when ultrasound and CT findings are equivocal.