Cystadenoma of the liver with ovarian-like stroma: case report

Cystadenomas are rare benign tumors with malignant potential. A 36-year-old woman presented with a 20-cm cystic mass in the left lobe of the liver. Surgery confirmed the diagnostic imaging findings. We present a case of cystadenoma of the liver with ovarian-like stroma and its associated radiologic characteristics.     

Angiomyolipoma of the liver: significance of CT and MR dynamic study

Angiomyolipoma is a benign mesenchymal tumor that has been reported frequently in the kidney but rarely in the liver. In the present study, we present four cases of hepatic angiomyolipoma with different radiologic appearances, discuss differential diagnosis, and review previously reported cases. One of our cases was followed for 8 years. Computed tomography (plain, enhanced, and dynamic study), magnetic resonance imaging (T1-weighted spin echo, T2-weighted spin echo, and dynamic study), ultrasonography, and angiography were performed in all cases. Although different radiologic appearances were observed in the tumors, based on different proportions of fat, blood vessels, and muscle, three cases were diagnosed as angiomyolipoma. In one case, it was quite difficult to make radiologic diagnosis; hepatocellular carcinoma with fatty metamorphosis in part was most likely suspected, but histopathological examination revealed angiomyolipoma with few fat elements. In the present study, early and prolonged enhancement of the lesion with the special pattern of time density/intensity curve was significant for angiomyolipoma, and we suggest that preoperative radiologic diagnosis of the lesion is possible in most of the cases. However, it can be quite difficult to distinguish angiomyolipoma from some hepatocellular carcinomas with fatty metamorphosis. Received: 25 April 1997/Accepted: 25 June 1997     

Cystic peripheral cholangiocarcinoma: sonography and CT

A case of cystic peripheral cholangiocarcinoma is presented. Both sonography and computed tomography (CT) demonstrated a large intrahepatic cystic neoplasm containing an enhancing solid portion. Despite the very rare incidence of this tumor, we believe that cystic degeneration of peripheral cholangiocarcinoma should be considered with these radiologic findings.     

Unilateral renal cystic disease in an adult

Unilateral renal cystic disease (URCD) is a rare, nonfamilial, nonprogressive, unilateral cystic disorder of the kidney. Very few adults with this condition have been documented [1–4]. We describe a case with a 30 year radiologic follow-up. Absence of a family history of cystic renal disease, benign clinical course through adulthood, and limitation of the process to one kidney distinguish this condition from asymmetric autosomal dominant polycystic kidney disease (ADPKD).     

Patterns of calcifications and cholangiographic findings in hepatobiliary tuberculosis

The radiologic findings on conventional examinations (plain films and cholangiograms) in a large group of patients with proven hepatobiliary tuberculosis are reviewed. The plain film findings of large chalky and confluent hepatic calcifications or nodal-type calcifications along the course of the common bile duct are suggestive of hepatobiliary tuberculosis. Small, discrete, scattered calcifications may be mimicked by histoplasmosis but can be differentiated from hepatobiliary tuberculosis. Obstructing defects seen on cholangiography are indicative of tuberculosis when adjacent calcifications are present. The patterns of liver calcifications could provide a clue to the diagnosis of hepatobiliary tuberculosis and its differentiation from liver calcifications of various other etiologies.     

Simultaneous endoscopic and radiologic examination of the colon

The selective radiologic visualization of pathologic ileocolonoscopic findings using contrast medium offers various advantages over endoscopy or radiologic evaluation performed alone. It allows one to combine a macroscopic biopsy with the radiologic examination and documentation procedure. The technique proves useful to document benign and malignant stenoses and tumors of the colon, diverticular disease, and mucosal abnormalities in long-standing ulcerative colitis and Crohn's disease, and to visualize fistulae, the appendix, or terminal ileum. Up to now, 146 patients have been examined without complication.     

Mesenteric panniculitis

We have reviewed the case of a young man with an omental mass diagnosed as mesenteric panniculitis. The clinical history, physical findings, and laboratory and radiologic studies were typical of this disorder. The diagnosis was suggested by CT scan, and confirmed on surgical biopsy. Our patient has had the typically benign course seen with mesenteric panniculitis.     

Low grade chondrosarcoma of the nasal septum

Chondrosarcoma of the nasal septum is extremely rare. In some cases, it may be difficult to preoperatively differentiate low grade chondrosarcoma from benign cartilaginous tumors such as chondroma. We report a case of low grade chondrosarcoma of the nasal septum with characteristic radiologic findings. Characteristic radiologic findings such as calcifications on computed tomography scan and a ring-and-arc pattern on enhanced T1 weighted image were useful in the preoperative diagnosis of low grade chondrosarcoma of the septum. Awareness of radiologic findings of low grade chondrosarcoma can help to make an accurate diagnosis and perform appropriate excision, leading to successful local control.     

Gallbladder perforation: Preoperative diagnosis by combined imaging techniques

Gallbladder perforation represents the most serious complication of cholecystitis. Rapid preoperative diagnosis is necessary because of the high morbidity and mortality associated with it. The authors present a case of gallbladder perforation in a 64-year-old man who had been on high doses of steroids. This case was diagnosed preoperatively by combined radiologic imaging methods.     

SPECT/螺旋CT融合显像鉴别诊断颅骨良恶性病变的临床价值

目的：探讨SPECT/螺旋CT融合显像鉴别诊断颅骨良恶性病变的临床价值。方法：对19例恶性肿瘤患者全身骨扫描（WBS）显示颅骨放射性浓聚的21个病灶行SPECT/CT融合显像,由两名有经验的核医学科医生独立阅片。患者同期接受MRI和/或CT检查,各检查时间间隔不超过两周,并对所有病例进行随访,平均随访约9个月,随访结果主要根据随后的影像学检查（MRI、CT或随后的骨扫描）及临床信息。结果：根据同期影像及随访检查共10个病灶诊断为恶性病变,11个病灶诊断为良性病变。SPECT/CT融合显像检出全部10个恶性病灶及8个良性病变,诊断符合率为85.71%。1个病灶在SPECT/CT融合显像中诊断为恶性,而同期MRI及随访检查显示良性病变。另有两个病灶在SPECT/CT中难以确定其性质,同期影像及随访检查亦显示为良性。SPECT/CT融合显像在肯定性诊断为良、恶性病灶中诊断颅骨恶性病变的敏感性、特异性、阳性预测值、阴性预测值分别为100.00%、88.89%、90.91%、100.00%。结论：SPECT/螺旋CT融合显像对鉴别诊断颅骨良恶性病变有较高的敏感性和特异性。     

MR imaging of malignant mesenchymal tumors of the liver

Magnetic resonance (MR) features of five primary malignant mesenchymal neoplasms (plasmocytoma, leiomyosarcoma, undifferentiated sarcoma, epithelioid hemangioendothelioma, and angiosarcoma) of the liver were reported. All tumors were hypointense on T1-weighted images and hyperintense on T2-weighted images. No halo and intravenous extension were noted. A target appearance was revealed in epithelioid hemangioendothelioma. MR findings of angiosarcoma were essentially the same as those of cavernous hemangiomas (markedly hyperintense with hypointense linear septa on T2-weighted images). MR findings of these rare hepatic malignancies were nonspecific, although they were quite different from those of typical hepatocellular carcinomas. This study suggested that MR differentiation of primary hepatic mesenchymal tumors from other common benign and malignant neoplasms was difficult; however, the number of studied cases was limited.     

Preoperative radiographic diagnosis of a Spigelian hernia containing large and small bowel

A case is reported in which the preoperative diagnosis of a Spigelian hernia containing both large and small bowel was made by radiographic means. The anatomy, clinical findings, and radiologic picture of this condition are discussed.     

Transcatheter arterial embolization in the management of hemobilia

Background This retrospective analysis evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) in the treatment of significant hemobilia. The imaging findings, embolization technique, complications, and efficacy are described. Methods Thirty-two consecutive patients (21 male, 11 female, age range 8–61 years) who were referred to the radiology department for severe or recurrent hemobilia were treated by TAE. Causes of hemobilia were liver trauma (n = 19; iatrogenic in six and road traffic accident in 13), vasculitis (n = 6), vascular malformations (n = 2), and hepatobiliary tumors (n = 5). Iatrogenic liver trauma was secondary to cholecystectomy in those six patients. Four of five hepatobiliary tumors were inoperable malignant tumors and one was a giant cavernous hemangioma. Arterial embolization was done after placing appropriate catheters as close as possible to the bleeding site. Embolizing materials used were Gelfoam, polyvinyl alcohol particles or steel coils, alone or in combination. Postembolization angiography was performed in all cases to confirm adequacy of embolization. Follow-up color Doppler ultrasound and contrast-enhanced computed tomography was done in all patients. Results Ultrasonic, computed tomographic, and angiographic appearances of significant hemobilia were assessed. Angiogram showed the cause of bleeding in all cases. Three patients with liver trauma due to accidents required repeat embolization. Eight patients required surgery due to failed embolization (continuous or repeat bleeding in four patients, involvement of the large extrahepatic portion of hepatic artery in two, and coexisting solid organ injuries in two). Severity of hemobilia did not correlate with grade of liver injury. All 13 patients with blunt hepatic trauma showed the cause of hemobilia in the right lobe. No patient with traumatic hemobilia showed an identifiable cause in the left lobe. There were no clinically significant side effects or complications associated with TAE except one gallbladder infarction, which was noted at surgery, and cholecystectomy was performed with excision of the hepatic artery aneurysm. Conclusion TAE is a safe and effective interventional radiologic procedure in the nonoperative management of patients who have significant hemobilia.     

Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study

Background: This prospective study evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) for the treatment of symptomatic cavernous hemangiomas of the liver. The technique, its complications, and effectiveness also were analyzed. Methods: Eight patients (five male, three female; mean age ± SD = 47.75 ± 8.59 years) with symptomatic cavernous hemangiomas of the liver were treated by TAE with polyvinyl alcohol particles or gelfoam and steel coils (single session) followed by supportive treatment. Tumor characterization (including the extent and number of lesions) was done on triple-phase helical computed tomography or gadolinium-enhanced dynamic magnetic resonance imaging. Results: The lesions were located in the right lobe in five patients, left lobe in one, and both lobes in two. The largest diameter of the lesions was 6–18 cm (9.28 ± 5.13 cm). The treatment response was assessed on follow-up ultrasound and color Doppler and/or contrast-enhanced helical computed tomography. There were no treatment-related deaths and morbidity was minimal. Embolization was the only method of treatment in seven patients; however, one patient had surgery after TAE because the symptoms were only partly relieved. Indications for embolization were abdominal pain (eight patients), rapid tumor enlargement (four of eight), and recurrent jaundice (one of eight). Symptomatic improvement was documented in all patients after embolization. Symptoms did not worsen in any patient. The mean size of the tumor did not show any statistically significant change on follow-up radiologic examinations. However, in one patient, the tumor significantly regressed in size after embolization. Conclusion: TAE of hepatic cavernous hemangioma is a useful procedure in the therapy of symptomatic hemangiomas. Received: 13 July 2000/Revision accepted: 27 December 2000     

肝肿瘤超声造影的血流动力学诊断研究

目的：研究在多普勒超声造影中肝实质性占位血流信号的改变。方法：选择经手术及病理证实的61例肝占位性病变,其中肝恶性肿瘤42例,良性病变19例,均经肘静脉注射浓度为400mg/ml的Levovist 6-7ml后,研究肝良恶性肿瘤中彩色多普勒信号的增强情况,结果：造影前,后彩色多谱勒血流显像显示及有彩色务流信号的肝实质性占位,良性分别为52．6％（10／19）及73．6％（14／19）,恶性分别为80．9％（34／42）及100％（42／42）。平均开始增强时间,峰值出现时间,增强总持续时间良性占位分别为37s,92s,496s,恶性占们分别为29s,78s,405s,良恶性比较差异有显著性意义。结论：Levovist能明显增强肝实质性占位病变中的彩色多普勒血流信号,肝恶性肿瘤的增强时间较良性肿瘤明显缩短,可以帮助鉴别诊断。     

Characterization of solid liver lesions with color and pulsed Doppler imaging

Background: To assess the usefulness of color Doppler and duplex sonography in the characterization of solid liver lesions. Methods: We performed color Doppler and duplex sonography on 106 solid hepatic lesions. With color Doppler, we evaluated the aspect and distribution of tumoral vessels. The pulsed Doppler parameters considered were only those showing the highest systolic peak velocity values. Results: Intratumoral color and pulsed Doppler signals were obtained in 81% (59/73) of malignant tumors (p < 0.0001) but only in 18% (6/33) of benign tumors. Ninety-six percent (45/47) of the lesions with arterial intratumoral and peritumoral signals were malignant, whereas 4% were benign (p < 0.0001). Only eight (11%) malignant lesions had intratumoral venous signal vis-a-vis 23 (70%) benign. Twelve cases showing intratumoral venous Doppler signal as a single finding were benign. No statistically significant differences were observed in the quantitative parameters recorded by pulsed Doppler (Student t test, p < 0.05), there having been a clear overlapping in the values obtained in benign and malignant lesions. Conclusions: (a) The type of signal (arterial or venous) and its distribution detected by color and pulsed Doppler is more helpful than the assessment of the spectral quantitative parameters obtained by pulsed Doppler. (b) The presence of intratumoral venous flow remarkably suggests benignancy. (c) The presence of both intra- and peritumoral arterial flow in the same lesion strongly suggests malignancy. Received: 3 January 1997/Revision accepted: 17 December 1997     

Nonsurgical diagnosis and management of an inflammatory pseudotumor of the spleen in a child

Primary splenic tumors in children are rare and usually benign. We report the case of a 7-year-old boy with a splenic mass that initially resembled an infectious process. Histopathologic examination of a specimen obtained using sonographically guided Tru-cut needle biopsy, performed after angiography, revealed an inflammatory pseudotumor of the spleen, an extremely rare benign lesion. The lesion has been managed conservatively with clinical and sonographic follow-up. This case shows that benign lesions of the spleen can easily be diagnosed using current radiologic and histopathologic techniques without the need for surgery, thus allowing total or even partial splenectomy to be reserved for patients in whom a mass cannot be diagnosed or in whom clinical progression is evident.     

CT引导下肝脏病变穿刺活检术的临床应用

目的探讨CT引导下肝脏病变穿刺活检术的临床应用价值。方法利用CT定位选择合适进针点,应用直径18～20 G活检针对34例肝脏病变病人行经皮肝脏穿刺活检。结果34例病人取得病理标本95个。其中良性病变6例,占18%,包括肝脓肿1例,肝血管瘤3例,肝硬化结节2例;恶性病变28例,占82%,包括肝癌8例,肝转移瘤16例,胆管癌4例。活检阳性率91.2%（31/34）,假阴性率8.8%（3/34）。1例出现肝动脉-门静脉瘘,其他无严重并发症。结论CT引导下穿刺活检术是肝脏病变诊断和鉴别诊断的一种安全而又准确的方法,具有独特的优势与良好的诊断应用价值。     

Sonography of fat necrosis of the breast: Correlation with mammography and MR imaging

Fat necrosis (FN) of the breast is a benign nonsuppurative inflammatory process of the adipose tissue. The radiologic appearance ranges from benign to suspicious for malignancy; therefore, it is very important to know the distinguishing radiologic features of FN on different modalities. Mammography is more helpful in identifying FN than ultrasonography in most of the cases, and MRI may also be used to rule out malignancy as an adjunct to mammography and sonography. Even when modern diagnostic modalities are used, biopsy may still be unavoidable for some cases. In conclusion, an accurate history and familiarity with the radiologic findings are crucial to recognizing FN and avoiding unnecessary interventions. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 41 :415–423, 2013     

Splenosis: Ultrasound and CT findings in a case complicated by an intraperitoneal implant traumatic hematoma

A case of intraperitoneal splenosis, found incidentally at ultrasound examination in a 35-year-old man, is reported. The diagnosis, suspected on the basis of computed tomographic (CT) and radionuclide studies, was established by surgery. Three years later, after direct trauma, ultrasound and CT studies revealed a surgically proven splenosis implant hematoma. The contribution of radiologic examinations in the diagnosis of splenosis is emphasized.