Primary splenic malignant lymphoma associated with hepatitis C virus infection

We present two cases of primary splenic malignant lymphoma associated with chronic hepatitis C virus infection detected early by routine follow-up imaging studies. Septumlike structures were seen on postcontrast computed tomography or magnetic resonance imaging, which presented characteristic gross findings. These findings may suggest primary splenic malignant lymphoma during the course of chronic hepatitis C. Received: 17 March 2000/Accepted: 19 April 2000     

Spontaneous gastrosplenic fistula: a rare complication of splenic diffuse large cell lymphoma

A gastrosplenic fistula is a very rare complication with a gastric or splenic lesion. Splenic, diffuse, large cell lymphoma may be one cause of this distinctive complication. We present a patient with spontaneous gastrosplenic fistula secondary to pathologically proven diffuse splenic large cell lymphoma, with radiography and computed tomography. Received: 30 November 2001/Accepted: 19 December 2001     

Hemosuccus pancreaticus--a rare cause of gastrointestinal bleeding: diagnosis and interventional radiological therapy

Hemorrhage from the pancreatic duct, i.e. hemosuccus pancreaticus (HP), is a rare cause of gastrointestinal bleeding. Pancreatic hemosuccus is usually due to the rupture of an aneurysm of a visceral artery, most likely the splenic artery, in chronic pancreatitis. Other causes of HP are rare. We present a case of HP in a female patient with no history but with positive findings of chronic calcifying pancreatitis upon ultrasonographic investigation, computed tomography scan, and endoscopic retrograde cholangiopancreatography. With detectable fresh blood in the descending duodenum, angiography of the celiac artery revealed an aneurysm of the splenic artery as the suspected cause of intermittent bleeding from the pancreatic duct. The treatment is traditionally surgical or by interventional radiological means. This is the first case described in the literature in which interventional radiological therapy involved implantation of an uncoated metal Palmaz stent in the splenic artery. In the follow-up of 18 months no relapse of HP was observed.     

Arteriovenous fistula secondary to iliac mycotic aneurysm: helical CT findings

We describe the case of a 59-year-old man who presented a mycotic aneurysm of the common right iliac artery due to Streptococcus agalactiae and developed an arteriovenous fistula within the inferior vena cava secondary to spontaneous rupture of the aneurysm. The clinical syndrome, helical computed tomographic, and angiographic findings are described and discussed. Received: 25 February 1999/Accepted: 7 April 1999     

Spiral CT virtual endoscopy of abdominal arteries: clinical applications

Virtual endoscopy enables the creation of endoluminal views of the aorta and its branches by processing spiral computed tomographic (CT) images, thereby allowing the preoperative and postoperative evaluations of abdominal aortic aneurysms, aneurysms of the splenic, celiac, and common iliac arteries, and renal artery stenoses. Moreover, it is helpful for verifying the position of stents and endoprostheses from within the aortic lumen. This method is a promising addition to spiral CT. Received: 3 May 1999/Accepted: 2 June 1999     

Completely thrombosed splenic artery aneurysm mimicking cystic pancreatic mass: Computed tomographic findings

A case of a completely thrombosed aneurysm of the splenic artery is reported. The central lumen of the aneurysm was not enhanced on computed tomography (CT); therefore, a cystic pancreatic mass could not be excluded. This entity should be considered in the differential diagnosis when a cystic peripancreatic mass with a calcified rim is detected on CT.     

Left renal vein aneurysm: imaging findings

A renal vein aneurysm is a rare vascular disease. To our knowledge, only six cases have been reported. We describe a 57-year-old woman with a left renal vein aneurysm diagnosed by a combination of ultrasonography, color Doppler ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging.     

Gaucher disease of the spleen: CT and MR findings

We present a 26-year-old male patient with Gaucher disease who presented with epigastric pain and a palpable mass in the left abdomen. Ultrasound, abdominal computed tomography, and magnetic resonance imaging showed massive splenomegaly with multiple splenic nodules up to 7 cm in diameter. Splenic nodules should be included in the differential diagnosis of splenic masses. Follow-up is necessary because of the increased incidence of hematologic malignancies in Gaucher disease. Received: 28 September 1999/Accepted: 20 October 1999     

Preoperative evaluation of Klatskin tumor: accuracy of spiral CT in determining vascular invasion as a sign of unresectability

Background: To assess the accuracy of spiral computed tomography (CT) in predicting the resectability of Klatskin tumor as determined by vascular invasion. Methods: Twenty-one consecutive patients with Klatskin tumor who had undergone laparotomy were included in this study. The preoperative thin-section (5-mm-thick) spiral CT scans of these patients were assessed for the surgical resectability of tumor by evaluating the vascular invasion. The criterion for vascular invasion indicating unresectability was the tumoral invasion of the proper hepatic artery or main portal vein or simultaneous invasion of one side of the hepatic artery and the other side of the portal vein. Results: All nine patients with tumors thought to be unresectable on the basis of CT findings had tumors that were unresectable at surgery (positive predictive value, 100%). Of 12 patients with tumors thought to be resectable, six had resectable tumors (negative predictive value, 50%). Spiral CT failed to detect small hepatic metastasis (n= 1), lymph node metastasis (n= 1), extensive tumor (n= 2) and variation of bile duct (n= 2), which precluded surgical resection. Conclusion: Spiral CT is a reliable method for detecting vascular invasion and unresectable tumors. However, it has limitations in detecting variations of the bile duct or the intraductal extent of tumor. Received: 24 November 1999/Accepted: 26 January 2000     

Widespread abdominal venous thrombosis in paroxysmal nocturnal hemoglobinuria diagnosed on CT

Paroxysmal nocturnal hemoglobinuria is a rare disorder characterized by pancytopenia. One of the main manifestations of this disease is development of widespread life-threatening venous thrombosis, which may involve multiple abdominal veins. We describe two patients with paroxysmal nocturnal hemoglobinuria with clinically unsuspected portal, splenic, and mesenteric venous thromboses that were diagnosed on computed tomography. This complication should be clinically suspected in patients suffering from paroxysmal nocturnal hemoglobinuria who present with abdominal pain, and it should be sought by the radiologist on pre- and postcontrast computed tomography. Received: 3 October 2000/Accepted: 15 November 2000     

Aneurysms of the portal vein and superior mesenteric vein

Only scattered reports of portal vein and superior mesenteric vein aneurysms appear in the literature. Case reports of three patients with portal vein and superior mesenteric vein aneurysms diagnosed by computed tomography (CT) and gray-scale, color Doppler, and duplex Doppler sonography are presented. In one case, an isolated portal vein aneurysm was demonstrated. In the second case, an aneurysm of the portal vein and superior mesenteric vein resulting in biliary ductal dilatation was observed. In the third case, an isolated superior mesenteric vein aneurysm was found. None of the patients had a history or clinical evidence of underlying liver disease, pancreatitis, or other disease states that would predispose them to the development of aneurysms. The clinical presentations, possible etiologies, and imaging features of portal vein and superior mesenteric vein aneurysms are reviewed. The value of CT and sonography in the detection and characterization of these rare aneurysms is discussed. Received: 29 February 1996/Accepted: 10 April 1996     

Laparoscopic distal pancreatectomy for hemosuccus pancreaticus due to an intraductal papillary mucinous neoplasm

Hemosuccus pancreaticus (HP) is a condition that is defined as gastrointestinal hemorrhage which occurs through the pancreatic duct. We present the rare case of a 75-year-old woman who developed HP caused by intraductal papillary mucinous neoplasm (IPMN). She had been followed for sarcoidosis, splenic artery aneurysm and pancreatic cyst. The patient presented to the emergency room of our hospital with epigastric pain and bloody discharge. Computed tomography revealed hemorrhage from a splenic artery aneurysm in a cystic lesion of the pancreas. On angiography, extravasation from the splenic artery was observed. Thus, we performed coil embolization. After interventional radiography (IVR), magnetic resonance imaging and endoscopic retrograde pancreatography showed a branch duct IPMN. Based on these findings, elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was IPMN with HP caused by rupture of a splenic artery aneurysm. For such complicated cases, minimally invasive surgery is applicable after successful hemostasis by IVR.     

Massive upper gastrointestinal haemorrhage due to intragastric rupture of a splenic artery aneurysm

Most cases of splenic artery aneurysm are asymptomatic, being found incidentally at the time of investigations (e.g. ultrasound, computed tomography, angiography) or laparotomy for other conditions. Rupture of a splenic artery aneurysm with erosion into the stomach is a rare cause of massive upper gastrointestinal haemorrhage. This case report is, to our knowledge, only the second case of splenic artery aneurysm presenting with massive upper gastrointestinal haemorrhage due to erosion into the stomach in a nulliparous woman.     

Giant aneurysm of the splenic artery and huge varix

Giant aneurysm of the splenic artery and huge varix accompanied by portal hypertension and splenomegaly are described. Computed tomography proved to be an ideal tool in the evaluation of both aneurysm and varix. Enhancement scan revealed giant aneurysm as a round mass in the splenic hilus and huge varix as one oval and one bell-shaped shadow adjacent to the spleen. They were diagnosed by angiography.     

Intraoperative US diagnosis of pylephlebitis (portal vein thrombosis) as a complication of appendicitis: a case report

We report a case of infectious thrombosis of the superior mesenteric vein (pylephlebitis) that was suspected preoperatively with computed tomography and confirmed at intraoperative ultrasonography as confined to the extrahepatic portal vein and superior mesenteric vein. Intraoperative ultrasonography revealed intraluminal echogenic thrombus material in the dilated superior mesenteric and extrahepatic portal veins, slightly dilated open splenic vein, and numerous venous collaterals in the hepatoduodenal ligament. When preoperative imaging studies are inconclusive, intraoperative sonography can confirm the correct diagnosis of pylephlebitis and may give valuable information about the extent of the thrombosis. Received: 19 December 1995/Accepted: 31 January 1996     

Radiologic features of papillary adenoma and papillomatosis of the biliary tract

Background: The purpose of this study was to describe the imaging findings of papillary adenoma of the bile ducts. Methods: Imaging modalities including sonography, computed tomography, cholangiography, and endoscopic sonography obtained in five patients with papillary adenoma of the bile duct were retrospectively reviewed and correlated with pathologic findings. Results: In four cases, imaging findings were a dilatation of the bile ducts due to a protruding mass within the lumen of the common bile duct. In one case, the biliary tract obstruction was not due to the mass but to mucus secretion that was detected at sonography, endoscopic sonography, and cholangiography. Multiple lesions were observed in two cases at pathology and not detected preoperatively. All the lesions contained foci of in situ carcinoma or mild dysplasia. Conclusion: Imaging is useful in detecting bile duct tumors. Hypersecretion of mucus is rare but highly characteristic of bile duct adenoma. Received: 6 July 1995/Accepted: 18 August 1995     

Splenic trauma: evaluation with contrast-specific sonography and a second-generation contrast medium: preliminary experience.

OBJECTIVE: To report our experience in the assessment of splenic trauma with contrast-coded sonography and a second-generation contrast medium. METHODS: From January to May 2002, 120 patients were studied with sonography for suspected splenic trauma. Twenty-five were selected for further imaging because of sonographic findings positive for splenic injury, findings positive for peritoneal fluid only, indeterminate findings, and negative findings with high clinical or laboratory suspicion. These patients underwent contrast-enhanced harmonic sonography and contrast-enhanced helical computed tomography. RESULTS: Among the 25 patients studied, 6 had no spleen trauma at initial and follow-up evaluation. One patient had a hypoperfused spleen without parenchymal damage, and 18 had splenic injuries; these 19 patients were considered positive. Hemoperitoneum was identified by sonography, contrast-enhanced sonography, and contrast-enhanced computed tomography in 74% of the 19 positive cases. Perisplenic clots were recognized in 58% of the cases by computed tomography and in 42% by baseline and enhanced sonography. Splenic infarctions were found in 11% of cases by contrast-enhanced sonography and computed tomography; none was found by unenhanced sonography. Parenchymal traumatic lesions were identified in 12 of 18 patients with splenic injuries by unenhanced sonography, in 17 cases by contrast-enhanced sonography, and in all 18 cases by contrast-enhanced computed tomography. A minimal splenic lesion was found in the single patient with a false-negative contrast-enhanced sonographic finding. Contrast-enhanced sonography correlated appreciably better than unenhanced sonography in detecting injuries and in estimating their extent. Findings undetectable on unenhanced sonography were also noted: splenic hypoperfusion in 11% of positive cases on both contrast-enhanced sonography and contrast-enhanced computed tomography, contrast medium pooling in 21% of cases on both contrast-enhanced sonography and computed tomography, and contrast extravasation in 11% of cases on computed tomography and 5% on contrast-enhanced sonography. CONCLUSIONS: Contrast-enhanced sonography is a promising tool in the assessment of splenic trauma. In institutions where sonography is used as the initial procedure, this technique may increase its effectiveness.     

Pseudolesion in segment II of the liver observed on CT during arterial portography caused by the aberrant left gastric venous drainage

A rare case with a pseudolesion in segment II of the liver observed on computed tomography (CT) during arterial portography caused by the aberrant left gastric venous drainage is presented. Close observation of the celiac angiography was helpful in recognizing this pseudolesion. Selective catheterization of the left gastric artery and CT during its venous phase confirmed the etiology of the pseudolesion. Received: 11 June 1998/Revision accepted: 9 September 1998     

Spontaneous rupture of intrahepatic artery aneurysm with complicated vascular anomalies

An 18-year-old man developed a sudden onset of upper abdominal pain with vomiting. Ul-trasound and computed tomographic (CT) scans revealed the spontaneous rupture of an intrahepatic artery aneurysm with subcapsular hematoma. A celiac arteriogram demonstrated a ruptured intrahepatic artery aneurysm in the right lobe of the liver, right extrahepatic artery aneurysm, obliteration of gastroduodenal artery, and abnormal flow pattern of the splenic artery. Portal vein phase, using superior mesenteric arteriography, showed portal vein varices and obliteration of the portal trunk. A right hepatic lobectomy was performed. The cut surface of the resected liver revealed a ruptured intrahepatic artery aneurysm with massive hematoma.     

Bile duct hamartomas (Von Meyenburg complexes): value of MR imaging in diagnosis

We present a case of a patient initially believed to have multiple liver metastases based on ultrasound and computed tomography findings in whom a diagnosis of multiple bile duct hamartomas (von Meyenburg complexes) was indicated after ultrasound-guided liver biopsy. Magnetic resonance imaging aided greatly in confirming the diagnosis of von Meyenburg complexes, thereby avoiding laparotomy and open liver biopsy.