Vaginal arteriovenous malformation: MR imaging

Vaginal arteriovenous malformations (AVMs), although rare, can lead to life-threatening complications. We report the first case of a vaginal AVM whose diagnosis and follow-up were performed by magnetic resonance imaging (MRI). MRI findings of the AVM are the blood flow-related features within the tumor, such as the phase-shift artifact, paradoxical enhancement, and flow voids. Received: 10 October 1995/Accepted: 16 October 1995     

Perirenal fat necrosis secondary to hemorrhagic pancreatitis,mimicking retroperitoneal liposarcoma: CT manifestation

A case of resolving hemorrhagic pancreatitis resulting in massive left perirenal fat necrosis is reported. CT revealed a huge fat-containing mass that was thought to be retroperitoneal liposarcoma before operation. Pancreatitis with perirenal involvement is rarely encountered as a retroperitoneal mass. Received: 27 September 1995/Accepted: 25 October 1995     

Gastric sarcoidosis

Sarcoidosis of the gastrointestinal tract is uncommon even though involvement of the liver, spleen, and adenopathy are becoming recognizable entities on computed tomography (CT). Involvement of the stomach, the most common site of sarcoidosis of the gastrointestinal tract, is usually associated with pulmonary disease. The radiologic appearances of gastric involvement are variable. Positive biopsies may be obtained in a radiologically normal stomach. Ulceration resembling peptic ulcer disease may occur, and mucosal enlargement may be minor, diffusely nodular, or significant enough to mimic Menetrier disease. In its most dramatic form, a linitis plastica appearance resembling scirrhous carcinoma has been reported. Received: 10 October 1995/Accepted after revision: 31 January 1996     

Primary malignant lymphoma in the porta hepatis: a case report

A case of primary lymphoma in the porta hepatis is presented here. Cholangiography, angiography, ultrasonography and computed tomography suggested the presence of a mass in the porta hepatis, but all these failed to demonstrate the tumor clearly. Magnetic resonance imaging was very useful in defining the characteristics of the tumor and in delineating its extent, though it was not specifically diagnostic. Received: 28 March 1995/Accepted: 4 May 1995     

Crohn disease: CT findings after treatment

Within a period of 5 years, we followed by computed tomography (CT) three patients with Crohn disease who were undergoing treatment. From the spectrum of disease abnormalities, some subsided and others remained. Bowel wall thickening was the most common pretreatment CT finding but was somewhat altered after treatment. Received: 10 October 1995/Accepted after revision: 3 January 1996     

Carcinosarcoma of the extrahepatic bile ducts: cholangiographic and CT appearance

A case of histologically proven carcinosarcoma arising in the extrahepatic biliary tree is presented. The tumor appeared on cholangiography and computed tomography as a large expansile intraluminal mass causing biliary obstruction. Received: 19 May 1995/Accepted: 24 June 1995     

Percutaneous decompression of an iliopsoas hematoma

Spontaneous hematoma in the iliopsoas muscle is a serious complication of anticoagulant therapy. It causes severe pain and often results in loss of function of the femoral nerve. We present two cases in which percutaneous decompression of the hematoma was successfully performed to relieve intractable pain and to support functional restoration of the femoral nerve. Received: 30 August 1995/Accepted: 20 September 1995     

Bowel herniation through the torn diaphragm: II. Intestinal herniation

Five cases of intestinal herniation through the torn diaphragm are presented. Plain radiography, single-contrast examination, and ultrasonography show some simple features that either have not been previously published or need restatement. Some pitfalls that still delay diagnosis are also shown. Received: 28 March 1995/Accepted: 4 May 1995     

Mycotic aneurysm of the abdominal aorta:CT findings in three patients

We present three cases of mycotic aneurysms of the abdominal aorta that were initially diagnosed with computed tomography (CT). The accuracy of CT as the first imaging technique in the diagnosis of this condition is reviewed in light of our results and those reported in the literature. Received: 7 November 1995/Accepted: 6 December 1995     

A new criterion in differentiation of pancreatitis and pancreatic carcinoma: artery-to-vein ratio using the superior mesenteric vessels

Evaluation of infiltration of the superior mesenteric vein (SMV) and artery (SMA) fat planes has been considered in differentiating pancreatic carcinoma from pancreatitis. Some pancreatitis cases, however, can cause perivascular fat plane obliteration due to extension of the inflammatory process, mimicking appearances of carcinoma. This study investigated the diameters of SMV and SMA on CT scans, just caudal to the origin of SMA and portal confluens, in 68 pancreatitis and in 48 pancreatic carcinoma patients. SMA-to-SMV diameters (A/V diameter) were compared and ratios were obtained. In conclusion, it appears that when the A/V ratio is over 1.0, a malignant condition can be suspected. This may be used as a secondary criterion in the differential diagnosis of pancreatitis and pancreatic carcinoma. Received: 11 January 1995/Accepted after revision: 31 March 1995     

Venous return by the paraumbilical and hepatic veins in case of superior vena cava obstruction

Pseudolesion in segment IV of the liver is a well-known diagnostic pitfall during arterial portography or even spiral computed tomography (CT) of the liver. It has suggested that this pseudolesion is the result of an abnormality in subsegmental perfusion. We report a case of an early dense contrast enhancement of segment IV of the liver by epigastric and paraumbilical veins in a patient with a superior vena cava obstruction. A pseudolesion in segment IV was observed in this patient on a spiral CT of the liver obtained during the portal phase. Received: 31 May 1995/Accepted: 6 July 1995     

Malignant fibrous histocytoma of the inferior vena cava: appearances on contrast-enhanced spiral CT and MRI

Primary malignant tumors of the inferior vena cava are infrequent. We report a very rare case of primary malignant fibrous histiocytoma of the inferior vena cava and describe the contrast-enhanced spiral computed tomographic and magnetic resonance imaging findings. Received: 16 March 1995/Accepted: 23 April 1995     

Arterial embolization to control renal hemorrhage in patients with percutaneous nephrostomy

Two patients with renal hemorrhage treated by arterial embolization are reported. In one patient, one kidney was injured and the another had poor function. The other patient had one kidney. Although both patients had hematuria and underwent percutaneous nephrostomy, the bleeding location was not detected angiographically. Repeated embolization and irrigations through a nephrostomy catheter following each embolization arrested the bleeding. Received: 28 April 1995/Accepted: 2 June 1995     

Primary biliary tract malignant melanoma

Primary melanoma is rarely diagnosed in the biliary tract; only three cases of primary melanoma of the bile ducts have been reported previously. The skin and squamous mucous membranes are the most common primary sites. We report two patients who represent the fourth and fifth reported cases of primary bile duct melanoma. Received: 24 March 1995/Accepted: 3 May 1995     

Computed tomographic appearance of sigmoid volvulus

The computed tomographic (CT) appearance of two cases of sigmoid colon volvulus is described. Both underwent plain abdominal radiographs, contrast enema, and CT. The findings of sigmoid volvulus at CT were characteristic, having a whirl pattern of the dilated sigmoid loop around mesocolon and vessels and a bird-beak aspect of the afferent and efferent segments. CT may be valuable in a case of unusual clinical or plain film presentation as an alternative to contrast enema. Received: 24 March 1995/Accepted: 3 May 1995     

Insulinoma: correlation of short-TI inversion-recovery (STIR) imaging and histopathologic findings

We studied the value of short-TI inversion-recovery (STIR) imaging for the localization of pancreatic insulinoma. Four patients (three women and one man aged 35–65 years) with surgically proven insulinoma were included in this study. All patients were examined by MR imaging with spin echo (SE) and STIR sequences. The STIR images were compared with the histopathologic findings in each case. In two patients, the tumors were markedly hyperintense on STIR images, and a 5-mm insulinoma was depicted only by this imaging method in one of the two. In the other two patients, 10-mm insulinomas were only slightly hyperintense on STIR images. The latter tumors had a higher content of collagen fibers than the former, indicating that the amount of collagen influences the signal intensity of insulinoma. Despite some limitations, STIR imaging is a useful noninvasive method for the localization of pancreatic insulinoma. Received: 11 October 1994/Accepted after revision: 10 April 1995     

MRI of round ligament leiomyoma associated with Mayer-Rokitansky-Kuster-Hauser syndrome

We report the magnetic resonance appearance of a case of round ligament leiomyoma that presented as a rapid growing inguinal mass in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome. Received: 15 September 1997/Accepted: 20 October 1997     

Vaginal opacification during defecography: utility of placing a folded gauze square at the introitus

We evaluated the value of placement of a folded gauze square into the urogenital introitus to improve vaginal opacification in 90 patients who underwent defecography. Of the 50 patients who retained the gauze in the introitus, 96% demonstrated excellent or good vaginal opacification. By contrast, only 75% of the 40 patients who lost the gauze during the study were able to achieve the same level of opacification. This difference was shown to be statistically significant (p < 0.002), suggesting that placement of a folded gauze square in the introitus limits loss of contrast from the vagina, which improves vaginal opacification. Received: 12 October 1998/Revision accepted: 27 January 1999     

Intrarenal varices in portal hypertension: demonstration by color Doppler imaging

The gray-scale ultrasonographic appearances of dilated intrarenal vascular structures may mimic peripelvic cysts or hydronephrosis. We report a patient with portal hypertension in whom color Doppler ultrasound was found to be a very practical imaging technique in demonstrating varices of the renal segmental veins. Received: 14 November 1995/Accepted: 22 December 1995     

Demonstration of false-negative findings on CT hepatic angiography

False-negative findings on CT angiography (CTA) in two patients with hepatocellular carcinoma (HCC) were demonstrated. CTA images of one patient with an aberrant left hepatic artery branching from the left gastric artery and another patient whose right hepatic artery was occluded owing to an unknown cause failed to demonstrate HCCs. This report suggests one of the diagnostic pitfalls of CTA for diagnosis of liver tumors. Received: 1 August 1995/Accepted: 12 September 1995