Splenic lymphoma: differentiation from splenic cyst with ultrasonography

Background and Methods: Lymphoma can be nearly anechoic and mimic a cyst on ultrasonography (US). To investigate whether this phenomenon occurs at the level of the spleen, we analyzed the US findings of 38 cases of splenic lymphoma and 16 cases of splenic cyst. Results: (1) With regard to shape, echogenicity of the lesion, and mode of posterior echo, there was no difference between splenic lymphomas and splenic cysts. However, the boundaries of the lesions were indistinct in splenic lymphomas and distinct in splenic cysts. (2) Blood flow signals and vascular penetration were seen exclusively in splenic lymphomas. Conclusion: The mode of boundary echo (distinct or indistinct) distinguishes splenic lymphomas from splenic cysts. Color Doppler US increases the diagnostic confidence of US. Received: 25 September 2000/Revision accepted: 27 December 2000     

MR imaging of primary uterine lymphoma

Primary malignant lymphoma of the uterus is a rare disease. We present the MR findings in three cases where the uterus was the initial site. MR findings were retrospectively evaluated. Although the intact junctional zone is a specific finding for lymphoma, diffuse enlargement of the uterus and relatively homogeneous signal intensity on MR imaging in spite of large tumor size are helpful for diagnosing uterine lymphoma. Received: 14 March 1996/Accepted: 22 March 1996     

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     

Cirrhosis: spectrum of findings on unenhanced and dynamic gadolinium-enhanced MR imaging

The appearance of the cirrhotic liver on computed tomography can be difficult to evaluate and can frustrate the radiologist distinguishing benign from malignant lesions. Hepatic edema, fibrosis, atrophy, and vascular abnormalities are common in the cirrhotic liver and produce derangements in morphology, attenuation, and perfusion, limiting the accurate characterization of hepatic masses. With the development of fast magnetic resonance (MR) sequences and dynamic postgadolinium-enhanced imaging, most hepatic lesions with uncertain etiology on computed tomography can be accurately characterized on MR imaging. We describe MR imaging techniques useful for imaging cirrhosis and its complications. We also illustrate the spectrum of findings in the cirrhotic liver on dynamic gadolinium-enhanced MR imaging, including reticular and confluent fibrosis, fatty infiltration, hemochromatosis, regenerating nodules, dysplastic nodules, hepatocellular carcinoma, and sequela of portal hypertension. Received: 16 November 2000/Revision accepted: 7 February 2001     

Primary malignant fibrous histiocytoma of the liver: imaging features of five surgically confirmed cases

Background: The purpose of the present study was to describe the various imaging features of primary malignant fibrous histiocytoma (MFH) of the liver, a rare tumor of mesenchymal origin. Methods: Sonography (n= 5), computed tomography (CT; n= 5), magnetic resonance (MR) imaging (n= 2), and hepatic arteriography (n= 3) in five patients who underwent partial hepatectomy for tumor resection were retrospectively reviewed and correlated with pathologic findings. Results: All tumors were clearly demarcated from surrounding hepatic parenchyma in sectional imaging with (n= 2) or without (n= 3) a fibrous capsule, which was pathologically verified. Internal architecture of abundant fibrosis, myxoid degeneration, and/or hemorrhagic necrosis reflected the sonographic, CT and MR imaging findings. Marginal tumor staining without definite tumor vasculature was the main feature of hepatic arteriography. There was no intratumoral calcification. All three tumors involving the right lobe of the liver invaded the right hemidiaphragm. Conclusion: Although there were no unique findings of primary hepatic MFH, a combined interpretation of various imaging modalities may elucidate the malignant nature of the tumor. Received: 20 May 1998/Accepted after revision: 1 July 1998     

Presacral epidermoid cyst: imaging findings with histopathologic correlation

Background: The aim of this study was to determine the imaging characteristics of presacral epidermoid cysts and correlate the imaging findings with the histopathologic findings. Methods: We retrospectively reviewed sonographic, computed tomographic, and magnetic resonance examinations in four consecutive patients with a pathologically proven presacral epidermoid cyst. Imaging findings of the presacral epidermoid cyst were correlated with the histopathologic findings. Results: In all four patients, sonography showed a presacral mass with a heterogeneous low echogenicity, and computed tomography showed a discrete well-defined hypodense presacral mass with a thin wall. In the three patients who underwent magnetic resonance imaging, the mass showed a heterogeneous low signal intensity on the T1-weighted image and a high signal intensity with multiple small foci of low signal intensity in the nondependent portion of the mass on the T2-weighted image. These imaging findings correlated well with the pathologic results. Aggregates of keratinous material contributed to these imaging findings. Conclusion: In the diagnosis of the presacral epidermoid cyst, sonographic and magnetic resonance imaging findings may be helpful. Received: 16 May 2000/Accepted: 14 June 2000     

Gastric volvulus associated with congenital diaphragmatic hernia, wandering spleen, and intrathoracic left kidney: CT findings

We present an unusual case of gastric volvulus associated with wandering spleen, a delayed manifestation of congenital diaphragmatic hernia and left intrathoracic kidney. Gastric volvulus should be considered in any infant with unexplained vomiting and left diaphragmatic anomaly: in these patients, developmental disorders of the peritoneal visceral attachments of the left upper abdomen may coexist. The absence of ligamentous connections between the stomach, posterior abdominal wall, and spleen result in wandering spleen. We emphasize prompt surgical therapy to avoid gastric and splenic necrosis. Radiologic findings and the appearance of this complex congenital malformation are reported. Received: 18 August 2000/Accepted: 20 September 2000     

Neoplasms containing normal hepatic vessels: imaging features

Background: We investigated the incidence and imaging features of hepatic neoplasms containing normal hepatic vessels. Methods: Among 3183 patients with various hepatic neoplasms, we found nine patients with normal hepatic vessels traversing hepatic neoplasms. The presence of mass effect on the vessel traversing hepatic neoplasms was evaluated. Other suggestive findings of neoplasms such as altered hepatic contour, portal vein thrombosis, mass effect on extratumoral vessel, and bile duct dilatation were analyzed. Results: Thirteen hepatic vessels (nine hepatic veins and four portal veins) extended through hepatic neoplasms in nine patients. Undisturbed hepatic vessels within the neoplasms were found in five patients with either primary or metastatic hepatic neoplasm. In one patient with undisturbed hepatic vessels within the neoplasm, there were no associated abnormal findings such as biliary dilatation, change of hepatic contour, or any changes involving the vessels external to neoplasms. Conclusion: Although rare, various primary and secondary hepatic neoplasms can have normal hepatic vessels passing through them without mass effect. However, correct diagnosis in most neoplasms would be possible with careful examination of associated findings. RID=" ID=" <E5>Correspondence to:</E5> J. K. Han Received: 2 February 2000/Accepted: 5 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     

Primary small bowel tumors: a radiologic-pathologic correlation

Background: Primary small bowel tumors are rare and their preoperative diagnosis is unsatisfactory. The cornerstone of diagnosis remains contrast radiography. The present study was done to evaluate the radiologic findings of primary small bowel tumors as shown on enteroclysis and to correlate these observations with surgical and histopathologic findings. Methods: Seventy two patients with primary small bowel tumors identified by enteroclysis were evaluated. All the patients were subjected to jejunal biopsy or surgery. The diagnosis was established by histopathologic examination in all cases. Results: Radiologic findings were suggestive of benign tumors in 19 patients and malignant tumors in 31 patients. Nonspecific findings in the form of diffuse involvement of the small bowel were noted in 22 patients. There was 100% radiologic–surgical correlation. Leiomyomas and lymphomas were the most common benign and malignant tumors, respectively. Tumor specificities were 89.5% for benign tumors and 41.5% for malignant tumors. Conclusion: Distinctive morphologic patterns as shown on enteroclysis are highly suggestive of specific tumor types in the majority of cases. Received: 25 April 2000/Revision accepted: 20 September 2000     

Sinusoidal spread of liver metastases from renal cell carcinoma: simulation of diffuse liver disease on MR imaging

Rarely, hepatic metastases can simulate hepatic infiltrative diseases. We present a case of a patient with advanced metastatic renal cell carcinoma who developed hepatomegaly and clinical signs of hepatocellular injury. On magnetic resonance imaging, the injury simulated a diffuse process, e.g., acute fulminant viral or chemical hepatitis or drug toxicity. Despite its high resolution, magnetic resonance imaging might not depict focal lesions in patients with extensive metastases. In correlation with clinical history, malignant disease should be considered when diffusely abnormal hepatic signal intensity is noted. Received: 2 April 2001/Revision accepted: 21 April 2001     

Hepatic iron deposition on MR imaging in patients with chronic liver disease: correlation with serial serum ferritin concentration

Background: To evaluate the relationship between magnetic resonance (MR) imaging grading of iron deposition and serial serum ferritin concentration in patients with chronic viral liver diseases. Methods: In 80 patients with viral hepatitis and cirrhosis, MR images including T2*-weighted gradient echo images (echo time ≥ 6.5 ms) were reviewed. The grades of parenchymal iron deposition and iron-containing nodules in the liver and spleen and the liver-to-muscle and spleen-to-muscle signal intensity ratios were compared with the most recent, the mean, the lowest, and the highest values from all available serum ferritin levels. Results: The serum ferritin concentration was significantly correlated with the grades of iron deposition in liver and spleen and with the grades of iron-containing nodules seen on MR images (p < 0.05). Liver-to-muscle signal intensity ratio was weakly correlated with the ferritin concentrations. Among categories of ferritin concentration, correlation with MR grades was highest for mean ferritin concentration (r = 0.487, p < 0.001). Conclusion: MR imaging grades of hepatic iron and siderotic nodules correlate with serum ferritin, especially with the mean levels. Received: 9 May 2000/Accepted: 28 June 2000     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001     

Icteric-type hepatoma: magnetic resonance imaging and magnetic resonance cholangiographic features

Background: We evaluated the imaging features of magnetic resonance imaging (MRI) and magnetic resonance cholangiography (MRC) of icteric-type hepatoma and correlated these with the findings of endoscopic retrograde cholangiography (ERC), percutaneous cholangiography, and surgery. Methods: Thirteen patients with viral hepatitis complicated by cirrhosis of the liver and obstructive jaundice underwent MRC and dynamic MRI. Five patients received percutaneous transhepatic cholangiography and drainage; one of these patients also underwent resection of the left hepatic lobe. Another patient received MRC followed by thrombectomy and T-tube insertion. ERC and endoscopic nasobiliary drainage were performed in another patient for bile diversion. Results: Primary liver tumors and dilatation of biliary system were demonstrated in all patients. No capsule formation could be found in any primary liver tumors. MRI showed the simultaneous presence of an intraluminal tumor in the portal trunk and common hepatic duct in eight patients. Three different MRC features were found: (a) an oval defect in the hilar bile duct(s) with dilated intrahepatic ducts (n= 9), (b) dilated intrahepatic ducts with missing major bile ducts (n= 2), and (c) localized stricture of the hilar bile duct(s) (n= 2). Conclusion: The presence of one or more of the following features in multiplanar MRI and MRC help to identify this rare, specific type of hepatocellular carcinoma: (a) the presence of an intraluminal tumor in both the portal trunk and the common hepatic duct, (b) enhancement of the intraluminal tumor in the common hepatic duct on the arterial phase, (c) type I MRC feature, and (d) hemobilia, blood clot within the gallbladder, and/or type II MRC feature. Received: 12 January 2000/Revision accepted: 12 July 2000     

Hyaline vascular-type Castleman disease: a rare cause of a hypervascular retroperitoneal mass

We present the cross-sectional imaging and angiographic findings of hyaline vascular-type Castleman disease located in the retroperitoneum. The diagnosis was made postoperatively. This entity can simulate a malignant neoplasm. The histologic subtypes and presentations of Castleman disease and the differential diagnosis of retroperitoneal masses are discussed. Received: 12 August 1999/Accepted: 8 September 1999     

Macronodular deformity of the spleen

Background and methods: Macronodular splenic deformity without a focal lesion has rarely been reported. We present three such cases and discuss the possible pathomechanism. Results: There was one case of macronodular deformity of unknown cause. In this case, the liver was elongated anteriorly over the dome of the spleen, and the markedly deformed spleen mimicked a round lesion in the left lobe of the liver. Color Doppler ultrasonography showed the major intra- and perisplenic vessels to be patent. There were two cases of macronodular deformity associated with extended portal thrombosis. In both cases, portal thrombosis extended throughout the intrahepatic and extrahepatic portal systems, and this portal flow disturbance was presumed to be the cause of the splenic deformity. Conclusion: Although very rare, thrombosis should be sought throughout the portal system when ultrasonography shows a markedly deformed spleen. Marked splenic deformity, especially in cases with an elongated liver, may mimic a liver tumor. A good understanding of its sonographic appearance may help sonographers prevent a hazardous misdiagnosis. Received: 7 August 2000/Accepted: 6 September 2000     

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     

EUS and ERCP features of nonalcoholic duct-destructive, mass-forming pancreatitis before and after treatment with prednisolone

Nonalcoholic, duct-destructive, mass-forming pancreatitis in a 28-year-old man was presented with endoscopic ultrasonographic (EUS) and endoscopic retrograde cholangiopancreatographic (ERCP) findings before and after corticoid therapy. Because this disease is often mistaken for a malignant tumor, EUS combined with ERCP may provide imaging characteristics useful for differentiation from malignant tumor, for early diagnosis, and for monitoring therapeutic effects. Received: 12 February 2001/Accepted: 21 March 2001     

Radiologically identifiable intratumoral portal vein in intrahepatic cholangiomas: a diagnostic pitfall

Background: Although intratumoral patent portal vein (ITPV) is one of the characteristic features of benign hepatic lesions, ITPVs can be demonstrated in malignant tumors. We present the spectrum of MR and CT findings of ITPV identified in intrahepatic cholangiomas with pathological correlations. Methods: The ultrasound, CT and/or MRI findings of pathologically-confirmed intrahepatic cholangiomas were reviewed and correlated with surgical specimen or autopsy findings. Results: Intratumoral patent vessels were radiographically-demonstrated in 5 patients with intrahepatic cholangiomas. All intratumoral vessels were secondary or tertiary order portal vein branches. Some wall thickening was identified on pathological examinations. Conclusion: The radiological demonstration of intratumoral portal vein is not a specific sign of benignity. In the case of a hepatic tumor with a patent portal tract, cholangioma should be considered, as well as benign tumors or lymphoma. Received: 28 February 1995/Accepted: 29 March 1995     

Sclerosed hemangioma of the liver

We report the radiologic findings of sclerosed hemangioma (SH), a rare variant of hepatic hemangioma. Dynamic contrast-enhanced computed tomography showed a hypodense mass in the liver with delayed enhancement. T2-weighted magnetic resonance imaging showed the mass as hypointense in relation to cerebrospinal fluid. The final diagnosis of SH was made pathologically. Although SH is rare, understanding its radiologic appearance is important to avoid unnecessary surgery and should be included in the differential diagnoses of hepatic lesion with delayed enhancement. Received: 22 May 2000/Revision accepted: 15 November 2000