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Knight J, Kamaya A, Fetzer D, Dahiya N, Gabriel H, Rodgers SK, Tublin M, Walsh A, Bingham D, Middleton W, Fung C. Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines. Abdom Radiol (NY) 2024:10.1007/s00261-024-04197-9. [PMID: 38411693 DOI: 10.1007/s00261-024-04197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10-14 mm 'extremely low risk' or '7-14 mm' low risk polyps that decrease in size by ≥ 4 mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone.
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Affiliation(s)
- Jessica Knight
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - David Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Scottsdale, Phoenix, AZ, 85259, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Andrew Walsh
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - David Bingham
- Department of Pathology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
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Bromfield B, Tellez R, Hughes DL, Brown R, Andrzejewski M, Bawa A, Lin FP, Tublin M, Triulzi D, Ganoza A, Duarte-Rojo A. TEG-based transfusion protocol is associated with decreased blood product use without increased risk of hemoperitoneum. Hepatol Commun 2023; 7:e0292. [PMID: 37889553 PMCID: PMC10615392 DOI: 10.1097/hc9.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/14/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Thromboelastography (TEG) informs the need for blood product transfusions to prevent procedural bleeding complications in patients with cirrhosis. We aimed to evaluate the impact of using a TEG-based transfusion protocol on blood product utilization before paracentesis and the post-paracentesis hemoperitoneum (PPH) incidence. METHODS We conducted an ambispective analysis of patients with cirrhosis who underwent paracentesis from 2017 to 2021. In May 2019, we enacted a TEG-based transfusion protocol to guide pre-paracentesis blood product use. Patients with platelets < 20,000 or international normalized ratio ≥ 4 underwent TEG and received blood products if r value > 10 min or MA <30 mm. Patients were divided into pre-TEG and post-TEG protocol cohorts based on the date of paracentesis. Pre-paracentesis blood product transfusions in the form of platelets, fresh frozen plasma, and cryoprecipitates were recorded. PPH was defined as a decrease in hemoglobin of ≥1 g and the presence of blood on diagnostic imaging and/or the need for therapeutic intervention. RESULTS A total of 483 patients underwent 1281 paracenteses. The main etiologies of cirrhosis were alcohol (43%) and NASH (25%), and the mean MELD-sodium was 22±6. Pre-TEG and post-TEG protocol cohort sizes were similar: 253 patients and 607 paracenteses versus 230 patients and 674 paracenteses. After TEG-protocol implementation, blood product transfusions decreased significantly (228 vs. 49 products, p<0.001) with associated cost savings. One patient in each cohort developed PPH. CONCLUSION Implementation of a pre-paracentesis TEG-based transfusion protocol for patients with cirrhosis successfully resulted in decreased blood product use with no associated increase in incidence of PPH.
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Affiliation(s)
- Brittany Bromfield
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roberto Tellez
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dempsey L. Hughes
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Rebecca Brown
- University of Pittsburgh School of Medicine, Pennsylvania, USA
| | - Margaret Andrzejewski
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aditi Bawa
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fei-Pi Lin
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darrell Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Armando Ganoza
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
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Ramonell KM, Ohori NP, Liu JB, McCoy KL, Furlan A, Tublin M, Carty SE, Yip L. Changes in thyroid nodule cytology rates after institutional implementation of the Thyroid Imaging Reporting and Data System. Surgery 2023; 173:232-238. [PMID: 36244809 DOI: 10.1016/j.surg.2022.06.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/18/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System for ultrasound classification of malignancy risk was developed to better triage thyroid nodules for fine-needle aspiration biopsy. To examine further, we compared thyroid cytologic classification rates in nodules before and after institutional Thyroid Imaging Reporting and Data System implementation. METHODS Cytology diagnoses by Bethesda criteria (categories I-VI) from January 2014 to October 2021 were retrieved; observed changes in yearly category frequency were analyzed by linear regression; and pooled cohorts of pre- (2014-2018) and post-Thyroid Imaging Reporting and Data System (2019-2021) cytology call rates were compared. RESULTS Overall, 7,413 cytologic specimens were included (range/year 715-1,444). From 2014 to 2021, the proportion of benign (Bethesda category II) diagnosis per year declined stepwise from 49.7% to 19.4%, and atypia of undetermined significance/follicular lesion of undetermined significance (Bethesda category III) increased sequentially from 21.3% to 51.5%. Between 2014 and 2021, Bethesda category III diagnosis increased on average by 4.8% per year (95% confidence internal, 3.29-5.54; P < .001) and Bethesda category II results decreased on average by 4.4% per year (95% confidence interval, 6.29-3.42; P < .001). When comparing pre- and post-Thyroid Imaging Reporting and Data System, the proportion of Bethesda category II cytology results decreased (43.1% vs 21%; P = .001) while Bethesda category III (28.3% vs 47.7%; P = .002) and Bethesda category V (1.1% vs 1.7%; P = .015) results increased. CONCLUSION After implementation of American College of Radiology Thyroid Imaging Reporting and Data System ultrasound criteria, we observed a 2.5-fold decline in the rate of benign cytology and an increase in the proportion of atypia of undetermined significance/follicular lesion of undetermined significance results.
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Affiliation(s)
- Kimberly M Ramonell
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Jason B Liu
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Kelly L McCoy
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Sally E Carty
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Linwah Yip
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
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Tublin J, Lindquester W, Dhangana R, Tublin M. Abstract No. 228 Trends toward the use of image guidance for paracentesis and thoracentesis in Medicare enrollees from 2012 to 2018. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cannella R, Borhani AA, Tublin M, Behari J, Furlan A. Diagnostic value of MR-based texture analysis for the assessment of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Abdom Radiol (NY) 2019; 44:1816-1824. [PMID: 30788556 DOI: 10.1007/s00261-019-01931-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the performance of MR-based texture analysis (TA) for the assessment of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS Fifty-four adult patients (33 females, 21 males, mean age 49.8 ± 13.5 years) with biopsy-proven NAFLD were enrolled and underwent MR imaging on a 1.5 T system. TA parameters were extracted on axial noncontrast 3D-GRE T1W images (slice thickness = 4.6 mm) using a commercially available research software (TexRAD). Receiver operating curves (ROC), areas under the ROC (AUROC) and 95% confidence intervals (CI) were calculated to assess the accuracy of each TA parameter for the diagnosis of significant (F ≥ 2) and advanced fibrosis (F ≥ 3). The correlation between TA and histopathological features of nonalcoholic steatohepatitis (NASH) was tested calculating the Spearman's rank correlation coefficient (ρ). RESULTS Thirty-seven (68%) subjects had significant fibrosis and 20 (37%) had advanced fibrosis. The TA parameters with the best performance were standard deviation (SD) and entropy, respectively, with AUROC 0.755 (95% CI 0.619-0.862, p ≤ 0.0002) and 0.769 (95% CI 0.634-0.873, p < 0.0001) for significant fibrosis and AUROC 0.746 (95% CI 0.609-0.854, p ≤ 0.0004) and 0.754 (95% CI 0.618-0.861, p ≤ 0.0002) for advanced fibrosis. SD and entropy demonstrated a moderate correlation with the degree of fibrosis (ρ = 0.457 and 0.480; p < 0.01). No significant correlation was found between TA parameters and other histopathological features of NASH. CONCLUSIONS Entropy and SD extracted on T1-weighted MR images have fair accuracy for the diagnosis of significant and advanced hepatic fibrosis in patients with NAFLD.
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Affiliation(s)
- Roberto Cannella
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Section of Radiology - Di.Bi.Med, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Amir A Borhani
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Jaideep Behari
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Rangaswamy B, Minervini M, Tublin M, Sholosh B, Dasyam AK. Imaging and Pathologic findings of Hepatic Small Vessel Hemangioma. Curr Probl Diagn Radiol 2018; 48:626-628. [PMID: 29576414 DOI: 10.1067/j.cpradiol.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/22/2022]
Abstract
Hepatic small vessel hemangioma represents a distinct yet very rare pathologic entity of the liver. The entity has also been in the past referred to as adult capillary hemangioma of the liver and congenital noninvoluting hemangioma. Imaging findings are not definitive and biopsy or resection is ultimately necessary. Pathologically these represent vasoformative abnormalities with infiltrative margins that can potentially mimic hepatic angiosarcoma. Immunohistochemistry can help differentiate hepatic small vessel hemangioma from angiosarcoma. Given the infiltrative growth pattern and unknown outcomes, resection and or close follow up has been recommended. Recently the term hepatic small vessel neoplasm has been coined in view of the unknown outcomes and some concerning findings on molecular analysis. We report 2 cases of this unusual entity and describe its imaging, gross pathologic, histopathologic, and immunohistochemical features.
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Affiliation(s)
| | - Marta Minervini
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mitchell Tublin
- Department of Radiology University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Biatta Sholosh
- Department of Radiology University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Anil K Dasyam
- Department of Radiology University of Pittsburgh Medical Center, Pittsburgh, PA.
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Tublin M. Richard L. Baron, MD, President, Radiological Society of North America, 2016. Radiology 2015; 278:4-5. [PMID: 26690987 DOI: 10.1148/radiol.2015154046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Whiteside TL, Ferris RL, Szczepanski M, Tublin M, Kiss J, Johnson R, Johnson JT. Dendritic cell-based autologous tumor vaccines for head and neck squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E494-501. [PMID: 25735641 DOI: 10.1002/hed.24025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND An autologous vaccine of apoptotic tumor cells (ATCs) and dendritic cells (DCs) was administered to patients with stage III/IV head and neck squamous cell carcinoma (HNSCC) to study safety and feasibility. METHODS Autologous DCs were generated from monocytes, loaded with ATCs, and delivered intranodally. Delayed-type hypersensitivity (DTH) and immunological endpoints were measured prevaccination and postvaccination. Clinical follow-up was required. RESULTS Tumors obtained from 30 patients yielded 2 × 10(6) to 2 × 10(8) tumor cells. Only 19 of 30 (63%) were sterile. Ten of 30 patients (33%) had ≥1 × 10(7) sterile tumor cells required for vaccine production. Eight of 10 patients had positive recall DTH. Five of 10 patients were leukapheresed to generate DCs. Four of 5 patients were vaccinated. ATC-reactive T cells were detected in 3 of 4 patients. All 4 patients survived >5 years. The trial failed to enroll the projected 12 patients and was terminated. CONCLUSION This vaccine was safe and immunogenic but feasible only in patients with HNSCC with positive prevaccine DTH and ≥1 × 10(7) sterile tumor cells. All vaccinated patients were long-term disease-free survivors. © 2015 Wiley Periodicals, Inc. Head Neck 38: E494-E501, 2016.
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Affiliation(s)
- Theresa L Whiteside
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Cancer Institute Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Cancer Institute Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Miroslaw Szczepanski
- University of Pittsburgh Cancer Institute Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph Kiss
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Cancer Institute Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Rita Johnson
- University of Pittsburgh Cancer Institute Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Cancer Institute Hillman Cancer Center, Pittsburgh, Pennsylvania
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Abstract
OBJECTIVES Paragangliomas are neuroendocrine tumors derived from extra-adrenal paraganglionic cells of the autonomic nervous system. Paragangliomas of the thyroid are rare, with only 28 cases reported in the literature. The sclerosing paraganglioma variant, characterized by marked stromal sclerosis and hyalinization, has scarcely been reported. METHODS A 36-year-old woman with a history of a 1-cm vagal schwannoma followed with serial magnetic resonance imaging presented with a new solitary 2.5-cm enhancing soft tissue mass in the left thyroid. RESULTS Ultrasound examination of the thyroid revealed a hypoechoic, hypervascular, malignant-appearing mass. Two fine-needle aspirations were insufficient for diagnosis, and the mass was deemed a lesion of undetermined significance with subsequent indeterminate molecular testing. A diagnostic left thyroid lobectomy was performed, and pathologic examination revealed a lesion consistent with a sclerosing paraganglioma. CONCLUSIONS Sclerosing paragangliomas are rare tumors, and only 1 case involving a primary thyroid mass has been reported in the literature. Although the sclerosing variant has features suggestive of malignancy, the true incidence of malignancy is unknown, given the rarity of its presentation. However, given the overall benign nature of paragangliomas, the sclerosing variant is also likely benign, despite its malignant features on ultrasound and histopathologic examination.
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Affiliation(s)
- John Evankovich
- Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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Wang JH, Furlan A, Kaya D, Goshima S, Tublin M, Bae KT. Pneumatosis intestinalis versus pseudo-pneumatosis: review of CT findings and differentiation. Insights Imaging 2010; 2:85-92. [PMID: 22347936 PMCID: PMC3259395 DOI: 10.1007/s13244-010-0055-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 11/18/2010] [Indexed: 12/18/2022] Open
Abstract
Pneumatosis intestinalis is defined as the presence of gas within the wall of the gastrointestinal tract. Originally described on plain abdominal radiographs, it is an imaging sign rather than a specific diagnosis and it is associated with both benign and life-threatening clinical conditions. The most common life-threatening cause of pneumatosis intestinalis is bowel ischaemia. Computed tomography (CT) is usually requested to detect underlying disease. The presence of pneumatosis intestinalis often leads physicians to make a diagnosis of serious disease. However, an erroneous diagnosis of pneumatosis intestinalis may be made (i.e. pseudo-pneumatosis) when intraluminal beads of gas are trapped within or between faeces and adjacent mucosal folds. The purpose of this pictorial essay is to review and describe the CT imaging findings of pneumatosis and pseudo-pneumatosis intestinalis and to discuss key discriminatory imaging features.
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Affiliation(s)
- Jin Hong Wang
- Department of Radiology, University of Pittsburgh School of Medicine, Presbyterian South Tower, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh School of Medicine, Presbyterian South Tower, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Diana Kaya
- Department of Radiology, University of Pittsburgh School of Medicine, Presbyterian South Tower, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Satoshi Goshima
- Department of Radiology, Gifu University School of Medicine, Yanagido, Gifu, 501-1193 Japan
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, Presbyterian South Tower, 200 Lothrop St, Pittsburgh, PA 15213 USA
| | - Kyongtae T. Bae
- Department of Radiology, University of Pittsburgh School of Medicine, Presbyterian South Tower, 200 Lothrop St, Pittsburgh, PA 15213 USA
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Abstract
Autoimmune pancreatitis (AIP) is a benign, IgG4-related, fibroinflammatory form of chronic pancreatitis that can mimic pancreatic ductal adenocarcinoma both clinically and radiographically. Laboratory studies typically demonstrate elevated serum IgG4 levels and imaging studies reveal a diffusely or focally enlarged pancreas with associated diffuse or focal narrowing of the pancreatic duct. The pathologic features include periductal lymphoplasmacytic inflammation, obliterative phlebitis, and abundant IgG4-positive plasma cells. The treatment of choice for AIP is steroid therapy. Diagnostic criteria for AIP have been proposed that incorporate histologic, radiographic, serologic, and clinical information.
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Affiliation(s)
- Alyssa M Krasinskas
- Department of Pathology, University of Pittsburgh, UPMC - Presbyterian, 200 Lothrop Street, A610, Pittsburgh, PA 15213, USA.
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Malek SK, Potdar S, Martin JA, Tublin M, Shapiro R, Fung JJ. Percutaneous Ultrasound-Guided Pancreas Allograft Biopsy: A Single-Center Experience. Transplant Proc 2005; 37:4436-7. [PMID: 16387139 DOI: 10.1016/j.transproceed.2005.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Indexed: 11/16/2022]
Abstract
Percutaneous ultrasound-guided pancreas allograft biopsy is the preferred technique for evaluating pancreas allograft rejection. Experience from large centers has shown it to be safe and effective. We report our experience with 120 percutaneous allograft biopsies performed at a single center. Biopsy tissue was obtained in 54 patients. Thirty-three patients received simultaneous pancreas and kidney transplants, 14 received isolated pancreas transplants, and 7 received a pancreas transplant after kidney transplantation. Biopsies were performed by pancreas transplantation surgeons with the assistance of radiologists under ultrasound guidance using an Acuson XP 128/10 ultrasound machine. One hundred twenty allograft biopsies were performed in 54 patients. Twenty-seven (50%) patients underwent multiple biopsies. In 102 (85%) biopsies the specimens were adequate for examination. Eighteen (15%) biopsy samples had no pancreatic tissue and showed surrounding fat and small bowel. 1 (1.8%) patient bleeding developed that required transfusion of 3 units of packed red blood cells, but no surgical intervention was necessary. One (1.8%) patient had a pancreatic fistula, which healed with nonoperative management. Biochemical evidence of pancreatitis was noted in 5 (9.2%) patients, but none of these patients had clinical signs of pancreatitis. Percutaneous ultrasound-guided pancreas allograft biopsy is a safe procedure with a low complication rate and a high tissue yield for histopathologic examination.
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Affiliation(s)
- S K Malek
- Department of Transplant Surgery, Geisinger Medical Center, Danville, Pennsylvania 17822, USA.
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Affiliation(s)
- L Miroult
- Albany Medical College, New York 12208, USA
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