Adventitial cystic disease of the popliteal artery communicating with the knee joint. A case report

We describe the case of a patient with adventitial cystic disease of the popliteal artery in which a direct anatomic communication between the cysts and the nearby knee joint was demonstrated by magnetic resonance imaging and confirmed by surgery. This unusual observation could shed some light on the much debated question of the cause, the pathogenesis, and the management of the affection. Moreover, it emphasizes the importance and the role of magnetic resonance imaging in the diagnosis of adventitial cystic disease of the popliteal artery.

Magnetic resonance cholangiopancreatography: interest of IV secretin administration in the evaluation of pancreatic ducts

The aim of this study was to investigate whether IV secretin administration is useful to enhance the delineation of the main pancreatic duct (MPD) and its side branches, and if it provides additional information concerning signal voids and strictures. Twenty-seven patients referred for abdominal pain or laboratory abnormalities (group 1, n = 13) or for the follow-up of chronic pancreatitis (CP; group 2, n = 14) were studied. Magnetic resonance cholangiopancreatography was acquired at 1.5 T before and after IV secretin by a coronal 3D TSE T2-weighted sequence with maximum intensity projection postprocessing. In group 1 secretin provided a better visualization of MPD in 9 patients. In a patient with pancreas divisum, it allowed suggestion of stenosis of the accessory papilla, confirmed at endoscopic retrograde cholangiopancreatography (ERCP). In group 2 secretin provided a better visualization of MPD only in the 3 patients with mild disease. A mild dilation upstream a stricture occurred in 2 cases and a marked dilation appeared upstream a wallstent which was non-patent at ERCP. Few changes were noticed concerning side branches. These preliminary results indicate that in patients without CP, secretin improves MPD delineation avoiding invasive diagnostic ERCP. In patients with mild CP secretin does not improve the characterization of signal voids, but it may be useful to appreciate their significance and to follow-up stenosis.

Magnetic resonance cholangiopancreatography (MRCP): a perspective on potential clinical applications

The recent development of MRCP allowed the recognition of the potential role of Magnetic Resonance (MR) in pancreatobiliary imaging. The increasing interest on MRCP relies on its non invasiveness (there is no need for contrast media administration) and on the projectional display of the biliary and pancreatic ducts in a way similar to endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). In addition, it offers the opportunity for dynamic analysis of biliopancreatic ducts which is useful in the assessment of subtle ductal alterations. The future of this attractive technique will depend on the demonstration of its diagnostic accuracy and on its availability. This article discusses the potential role of MRCP in the evaluation of biliary tract and pancreatic duct diseases.

Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation

PURPOSE

To assess the utility of dynamic MR pancreatography in the evaluation of the behavior of the pancreatic duct after secretin stimulation and to estimate pancreatic exocrine reserve in patients suspected of having acute recurrent or chronic pancreatitis.

MATERIALS AND METHODS

Ten healthy volunteers and 13 patients suspected of having pancreatic disease and no obvious markers of chronic pancreatitis were studied. Single-shot turbo spin-echo T2-weighted dynamic MR pancreatograms were obtained before and every 30 seconds during the 10 minutes after secretin administration. Morphologic features and diameter of the pancreatic duct were monitored before and during secretin stimulation. Duodenal filling volume was graded. Results were compared with those of endoscopic retrograde cholangiopancreatography and secretin stimulation testing with collection of pancreatic fluid.

RESULTS

Secretin improved the delineation of ductal morphologic features in both groups. Persistent dilatation of the pancreatic duct after stimulation (five patients) was a significant finding (P = .0015) in the diagnosis of papillary stenosis. The mean duodenal filling score was significantly lower in patients with reduced exocrine function (six patients) than that in the volunteers (P < .0001).

CONCLUSION

The use of dynamic MR pancreatography with secretin stimulation may be useful for diagnosing pancreatic papillary stenosis or dysfunction and for detecting reduced pancreatic exocrine reserve.

Splenic parenchymal complications of pancreatitis: CT findings and natural history

PURPOSE

Splenic parenchymal complications of pancreatitis are unusual and potentially life threatening. They usually require splenectomy in patients in poor condition. The present study describes natural history of splenic parenchymal complications and the role of CT scan in diagnosis and follow-up.

METHOD

A retrospective study of 16 consecutive patients with splenic complications diagnosed by CT during staging of pancreatitis was performed. The presence and importance of splenic infarct, abscess, subcapsular collection, and hemoperitoneum were correlated with the patients' symptoms, type of management, and follow-up.

RESULTS

No specific symptomatology was observed except in two cases of acute and massive hemoperitoneum. Fourteen infarcts, 11 subcapsular collections, 1 abscess, and 3 hemoperitoneums were observed. Four patients underwent splenectomy including two as an emergency for hemodynamic instability. Twelve patients were conservatively and successfully managed.

CONCLUSION

Most splenic parenchymal complications of pancreatitis regress spontaneously and may be managed conservatively. Surgical indication is based mainly on clinical findings. CT is useful for detection and follow-up of these complications.

Delayed enhancement of the bowel wall: a new CT sign of small bowel strangulation

PURPOSE

To report a new CT sign of small bowel strangulation.

MATERIALS AND METHODS

Two cases of small bowel obstruction evaluated by spiral CT with intravenous contrast injection.

RESULTS

In both cases we observed an absence of parietal enhancement of the diseased bowel loop, visible on early scans only. This feature was accompanied by signs of bowel obstruction. The two patients had a segment of necrotic ileum resected.

CONCLUSION

Delayed enhancement of a bowel loop in cases of small bowel obstruction should suggest the diagnosis of strangulation and lead to rapid surgical treatment.

Case report: Renal pseudotumours mimicking tumour recurrence after partial nephrectomy

Partial nephrectomy and tumour enucleation are increasingly accepted as an organ sparing approach for small renal cell carcinomas. Repeated computed tomography or sonography for the early detection of tumour recurrence are mandatory during the follow-up. We report two cases of renal pseudotumour mimicking a tumour recurrence: one case is related to the pseudotumoral appearance on sonography of a tumour defect filled by a fatty flap, and the other to the relative migration of an accessory spleen into the site of the cuneiform nephrectomy. The recognition of renal pseudotumours following partial nephrectomy prevents confusion with tumour recurrence on follow-up examinations.