Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute...Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.展开更多
Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahe...Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension(PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt(PSS) and revision of PSS.展开更多
Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary ...Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing management.These lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging techniques.Contrast enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver lesions.Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities.Classic imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent years.It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis.In this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.展开更多
We report a case of a 42-year-old male with symptomatic choledochocele and incidental pancreas divisum diagnosed with magnetic resonance cholangiopancreatography (MRCP). Small choledochocele is rare congenital malform...We report a case of a 42-year-old male with symptomatic choledochocele and incidental pancreas divisum diagnosed with magnetic resonance cholangiopancreatography (MRCP). Small choledochocele is rare congenital malformation associated with non-specific symptoms and a delay in diagnosis. The coexistence of choledochocele and pancreas divisum is extremely rare with only two case reports published in literature. In both cases MRCP failed to diagnose any biliary or pancreatic abnormality. This case suggests that the patients with recurrent abdominal pain and pancreas divisum should not be presumed to be suffering from pancreatitis. Careful evaluated for additional anomalies in the biliary tree should be sought for refractory symptoms. MRCP is a useful one-stop-shop for diagnosing pancreatic and biliary ductal anomalies.展开更多
The original 1992 Atlanta Classification Systemfor acute pancreatitis was revised in 2012 by the Atlanta Working Group,assisted by various national and international societies,through web-based consensus.This revised ...The original 1992 Atlanta Classification Systemfor acute pancreatitis was revised in 2012 by the Atlanta Working Group,assisted by various national and international societies,through web-based consensus.This revised classification identifies two phases of acute pancreatitis:early and late.Acute pancreatitis can be either oedematous interstitial pancreatitis or necrotizing pancreatitis.Severity of the disease is categorized into three levels:mild,moderately severe and severe,depending upon organ failure and local/systemic complications.According to the type of pancreatitis,collections are further divided into acute peripancreatic fluid collection,pseudocyst,acute necrotic collection,and walled-off necrosis.Insight into the revised terminology is essential for accurate communication of imaging findings.In this review article,we will summarize the updated nomenclature and illustrate corresponding imaging findings using examples.展开更多
The liver is the second most-often transplanted solid organ after the kidney,so it is clear that liver disease is a common and serious problem around the globe.With the advancements in surgical,oncological and imaging...The liver is the second most-often transplanted solid organ after the kidney,so it is clear that liver disease is a common and serious problem around the globe.With the advancements in surgical,oncological and imaging techniques,orthotopic liver transplantation has become the first-line treatment for many patients with end-stage liver disease.Ultrasound,and Doppler are the most economical and cost-effective imaging modalities for evaluating postoperative fluid collections and vascular complications.Computed tomography(CT)is used to confirm the findings of ultrasound and look for pulmonary complications.Magnetic resonance imaging(MRI)is used for the diagnosis of biliary complications,bile leaks and neurological complications.This article illustrates the imaging options for diagnosing the various complications that can be encountered in the postoperative period after liver transplantation.展开更多
A variety of chest manifestations are seen in patients with chronic liver diseases,namely hepatopulmonary syndrome,portopulmonary hypertension,intrathoracic portosystemic collaterals,hepatic hydrothorax,infections,dru...A variety of chest manifestations are seen in patients with chronic liver diseases,namely hepatopulmonary syndrome,portopulmonary hypertension,intrathoracic portosystemic collaterals,hepatic hydrothorax,infections,drug-induced changes,manifestations of hepatocellular carcinoma,gynecomastia,acute respiratory distress syndrome,autoimmune changes,aspiration pneumonitis and changes due to a1-antitrypsin deficiency.Gastroenterologists and radiologists should be aware of these entities;knowledge of the imaging findings specific to each condition is of prime importance for managing such patients.展开更多
We present a rare case of spontaneous trans-splenic shunt and intra-splenic collaterals in a patient with liver cirrhosis and portal hypertension.The shunt and presence of cirrhosis and portal hypertension was inciden...We present a rare case of spontaneous trans-splenic shunt and intra-splenic collaterals in a patient with liver cirrhosis and portal hypertension.The shunt and presence of cirrhosis and portal hypertension was incidentally detected by abdominal computed tomographic imaging during evaluation for abdominal pain.There has been a single report on the presence of trans-splenic shunt in two children with extra-hepatic portal venous obstruction but no cases that report intra-splenic collaterals:to the best of our knowledge,this is the first reported case of spontaneous trans-splenic shunt in the presence of intra-splenic collaterals and incidental multiple splenic artery aneurysms that developed in an adult with compensated cirrhosis and portal hypertension.展开更多
文摘Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.
文摘Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension(PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt(PSS) and revision of PSS.
文摘Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing management.These lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging techniques.Contrast enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver lesions.Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities.Classic imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent years.It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis.In this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.
文摘We report a case of a 42-year-old male with symptomatic choledochocele and incidental pancreas divisum diagnosed with magnetic resonance cholangiopancreatography (MRCP). Small choledochocele is rare congenital malformation associated with non-specific symptoms and a delay in diagnosis. The coexistence of choledochocele and pancreas divisum is extremely rare with only two case reports published in literature. In both cases MRCP failed to diagnose any biliary or pancreatic abnormality. This case suggests that the patients with recurrent abdominal pain and pancreas divisum should not be presumed to be suffering from pancreatitis. Careful evaluated for additional anomalies in the biliary tree should be sought for refractory symptoms. MRCP is a useful one-stop-shop for diagnosing pancreatic and biliary ductal anomalies.
文摘The original 1992 Atlanta Classification Systemfor acute pancreatitis was revised in 2012 by the Atlanta Working Group,assisted by various national and international societies,through web-based consensus.This revised classification identifies two phases of acute pancreatitis:early and late.Acute pancreatitis can be either oedematous interstitial pancreatitis or necrotizing pancreatitis.Severity of the disease is categorized into three levels:mild,moderately severe and severe,depending upon organ failure and local/systemic complications.According to the type of pancreatitis,collections are further divided into acute peripancreatic fluid collection,pseudocyst,acute necrotic collection,and walled-off necrosis.Insight into the revised terminology is essential for accurate communication of imaging findings.In this review article,we will summarize the updated nomenclature and illustrate corresponding imaging findings using examples.
文摘The liver is the second most-often transplanted solid organ after the kidney,so it is clear that liver disease is a common and serious problem around the globe.With the advancements in surgical,oncological and imaging techniques,orthotopic liver transplantation has become the first-line treatment for many patients with end-stage liver disease.Ultrasound,and Doppler are the most economical and cost-effective imaging modalities for evaluating postoperative fluid collections and vascular complications.Computed tomography(CT)is used to confirm the findings of ultrasound and look for pulmonary complications.Magnetic resonance imaging(MRI)is used for the diagnosis of biliary complications,bile leaks and neurological complications.This article illustrates the imaging options for diagnosing the various complications that can be encountered in the postoperative period after liver transplantation.
文摘A variety of chest manifestations are seen in patients with chronic liver diseases,namely hepatopulmonary syndrome,portopulmonary hypertension,intrathoracic portosystemic collaterals,hepatic hydrothorax,infections,drug-induced changes,manifestations of hepatocellular carcinoma,gynecomastia,acute respiratory distress syndrome,autoimmune changes,aspiration pneumonitis and changes due to a1-antitrypsin deficiency.Gastroenterologists and radiologists should be aware of these entities;knowledge of the imaging findings specific to each condition is of prime importance for managing such patients.
文摘We present a rare case of spontaneous trans-splenic shunt and intra-splenic collaterals in a patient with liver cirrhosis and portal hypertension.The shunt and presence of cirrhosis and portal hypertension was incidentally detected by abdominal computed tomographic imaging during evaluation for abdominal pain.There has been a single report on the presence of trans-splenic shunt in two children with extra-hepatic portal venous obstruction but no cases that report intra-splenic collaterals:to the best of our knowledge,this is the first reported case of spontaneous trans-splenic shunt in the presence of intra-splenic collaterals and incidental multiple splenic artery aneurysms that developed in an adult with compensated cirrhosis and portal hypertension.
