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NERRS Abd Rad Answers 2012
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NERRS Abd Rad Answers 2012






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NERRS Abd Rad Answers 2012 Presentation Transcript

  • 1. NERRS Case 145-year-old man with chronic low grade fevers and right upper quadrant pain Paul B. Shyn, MD
  • 2. NERRS Case 1 HEPATIC FASCIOLIASIS zoonotic disease (liver fluke Fasciola Hepatica) end host sheep or cattle, int host freshwater snail found in humans “by chance” who have ingested contaminated watercress or water 2 stages: the hepatic (acute, invasive) stage and the biliary (chronic, obstructive) stage serologic confirmation or eggs in stool is mandatory for a final diagnosis Diagnostic imaging in the study of human hepatobiliary fascioliasis. Cantisani V, Cantisani C, Mortelé K, et al. Radiol Med. 2010;115(1):83-92.
  • 3. NERRS Case 1 HEPATIC FASCIOLIASISSonography  non-specific, hypoechoic subcapsular areasCT  single or multiple hypodense nodular areas or tunnel-like branching or tortuous peripheral hypodensities (penetration of parasite through Glisson’s capsule) + capsular enhancement Diagnostic imaging in the study of human hepatobiliary fascioliasis. Cantisani V, Cantisani C, Mortelé K, et al. Radiol Med. 2010;115(1):83-92.
  • 4. NERRS Case 1 HEPATIC FASCIOLIASISMRI  capsular hyperintensity on T2 weighted images  multiple peripheral lesions, hyperintense on T2 and peripheral prgressive enhancementDD schistosomiasis, echinococcosis, toxocara cholangitis, liver abscesses Diagnostic imaging in the study of human hepatobiliary fascioliasis. Cantisani V, Cantisani C, Mortelé K, et al. Radiol Med. 2010;115(1):83-92.
  • 5. NERRS Case 229-year-old female with left upper quadrant discomfort Christina LeBedis, MD
  • 6. NERRS Case 2 DIAGNOSIS & DISCUSSION• Diagnosis solid pseudopapillary tumor solid & papillary epithelial neoplasm (SPEN) “DAUGHTER”• Clinicodemographic Features benign (85%) or low grade malignant young women (85%, age 25y) no race & location predilection
  • 7. NERRS Case 2 IMAGING FEATURES• Classic Appearance solitary large (mean 9.3 cm) well demarcated capsule solid & cystic areas hemorrhage calcifications (30%)
  • 8. NERRS Case 2 IMAGING FEATURES• Solid pseudopapillary carcinoma (15%) size lesion (> 5 cm ?) and age not different male gender duct obstruction vascular invasion metastatic disease  5-year survival 96%
  • 9. NERRS Case 2 DIFFERENTIAL DIAGNOSIS• Encapsulated Pancreas Lesions Mucinous Cystic Neoplasm Pancreatic Endocrine Tumor Pancreatic Pseudocyst Sugar Tumor (PEComa)
  • 10. Rare Cystic Tumors ENDOCRINE TUMORS body and tail, middle age 75% sporadic, 25% MEN-1 most tumors “functioning” “hyperfunctioning”, “functional”, or “syndromic” cystic endocrine tumors 56/133 (42%) cystic or areas of necrosis larger than solid lesions (8.4 cm vs 2.9 cm) especially non-syndromic (36/56)
  • 11. NERRS Case 334-year-old female with recurrent right upper quadrant pain Kathleen McCarten, MD
  • 12. NERRS Case 3 CAROLI DISEASE What ?  congenital ductal plate abnormality  saccular dilatation of the bile ducts  communicating with biliary tree  segmental (>) or diffuse  associated abnormalities medullary sponge kidney renal tubular ectasia congenital hepatic fibrosis (Caroli Syndrome)
  • 13. NERRS Case 3 CAROLI DISEASEMRIductal dilationintrahepatic onlycommunicatingsaccular bile ducts« eye of the tiger »« central dot »
  • 14. NERRS Case 3 OTHER CHOLEDOCHAL CYSTS congenital cystic dilatations of ducts > anomalous common channel pancreatic juice reflux prevalence much higher in Japan (1/1,000) versus US (1/130,000) 8:1 female predominance 60% present before age 10 De Wilde VG, et al. Choledochal cysts in the adult. Endoscopy (1991) 23:4-7
  • 15. NERRS Case 3CHOLEDOCHAL CYSTS - TODANI • Type I - solitary fusiform extrahepatic • Type II - extrahepatic supraduodenal diverticulum • Type III - choledochocele • Type IV - multiple extrahepatic cyts or intra + extrahepatic • Type V - Caroli’s disease
  • 16. NERRS Case 447-year-old female with abdominal pain and fever Suzie Yi Huang, MD
  • 17. NERRS Case 4 ECTOPIC PANCREAS usually 0.5 cm - 2 cm [rarely up to 5 cm] incidence varies location (> submucosa [50%])  most commonly stomach (26- 38%), duodenum, jejunum (16%), Meckel diverticulum or ileum  rare in colon, esophagus, gallbladder, bile ducts, liver, spleen, umbilicus, mesentery, mesocolon, omentum usually asymptomatic stenosis, ulceration, bleeding, invagination, ca
  • 18. NERRS Case 543-year-old female with pelvic pain and rectal bleeding Frank Scholtz, MD
  • 19. NERRS Case 5 SIGMOID ENDOMETRIOSIS 6-10% of female population; retrograde menstruation 10% GI involvement (deep endometriosis) extensive fibrosis, little endometrial-like cells iso-intense to muscle on T1- and T2-WI “mushroom cap” sign on T2-weighted images rarely progressive, rarely recurrent DD: adenoca – treatment: hormonal or surgery Evaluation of colonic involvement in endometriosis: double- contrast barium enema vs. magnetic resonance imaging. Faccioli N, Foti G, Manfredi R, et al. Abdom Imaging 2010;35(4):414-21.