NERRS Case 145-year-old man with chronic low grade fevers and right upper quadrant pain Paul B. Shyn, MD
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.
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.
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.
NERRS Case 229-year-old female with left upper quadrant discomfort Christina LeBedis, MD
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
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)
NERRS Case 334-year-old female with recurrent right upper quadrant pain Kathleen McCarten, MD
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)
NERRS Case 3 CAROLI DISEASEMRIductal dilationintrahepatic onlycommunicatingsaccular bile ducts« eye of the tiger »« central dot »
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
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
NERRS Case 447-year-old female with abdominal pain and fever Suzie Yi Huang, MD
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
NERRS Case 543-year-old female with pelvic pain and rectal bleeding Frank Scholtz, MD
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.