Biomedical subjects
Publications and source records attributed to B Van Beers.
The natural history of pseudoaneurysms complicating pancreatitis is unknown. A patient with chronic pancreatitis is described in whom thrombosis of a splenic artery pseudoaneurysm occurred. Early diagnosis and radical treatment of a bleeding pseudoaneurysm are mandatory. When elective treatment is considered, however, contrast enhanced computed tomography may be useful just before surgery as thrombosis may occur.
Twelve caucasian patients with intraperitoneal hemorrhage due to spontaneous rupture of hepatocellular carcinoma were treated by emergency transcatheter arterial embolization (n = 9) or chemoembolization (n = 3). Pretreatment angiography showed active bleeding (extravasation of contrast medium) in two patients only. Successful hemostasis was initially achieved in all patients. Early recurrence of hemorrhage was noted in 3 patients with large tumors; two were successfully treated by a second embolization and one died immediately after the first embolization. Of the 12 patients, two underwent subsequent chemoembolization while two had surgical resection of their tumors. The mean length of survival was 7 months from the time of rupture. No serious complications related to embolization or chemoembolization were noted. Our data suggest that emergency embolization or chemoembolization is an effective treatment in caucasian patients with intraperitoneal hemorrhage from hepatocellular carcinoma. Prognosis of ruptured hepatocellular carcinoma in those patients, however, remains poor.
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We report a case of focal nodular hyperplasia in an adolescent with a spontaneous intrahepatic portosystemic venous shunt. Diagnosis was established by duplex and color Doppler ultrasound, computed tomography, magnetic resonance imaging, and histology. This association further supports the hypothesis that focal nodular hyperplasia is a response to a preexisting vascular abnormality.
Computed tomography (CT) was compared with magnetic resonance (MR) imaging in depicting the capsule and the mosaic pattern of hepatocellular carcinoma in 34 patients. The kappa statistic was used to compare results from both modalities. For the detection of the capsule, there was a substantial agreement beyond chance between late enhanced CT (more than 5 min after dynamic CT) and MR imaging (kappa = 0.76). Late enhanced CT and MR imaging had almost perfect agreement for the demonstration of the mosaic pattern (kappa = 0.85). These agreements were better than the agreements between unenhanced CT and MR imaging or between early enhanced CT and MR imaging. These results suggest that late enhanced CT compares favorably with MR imaging in depicting the capsule and the mosaic pattern of hepatocellular carcinoma.
Extracorporeal shock wave lithotripsy of gallstones is a safe and well-tolerated procedure. Patients are now treated without general anesthesia and, increasingly, on an outpatient basis. Skin petechiae and transient hematuria are the most common side effects. Episodes of biliary colic are common in the follow-up period, but more serious adverse side effects such as cholecystitis and pancreatitis are distinctly uncommon. It is estimated that only 15% to 20% of all patients with symptomatic cholelithiasis are suitable lithotripsy candidates. As our knowledge of the procedure grows, it seems clear that the best results are obtained in patients with solitary radiolucent stones less than or equal to 20 mm, with stone-free rates at 12 months above 80%, for this selected group of patients. Adjuvant oral bile-acid dissolution therapy should be used in conjunction with gallstone lithotripsy. Gallstone recurrence remains to be established by clinical studies. Therapy for gallstones in 1991 has to be reevaluated by an interdisciplinary approach, taking into account not only open cholecystectomy, but also other modalities such as medical dissolution, laparoscopic surgery, percutaneous cholecystolithotomy and extra-corporeal shock wave lithotripsy. The appeal of the laparoscopic approach will substantially reduce the pool of patients for lithotripsy. Nevertheless, lithotripsy will continue to be a viable treatment option for patients with a single radiolucent stone. It is an outpatient procedure and doesn't require any incision or general anesthesia.
A case of chronic biliary fascioliasis is reported, which was confirmed by endoscopic retrograde cholangiography. After unsuccessful attempts of treatment with classic antiparasitic drugs, cure was obtained with triclabendazole the absorption of which was studied.
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To evaluate the accuracy of surface coil gradient-echo (GRE) imaging in the detection of regenerative nodules of hepatic cirrhosis, 53 patients with diffuse liver disease, among whom 31 had cirrhosis, were prospectively investigated. Three GRE sequences acquired with a surface coil were used in the study: a T2*-weighted, a T1-weighted, and a gadopentetate-enhanced sequence. ROC analysis showed that two surface coil GRE sequences were superior to conventional T2-weighted spin-echo imaging acquired with a body coil for the detection of regenerative nodules. The detection of regenerative nodules was also more accurate for the diagnosis of cirrhosis than the measurement of the caudate-to-right lobe ratio. These results suggest that there could be a potential for surface coil GRE imaging in the assessment of the characteristic macroscopic alterations of cirrhosis.
Ten male patients with ultrasonographic evidence of an internal genital anomaly associated with ipsilateral renal agenesis are presented. The abnormalities consist of seminal vesicle agenesis in 4, seminal vesicle cyst in 3, Wolffian duct remnant in 2, and Mullerian duct remnant in 1. Such developmental defects are due to a primary anomaly of the mesonephros. Due to its capability of visualizing the lumbar and pelvic regions simultaneously, ultrasonography appears to be the first-choice imaging modality for the screening of such genitourinary developmental malformations.
A study group of 50 patients in whom the left portal vein diameter was equal to or greater than the right portal vein diameter (LPVD greater than or equal to RPVD) was prospectively compared on ultrasonography with a control group of 50 patients with LPVD less than RPVD. Clinical and laboratory data indicating chronic alcoholic liver disease (CALD) were observed with a significantly higher frequency in the study group than in the control group. It emerges from this study that LPVD greater than or equal to RPVD represents a useful ultrasonographic sign of CALD, corresponding to a relative enlargement of the left hepatic lobe compared with the right.
The anatomic relationship between the popliteal artery and vein means that an arteriovenous fistula can be created when a popliteal artery approach is used for endovascular interventions. To determine the best site for retrograde puncture of the popliteal artery, we studied six cadaveric specimens, CT scans of 31 patients at 280 levels, and 30 plain radiographs of the knee. In the cadaveric specimens, the vessels were enclosed in a common sheath. In 92% of all levels studied on CT, the artery was anterior to the vein (anterolateral in 9%, anteromedial in 43%, strictly anterior in 40%), and more than 25% of the diameter of the artery overlapped the vein in 87% of these levels. However, at the most cranial level analyzed (64 mm above the femorotibial joint space level), such an overlap occurred in only 60%, and the artery was medial in 25%, resulting in a relationship between the artery and the vein that involved less risk of fistula. On radiographic study, the popliteal crease was located above the level of the joint space (considered the most reliable landmark of the popliteal fossa anatomy) in 97% of cases, although the values were scattered (mean, 2.9 +/- 1.5 cm). In order to minimize the risk of creating an arteriovenous fistula, we recommend a skin incision be located 3-4 cm above the joint level as determined by fluoroscopy, and a puncture directed obliquely from caudal to cranial and from medial to lateral.
Duplication of the gallbladder is a rare congenital anomaly. Preoperative diagnosis is sometimes difficult. We report the imaging findings of two cases of gallbladder duplication. Cholecystography and sonography are complementary for this diagnosis.
Nineteen patients with suspected hepatic neoplasms underwent dynamic computed tomography (CT) and computed tomographic porotography (CTP) in a preoperative setting. Nontumorous attenuation differences in the liver were observed in 8 patients (42%) with CTP and in 2 patients (10.5%) with dynamic CT (p less than 0.05). Although nontumorous attenuation differences are significantly more frequent with CTP than with dynamic CT, they are seldom a diagnostic problem because of their geographic pattern.
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Intravenous digital subtraction angiography was used to determine prospectively the positional variations of the common carotid bifurcation in 100 consecutive patients with clinically suspected arteriosclerotic disease. The most common position (97/200, 48.5%) of the external carotid artery was anteromedial to the internal carotid artery. Position of the external carotid artery anterolateral to the internal carotid artery was noted in 26/200 (13%) bifurcations, but this anatomical variant was more common on the right (21/100) than on the left (5/100) (p less than 0.01). Practical implications may be drawn from this study. For digital subtraction angiography, the left anterior oblique view has to be considered the projection of choice and the right common carotid bifurcation is less likely to be adequately displayed than the left one; for duplex ultrasonography, optimal visualization is obtained from a posterolateral orientation of the transducer.
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Thirty patients with hemangiomas (n = 6), benign liver cell tumors (n = 7), and primary or metastatic malignant tumors of the liver (n = 17) underwent dynamic MR imaging with Gd-DTPA to determine the value of the procedure in the differentiation of hepatic tumors. The diagnoses were proved by histology or follow-up. Hemangiomas had a significantly greater mean T2 value (192.1 +/- 34.8 msec) than did both benign liver cell tumors (71.9 +/- 16.9 msec; p less than .01) and primary or metastatic malignant tumors (79.7 +/- 21.2 msec; p less than .01), but the T2 values of benign liver cell tumors and malignant tumors were not significantly different. Both hemangiomas and benign liver cell tumors had a significantly greater mean signal-intensity ratio (1.86 +/- 0.60 and 1.77 +/- 0.26, respectively) than did malignant tumors (1.04 +/- 0.34; p less than .01) in the early phase after Gd-DTPA administration, and hemangiomas had a significantly greater signal-intensity ratio (1.59 +/- 0.21) than did both benign liver cell tumors (1.21 +/- 0.08; p less than .01) and malignant tumors (1.06 +/- 0.26; p less than .01) in the delayed phase. These results suggest that dynamic MR images obtained after administration of Gd-DTPA are useful in differentiating hepatic hemangiomas, benign liver cell tumors, and malignant liver lesions.