We present magnetic resonance imaging findings in a patient with proven hepatic veno-occlusive disease (VOD) caused by the use of "poppers," a recreational drug used during anal intercourse. Although this report emphasizes the differential magnetic resonance imaging features between VOD and Budd-Chiari syndrome, our case is unique because the VOD was induced by unrelated substances.

Adult↗

PubMedDate not supplied

Usual and unusual causes of extrahepatic cholestasis: assessment with magnetic resonance cholangiography and fast MRI.

Cholestasis may result from hepatocellular (intrahepatic) disease or biliary tract (extrahepatic) abnormalities. Etiologies causing extrahepatic cholestasis are extremely diverse and invasive procedures, such as endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), were previously required to establish the diagnosis. Due to refinements of magnetic resonance imaging (MRI) techniques, the patient with extrahepatic cholestasis currently can be evaluated noninvasively, and the information revealed frequently exceeds the findings obtained by ERCP and PTC. In this essay, we illustrate the classic MR cholangiographic (MRC) and MRI features of a variety of disorders causing extrahepatic cholestasis, including non-neoplastic disorders of the biliary tract (congenital abnormalities, infectious processes, iatrogenic disorders, and postsurgical complications) and neoplastic conditions (e.g., tumors of the pancreas, biliary tree, liver, ampulla, and regional lymph nodes). In most cases, familiarity with the key MRC features in addition to information obtained via cross-sectional MR images provide sufficient information for adequate lesion characterization.

Bile Ducts, Extrahepatic↗

PubMedDate not supplied

Asymptomatic nonspecific serum hyperamylasemia and hyperlipasemia: spectrum of MRCP findings and clinical implications.

We assessed the magnetic resonance cholangiopancreatographic (MRCP) findings in patients with asymptomatic, mild elevations of serum amylase and lipase levels to determine whether there might be a pathoanatomic cause for these laboratory abnormalities. MRCP was performed in 633 consecutive patients. Of these, 54 (8.5%) images were obtained in patients with asymptomatic serum hyperamylasemia and hyperlipasemia. MRCP was performed on a 1.0-T MR system; breath-hold gradient-recall, half-Fourier acquisition, and rapid acquisition with relaxation enhancement sequences were obtained. Findings were verified by follow-up, biopsy, or surgery. One-sided, large-sample z tests were used to compare the incidence of abnormalities between the study and control groups (579 patients). The pancreas appeared abnormal on MRCP in 31 patients (57%), including the pancreas divisum in 10 patients (18.5%). Other findings included morphologic changes compatible with chronic pancreatitis in nine patients (16.6%) and a healed pancreatic laceration, juxtapapillary duodenal diverticulum, papillary sclerosis, intraductal pancreatic lithiasis, and hemochromatosis in one patient each (1.9%). Small cystic lesions (< 1 cm) within the pancreas were seen in 15 patients (27.8%). In eight patients, these were associated with other abnormalities (pancreas divisum in three patients, chronic pancreatitis in four, and pancreatic laceration in one). No malignancy was diagnosed. The incidences of normal examination (p = 0.01), pancreas divisum (p < 0.005), and a small cystic lesion (p = 0.01) as solitary findings in this subgroup of patients were significantly higher when compared with the remainder of the studied population. Investigation of asymptomatic patients with nonspecific hyperamylasemia and hyperlipasemia by means of MRCP yielded pancreatic findings in more than 50% of these patients. Pancreas divisum was found more often than expected in the general population.

Female↗

PubMedDate not supplied

Flush symptoms caused by a mesenteric carcinoid without liver metastases.

Flushing is a known symptom in intestinal carcinoid tumors which usually occurs only in the presence of liver metastases. A 62-year-old women presented with abdominal pain, nausea and flush symptoms. US, CT, octreotide scintigraphy and biopsy revealed a primary mesenteric carcinoid with retroperitoneal lymph node metastases and a solitary leftsided supraclavicular lymph node metastasis proving lymphatic spread over the thoracic duct, but liver metastases were excluded. This is a report on a mesenteric carcinoid which lead to flush symptoms despite absence of liver metastases, since retroperitoneal lymph node metastases enabled a direct hormone release into the systemic circulation.

Biopsy↗

PubMedDate not supplied

The San Francisco experience.

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Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

AIDS. Reaching the disposessed.

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Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

AIDS. Taking charge.

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Acquired Immunodeficiency Syndrome↗