Groove pancreatitis is a distinct form of chronic pancreatitis characterized by inflammation and fibrous tissue formation, affecting the groove area between the head of the pancreas, the duodenum and the common bile duct. It is manifested on imaging by a sheet-like mass in the groove area near the minor papilla. Thickening of the duodenal wall and cystic transformation in the duodenal wall also represent common imaging features. Pathogenesis is still unclear, and clinical presentation is not specific. Endoscopic ultrasonography (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) demonstrate imaging findings consistent with the disease in typical cases, but specific diagnosis is challenging in a number of patients where biopsy is required. The disease may mimic pancreatic, common bile duct or duodenal wall cancer that requires prompt and excessive surgical intervention, as opposed to groove pancreatitis where initial conservative treatment is suggested. The clinical, histopathological and radiological features on cross-sectional imaging of this entity are discussed in this review, and differential diagnostic clues are given.
Cystic formations within the liver are a frequent finding among populations. Besides the common cystic lesions, like simple liver cysts, rare cystic liver lesions like cystadenocarcinoma should also be considered in the differential diagnosis. Thorough knowledge of each entity's nature and course are key elements to successful treatment. Detailed search in PubMed, Cochrane Database, and international published literature regarding rare cystic liver lesions was carried out. In our research are included not only primary rare lesions like cystadenoma, hydatid cyst, and polycystic liver disease, but also secondary ones like metastasis from gastrointestinal stromal tumors lesions. Up-to date knowledge regarding diagnosis and management of rare cystic liver lesions is provided. A diagnostic and therapeutic algorithm is also proposed. The need for a multidisciplinary approach by a team including radiologists and surgeons familiar with liver cystic entities, diagnostic tools, and treatment modalities is stressed. Patients with cystic liver lesions must be carefully evaluated by a multidisciplinary team, in order to receive the most appropriate treatment, since many cystic liver lesions have a malignant potential and evolution.
Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. We present a rare case of a 44-year-old female patient with intestinal obstruction due to ileocolic and colocolonic intussusception secondary to an intramural cecal lipoma. Diagnosis was made by barium enema and abdominal computed tomography and was confirmed by colonoscopy. After failure of conservative treatment, the patient underwent surgery.
The aim of the study was to calculate radiation doses for patients and staff during interventional Endoscopic retrograde cholangiopancreatography (ERCP) procedures. Patient age (A), kerma-area product (KAP), fluoroscopy time (T) and total number of films (F) were collected for 157 interventional ERCP procedures. One endoscopist (>10 y of experience) monitored using a thermoluminescent dosemeter worn over the lead apron performed the ERCPs. Median (range) KAP was 3.1 Gy cm(-2) (0.1-106.7 Gy cm(-2)). Median (range) A, T and F were 72 y, 2.6 (0.2-26.0) min and 2 (1-4) images, respectively. No correlation was observed between KAP and A, T or F. Monthly endoscopist dose was negligible due to the use of lead apron, collar and two lead-articulated ceiling mounted shields. The endoscopist dose is minimal when using appropriate protective measures. Patient doses showed large variation that has to be further investigated.
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