Magnetic resonance imaging (MRI) is rapidly emerging as a useful imaging modality for the evaluation of the gastrointestinal tract. Increasingly rapid sequences and improving hardware have significantly improved the visualisation of diseases of the colon. MRI has a major advantage over CT in that there is no ionising radiation. In our institution, MRI has increasingly been used as a complimentary imaging modality to CT in the diagnosis and evaluation of diverticulitis and its complications. In this review article, we illustrate the emerging role of MRI in the diagnosis and evaluation of colonic diverticulitis.
Retroperitoneal fibrosis is a rare condition characterized by the development of fibrous plaques in the retroperitoneal space. The fibrous plaques characteristically arise distal to the bifurcation of the abdominal aorta and progress to encase the iliac vessels distally and are defined by the associated encasement of one or both ureters. Imaging plays an important role in not only establishing the diagnosis, but also in monitoring disease progression. Historically, the radiological diagnosis was made predominantly by intravenous urography and retrograde pyelography. More recently, advances in cross-sectional imaging with ultrasound and contrast-enhanced CT have allowed for a more precise diagnosis as well as helping to accurately define the extent of the disease. At our institution, we have found ultra-fast MRI to also play a useful role in establishing the diagnosis. In particular, magnetic resonance urography using HASTE (half Fourier-acquired single shot turbo spin-echo) sequences allow a safe alternative to intravenous urography, particularly in patients with poor renal function. The purpose of this article is to describe the role of the various imaging methods available to the radiologist and to emphasize the important role that the interventional radiologist now plays, not only in obtaining tissue for diagnosis, but also in providing treatment of the disease by percutaneous nephrostomy drainage and subsequent stent placement in select cases.
We read with great interest the excellent case report and discussion by Drs. Puri et al. describing the role of percutaneous thrombin injection for the treatment of a post-pancreatitis pseudoaneurysm of the splenic artery [1]. We would like to add to their experience a similar case that we encountered that further adds to the potential role of percutaneous treatment of pseudoaneurysms complicating pancreatitis. In the case we describe, the patient had an established history of chronic pancreatitis and presented with an enlarging pseudoaneurysm of the gastroduodenal artery. This was successfully treated with percutaneous thrombin injection under computed tomography (CT) guidance. Case reportA 24-year-old-man presented with a recurrent bout of pancreatitis. He had a history of multiple admissions for known chronic pancreatitis related to alcohol. On the present admission, he had a large infected pseudocyst to the left of his pancreas that was successfully drained. He made a slow recovery with episodes of pneumonia and sepsis complicating his treatment. On the sixth week of admission, he developed further abdominal pain, and a contrast enhanced CT was performed. This demonstrated a large 4×3.5-cm pseudoaneurysm of the gastroduodenal artery (Fig. 1). Initial attempt to perform trans catheter embolization of the pseudoaneurysm was unsuccessful. Surgery was not felt to be feasible, as the patient had a large amount of phlegmon and varices around the pancreatic head making surgery technically difficult. It was therefore decided to attempt to treat the aneurysm by percutaneous thrombin injection. Under CT guidance, a 22-gauge needle was advanced into the aneurysm. Contrast was injected directly into the aneurysm to ensure correct needle position (Fig. 2). Thrombin was then slowly injected into the pseudoaneurysm. Immediate follow up CT showed occlusion of the pseudoaneuysm. The patient had mild abdominal pain post-procedure, which resolved over the next 2 h. He otherwise made an uneventful recovery. Follow-up CT performed 1 week post-procedure confirmed occlusion of the pseudoaneurysm (Fig. 3). Fig. 1 Pre-treatment CT demonstrates a pseudoaneurysm of the gastroduodenal artery (arrow)
Osseous haemophilic pseudotumours are uncommon. The commonest sites of involvement are the femur and the pelvis. Trauma is the initiating factor in most reported cases and repeated bleeding into the lesion contributes to their growth. Most lesions grow slowly and are often asymptomatic. Complications include massive haemorrhage, infection and pathological fracture. We present an extremely unusual presentation where a large haemophilic pseudotumour of the pelvis extended to impinge the adjacent colon, resulting in large bowel obstruction.
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