Epiploic appendagitis is a rare cause of abdominal pain. Diagnosis of epiploic appendagitis, although infrequent, is easily made with CT or ultrasonography in experienced hands. As reported in the literature, most patients with primary epiploic appendagitis are treated conservatively without surgery, with or without anti-inflammatory drugs. A small number of patients are treated with antibiotics and some patients require surgical intervention to ensure therapeutic success. Symptoms of primary epiploic appendagitis usually resolve with or without treatment within a few days. A correct diagnosis of epiploic appendagitis with imaging procedures enables conservative and successful outpatient management of the condition and avoids unnecessary surgical intervention and associated additional health-care costs. Gastroenterologists and all medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions, such as diverticulitis, cholecystitis and appendicitis. This article reviews epiploic appendagitis and includes discussion of clinical findings, pathophysiology, diagnosis and therapeutic possibilities.

Objective-Synovial cysts of the vertebral facet joints are a source of nerve root compression. DiVerent surgical procedures are in use, but no consensus has been formed so far as to which method should be used in synovial cysts. To clarify the role of surgical management, the eYcacy of operative procedures and factors influencing the outcome in our own series of 19 patients treated between 1994 and 1998 were analysed. Methods-Nineteen patients with a mean age of 65 years underwent surgery for medically intractable radicular pain or neurological deficits caused by synovial cysts. The patients' records were retrospectively analysed for neurological deficits, cysts diameter, operative approach, segmental hypermobility, and clinical outcome; CT and MRI were analysed for additional degenerative changes. Results-In 17 patients an excellent result and in two patients a good postoperative result was achieved. Twelve patients were found to have hypermobility of the facet joints and six had spondylolisthesis. There was no correlation between cyst diameter, operative approach, and outcome. No intraoperative or postoperative complications occurred. Conclusions-Age and hypermobility may play a part in the aetiology of facet joint synovial cysts. As all operative strategies showed equally good clinical outcome, total excision via a small flavectomy as the least invasive approach should be considered therapy of choice in patients with cysts causing neurological deficits. (J Neurol Neurosurg Psychiatry 2001;70:74-77) Keywords: facet joint; flavectomy; lumbar spine; spondylolisthesis; radicular pain; synovial cyst Space occupying lesions of the spinal canal often cause radicular pain or neurological deficits and are most commonly caused by either disc herniation or a bony stenosis of the spinal canal. In a few cases pain in the leg and accompanying paraesthesia is caused by neurinomas or inflammatory processes. A rare source of extradural mass eVects are cysts of the facet joints (accounting for an incidence of 0.8% in our institution). They are cited in the literature as synovial or ganglion cysts.

OBJECTIVE. The purposeof our studywas to assessthe potentialof thin-sectionmul tiphasichelicalCT in diagnosisandstagingof hilar cholangiocarcinomas. SUBJECTS AND METHODS. IdenticallycollimatedhelicalCT studieswereperformedbefore and during the hepatic artery dominant phase and during the portal vein dominant phase of contrastenhancementin 29 consecutivepatientswith proven hilar cholangiocarcinomas.Dif ferencesin attenuation betweenthetumorandtheliverwerecalculatedin eachcaseby subtract ing the average attenuation of the tumor from that of the liver. A four-point scale termed a â€oe¿ lesion conspicuityscore― was usedto determineratesof tumordetection.CT findingswere correlated with surgically assessed extent of tumor, histologic findings, or both in all cases. RESULTS. Ten (34%) of the 29 hilar cholangiocarcinomas were detectedon unenhanced images.All hilar cholangiocarcinomas (100%) were seenon hepaticartery dominantphase scans,and 25 (86%) of 29 hilar cholangiocarcinomas were seen on portal vein dominant phase scans, regardless of the morphologic appearance. An infiltrating stenotic lesion was found in 17 (59%) of 29 patients, an exophytic hilar lesion was found in 11 patients (38%), and one patient (3%) had an intraluminal polypoid lesion. Mean differences in enhancement between infiltrating stenotic lesions and the liver were significantly greater on hepatic artery dominant phase scans (28 ±10 H) than on portal vein dominant phase scans (10 ±8 H), whereas the mean difference in enhancement between the exophytic lesions and the liver was statisticallygreaterduringtheportalveindominantphase(p < .01). Two of the hilar cholang iocarcinomas were resectableat surgery, and I 8 were not.The overallaccuracyof helicalCT for assessing resectability was 60%. In 10 (56%) of 18 patients, unresectable disease was cor rectlydiagnosedwith helicalCT (sensitivity, 56%). Eight (44%) of I 8 patientsconsideredto have resectable tumors with helical CT had unresectable tumors at surgery. A resectable Ut mor was correctly diagnosed in two patients with helical CT. CONCLUSION.MultiphasichelicalCT canbe usedto detectandclassifyhilar cholang iocarcinomas. However,theexactproximaltumorextentalongbile ductstendsto be underes timated with helical CT; therefore, helical CT is inaccurate for determining resectability.H ilar cholangiocarcinomas are typi cally small, slow-growing, locally invasive tumors that have a dismal prognosis ifleft untreated, witha meansurvival of approximately 3 months after initial presen tation [1â€"7]. The anatomic location of hilar cholangiocarcinoma makesresectiondifficult [7]. Surgical exploration of these patients should be undertaken only when preoperative examination has shown a potential for curative resection because the risks of palliative surgery for malignant obstructive jaundice are high, with surgical mortality rates of 20â€"30% [8,9]. Accordingly, preoperative assessment of resec tability of hilar cholangiocarcinoma has in creased in importance in recent years because percutaneous and endoscopic p...

Aortoiliac tortuosity is associated with increased complexity of endovascular aneurysm repair and with predischarge endoleak but does not appear to affect intermediate-term results. Computer-based 3D measurement of aortoiliac tortuosity is feasible and clinically meaningful. Its ultimate role in relation to human assessment must be further defined in future studies.

Nephrographic-phase scans enabled greater lesion detection and better characterization of small renal masses than corticomedullary-phase scans. Nephrographic-phase scans should be obtained when only monophasic scanning is used to detect small renal masses.

The aim of this study was to evaluate the potential of multiphasic multidetector-row CT (MDCT) in the detection and staging of transitional cell carcinomas (TCC) of the upper urinary tract. We performed a retrospective chart review of 39 consecutive patients with 41 histologically verified TCC of the renal pelvis and/or the ureter. The urinary tract was examined using MDCT performing unenhanced and contrast-enhanced scans during the corticomedullary (CMP), nephrographic (NP) and pyelographic phase (PP). Tumors were staged according to the TNM classification. MDCT and histopathological findings were correlated. The attenuation of the lesions was documented in Hounsfield units (HU). In MDCT, all 41 TCC--including two multicentric TCC--were detected. TCC confined to the organ (stage 0a-II) was correctly staged in 28/29 tumors (96.6%). Stage III-IV tumors were correctly staged in 8/12 patients (66.6%). Overall, MDCT was accurate in predicting pathologic TNM stage in 36/41 upper urinary tract TCC (87.8%). There was no significant difference of mean attenuation of TCC between CMP, NP and PP (P > 0.05). MDCT with its high spatial and temporal resolution is an accurate tool for detection TCC of the upper urinary tract, with 87.8% accuracy in predicting its stage.

Aneurysm volume increases immediately after endovascular repair. After repair, aneurysm volume gradually decreases and aortoiliac length remains unchanged. Changes in volume parallel changes in maximal aneurysm diameter, and their association with the presence of an endoleak does not appear to be appreciably stronger.

The purpose of the study was to determine the frequency of associated MR imaging findings in patients with symptomatic lumbar intraspinal synovial cysts, and to correlate MR with surgical findings. MR imaging studies of 18 patients with surgically and histopathologically proven lumbar intraspinal synovial cysts were retrospectively analyzed and correlated with surgical findings. The diameters of the synovial cysts ranged from 10 mm to 28 mm, with a mean of 16 mm. A nonhemorrhagic cyst was found in 15 patients (83%), and a hemorrhagic cyst in three patients (17%). Degenerative spondylolisthesis was found in six patients (33%) at the level of the synovial cyst, with displacement ranging from 3 to 5 mm, mean 4 mm. Surgery revealed instability and hypermobility of the facet joint at the level of the synovial cyst in all patients with degenerative spondylolisthesis, and in five additional patients. Symptomatic synovial cysts of the lumbar spine were associated with degenerative spondylolisthesis in six of 18 patients (33%) and with instability of the facet joint in 11 (61%). These findings may support the theory that increased segmental motion plays a role in the pathogenesis of synovial cysts.