Complicated small-bowel diverticulosis is a rather uncommon cause of upper abdominal pain.
It may lead to symptoms presenting with an acute onset or to chronic and nonspecific complaints. As the presentation is often similar to other pathologies (acute appendicitis, pancreatitis, or acute cholecystis) and in many cases diagnosis is made on basis of surgical findings, careful analysis of the imaging landmarks may be warranted to aid in the early stages of detection. In this report, we present clinical and morphological findings in three patients where small-bowel diverticulitis was surgically proven. The relevant literature is reviewed, and typical imaging properties are discussed.
Various conditions may result in forefoot pain. Magnetic resonance (MR) imaging allows accurate assessment of many of these conditions. We provide an overview of forefoot disorders divided into bones, capsule and plantar plate, musculotendinous structures, neurovascular structures, and subcutaneous tissue. We review normal anatomical features as well as MR imaging findings of common disorders.
A 76-year-old man was referred to the hospital because of stomach pain, vomiting, and fever persisting for a few days. On physical examination, there was no abdominal tenderness.Initial blood tests revealed normal white cell count and elevated liver aminotransferases (aspartate amino-, and gamma-glutamyl transferase (1328 U/L, normal range <35). Bilirubin was normal. At the emergency unit, computed tomography (CT) was performed showing an infiltrating mass with small rather linear calcifications in the right liver lobe extending through the main bile duct into the pancreatic head. (Fig. 1) Magnetic resonance imaging (MRI) demonstrated a T 2 hyperintense to intermediate intense, T 1 hypointense, diffusion restrictive, complex solid neoplasm with a tubular aspect and slight contrast uptake, extending from the main bile duct into the right intrahepatic bile ducts. There is focal invasion into the cystic duct and the gallbladder. (Fig. 2) The differential diagnosis includes biliary papillomatosis, polypoid cholangiocarcinoma and hepatocellular carcinoma with intraductal growth. Surgery was performed with peroperative histology of frozen samples showing papillary carcinoma. Paraffin embedded samples showed dysplastic epithelium of the bile ducts with diffuse papillary proliferations. There are atypical columnar cells and only slight development of fibrovascular structures. The epithelium shows ulcerations and a high grade of dysplasia with hyperchromatic nuclei and a large number of mitotic figures. There Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.Address reprint requests to: Lieve Braeye, M.D., Half Daghmael 6 bus 301,
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