Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.
Hairy cell leukemia (HCL) treatment in elderly, frail subjects is still unsatisfactory, and interferons, old-fashioned therapies, can be effectively used in this subset of patients. Here, to the best of our knowledge, we report for the first time an old, frail HCL patient effectively and safely treated with pegylated interferon-α-2a in monotherapy as a first-line treatment. At diagnosis, the patient arrived in a life-threating condition due to severe neutropenia and splenomegaly with high risk of splenic rupture. However, splenectomy was proposed and refused by the patient; therefore, a therapy with pegylated interferon-α-2a was initiated. After six months of therapy, the patient displayed the disappearance of palpable splenomegaly and of peripheral hairy cells at morphological examination without any drug-related adverse event. Our case report supports the use of pegylated interferon-α-2a in monotherapy as an effective and safe alternative therapeutic option in frail, elderly patients not eligible for purine analogous or targeted therapies.
CTU represents the natural technical and instrumental evolution of urography. The multidetector technology, with the possibility of retro-reconstruction of the images, has allowed the direct representation of the excretory tract with a significant reduction in acquisition times, decreasing motion artifacts and increasing the definition of the processed images. Split-Bolus CT dynamic study allows us to obtain, in a single image acquisition, both the nephrographic and the renal excretory phases; at the same time, we can obtain information of the parenchymal organs in the abdominal cavity as in the portal/nephrographic phase of a standard CT protocol. The main advantage of Split-Bolus CTU is undoubtedly the significant saving of the radiation dose administered to the patient, related to the reduction in the number of phases acquired, with a reported diagnostic efficacy comparable to traditional protocols in terms of imaging quality. The Split Bolus technique has been used in several clinical contexts, such as in the characterization of focal liver lesions, in acute pulmonary embolism and in polytrauma patients.
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