Mural Thickening Research Articles

Extended Cholecystectomy with Reconstruction of Right Hepatic Artery for Carcinoma Gallbladder: A Case Report

The role of vascular reconstruction in surgical resection of advanced carcinoma gall bladder remains unclear, with scarce available literature. Evaluating the benefit of curable resection against the risk of increased postoperative morbidity remains a fine balancing act. Here, we report a case of a 45-year-old male who presented with obstructive jaundice and significant weight loss over 3 months. CECT showed bilateral IHBRD with patent primary confluence and an enhancing polypoidal mass in the proximal CBD of size 11 x 12 mm, in continuity with asymmetric mural thickening of GB neck. Fat planes with vascular structures were seen to be preserved. Possibilities of carcinoma gall bladder or cholangiocarcinoma were considered. Patient underwent ERCP and stenting of the right ductal system for resolution of jaundice. Extended cholecystectomy with extrahepatic bile duct resection and Roux-En-Y hepaticojejunostomy was performed. Intraoperatively, right hepatic artery was found involved with tumor; therefore, a 1 cm segment of the artery was resected and end to end anastomosis was done. Finally, a diagnosis of adenocarcinoma of gallbladder with positive liver resection margin (R1 resection) was made on histopathological examination. The resected right hepatic artery margins, however, were found to be free of tumor. Post-operative course remained uneventful, with no vascular complications. Patient received adjuvant chemoradiotherapy. He remains symptom free at 10 months post-surgery. Our case highlights that right hepatic artery reconstruction can be done in advanced carcinoma gallbladder with low surgical risk and that it remains a viable option for achieving curative resection.

Ultrasound and Computed Tomography Features of Non Cirrhotic Portal Hypertension caused due to Non Cirrhotic Portal Fibrosis and Extrahepatic Portal Vein Obstruction: A Retrospective Study

Introduction: Non Cirrhotic Portal Hypertension (NCPH) encompasses a wide range of disorders that are characterised by increased portal pressure with the absence of cirrhosis of liver. The disorders are classified anatomically based on the site of blood flow obstruction into prehepatic, hepatic and posthepatic causes. These numerous and variable aetiological factors and the lack of standardised diagnostic criteria, makes NCPH under-recognised both clinically and pathologically and often being falsely labelled as cryptogenic cirrhosis. Therefore, it is important for radiologists to be aware of the imaging features that constitute NCPH for its early recognition, so that appropriate management can be carried out. Aim: To assess the distinct ultrasound and Computed Tomography (CT) features of the two main causes of NCPH: Non Cirrhotic Portal Fibrosis (NCPF) and Extrahepatic Portal Venous Obstruction (EHPVO). Materials and Methods: This retrospective observational study included all radiologically diagnosed cases of NCPH who underwent ultrasound and CT examination at the Institution between June 2020-June 2021. A total of 10 patients met the inclusion criteria. The various imaging features of NCPF and EHPVO were analysed and tabulated. Results: The study showed male predominance with males and females being seven and three, respectively. The mean age of the patients in the study was 35.1 years. The common cause in both NCPF and EHPVO was idiopathic. The most characteristic imaging finding in EHPVO was cavernous transformation of the portal vein seen in all cases and that in NCPF being dilatation of the spleno-portal axis and mural thickening of the main portal vein seen in all the cases. Conclusion: The present study demonstrated the characteristic imaging features of NCPF and EHPVO which are leading cause of NCPH, facilitating radiologist to identify the conditions and not label cases with Portal Hypertension (PHT) as cryptogenic cirrhosis.

Evaluating the value of different sonographic findings in diagnosis of acute appendicitis in children.

Introduction:Appendicitis is one of the most common paediatric surgical emergencies occurring in about 7% of healthy children. To make a definitive diagnosis preferably avoiding unnecessary X-ray radiation exposure, ultrasound is the ideal modality. The aim of this study is to evaluate the diagnostic value of sonographic findings in children with acute appendicitis and comparing them with surgical findings to demonstrate the safety, simplicity and accuracy of this procedure in emergency departments as the first diagnostic procedure.Materials and Methods:One hundred and eight children aged 1–15 years suspected of acute appendicitis in our tertiary hospital emergency department enrolled the study. Patients presenting as acute abdomen suspected as having acute appendicitis underwent abdominal ultrasonography (US) at first. Sonographic findings were compared to surgical and pathologic results, and sensitivity and specificity of each sonographic parameter in paediatric appendicitis were evaluated.Results:The analysis of sonographic results showed that 67.6% of patients had acute appendicitis, 13.9% had perforated appendicitis and 18.5% had normal appendix. On the other hand, there were acute appendicitis in 63.9% of patients, perforated appendicitis in 12% and normal appendix in 8.3% in surgical reports. Sensitivity of uncompressible appendicitis, appendicitis, maximal outer diameter (MOD) above 6 mm, maximal mural thickness (MMT) above 3 mm, round appendix was 98.68%, 28.04%, 94.74%, 61.84% and 68.42%, respectively. Specificity of incompressible appendicitis, appendicitis, MOD above 6 mm, MMT above 3 mm, round appendix was 64.71%, 96.15%, 64.71%, 82.35% and 94.12%, respectively. Overall sensitivity and specificity of US in appendicitis were 97.56% and 69.23%, respectively.Conclusion:According to the findings of this study, sensitivity of US in diagnosing appendicitis is higher than other studies, but its specificity was lower. Ultrasonographic accuracy and efficacy to diagnose acute appendicitis in children are high enough to allow clinicians to do it as an imaging modality of first choice, and also, in problematic cases to assist correct clinical diagnosis avoiding unnecessary X-ray exposure, decreasing negative appendectomies, decreasing perforation rate and lowering the cost of patients. Furthermore, negative US do not justify immediate computed tomography because clinical re-evaluation and a second US can help greatly the clinicians in the correct diagnosis.

Abdominal and pelvic imaging findings in COVID-19

Pulmonary imaging findings of Coronavirus disease 2019 (COVID-19) has been widely described, but recently few studies have been published about abdominal and pelvic radiological presentation. The aim of this study was to provide an overview of abdominal imaging findings in patients with COVID-19. After investigation of recent published literature we came to conclusion that most common findings are associated with gastrointestinal abnormalities with mural thickening of part of gastrointestinal tract being the most common, followed by vascular and less frequently described solid organ and gallbladder abnormalities. It is important to be familiar with abdominal COVID-19 manifestations, since they’re often implicated with the development of poor clinical outcomes.

790 Upper Gastrointestinal (UGI) Mural Thickening on Computed Tomography (CT) and its Significance in The Multi-Disciplinary Team (MDT) Pathway

Abstract Aim Patients are frequently referred to the UGI MDT based on CT reported thickening of either the oesophagus, stomach, or duodenum. We have sought to illustrate the efficacy of CT within the UGI cancer referral pathway. Method A retrospective analysis was carried out on patients referred to the UGI MDT at a University Teaching Hospital over a 22-month period. Patients referred with CT evidence of UGI tract thickening prior to endoscopy were included. CT findings were correlated with symptomatology, subsequent endoscopy, and histology findings. Results 442 patients were referred to the UGI MDT between April 2014 and February 2016. 125 were referred for CT thickening alone (67 (53.2%) oesophageal, 49 (39.2%) gastric, 9 (7.2%) duodenal). 49 (39.2%) patients were subsequently diagnosed with UGI cancer, 57 (45.6%) had evidence of benign disease and 18 (14.4%) patients had no abnormality evident on endoscopy. CT thickening of 15mm and above was significantly more likely be malignant versus thickening less than 15mm [42/87 (48.3%) vs 7/38 (18.4%); p < 0.05]. Patients with thickening in the presence of a hiatus hernia were significantly less likely to have an associated cancer vs those without [3/26 (13%) vs 20/42 (51.1%); p < 0.05]. Conclusions We conclude that patients should not be referred for MDT opinion on CT evidence of UGI thickening alone. All patients should have an endoscopy prior to referral, particularly those with a hiatal hernia on CT. A high index of suspicion for malignancy should be adopted in patients with thickening greater than 15mm on imaging.

S3713 Pre-Pyloric Gastric Ulcer Leading to Stenosed Pylorus, Obstruction of Gastric Outlet and Pseudo-Gastroparesis

Introduction: Gastric outlet obstruction (GOO) is a syndrome manifested with combination of early satiety, abdominal pain, postprandial vomiting and weight loss. The usual etiology is either mechanical (benign or malignant) or motility related. Most common cause of benign obstruction is peptic ulcer disease. Here we discuss a case of pre-pyloric ulcer with significant stenosis that mimics gastroparesis causing acquired GOO. Case Description/Methods: 58 year old female with history of migraines, anxiety and chronic pain presented with generalized weakness and epigastric pain. She had been taking 2 pills of aspirin and Advil each every 3 hours for past 2 weeks for her toothache. She also reported melanotic stools. In the ER, she was vitally stable but had hemoglobin of 5.5. CTA of abdomen pelvis noted abnormal duodenum with diffuse mural thickening and mildly prominent lymph nodes. She was transfused 2 units of PRBC. EGD done revealed linear antral ulcer occupying two-thirds of pre-pyloric area measuring 4 cm extending into the pylorus with minimal oozing on contact. Pylorus was severely narrowed and ulcerated; it could not be traversed with adult scope. XP scope was then used which passed with ease through the pylorus into the duodenal bulb which appeared to be severely ulcerated. Rest of the duodenum was normal. Patient subsequently had Gastrografin follow through study to evaluate for gastric outlet obstruction which showed suspected mild stenosis &/or edema in pylorus secondary to ulcerative dislocation; however no bowel obstruction was noted since the contrast passed through the duodenum. Biopsy ruled out malignancy & H. pylori infection and was consistent with chemical gastropathy. Gastrin level was also noted to be normal. Patient was on placed on clear liquid diet initially and later transitioned to full liquids since she was unable to tolerate solid foods. She had a repeat EGD 4 weeks later while on Pantoprazole 2 times daily and eventually showed partial resolution of ulcerated lesions. Discussion: Pre-pyloric ulcers are the most common form of peptic ulcer disease leading to GOO. Most common site is the pyloric channel or duodenal bulb which was the case in our patient. Acute ulcers usually cause inflammation and edema that leads to tissue deformation and obstruction especially with solid food particles getting lodged into the ulcer. Despite these, obstruction usually occurs in 2% of the cases of peptic ulcer disease and is the least common complication contributing to gastroparesis like symptoms.Figure 1.: Figure 1). Pre-pyloric stomach ulcer 2). Pre-pyloric stomach ulcer 3). Pylorus with food residue/Bezoar stuck in the stenosed pylorus 4). Pre-pyloric stomach ulcer after 4 weeks of Protonix therapy 5). Ulcer at 11-1 o clock 6). Ulcer at 12 o clock.

S1347 Comparison of Magnetic Resonance Enterography and Balloon Assisted Enteroscopy in the Detection of Active Small Bowel Inflammation in Patients with Crohn’s Disease

Introduction: There are several modalities to detect active inflammation in the small intestine in patients with Crohn’s disease. Magnetic resonance (MR) enterography is a recommended non-invasive imaging technique that can detect inflammation, strictures and fistulas. Balloon assisted enteroscopy (BAE) allows direct visualization and sampling of the small intestine. We aimed to compare MRE and BAE in the detection of active small bowel inflammation in patients with Crohn’s disease. Methods: We performed a retrospective analysis of patients with Crohn’s disease who underwent both MRE and BAE between January 2011 and March 2021. All patient charts were analyzed for MRE findings, BAE findings, age, sex, and surgical history. MRE was considered positive for active inflammation if findings included mural thickening, mucosal enhancement, mesenteric edema and lymphadenopathy. BAE was considered positive for active inflammation if ulceration seen and inflammation confirmed on pathology. Results: Retrospective review identified a total of 96 patients with both MRE and BAE performed. A total of 18 patients were excluded since the time between MRE and BAE was greater than one year. Of the remaining 78 patients, 40 patients (51.2%) had a history of prior Crohn’s related surgery. Three BAE (3.7%) were unsuccessful in reaching small intestine findings seen on MRE due to stricture or adhesions. The agreement of a lack of active inflammation between MRE and BAE findings occurred in 17 patients (21.7%). MRE and BAE agreed with the presence of active inflammation in 34 patients (43.5%). In three patients (3.7%), MRE showed active inflammation but BAE did not find any visual or pathologic evidence of active inflammation. In 19 patients (24.3%), MRE was negative for active inflammation but BAE was positive. When compared to the other groups, this group had higher rates of prior surgery (63.2%) and higher rates of inflammatory stricture (52.6%). Conclusion: In patients with Crohn’s disease, MRE and BAE are helpful modalities in detecting active inflammation in the small intestine. In patients with a history of Crohn’s related surgery, BAE may be more helpful in determining presence of active inflammation or inflammatory strictures. Despite history of surgery, BAE is successful in reaching small bowel lesions.

S2884 Pelvic Inflammatory Disease as an Unusual Cause of Ascites

Introduction: Pelvic inflammatory disease (PID) is an infection of the upper genital tract, including the uterus, fallopian tubes, and/or ovaries. Neisseria gonorrhea, Chlamydia trachomatis, and Mycoplasma genitalium are the most frequently isolated pathogens. Case Description/Methods: A 25-year-old female presented with an 8-day history of lower abdominal pain associated with fevers, chills, vomiting, and non-bloody diarrhea. Patient denied recent travel, changes in her diet, family history of Inflammatory Bowel Disease. Her abdomen was diffusely tender. Routine laboratory testing was unremarkable. CT scan of the abdomen and pelvis (Figure 1) showed focal small bowel mural thickening, concerning for gastroenteritis. COVID PCR, HIV antigen/antibody, blood cultures, Clostridium difficile toxin and stool pathogen PCR panel were all negative. Patient was presumed to have viral gastroenteritis and was discharged home. She was readmitted two days later for worsening nausea and vomiting. Laboratory testing was significant for WBC 12.7 x 109/L, potassium of 2.8 mEq, INR 1.7, CRP 19.24 mg/dL. A repeat CT abdomen and pelvis (Figure 2) showed a re-demonstration of marked wall thickening of the small bowel most consistent with enteritis, and the development of large loculated ascites in the mid abdomen and pelvis with peritoneal thickening and enhancement. Diagnostic paracentesis showed PMNs 990, RBCs 4000, SAAG < 1.1, total protein 3.7 g/dl, glucose 29 mg/dl, and LDH 1609 U/L. Peritoneal cultures grew Neisseria gonorrhea. Patient was discharged home on a two-week course of IV ceftriaxone, metronidazole and doxycycline with improvement in clinical symptoms. Repeat diagnostic imaging showed interval improvement and resolution of ascites. Discussion: Acute symptomatic PID presents with lower abdominal pain associated with fevers, chills, nausea, vomiting, vaginal discharge and/or intermenstrual bleeding. PID may present with RUQ pain in the setting of liver capsular inflammation, also known as perihepatitis i.e. Fitz-Hugh Curtis Syndrome. Perihepatitis occurs in about 10% of woman with acute PID. However, the development of ascites as a presenting complication of PID is very rare. In this case, the ascites fluid studies were not consistent with portal hypertension with a SAAG < 1.1. In addition, PMNs > 250 cells suggested bacterial peritonitis. Furthermore, per the Runyon’s criteria, this pattern resembled secondary bacterial peritonitis with a total protein >1 g/dL, glucose < 50 mg/dL, and LDH > upper limit of normal serum.Figure 1.: CT abdomen and pelvis on presentation showing small bowel mural thickening and enhancement.Figure 2.: CT abdomen and pelvis on representation showing large volume ascites with continued small bowel mural thickening and enhancement.

IgG4-related disease as a rare cause of gastric outlet obstruction: a case report and literature review

BackgroundIgG4-related disease involvement of the digestive tract is very rare. In few reported cases of isolated gastric/duodenal IgG4-related disease, none of which resulted in luminal obstruction.Case presentationA 59 years old female presented with longstanding gastrointestinal symptoms. CT showed mural thickening of the proximal duodenum. Gastroscopy showed antral ulcer extending into the duodenum with outlet obstruction and biopsy showed acute on chronic duodenitis. Whipple’s procedure was performed and IgG4-related disease was diagnosed on final pathology. Symptoms were revolved on mycophenolate mofetil and prednisone with no recurrence.ConclusionsOur case is the only reported case with gastric outlet obstruction secondary to gastroduodenal IgG4-related disease. The diagnosis should be considered in the differential diagnosis of unexplained duodenal stricture, gastric outlet obstruction or gastrointestinal ulceration. IgG4-related disease usually responds to steroids but long-term response rates to steroid-sparing agents, especially in the subset of patients with luminal IgG4-related disease remains to be determined.

Assessment of Imaging Features of Crohn's Disease with MR Enterography.

To evaluate the frequency of pathological findings determined on magnetic resonance (MR) enterography (MRE) in patients with Crohn's Disease. A retrospective analysis of the MRE images was made in 34 female and 41 male patients (mean age 41 years) with Crohn's disease. The prevalence of bowel wall (mural thickening, mural edema, mural fat deposits, mucosal enhancement, ulceration, cobblestone appearance, pseudopolyps) and mesenteric fatty tissue alterations (fatty tissue proliferation, mesenteric hypervascularity, enlarged lymph nodes, peri-enteric inflammation, reactive fluid), complications due to penetrating (fistula, sinus tract, abscess) and stenosing processes (fibrotic and inflammatory stenosis, obstruction, dilatation), and involvement of the colon were determined. The most frequently observed changes in the bowel wall and mesenteric fatty tissue were mural thickening (98.7%) and enlargement of mesenteric lymph nodes (76%), respectively. Stenosis was the most common complication (76%). The most frequently seen pathology of the colon was ileocecal valve thickening and enhancement (74.7%). MR enterography is a useful imaging modality for the evaluation of changes in both the mesenteric fatty tissue and the bowel wall. As there is no use of ionizing radiation, MR enterography should be the preferred imaging modality during follow-up of patients with Crohn's disease.

Colonic adenocarcinoma resulting in recurrent colic and hematochezia in an Arabian stallion

A fourteen-year-old Arabian stallion was presented with general weakness and hematochezia. Clinical examination showed tachycardia but the rest of the physical parameters were within normal limits. Transcutaneous abdominal ultrasonography showed distended small intestinal loops with normal motility but increased mural thickness. Gastroscopic examination revealed small focal lesions in the non-glandular part of the stomach around the margo plicatus of the greater curvature, with a score of II/IV Equine Gastric Ulcer Syndrome. Blood analysis revealed anemia, hypoproteinemia and neutrophilia. Treatment was palliative and was determined based on the initial findings. Despite intensive medical treatment, the horse was euthanized due to progressive deterioration of its condition. Post-mortem necropsy and histopathology revealed an adenocarcinoma with osseous metaplasia within the left dorsal colon.

CT Imaging Characteristics and Influence Factors of Renal Dialysis-Associated Peritoneal Injury.

Peritoneal dialysis (PD), as one of the main renal replacement modalities for end-stage renal disease, gets the advantages of better protection of residual renal function and better quality of survival. However, ultrafiltration failure after peritoneal injury is an important reason for patients to withdraw from PD treatment. Peritonitis is a major complication of peritoneal dialysis, which results in an accelerated process of peritoneal injury due to direct damage from acute inflammation and local release of cytokine TGF-β. In this paper, the application of ultrasound to examine the peritoneum revealed a positive correlation between peritoneal thickness and the development of peritonitis. The results of this study also further confirmed the effect of peritonitis on peritoneal thickening. A multifactorial regression analysis also revealed that peritonitis and its severity were independent risk factors for peritoneal thickening and omental structural abnormalities. This paper reported a correlation between mural peritoneal thickness and peritoneal transit function. In this study, patients with high peritoneal transit and high mean transit were found to be more prone to omental structural abnormalities than patients with low mean and low transit and a higher proportion of patients with mural peritoneal thickening, but this did not reach statistical significance, which may be related to the still small number of cases.

Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease.

BackgroundUltrasonographically detected gallbladder wall edema (GBWE) is a marker for anaphylaxis in dogs. Cardiac disease can cause GBWE with similar signs and should be included as a differential diagnosis to prevent interpretation errors.Hypothesis/ObjectivesDocument GBWE associated with cardiac disease.AnimalsFourteen client‐owned animals.MethodsProspective case series with abdominal focused assessment with abdominal sonography in trauma, triage and tracking (AFAST), and thoracic focused assessment with abdominal sonography in trauma, triage, and tracking (TFAST) performed at triage. Animals with GBWE and cardiac disease were enrolled. A board‐certified radiologist reviewed images to confirm cardiac disease, GBWE, and characterize the caudal vena cava (CVC) and hepatic veins.ResultsThirteen dogs and 1 cat had GBWE associated with cardiac disease. Gallbladder findings included mural thickness ranging from 3 to 5 mm, mild to moderate sludge (n = 3), and mild to moderate luminal distension (n = 6). CVC and hepatic venous distension were found in 5/6. Cardiac diagnoses in dogs included 11 with pericardial effusion (PCE) and 1 each with dilated cardiomyopathy and right‐sided myocardial failure. Severity of PCE was rated as mild (n = 1), moderate (n = 6), or severe (n = 4). Seven of 11 had pericardiocentesis performed. Nine of 13 had ascites with 4 having abdominal fluid scores of 1 (n = 2), 2 (n = 2), 3 (n = 1), and 4 (n = 0). Lung ultrasound findings were as follows: dry lung (n = 6), B‐lines (n = 4), and nodules (n = 1). The cat had moderate PCE, ascites scored as 1, and severe right‐sided ventricular enlargement associated with a ventricular septal defect. Primary presenting complaints included acute weakness (n = 9), acute collapse (n = 5), gastrointestinal signs (n = 3), respiratory distress (n = 2), and need for cardiopulmonary resuscitation (n = 1).Conclusions and Clinical ImportanceUltrasonographically detected GBWE was associated with PCE in this small cohort of cases.

The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy

Background: Mural thickening (MT) on computed tomography (CT) poses a diagnostic dilemma in the absence of clear reporting guidelines. The aim of this study was to analyse CT reports, identifying patients in whom gastrointestinal wall MT was observed, and to correlate these reports with subsequent endoscopic evaluation. Methods: Patients with MT who had follow-up endoscopy were included in the study (n = 308). The cohort was subdivided into upper gastrointestinal mural thickening (UGIMT) & lower gastrointestinal mural thickening (LGIMT). Results: In total, 55.71% (n = 122) of colonoscopies and 61.8% (n = 55) of gastroscopies were found to be normal. Haemoglobin (HB) level in combination with MT was a predictor of neoplasia in both arms (p = 0.04 UGIMT cohort, p < 0.001 LGIMT cohort). In addition to this, age was a significant correlative parameter in both UGIMT and LGIMT cohorts (p = 0.003, p < 0.001 respectively). Dysphagia and weight loss were associated with UGI malignancies (38 and 63% respectively) and rectal bleeding was correlative in 20% of patients with LGI malignancies. Conclusion: HB, advancing age, and red flag symptoms are potentially useful adjuncts to MT in predicting upper and lower gastrointestinal malignancies. We propose the adoption of a streamlined pathway to delineate patients who should undergo endoscopic investigation following CT identification of MT.

Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn's Disease?

Background and Objectives: To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological reference standard. Material and Methods: Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. Results: Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis (p = 0.01). Pre-stenotic bowel dilatation positively correlated with FS (p = 0.002). The ADC value negatively correlated with FS (p < 0.001) and was different between FS grades (p < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate–severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). Conclusions: Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients.

Xanthogranulomatous cholecystitis mimicking gallbladder cancer on 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan

The abnormal thickening of the gallbladder (GB) wall can be caused by a malignant condition like gallbladder carcinoma or by benign lesions such as chronic cholecystitis or xanthogranulomatous cholecystitis (XGC). Mural thickening is a common finding between them as fluorodeoxyglucose (FDG) can be taken up by inflammatory cells also. Here, we present a patient with irregular thickening of the GB wall which was suspected to of GB carcinoma since FDG positron emission tomography/computed tomography scan showed increased tracer uptake in the lesion. However, after surgery the histopathological report was suggestive of XGC.

The Cost of Diagnostic Delay and Error.

For years, diagnostic delays and errors have been tolerated and often ignored, although they have been reported as a leading cause of patient harm.1 Beyond the evident impact on patient outcomes, there are limited data investigating the effect of such delays and errors on health care expenditure. The National Academy of Medicine estimates that $750 billion, or 30% of annual health care spending, is wasted in unnecessary services and other inefficiencies,2 but the contributions of diagnostic error to these excess costs remains uncertain. For this edition of Bending the Value Curve, we present a case that highlights the impact of a diagnostic delay on health care use and expenditures and illustrates factors contributing to the delay. Verbal informed consent for writing this report was obtained from the patient and his guardian. A 17-year-old boy presented to his primary care physician with rectal pain, intermittent rectal bleeding, and loose stools. He denied abdominal pain, fever, weight loss, or sexual activity, and his physical examination revealed anal tenderness to palpation, with no visible tears, bulges, or lesions. He was prescribed escalating treatments for possible hemorrhoids but had minimal improvement over 2 weeks. After a telehealth consult with gastroenterology (because of coronavirus disease 2019 [COVID-19] restrictions at the time), blood and stool samples were obtained for workup of inflammatory bowel disease (IBD), celiac disease, and infectious colitis, and urine samples were sent to evaluate for sexually …

ROLE OF MAGNETIC RESONANCE ENTEROGRAPHY IN THE DIAGNOSTICS OF ACTIVE CROHN’S DISEASE IN CHILDREN

Crohn’s disease (CD) is an idiopathic inflammatory bowel disease of the gastrointestinal tract. It is more common in the developed and industrialized countries, particularly in the Western Europe and North America. Up to 20–30% of patients present first symptoms during childhood or adolescence. Traditionally it is diagnosed by clinical indicates, endoscopy and histological findings. Assessment of the disease activity and location along the gastrointestinal tract are of crucial importance for diagnosis and implementation of the proper treatment. Active inflammation can manifest as mural thickening, edema, ulcerations, abscesses or fistulas. Magnetic resonance enterography (MRE) is the most modern radiological method in depicting all of these manifestations of CD.

ROLE OF MAGNETIC RESONANCE ENTEROGRAPHY IN THE DIAGNOSTICS OF ACTIVE CROHN’S DISEASE IN CHILDREN

Abstract Background Crohn’s disease (CD) is an idiopathic inflammatory bowel disease of the gastrointestinal tract. It is more common in the developed and industrialized countries, particularly in the Western Europe and North America. Up to 20–30% of patients present first symptoms during childhood or adolescence. Traditionally it is diagnosed by clinical indicates, endoscopy and histological findings. Assessment of the disease activity and location along the gastrointestinal tract are of crucial importance for diagnosis and implementation of the proper treatment. Active inflammation can manifest as mural thickening, edema, ulcerations, abscesses or fistulas. Magnetic resonance enterography (MRE) is the most modern radiological method in depicting all of these manifestations of CD. Objective The aim of the study was to assess the value of MRE in evaluation of Crohn’s disease in pediatric patients. Materials and Methods 18 children (8 boys, 10 girls) with confirmed diagnosis of Crohn’s disease, were included in the study. Each patient underwent MR enterography with intravenous administration of a contrast agent. All studies were performed using a 1.5T scanner according to a local study protocol. Results All MRE findings were associated with small bowel inflammation. All patients showed asymmetric ileal wall thickening and edema. Edematous ileocecal valve was visible in 8 patients. In 7 cases reactive lymphadenopathy was detected (lymph nodes ≥ 10 mm in short axis). In 4 patients small intestine fistulas were found, whereas abscess was observed in another 4 patients. In contrast-enhanced images, a vivid enhancement of the affected bowel section was revealed in all patients and in 10 children inflammatory infiltration of periintestinal fat was depicted. Conclusion MRE is a reliable tool in diagnosis, evaluation of the disease activity and assessment of potential complications of Crohn’s disease. Due to the lack of ionizing radiation MRE exhibits beneficial safety profile and can be offered to patients who repeatedly require follow-up examinations, especially in pediatric patients.

Comparative Study of Ultrasound and Magnetic Resonance Imaging of Adnexal Masses

Background: Current study aimed to assess the role of ultrasound and MRI in the evaluation of adnexal mass lesions and comparison with clinical outcomes. Subjects &amp; Methods: A total of 30 suspected adnexal mass detected on ultrasonography was performed MRI, and accuracy of both USG and MRI were compared with histopathology. Results: Abdominal pain was predominantly confined to the lower abdomen in13 of 30 cases (43.3%). On USG total number of benign lesions was 19, and the total number of malignancies was 11. However, on MRI, 21 cases were mild, and 9 cases were malignant. six cases were diagnosed as malignant in ultrasound. In these six cases, two cases were serous cystadenocarcinoma, two were mucinous cystadenocarcinoma, one was serious papillary cystadenocarcinoma of the fallopian tube, and one was a malignant tubo-ovarian mass. MRI accurately diagnosed 4 indeterminate cases that correlated with the histopathology report. 9 malignant lesions were diagnosed as malignant by MRI were 3 cases of serous cystadenocarcinoma, 2 cases of mucinous cystadenocarcinoma, 1 case of malignant tubo-ovarian mass, 1 case of endometrioid carcinoma, 1 case of serous papillary cystadenocarcinoma of the fallopian tube and 2 cases of malignant sex cord-stromal neoplasms. Both the cases of serous cystadenomas were correctly diagnosed as benign lesions on both ultrasound and MRI. There were 2 cases of mucinous cystadenocarcinoma, which were accurately diagnosed as malignant on both USG and MRI due to the presence of solid components, mural thickening. The sensitivity, specificity, and accuracy of USG were 36.6%, 94% and 55% respectively. The sensitivity, specificity, and accuracy of MRI were 81.80%, 94.7%, and 65.7%, respectively. Conclusion: The best agreement was observed between MR findings and diagnosis in origin, tissue content, and tissue characteristics. Sonography had a weak correlation in context to the definitive diagnosis for the origin and tissue content of a mass.