Malignant transformation is a rare but well-documented complication of endometriosis, occurring in 0.7% to 1% of cases. The ovary is involved in 76% of such cases, and extragonadal sites constitute the remaining 24%: the colon and rectum are involved in only 5%. Several previous papers have discussed risk factors for and immunohistochemical studies of malignant transformation of intestinal endometriosis, but few include imaging features. In this report, we demonstrate and discuss the imaging features of a case of malignant transformation of intestinal endometriosis.
Transjugular intrahepatic portosystemic shunt (TIPSS) is recognized as a useful technique in cases that fail to respond to two endoscopic sessions after acute variceal bleeds. TIPSS has been shown to be as effective in managing acute gastric bleeds as in managing acute oesophageal bleeds. The major complications of TIPSS procedures are shunt insufficiency and hepatic encephalopathy. New or worsened hepatic encephalopathy after TIPSS has been seen in up to 35% of cases, and it has been reported to be refractory to conservative medical treatment in up to 7% of cases, in whom further intervention has been necessary to reduce flow through the TIPSS. This may be performed by occluding the shunt completely or by using one of a variety of endovascular devices aimed at reducing the calibre of the stent lumen, which increases the portosystemic pressure gradient across the stent and improves intrahepatic portal bloodflow. Such techniques often improve the encephalopathy, but they may increase the risk of variceal bleeding, requiring a fine balance between the two. In this article, we describe a method to increase the portosystemic pressure gradient across the shunt in a controllable way, thus reducing encephalopathy but also minimizing the risks of further bleeding.
A little girl aged 2.5 years presented with left-sided facial weakness of acute onset and approximately 9 months duration (according to the mother). There was no history of a previous viral illness, ear discharge or trauma. The child’s behaviour was reported as normal and there was no impairment in developmental and motor skills. Her delivery had been normal and her birth weight was 2.1 kg. Neurological examination confirmed a left 7th cranial nerve lower motor nerve palsy, with no associated 6th nerve involvement or bulbar palsy. Fundoscopy was normal and there were no signs of raised intracranial pressure, nor were cerebellar signs elicited. Power and deep tendon reflexes in the limbs were normal. CT demonstrated a cystic mass of the fourth ventricle, and MRI was requested for further evaluation. MRI of the brain was performed before and after gadolinium DTPA contrast injection, in the sagittal
Whereas metastasis to bone is not uncommon for certain primary tumours, metastasis to the distal appendicular skeleton is extremely rare. Hypernephroma metastasizing to the calcaneum has been described in only a small number of cases and is even less common as the presenting feature of an occult renal cell carcinoma. Highly vascular bone metastases of the calcaneum mimicking vascular malformations are rarer still; to our knowledge there have been no previously reported cases. We present two cases of occult renal cell carcinoma presenting as a vascular lesion of the foot.
Portal vein aneurysms are not commonly encountered in clinical practice. They are usually extrahepatic and occasionally intrahepatic. Most are asymptomatic and detected incidentally; they may be associated with portal hypertension. Complications include thrombosis, rupture and formation of portosystemic shunts. A review of the Englishlanguage literature revealed 47 cases of portal vein aneurysm, but there has been only one Englishlanguage report in more than the last three decades of a such an aneurysm leading to cholestasis. We present such a case, together with a comprehensive review of the literature on portal vein aneurysms.
Bouveret’s syndrome is a rare condition characterized by gastric outlet obstruction secondary to impacted gallstone in the duodenal bulb. It occurs most commonly in elderly women who are often in poor general condition and at high surgical and mortal risk. Relief of the acute gastric obstruction is of primary importance. Endoscopic treatment with stone extraction, extracorporeal shockwave lithotripsy, intracorporeal electrohydraulic lithotripsy and endoscopic laser lithotripsy have all been described as alternatives to surgery. We present a case where the patient’s poor clinical state precluded a surgical procedure and palliative treatment in the form of fluoroscopic duodenal stent insertion was carried out, with good result.
Extravasation of iodinated contrast media into peripheral soft tissue at the site of intravenous (IV) injection is a familiar complication. Although the reported overall rate of extravasation is relatively low (0.04%–1.3%), it is commonly seen because of the large number of radiological studies that require the use of IV contrast media. In particular, the increasing reliance on power injectors that deliver contrast media at a fast rate for CT studies has necessitated a high level of awareness of the nature of extravasation, its prevention and treatment. Occasionally, an alternative route of contrast administration may be required in patients with poor peripheral IV access, and an existing central venous catheter is used in some institutions although this practice is discouraged by most manufacturers of such catheters. Even though the central line is carefully checked for patency and integrity and the injection rate is typically lowered, a theoretical risk exists for extravasation along the course of the catheter and, specifically, into the mediastinum. However, there is little documentation in the literature of the natural course of extravasated contrast media in the mediastinum. We present a case in which contrast medium was extravasated into the mediastinum of an individual
The disorder usuallypresents with chronic localized back pain often ofseveral months’ duration. We report an unusualcase in which a non-obese person, without any ofthe above risk factors, presented acutely withsevere back pain following a lumbar puncture forsuspected subarachnoid haemorrhage. The symp-toms were subsequently found to be due to spinalepidural lipomatosis. A brief review of the relevantliterature is also presented.
