La classification d’Atlanta de la pancréatite aiguë, présentée en 1992, divise les patients en groupes affectés de formes légères et sévères sur la base de critères cliniques et biochimiques. Récemment, la terminologie et le schéma de classification proposés lors du Symposium initial d’Atlanta ont été révisés, et une nouvelle déclaration de consensus a été établie par le Groupe de travail sur la classification de la pancréatite aiguë (Acute Pancreatitis Classification Working Group). Les principaux changements comprennent la subdivision des épanchements liquidiens aigus en « épanchement liquidien péripancréatique aigu » et « épanchement liquidien pancréatique/péripancréatique postnécrotique aigu » (épanchement nécrotique aigu) en fonction de la présence de débris nécrotiques. Les épanchements liquidiens retardés ont de même été subdivisés en « pseudokyste » et en « nécrose pancréatique circonscrite » (walled-off necrosis). L’utilisation appropriée des nouveaux termes décrivant les épanchements liquidiens est importante pour la prise de décision chez les patients atteints de pancréatite aiguë. L’objectif de cet article de synthèse est de présenter un aperçu des complications de la pancréatite aiguë, en soulignant leur signification pronostique et leur impact sur la prise en charge clinique, et de clarifier les confusions terminologiques concernant les épanchements liquidiens pancréatiques.

The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.

La pancréatite aiguë est une maladie inflammatoire aiguë du pancréas qui peut également affecter les tissus environnants ou les organes distants. La Classification d’Atlanta de la pancréatite aiguë, présentée en 1992, répartit les patients en groupes affectés de forme légère ou sévère sur la base de critères cliniques et biochimiques. Récemment, la terminologie et le schéma de classification établis lors du Symposium initial d’Atlanta ont été révisés et un nouveau texte de consensus a été proposée par le Groupe de travail sur la classification de la pancréatite aiguë (Acute Pancreatitis Classification Working Group). D’une manière générale, une imagerie est recommandée pour confirmer le diagnostic clinique, explorer l’étiologie et effectuer une gradation de l’étendue de la sévérité de la pancréatite aiguë. L’échographie constitue la modalité d’imagerie de première ligne dans la plupart des centres pour la confirmation du diagnostic de pancréatite aiguë et l’élimination d’autres causes d’abdomen aigu, mais elle présente des limites dans un cadre clinique aigu. La tomodensitométrie permet non seulement d’établir le diagnostic de la pancréatite aiguë, mais également de déterminer le stade de sévérité de la maladie. L’imagerie par résonance magnétique a conquis un rôle encore plus important dans le diagnostic de la pancréatite aiguë. Elle est particulièrement utile chez les patients présentant des allergies à l’iode, pour caractériser des épanchements et évaluer des anomalies ou des déconnexions des canaux pancréatiques. L’objectif de cet article de synthèse est de présenter un aperçu de la pancréatite aiguë, de clarifier les confusions terminologiques, de souligner le rôle de l’échographie, de la tomodensitométrie et de l’imagerie par résonance magnétique en fonction du contexte clinique correct et de comparer les avantages et les limites de chacune de ces modalités.

Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.

Rhino-orbito-cerebral mucormycosis (ROCM) is a rare, fulminant opportunistic fungal infection that is mostly seen in immunocompromised or diabetic patients. The disease should be recognised and treated immediately. We present here MR imaging findings of two patients with histopathologically proven ROCM. One of the cases had a history of corticosteroid treatment and iatrogenic diabetes mellitus and although amphotericin B was started immediately, the disease progressed and surgical debridement was necessary. The second case was a patient with diabetes mellitus type 1 in whom ROCM had occurred following an abdominal surgery; amphotericin B treatment alone was adequate in this patient.

Lipomas of the colon are uncommon tumour of the gastrointestinal tract, but cause diagnostic difficulty when they are symptomatic. We reported two cases of symptomatic, large colonic lipoma. Colonoscopy was incomplete because of the narrowing lumen caused by lipomas. By the help of computed tomography colonography/virtual colonoscopy, colonic lipomas were diagnosed correctly, but also proximal colon was examined.

Multiseptate gallbladder, a rare congenital anomaly, may exist as an isolated anomaly or may coexist with other biliary system anomalies. We report a case of a multiseptate, ectopic, hypoplastic gallbladder associated with a choledochal cyst. The diagnosis was made using sonography and magnetic resonance cholangiopancreaticography. (C) 2006 Wiley Periodicals, Inc.

BACKGROUND:We evaluated the usefulness of magnetic resonance (MR) peritoneography for the examination of complications from continuous ambulatory peritoneal dialysis (CAPD).METHODS:MR peritoneography was performed in 20 patients who had suspected CAPD-related complications. Patients who had active peritonitis were not included in the study. Before MR imaging, a mixture of 2000 mL of peritoneal dialysis solution and 20 mL of gadopentetate dimeglumine was instilled into the peritoneal cavity. MR imaging was performed on a 1.0-Tesla system using a body coil. Axial, coronal, and sagittal fat-saturated fast spoiled gradient echo (repetition/echo times, 100/6.3 ms; flip angle, 90 degrees), axial fat-saturated T2-weighted fast spin echo (repetition/echo times, 6000/107 ms), and coronal fat-saturated T2-weighted fast spin echo (repetition/echo times, 3000/96.2 ms) images of the abdomen and the pelvis were obtained. After drain-age, triplanar fat-saturated fast spoiled gradient echo images were repeated with the same parameters.RESULTS:Homogeneous distribution of the dialysate in the peritoneal cavity was detected in 18 patients (90%). In 12 patients (60%), fluid leaks were discovered peripheral to the exit site, tunnel, and site of peritoneal entrance of the catheter. Fluid leaks through the abdominal wall in five patients (25%), retroperitoneum in one patient (5%), and a previous operation site in one patient (5%) were demonstrated. No abnormal finding was detected in three patients (15%) who had clinically suspected complications, whereas a dialysate leak was found in two patients (10%) who had no significant finding at physical examination.CONCLUSIONS:MR peritoneography provides detailed information about the anatomic distribution of dialysate leaks in patients treated with CAPD and poses no risks associated with ionizing radiation and nephrotoxic contrast medium.

OBJECTIVEOur aims were to evaluate the detectability, configuration, location, and dimensions of the cisterna chyli on heavily T2-weighted images obtained with a single-shot fast spin-echo technique and to determine whether the disorders that have the potential to affect the abdominal lymphatic drainage could change the cisternal dimensions.MATERIALS AND METHODSThin-collimated axial and coronal images that were originally obtained for MR cholangiopancreatography in 125 patients were reviewed by three observers individually for the presence of abdominal lymphatic confluence. The configuration, location, and dimensions of hyperintense ductal or saccular structures immediately anterior to the vertebral bodies below the diaphragma were recorded. The differences between the mean values of the diameters of the cisterna chyli obtained in the control group and in groups in which lymphatic drainage was expected to be abnormally high were compared using a one-way analysis of variance test.RESULTSAbdominal confluence of the lymphatics was shown in 96% of patients. The most common configuration of the cisterna chyli was tubular (42.5%). It was located at the level of L1-2 in 33% of cases and at the midline in 70%. Mean longitudinal, anteroposterior, and transverse diameters of the duct were 33.45 +/- 1.74 (SD) mm, 5.23 +/- 0.13 mm, and 5.23 +/- 0.15 mm, respectively. No significant difference was found in the mean values of antero-posterior, transverse, and longitudinal diameters of the cisterna chyli in the control group and in the groups expected to have an increased flow into the cisterna chyli.CONCLUSIONAbdominal confluence of lymphatics seems to be present on most of the heavily T2-weighted images. Its morphologic details and extensions can be visualized on images reconstructed with a maximum-intensity-projection algorithm. Any disorder does not necessarily lead to dilatation of these lymphatic structures.

Cisterna Chyli: An Incidental Finding on MR CholangiopancreatographyAyşe ErdenAudio Available | Share

Our purpose was to present the enhancement patterns of the liver on MR angiography in patients with hepatic outflow obstruction. Twenty-three patients with Budd-Chiari syndrome (4 in acute stage and 19 in chronic stage of the disease) were examined with 3D contrast-enhanced MR angiography. During early and late portal venous phase of MR angiography the pattern of parenchymal enhancement was assessed on source images. The enhancement patterns were evaluated under 4 groups as following: (a) central (b) peripheral (c) patchy and (d) homogeneous enhancement. The morphologic changes in the liver (lobar hypertrophy or atrophy, hepatic surface irregularities) were also recorded. In the acute stage global liver enlargement (75%) with caudate hypertrophy (100%) and central enhancement of the liver (75%) were suggestive findings of the hepatic outflow obstruction. The left lobe hypertrophy (53%) associated with the caudate lobe hypertrophy (72%) and irregular surface (26%) were predominant in the chronic stage of the disease. The enhancement patterns seen in chronic disease were variable and reflected the persistent stasis of the portal blood flow (patchy enhancement in 32% of the patients) or the altered hemodynamics of the liver due to the development of subcapsular collaterals (peripheral enhancement in 21% of the patients). Homogeneous enhancement of the liver in Budd-Chiari syndrome may indicate the chronicity of the outflow obstruction (37%) and shows a more stable hepatic perfusion that occurs after the formation of intra and extrahepatic collateral veins. The morphological and perfusional features on multiphase contrast-enhanced MR angiography are valuable in understanding the effects of the hepatic outflow obstruction on the liver parenchyma.

The purpose of this study is to compare contrast-enhanced three-dimensional (3D) magnetic resonance (MR) portograms to Doppler sonography in detection of portal venous abnormalities. Thirty-five consecutive patients, who were suspected of having portal venous system abnormalities, were examined with MR portography and Doppler sonography. Vascular abnormalities were identified in 27 of 35 patients. There was statistically significant agreement between the results of MR portography and Doppler sonography. The major limitation of contrast-enhanced 3D MR portography was its inability to provide objective hemodynamic data regarding flow direction and flow pattern.

We describe a patient in whom endoscopy failed to determine the origin of gastrointestinal bleeding, and magnetic resonance angiography showed dilated inferior pancreaticoduodenal veins that were considered indirect signs of the duodenal angiodysplasia. Incidentally, a connection between the inferior vena cava and the inferior pancreaticoduodenal veins were also noted. Repeat endoscopy and catheter angiography confirmed the presence of the angiodysplasias.

We describe a 48-year-old male patient who presented with rectal fullness and pain. Magnetic resonance imaging (MRI) and computed tomographic studies revealed a noncalcified, unilocular, cystic mass lesion with well-defined borders. On MRI nondependent fat spheres were detected inside the cyst. The same pattern has been described in dermoid cyst of the ovary. We suggest that this MRI pattern is specific to dermoid cysts.

A 30-year-old male with T-cell acute lymphoblastic leukemia presented with facial numbness. Neurological examination revealed paresthesia of the left trigeminal nerve. Cerebrospinal fluid (CSF) cytology showed no atypical cells. Gadolinium-enhanced magnetic resonance (MR) imaging demonstrated enlargement and enhancement of intracranial portions of the left trigeminal nerve. The abnormal MR imaging findings almost completely resolved after the chemotherapy. Gadolinium-enhanced MR imaging is not only a useful procedure for the early diagnosis of cranial nerve invasion by leukemia but it might be helpful to follow the changes after the treatment.

Brucellosis is an infection characterized by nonspecific manifestations and usually involves the reticuloendothelial and musculoskeletal systems., Endocarditis and aneurysm formations are uncommon sequelae of the disease.(2,3) In this report we present imaging findings of a patient with brucellosis in whom cardiovascular system involvement was predominant during the course of the disease.

Post-traumatic intrasplenic pseudoaneurysms are very rare in children. Since pseudoaneurysms may expand a splenic hematoma and cause delayed splenic rupture, early diagnosis and treatment are crucial. In this report, we describe the case of a 12-year-old boy with a delayed splenic rupture caused by a splenic hematoma containing 2 pseudoaneurysms. Abdominal sonography showed free intraperitoneal fluid and a mildly enlarged spleen with a large heterogeneous area occupying the upper half of the organ. Two anechoic lesions (15 and 4 mm) were seen inside the hematoma near the splenic hilum. Color Doppler sonography demonstrated turbulent arterial flow within the lesions, suggesting pseudoaneurysms. On CT, the lesions enhanced simultaneously with the splenic artery in the arterial phase of contrast enhancement. CT also showed an intrasplenic arterial branch leading to the larger of the 2 pseudoaneurysms. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:102–104, 2001.

OBJECTIVE:Radiography was traditionally used in the preoperative treatment of neonates with tracheoesophageal atresia and tracheoesophageal fistula. The aim of this study was to assess the potential use of three-dimensional CT in the evaluation of this complex congenital malformation.CONCLUSION:Three-dimensional CT coupled with reformations in the three orthogonal planes may have a complementary diagnostic role in congenital esophageal atresia.