Epidermoid cysts are rare lesions that can occur anywhere in the body. They are associated with elevated serum levels of CA 19-9. The spleen represents the most common site of intra-abdominal localisation. Only two cases of diaphragmatic epidermoid cyst are reported in the literature. We present the case of a 61-year-old woman with a small suprasplenic subdiaphragmatic cyst discovered during the investigation of left flank pain. The establishment of an adequate diagnosis was challenging due to the difficulty in specifying the exact localisation of the cyst, the extremely elevated CA 19-9 level of 19,000 and the high uptake on 18-fluoro-2-deoxy-D-glucose positron emission tomography. The definitive diagnosis followed complete surgical excision. Intra-abdominal epidermoid cysts are usually discovered incidentally on imaging for another reason. The cyst is lined by squamous epithelium responsible for the secretion of CA 19-9. The elevation of serum CA 19-9 is due to small rupture or increased intraluminal pressure followed by diffusion to the bloodstream. Surgery with en-bloc resection represents the optimal treatment to avoid any risk of recurrence. The definitive diagnosis is established by demonstrating positive immunohistopathological staining of epithelial cell to CA 19.9.

Background: Pyocolpos, an uncommon accumulation of pus in the vagina, has not been previously reported in an elderly woman.Case : A 76-year-old woman was hospitalised with post-menopausal bleeding and fever. Pelvic examination revealed an obstructed vagina. A gadolinium MRI showed pyocolpos. After surgical drainage, the patient rapidly recovered.Conclusion : Pyocolpos in elderly woman may appear spontaneously without any history of gynaecologic cancer or trauma.

PURPOSE To prospectively compare the diagnostic performance of ultrasonography (US) and unenhanced multi-detector row computed tomography (CT) in patients suspected of having acute appendicitis by using surgery or clinical follow-up as the reference standard. MATERIALS AND METHODS The institutional review board approved the research protocol. Written informed consent was obtained from all patients or, for those who were adolescents, from their parents. Ninety-four patients (59 female and 35 male patients) aged 16-81 years (mean, 38 years) who were suspected of having acute appendicitis underwent both US and unenhanced multi-detector row CT of the entire abdomen. The examinations were performed within 1-2 hours of each other. US and CT images were obtained and prospectively interpreted by a different radiologist from a group of abdominal radiologists or a group of residents and general radiologists. Radiologists proposed an overall diagnosis and an alternative diagnosis. Data from US and CT were compared, and the definite diagnosis was established with surgical findings (n = 40) or results of clinical follow-up (n = 54) as the reference standard. Comparisons were made for each group of radiologists and the patient's age, body mass index (BMI), and sex. Proportion comparisons were made by using the Pearson chi2 test or the Fisher exact test. Continuous variables were compared between groups with the Mann-Whitney U test. RESULTS Thirty patients had definite appendicitis. The sensitivity, specificity, positive and negative predictive values, and accuracy were not significantly different between US and CT or between groups of radiologists (P values ranged from .389 to >.99), regardless of the patient's BMI (P values ranged from .073 to >.99). Misclassifications were compared with the definite alternative diagnosis and were not significantly different between US and CT or between groups of radiologists (P = .061-.592), regardless of patient age (P = .875) or sex (P = .151 and >.99 for male and female patients, respectively). The frequency of inconclusive examinations, however, was significantly higher with US than with CT, regardless of radiologist experience (P = .020 and <.001, respectively). CONCLUSION Although the diagnostic performances of US and multi-detector row CT are comparable, more inconclusive images were obtained with US.

The role of diagnostic imaging in chronic and inflammatory pancreatitis is to detect structural changes of the ducts and pancreatic parenchyma, to assess the functional integrity of the gland, to detect associated complications, and to assist in management. These goals may be achieved using helical CT and MR imaging with secretin stimulation. In this review, the advantages of each technique are discussed and illustrated.

Objective: The purpose of this study was to determine the incidence of lymph node and ovarian metastases in newly diagnosed uterine leiomyosarcoma (LMS). Methods: We used our databases to identify 64 consecutive patients with uterine LMS treated between 04/1993 and 12/2004. Patients were included if there was clear documentation of lymph nodes and/or ovarian tissue in their pathologic reports. Clinical data were extracted from electronic medical records. Results: There were 62 (96%) patients in whom an oopherectomy, 14 (22%) total or infracolic omentectomies and 16 (25%) patients in whom lymph node sampling was performed as a part of the initial surgical management of uterine LMS. Bilateral oopherectomy was performed in 57 (91%) of the 62 patients. The median numbers of pelvic, para-aortic, and total lymph nodes acquired were 16 (range, 1-36), 20 (range, 4-40) and 36 (range 4-84), respectively. Ovarian metastases were found in 4 (6.2%) out of 62 patients. Positive lymph nodes were seen in 5 (31%) of 16 patients. Omentum metastases were found in 2 (14%) out of 14 patients. None of the patients with stage 1-2 disease had positive lymph nodes and omentum metastases. Conclusions: Although the incidence of ovarian involvement is low in uterine LMS, lymph node involvement is commonly seen (31%) when properly lymph node sampling is done. Lymph node involvement is most commonly associated with extrauterine disease (stage 3-4), but because of high incidence of positivity with staging and importance in planning future therapy lymph node and omentum sampling should be done in every patient with a preoperative and intraoperative diagnosis of uterine LMS.

Radiofrequency ablation (RFA) recently emerged as an efficient and safe local ablative method to treat unresecable liver tumours. Currently however, the full spectrum of potential complications of RFA remains undetermined. We report a case of severe biliary complication, associating main bile duct stricture and biliary pleural fistula, arising after extensive RFA for unresectable liver metastasis of central location. Treatment consisted of external drainage of the pleural effusion and internal endoscopic drainage via a biliary stenting. This description of a life-threatening complication emphazises the need to better knowledge of the contraindications of RFA, particularly for the treatment of large tumours at proximity of main bile ducts.

Evaluer l’apport de l’opacification colique dans la mise en évidence des localisations coliques de l’endométriose. Une série de 36 patientes consécutives ayant bénéficié d’une résection chirurgicale d’implant endométriotique entreprenant le recto-sigmoïde ou le côlon. La mise au point pré-opératoire incluait dans tous les cas la réalisation d’un lavement baryte en double contraste. Le diagnostic d’atteinte digestive était fondé sur la présence d’une spiculation du contour colique avec froncement des plis associée à une empreinte sous muqueuse. La visualisation d’une compression extrinsèque simple n’entraînait pas de diagnostic positif. On retrouvait 8 atteintes du rectum, 3 de la jonction rectosigmoïdienne, 5 du rectum et du sigmoïde, 18 du sigmoïde, 1 de la jonction côlon descendant sigmoïde et 1 du bas fond cæcal. Le lavement baryte était positif chez 35 patientes soit une sensibilité de 97 %. Le lavement baryté colique en double contraste a une haute valeur prédictive positive dans le diagnostic de l’endométriose colo-rectale.

BACKGROUND & AIMS:This study aimed to compare the accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in assessing acute pancreatitis (AP) and to explore the correlation between MRI findings and clinical outcome.METHODS:Patients with AP were investigated by contrast-enhanced CT and MRI on admission and 7 and 30 days thereafter. MRI was performed with intravenous secretin and contrast medium. Balthazar's grading system was used to measure CT and MRI severity indices (CTSI and MRSI, respectively).RESULTS:Thirty-nine patients (median age, 47 years; range, 15-86) were studied. AP was of biliary etiology in 19 patients (49%). On admission, AP was assessed clinically as severe in 7 patients (18%). A strong correlation was demonstrated between CTSI and MRSI on admission and 7 days later. MRSI on admission correlated with the following: the Ranson score, C-reactive protein levels 48 hours after admission, duration of hospitalization, and clinical outcome regarding morbidity, including local and systemic complications. Considering the Ranson score as the gold standard, MRI detected severe AP with 83% (58-96, 95% CI) sensitivity, 91% (68-98) specificity vs. 78% (52-93) and 86% (63-96) for CT. Magnetic resonance cholangiopancreatography after i.v. secretin injection showed pancreatic duct leakage in 3 patients (8%).CONCLUSIONS:MRI is a reliable method of staging AP severity, has predictive value for the prognosis of the disease, and has fewer contraindications than CT. It can also detect pancreatic duct disruption, which may occur early in the course of AP.

Aim The aim of this study was to evaluate the role of the 18F-FDG-PET in the preoperative evaluation of patients with oesophageal or gastro-oesophageal junction (GEJ) cancer and to define its impact on therapeutic management. Patients and methods This study included 58 patients with biopsy proven oesophageal or GEJ cancer who underwent PET in addition to the conventional diagnostic work-up. The sensitivity, specificity and accuracy of CT and PET were calculated for detection of tumour and distant metastases. Results The sensitivity, specificity and accuracy of tumour detection were, respectively, 84, 100 and 84% for CT and 87, 100 and 87% for PET (p=ns). PET permitted detection of distant metastases, which were not seen on CT in seven patients. In two patients, a second primary tumour was detected on PET. Conclusions The sensitivity of PET for loco regional lymph nodes detection is low. The major clinical impact is the detection of distant metastases.

BACKGROUND:We investigated the feasibility, safety, and efficacy of laparoscopic antireflux surgery (LARS) after failure of Enteryx injection in the lower esophageal sphincter for the treatment of gastroesophageal reflux disease (GERD).METHODS:Four patients underwent LARS after failure of Enteryx injection. Particular care was taken during the procedure to identify unusual material or fibrosis.RESULTS:All patients underwent LARS successfully. In three patients, tight adhesions with fibrous tissues and black foreign material were observed around the esophagus. No complications occurred during the procedures. The postoperative period was uneventful and functional results were excellent.CONCLUSION:LARS following Enteryx injection is feasible. Careful dissection is mandatory to avoid operative complications. Both techniques may be considered as options for treating GERD.

Primary Hodgkin's Lymphoma of the EsophagusEmmanuel Coppens1, Issam El Nakadi2, Nathalie Nagy3 and Marc Zalcman1Audio Available | Share

Background: The purpose of this report is to describe the radiologic appearances of laparoscopic adjustable silicone gastric banding (LASGB), a new surgical treatment for morbid obesity. In this procedure, a silicone band is fastened around the fundus, delimitating a small proximal gastric pouch and stoma. The inner surface of the band is inflatable and connected by a thin silicone tube to an access port. This allows postoperative stoma size adjustment by puncturing the port and injecting or withdrawing saline solution.