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A 60-year-old woman was admitted to hospital for acute post prandial epigastric pain and vomiting.

The authors report a case of liver trauma with hematoma complicated with a pseudoaneurysm. The latter was suspected on day 7, with a monophasic helical CT and was demonstrated with helical CT angiography. Arteriography confirmed the lesion and showed an associated arteriovenous fistula, unsuspected on helical CT. The pseudoaneurysm was managed with transcatheter embolization, completed with percutaneous embolization because of vascular spasm.

The aim of our study was to assess the value of sonography in the diagnosis of acute intestinal occlusion.Sonographic findings were reviewed in 50 cases of intestinal occlusion (39 small bowel and 11 colonic occlusions). The final diagnosis was based on surgical findings (n = 40) or clinical course and further imaging findings (n = 10).Occlusion was correctly detected with sonography in 48 cases (96%). The location was correctly established with sonography in 43 cases (86%). The precise cause was suggested with sonography in 21 cases (42%).These results confirm the value of sonography for the diagnosis of intestinal occlusion and the identification of its level and its cause.

Intraductal papillary-mucinous tumours are rare epithelial tumours with all intermediate types occurring from papillary to mucin-hypersecreting forms. They affects generally old men and recurring pancreatitis is the main clinical feature. Endoscopic Retrograde Pancreatography is the best diagnostic method, showing large dilatation of the ducts and filling defects due to mucin's plugs or papillary tumour. IPMT are slow-growing and have low malignant potential; as to far, surgical resection is considered mandatory, however, better distinction between benign and malignant evolution will probably select cases in which conservative follow-up may be proposed.

Iron oxide particles are a potent class of MR contrast agents. Depending on their size and formulation, iron oxides are selectively taken up by the reticuloendothelial system or the hepatocytes. Experimental and clinical studies have shown that iron oxides can improve the detection and the characterization of liver tumors and can contribute to the detection of diffuse liver lesions. These tissue-specific MR contrast agents combine anatomic and functional information about liver lesions.

The multiplanar capability of spiral CT improves the evaluation of bile duct lesions. In particular, spiral CT after intravenous administration of a cholangiographic agent (spiral CT cholangiography) provides adequate 2D and 3D images of the bile ducts in patients with normal bilirubin levels. Spiral CT cholangiography may be particularly useful as a noninvasive imaging method to detect biliary anatomic variations and bile duct stones before or after laparoscopic cholecystectomy. This technique does not replace retrograde cholangiography which has therapeutic applications, but might help to select patients who need to undergo invasive procedures such as retrograde cholangiography.

We report on a patient admitted for work up of prostatic carcinoma in which CT study showed an excavated mass involving the sigmoid colon and the bladder dome. Barium enema showed a double track pattern associated with diverticular disease. By surgery the mass was separated from the urinary bladder and the sigmoid resected. On pathological exam diverticulitis was evident as well as an organised colocolic fistula in the thickened fibrotic subserosal fat. The usefulness of opacifying the colon is highlighted.

The sensitivity of ultrasonography (US) as the initial imaging procedure in acute diverticulitis of the left colon was retrospectively compared with that of computed tomography (CT) in 34 patients. Final diagnosis was based on clinical findings and follow-up in a first group of 20 patients with mild diverticulitis, and was proved by surgery in a second group of 14 patients with severe diverticulitis. In the first group, US showed findings consistent with diverticulitis in 19 patients, as did CT. The image of an inflamed diverticulum was shown by US in 10 patients. In the surgical group, findings consistent with diverticulitis were shown by US in 11 cases, and by CT in 13 cases. An inflamed diverticulum was not detected at US in this group of patients, presumably because the diverticulum was incorporated in the inflammatory process. These results suggest that US is a valuable technique in the initial evaluation of patients suspected of having acute diverticulitis, especially when the disease is not severe. The image of an inflamed diverticulum shown at US strongly suggests the diagnosis of mild diverticular disease. When diverticulitis is severe, CT should be performed in addition to US.

Twelve caucasian patients with intraperitoneal hemorrhage due to spontaneous rupture of hepatocellular carcinoma were treated by emergency transcatheter arterial embolization (n = 9) or chemoembolization (n = 3). Pretreatment angiography showed active bleeding (extravasation of contrast medium) in two patients only. Successful hemostasis was initially achieved in all patients. Early recurrence of hemorrhage was noted in 3 patients with large tumors; two were successfully treated by a second embolization and one died immediately after the first embolization. Of the 12 patients, two underwent subsequent chemoembolization while two had surgical resection of their tumors. The mean length of survival was 7 months from the time of rupture. No serious complications related to embolization or chemoembolization were noted. Our data suggest that emergency embolization or chemoembolization is an effective treatment in caucasian patients with intraperitoneal hemorrhage from hepatocellular carcinoma. Prognosis of ruptured hepatocellular carcinoma in those patients, however, remains poor.

Computed tomography (CT) of the esophagus, the stomach and the duodenum allows characterization of some lesions: lipomas, cysts and duplications, recent haematomas, vascular anomalies. CT is particularly used for the extramural staging of neoplasms: despite important limitations, CT may be useful as staging test to identify a subgroup of patients with definitive metastases or local invasion who therefore have unresectable tumors. CT is helpful for the staging of lymphomas. The importance of this staging classification is reflected in differences in treatment and prognosis. CT is also useful for the follow-up after treatment, the diagnosis of recurrence and postoperative complications.

We made the diagnosis of internal jugular vein thrombosis by computed tomography in 3 cases. The CT diagnostic signs are the following: widening of the vein caliber, absence of opacification or nonhomogeneous aspect of the opacification of the lumen, and parietal contrast fixation. Classical and more recent etiology refers to cervico-facial infections and injuries, central venous catheterizations and local surgery, compression by a cervical mass, and use of oral contraceptives. The advantage of CT consists in its noninvasive contribution to defining a diagnosis that pathology, which is nonspecific (painful cervical tumefaction), often cannot reach.

to assess the signs of TIPS dysfunction at Doppler sonography.retrospective study of signs observed in 106 TIPS including 31 TIPS with dysfunction (portoauricular pressure gradient12 mmHg).the signs of TIPS dysfunction were a decrease in the mean velocity in the TIPS (for a velocity40 cm/sec, 90% sensitivity, 96%), a hepatopetal intrahepatic portal flow (on the right 90% sensitivity, 100% specificity, on the left 95% sensitivity, 92% specificity), a lack of cardiac modulation of the signal in the TIPS (93% sensitivity, 65% specificity), a hepatic vein flow reversal (30% sensitivity, 100% specificity), and, the only direct sign of stenosis, an increase of the mean velocity in the stenosis (42% sensitivity, 95% specificity for a velocityor = 1 m/sec).the most sensitive Doppler signs of tips dysfunction are the indirect signs of stenosis.

Detection of acute intestinal ischemia is a diagnostic challenge. Color Doppler sonography of the abdomen may contribute to its diagnosis by showing lesions of the gut wall associated with occlusion or stenosis of the mesenteric vessels. Our overview of the sonographic findings of acute intestinal ischemia is presented as well as a proposition of algorithm for the working up to the diagnosis based on recent clinical experience.

The aim of this study was to evaluate the contribution of colour Doppler sonography in the diagnosis of acute intestinal ischaemia. In a two years experience, all patients admitted for acute abdominal pain in our emergency department were evaluated with colour Doppler sonography of the abdomen. The final diagnosis based on clinical evolution, endoscopic or surgical findings and further radiological investigations was compared to the sonographic results. Therapy and final outcome of the patients with acute intestinal ischaemia were also evaluated. In twenty-one patients a final diagnosis of acute intestinal ischaemia (mesenteric ischaemia (n = 13) and ischaemic colitis (n = 8)) was made. Intestinal ischaemia was correctly diagnosed by initial clinical and biological data and further confirmed by sonography in eight cases (mesenteric ischaemia (n = 2) and ischaemic colitis (n = 6)). Eleven other cases were detected by suggestive colour Doppler sonography features (mesenteric ischaemic (n = 10) and ischaemic colitis (n = 1)). Sixteen of the 21 patients had a final favourable outcome (mesenteric ischaemia (10/ 13) and ischaemic colitis (6/8)). We conclude that sonography has a place in the diagnosis of acute intestinal ischaemia and has to be integrated in the diagnostic algorithm of this acute condition. By this way, this diagnosis may be suspected earlier and may allow a prompt and adapted treatment with possible improvement in survival rate.

Familial adenomatous polyposis (FAP) is characterised by hundreds of colorectal adenomas. Endocrine neoplasms have occasionally been reported, as have gastric polyps, which are usually hamartomatous in the fundus of the stomach and adenomatous in the antrum. A 57 year old man with colorectal, gastric, and periampullary adenomatous polyposis, in association with three bilateral adrenocortical adenomas, is presented. Mutation screening showed a 5960delA germline mutation in the adenomatous polyposis coli (APC) gene predicted to lead to a premature stop codon. This mutation was found in three of the four children of the patient. Western blot analysis of a lymphoblastoid cell line derived from the patient failed to detect any truncated APC polypeptide. This rare 3' mutation is responsible for an unusually complex and late onset phenotype of FAP. Keywords: familial adenomatous polyposis; APC mutation; adrenal adenoma

Various acute intestinal diseases can be imaged with ultrasound and in particular intestinal occlusion, acute ischemia and inflammatory diseases such as appendicitis and diverticulitis. We review the contribution and limitations of ultrasound to these diagnoses.