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Portal hypertension is one of the most important causes of morbidity and mortality in cirrhotic patients. A color Doppler evaluation of the left gastric vein (LGV) has proven utility in the prediction of esophageal varices and variceal bleeding in patients with portal hypertension. The purpose of this review is to discuss the ultrasound evaluation, imaging findings, and clinical application of Doppler ultrasound in the assessment of the LGV. Knowledge of the color Doppler technique and imaging findings of the LGV may help clinicians improve the monitoring of portal hypertension and predict patients with a high risk of esophageal varices.

The aim of the study is to evaluate the diagnostic performance of apparent diffusion coefficient (ADC) and apparent kurtosis coefficient (Kapp) for the characterization of prostate lesions on 1.5T MRI. This retrospective study included 34 patients with at least one lesion with PI-RADS score≥ 3. Performances of ADC and Kapp were evaluated using the Mann-Whitney U test and receiver operating characteristics curve (AUROC). Lesions with Gleason score≥6 had significantly lower Kapp compared to benign lesions (p=0.025). The ADC-ratio was the only significantly different parameter between GS≥7 and GS=6 lesions (p=0.039). Kapp showed the largest AUROC for the diagnosis of GS≥6 prostate cancers (AUROC: 0.741, p=0.025), while the largest AUROC for the diagnosis of GS≥7 prostate cancers was achieved by the ADC-ratio (AUROC: 0.709, p=0.039). While Kapp demonstrated no significant benefit in characterization of prostate cancers compared to ADC, it could be helpful to distinguish benign lesions from prostate cancers.

Congenital cystic lesions of the bile ducts represent a spectrum of liver and biliary system lesions, resulting from abnormal embryologic development of the ductal plate. These disorders include Caroli disease, choledochal cysts, autosomal dominant polycystic liver disease, congenital hepatic fibrosis, and biliary hamartomas. Each disorder carries a peculiar clinical presentation, prognosis, and risk of complications. Knowledge of radiological findings of fibropolycystic liver diseases is crucial for their appropriate detection and for differential diagnosis with other similar hepatic cystic lesions, in order to avoid relevant misdiagnosis. The aim of this review is to provide an illustrative summary of the most relevant imaging findings of these conditions as encountered on ultrasound, computed tomography, and magnetic resonance imaging, and provide pearls for imaging-based differential diagnosis. (c) 2019 Elsevier Inc. All rights reserved.

COVID-19 has infected more than 2 million people in the world in less than 5months outbreak. Chest imaging is recommended for triage of suspected cases of COVID-19 with moderate-severe clinical features and high pre-test probability of disease, and may help for patient follow-up and to identify patients at higher risk of disease worsening. This pictorial essay illustrates typical and uncommon imaging findings of COVID-19 pneumonia and the role of imaging for patient management.

Coronavirus disease 2019 (COVID-19) is a newly emerging human infectious disease that has quickly become a worldwide threat to health, mainly causing severe acute respiratory syndrome. In addition to the widely described respiratory syndrome, COVID-19 may cause life-treating complications directly or indirectly related to this infection. Among these, thrombotic complications have emerged as an important issue in patients with COVID-19 infection, particularly in patients in intensive care units. Thrombotic complications due to COVID-19 are likely to occur due to a pro-coagulant pattern encountered in some of these patients or to a progressive endothelial thrombo-inflammatory syndrome causing microvascular disease. In the present authors' experience, from five different hospitals in Italy and the UK, imaging has proved its utility in identifying these COVID-19-related thrombotic complications, with translational clinical relevance. The aim of this review is to illustrate thromboembolic complications directly or indirectly related to COVID-19 disease. Specifically, this review will show complications related to thromboembolism due to a pro-coagulant pattern from those likely related to an endothelial thrombo-inflammatory syndrome.

Hydatid disease is a worldwide zoonosis endemic in many countries. Liver echinococcosis accounts for 60–75% of cases and may be responsible for a wide spectrum of complications in about one third of patients. Some of these complications are potentially life-threatening and require prompt diagnosis and urgent intervention. In this article, we present our experience with common and uncommon complications of hepatic hydatid cysts which include rupture, bacterial superinfection, and mass effect-related complications. Specifically, the aim of this review is to provide key imaging features and diagnostic clues to guide the imaging diagnosis using a multimodality imaging approach, including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and endoscopic retrograde cholangiopancreatography (ERCP).

Abdominopelvic vascular compression syndromes include a variety of uncommon conditions characterized by either extrinsic compression of blood vessels by adjacent anatomical structures (i.e., median arcuate ligament syndrome, nutcracker syndrome, May-Thurner syndrome) or compression of hollow viscera by adjacent vessels (i.e., superior mesenteric artery syndrome, ureteropelvic junction obstruction, ureteral vascular compression syndromes, portal biliopathy). These syndromes can be unexpectedly diagnosed even in asymptomatic patients and the predisposing anatomic conditions can be incidentally discovered on imaging examinations performed for other indications, or they can manifest with atypical abdominal symptoms and acute complications, which may lead to significant morbidity if unrecognized. Although computed tomography (CT) is an accurate noninvasive technique for their detection, the diagnosis remains challenging due to the uncommon clinical presentation and often overlooked imaging features. Dynamic imaging may be performed in order to evaluate patients with inconstant symptoms manifesting in a specific position. The purposes of this paper are to review the CT imaging findings of abdominopelvic vascular compression syndromes, correlating with anatomical variants and to provide key features for the noninvasive imaging diagnosis.

Spontaneous or traumatic rupture of renal cysts, documented by radiological imaging, occurs infrequently. The pathogenesis of a cyst rupture is still unclear, except when it has occurred following trauma or when the cyst has become infected. Imaging plays a crucial role in the diagnosis, management, surveillance, and choice of lesions that need treatment.

Behçet’s disease is a chronic and multisystemic inflammatory vascular disease of unknown etiology, affecting vessels of all kinds and sizes. The involvement of the vascular system is observed in approximately 5-30% of patients. The most frequent vascular manifestations are venous thrombosis followed by arterial aneurysms and arterial thrombosis. The identification of vascular involvement is very important for prognosis, indeed the rupture of an arterial aneurysm represents the leading cause of sudden death in patients with Behçet’s disease. Computed tomography (CT) plays a crucial role in the identification and in the follow-up of vascular involvement. In this paper, we report the case of a 42-year-old woman with Behçet’s disease, admitted to our emergency department for hemoptysis, showing pulmonary and visceral artery aneurysms identified at CT examination. A particular “string of beads” appearance of pulmonary arteries is described. We report, also, follow-up CT examination after medical therapy showing pulmonary artery aneurysms reduction and visceral artery aneurysms stability.

Epiploic appendagitis is the acute inflammation and infarction of epiploic appendages, commonly secondary to torsion. It is a great mimicker as its clinical manifestation may be similar to appendicitis, diverticulitis, or colitis. Focal abdominal pain, tenderness, and mild pyrexia are clinical features of the condition [1]. Epiploic appendages are pedunculated adipose structures which extend from the serosal surface of the colon, along the free taenia and taenia omentalis. They are abundant in the caecum and sigmoid colon and absent in the rectum

Congenital pulmonary airway malformations (CPAMs) are a heterogeneous group of congenital, non-hereditary lesions of the lung, cystic and non-cystic type with clear developmental anomalies and evident malformative changes, which derive from the excessive proliferation of the tubular bronchial structures. We described two rare cases of type IV CPAM detected in adult patients with different clinical presentation: one of these cases was symptomatic, complaining of cough and hemoptysis. Conversely, the other case was reported as incidental findings in patient with abdominal pain without respiratory symptoms. Chest computed tomography (CT) scan was performed showing voluminous cystic formations with fibrotic septa within the lesions in both patients. The patient with hemoptysis was subjected to video assisted thoracoscopic lobectomy, while the other one was hospitalized to perform biopsy, which confirmed the diagnosis of CPAM. All patients were advised to follow-up. The incidence of type IV CPAM in adult patients is probably underestimated; the knowledge of the CT features of CPAM is crucial for a correct diagnosis and an appropriate management of asymptomatic patients, which may be conservative.

The starry sky liver: multiple biliary hamartomas on MR cholangiopancreatography

Endometriosis is a common gynecologic disorder characterized by ectopic endometrial tissue growth outside the uterine cavity. Although usually occurring in pelvic organs, endometrial lesions may involve urinary tract. Renal endometriosis is extremely rare and it has only occasionally been reported in the past. We report two cases of patients with renal cystic lesions, incidentally found at imaging techniques during oncologic follow-up for gastric sarcoma and melanoma, initially misinterpreted as complicated haemorrhagic cysts and then histologically characterized as renal localizations of extragenital endometriosis.

Splenic hamartoma (or splenoma) is a rare, benign, vascular tumor, often incidentally found at imaging, surgery or autopsy. Albeit usually asymptomatic and rare in children, when it occurs in the pediatric population it is more commonly symptomatic. We report a case of a 15-year-old girl with iron-deficiency anemia and beta-thalassemia, who had a large (10 × 8 × 7 cm) splenic lesion with calcifications, incidentally found during follow-up for splenomegaly and histologically characterized as hamartoma with calcified areas. The association of hamartoma and hematological disorders is a very unusual condition in children.

Gastric rupture following blunt abdominal trauma is a rare presentation with a reported incidence of 0.02-1.7% in current literature. Traumatic gastric rupture is usually associated with other visceral injuries, such as splenic lesions and fractures. Prompt diagnosis and early intervention reduce mortality and morbidity. History of a recent meal has been implicated in traumatic gastric rupture. 2 We report a case of blunt abdominal trauma with an isolated gastric rupture after a motor vehicle accident, managed successfully without any post-operative morbidity and mortality.

CLASSICS IN ABDOMINAL RADIOLOGY