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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.

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.