1/9. CT halo sign in pulmonary metastases from mucinous adenocarcinoma of the pancreas.The CT halo sign was first described in immunocompromised patients with invasive pulmonary aspergillosis. Although the halo sign was originally thought to be specific for invasive pulmonary aspergillosis, it has been reported in a wide variety of pulmonary abnormalities in both immununocompromised and immunocompetent patients. We report a case of mucinous adenocarcinoma of the pancreas metastatic to the lungs in which there were multiple pulmonary nodules showing the halo sign. This case further illustrates the nonspecific nature of the CT halo sign and the need to consider malignancy as a cause in immunocompetent patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/9. chylous ascites as the main manifestation of left ventricular dysfunction: a case report.BACKGROUND: Ascites is one of the most common complications of liver diseases, even though in 15% of the cases it is related to extrahepatic diseases; 3% are of cardiac nature and they appear associated with signs and symptoms of heart failure. CASE PRESENTATION: A 70 year old man was admitted with more than one year history of abdominal distension and a weight gain of 10 kilograms. He is asymptomatic and walks 2000-3000 meters a day without angor or dyspnea. The physical examination shows moderate abdominal distension, with no hepatosplenomegaly or edema, and there is mild jugular vein distension. The studies performed (complete laboratory work up, paracentesis, liver biopsy, echocardiogram, intrahepatic pressure measurements, etc.) showed a chylous ascites related to portal hypertension, and left ventricular dysfunction was the only probable cause found. CONCLUSION: Asymptomatic heart dysfunction can mimic liver disease and should be kept in mind as a cause of chylous ascites.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/9. Variable expression of IgG2 deficiency.Sustained and significant reversal of antibody deficiencies is uncommon, although it has been noted in some cases during childhood and after viral infections. We report a case of reversal of IgG2 deficiency after splenectomy. A 46-year-old man who suffered recurrent sinusitis despite antibiotic therapy was noted to have IgG2 deficiency and cutaneous anergy. Replacement therapy with intravenous immunoglobulin ameliorated his symptoms. After 13 months of therapy, the patient had a diagnostic laparotomy and splenectomy because of portal hypertension, hypersplenism, and consideration of underlying malignancy. No evidence of malignancy or infection, including human immunodeficiency virus, active cytomegalovirus, or Epstein-Barr virus infection, was found. After splenectomy, the patient's serum IgG2 level normalized without replacement therapy. Subsequently, it fell, then normalized once more, and remains normal. The patient also demonstrated positive reactions to delayed hypersensitivity testing after splenectomy, but, subsequently, became anergic and remains anergic at the present time. Since the splenectomy he has remained clinically well without antibiotics or immunoglobulin replacement. in vitro analysis of his lymphocyte function demonstrated impaired T cell proliferation as well as an intrinsic B cell differentiation defect. This case demonstrates the potentially dynamic nature of IgG subclass deficiencies.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/9. arteriovenous fistula and portal hypertension secondary to islet-cell tumor of the pancreas.A case of portal hypertension secondary to an arteriovenous fistula in a pancreatic tumor is presented. Recurrent gastrointestinal hemorrhage prompted endoscopy which revealed esophageal varices and an abnormal papilla of Vater. ultrasonography and arteriography were instrumental in demonstrating the nature of the pathological process. In this situation portal hypertension resulted from increased portal venous flow rather than portal obstruction. Correction must include obliteration of systemic arterial to portal venous communication.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/9. Functional asplenia and portal hypertension in a patient with primary splenic hemangiosarcoma.A 60-year-old man with primary splenic hemangiosarcoma (PSH) presented with weakness, weight loss, abdominal pain, and anemia. physical examination revealed hepatomegaly, ascites, and firm, huge splenomegaly. ultrasonography showed many nodular structures characterized by hypoechogenic and hyperechogenic areas. The patient also had portal hypertension, which was confirmed by physical findings and by measurement of portal vein pressure during operation. A liver-spleen scan using Tc-99m sulfur colloid and Tc-99m labeled heat denatured erythrocytes failed to demonstrate any splenic uptake, a reliable feature of functional asplenia. Although on a total body scan with Ga-67 citrate there was no splenic uptake, there was gallium uptake in the liver, where the presence of the metastatic lesion was histopathologically verified and confirmed by operation. There was also uptake in the middle zones of the lungs. Ga-67 citrate imaging appears to be helpful in the diagnosis of metastasis of PSH, and PSH can rarely cause portal hypertension.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/9. aneurysm of the splenic artery.Two cases of multiple aneurysms of the splenic artery are reported. The aneurysms themselves were asymptomatic and the patients were operated upon for other reasons. In the first case the aneurysm was of an arteriosclerotic nature and in the second it coexisted with portal hypertension. The literature on this subject is briefly reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/9. Systemic lupus erythematosus associated with multiple nodular hyperplasia of the liver.Three autopsy cases of systemic lupus erythematosus with unique association of multiple nodular hyperplasia (MNH) of the liver, portal hypertension, and hypertensive pulmonary vascular disease are reported. None of the patients had received oral contraceptive or androgenic steroid, but they were treated with glucocorticoids for 2 to 11 years. Raynaud's phenomenon, sclerodactyly, and mild impairment of the kidney were the common clinical features. Macroscopically, MNH is characterized by many nodules scattered throughout the non-cirrhotic liver, and histologically, each nodule is made up of normal-appearing hepatocytes and not encapsulated. Portal tracts are scanty in the nodules. MNH seems to be a regenerative-hyperplastic process, but its true nature still remains unclear. Relationships between MNH and portal hypertension, MNH and pulmonary hypertension, and collagen disease and pulmonary hypertension are discussed. A brief review of the literature concerning multiple benign hepatocellular tumors similar to MNH is also presented.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/9. Imaging findings in giant pseudotumoral paraesophageal varices.We report a case of variceal changes of the azygos vein, hemiazygos vein, and paraesophageal collaterals presenting as bilateral posterior mediastinal masses in a patient with long-standing portal hypertension due to hepatosplenic schistosomiasis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. Dynamic CT allowed the diagnosis in demonstrating the vascular nature of these masses, which enhanced to the same degree as the other vessels. Noninvasive techniques, such as color Doppler sonography and MRI, may also be useful due to their multiplanar capabilities.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/9. An unusual localization of massive portasystemic collaterals: CT angiographic demonstration.This article presents a patient with portal hypertension in whom an unusual localization for portosystemic collaterals have incidentally been found. Upper abdominal sonography revealed tubular structures filling the whole perirenal and partially the perihepatic area, and their venous nature was demonstrated with duplex Doppler sonography. Spiral CT angiography identified the right-sided retroperitoneal location and mesenteric-lumbar route of the collaterals. Upper gastrointestinal endoscopy with antral biopsy and percutaneous liver biopsy were performed. Laboratory results and specimen evaluation revealed chronic active hepatitis due to hepatitis-B infection. attention is drawn to the abnormal location of these vessels, together with the noninvasive nature and competence of CT angiography in demonstrating vascular pathologies.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |