ObjectiveTo analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized.Materials and MethodsOne hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT)-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded.ResultsAortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed.ConclusionConsidering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject.

The persistent sciatic artery is a rare anatomical variant, representing the persistence of the sciatic artery in adult life that is responsible for the major blood supply to the lower limb in early embryologic development. Such persistence may be bilateral and can remain asymptomatic for many years. However, aneurysmal degeneration has been described as a complication of the persistent sciatic artery, which may cause critical limb ischemia resulting from thrombosis or embolization of aneurysm thrombus. Digital subtraction angiography, Doppler ultrasound, computed tomography angiography and magnetic resonance angiography are the most frequently used diagnostic tools to detect, classify and determine the presence of complications of a PSA. Early detection of this vascular abnormality on imaging studies can avoid life-threatening complications. We describe 4 patients with PSA that were diagnosed as an incidental finding in magnetic resonance imaging of the hip and demonstrate its characteristic imaging appearance.

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Abdominal angiostrongyliasis (AA) is a disease caused by Angiostrongylus costaricensis, a nematode that can infect humans accidentally through the ingestion of larvae. Worms live inside intestinal small vessels and can lead to gastrointestinal symptoms and bowel necrosis in otherwise healthy patients. Therefore, abdominal angiostrongyliasis may be important in the differential diagnosis with systemic vasculitides and other rheumatic diseases with vascular involvement. We report a case of abdominal angiostrongyliasis in an 18-year-old woman presenting with necrosis of the terminal ileum.

BACKGROUNDBone and joint tuberculosis reaches up to 35% of cases of extrapulmonary tuberculosis (TB), especially in immunosuppressed patients. Skeletal TB most often involves the thoracic spine (Pott's disease), followed by tuberculous arthritis in weight-bearing joints and extraspinal TB osteomyelitis. The sacroiliac joint (SI) is an uncommon site of infection and its diagnosis is often delayed. CASE REPORTA 37-year-old woman, housewife, with no comorbidities, presents with a 6-month progressive inflammatory low back and right gluteal pain. During this time, she used several anti-inflammatory drugs with partial improvement of symptoms and frequent recurrence. Two weeks before admission, she started presenting evening fever and night sweats and was treated with amoxicillinclavulanate for seven days, with no improvement in symptoms. There was a loss of 5 kg throughout the period. She came to the emergency with disabling low back pain, no respiratory, genitourinary or gastrointestinal symptoms. Her physical examination revealed stable vital signs, pain in SI topography, and positive Patrick's and Gaenslen's tests. Laboratory tests were performed showing mild normocytic normochromic anemia, high levels of erythrocyte sedimentation rate and C-reactive protein, negative viral serology. Magnetic resonance imaging (MRI) of sacroiliac joints revealed sacroiliitis with inflammatory and infectious features (Figure 1). A computed tomography (CT) was carried out to guide a biopsy, also showing bone erosions (Figure 2). A chest CT demonstrated a miliary pattern (Figure 3). Joint fluid showed a rapid test (PCR) for Mycobacterium tuberculosis and negative acid-fast bacillus (AFB) test. Mycobacterium tuberculosis culture and IGRA (interferon gamma release assay) were performed with a positive result. Treatment with rifampicin, isoniazid, pyrazinamide and ethambutol were started.