Torsion of an accessory spleen is a very unusual entity that can appear with abdominal pain associated with the presence of an avascular mass. We report the case of a 13-year-old boy with torsion and infarction of an accessory spleen presenting as a painful abdominal mass in which imaging examination with US, CT and MR showed a large avascular mass in the upper left abdomen.

No abstract

No abstract

Purpose: To investigate the ability of contrast-enhanced ultrasound (CEUS) to differentiate benign from malignant lesions causing biliary duct obstruction. Materials and Methods: Between November 2006 and December 2013, 59 patients with bile duct obstruction of undetermined cause in baseline ultrasound underwent CEUS study. The enhancement and posterior washout were analyzed in real time all along the study duration (5?). The final diagnosis suggested by CEUS was compared with histologic diagnosis (47.5%) or with radiologic follow-up with TC, RM or ERCP. Results: Final diagnoses included 42 malignant lesions (cholangiocarcinoma n=22, metastases n=6, pancreatic carcinoma n=6, hepatocarcinoma n=4, gallbladder carcinoma n=2, ampullary carcinoma n=1 and lymphoma n=1) and 17 benign lesions (lithiasis or biliary sludge n=15, xanthogranulomatous cholecystitis n=1 and indeterminate n=1). CEUS accuracy compared with final diagnoses based on combined reference standard was 86.4%. CEUS correctly identified 36 of 42 malignant lesions (sensibility 85.7%) and 15 of 17 benign lesions (specificity 88.2%). The positive predictive value of CEUS for malignancy was 94.7%, while the negative predictive value was 71.4%. Conclusion: CEUS is useful to differentiate between benign and malignant causes of obstructive jaundice. This technique improves the detection of bile duct invasion in hepatic neoplasms and permits better evaluation of intra- and extraductal extension of hilar hepatobiliary tumors.

We report on a case of chylous ascites associated with acute pancreatitis secondary to gallbladder stone disease, in a patient undergoing continuous ambulatory peritoneal dialysis. The initial clinical presentation was one of bacterial peritonitis, with later appearance of chylous peritoneal drainage. Diagnosis was suggested by abdominal computed tomography and confirmed by surgical exploration. We discuss the main diagnostic keys of peritoneal dialysis-associated pancreatitis and the possible etiologic role of this entity in chylous ascites of these patients.