Mucinous cystadenoma is a rare tumour of the appendix and is associated with mucocele formation as well as an increased risk of adenocarcinoma of the colon and ovaries. Preoperative imaging is important for diagnosing mucocele formation, associated complications, and malignancies. A rare case of mucinous cystadenoma and a review of the clinical and radiological features of mucinous cystadenoma are presented.

A 69-year-old man attended the Accident & Emergency Department complaining of abdominal distension for one day. He had no abdominal pain. On physical examination, he was afebrile and the vital signs were stable. The abdomen was distended. There was no abdominal tenderness, guarding, nor rebound tenderness elicited. A supine abdominal radiograph was taken (Figure 1).

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Objective: To describe the pattern of bronchostenosis revealed by computed tomography and virtual bronchoscopy in patients with active tuberculous endobronchitis and associated pulmonary manifestations. Methods: This retrospective study was conducted in Hong Kong, which is an endemic region for tuberculosis, where tuberculous endobronchitis remains a noteworthy clinical entity, with reported frequency of 10 to 40% in patients with active pulmonary tuberculosis. Medical records of a series of 18 patients with active endobronchial tuberculosis (without acquired immunodeficiency syndrome), having acid-fast bacilli in sputum smears, underwent computed tomography and virtual bronchoscopy in two regional hospitals between January 2007 and October 2009 were reviewed. The location, morphology, length, and percentage of luminal bronchostenotic narrowing were evaluated by such imaging and compared with fibre-optic bronchoscopy findings. Associated parenchymal manifestations, namely tree-in-bud nodules, cavitary lesions, segmental atelectasis and enlarged mediastinal lymph nodes, were assessed. Results: Involvement of tuberculous endobronchitis at a single major lobar bronchus with contiguous spread along ipsilateral bronchial tree was observed in most patients (n = 16, 89%). A mural cause of bronchostenosis remained the most frequent finding (n = 12, 67%), with irregular circumferential thickening predominating (n = 8, 44%). Regarding associated parenchymal manifestations, tree-in-bud nodules occurred in all patients (n = 18, 100%); cavitary lesions (n = 9, 50%) and segmental atelectasis (n = 7, 39%) were less frequent. Mediastinal lymph node enlargement was a rare finding (n = 3, 17%). Fibre-optic bronchoscopy performed during the same admission showed confirmatory results in all available cases (n = 14). Conclusion: Centripetal spread of tuberculous endobronchitis from distal small airways to proximal central airway was observed in the majority of our patients. This could correlate with probable pathogenic mechanisms including the submucosal lymphatic spread of tuberculous bacilli and the implantation of bacilli by infected sputum along the bronchial tree. Relative left-sided predominance of bronchial involvement was observed, possibly related to intrinsic anatomical difference in lymphatic drainage between left-and right-sided bronchi. Irregular circumferential and eccentric mural thickening was the most common morphological pattern of bronchostenosis with mural thickening. Mediastinal lymph node enlargement was rare.

Splenic injury or splenic ligament tear following colonoscopy is a rare but potentially life-threatening complication. It is often overlooked due to its bizarre clinical presentation and non-specific imaging features. It commonly presents as a delayed but serious complication that results in massive haemoperitoneum due to splenic injury. Urgent radiological or surgical intervention is required to control the bleeding and stabilise the patient's condition. The imaging features in relation to the relevant radiological anatomy have seldom been discussed in radiology literature. We report a case of massive haemoperitoneum following colonoscopy. The preliminary findings in preoperative computed tomography scan and digital subtraction angiography were confirmed during surgery which showed a tear in the splenocolic ligament with active bleeding. In addition, we review the anatomy of splenic ligaments and nearby vessels, and the role of computed tomography scan and digital subtraction angiography in identifying these structures. Knowledge about the relevant anatomy is crucial in understanding the pathogenesis and treatment options for this condition.