We describe a unique case of a patient who presented with a linear, transverse, and incidentally-detected main pancreatic duct dilatation that was caused by the intrapancreatic-replaced common hepatic artery, detected on the MDCT, MRCP and endoscopic retrograde cholangiopancreatography. We believe this case to be the first of its kind reported in the literature.
Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic/complications/diagnosis ; Dilatation, Pathologic/diagnosis/etiology ; Hepatic Artery/*abnormalities ; Humans ; Incidental Findings ; Magnetic Resonance Imaging ; Male ; Middle Aged ; *Pancreatic Ducts ; Tomography, X-Ray Computed

Self-expandable stents are widely available for the treatment of perforation of the gastrointestinal tract. Because of the risk of migration, there has been no report of the use of self-expandable stents for the treatment of perforation of the colon or rectum. This is a report of successful treatment of iatrogenic colonic perforation during balloon dilatation of anastomotic stricture with a fully covered stent. Fully covered, self-expandable metallic stents can be considered useful tools for management of this condition.
Aged, 80 and over ; Colon/*injuries/pathology/radiography ; Colonic Diseases/diagnosis/*therapy ; Constriction, Pathologic ; Dilatation/*adverse effects ; Humans ; *Iatrogenic Disease ; Intestinal Obstruction/diagnosis/*therapy ; Intestinal Perforation/diagnosis/etiology/*therapy ; Male ; *Metals ; Prosthesis Design ; Sigmoidoscopy ; *Stents ; Treatment Outcome ; Wound Healing

Although pulsatile tinnitus can be audible, objective demonstration of this heartbeat-synchronous sound has rarely been successful. We report a rare case of pulsatile tinnitus in a 44-yr-old female patient, which was induced by a large mastoid emissary vein (MEV) and objectively documented by Doppler sonography of the left posterior auricular region. The tinnitus was intermittent and the patient could adapt to the tinnitus without intervention on the mastoid emissary vein. These findings suggest that a single large MEV can cause pulsatile tinnitus in the absence of other vascular abnormalities, and imaging studies of the posterior fossa and Doppler ultrasonography can aid the diagnosis in such cases.
Adult ; Dilatation, Pathologic/complications ; Female ; Humans ; Jugular Veins/radiography/ultrasonography ; Magnetic Resonance Imaging ; Mastoid/blood supply/ultrasonography ; Tinnitus/*diagnosis/etiology ; Tomography, X-Ray

OBJECTIVETo compare the findings of pancreaticobiliary duct dilation due to pancreatic carcinoma and chronic pancreatitis by magnetic resonance cholangiopancreatography (MRCP).

METHODSMRCP findings in 28 cases of pancreatic carcinoma and 42 cases of chronic pancreatitis were retrospectively analyzed. Both plain MR and MRCP examinations were performed in all the cases after oral Gd-DTPA dilution.

RESULTSMRCP in the patients with pancreatic carcinoma displayed dilated pancreatic duct with smooth and regular caliber (n=16, 72.7%), dilated common biliary duct with abrupt rupture in most cases (n=18, 90%) and intra- and extra-hepatic cholangiectasis (n=12, 42.8%), and the double-duct sign (n=19, 86.5%). In the patients with chronic pancreatitis, MRCP identified irregular dilation of the pancreatic duct across the whole segment of the lesion (n= 20, 60.6%), taper of the dilated common bile duct (n=8, 80%), stones within the pancreatic duct (n=5, 11.9%), and pancreatic pseudocsyt within the pancreatic duct (n=21, 50%).

CONCLUSIONCholangiopancreatographic findings of pancreaticobiliary duct dilation are of great value in distinguishing pancreatic carcinoma from chronic pancreatitis.

Adult ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Magnetic Resonance ; methods ; Chronic Disease ; Common Bile Duct ; pathology ; Diagnosis, Differential ; Dilatation, Pathologic ; etiology ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Ducts ; pathology ; Pancreatic Neoplasms ; complications ; diagnosis ; Pancreatitis ; complications ; diagnosis ; Reproducibility of Results ; Sensitivity and Specificity

A 34-year-old woman was admitted to the hospital because of recently aggravated right heart failure without angina for 5 months. When she was 25 years old, patch repair with Polytetrafluoroethylene (PTFE) was performed for the secondum type of atrial septal defect (ASD) with moderate pulmonary hypertension. The chest PA, echocardiography and cardiac catheterization at current admission revealed Eisenmenger syndrome without intracardiac shunt. Chest CT scan with contrast revealed markedly dilated pulmonary trunk, both pulmonary arteries and concave disfigurement of the left side of the ascending aorta suggesting extrinsic compression, as well as total occlusion of the ostium of the left main coronary artery that was retrogradly filled with collateral circulation from the right coronary artery. The coronary angiography showed normal right coronary artery and the collaterals that come out from the conus branch to the mid-left anterior descending artery (LAD) and that from distal right coronary artery to the left circumflex artery (LCX) and to the distal LAD, respectively. On aortography, the left main coronary artery was not visualized with no stump, suggestive of total occlusion of the ostium of the left main coronary artery. From our experience, it is possible to say that the occlusion of the ostium of the left main coronary can be induced by the dilated pulmonary artery trunk due to ASD with pulmonary hypertension and that, if the ASD closure was too late, the narrowing or obstruction of the left coronary artery could not be resolved even after operation owing to irreversible pulmonary hypertension.
Adult ; Case Report ; Constriction, Pathologic/etiology/radiography ; Coronary Disease/*etiology/radiography ; Dilatation, Pathologic/etiology ; Eisenmenger Complex/diagnosis ; Female ; Heart Septal Defects, Atrial/*complications ; Human ; Hypertension, Pulmonary/*complications ; *Pulmonary Artery/radiography