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Advances in the Diagnostic Imaging of Gastrointestinal Diseases
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Advances in the Diagnostic Imaging of Gastrointestinal Diseases

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 20802

Special Issue Editors

Prof. Dr. Adrian Saftoiu

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Guest Editor
Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, Universitatea de Medicina si Farmacie Craiova, Craova, Romania
Interests: gastroenterology; chronic pancreatitis; elastography; EUS; liver cirrhosis; pancreatic cancer; endoscopic retrograde cholangiopancreatography; pancreatic diseases; hepatocellular carcinoma; gastric cancer
Special Issues, Collections and Topics in MDPI journals
Dr. Bogdan Silviu Ungureanu

E-Mail Website
Guest Editor
Center for Research in Gastroenterology and Hepatology, Universitatea de Medicina si Farmacie Craiova, Craova, Romania
Interests: endoscopy; gastrointestinal diseases; endoscopic retrograde cholangiopancreatography; hepatocellular carcinoma; liver diseases and immunology; EUS; pancreas; biliary tract diseases; pancreatic cancer; surgery
Dr. Irina M. Cazacu

E-Mail Website
Guest Editor
1. Department of Oncology, Fundeni Clinical Institute, 022328 Bucharest, Romania
2. Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
Interests: digestive oncology; cancer biomarkers; cancer screening; pancreatic cancer; clonal hematopoiesis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Novel imaging techniques have prompted a sweeping transition from a clinical setting to a more complex management of gastrointestinal diseases. From ultrasonography (US) to computed tomography (CT) and magnetic resonance imaging (MRI), as well as endoscopy, and more complex procedures such as endoscopic ultrasound or ERCP, the diagnosis of and therapy for gastrointestinal diseases have evolved considerably, improving quality of life and disease prognosis.

Nonetheless, gastrointestinal cancers largely benefit from imaging technology evolution, because this advancement helps delineate early cancer development and differentiate benign tumors from malignant tumors. Moreover, tumor perfusion methods may provide information on tumor biology and oncologic effectiveness. Endoscopic and ultrasound techniques have prevailed in day-to-day practice and data imaging has evolved gradually to HD and microscopic information to help the physician explore new diagnostic and therapeutic avenues.

Valuable information on patients’ diagnostic imaging may be easily assembled and directed for therapy rapidly and efficiently. Our Special Issue focuses on available diagnostic imaging for gastrointestinal diseases to help all practitioners become more acquainted with all new advancements.

Prof. Dr. Adrian Saftoiu
Dr. Bogdan Silviu Ungureanu
Dr. Irina M. Cazacu
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

 

Keywords

  • gastrointestinal diseases
  • gastrointestinal malignancies
  • endoscopy
  • endoscopic ultrasound
  • confocal laser endomicroscopy
  • ERCP
  • ultrasound
  • CEUS
  • CT
  • MRI

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Published Papers (12 papers)

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Research

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12 pages, 814 KiB  
Article
Effects of Medication Period and Gastrin Levels on Endoscopic Gastric Mucosal Changes in Long-Term Proton Pump Inhibitor Users
by Hiroko Suda, Koichi Sakurai, Sachi Eto, Satomi Fujie, Ayako Okuda, Takayuki Takeichi, Masayuki Urata, Tetsuya Murao, Kiwamu Hasuda, Masahiro Hirano, Yo Kato and Ken Haruma
Diagnostics 2024, 14(22), 2540; https://doi.org/10.3390/diagnostics14222540 - 13 Nov 2024
Viewed by 397
Abstract
Background/Objectives: Proton pump inhibitor (PPI) use has increased worldwide, including in continuous and longer-term users. Recent reports highlight PPI-related endoscopic gastric mucosal changes, including fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cracked and cobblestone-like mucosa (CCLM), and black [...] Read more.
Background/Objectives: Proton pump inhibitor (PPI) use has increased worldwide, including in continuous and longer-term users. Recent reports highlight PPI-related endoscopic gastric mucosal changes, including fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cracked and cobblestone-like mucosa (CCLM), and black spots. PPI use elevates gastrin levels because of acid inhibition, and hypergastrinemia might be relevant to these findings. In this cross-sectional study, we retrospectively examined gastric mucosal changes in long-term PPI users, focusing on medication period and gastrin levels. Methods: We enrolled 57 patients who received a PPI (>1 year) at two clinics between January 2021 and March 2022. Participants were classified according to medication period: 1 < 5, 5–10, and ≥10 years. Gastrin levels were categorized as low, middle, and high (<250, 250–500, and ≥500 pg/mL, respectively). Odds ratios (OR) were estimated to assess the risk of endoscopic findings. Results: Of the 57 patients, 6 (10.5%), 25 (43.9%), and 26 (45.6%) were PPI users of 1 < 5, 5–10, and ≥10 years, respectively. There were no significant differences in the incidence of endoscopic findings among the medication periods. Low, middle, and high gastrin groups included 21 (36.8%), 21 (36.8%), and 15 (26.3%) patients, respectively. CCLM incidence was significantly elevated in higher gastrin level groups: middle (OR, 6.60; 95% confidence interval [CI], 1.46–29.75; p = 0.014) and high (OR, 9.00; 95% CI, 1.79–45.23; p = 0.0008) (p-trend = 0.0171). No significant differences were observed for other findings. Conclusions: No elevated risk of PPI-related gastric epithelial changes in long-term PPI users was observed time-dependently. Notably, higher gastrin levels were positively associated with CCLM development, irrespective of the medication period. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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11 pages, 2824 KiB  
Article
Esophagogastroduodenal Findings in Patients with Intraductal Papillary Mucinous Neoplasms
by Dana Zelnik Yovel, Erwin Santo, Majd Khader, Roie Tzadok, Nir Bar, Asaf Aizic, Oren Shibolet and Dana Ben-Ami Shor
Diagnostics 2023, 13(12), 2127; https://doi.org/10.3390/diagnostics13122127 - 20 Jun 2023
Viewed by 1410
Abstract
The association between intraductal papillary mucinous neoplasms (IPMNs) and extra-pancreatic malignancies is controversial. This cross-sectional study compared esophagogastroduodenal findings in 340 IPMN patients to those of age- and gender-matched controls without known IPMNs who underwent esophagogastroduodenoscopies (EGDs) for similar clinical reasons. The presence [...] Read more.
The association between intraductal papillary mucinous neoplasms (IPMNs) and extra-pancreatic malignancies is controversial. This cross-sectional study compared esophagogastroduodenal findings in 340 IPMN patients to those of age- and gender-matched controls without known IPMNs who underwent esophagogastroduodenoscopies (EGDs) for similar clinical reasons. The presence of gastric and esophageal cancer, Barrett’s esophagus, neuroendocrine tumors (NETs), gastrointestinal stromal tumors (GISTs), gastric adenomas, and ampullary tumors was assessed. The results showed that 4/340 (1.2%) of the IPMN patients had gastric cancer and 1/340 (0.3%) had esophageal cancer. The matched control group had a similar incidence of gastric cancer (5/340) (1.5%), with no esophageal cancer cases (p > 0.999). The overall incidence of other esophagogastroduodenal conditions did not significantly differ between the IPMN patients and the controls. However, the incidence of gastric cancer in the IPMN patients was higher than expected based on national cancer registry data (standardized incidence ratio of 31.39; p < 0.001; CI 8.38–78.76). In conclusion, IPMN patients have a significantly higher incidence of gastric cancer compared to the general population. However, the incidence of esophagogastroduodenal findings, including gastric and esophageal cancer, is similar between IPMN patients and those who undergo an EGD for similar clinical indications. Further research is needed to determine optimal surveillance strategies for IPMN patients regarding their risk of developing gastric cancer. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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Review

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18 pages, 5345 KiB  
Review
The Endoscopic Management of Zenker’s Diverticulum: A Comprehensive Review
by Giuseppe Dell’Anna, Ernesto Fasulo, Jacopo Fanizza, Rukaia Barà, Edoardo Vespa, Alberto Barchi, Paolo Cecinato, Lorenzo Fuccio, Vito Annese, Alberto Malesci, Francesco Azzolini, Silvio Danese and Francesco Vito Mandarino
Diagnostics 2024, 14(19), 2155; https://doi.org/10.3390/diagnostics14192155 - 27 Sep 2024
Viewed by 636
Abstract
Zenker’s Diverticulum (ZD) is the most common hypopharyngeal diverticulum; however, it is often underdiagnosed. It results from the herniation of the mucosa and submucosa through Killian’s Triangle. Dysphagia is the primary symptom, occurring in 80–90% of cases. The primary goal of treatment is [...] Read more.
Zenker’s Diverticulum (ZD) is the most common hypopharyngeal diverticulum; however, it is often underdiagnosed. It results from the herniation of the mucosa and submucosa through Killian’s Triangle. Dysphagia is the primary symptom, occurring in 80–90% of cases. The primary goal of treatment is to transect the cricopharyngeal muscle (CM) and connect the ZD cavity to the esophageal lumen. Traditional treatments include surgical open transcervical diverticulectomy and CM septomyotomy, using rigid or flexible endoscopes. However, surgery is burdened by technical difficulties and not negligible rates of adverse events (AEs). For this reason, endoscopic techniques for ZD treatment have gained traction in recent years. Flexible endoscopic septum division (FESD), introduced nearly 20 years ago, involves a full-thickness incision of the diverticular septum. The advent of third-space endoscopy has led to the application of these techniques to ZD treatment as well. Zenker-POEM (Z-POEM) and, subsequently, Per Oral Endoscopic Septomyotomy (POES) have been developed. Hybrid techniques, such as Peroral Endoscopic Diverticulotomy (POED) and tunneling-free methods, represent additional ZD treatment options. This review outlines the armamentarium of ZD endoscopic management, summarizing the characteristics of these techniques, their benefits and limitations, and highlighting future research directions. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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14 pages, 440 KiB  
Review
Impaired Intestinal Permeability Assessed by Confocal Laser Endomicroscopy—A New Potential Therapeutic Target in Inflammatory Bowel Disease
by Stefan Chiriac, Catalin Victor Sfarti, Horia Minea, Carol Stanciu, Camelia Cojocariu, Ana-Maria Singeap, Irina Girleanu, Tudor Cuciureanu, Oana Petrea, Laura Huiban, Cristina Maria Muzica, Sebastian Zenovia, Robert Nastasa, Remus Stafie, Adrian Rotaru, Ermina Stratina and Anca Trifan
Diagnostics 2023, 13(7), 1230; https://doi.org/10.3390/diagnostics13071230 - 24 Mar 2023
Cited by 6 | Viewed by 2205
Abstract
Inflammatory bowel diseases (IBD) represent a global phenomenon, with a continuously rising prevalence. The strategies concerning IBD management are progressing from clinical monitorization to a targeted approach, and current therapies strive to reduce microscopic mucosal inflammation and stimulate repair of the epithelial barrier [...] Read more.
Inflammatory bowel diseases (IBD) represent a global phenomenon, with a continuously rising prevalence. The strategies concerning IBD management are progressing from clinical monitorization to a targeted approach, and current therapies strive to reduce microscopic mucosal inflammation and stimulate repair of the epithelial barrier function. Intestinal permeability has recently been receiving increased attention, as evidence suggests that it could be related to disease activity in IBD. However, most investigations do not successfully provide adequate information regarding the morphological integrity of the intestinal barrier. In this review, we discuss the advantages of confocal laser endomicroscopy (CLE), which allows in vivo visualization of histological abnormalities and targeted optical biopsies in the setting of IBD. Additionally, CLE has been used to assess vascular permeability and epithelial barrier function that could correlate with prolonged clinical remission, increased resection-free survival, and lower hospitalization rates. Moreover, the dynamic evaluation of the functional characteristics of the intestinal barrier presents an advantage over the endoscopic examination as it has the potential to select patients at risk of relapses. Along with mucosal healing, histological or transmural remission, the recovery of the intestinal barrier function emerges as a possible target that could be included in the future therapeutic strategies for IBD. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
20 pages, 7702 KiB  
Review
The Role of MRI in the Diagnosis of Solid Pseudopapillary Neoplasm of the Pancreas and Its Mimickers: A Case-Based Review with Emphasis on Differential Diagnosis
by Jelena Djokic Kovac, Aleksandra Djikic-Rom, Aleksandar Bogdanovic, Aleksandra Jankovic, Nikica Grubor, Goran Djuricic and Vladimir Dugalic
Diagnostics 2023, 13(6), 1074; https://doi.org/10.3390/diagnostics13061074 - 13 Mar 2023
Cited by 2 | Viewed by 3801
Abstract
Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. [...] Read more.
Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. However, atypical imaging presentation in the form of small solid tumors or uniformly cystic lesions might also be seen, which can be explained by specific pathological characteristics. Other imaging features such as a round shape, the absence of main pancreatic duct dilatation, and slow growth, in combination with vague symptoms, favor the diagnosis of SPNs. Nevertheless, the radiological findings of SPN might overlap with other solid and cystic pancreatic neoplasms, such as neuroendocrine tumors, serous and mucinous neoplasms, and even small pancreatic adenocarcinomas. In addition, a few benign non-tumorous conditions including walled-of-necrosis, and intrapancreatic accessory spleen may also pose diagnostic dilemmas simulating SPNs on imaging studies. The aim of this manuscript is to provide a comprehensive overview of the typical and atypical imaging features of SPNs and to describe useful tips for differential diagnosis with its potential mimickers. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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15 pages, 2690 KiB  
Review
Artificial Intelligence—The Rising Star in the Field of Gastroenterology and Hepatology
by Madalina Stan-Ilie, Vasile Sandru, Gabriel Constantinescu, Oana-Mihaela Plotogea, Ecaterina Mihaela Rinja, Iulia Florentina Tincu, Alexandra Jichitu, Adriana Elena Carasel, Andreea Cristina Butuc and Bogdan Popa
Diagnostics 2023, 13(4), 662; https://doi.org/10.3390/diagnostics13040662 - 10 Feb 2023
Cited by 5 | Viewed by 2420
Abstract
Artificial intelligence (AI) is a term that covers a multitude of techniques that are used in a manner that tries to reproduce human intelligence. AI is helpful in various medical specialties that use imaging for diagnostic purposes, and gastroenterology is no exception. In [...] Read more.
Artificial intelligence (AI) is a term that covers a multitude of techniques that are used in a manner that tries to reproduce human intelligence. AI is helpful in various medical specialties that use imaging for diagnostic purposes, and gastroenterology is no exception. In this field, AI has several applications, such as detecting and classifying polyps, detecting the malignancy in polyps, diagnosing Helicobacter pylori infection, gastritis, inflammatory bowel disease, gastric cancer, esophageal neoplasia, and pancreatic and hepatic lesions. The aim of this mini-review is to analyze the currently available studies regarding AI in the field of gastroenterology and hepatology and to discuss its main applications as well as its main limitations. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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21 pages, 13818 KiB  
Review
Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines
by Christopher Kloth, Benedikt Haggenmüller, Annika Beck, Martin Wagner, Marko Kornmann, Jochen P. Steinacker, Nora Steinacker-Stanescu, Daniel Vogele, Meinrad Beer, Markus S. Juchems and Stefan A. Schmidt
Diagnostics 2023, 13(3), 454; https://doi.org/10.3390/diagnostics13030454 - 26 Jan 2023
Cited by 4 | Viewed by 3096
Abstract
Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The [...] Read more.
Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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Other

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9 pages, 1878 KiB  
Case Report
The Diagnosis of Wilkie’s Syndrome Associated with Nutcracker Syndrome: A Case Report and Literature Review
by Ludovico Abenavoli, Felice Imoletti, Giuseppe Quero, Valentina Bottino, Viviana Facciolo, Giuseppe Guido Maria Scarlata, Francesco Luzza and Domenico Laganà
Diagnostics 2024, 14(17), 1844; https://doi.org/10.3390/diagnostics14171844 - 23 Aug 2024
Viewed by 687
Abstract
Superior mesenteric artery (SMA) syndrome or Wilkie’s syndrome is a vascular compression disorder that causes the abnormal compression of the third portion of the duodenum by the SMA. It has a low incidence rate, which is higher in young women, and is rarely [...] Read more.
Superior mesenteric artery (SMA) syndrome or Wilkie’s syndrome is a vascular compression disorder that causes the abnormal compression of the third portion of the duodenum by the SMA. It has a low incidence rate, which is higher in young women, and is rarely associated with the Nutcracker phenomenon: a condition of the compression of the left renal vein between the SMA and the aorta, which manifests as pain in the left flank and pelvis. Here, we report on the case of a 54-year-old woman with a history of repeated episodes of abdominal pain caused by the Nutcracker syndrome and Wilkie’s syndrome. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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3 pages, 947 KiB  
Interesting Images
Navigating the Labyrinth: When the “Mesenterium Commune” Turns Colonoscopy into an Endoscopic Rollercoaster
by Giacomo Emanuele Maria Rizzo, Silvia Ferriolo, Lucio Carrozza, Gabriele Rancatore and Mario Traina
Diagnostics 2024, 14(11), 1072; https://doi.org/10.3390/diagnostics14111072 - 22 May 2024
Viewed by 882
Abstract
These images involved the case of a 51-year-old woman who had a history of chronic abdominal pain, iron deficiency, and diarrhoea but no blood or mucus in her stool. She had never undergone major abdominal surgery, and her past medical evaluation diagnosed her [...] Read more.
These images involved the case of a 51-year-old woman who had a history of chronic abdominal pain, iron deficiency, and diarrhoea but no blood or mucus in her stool. She had never undergone major abdominal surgery, and her past medical evaluation diagnosed her with celiac disease, leading to the adoption of a gluten-free diet alleviating most of her gastrointestinal symptoms. However, years later, her abdominal pain returned, so she underwent an abdominal ultrasound, revealing non-specific bowel loop dilation, and a weakly positive faecal occult blood test led to a colonoscopy. Despite many efforts to advance the scope beyond the transverse colon, colonoscopy was arduous and not complete, even after several changes in decubitus and abdominal compressions. Therefore, a virtual colonoscopy was conducted, revealing no intraluminal masses, but the entire colon was located on the left side of the abdomen. Indeed, the results showed sigma and that most of the colon was curled up in the small pelvis. This rare anatomical variant, known as “Mesenterium commune” (MC), is a type of gut malrotation that develops in childhood due to a lack of omphalomesenteric loop rotation during the embryonic period. This condition can lead to episodes of intestinal obstruction, potentially resulting in an acute abdomen and leading to surgical correction. Symptoms include chronic recurring abdominal pain, nausea, vomiting, and occasionally bloody stools. Few cases of this extremely rare condition have been reported in the literature so far. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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4 pages, 2075 KiB  
Interesting Images
Pseudokidney Sign in Gastric Cancer
by Thomas Ferenc, Jelena Svetec Dvorski, Andro Matković, Maja Mijić, Eva Lovrić and Vinko Vidjak
Diagnostics 2024, 14(9), 896; https://doi.org/10.3390/diagnostics14090896 - 25 Apr 2024
Viewed by 1094
Abstract
Pseudokidney sign (PKS) is a characteristic sonographic finding of an abnormal mass with a reniform appearance, and a hyperechoic central region surrounded by a hypoechoic area. It has been seldom documented in gastric cancer. A 75-year-old male patient presented with a palpable abdominal [...] Read more.
Pseudokidney sign (PKS) is a characteristic sonographic finding of an abnormal mass with a reniform appearance, and a hyperechoic central region surrounded by a hypoechoic area. It has been seldom documented in gastric cancer. A 75-year-old male patient presented with a palpable abdominal resistance in the left upper abdominal quadrant and ultrasound evaluation revealed a well-vascularized mass presenting with PKS. Regional lymphadenopathy was also found, and the working diagnosis of gastric cancer was established. The suspected diagnosis was later verified endoscopically and on pathohistological examinations as gastric adenocarcinoma. Computed tomography staging also revealed distant metastases to the lungs, liver, and adrenal glands and abdominal lymphadenopathy. The PKS often indicates gastrointestinal pathology, and it may be seen in benign and malignant conditions due to gastrointestinal wall thickening. Therefore, additional diagnostic examinations are advised for a more definite diagnosis. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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6 pages, 2291 KiB  
Interesting Images
Ultrasound-Guided Coarse Needle Biopsy Diagnosed Isolated Hepatic Malignant Melanoma with Undetermined Origin in TB Patient: A Case Report
by Kailing Chen, Yi Dong, Weibin Zhang, Hong Han, Feng Mao, Hui Zhang and Wenping Wang
Diagnostics 2023, 13(1), 42; https://doi.org/10.3390/diagnostics13010042 - 23 Dec 2022
Viewed by 1599
Abstract
Isolated hepatic malignant melanoma with undetermined origin is relatively rare and the imaging findings vary significantly in published studies. In this report, we described an elderly male patient with pulmonary tuberculosis who was diagnosed with isolated hepatic malignant melanoma with undetermined origin by [...] Read more.
Isolated hepatic malignant melanoma with undetermined origin is relatively rare and the imaging findings vary significantly in published studies. In this report, we described an elderly male patient with pulmonary tuberculosis who was diagnosed with isolated hepatic malignant melanoma with undetermined origin by ultrasound-guided percutaneous coarse needle biopsy (US-CNB). The hepatic melanoma was detected accidentally on chest CT. On contrast-enhanced ultrasound (CEUS), it presented an enhancement pattern of fast washin and slow washout. However, on magnetic resonance imaging (CEMRI), it showed non-rim hyperenhancement in the arterial phase but hypointensity in the late phase, mimicking hepatocellular carcinoma. With inconsistent results, the patient underwent fluorine-18-fluro-2-deoxy-D-glucose-positron emission tomography/computed tomography (18F-FDG-PET/CT). The mass showed mild 18F-FDG uptake with SUVmax of 4.7, and hypermetabolic nodules were observed in the lung, chest wall, thoracic vertebra, and pelvis. Due to the advanced stage of the tumor, US-CNB was performed to acquire a pathological diagnosis. The immunohistochemical staining suggested malignant melanoma. Of note, no primary tumor was revealed. Finally, the patient refused systemic therapy and died from tumor progression seven months later. Hence, CEUS and CEMRI is fundamental in the diagnosis of hepatic melanoma, and PET-CT is helpful in clinical staging. For controversial results, US-CNB is required to establish the pathological diagnosis. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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8 pages, 642 KiB  
Case Report
Hereditary Hemorrhagic Telangiectasia—A Case Series Experience from a Liver Transplant Center in Romania
by Christopher Pavel, Teodor Cabel, Dragoș Dinuță, Alexandru Zaharia, Simona Olimpia Dima, Vasile Sandru, Mugur Cristian Grasu and Mariana Mihaila
Diagnostics 2022, 12(12), 2959; https://doi.org/10.3390/diagnostics12122959 - 26 Nov 2022
Cited by 1 | Viewed by 1499
Abstract
Hereditary hemorrhagic telangiectasia (HHT) has significant morbidity due to multiorgan involvement and an unpredictable disease course. We analyzed the data of 14 patients diagnosed with HHT. The case series comprised 14 patients with a median age at presentation of 48 years old (41–74 [...] Read more.
Hereditary hemorrhagic telangiectasia (HHT) has significant morbidity due to multiorgan involvement and an unpredictable disease course. We analyzed the data of 14 patients diagnosed with HHT. The case series comprised 14 patients with a median age at presentation of 48 years old (41–74 years). In twelve patients (85.7%), the diagnosis was confirmed by using the Curacao Criteria. The most common reason for admission was epistaxis, with 9 patients (57%) presenting with nosebleed refractory to prolonged self-tamponade. The biochemical abnormalities identified were elevations in AP and gamma-GT; liver synthetic function was generally normal, even though 21% of patients had clinical or imaging findings for cirrhosis. Nosebleeds were the main reason for admission and significantly impacted quality of life through anemia and frequent hospital admissions. However, the visceral manifestations seemed to be more serious. The hepatic arteriovenous malformations (AVMs) appeared to remain asymptomatic or led to minimal changes for the majority of patients; some cases were associated with liver and biliary tract ischemia, necrosis leading to acute liver failure and even death. Hepatic AVMs can also lead to high-output heart failure due to arterio-venous shunting. The most frequent AVM was hepatic artery to hepatic vein, with secondary hepatic vein dilation and hemodynamic consequences. Full article
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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