Diagnostics

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26 pages, 15080 KiB

Open AccessArticle

Mesopancreas—Anatomical Insights and Its Implications for Diagnosis and Clinical and Surgical Practice

by Florin-Mihail Filipoiu, Georgian-Theodor Badea, Mihaly Enyedi, Ștefan Oprea, Zoran-Florin Filipoiu and Daniela-Elena Gheoca Mutu

Diagnostics 2025, 15(7), 914; https://doi.org/10.3390/diagnostics15070914 - 2 Apr 2025

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Abstract

Background: The concept of mesopancreas is frequently discussed in the surgical literature as the neural pathway for metastatic spread in pancreatic head cancer. It generally refers to a retro-pancreatic plane that should be resected to reduce the incidence of regional metastases. However, this [...] Read more.

Background: The concept of mesopancreas is frequently discussed in the surgical literature as the neural pathway for metastatic spread in pancreatic head cancer. It generally refers to a retro-pancreatic plane that should be resected to reduce the incidence of regional metastases. However, this concept remains poorly defined, both embryologically and anatomically. Our objective was to establish a clear embryological and anatomical definition of the mesopancreas, making anatomical data more applicable in surgical practice. Methods: We examined seven cadavers (5 males, 2 females, aged 62–71) with no medical or surgical history, preserved in 9% formalin at Carol Davila University’s Anatomy Department. Regional dissections were performed in successive planes, highlighting the celiac ganglia and the associated network of neural connections that comprise the mesopancreas. Results: Our study defines the “mesopancreas” as remnants of primordial mesenteries that coalesced into the Treitz fascia. We identified its functional components as nerve fibers linking the celiac ganglia and superior mesenteric plexus to the pancreas, along with vascular structures, lymphatics, and connective and adipose tissue. These components likely contribute to regional metastasis in pancreatic head cancer. While resection of the mesopancreas could help prevent metastasis, its complex anatomy and proximity to major vessels pose significant surgical challenges. Conclusions: Based on our findings, we propose a plausible definition for the term “mesopancreas”. It encompasses the structures that originated as part of the primordial mesenteries, which subsequently coalesced, resulting in the formation of the Treitz fascia. In essence, the mesopancreas is the functional content of a former mesentery. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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15 pages, 11947 KiB

Open AccessArticle

The Effectiveness of Mesh-Less Pectopexy in the Treatment of Vaginal Apical Prolapse—A Prospective Study

by Marilena Pirtea, Ligia Bălulescu, Laurentiu Pirtea, Simona Brasoveanu, Cristina Secosan, Lavinia Balan, Flavius Olaru, Alexandru Dabica, Mădălin-Marius Margan and Dan Navolan

Diagnostics 2025, 15(5), 526; https://doi.org/10.3390/diagnostics15050526 - 21 Feb 2025

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Abstract

Objectives: Pelvic organ prolapse (POP) is a common condition affecting women, often requiring surgical intervention. Laparoscopic pectopexy has gained popularity, but there is ongoing debate about the efficacy and safety of mesh versus thread as fixation materials. This study aims to compare the [...] Read more.

Objectives: Pelvic organ prolapse (POP) is a common condition affecting women, often requiring surgical intervention. Laparoscopic pectopexy has gained popularity, but there is ongoing debate about the efficacy and safety of mesh versus thread as fixation materials. This study aims to compare the outcomes of these two techniques, focusing on cure, recurrence and postoperative complication rates. Methods: A prospective analysis was conducted on patients undergoing laparoscopic pectopexy for POP. This prospective study included 78 patients diagnosed with pelvic organ prolapse stage II–IV according to the POP-Q system. Thirty-six (46.15%) underwent laparoscopic pectopexy with mesh and forty-two patients (53.84%) underwent the laparoscopic pectopexy procedure with thread. Data on cure rates, recurrence, mild asymptomatic cystocele and chronic pain were analyzed. Statistical significance was assessed using chi-squared and Fisher’s exact tests. Results: The cure rate was high in both group: 94.4% in the Mesh group and 100% in the thread group. Recurrence of vaginal apex prolapse occurred in 5.56% of the Mesh group, while no recurrence was observed in the thread group. Chronic pain was reported in 11.11% of the Mesh group but was absent in the thread group (p < 0.05). The overall rate for cystocele across all participants was 44.87% (40.48% of patients in the thread group experienced mild asymptomatic cystocele, compared to 50% in the Mesh group). No intraoperative complications were reported in either group. Conclusions: Thread-based laparoscopic pectopexy demonstrates equivalent or superior outcomes compared to mesh, with a high cure rate, no recurrence rate and no chronic pain. These findings support the use of thread as a safer alternative, aligning with FDA guidelines on mesh usage. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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15 pages, 3867 KiB

Open AccessArticle

Two-Dimensional Shear-Wave Elastography: Accuracy in Liver Fibrosis Staging Using Magnetic Resonance Elastography as the Reference Standard

by Puwitch Charoenchue, Jiraporn Khorana, Taned Chitapanarux, Nakarin Inmutto, Wittanee Na Chiangmai, Amonlaya Amantakul, Suwalee Pojchamarnwiputh and Apichat Tantraworasin

Diagnostics 2025, 15(1), 62; https://doi.org/10.3390/diagnostics15010062 - 29 Dec 2024

Cited by 1 | Viewed by 1144

Abstract

Background: The accurate staging of liver fibrosis is crucial for managing chronic liver disease (CLD). Although magnetic resonance elastography (MRE) is the reference standard for noninvasive fibrosis assessment, its cost, specialized hardware, and operational demands restrict accessibility. In contrast, two-dimensional shear-wave elastography (2D-SWE) [...] Read more.

Background: The accurate staging of liver fibrosis is crucial for managing chronic liver disease (CLD). Although magnetic resonance elastography (MRE) is the reference standard for noninvasive fibrosis assessment, its cost, specialized hardware, and operational demands restrict accessibility. In contrast, two-dimensional shear-wave elastography (2D-SWE) is more affordable, accessible, and widely integrated into routine ultrasound systems. Objective: Our aim was to determine the optimal 2D-SWE cut-offs for detecting significant fibrosis (≥F2) and evaluate its diagnostic performance across fibrosis stages. Methods: In this prospective study, 71 patients with suspected CLD underwent same-day MRE and 2D-SWE. MRE-defined cut-offs categorized fibrosis stages (≥3.5 kPa for significant fibrosis). Sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and likelihood ratios were calculated for various 2D-SWE thresholds. Results: At a 2D-SWE cut-off of 7.0 kPa, sensitivity for detecting ≥F2 fibrosis was 100% with a specificity of 85.7% and a positive likelihood ratio (LR+) of 7.0. Increasing the threshold to 8.0 kPa improved specificity to 91.8% while maintaining a sensitivity of 86.4% and achieving an AUROC of 0.89. For cirrhosis, a cut-off of 11.0 kPa achieved 100% sensitivity and 96.9% specificity. A 5.0 kPa cut-off reliably excluded abnormal stiffness with 89.1% sensitivity. Conclusions: Two-dimensional SWE is a reliable method for staging liver fibrosis. Thresholds of 7.0 kPa for screening significant fibrosis, 8.0 kPa for confirmation, and 11.0 kPa for diagnosing cirrhosis demonstrate high diagnostic accuracy. A 5.0 kPa cut-off effectively excludes abnormal liver stiffness. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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16 pages, 2370 KiB

Open AccessArticle

Negative and Positive Predictors of Anastomotic Leakage in Colorectal Cancer Patients—The Case of Neutrophil-to-Lymphocyte Ratio

by Aristeidis Ioannidis, Georgios Tzikos, Aikaterini Smprini, Alexandra-Eleftheria Menni, Anne Shrewsbury, George Stavrou, Daniel Paramythiotis, Antonios Michalopoulos and Katerina Kotzampassi

Diagnostics 2024, 14(16), 1806; https://doi.org/10.3390/diagnostics14161806 - 19 Aug 2024

Cited by 1 | Viewed by 1355

Abstract

Colorectal surgery for cancer is associated with a high rate of surgical complications, including anastomotic leakage. The ability to predict the risk of leakage early enough seems to be of high value, since it would facilitate the design of personalized treatment and duration [...] Read more.

Colorectal surgery for cancer is associated with a high rate of surgical complications, including anastomotic leakage. The ability to predict the risk of leakage early enough seems to be of high value, since it would facilitate the design of personalized treatment and duration of hospitalization. Although different studies present the neutrophil-to-lymphocyte ratio [NLR] as having a strong predictive value, there is a discrepancy with respect to which postoperative day is the most reliable. We evaluated a series of NLR values, from the day before surgery up to the POD7, in a cohort of 245 colorectal surgery patients in order to clarify the best predictable score for the identification of the risk of anastomotic leakage. There were 28 patients with leaks. ROC curve analysis of NLR on POD1 indicates that a cut-off point ≥ 7.4 exerts a negative prediction for leakage (AUC 0.881, sensitivity 68.7%, specificity 96.4%, PPV 28.4%, and NPV of 99.3%), thus excluding 150 patients from the risk of leakage. Furthermore, the ROC curve analysis of NLR on POD4 indicates that a cut-off point ≥ 6.5 gives a positive prediction of leakage (AUC 0.698, sensitivity 82.1%, specificity 51.6%, PPV 17.6%, and NPV of 95.6%), thus indicating 52 patients as being at high risk of leakage. Finally, NLR failed to identify five leaks out of twenty-eight. These results strongly indicate the ability of NLR on POD1 to predict patients at low risk of developing a leak and then on POD4 to predict the high-risk patients. This makes our study particularly innovative, in that it enables doctors to concentrate on potential high-risk patients from POD1. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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8 pages, 1123 KiB

Open AccessArticle

Value of Ultrasound Super-Resolution Imaging for the Assessment of Renal Microcirculation in Patients with Acute Kidney Injury: A Preliminary Study

by Xin Huang, Yao Zhang, Qing Zhou and Qing Deng

Diagnostics 2024, 14(11), 1192; https://doi.org/10.3390/diagnostics14111192 - 5 Jun 2024

Cited by 4 | Viewed by 1825

Abstract

The present study aimed to explore the clinical applicability of ultrasound super-resolution imaging (US SRI) for assessing renal microcirculation in patients with acute kidney injury (AKI). A total of 62 patients with sepsis were enrolled in the present study—38 with AKI and 24 [...] Read more.

The present study aimed to explore the clinical applicability of ultrasound super-resolution imaging (US SRI) for assessing renal microcirculation in patients with acute kidney injury (AKI). A total of 62 patients with sepsis were enrolled in the present study—38 with AKI and 24 control patients—from whom renal ultrasounds and clinical data were obtained. SonoVue contrast (1.5 mL) was administered through the elbow vein and contrast-enhanced ultrasound (CEUS) images were obtained on a Mindray Resona A20 ultrasound unit for 2 min. The renal perfusion time-intensity curve (TIC) was analyzed and, after 15 min, additional images were obtained to create a microscopic blood flow map. Microvascular density (MVD) was calculated and its correlation with serum creatinine (Scr) levels was analyzed. There were significant differences in heart rate, Scr, blood urea nitrogen, urine volume at 24 h, and glomerular filtration rate between the two groups (p < 0.01), whereas other characteristics, such as renal morphology, did not differ significantly between the AKI group and control group (p > 0.05). The time to peak and mean transit times of the renal cortex in the AKI group were prolonged compared to those in the control group (p < 0.01), while the peak intensity and area under the TIC were lower than those in the control group (p < 0.05). The MVD of the renal cortex in the AKI group was lower than that in the control group (18.46 ± 5.90% vs. 44.93 ± 11.65%; p < 0.01) and the MVD in the AKI group showed a negative correlation with Scr (R = −0.84; p < 0.01). Based on the aforementioned results, US SRI can effectively assess renal microcirculation in patients with AKI and is a noninvasive technique for the diagnosis of AKI and quantitative evaluation of renal microcirculation. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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13 pages, 1154 KiB

Open AccessArticle

Machine Learning-Based Algorithms for Enhanced Prediction of Local Recurrence and Metastasis in Low Rectal Adenocarcinoma Using Imaging, Surgical, and Pathological Data

by Cristian-Constantin Volovat, Dragos-Viorel Scripcariu, Diana Boboc, Simona-Ruxandra Volovat, Ingrid-Andrada Vasilache, Corina Ursulescu-Lupascu, Liliana Gheorghe, Luiza-Maria Baean, Constantin Volovat and Viorel Scripcariu

Diagnostics 2024, 14(6), 625; https://doi.org/10.3390/diagnostics14060625 - 15 Mar 2024

Viewed by 1642

Abstract

(1) Background: Numerous variables could influence the risk of rectal cancer recurrence or metastasis, and machine learning (ML)-based algorithms can help us refine the risk stratification process of these patients and choose the best therapeutic approach. The aim of this study was to [...] Read more.

(1) Background: Numerous variables could influence the risk of rectal cancer recurrence or metastasis, and machine learning (ML)-based algorithms can help us refine the risk stratification process of these patients and choose the best therapeutic approach. The aim of this study was to assess the predictive performance of 4 ML-based models for the prediction of local recurrence or distant metastasis in patients with locally advanced low rectal adenocarcinomas who underwent neoadjuvant chemoradiotherapy and surgical treatment; (2) Methods: Patients who were admitted at the first Oncologic Surgical Clinic from the Regional Institute of Oncology, Iasi, Romania were retrospectively included in this study between November 2019 and July 2023. Decision tree (DT), naïve Bayes (NB), support vector machine (SVM), and random forest (RF) were used to analyze imagistic, surgical, and pathological data retrieved from the medical files, and their predictive performance was assessed; (3) Results: The best predictive performance was achieved by RF when used to predict disease recurrence (accuracy: 90.85%) or distant metastasis (accuracy: 89.63%). RF was closely followed by SVM (accuracy for recurrence 87.8%; accuracy for metastasis: 87.2%) in terms of predictive performance. NB and DT achieved moderate predictive power for the evaluated outcomes; (4) Conclusions: Complex algorithms such as RF and SVM could be useful for improving the prediction of adverse oncological outcomes in patients with low rectal adenocarcinoma. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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12 pages, 266 KiB

Open AccessArticle

Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis

by Paul Lorin Stoica, Dragos Serban, Dan Georgian Bratu, Crenguta Sorina Serboiu, Daniel Ovidiu Costea, Laura Carina Tribus, Catalin Alius, Dan Dumitrescu, Ana Maria Dascalu, Corneliu Tudor, Laurentiu Simion, Mihail Silviu Tudosie, Meda Comandasu, Alexandru Cosmin Popa and Bogdan Mihai Cristea

Diagnostics 2024, 14(3), 346; https://doi.org/10.3390/diagnostics14030346 - 5 Feb 2024

Cited by 5 | Viewed by 2809

Abstract

Laparoscopic cholecystectomy (LC) is the gold standard treatment in acute cholecystitis. However, one in six cases is expected to be difficult due to intense inflammation and suspected adherence to and involvement of adjacent important structures, which may predispose patients to higher risk of [...] Read more.

Laparoscopic cholecystectomy (LC) is the gold standard treatment in acute cholecystitis. However, one in six cases is expected to be difficult due to intense inflammation and suspected adherence to and involvement of adjacent important structures, which may predispose patients to higher risk of vascular and biliary injuries. In this study, we aimed to identify the preoperative parameters with predictive value for surgical difficulties. A retrospective study of 255 patients with acute cholecystitis admitted in emergency was performed between 2019 and 2023. Patients in the difficult laparoscopic cholecystectomy (DLC) group experienced more complications compared to the normal LC group (33.3% vs. 15.3%, p < 0.001). Age (p = 0.009), male sex (p = 0.03), diabetes (p = 0.02), delayed presentation (p = 0.03), fever (p = 0.004), and a positive Murphy sign (p = 0.007) were more frequently encountered in the DLC group. Total leukocytes, neutrophils, and the neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the DLC group (p < 0.001, p = 0.001, p = 0.001 respectively). The Tongyoo score (AUC ROC of 0.856) and a multivariate model based on serum fibrinogen, thickness of the gallbladder wall, and transverse diameter of the gallbladder (AUC ROC of 0.802) showed a superior predictive power when compared to independent parameters. The predictive factors for DLC should be assessed preoperatively to optimize the therapeutic decision. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

12 pages, 6956 KiB

Open AccessArticle

The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge

by Yangyang Liu, Dajing Guo, Xiaojing He, Xi Liu, Weijie Chen, Lingli Chen, Yuan Ji, Mengsu Zeng and Mingliang Wang

Diagnostics 2023, 13(18), 2998; https://doi.org/10.3390/diagnostics13182998 - 20 Sep 2023

Cited by 1 | Viewed by 1475

Abstract

Purpose: To characterize the magnetic resonance imaging features of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma (LELCC). Materials and Methods: Thirty-four patients with 38 histologically confirmed LELCCs were enrolled retrospectively from January 2014 to August 2022. We evaluated the clinical features, histologic findings, and imaging manifestations [...] Read more.

Purpose: To characterize the magnetic resonance imaging features of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma (LELCC). Materials and Methods: Thirty-four patients with 38 histologically confirmed LELCCs were enrolled retrospectively from January 2014 to August 2022. We evaluated the clinical features, histologic findings, and imaging manifestations on dynamic enhanced MRI. Results: 74% (25/34) of the cases were associated with EBV infection. Moreover, patients infected with EBV exhibited a lower level of Ki-67 proliferation. The serum CA199 level was elevated in 10 patients. The median tumor diameter was 2.8 cm (range, 1.1–8.7 cm). Most tumors were well-defined with a smooth or lobulated margin and showed peripheral hyperintensity and central hypointensity on T2-weighted imaging (T2WI). T2 hyperintense foci were recognized in 8 patients. In the dynamic enhanced MRI, 21 tumors demonstrated Type A enhancement pattern (rim enhancement), 10 demonstrated Type B (rapid wash-in and wash-out), and seven demonstrated Type C (rapid wash-in without wash-out). Capsular enhancement in PVP or DP was found in 22 tumors. A few patients had satellite lesions, portal vein thrombosis, bile duct dilatation, and distal metastasis. Lymph node metastases were discovered pathologically in 11 patients. Conclusions: MRI findings of LELCC vary and are non-specific. While a majority of LELCCs exhibit typical features of intrahepatic cholangiocarcinoma (iCCA), unique findings like T2 hyperintense foci or capsular enhancement could suggest LELCC. EBV infection and elevated tumor markers can aid in differentiation. However, given the mimics of some cases of liver hypervascular lesions, histological examination remains essential for definitive diagnosis. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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Review

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16 pages, 2850 KiB

Open AccessReview

Rare Diaphragmatic Hernias in Adults—Experience of a Tertiary Center in Esophageal Surgery and Narrative Review of the Literature

by Dragos Predescu, Florin Achim, Bogdan Socea, Mihail Constantin Ceaușu and Adrian Constantin

Diagnostics 2024, 14(1), 85; https://doi.org/10.3390/diagnostics14010085 - 29 Dec 2023

Cited by 2 | Viewed by 3413

Abstract

A rare entity of non-hiatal type transdiaphragmatic hernias, which must be clearly differentiated from paraoesophageal hernias, are the phrenic defects that bear the generic name of congenital hernias—Bochdalek hernia and Larey-Morgagni hernia, respectively. The etiological substrate is relatively simple: the presence of preformed [...] Read more.

A rare entity of non-hiatal type transdiaphragmatic hernias, which must be clearly differentiated from paraoesophageal hernias, are the phrenic defects that bear the generic name of congenital hernias—Bochdalek hernia and Larey-Morgagni hernia, respectively. The etiological substrate is relatively simple: the presence of preformed anatomical openings, which either do or do not enable transit from the thoracic region to the abdominal region or, most often, vice versa, from the abdomen to the thorax, of various visceral elements (spleen, liver, stomach, colon, pancreas, etc.). Apart from the congenital origin, a somewhat rarer group is described, representing about 1–7% of the total: an acquired variant of the traumatic type, frequently through a contusive type mechanism, which produces diaphragmatic strains/ruptures. Apparently, the symptomatology is heterogeneous, being dependent on the location of the hernia, the dimensions of the defect, which abdominal viscera is involved through the hernial opening, its degree of migration, and whether there are volvulation/ischemia/obstruction phenomena. Often, its clinical appearance is modest, mainly incidental discoveries, the majority being digestive manifestations. Severe digestive complications such as strangulation, volvus, and perforation are rare and are accompanied by severe shock, suddenly appearing after several non-specific digestive prodromes. Diagnosis combines imaging evaluations (plain radiology, contrast, CT) with endoscopic ones. Surgical treatment is recommended regardless of the side on which the diaphragmatic defect is located or the secondary symptoms due to potential complications. The approach options are thoracic, abdominal or combined thoracoabdominal approach, and classic or minimally invasive. Most often, selection of the type of approach should be made taking into account two elements: the size of the defect, assessed by CT, and the presence of major complications. Any hiatal defect that is larger than 5 cm² (the hiatal hernia surface (HSA)) has a formal recommendation of mesh reinforcement. The recurrence rate is not negligible, and statistical data show that the period of the first postoperative year is prime for recurrence, being directly proportional to the size of the defect. As a result, in patients who were required to use mesh, the recurrence rate is somewhere between 27 and 41% (!), while for cases with primary suture, i.e., with a modest diaphragmatic defect, this is approx. 4%. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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9 pages, 1726 KiB

Open AccessCase Report

A Rare Encounter: Gastric Ulcer Penetration into the Splenic Hilum Presenting with Upper Gastrointestinal Bleeding and a Massive Splenic Haematoma—Case Report and Literature Review

by Ioana-Irina Rezuș, Vasile-Claudiu Mihai, Diana Elena Floria, Andrei Olteanu, Vlad Ionut Vlasceanu, Radu Petru Soroceanu, Alin Constantin Pinzariu, Brigitta Teutsch and Sergiu Tudose-Timofeiov

Diagnostics 2025, 15(5), 617; https://doi.org/10.3390/diagnostics15050617 - 4 Mar 2025

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Abstract

Background: Despite advancements in prevention and treatment, peptic ulcer disease (PUD) remains a public health burden, with potentially high mortality rates when not managed properly. Recent studies indicate bleeding as the most prevalent complication, followed by perforation or penetration into adjacent organs and [...] Read more.

Background: Despite advancements in prevention and treatment, peptic ulcer disease (PUD) remains a public health burden, with potentially high mortality rates when not managed properly. Recent studies indicate bleeding as the most prevalent complication, followed by perforation or penetration into adjacent organs and pyloric obstruction. In rare cases, posterior wall or greater curvature ulcers of the stomach can penetrate, leading to splenic artery pseudoaneurysms. With nonspecific symptoms and low incidence, it is highly important that these entities are not overlooked in the diagnosis of patients with upper gastrointestinal bleeding. Case Report: We present the case of a 44-year-old patient presenting for upper abdominal pain and haematemesis while being haemodynamically stable. Emergency ultrasound described a dysmorphic spleen, with a transonic image with a Doppler signal in the splenic hilum. Upper gastrointestinal tract endoscopy detected a blood-filled stomach, without the possibility of identifying the bleeding source. The CT scan revealed active bleeding with peri splenic haematoma. Intraoperatively, a posterior gastric wall penetration into the spleen was identified, and an atypical gastric resection and caudal splenopancreatectomy were performed. The postoperative course was marked by the identification of a staple line leak in the upper pole of the stomach, which was treated conservatively, with a favourable outcome, and the patient was discharged after two weeks. Conclusions: Upper gastrointestinal tract haemorrhage needs fast intervention and suitable management. The multidisciplinary team plays a key role in identifying and treating rare causes such as penetration into the splenic hilum. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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10 pages, 17960 KiB

Open AccessCase Report

Diagnostic Challenges in Difficult-to-Localize Insulinomas: A Case Report and Review of Literature

by Nikica M. Grubor, Nikola N. Grubor and Marjan Micev

Diagnostics 2024, 14(15), 1600; https://doi.org/10.3390/diagnostics14151600 - 25 Jul 2024

Cited by 1 | Viewed by 1203

Abstract

Non-somatostatin receptor expressing hypovascular insulinomas can be challenging to prove through imaging. This case highlights the utility of a structured approach to molecular imaging in patients with confirmed endogenous hyperinsulinemia. A 54-year-old woman was admitted because of a sudden loss of consciousness. Her [...] Read more.

Non-somatostatin receptor expressing hypovascular insulinomas can be challenging to prove through imaging. This case highlights the utility of a structured approach to molecular imaging in patients with confirmed endogenous hyperinsulinemia. A 54-year-old woman was admitted because of a sudden loss of consciousness. Her relative reported that she complained of dizziness, intense sweating, blurry vision, and upper extremity tingling before becoming unresponsive for 20 min, after which the patient had little recollection of the event. She experienced similar episodes of shorter duration, trouble recalling everyday events, and unintentional weight gain of over 10 kg during the previous two years. Abdominal magnetic resonance imaging (MRI) and multidetector computerized tomography (MDCT) were unremarkable. Selective arterial calcium stimulation significantly increased hepatic venous insulin concentrations when the superior mesenteric and gastroduodenal arteries were stimulated. Technetium-99m (99mTc) octreotide single-photon emission computed tomography (SPECT) did not localize the lesion. Gallium-68 DOTA-Exendin-4 PET/CT acquisition was performed. A single intense 2 cm hyperperfused pancreatic lesion was located anteriorly in the head of the pancreas. Earlier targeted PET/CT imaging and recognition of significant neuropsychiatric symptoms attributable to the patient’s hypoglycemic state might have accelerated the resolution of her condition and obviated the need for unnecessary testing. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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4 pages, 10345 KiB

Open AccessInteresting Images

Giant Lipoma of the Bauhin’s Valve

by Cosmina Fugărețu and Catalin Misarca

Diagnostics 2024, 14(5), 562; https://doi.org/10.3390/diagnostics14050562 - 6 Mar 2024

Viewed by 1379

Abstract

Lipomas are benign tumors that can affect the digestive tract, everywhere from the hypopharynx to the rectum. Lipomas affecting the large intestine are the second most common benign tumor, after colon adenoma. We present the case of a 46-year-old patient who was initially [...] Read more.

Lipomas are benign tumors that can affect the digestive tract, everywhere from the hypopharynx to the rectum. Lipomas affecting the large intestine are the second most common benign tumor, after colon adenoma. We present the case of a 46-year-old patient who was initially hospitalized in the Gastroenterology Clinic with a diagnosis of gastrointestinal bleeding. The colonoscopy raised the suspicion of a malignant tumor of the transverse colon, but the computed tomography scan showed the existence of a lipoma that measured 16/11/12 cm that occupied the ascending and transverse colon, though the CT examination could not determinate the origin of the lipoma. After restoring the hydro-electrolytic and fluid balance of the patient, surgery was performed and a huge lipoma of the ileocecal valve was discovered. Extended right hemicolectomy was performed, with good subsequent postoperative recovery of the patient, who was discharged on the fifth day after the surgery. The peculiarity of this case is the huge size of the benign tumor. Lipomas with digestive system localization, although rare, must be considered in patients arriving at the Emergency Department with digestive hemorrhages, intussusception and even intestinal obstruction. Full article

(This article belongs to the Special Issue Abdominal Diseases: Diagnosis, Treatment and Management)

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