Tumors with macroscopic bile duct thrombi in non-HCC patients:Dynamic multi-phase MSCT findings

Non-hepatocellular carcinoma(non-HCC) with macroscopic bile duct tumor thrombus(BDTT) formation is rare,few radiological studies have been reported.In this case report,we retrospectively analyzed the imaging findings of three cases of non-HCC with macroscopic BDTT on dynamic enhanced multislice computed tomography(MSCT) scan.One case of primary hepatic carcinosarcoma was presented as a solitary,large welldefined tumor with significant necrotic changes.One case of liver metastasis from colon cancer was presented as a lobulated,large ill-defined tumor.One case of intraductal oncocytic papillary neoplasm involved the entire pancreas,presented as a cystic and solid mass with multilocular changes(the individual loculi were less than 5.0 mm in diameter).The bile duct was dilated due to expansible growth of the BDTT in all three patients.The BDTT was contiguous with hepatic or pancreatic tumor,and both of them showed the same enhancement patterns on dynamic contrast-enhanced computed tomography scan:early enhancement in the hepatic arterial phase and a quick wash-out of contrast agent in the portal and equilibrium phases.Macroscopic BDTT in non-HCC patient is rare,dynamic enhanced MSCT scan may be valuable in the diagnosis of non-HCC with BDTT.

Transient small bowel angioedema due to intravenous iodinated contrast media

Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good under-standing of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.