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The authors report the case of a 57-year-old patient operated for adrenal metastasis from follicular thyroid carcinoma with intracardiac thrombus, who subsequently developed disseminated metastases leading to death 9 months after the operation. Adrenal metastases of thyroid carcinomas are rare and can be treated surgically when they are isolated. These metastases may appear many years after initial thyroid surgery requiring regular surveillance, especially by serum thyroglobulin assay in the case of well differentiated carcinoma.

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We report two cases of emphysematous pyelonephritis in diabetic patients. The first suffered from emphysematous pyelonephritis and emergency nephrectomy was performed. The second patient suffered from emphysematous pyelitis and was successfully treated by nephrostomy. We present a comprehensive review of the literature on emphysematous pyelonephritis and discuss the indications and the results of treatments of this rare and severe infection.

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Our objective was to describe the main aspects of MR imaging in Caroli's disease. Magnetic resonance cholangiography with a dynamic contrast-enhanced study was performed in nine patients with Caroli's disease. Bile duct abnormalities, lithiasis, dot signs, hepatic enhancement, renal abnormalities, and evidence of portal hypertension were evaluated. Three MR imaging patterns of Caroli's disease were found. In all but two patients, MR imaging findings were sufficient to confirm the diagnosis. Moreover, MR imaging provided information about the severity, location, and extent of liver involvement. This information was useful in planning the best therapeutic strategy. Magnetic resonance cholangiography with a dynamic contrast-enhanced study is a good screening tool for Caroli's disease. Direct cholangiography should be reserved for confirming doubtful cases.

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Congenital bile duct diseases consist of ductal plate development abnormalities and are genetically determined. These biliary abnormalities are encountered mainly in congenital fibrocystic diseases, represented by congenital hepatic fibrosis and different forms of Caroli disease. On the other hand, polycystic hepatic diseases also present cystic abnormalities, which could be confused with biliary dilatations, especially in the perihilar area. Further, intricate forms between Caroli and polycystic hepatic diseases are possible. In congenital bile duct paucity, which is extremely rare, the biliary tree, located on the opposite, is not visible. MRI modalities for the analysis of the biliary tree are mainly represented by T -weighted sequence, also known as MR cholangiography (MRCP), and T gadolinium-enhanced sequences. Familiarity with the most common appearances of congenital bile duct dilations, its variants, and related complex diseases facilitates accurate diagnosis and allows and helps avoid misinterpretation.

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Chronic mesenteric ischemia (CMI) is rare and is often diagnosed late. Fatal malabsorption-related complications or acute ischemic events occur in the absence of treatment. Diagnosis depends on careful acquisition of a medical history and elimination of other conditions. No sensitive and specific tests are available for functional diagnosis of CMI. If other causes of abdominal pain and weight loss have been confidently ruled out, evidence of visceral artery occlusion at noninvasive imaging (Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) suggests CMI. Until the 1990s, open surgery was considered the treatment of choice; percutaneous transluminal angioplasty (PTA) was reserved for patients for whom surgery carried a high risk. However, open surgery carries a nonnegligible risk of morbidity and mortality. In recent years, PTA with stent placement has been recognized as a minimally invasive means of obtaining good long-term results with an acceptable recurrence rate and consequently has been suggested for primary treatment of CMI. New treatments including administration of fibrinolytic agents before PTA of chronic occlusions, routine revascularization of one or more arteries, and stent placement will probably be validated in the near future. Similarly, new data on selection of the best approach will become available soon.

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PURPOSE: The purpose of this work was to conduct an MR cholangiography study of hepatobiliary abnormalities in autosomal dominant polycystic kidney disease (ADPKD) and to correlate these abnormalities with the risk of infection. METHOD: Cystic and intrahepatic bile duct (IHBD) abnormalities identified by MR cholangiography in 93 ADPKD patients were studied retrospectively. A blind study of liver function tests, renal insufficiency, and infectious episodes was also carried out. Correlations among these data were looked for using univariate analysis. RESULTS: Intrahepatic cysts were present in 84 of 93 patients and peribiliary cysts in 59 of 90 patients. IHBDs were abnormal in 25 of 90 patients (tubular dilatation in 15 cases and bead-like dilatation in 16). IHBD abnormalities were correlated with hepatobiliary infections (p = 0.0012), gamma-glutamyltranspeptidase elevation (p = 0.018), and terminal renal failure (p = 0.006). CONCLUSION: This study confirms the complexity of hepatobiliary involvement in ADPKD. Various types of cystic lesions can arise, and patients with IHBD abnormalities are at increased risk for hepatobiliary infection.

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