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ABSTRACT: Thoracoabdominal duplication cysts are a congenital malformation of the posterior primitive foregut with synchronous thoracic and abdominal duplication cysts being found in up to 15% of cases. The presentation of duplication cysts depends on their location, size, and other factors, like the presence of ectopic functioning gastric mucosa, which is reported in 20%-30% of duplication cysts. 99mTc-pertechnetate scintigraphy along with SPECT/CT helps in the preoperative localization of ectopic functioning gastric mucosa in these duplication cysts. We report the scintigraphic and SPECT/CT findings of one such case, which helped in the final diagnosis and management of the patient.
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Mucosa Gástrica , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Pertecnetato de Sodio Tc 99m , Humanos , Mucosa Gástrica/diagnóstico por imagen , Quistes/diagnóstico por imagen , Coristoma/diagnóstico por imagen , Masculino , Femenino , Abdomen/diagnóstico por imagenRESUMEN
BACKGROUND: Traumatic pulmonary pseudocyst is a rare "cystlike" lung lesion that typically develops following blunt chest trauma. It differs from lung cancer associated with cystic airspaces in terms of pathogenic mechanisms, clinical manifestations, and radiological features. Furthermore, there are few reports of the diagnostic bias between traumatic pulmonary pseudocyst and lung cancer associated with cystic airspaces. Here, we present a rare case of lung cancer associated with cystic airspaces that mimicks traumatic pulmonary pseudocyst. CASE PRESENTATION: A 61-year-old man with no chest medical or surgical history, no chest radiologic examination within the last five years, and no smoking history had an air-filled "cystlike" lesion surrounded by solid components and ground-glass opacities in the middle third of the right upper lobe of the lung during a computed tomography evaluation following blunt chest trauma. He was initially diagnosed with traumatic pulmonary pseudocyst and treated conservatively. On the third post-trauma day, he experienced hemoptysis, which was successfully treated with intravenous hemostatic medication. On the ninth post-trauma day, he exhibited a significant hemoptysis and a moderate dyspnea. A subsequent chest computed tomography scan demonstrated that the solid components had entered the lesion's cavity and significantly expanded, and the surrounding ground-glass opacities had slightly enlarged. A contrast-enhanced chest computed tomography scan and a three-dimensional reconstruction computed tomography image confirmed that the solid components were a hematoma caused by damage to the right upper pulmonary vein. A right upper lobectomy was performed based on the concern about severe intrapulmonary bleeding. An intraoperative frozen section analysis showed significant bleeding in the lung parenchyma. Adenosquamous carcinoma was unexpectedly identified during the postoperative pathological examination of the resected specimen. A diagnosis of primary lung adenosquamous carcinoma was made. He was discharged on the seventh postoperative day and followed up for two years without any recurrence. CONCLUSIONS: The potential of lung cancer associated with cystic airspaces should be considered for "cystlike" lung lesions discovered in elderly patients after blunt chest trauma. A comprehensive review of the medical history, meticulous analysis of the radiological findings, and close monitoring can help clinicians reduce the risk of diagnostic bias.
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Carcinoma Adenoescamoso , Quistes , Neoplasias Pulmonares , Tomografía Computarizada por Rayos X , Humanos , Masculino , Persona de Mediana Edad , Diagnóstico Diferencial , Quistes/diagnóstico por imagen , Quistes/diagnóstico , Quistes/etiología , Carcinoma Adenoescamoso/cirugía , Carcinoma Adenoescamoso/diagnóstico , Heridas no Penetrantes/complicaciones , Neumonectomía/métodos , Traumatismos Torácicos/complicaciones , Pulmón/diagnóstico por imagenRESUMEN
BACKGROUND: Prenatally diagnosed hepatic hilar cysts are a challenging finding for the clinician. They can either be a sign of cystic biliary atresia (BA) or a choledochal cyst (CC), two diagnoses with different postnatal management and prognosis. Based on a case report of four patients, we aim to propose a management algorithm for prenatally diagnosed "hepatic hilar cysts". CASE PRESENTATION: A hepatic hilar cyst, ranging from 5 to 25 mm, was detected prenatally in all four girls confirmed postnatally along with the presence of a gallbladder. Stool color was normal until two weeks of life at which time the stool color became lighter, and the patients developed cholestasis. All were operated before seven weeks of life: Case 1 had a CC with patent but irregular intrahepatic bile ducts at intraoperative cholangiogram, and no communication with the duodenum. A Roux-en-Y bilioenteric anastomosis was performed. The cyst showed complete epithelial lining loss, and liver pathology showed BA features. Case 2 had the final diagnosis of cystic BA with patent but abnormal intrahepatic bile ducts. She underwent two operations: the first operation at four weeks as described for case 1, since intraoperative findings were similar, as was histology. As cholestasis increased postoperatively, she underwent a Kasai hepato-porto-enterostomy six weeks later, where distinct BA findings were found with complete scarring of the hilar plate. Case 3 had a cystic BA with the cyst located within the common bile duct and atretic bile ducts proximal to the porta hepatis. It exhibited no communication with the liver or duodenum. A Kasai operation was performed, with histology showing complete epithelial loss within the cyst wall and scarring of the hilar plate. Case 4 had a cystic BA presenting a completely obliterated hepatic duct with the cyst lying within the common bile duct. A Kasai procedure was performed. Histology showed a common bile duct with a residual lumen of 0.1 mm. CONCLUSIONS: The spectrum of disease from CC to BA in the setting of a prenatally discovered hepatic hilar cyst is emphasized. Even if cholangiogram differentiates most patients with BA from those with CC, caution is advised for transitional types.
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Atresia Biliar , Quiste del Colédoco , Vesícula Biliar , Humanos , Quiste del Colédoco/cirugía , Quiste del Colédoco/diagnóstico por imagen , Femenino , Atresia Biliar/cirugía , Atresia Biliar/diagnóstico , Atresia Biliar/complicaciones , Vesícula Biliar/anomalías , Vesícula Biliar/patología , Vesícula Biliar/cirugía , Recién Nacido , Embarazo , Ultrasonografía Prenatal , Diagnóstico Diferencial , Quistes/cirugía , Quistes/diagnóstico por imagen , LactanteRESUMEN
Herein, we report a case of a man with a large symptomatic hepatic cyst that gradually enlarged over a follow-up period of 15 years, which eventually caused epigastric fullness and obstructive jaundice. The patient underwent percutaneous cystic drainage followed by sclerotherapy using minocycline hydrochloride combined with intracystic lavage. The treatment resulted in a significant reduction in the hepatic cyst size, symptom improvement, and absence of recurrence for 670 days.
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Quistes , Hepatopatías , Minociclina , Escleroterapia , Humanos , Minociclina/administración & dosificación , Masculino , Quistes/terapia , Quistes/diagnóstico por imagen , Hepatopatías/terapia , Irrigación Terapéutica , Resultado del Tratamiento , Drenaje , Persona de Mediana EdadRESUMEN
We present the case of a patient with leukoencephalopathy with calcifications and cysts (LCC), who experienced progressive severe hemiparesis despite multiple neurosurgical interventions of a large contralateral cyst. Bevacizumab was proposed as an ultimate treatment option based on prior case reports. While awaiting reimbursement approval for bevacizumab, major improvement occurred in both clinical and radiological disease manifestations. The disease course of LCC is variable and unpredictable; neurosurgical treatment should be reserved for severe and progressive neurological deficits. Bevacizumab has been reported as a promising alternative treatment option. Importantly, in our case the observed clinical improvement would have been attributed to the effects of bevacizumab, if started when requested. Our case underscores the need for a natural history study for LCC and the necessity of validating treatment efficacy by systematic evaluation through appropriate clinical trials rather than relying on anecdotal evidence from published case reports.
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Calcinosis , Leucoencefalopatías , Humanos , Leucoencefalopatías/diagnóstico por imagen , Leucoencefalopatías/complicaciones , Leucoencefalopatías/tratamiento farmacológico , Calcinosis/diagnóstico por imagen , Calcinosis/tratamiento farmacológico , Calcinosis/cirugía , Calcinosis/complicaciones , Quistes/cirugía , Quistes/complicaciones , Quistes/diagnóstico por imagen , Masculino , Bevacizumab/uso terapéutico , Persona de Mediana Edad , Imagen por Resonancia Magnética , Femenino , Quistes del Sistema Nervioso Central/cirugía , Quistes del Sistema Nervioso Central/complicaciones , Quistes del Sistema Nervioso Central/diagnóstico por imagen , Quistes del Sistema Nervioso Central/tratamiento farmacológicoRESUMEN
Splenic cysts are uncommon and classified into parasitic and non-parasitic origins. Non-parasitic cysts are further categorised into primary and secondary forms; primary cysts develop congenitally and progress into adulthood and secondary cysts result from factors such as abdominal trauma, infection or ischemia. This case series presents three instances of splenic cysts in children. The first case involves a splenic epidermoid cyst, the second a pseudocyst and the third a splenic epithelial cyst. All patients exhibited an abdominal lump in the left quadrant that increased in size over time, without additional symptoms. The third patient had a history of abdominal blunt trauma a year prior to symptom onset. Treatment approaches varied: the first and third patients underwent total splenectomy, while the second patient underwent aspiration drainage with frozen section analysis and partial splenectomy. All patients, first, second and third, were discharged 6, 3 and 5 days postoperatively, respectively, without complications. Splenic epithelial cyst (SEC) emerged as the predominant primary non-parasitic splenic cyst type, with an unclear pathogenesis. Typically asymptomatic, splenic cysts are commonly detected incidentally during imaging or exploratory laparotomy. Histopathology stands as the gold standard diagnostic method for splenic cysts. Although rare, paediatric splenic cysts should be considered in cases of abdominal trauma. Imaging serves a vital role in diagnosis, guiding decisions between conservative or surgical interventions based on cyst size, symptoms and associated complications.
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Quistes , Enfermedades del Bazo , Humanos , Enfermedades del Bazo/diagnóstico , Enfermedades del Bazo/cirugía , Niño , Masculino , Quistes/diagnóstico , Quistes/cirugía , Quistes/diagnóstico por imagen , Femenino , Adolescente , Esplenectomía , PreescolarRESUMEN
We report a case of a 26-year-old type 1 diabetic woman presenting with acute lower abdominal pain, bloating, and vomiting. Initial examination revealed right lower quadrant tenderness and a suprapubic mass. Computed tomography (CT) imaging identified a 12-cm cystic structure suggestive of a dilated bowel loop with an adjacent inflamed 7-cm small bowel segment. Surgical exploration uncovered a Merkel's diverticulum-associated duplication cyst originating from the Meckel's diverticulum. Subsequent complications included an anastomotic leak, requiring relook laparotomy and the formation of a double-barrel stoma. The patient recovered and was discharged on day 13. This case highlights the diagnostic challenge of Meckel's diverticulum-associated duplication cysts, emphasizing the need for vigilance in managing complex abdominal presentations.
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Abdomen Agudo , Quistes , Divertículo Ileal , Tomografía Computarizada por Rayos X , Humanos , Divertículo Ileal/complicaciones , Divertículo Ileal/cirugía , Divertículo Ileal/diagnóstico por imagen , Femenino , Abdomen Agudo/etiología , Adulto , Quistes/cirugía , Quistes/complicaciones , Quistes/diagnóstico por imagenRESUMEN
ABSTRACT: A 23-year-old man with papillary thyroid cancer underwent radioiodine ( 131 I) treatment following total thyroidectomy and node dissection. Posttreatment 131 I SPECT/CT images revealed an additional focus of increased 131 I activity in the left adrenal gland, raising suspicion for possible adrenal metastasis. Ultimately, pathological examination confirmed the diagnosis of an adrenal cyst.
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Quistes , Radioisótopos de Yodo , Neoplasias de la Tiroides , Humanos , Masculino , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Adulto Joven , Quistes/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Cáncer Papilar Tiroideo/diagnóstico por imagenRESUMEN
RATIONALE: Multilocular cystic hemangioma is a rare benign tumor classified as an atypical hemangioma. Currently, there are limited imaging reports available, and the imaging characteristics can be challenging to distinguish from other malignant multilocular cystic liver diseases such as cystadenocarcinoma, necessitating confirmation through pathological diagnosis. Here, we discuss the imaging features of 3 cases of multilocular cystic hemangiomas. PATIENT CONCERNS AND DIAGNOSES: Case 1 was a 24-year-old young female, and Case 2 involved a 60-year-old elderly male. Both patients were asymptomatic and physical examination revealed hepatic space-occupying lesions. Imaging findings revealed multilocular cystic lesions in the left liver with septa, calcification, a high diffusion-weighted magnetic resonance imaging (DWI) signal at the edge of the lesion, and progressive enhancement of the cyst wall and septa. Case 3 involved a 50-year-old male patient with epigastric distending pain for 1 month and sudden severe abdominal pain for 14 hours. Imaging results revealed a multilocular cystic lesion in the left liver with septa and tumor bleeding, a high DWI signal, and an enhanced cyst wall and septa. The pathological diagnosis confirmed a hepatic hemangioma. INTERVENTIONS: All 3 patients underwent liver tumor resection. OUTCOMES: All 3 patients recovered successfully without any intraoperative or postoperative complications during the follow-up periods of 5 years, 6 months, and 5 months. There were no signs of recurrence. LESSONS: Liver imaging revealed multilocular cystic lesions with features, such as compartmentalization, calcification, or bleeding. Multilocular cystic hemangiomas should be considered in imaging diagnosis. Enhancing our understanding of multilocular cystic hemangiomas can aid in improving the differential diagnosis of other malignant multilocular cystic liver diseases, ultimately reducing unnecessary liver resection.
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Hemangioma , Neoplasias Hepáticas , Humanos , Masculino , Persona de Mediana Edad , Hemangioma/cirugía , Hemangioma/diagnóstico , Hemangioma/diagnóstico por imagen , Hemangioma/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/diagnóstico , Femenino , Adulto Joven , Diagnóstico Diferencial , Quistes/diagnóstico por imagen , Quistes/cirugía , Quistes/patología , Quistes/diagnóstico , Hígado/patología , Hígado/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: We conducted this study to clarify the magnetic resonance imaging (MRI) characteristics of lobular endocervical glandular hyperplasia (LEGH) and Nabothian cysts. METHODS: This study included 48 patients who underwent hysterectomy at our institution between 2016 and 2020 for suspected LEGH. Histopathological studies confirmed the presence of 25 Nabothian cysts and 23 cases of LEGH. We retrospectively analyzed five characteristic MRI findings: (1) located at the upper cervical canal, (2) positioned within the cervical stroma, (3) not circumscribing the cervical canal, (4) low- to iso-intensity on T1-weighted images (T1WI), and (5) "cosmos" or "microcystic" pattern. We compared the diagnostic accuracy of these findings for LEGH and Nabothian cysts using sensitivity, specificity, and predictive values. Combinations of findings were also calculated. RESULTS: The characteristics "cosmos" or "microcystic" pattern, lesion not circumscribing the cervical canal, and low/iso-intensity on T1WI had a sensitivity and specificity greater than 50%. The sensitivity was 73.9% and specificity 84.0% when a combination of "cosmos" or "microcystic" pattern and lesion not circumscribing the cervical canal was present. CONCLUSION: The coexistence of a "cosmos" or "microcystic" pattern and not circumscribing the cervical canal was the most characteristic finding that distinguished LEGH from Nabothian cysts. When neither of these findings is present, Nabothian cyst can be suspected.
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Cuello del Útero , Quistes , Imagen por Resonancia Magnética , Sensibilidad y Especificidad , Humanos , Femenino , Estudios Retrospectivos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Quistes/diagnóstico por imagen , Quistes/diagnóstico , Quistes/patología , Adulto , Cuello del Útero/patología , Cuello del Útero/diagnóstico por imagen , Anciano , Hiperplasia/diagnóstico por imagen , Hiperplasia/diagnóstico , Hiperplasia/patología , Histerectomía , Enfermedades del Cuello del Útero/diagnóstico , Enfermedades del Cuello del Útero/diagnóstico por imagen , Enfermedades del Cuello del Útero/patología , Cuidados Preoperatorios/métodos , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugíaRESUMEN
BACKGROUND: Intussusception with intestinal malrotation is termed as Waugh's syndrome. The incidence of Waugh's syndrome is less than 1%. There are very few reported cases. Once presented, it is a pediatric surgical emergency. CASE PRESENTATION: We present here two cases of Waugh's syndrome: an 11-month-old male patient of Punjabi descent and a 4-month-old female patient of Afghan descent who presented to us with abdominal pain and bleeding per rectum. Abdominal sonography revealed an intussusception with a target sign. They were explored and perioperatively had intestinal malrotation alongside intussusception, thus a diagnosis of Waugh's syndrome was made. A right hemicolectomy and Ladd's procedure was performed. CONCLUSION: Waugh syndrome is a rare congenital anomaly but can present with vague abdominal symptoms. Once presented, it is a pediatric surgical emergency. The patient should be optimized followed by surgical exploration.
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Intususcepción , Humanos , Intususcepción/cirugía , Intususcepción/diagnóstico por imagen , Masculino , Femenino , Lactante , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/complicaciones , Vólvulo Intestinal/diagnóstico por imagen , Enfermedades del Ciego/cirugía , Enfermedades del Ciego/complicaciones , Enfermedades del Ciego/diagnóstico por imagen , Quistes/cirugía , Quistes/complicaciones , Quistes/diagnóstico por imagen , Dolor Abdominal/etiología , Colectomía , Ultrasonografía , Síndrome , Ciego/anomalías , Ciego/cirugía , Ciego/diagnóstico por imagenRESUMEN
BACKGROUND: Our aim was to determine whether the Apparent Diffusion Coefficient is able to predict the presence of a symptomatic pineal cyst by detecting cerebral edema. METHODS: We retrospectively analyzed MRIs of 45 patients with pineal cysts before and after resection and 51 patients without pineal cysts, comparing ADC values of thalamus, central, periventricular and subcortical white matter. Furthermore we evaluated cyst size and morphology and analyzed its correlation to ADC values in corresponding patients. RESULTS: Differences between patients with symptomatic pineal cyst and control group were not significant (p = 0.200 - 0.968). ADC ratios did not change significantly after resection of the cyst (p = 0.575 - 0.862). Cyst size showed no significant correlation to ADC ratios (p = 0.071 - 0.918). Raw data analyses revealed more significance, especially periventricularly and in central white matter, which resulted in significant interhemispheric differences in ADC ratios in both subgroups (p < 0.001 and p = 0.031). MRI of 1.5T showed consistently higher values than 3T but mostly insignificant. CONCLUSION: Our analysis revealed no evidence that pineal cysts lead to intracerebral edema caused by venous compression. Since variability was higher than the differences seen, ADC sequences do not appear to be an appropriate diagnostic tool for symptomatic pineal cysts.
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Edema Encefálico , Quistes , Glándula Pineal , Humanos , Estudios Retrospectivos , Femenino , Masculino , Adulto , Glándula Pineal/diagnóstico por imagen , Glándula Pineal/cirugía , Glándula Pineal/patología , Persona de Mediana Edad , Quistes/diagnóstico por imagen , Quistes/cirugía , Quistes/patología , Edema Encefálico/diagnóstico por imagen , Adulto Joven , Adolescente , Anciano , Imagen por Resonancia Magnética/métodos , Niño , Quistes del Sistema Nervioso Central/diagnóstico por imagen , Quistes del Sistema Nervioso Central/cirugía , Quistes del Sistema Nervioso Central/patología , Imagen de Difusión por Resonancia Magnética/métodos , Biomarcadores/análisisAsunto(s)
Imagen por Resonancia Magnética , Humanos , Quistes/diagnóstico por imagen , Quistes/cirugía , Femenino , MasculinoRESUMEN
Diagnosing liver lesions is crucial for treatment choices and patient outcomes. This study develops an automatic diagnosis system for liver lesions using multiphase enhanced computed tomography (CT). A total of 4039 patients from six data centers are enrolled to develop Liver Lesion Network (LiLNet). LiLNet identifies focal liver lesions, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), metastatic tumors (MET), focal nodular hyperplasia (FNH), hemangioma (HEM), and cysts (CYST). Validated in four external centers and clinically verified in two hospitals, LiLNet achieves an accuracy (ACC) of 94.7% and an area under the curve (AUC) of 97.2% for benign and malignant tumors. For HCC, ICC, and MET, the ACC is 88.7% with an AUC of 95.6%. For FNH, HEM, and CYST, the ACC is 88.6% with an AUC of 95.9%. LiLNet can aid in clinical diagnosis, especially in regions with a shortage of radiologists.
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Carcinoma Hepatocelular , Colangiocarcinoma , Aprendizaje Profundo , Hemangioma , Neoplasias Hepáticas , Tomografía Computarizada por Rayos X , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Carcinoma Hepatocelular/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Masculino , Hemangioma/diagnóstico por imagen , Colangiocarcinoma/diagnóstico por imagen , Colangiocarcinoma/patología , Femenino , Hígado/diagnóstico por imagen , Hígado/patología , Persona de Mediana Edad , Hiperplasia Nodular Focal/diagnóstico por imagen , Adulto , Anciano , Área Bajo la Curva , Quistes/diagnóstico por imagenRESUMEN
BACKGROUND: Adrenal cysts are rare and appropriate management is unclear due to a lack of data on their natural history. Understanding adrenal cyst growth patterns would assist in clinical management. METHODS: This single-institution study included all adult patients diagnosed with simple adrenal cysts between 2004 and 2021. Baseline characteristics and outcomes of those who underwent resection (ADX) or observation (OBS) were compared using the chi-squared test, student's t-test, and Wilcoxon rank-sum test. Growth curves and sensitivity analysis were plotted for all patients who had follow-up imaging. RESULTS: We identified 77 patients with imaging-confirmed adrenal cysts. The majority were female (75.3%) and more than half were white (55.8%). One-third of patients underwent ADX, and the remaining were observed. ADX patients were younger (median age [IQR]: 55.5 y [45.0-68.2 y] vs. 44.2 y [38.7-55.0 y], p = 0.01) and more likely to be Hispanic (12% vs. 0%, p = 0.05). ADX patients presented with larger cysts (5.6 vs. 2.6 cm, p = 0.002). The median time from diagnosis to last follow-up was 1.1 y for ADX and 4.1 y for OBS. Average growth for OBS was 0.3 cm/y, while average growth for ADX was 3.9 cm/y. In ADX patients, cysts >10 cm grew significantly faster than cysts <10 cm (median growth rate 13.2 cm/y vs. 0.3 cm/y, p < 0.05). There was no adrenal malignancy diagnosis, hyperfunctionality, or observation-related complications (e.g., rupture). CONCLUSION: While size >4-6 cm has guided surgical referral for solid adrenal masses, this study demonstrates a size threshold of 10 cm, below which asymptomatic, simple adrenal cysts can safely be observed.
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Enfermedades de las Glándulas Suprarrenales , Quistes , Humanos , Femenino , Masculino , Persona de Mediana Edad , Quistes/cirugía , Quistes/diagnóstico por imagen , Quistes/patología , Enfermedades de las Glándulas Suprarrenales/cirugía , Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Enfermedades de las Glándulas Suprarrenales/patología , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Adulto , Anciano , Estudios Retrospectivos , Adrenalectomía/métodos , Espera Vigilante , Tomografía Computarizada por Rayos XRESUMEN
Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providers must be familiar with the diagnosis and management of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs.
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Adenoma de Células Hepáticas , Quistes , Hiperplasia Nodular Focal , Hemangioma , Hepatopatías , Neoplasias Hepáticas , Humanos , Hiperplasia Nodular Focal/diagnóstico , Hiperplasia Nodular Focal/patología , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/diagnóstico por imagen , Hepatopatías/diagnóstico , Hepatopatías/terapia , Hepatopatías/diagnóstico por imagen , Hepatopatías/patología , Hemangioma/diagnóstico , Hemangioma/terapia , Hemangioma/patología , Hemangioma/diagnóstico por imagen , Quistes/diagnóstico , Quistes/diagnóstico por imagen , Quistes/patología , Adenoma de Células Hepáticas/diagnóstico , Adenoma de Células Hepáticas/patología , Adenoma de Células Hepáticas/terapia , Adenoma de Células Hepáticas/diagnóstico por imagen , Diagnóstico Diferencial , Gastroenterología/normas , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/diagnóstico por imagenRESUMEN
Objective: The aim of this study is to explore the practical value of prenatal magnetic resonance imaging (MRI) in the assessment of congenital cystic lung disease in fetuses, to evaluate the relative size of the lesion and the status of lung development, and to make an attempt at utilizing the strength of MRI in post-processing to obtain assessment indicators of the size of the lesion and the status of lung development, with which predictions can be made for the prognosis that these fetuses may face after birth. We retrospectively collected and analyzed the data of fetuses diagnosed with congenital cystic lung disease. Prenatal ultrasound examination of these fetuses led to the diagnosis that they were suspected of having congenital cystic lung disease and the diagnosis was confirmed by subsequent prenatal MRI. The fetuses were followed up to track their condition at birth (postnatal respiratory distress, mechanical ventilation, etc.), whether the fetuses underwent surgical treatment, and the recovery of the fetuses after surgical treatment. The recovery of the fetuses was followed up to explore the feasibility of prenatal MRI examination to assess fetal congenital pulmonary cystic disease, and to preliminarily explore the predictive value of prenatal MRI for the prognosis of fetuses with congenital pulmonary cystic disease. Methods: MRI fetal images were collected from pregnant women who attended the West China Second University Hospital of Sichuan University between May 2018 and March 2023 and who were diagnosed with fetal congenital pulmonary cystic disease by prenatal ultrasound and subsequent MRI. Fetal MRI images of congenital cystic lung disease were post-processed to obtain the fetal lung lesion volume, the fetal affected lung volume, the healthy lung volume, and the fetal head circumference measurements. The signal intensity of both lungs and livers, the lesion volume/the affected lung volume, the lesion volume/total lung volume, the cystic volume ratio (CVR), and the bilateral lung-liver signal intensity ratio were measured. The feasibility and value of MRI post-processing acquisition indexes for evaluating the prognosis of fetuses with congenital cystic lung disease were further analyzed by combining the follow-up results obtained 6 months after the birth of the fetus. Logistic regression models were used to quantify the differences in maternal age, gestational week at the time of MRI, CVR, and bilateral lung-to-liver signal intensity ratio, and to assess whether these metrics correlate with poor prognosis. Receiver operating characteristic (ROC) curves were used to assess the value of the parameters obtained by MRI calculations alone and in combination with multiple metrics for predicting poor prognosis after birth. Results: We collected a total of 67 cases of fetuses diagnosed with congenital cystic lung disease by fetal MRI between May 2018 and March 2023, and excluded 6 cases with no normal lung tissue in the affected lungs, 11 cases of fetal induction, and 3 cases of loss of pregnancy. In the end, 47 cases of fetuses with congenital cystic lung disease were included, of which 30 cases had a good prognosis and 17 cases had a poor prognosis. The difference in the difference between the signal intensity ratios of the affected and healthy sides of the lungs and livers of the fetuses in the good prognosis group and that in the poor prognosis group was statistically significant (P<0.05), and the signal intensity ratio of the healthy side of the lungs and livers was higher than the signal intensity ratio of the affected side of the lungs and livers. Further analysis showed that CVR (odds ratio [OR]=1.058, 95% confidence interval [CI]: 1.014-1.104), and the difference between the lung-to-liver signal intensity ratios of the affected and healthy sides (OR=0.814, 95% CI: 0.700-0.947) were correlated with poor prognosis of birth in fetuses with congenital cystic lung disease. In addition, ROC curve analysis showed that the combined application of lesion volume/affected lung volume and the observed difference in the signal intensity ratio between the affected and healthy lungs and liver predicted the prognosis of children with congenital cystic lung disease more accurately than the single-parameter judgment did, with the area under the curve being 0.988, and the cut-off value being 0.33, which corresponded to a sensitivity of 100%, a specificity of 93.3%, and a 95% CI of 0.966-1.000. Conclusions: Based on the MRI of fetuses with congenital cystic lung disease, we obtained information on lesion volume, lesion volume/affected lung volume, lesion volume/total lung volume, CVR, and bilateral lung-to-liver signal intensity ratio difference, all of which showing some clinical value in predicting the poor prognosis in fetuses with congenital cystic lung disease. Furthermore, among the combined indexes, the lesion volume/affected lung volume and bilateral lung-to-liver signal intensity ratio difference are more effective predictors for the poor prognosis of fetuses with congenital cystic lung disease, and show better efficacy in predicting the poor prognosis of fetuses with congenital cystic lung disease. This provides a new and effective predictive method for further assessment of pulmonary lung development in fetuses with congenital cystic lung disease, and helps improve the assessment and prediction of the prognosis of fetuses with congenital cystic lung disease.