1. NERRS Case 1
45-year-old man with chronic low
grade fevers and right upper
quadrant pain
Paul B. Shyn, MD

2. NERRS Case 1
HEPATIC FASCIOLIASIS
 zoonotic disease (liver fluke Fasciola Hepatica)
 end host sheep or cattle, int host freshwater snail
 found in humans “by chance” who have ingested
contaminated watercress or water
 2 stages: the hepatic (acute, invasive) stage and the
biliary (chronic, obstructive) stage
 serologic confirmation or eggs in stool is mandatory
for a final diagnosis
Diagnostic imaging in the study of human hepatobiliary fascioliasis.
Cantisani V, Cantisani C, Mortelé K, et al.
Radiol Med. 2010;115(1):83-92.

3. NERRS Case 1
HEPATIC FASCIOLIASIS
Sonography
 non-specific, hypoechoic subcapsular areas
CT
 single or multiple hypodense nodular areas or
tunnel-like branching or tortuous peripheral
hypodensities (penetration of parasite through
Glisson’s capsule) + capsular enhancement
Diagnostic imaging in the study of human hepatobiliary fascioliasis.
Cantisani V, Cantisani C, Mortelé K, et al.
Radiol Med. 2010;115(1):83-92.

4. NERRS Case 1
HEPATIC FASCIOLIASIS
MRI
 capsular hyperintensity on T2 weighted images
 multiple peripheral lesions, hyperintense on T2
and peripheral prgressive enhancement
DD
 schistosomiasis, echinococcosis, toxocara
 cholangitis, liver abscesses
Diagnostic imaging in the study of human hepatobiliary fascioliasis.
Cantisani V, Cantisani C, Mortelé K, et al.
Radiol Med. 2010;115(1):83-92.

5. NERRS Case 2
29-year-old female with left upper
quadrant discomfort
Christina LeBedis, MD

6. NERRS Case 2
DIAGNOSIS & DISCUSSION
• Diagnosis
solid pseudopapillary tumor
solid & papillary epithelial neoplasm (SPEN)
“DAUGHTER”
• Clinicodemographic Features
benign (85%) or low grade malignant
young women (85%, age 25y)
no race & location predilection

7. NERRS Case 2
IMAGING FEATURES
• Classic Appearance
solitary
large (mean 9.3 cm)
well demarcated
capsule
solid & cystic areas
hemorrhage
calcifications (30%)

8. NERRS Case 2
IMAGING FEATURES
• Solid pseudopapillary carcinoma (15%)
size lesion (> 5 cm ?) and age not different
male gender
duct obstruction
vascular invasion
metastatic disease
 5-year survival 96%

9. NERRS Case 2
DIFFERENTIAL DIAGNOSIS
• Encapsulated Pancreas Lesions
Mucinous Cystic Neoplasm
Pancreatic Endocrine Tumor
Pancreatic Pseudocyst
Sugar Tumor (PEComa)

10. Rare Cystic Tumors
ENDOCRINE TUMORS
 body and tail, middle age
 75% sporadic, 25% MEN-1
 most tumors “functioning”
 “hyperfunctioning”, “functional”, or
“syndromic”
 cystic endocrine tumors
56/133 (42%) cystic or areas of necrosis
larger than solid lesions (8.4 cm vs 2.9 cm)
especially non-syndromic (36/56)

11. NERRS Case 3
34-year-old female with recurrent
right upper quadrant pain
Kathleen McCarten, MD

12. NERRS Case 3
CAROLI DISEASE
 What ?
 congenital ductal plate abnormality
 saccular dilatation of the bile ducts
 communicating with biliary tree
 segmental (>) or diffuse
 associated abnormalities
medullary sponge kidney
renal tubular ectasia
congenital hepatic fibrosis (Caroli Syndrome)

13. NERRS Case 3
CAROLI DISEASE
MRI
ductal dilation
intrahepatic only
communicating
saccular bile ducts
« eye of the tiger »
« central dot »

14. NERRS Case 3
OTHER CHOLEDOCHAL CYSTS
 congenital cystic dilatations of ducts
 > anomalous common channel
 pancreatic juice reflux
 prevalence much higher in Japan
(1/1,000) versus US (1/130,000)
 8:1 female predominance
 60% present before age 10
De Wilde VG, et al. Choledochal cysts in the adult.
Endoscopy (1991) 23:4-7

15. NERRS Case 3
CHOLEDOCHAL CYSTS - TODANI
• Type I - solitary fusiform
extrahepatic
• Type II - extrahepatic
supraduodenal diverticulum
• Type III - choledochocele
• Type IV - multiple
extrahepatic cyts or intra +
extrahepatic
• Type V - Caroli’s disease

16. NERRS Case 4
47-year-old female with abdominal
pain and fever
Suzie Yi Huang, MD

17. NERRS Case 4
ECTOPIC PANCREAS
 usually 0.5 cm - 2 cm [rarely up to 5 cm]
 incidence varies
 location (> submucosa [50%])
 most commonly stomach (26-
38%), duodenum, jejunum (16%), Meckel
diverticulum or ileum
 rare in colon, esophagus, gallbladder, bile
ducts, liver, spleen, umbilicus, mesentery, mesocolon,
omentum
 usually asymptomatic
 stenosis, ulceration, bleeding, invagination, ca

18. NERRS Case 5
43-year-old female with pelvic pain and
rectal bleeding
Frank Scholtz, MD

19. NERRS Case 5
SIGMOID ENDOMETRIOSIS
 6-10% of female population; retrograde menstruation
 10% GI involvement (deep endometriosis)
 extensive fibrosis, little endometrial-like cells
 iso-intense to muscle on T1- and T2-WI
 “mushroom cap” sign on T2-weighted images
 rarely progressive, rarely recurrent
 DD: adenoca – treatment: hormonal or surgery
Evaluation of colonic involvement in endometriosis: double-
contrast barium enema vs. magnetic resonance imaging.
Faccioli N, Foti G, Manfredi R, et al. Abdom Imaging
2010;35(4):414-21.