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Brunner M, Ammer-Herrmenau C, Biggemann L, Ströbel P, König A, Ellenrieder V, Petzold G. [Metastasis or sarcoidosis - a diagnostic pitfall in metastatic rectal carcinoma]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:515-521. [PMID: 36126930 DOI: 10.1055/a-1880-1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Granulomatous diseases as sarcoidosis can impair the staging of metastatic diseases since metastasis are hard to distinguish from granulomas in standard imaging. This case report describes the diagnostic workup and therapy in a patient with simultaneous sarcoidosis and rectal cancer with hepatic metastasis and how a curative stadium was achieved. CASE DESCRIPTION A 71-year old male patient was diagnosed with an adenocarcinoma of the rectum after presenting with involuntary weight loss and anemia. Further diagnostics raised strong suspicion of hepatic, pulmonary and splenic metastasis. Histology after bronchoscopy surprisingly discovered non-caseating granulomas, leading to the diagnosis of sarcoidosis. Due to an obstructive tumor, a rectum resection was performed. Due to a high suspicion of splenic metastasis during surgery, the spleen was removed. Histology revealed no metastasis in the spleen but multiple granulomas due to sarcoidosis. After surgery, biopsy of a suspicious lesion in the liver revealed both metastasis and sarcoidosis in the same sample. The patient was treated with a pseudo(neo)adjuvant chemotherapy with 5-Fluorouracil, Leukovorin, Oxaliplatin (FOLFOX) and Panitumumab (Anti-EGF-antibody). After treatment, CT scan revealed two hepatic lesions decreasing in size, while all other lesions were metrically stable. A right hemihepatectomy followed and histology revealed both sarcoidosis and metastasis. The curated patient was sent to aftercare and there is no suspicion for a relapse (13 month after last surgery). DISCUSSION The simultaneous appearance of metastatic tumors and sarcoidosis creates a diagnostic dilemma since both manifestations can barely be distinguished in regular imaging technologies. This case report demonstrates that the histological work-up of affected organs with consecutive resections can cure a patient of a metastatic tumor disease, even in the context of simultaneous sarcoidosis.
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Affiliation(s)
- Marius Brunner
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Christoph Ammer-Herrmenau
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Lorenz Biggemann
- Institut für diagnostische und interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Alexander König
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Golo Petzold
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
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Tana C, Donatiello I, Caputo A, Tana M, Naccarelli T, Mantini C, Ricci F, Ticinesi A, Meschi T, Cipollone F, Giamberardino MA. Clinical Features, Histopathology and Differential Diagnosis of Sarcoidosis. Cells 2021; 11:59. [PMID: 35011621 PMCID: PMC8750978 DOI: 10.3390/cells11010059] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis is a chameleon disease of unknown etiology, characterized by the growth of non-necrotizing and non-caseating granulomas and manifesting with clinical pictures that vary on the basis of the organs that are mainly affected. Lungs and intrathoracic lymph nodes are the sites that are most often involved, but virtually no organ is spared from this disease. Histopathology is distinctive but not pathognomonic, since the findings can be found also in other granulomatous disorders. The knowledge of these findings is important because it could be helpful to differentiate sarcoidosis from the other granulomatous-related diseases. This review aims at illustrating the main clinical and histopathological findings that could help clinicians in their routine clinical practice.
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Affiliation(s)
- Claudio Tana
- Geriatrics Clinic, SS. Medical Department, SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy
| | - Iginio Donatiello
- Internal Medicine Unit, Medical Department, University Hospital of Salerno, 84121 Salerno, Italy;
| | - Alessandro Caputo
- Anatomical Pathology Unit, Department of Anatomical Pathology, University Hospital of Salerno, 84121 Salerno, Italy;
| | - Marco Tana
- 2nd Internal Medicine Unit, SS. Medical Department, SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy;
| | - Teresa Naccarelli
- Oncoematology Unit, Oncoematology Department, Tor Vergata Hospital of Rome, 00133 Rome, Italy;
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Radiology, SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy; (C.M.); (F.R.)
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Radiology, SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy; (C.M.); (F.R.)
| | - Andrea Ticinesi
- Internal Medicine Unit, Geriatric-Rehabilitation Department and Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (T.M.)
| | - Tiziana Meschi
- Internal Medicine Unit, Geriatric-Rehabilitation Department and Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (T.M.)
| | - Francesco Cipollone
- Department of Medicine and Science of Aging, Medical Clinic, SS Annunziata Hospital of Chieti, G. D’Annunzio University of Chieti, 66100 Chieti, Italy;
| | - Maria Adele Giamberardino
- Department of Medicine and Science of Aging and CAST, Geriatrics Clinic, SS. Annunziata Hospital of Chieti, G. D’Annunzio University of Chieti, 66100 Chieti, Italy;
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Tana C, Donatiello I, Coppola MG, Ricci F, Maccarone MT, Ciarambino T, Cipollone F, Giamberardino MA. CT Findings in Pulmonary and Abdominal Sarcoidosis. Implications for Diagnosis and Classification. J Clin Med 2020; 9:jcm9093028. [PMID: 32962242 PMCID: PMC7565100 DOI: 10.3390/jcm9093028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
Sarcoidosis is a granulomatous disorder of unknown etiology characterized by noncaseating granulomas virtually in every organ and tissue. This finding represents the most important diagnostic clue to reach a correct definition of sarcoidosis, although the biopsy is invasive and has several risk procedures. Several efforts are made to suspect the diagnosis of sarcoidosis by combining noninvasive elements, in particular from imaging, though these findings are often nonspecific and reflect the wide multifactorial pathogenesis. Every effort should be made to obtain a detailed radiological picture that, if associated with a suggestive clinical picture, could avoid the need of biopsy in some specific cases. In this narrative review, we aim to describe main computed tomography (CT) features of pulmonary and abdominal sarcoidosis, by reporting strengths and limits of this technique, in particular for the identification of extrapulmonary, isolated disease.
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Affiliation(s)
- Claudio Tana
- Geriatrics Clinic, “G. Bernabeo” Hospital, Contrada S. Liberata, 66026 Ortona (CH), Italy
- Correspondence: ; Tel./Fax: +39-085-9172287
| | - Iginio Donatiello
- Internal Medicine Unit, University Hospital of Salerno, 84131 Salerno, Italy;
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, “G.d’Annunzio” University, 66100 Chieti, Italy;
| | | | | | - Francesco Cipollone
- Medical Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio”, University of Chieti, 66100 Chieti, Italy;
| | - Maria Adele Giamberardino
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, 66100 Chieti, Italy;
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Arar O, Boni F, Meschi T, Tana C. Pulmonary Sarcoidosis Presenting with Miliary Opacities. Curr Med Imaging 2020; 15:81-83. [PMID: 31964332 DOI: 10.2174/1573405614666180806141415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lung lesions often appear in patients with sarcoidosis; however, miliary opacities are rare. We present the case of a 55-year-old Indian man who presented with dyspnea and low-grade fever. DISCUSSION Miliary Tuberculosis (TB) was initially suspected, despite the direct microscopic examination from bronchoalveolar lavage was negative for acid-fast bacilli because imaging showed miliary opacities, and transbronchial lung biopsy revealed the presence of typical caseating granulomas. Antitubercular treatment with the classic four-drug regimen was initiated. However, the patient did not improve and cultures were negative for Mycobacterium growth. The diagnosis of sarcoidosis was made only after a negative culture and clinical and histopathological re-evaluation of the case. CONCLUSION Although miliary sarcoidosis is rare, physicians should consider sarcoidosis in the differential diagnosis with conditions like tuberculosis, malignancy, and pneumoconiosis when patients present with miliary opacities who do not respond to the traditional treatment.
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Affiliation(s)
- Omar Arar
- Internal Medicine Unit, Medical Department, Guastalla Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Fabrizio Boni
- Internal Medicine Unit, Medical Department, Guastalla Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma, Italy
| | - Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma, Italy
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Tana C, Ticinesi A, Ricci F, Tana M, di Carlo S, Meschi T. Extrapulmonary Sarcoidosis: A Chameleon Disease at Imaging. Curr Med Imaging 2019. [DOI: 10.2174/157340561505190619094634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Claudio Tana
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
| | - Andrea Ticinesi
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Institute of Cardiology, Imaging and Clinical Sciences, , Italy
| | - Marco Tana
- Internal Medicine Unit, Urbino Hospital, Urbino, Italy
| | - Silvio di Carlo
- Geriatrics Unit, Hospital of Pescara, AUSL Pescara, Pescara, Italy
| | - Tiziana Meschi
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
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Tana C, Schiavone C, Ticinesi A, Ricci F, Giamberardino MA, Cipollone F, Silingardi M, Meschi T, Dietrich CF. Ultrasound imaging of abdominal sarcoidosis: State of the art. World J Clin Cases 2019; 7:809-818. [PMID: 31024952 PMCID: PMC6473121 DOI: 10.12998/wjcc.v7.i7.809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/08/2019] [Accepted: 03/16/2019] [Indexed: 02/05/2023] Open
Abstract
Since it has been recognized that sarcoidosis (SA) is not an exclusive disorder of the lungs but can also affect other organs such as the liver and spleen, efforts have been made to define specific imaging criteria for the diagnosis of the single organ involvement, and the concept has been reinforced that the exclusion of alternative causes is important to achieve the correct diagnosis. Ultrasound (US) is a useful tool to evaluate patients with suspected abdominal SA, such as of the liver, spleen, kidney, pancreas and other organs, showing findings such as organomegaly, focal lesions and lymphadenopathy. While the diagnosis of abdominal SA is more predictable in the case of involvement of other organs (e.g., lungs), the problem is more complex in the case of isolated abdominal SA. The recent use of contrast-enhanced ultrasound and endoscopic ultrasound elastography has provided additional information about the enhancement patterns and tissue rigidity in abdominal SA. Here we critically review the role of US in abdominal SA, reporting typical findings and limitations of current evidence and by discussing future perspectives of study.
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Affiliation(s)
- Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery, University-Hospital of Parma, Parma 43126, Italy
| | - Cosima Schiavone
- Department of Internistic Ultrasound, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Andrea Ticinesi
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery, University-Hospital of Parma, Parma 43126, Italy
| | - Fabrizio Ricci
- Department of Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Maria Adele Giamberardino
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Francesco Cipollone
- Medical Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Mauro Silingardi
- Internal Medicine Unit, Maggiore Hospital of Bologna, Bologna 40133, Italy
| | - Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery, University-Hospital of Parma, Parma 43126, Italy
| | - Christoph F Dietrich
- Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Bad Mergentheim D-97980, Germany
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7
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Affiliation(s)
- Claudio Tana
- Internal Medicine and Critical Subacute Care Unit Medicine Geriatric-Rehabilitation Department University-Hospital of Parma Via Antonio Gramsci 14 43126, Parma, Italy
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8
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Tana C, Schiavone C, Ticinesi A, Lauretani F, Nouvenne A, Dietrich CF, Meschi T. Hepatic artery resistive index as surrogate marker for fibrosis progression in NAFLD patients: A clinical perspective. Int J Immunopathol Pharmacol 2018; 32:2058738418781373. [PMID: 29873275 PMCID: PMC5992803 DOI: 10.1177/2058738418781373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Ultrasound (US) can reveal the presence of steatosis in non-alcoholic fatty liver disease (NAFLD), but its diagnostic accuracy to reveal signs of fibrosis is low except in advanced stages of disease (e.g. cirrhosis). Current guidelines suggest the use of clinical algorithms, such as the NAFLD fibrosis score, and elastography to predict the progression of fibrosis, and the integration of elastography improves the detection accuracy of liver stiffness. However, there is a lack of evidence about the correlation between clinical algorithms and conventional US, and elastography is limited by the relative low diffusion, necessity of training, and loss of diagnostic accuracy in patients with high body mass index (BMI), waist circumference, or increased thickness of parietal walls, with consequent significant rates of failure of measurement of liver stiffness. Recently, the measurement of hepatic artery resistive index (HARI) has demonstrated a significant positive correlation with fibrosis degree, as measured with NAFLD fibrosis score, suggesting that the fibrous tissue accumulation may result in increased arterial rigidity and, therefore, in a rise of resistance to flow, and that the different tissue composition of the liver (adipose versus fibrous) can influence HARI differently. These issues should be further investigated because some aspects are still unknown. The limited data currently justify the need of larger, prospective studies aimed at assessing whether HARI correlates with elastography results. In view of their effect on weight loss, serum lipid concentration, and hepatic arterial flow hemodynamics, it could be interesting to evaluate if lifestyle and diet changes can influence significantly HARI values in NAFLD patients.
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Affiliation(s)
- Claudio Tana
- 1 Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Cosima Schiavone
- 2 Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Andrea Ticinesi
- 1 Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Fulvio Lauretani
- 1 Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Antonio Nouvenne
- 1 Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Christoph Frank Dietrich
- 3 Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Tiziana Meschi
- 1 Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy
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Dietrich CF, Tana C, Caraiani C, Dong Y. Contrast enhanced ultrasound (CEUS) imaging of solid benign focal liver lesions. Expert Rev Gastroenterol Hepatol 2018; 12:479-489. [PMID: 29658347 DOI: 10.1080/17474124.2018.1464389] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasound is well accepted worldwide for imaging of the liver. Absences of radiation exposure, low cost and large diffusion are some of the advantages that make this technique the first to be used in the assessment of focal liver lesions (FLL). Areas covered: Contrast enhanced ultrasound (CEUS) has been introduced more than twenty years ago, and its detection rate is comparable to that of contrast enhanced magnetic resonance imaging (CEMRI) and contrast enhanced computed tomography (CECT). In this narrative review, we discuss the main CEUS features of benign liver lesions and controversies in published results including the gold standard chosen and the quality and knowledge of the preferred techniques. Expert commentary: CEUS is safe and allows an immediate evaluation of the nature of FLL. CEUS permits differentiation between malignant and benign FLL in healthy liver parenchyma by analysing the arterial, portal venous and late phases. CEMRI and CECT are reliable to characterize FLL but higher costs, radiation exposure, nephrotoxicity (in particular for CECT) and absence of real time imaging limit the appropriate evaluation of FLL. Therefore CEUS can be preferred in most clinical situations, and when results are unclear or suggestive for malignant FLL, biopsy and histological examination can be directly initiated avoiding unnecessary additional imaging.
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Affiliation(s)
- Christoph F Dietrich
- a Department of Internal Medicine 2 , Caritas Krankenhaus , Bad Mergentheim , Germany.,b Ultrasound Department , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Claudio Tana
- c Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department , University-Hospital of Parma , Parma , Italy
| | - Cosmin Caraiani
- d Department of Radiology , University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Yi Dong
- e Department of Ultrasound , Zhongshan Hospital, Fudan University , Shanghai , China
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Tana C, Silingardi M, Giamberardino MA, Cipollone F, Meschi T, Schiavone C. Emphysematous pancreatitis associated with penetrating duodenal ulcer. World J Gastroenterol 2017; 23:8666-8670. [PMID: 29358874 PMCID: PMC5752726 DOI: 10.3748/wjg.v23.i48.8666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
In the “proton pump inhibitors era”, a penetrating peptic ulcer (PPU) represents an exceptional cause of abdominal pain, and was more frequently observed in the past where there was not an effective antacid treatment. Ulcer-induced pancreatitis is very rare, too, and manifests with persistent, intense pain radiating to the back. A mild to severe pancreatitis with peripancreatic fluid collection can be observed at imaging. However, only a few cases of association between PPU and emphysematous pancreatitis (EP) have been published in the literature. EP is a rare but potentially fatal form of acute necrotizing pancreatitis in which gas grows in and outside the pancreas, and typically involves the whole parenchyma in diabetic individuals.
Here we report an extremely rare case of a duodenal ulcer penetrating the pancreas and complicated with EP. Unlike the classic form of EP, which involves the whole parenchyma and has a poor prognosis, we found that the emphysematous involvement of the pancreas by PPU has a benign course if a conservative therapy is promptly established. Gas is confined to the site of penetration, usually the pancreatic head, and ulcers most often involve the duodenum.
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Affiliation(s)
- Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma 43126, Italy
| | - Mauro Silingardi
- Internal Medicine Unit, Maggiore Hospital of Bologna, Bologna 40133, Italy
| | - Maria Adele Giamberardino
- Ce.S.I.-Met, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Francesco Cipollone
- Ce.S.I.-Met, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
- Regional Center for the Study of Atherosclerosis, Hypertension and Dyslipidemia, “SS Annunziata” Hospital - ASL Chieti, Chieti 66100, Italy
| | - Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma 43126, Italy
| | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
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Chaubal N, Joshi M, Bam A, Chaubal R. Contrast-Enhanced Ultrasound of Focal Liver Lesions. Semin Roentgenol 2016; 51:334-357. [PMID: 27743569 DOI: 10.1053/j.ro.2016.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nitin Chaubal
- Thane Ultrasound Center, Thane (W), MS, India; Jaslok Hospital & Research Centre, Mumbai.
| | - Mukund Joshi
- Thane Ultrasound Center, Thane (W), MS, India; Jaslok Hospital & Research Centre, Mumbai
| | - Anupam Bam
- Thane Ultrasound Center, Thane (W), MS, India
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Ren WP, Yu MH, Xu P. Contrast-enhanced ultrasonography vs contrast-enhanced computed tomography for assessing blood supply of liver metastases. Shijie Huaren Xiaohua Zazhi 2015; 23:1328-1332. [DOI: 10.11569/wcjd.v23.i8.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the value of contrast-enhanced ultrasonography (CEUS) vs contrast-enhanced computed tomography (CECT) in assessing the blood supply of liver metastases (LM).
METHODS: Fifty-five patients with LM (70 nodules) who underwent both CEUS and CECT were included. The degree of enhancement in arterial phase, the appearance of vasa vasorum and the classification of the blood supply around the nodule were compared between CEUS and CECT.
RESULTS: The degree of enhancement in arterial phase was more significant for CEUS than for CECT (1: 59% vs 5%; 0: 41% vs 62%; -1: 0% vs 33%) (P < 0.05). The appearance of vasa vasorum around the nodule was significantly more frequent for CEUS than for CECT (54% vs 34%, χ2 = 5.674, P = 0.017). The rate of abundant blood supply was 70% for CEUS, significantly higher than that for CECT (30%; χ2 = 19.330, P = 0.000).
CONCLUSION: CEUS is better than CECT in evaluation of blood supply of LM.
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Tana C, Wegener S, Borys E, Pambuccian S, Tchernev G, Tana M, Giamberardino MA, Silingardi M. Challenges in the diagnosis and treatment of neurosarcoidosis. Ann Med 2015; 47:576-91. [PMID: 26469296 DOI: 10.3109/07853890.2015.1093164] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and treatment of neurosarcoidosis can be very challenging for several reasons. It affects clinically 5%-10% of sarcoidosis patients, but can be found in up to 25% of autopsies. These data reveal that a high percentage of asymptomatic or misdiagnosed cases can be missed at an initial diagnostic approach. Clinical and imaging findings are often non-specific since they can be found in a large number of neurological disorders. Histopathology can also be confounding if not performed by an expert pathologist and not placed in an appropriate clinical context. In this review, we discuss clinical features, laboratory findings, imaging, and histology of neurosarcoidosis, and we report current evidence regarding drug therapy. We conclude that a correct diagnostic approach should include a multidisciplinary evaluation involving clinicians, radiologists, and pathologists and that future studies should evaluate the genetic signature of neurosarcoidosis as they could be helpful in the assessment of this uncommon disease. With head-to-head comparisons of medical treatment for neurosarcoidosis still lacking due to the rarity of the disease and an increasing number of immunomodulating therapies at hand, novel therapeutic approaches are to be expected within the next few years.
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Affiliation(s)
- Claudio Tana
- a Internal Medicine Unit , Guastalla Hospital, AUSL Reggio Emilia , Reggio Emilia , Italy
| | - Susanne Wegener
- b Department of Neurology , University Hospital Zurich and University of Zurich , Zurich , Switzerland
| | - Ewa Borys
- c Department of Pathology , Loyola University Medical Center and Stritch School of Medicine, Loyola University Chicago , Maywood , Illinois , USA
| | - Stefan Pambuccian
- c Department of Pathology , Loyola University Medical Center and Stritch School of Medicine, Loyola University Chicago , Maywood , Illinois , USA
| | - Georgi Tchernev
- d Polyclinic for Dermatology and Venereology and Medical Faculty , University Hospital Lozenetz and Sofia University , Sofia , Bulgaria
| | - Marco Tana
- e Department of Medicine and Science of Aging , "G. d'Annunzio" University , Chieti , Italy
| | | | - Mauro Silingardi
- a Internal Medicine Unit , Guastalla Hospital, AUSL Reggio Emilia , Reggio Emilia , Italy
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Hepatosplenic sarcoidosis: contrast-enhanced ultrasound findings and implications for clinical practice. BIOMED RESEARCH INTERNATIONAL 2014; 2014:926203. [PMID: 25215299 PMCID: PMC4151864 DOI: 10.1155/2014/926203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022]
Abstract
Sarcoidosis is a complex granulomatous disease that affects virtually every organ and tissue, with a prevalence that varies significantly among the sites involved. The role of conventional imaging, such as computed tomography and magnetic resonance imaging, in the assessment of hepatosplenic sarcoidosis is well established by revealing organ enlargement, multiple discrete nodules, and lymphadenopathy. In this review, we aim to describe contrast-enhanced ultrasound (CEUS) findings in liver and spleen involvement by sarcoidosis, reporting evidence from the literature and cases from our experience, after a brief update on safety profile, cost-effectiveness, and clinical indications of this novel technique. Furthermore, we highlight potential advantages of CEUS in assessing hepatosplenic sarcoidosis that may be useful in the clinical practice.
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Tana C, Iannetti G, Mezzetti A, Schiavone C. Splenic sarcoidosis remains a diagnostic challenge. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:156. [PMID: 24436217 DOI: 10.1002/jcu.22131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Claudio Tana
- Unit of Internistic Ultrasound, "G. d'Annunzio" University, Chieti-Pescara, Italy; Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
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