Objectives

Identify radiological signs related to subtle pancreatic trauma and concurrent extra-pancreatic findings associated with the mechanism of injury.

Accurately describe the relevant injury in the radiology report to guide further imaging/ management.

Review relevant management issues as applicable to the radiologist including imaging guided intervention.

Evaluate the role of further imaging including MRCP/ MR & ERCP.

Background

Pancreatic injuries are uncommon however, early recognition is important as they are associated with significant morbidity and mortality. Most injuries are secondary to blunt trauma for example, impact to the upper abdomen on the steering wheel in a road traffic accident. Pancreatic trauma is difficult to recognise given the often subtle imaging findings and distracting coexisting injuries to other abdominal organs.

Imaging findings OR Procedure findings

Early imaging findings in pancreatic trauma are often subtle including fluid surrounding the superior mesenteric artery/vein “cuff sign”, left anterior pararenal fascia thickening, peripancreatic fat stranding and fluid in the transverse mesocolon or lesser sac.

Assessment of pancreatic duct integrity is important as it informs the decision as to whether the patient requires surgery. The anatomic location of the contusion, laceration or fracture also aids in the assessment of the severity of the injury, with proximal injuries associated with a worse prognosis.

There is a high probability of developing a complication following pancreatic trauma. Complications include pancreatitis, haemorrhage, pseudocyst and fistula formation.

Conclusion

We will systematically illustrate imaging features of pancreatic trauma, present associated complications and discuss the role of further imaging/ image guided intervention.

Objectives

To review the appearances of intra-abdominal desmoid tumours across multiple imaging modalities

To examine pitfalls in the evaluation of extent of disease, in particular local invasion, so as to aid decisions regarding organs needed to transplant.

To appreciate resection considerations including; localising tumours to abdominal compartments and vascular considerations.

Background

Desmoid tumours are fibroblastic tumours most commonly arising from the mesentery, retroperitoneum or abdominal wall. Whilst they are benign lesions, they demonstrate extensive local invasion and often recur.

As a transplant centre we see a cohort of patients with advanced abdominal desmoid tumours who will require small bowel transplant (SBT) or multi visceral transplant (MVT) to allow resection.

Imaging findings OR Procedure findings

We will present desmoid tumour imaging characteristics at MR & CT including tumour morphology, common intra-abdominal sites and patterns of organ involvement. With case examples, we discuss important resection considerations and imaging pitfalls. Given the extensive local invasion of these tumours, we will review peritoneal compartment anatomy alongside different surgical transplant options required to support resection.

Patients with desmoid tumours often have an array of additional imaging findings associated with their underlying co-morbidity, for example, patients with Gardner’s syndrome develop adenomatous polyps, diffuse fibromatosis and osteomas.

Following extensive multivisceral resection and transplantation we review post operative imaging findings and complications.

Conclusion

Resection of locally advanced desmoid tumours requires close interaction of radiology and surgical teams. We will discuss pertinent imaging findings and pitfalls in interpretation, reviewing imaging in conjunction with surgical findings following extensive resections.

Purpose

Ultrasound (US) is the main imaging modality in the detection and follow up of early (and delayed) complications of liver transplantation. A routine post-operative US involves grey scale assessment of the liver parenchyma and biliary tree and doppler evaluation of the vasculature. We performed a retrospective study:

1. To evaluate the reporting clarity of day 0 liver transplant ultrasound

2. To gauge the current language used to communicate common findings.

3. To evaluate report conclusions and recommendations of further imaging/ management.

4. To assess the timeliness of initial day 0 liver transplant ultrasound

Material and methods

The transplant register collated at Addenbrooke’s Hospital was used to identify patients. A review of patient electronic records (EPIC), US report and US images on PACS was performed to generate the data set.

125 patients received a liver transplant between May 2017- May 2018. 2 patients were excluded as they did not have immediate post operative ultrasound imaging; 1 due to cardiac arrest intra operatively and the second due to technical factors.

Results

D0 US was performed in a timely manner with scan request to image acquisition in under 4 hours. Most reports (96.8 %) contained a conclusion and commented on expected features of a liver transplant assessment. Areas more frequently overlooked included: the presences of ascites and documentation the patency of hepatic veins. We propose the later likely occurred due to variant anatomy and uncertainty when labelling individual hepatic veins.

Conclusion

To reduce ambiguity in communication of transplant ultrasound assessment we plan to introduce a reporting proforma.