Objectives

To present the spectrum of Meckel’s diverticulum complications in non-pediatric patients and to discuss the role of MDCT in the diagnosis of this rare emergency condition.

Background

Meckel’s diverticulum is the commonest congenital anomaly of the gastrointestinal tract [2% of the population]. It is usually asymptomatic with a 4.2–6.4% lifetime risk of complication. Symptoms depend on the complication, and include rectal bleeding due to intestinal hemorrhage, abdominal pain, vomiting and distension resulting from obstruction and pain with fever due to diverticulitis. The diagnosis is often challenging with imaging playing the key role for the recognition of this rare entity and its differentiation from other common abdominal emergencies.

Imaging findings OR Procedure findings

Meckel’s diverticulum usually appears at MDCT scan as an abnormal outpouching, blind-ending fluid or gas-filled structure connected to the terminal ileum. An inflamed Meckel’s diverticulum shows wall enhancement and mesenteric fat stranding. Fluid collections or a frank abscess may also be present. In case of bowel obstruction, a Meckel’s diverticulum can be found at the site of the transition zone, occasionally with enteroliths within the lumen. Mesenteric fat stranding or an abscess may also be seen in case of inflammation. Meckel’s diverticulum may also act as a lead point for intussusception, resulting to bowel obstruction. Active extravasation of contrast from Meckel’s diverticulum, can be found in case of hemorrhage, along with perforation or hematoma.

Conclusion

MDCT findings of complicated Meckel’s diverticulum are variable, and radiologists should be aware of them, in the evaluation of patients with acute abdomen.

Objectives

To highlight the spectrum of IgG4-related disease affecting organs of the abdomen and describe their imaging findings.

Background

IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory multisystemic condition. The involved organs share several pathologic features and clinical and serologic similarities, including a lymphoplasmacytic infiltrate enriched in IgG4-positive plasma cells, and a variable degree of fibrosis. Elevated serum concentrations of IgG4 are common. Abdominal manifestations usually include pancreatic, biliary, renal and retroperitoneal involvement though stomach, liver, prostate, lymph nodes and mesentery are rarely involved. Autoimmune pancreatitis [Type I] is the commonest manifestation of the disease.

Imaging findings OR Procedure findings

Patients often present with subacute development of a mass in or diffuse enlargement of the affected organ, sometimes mimicking a neoplastic process.

Imaging findings of IgG4 syndrome include focal or diffuse enlargement of the pancreas, smooth distal biliary strictures, focal renal involvement and rarely peripelvic infiltration, and/or abnormal periaortic or perirenal soft tissue.

Typically, the sites affected show late enhancement, restricted diffusion on MRI and uptake on PET/CT, with resolution (or near resolution) of findings following corticosteroid therapy.

The combination of imaging findings with serological-histological findings (increased IgG4 levels and positive biopsy) and eventually response to corticosteroid therapy confirm the diagnosis of the disease. Imaging with CT, MRI and / or PET-CT is essential for assessing both the extent of the disease and the response to treatment.

Conclusion

Radiologists should be familiar with its clinical and imaging manifestations to avoid a delay in diagnosis and unnecessary surgical interventions.

Objectives

To present the spectrum of Meckel’s diverticulum complications in non-pediatric patients and to discuss the role of MDCT in the diagnosis of this rare emergency condition.

Background

Meckel’s diverticulum is the commonest congenital anomaly of the gastrointestinal tract [2% of the population]. It is usually asymptomatic with a 4.2–6.4% lifetime risk of complication. Symptoms depend on the complication, and include rectal bleeding due to intestinal hemorrhage, abdominal pain, vomiting and distension resulting from obstruction and pain with fever due to diverticulitis. The diagnosis is often challenging with imaging playing the key role for the recognition of this rare entity and its differentiation from other common abdominal emergencies.

Imaging findings OR Procedure findings

Meckel’s diverticulum usually appears at MDCT scan as an abnormal outpouching, blind-ending fluid or gas-filled structure connected to the terminal ileum. An inflamed Meckel’s diverticulum shows wall enhancement and mesenteric fat stranding. Fluid collections or a frank abscess may also be present. In case of bowel obstruction, a Meckel’s diverticulum can be found at the site of the transition zone, occasionally with enteroliths within the lumen. Mesenteric fat stranding or an abscess may also be seen in case of inflammation. Meckel’s diverticulum may also act as a lead point for intussusception, resulting to bowel obstruction. Active extravasation of contrast from Meckel’s diverticulum, can be found in case of hemorrhage, along with perforation or hematoma.

Conclusion

MDCT findings of complicated Meckel’s diverticulum are variable, and radiologists should be aware of them, in the evaluation of patients with acute abdomen.

Objectives

To highlight the spectrum of IgG4-related disease affecting organs of the abdomen and describe their imaging findings.

Background

IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory multisystemic condition. The involved organs share several pathologic features and clinical and serologic similarities, including a lymphoplasmacytic infiltrate enriched in IgG4-positive plasma cells, and a variable degree of fibrosis. Elevated serum concentrations of IgG4 are common. Abdominal manifestations usually include pancreatic, biliary, renal and retroperitoneal involvement though stomach, liver, prostate, lymph nodes and mesentery are rarely involved. Autoimmune pancreatitis [Type I] is the commonest manifestation of the disease.

Imaging findings OR Procedure findings

Patients often present with subacute development of a mass in or diffuse enlargement of the affected organ, sometimes mimicking a neoplastic process.

Imaging findings of IgG4 syndrome include focal or diffuse enlargement of the pancreas, smooth distal biliary strictures, focal renal involvement and rarely peripelvic infiltration, and/or abnormal periaortic or perirenal soft tissue.

Typically, the sites affected show late enhancement, restricted diffusion on MRI and uptake on PET/CT, with resolution (or near resolution) of findings following corticosteroid therapy.

The combination of imaging findings with serological-histological findings (increased IgG4 levels and positive biopsy) and eventually response to corticosteroid therapy confirm the diagnosis of the disease. Imaging with CT, MRI and / or PET-CT is essential for assessing both the extent of the disease and the response to treatment.

Conclusion

Radiologists should be familiar with its clinical and imaging manifestations to avoid a delay in diagnosis and unnecessary surgical interventions.