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Background: Duodenal diverticula are common and are usually asymptomatic. We have studied a substantial number of patients who had perforation of a duodenal diverticulum and found these challenging to diagnose with little guidance from prior publications., Methods: Retrospective study for the most recent 10-year period of all patients who had a discharge diagnosis of perforated duodenal diverticulum or duodenal diverticulitis and also had relevant imaging studies., Results: Eight patients had CT evaluation and six had upper GI fluoroscopic evaluation. All presented with acute abdominal pain. Duodenal diverticular perforation was spontaneous in 6 patients, and caused by endoscopy or feeding tube placement in one patient each. The diagnosis was made correctly by imaging in only 2 patients, while retrospective review showed clear evidence of a diverticulum and extraluminal gas in all cases. Clinical management included surgery in five patients and nonoperative management in three. Average duration of hospital stay was 32 days and two patients died., Conclusion: Perforation of a duodenal diverticulum may cause severe illness or death and is difficult to diagnose. Careful attention to CT findings and appropriate use of upper GI studies may allow more confident diagnosis and management.

Retraction of the liver capsule may be associated with a diverse spectrum of benign and malignant hepatic abnormalities. These include primary malignant neoplasms (epithelioid hemangioendothelioma, hepatocellular carcinoma, cholangiocarcinoma), secondary malignant neoplasms before and after treatment, and hepatic hemangioma, especially in cirrhotic livers. Other etiologies include confluent fibrosis in cirrhotic livers, chronic biliary obstruction (as can be seen in primary sclerosing cholangitis), and traumatic hepatic injury (iatrogenic and noniatrogenic). Because several recent studies have incorrectly reported hepatic capsular retraction as a specific sign of hepatic malignancy, it is important to understand the imaging appearances of the various etiologies associated with this sign to avoid misdiagnosis that may adversely affect the therapeutic approach.

We describe a case of fatal fulminant hepatic infection with gas replacement of the hepatic parenchyma and no evidence of a liquified abscess in a diabetic patient: a case of "emphysematous hepatitis," the hepatic equivalent of emphysematous pyelonephritis. Computed tomography and clinical findings are described.

Background: Our purpose was to review a series of 14 patients with atypical exocrine and endocrine pancreatic tumors to derive characteristic computed tomographic and pathologic features that might allow better diagnosis, categorization, and management of these patients., Methods: Medical records from several university medical centers were reviewed retrospectively., Results: We identified three separate types of pancreatic tumors that had substantially different morphologic and prognostic features. Among these rare tumors, anaplastic carcinoma was the most common (nine of 14 cases), and these tumors were large, partly necrotic, locally invasive, and invariably metastatic (lymph nodes and/or liver) at the time of diagnosis. Three patients with poorly differentiated (small cell) carcinoma had a confluent pancreatic mass and lymphadenopathy but no ductal obstruction, closely resembling lymphoma or metastatic disease. Two patients with giant cell (osteoclastlike) carcinoma had a large, encapsulated multicystic tumor with hemorrhage, and these tumors were resectable for cure., Conclusion: Although a specific diagnosis may not be possible in some cases, we believe that knowledge of certain pathologic and computed tomographic features should lead to optimal diagnosis, therapy, and prognosis.

We retrospectively evaluated 21 patients with Budd-Chiari syndrome who underwent liver transplant. The pathological findings were correlated with imaging studies that included computed tomography (CT) in all cases, sonography in 20, and magnetic resonance (MR) in 15. Pathological features of Budd-Chiari syndrome in subacute or chronic form, such as parenchymal fibrosis, hemorrhage, and congestion, were found in all resected livers. These occurred usually in conjunction with restricted hepatic veins due to thrombosis or fibrosis with partially recanalized lumen. The status of hepatic veins was correctly assessed and correlated with pathology in 13 of 20 patients who had sonograms, in 12 of 15 patients who had MR, and in nine of 18 patients with contrast-enhanced CT scans. Patency of the inferior vena cava was well seen by all three modalities; parenchymal abnormalities were best visible on CT (19 of 21), while ascites, caudate lobe enlargement and collateral vessels were best detected with MR or CT. We conclude that each imaging modality offers certain values and limitations in the assessment of vascular or parenchymal findings in Budd-Chiari syndrome.