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| 1 | Sonographic assessment of a suspected biloma:A case report and review of the literature显示文摘A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these. | Claudio Tana Patrizio D'Alessandro Armando Tartaro Marco Tana Andrea Mezzetti Cosima Schiavone | 2013 | World Journal of Radiology2013，5，5： | 6 |
| 2 | Impaired coagulation,liver dysfunction and COVID-19:Discovering an intriguing relationship显示文摘Coronavirus disease 2019(COVID-19)is,at present,one of the most relevant global health problems.In the literature hepatic alterations have been described in COVID-19 patients,and they are mainly represented by worsening of underlying chronic liver disease leading to hepatic decompensation and liver failure with higher mortality.Several potential mechanisms used by severe acute respiratory syndrome coronavirus 2(SARS-Co V-2)to cause liver damage have been hypothesized.COVID-19 primary liver injury is less common than secondary liver injury.Most of the available data demonstrate how liver damage in SARSCo V-2 infection is likely due to systemic inflammation,and it is less likely mediated by a cytopathic effect directed on liver cells.Moreover,liver alterations could be caused by hypoxic injury and drugs(antibiotics and non-steroidal antiinflammatory drugs,remdesivir,tocilizumab,tofacitinib and dexamethasone).SARS-Co V-2 infection can induce multiple vascular district atherothrombosis by affecting simultaneously cerebral,coronary and peripheral vascular beds.Data in the literature highlight how the virus triggers an exaggerated immune response,which added to the cytopathic effect of the virus can induce endothelial damage and a prothrombotic dysregulation of hemostasis.This leads to a higher incidence of symptomatic and confirmed venous thrombosis and of pulmonary embolisms,especially in central,lobar or segmental pulmonary arteries,in COVID-19.There are currently fewer data for arterial thrombosis,while myocardial injury was identified in 7%-17%of patients hospitalized with SARS-Co V-2 infection and 22%-31%in the intensive care unit setting.Available data also revealed a higher occurrence of stroke and more serious forms of peripheral arterial disease in COVID-19 patients.Hemostasis dysregulation is observed during the COVID-19 course.Lower platelet count,mildly increased prothrombin time and increased Ddimer are typical laboratory features of patients with severe SARS-Co V-2 infection,described as“COVID-19 associated coagulopathy.”These alterations are correlated to poor outcomes.Moreover,patients with severe SARS-Co V-2 infection are characterized by high levels of von Willebrand factor with subsequent ADAMTS13 deficiency and impaired fibrinolysis.Platelet hyperreactivity,hypercoagulability and hypofibrinolysis during SARS-Co V-2 infection induce a pathological state named as“immuno-thromboinflammation.”Finally,liver dysfunction and coagulopathy are often observed at the same time in patients with COVID-19.The hypothesis that liver dysfunction could be mediated by microvascular thrombosis has been supported by postmortem findings and extensive vascular portal and sinusoidal thrombosis observation.Other evidence has shown a correlation between coagulation and liver damage in COVID-19,underlined by the transaminase association with coagulopathy,identified through laboratory markers such as prothrombin time,international normalized ratio,fibrinogen,D-dimer,fibrin/fibrinogen degradation products and platelet count.Other possible mechanisms like immunogenesis of COVID-19 damage or massive pericyte activation with consequent vessel wall fibrosis have been suggested. | Damiano D'Ardes Andrea Boccatonda Giulio Cocco Stefano Fabiani Ilaria Rossi Marco Bucci Maria Teresa Guagnano Cosima Schiavone Francesco Cipollone | 2022 | World Journal of Gastroenterology2022，28，11： | 5 |
| 3 | Emphysematous pancreatitis associated with penetrating duodenal ulcer显示文摘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,usual y the pancreatic head,and ulcers most often involve the duodenum. | Claudio Tana Mauro Silingardi Maria Adele Giamberardino Francesco Cipollone Tiziana Meschi Cosima Schiavone | 2017 | World Journal of Gastroenterology2017，23，48： | 2 |
| 4 | Ultrasound imaging of abdominal sarcoidosis: State of the art显示文摘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. | Claudio Tana Cosima Schiavone Andrea Ticinesi Fabrizio Ricci Maria Adele Giamberardino Francesco Cipollone Mauro Silingardi Tiziana Meschi Christoph F Dietrich | 2019 | World Journal of Clinical Cases2019，7，7： | 2 |
| 5 | Contrast-enhanced ultrasound in portal venous system aneurysms: A multi-center study显示文摘AIM:To investigate contrast-enhanced ultrasound(CEUS)findings in portal venous system aneurysms(PVSAs).METHODS:In this multi-center,retrospective,case series study,we evaluated CEUS features of seven cases of PVSAs that were found incidentally on conventional ultrasound in the period 2007-2013.Three Ultrasound Centers were involved(Chieti,Italy,Bad Mergentheim,Germany,and Cluj-Napoca,Romania).All patients underwent CEUS with Sonovue?(Bracco,Milan,Italy)at a standard dose of 2.4 m L,followed by10 m L of 0.9%saline solution.The examinations were performed using multifrequency transducers and low mechanical index.We considered aneurysmal a focal dilatation of the portal venous system with a size that was significantly greater than the remaining segments of the same vein,and that was equal or larger than21 mm for the extrahepatic segments of portal venous system,main portal vein and bifurcation,and 9 mm for the intrahepatic branches.RESULTS:After contrast agent injection,all PVSAs were not enhanced in the arterial phase(starting 8-22s).All PVSAs were then rapidly enhanced in the early portal venous phase(starting three to five seconds after the arterial phase,11-30 s),with persistence and slow washout of the contrast agent in the late phase(starting 120 s).In all patients,CEUS confirmed the presence of a'to-and-fro'flow by showing a swirling pattern within the dilatation in the early portal venous phase.CEUS also improved the delineation of the lumen,and was reliable in showing its patency degree and integrity of walls.In one patient,CEUS showed a partial enhancement of the lumen with a uniformly nonenhancing area in the portal venous and late phases,suggesting thrombosis.CONCLUSION:In our case series,we found that CEUS could be useful in the assessment and follow-up of a PVSA.Further studies are needed to validate its diagnostic accuracy. | Claudio Tana Christoph F Dietrich Radu Badea Liliana Chiorean Vincenzo Carrieri Cosima Schiavone | 2014 | World Journal of Gastroenterology2014，20，48： | 1 |
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