Browsing by Author "Mašulović, Dragan (57215645003)"

Introduction Primary hepatic lymphoma (PHL) is a rare disease and represents lymphoproliferative disorder confined to the liver parenchyma. This condition is difficult to distinguish from other liver diseases. Histopathology is essential and confirms the diagnosis. Treatment options for PHL include surgery, chemotherapy, radiation, or combinations of these modalities. The objective of this this report is to present a case of PHL and to discuss disease features and treatment options in order to facilitate diagnostics and therapy. Case outline A 72-year-old female was presented with abdominal pain, nausea, weight loss, and fatigue. Computed tomography (CT) revealed hypoattenuating solitary lesion in liver segment VIII. The detected liver lesion showed elevated 2-[fluorine 18] fluoro-2-deoxy-D-glucose uptake on positron emission tomography/CT examination. Extrahepatic disease was not detected. The tumor board opted for surgery, and atypical resection of liver segments VII and VIII was performed. Pathohistological examination of the resected tumor demonstrated liver infiltration with non-Hodgkin’s lymphoma, diffuse large B-cell type. Postoperative recovery was complicated by fluid collections in the right subphrenic space, successfully managed by percutaneous drainage. Subsequently, the patient was treated with chemotherapy and attained a complete remission documented by negative CT findings. Conclusion PHL can easily be misdiagnosed as another more frequent primary liver tumor due to its non-specific clinical manifestations, laboratory and imaging findings, and therefore should be considered in the differential diagnosis of a hepatic lesion. © 2020, Serbia Medical Society. All rights reserved.

Background and Objectives: Hepatocellular carcinoma (HCC) most frequently metastasizes in the lungs, abdominal lymph nodes and adrenal glands. Metastatic spread to the head and neck area is extremely rare. In the presented case, an uncommon site of solitary metastatic spread of HCC to the mandible confirmed after the core biopsy of the lesion is reported. There have been only about 80 cases of mandibular HCC metastases described in the literature to date. We contribute our experience to the pool of data. Case presentation: A 65-year-old female with HCV-related liver cirrhosis was diagnosed with an HCC that was successfully treated with liver resection. Subsequently, the patient had developed COVID-19 disease, which was associated with a painless swelling in the left jaw. A neck MDCT scan demonstrated an osteolytic soft-tissue mass in the left mandible, with the characteristics consistent for the metastasis of HCC. In order to confirm the diagnosis, a core biopsy of the mandibular mass was performed. The pathohistological evaluation confirmed the presence of a metastatic HCC in the mandible. No other sites of disease dissemination were identified in extensive MDCT scans. Despite considering various treatments, including symptomatic and palliative, the patient’s overall prognosis remained poor. Conclusions: Isolated metastases of HCC to the orofacial region are extremely rare; however, it should be considered in patients with known risk factors for HCC development. Early diagnosis is critical, and clinicians should consider this possibility of HCC spread when assessing patients with orofacial swelling, among those patients with risk factors for HCC. The overall prognosis for such patients remains poor, emphasizing the challenges in managing these cases. © 2023 by the authors.

A trichobezoar is an intraluminal mass of hair growing continuously with additional ingestion, while Rapunzel syndrome refers to a giant gastric trichobezoar that extends from the stomach into the small intestine. We present a case of Rapunzel syndrome as an uncommon cause of upper gastrointestinal (GI) symptoms in a young adult woman who denied trichotillomania and trichophagia. Preoperative radiological assessment was pivotal in planning a preferable therapeutic approach. The patient underwent laparotomy and prepyloric gastrotomy, resulting in satisfactory postoperative outcomes. Trichobezoars are extremely rare and predominantly affect young women with underlying psychiatric conditions. Although uncommon, they cause severe upper gastrointestinal symptoms and may even lead to various complications. This case report helps in understanding the presentation of gastric trichobezoar and Rapunzel syndrome, including their range of symptoms, radiological appearance, and associated findings, to make an accurate diagnosis and guide an appropriate treatment approach. Copyright © 2025 Mijović, Vasin, Hasanagić, Vukmirović, Tomić, Tošić, Pavlović, Mašulović and Đurić Stefanović.

Background: Pancreatic adenocarcinoma is a highly lethal disease even in initially resectable patients. Functional imaging procedures such as diffusion-weighted imaging (DWI) and computed tomography (CT)-perfusion might facilitate preoperative prediction of factors influencing prognosis in patients with pancreatic adenocarcinoma. Purpose: To evaluate CT-perfusion and DWI quantitative parameters of pancreatic adenocarcinoma and to assess their correlation with clinicopathological features. Material and Methods: Forty-four patients with histopathologically proven pancreatic adenocarcinoma underwent CT-perfusion and DWI for estimating blood volume (BV), blood perfusion (BF), mean transit time (MTT), time to peak (TTP), and apparent diffusion coefficient (ADC) values. The statistical analysis was performed using Wilcoxon matched-pairs test, t-test for independent samples, Spearman’s rank correlation coefficient (rs), and receiver operating characteristic analysis. Results: The mean CT-perfusion parameters and ADCs were significantly different in pancreatic adenocarcinoma versus healthy parenchyma. BV (2.66 ± 0.98 mL/100g), BF (17.45 ± 4.06 mL/min/100g), and ADCs (0.91 ± 0.15 × 10−3mm/s2) in high-grade tumors were significantly lower in comparison to low-grade tumors (BV = 5.35 ± 1.36 mL/100g, BF = 28.51 ± 7.73 mL/min/100g, ADC = 1.07 ± 0.21 × 10−3mm/s2). For prediction of high-grade tumors, the sensitivity and specificity were 79.2% and 82.4% for BF and 87.5% and 88.2% for BV, respectively. A significant negative correlation was found between BV and tumor size (rs = −0.445, P = 0.029), MTT and tumor size (rs = −0.330, P = 0.043), BV and M-stage (rs = −0.286, P = 0.049), and ADC and M-stage (rs = −0.274, P = 0.038). Moreover, BF and BV values were significantly associated with ADCs. Conclusion: CT-perfusion parameters and ADC values could improve preoperative assessment of pancreatic adenocarcinoma with possibility of tumor grade prediction. © The Foundation Acta Radiologica 2018.

Background: Pancreatic adenocarcinoma is a highly lethal disease even in initially resectable patients. Functional imaging procedures such as diffusion-weighted imaging (DWI) and computed tomography (CT)-perfusion might facilitate preoperative prediction of factors influencing prognosis in patients with pancreatic adenocarcinoma. Purpose: To evaluate CT-perfusion and DWI quantitative parameters of pancreatic adenocarcinoma and to assess their correlation with clinicopathological features. Material and Methods: Forty-four patients with histopathologically proven pancreatic adenocarcinoma underwent CT-perfusion and DWI for estimating blood volume (BV), blood perfusion (BF), mean transit time (MTT), time to peak (TTP), and apparent diffusion coefficient (ADC) values. The statistical analysis was performed using Wilcoxon matched-pairs test, t-test for independent samples, Spearman’s rank correlation coefficient (rs), and receiver operating characteristic analysis. Results: The mean CT-perfusion parameters and ADCs were significantly different in pancreatic adenocarcinoma versus healthy parenchyma. BV (2.66 ± 0.98 mL/100g), BF (17.45 ± 4.06 mL/min/100g), and ADCs (0.91 ± 0.15 × 10−3mm/s2) in high-grade tumors were significantly lower in comparison to low-grade tumors (BV = 5.35 ± 1.36 mL/100g, BF = 28.51 ± 7.73 mL/min/100g, ADC = 1.07 ± 0.21 × 10−3mm/s2). For prediction of high-grade tumors, the sensitivity and specificity were 79.2% and 82.4% for BF and 87.5% and 88.2% for BV, respectively. A significant negative correlation was found between BV and tumor size (rs = −0.445, P = 0.029), MTT and tumor size (rs = −0.330, P = 0.043), BV and M-stage (rs = −0.286, P = 0.049), and ADC and M-stage (rs = −0.274, P = 0.038). Moreover, BF and BV values were significantly associated with ADCs. Conclusion: CT-perfusion parameters and ADC values could improve preoperative assessment of pancreatic adenocarcinoma with possibility of tumor grade prediction. © The Foundation Acta Radiologica 2018.

Background and Objectives. Cholestasis activates complex mechanisms of liver injury and as a result has an increased production of matrix metalloproteinases (MMP). Depending on the stage of liver disease, different matrix metalloproteinases expressions have been detected and could serve as indirect biomarkers as well as therapeutic targets. MMP-9 proteolytic activity has a proven role in both liver regeneration and neoplastic cell invasion in various malignancies. The purpose of this prospective cohort study was to evaluate the effect of external biliary drainage on enzyme activity of MMP-9 in the serum of patients with malignant hilar biliary obstruction. Materials and Methods. Between November 2020 and April 2021, 45 patients with malignant hilar biliary obstruction underwent percutaneous biliary drainage following determination of serum MMP-9 enzyme activity (before treatment and 4 weeks after the treatment) by gelatin zymography. Results. MMP-9 values decreased statistically significantly 4 weeks after percutaneous biliary drainage (p = 0.028) as well as the value of total bilirubin (p < 0.001), values of direct bilirubin (p < 0.001), aspartate aminotransferase (AST) (p < 0.001), alanine transaminase (ALT) (p < 0.001), and gamma-glutamyl transferase (GGT) (p < 0.001). Conclusions. In patients with malignant hilar biliary obstruction treated by external percutaneous biliary drainage for cholestasis resolution, a significant reduction in MMP-9 serum values was noted 4 weeks after the treatment. © 2023 by the authors.

Emphysematous pancreatitis represents the presence of gas within or around the pancreas on the ground of necrotizing pancreatitis due to superinfection with gas-forming bacteria. This entity is diagnosed on clinical grounds and on the basis of radiologic findings. Computed tomography is the preferred imaging modality used to detect this life-threating condition. The management of emphysematous pancreatitis consists of conservative measures, image-guided percutaneous catheter drainage or endoscopic therapy, and surgical intervention, which is delayed as long as possible and undertaken only in patients who continue to deteriorate despite conservative management. Due to its high mortality rate, early and prompt recognition and treatment of emphysematous pancreatitis are crucial and require individualized treatment with the involvement of a multidisciplinary team. Here, we present a case of emphysematous pancreatitis as an unusual occurrence and discuss disease features and treatment options in order to facilitate diagnostics and therapy. © 2024 by the authors.

[No abstract available]

Background and Objectives: Treatment of cancer patients during the COVID-19 pandemic has been a challenge worldwide. In accordance with the current recommendations for hepatocellular carcinoma (HCC) management during the COVID-19 pandemic, loco-regional therapy such as transarterial chemoembolization (TACE) was proposed with the purpose of achieving local tumor control and improving overall survival. The aim of this prospective cohort study was to evaluate the outcomes of TACE treatment in patients with HCC during the COVID-19 pandemic in comparison with the outcomes of patients treated in the pre-pandemic period. Materials and Methods: Between September 2018 and December 2021, 154 patients were managed by serial TACE procedures for different liver tumors. Ninety-seven patients met the study criteria and were divided into two groups: the study group n = 49 (patients treated from May 2020 to December 2021); the control group n = 48 (patients treated from September 2018 to May 2020). Results: The mean waiting time for TACE was significantly longer in the study group compared to the control group (p < 0.001). No significant difference in survival between the groups is noted (log-rank test p = 0.823). In multivariate analysis, the MELD score (HR 1.329, 95% CI 1.140–1.548, p < 0.001) remained a significant predictor of mortality. Conclusions: COVID-19 pandemic did not affect the final outcome of TACE treatment. © 2022 by the authors.

Background: Intrahepatic mass-forming cholangiocellular carcinoma (IMC) is the second most common primary liver tumor. The differentiation between IMC and solitary hypovascular liver metastases (SHLM) represents a diagnostic challenge due to many overlapping magnetic resonance imaging (MRI) features. Purpose: To determine the value of diffusion-weighted imaging (DWI) in addition to conventional MRI for the distinction between intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases. Material and Methods: Fifty-three patients with pathologically proven IMC (n = 31) and SHLM (n = 22) who had undergone MRI and DWI before surgery or percutaneous biopsy were enrolled in this study. The following MRI features were analyzed: the size and shape of the lesion, presence of capsular retraction and segmental biliary dilatation, T2-weighted (T2W) signal intensity, the presence of target sign on DWI and enhancement pattern. Apparent diffusion coefficient (ADC) values were calculated for each lesion (b = 800 s/mm2). Univariate and multivariate logistic regression analyses were used to identify significant differentiating features between IMCs and SHLMs. Results: Univariate analysis revealed that following parameters favor diagnosis of IMCs over SHLMs: lobulating shape, heterogeneous T2W signal intensity, capsular retraction, segmental biliary dilatation, target sign on DWI and rim-like enhancement on arterial phase followed by progressive enhancement in delayed phases. ADC values measured in the periphery of the lesion were significantly lower in IMCs in comparison to SHLMs. Multivariate analysis revealed that target sign on DWI was the most significant predictor of IMCs. Conclusion: Qualitative DWI analysis with target sign significantly improves diagnostic accuracy for differentiation among IMC and SHLM lesions. © 2017, © The Foundation Acta Radiologica 2017.

Background: Intrahepatic mass-forming cholangiocellular carcinoma (IMC) is the second most common primary liver tumor. The differentiation between IMC and solitary hypovascular liver metastases (SHLM) represents a diagnostic challenge due to many overlapping magnetic resonance imaging (MRI) features. Purpose: To determine the value of diffusion-weighted imaging (DWI) in addition to conventional MRI for the distinction between intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases. Material and Methods: Fifty-three patients with pathologically proven IMC (n = 31) and SHLM (n = 22) who had undergone MRI and DWI before surgery or percutaneous biopsy were enrolled in this study. The following MRI features were analyzed: the size and shape of the lesion, presence of capsular retraction and segmental biliary dilatation, T2-weighted (T2W) signal intensity, the presence of target sign on DWI and enhancement pattern. Apparent diffusion coefficient (ADC) values were calculated for each lesion (b = 800 s/mm2). Univariate and multivariate logistic regression analyses were used to identify significant differentiating features between IMCs and SHLMs. Results: Univariate analysis revealed that following parameters favor diagnosis of IMCs over SHLMs: lobulating shape, heterogeneous T2W signal intensity, capsular retraction, segmental biliary dilatation, target sign on DWI and rim-like enhancement on arterial phase followed by progressive enhancement in delayed phases. ADC values measured in the periphery of the lesion were significantly lower in IMCs in comparison to SHLMs. Multivariate analysis revealed that target sign on DWI was the most significant predictor of IMCs. Conclusion: Qualitative DWI analysis with target sign significantly improves diagnostic accuracy for differentiation among IMC and SHLM lesions. © 2017, © The Foundation Acta Radiologica 2017.

Background and Objectives: Total knee arthroplasty (TKA) has become the treatment of choice for advanced osteoarthritis. The aim of this paper was to show the possibilities of optimizing the Perth CT protocol, which is highly effective for preoperative planning and postoperative assessment of alignment. Materials and Methods: The cross-sectional study comprised 16 patients for preoperative planning or postoperative evaluation of TKA. All patients were examined with the standard and optimized Perth CT protocol using advance techniques, including automatic exposure control (AEC), iterative image reconstruction (IR), as well as a single-energy projection-based metal artifact reduction algorithm for eliminating prosthesis artifacts. The effective radiation dose (E) was determined based on the dose report. Imaging quality is determined according to subjective and objective (values of signal to noise ratio (SdNR) and figure of merit (FOM)) criteria. Results: The effective radiation dose with the optimized protocol was significantly lower compared to the standard protocol (p < 0.001), while in patients with the knee prosthesis, E increased significantly less with the optimized protocol compared to the standard protocol. No significant difference was observed in the subjective evaluation of image quality between protocols (p > 0.05). Analyzing the objective criteria for image quality optimized protocols resulted in lower SdNR values and higher FOM values. No significant difference of image quality was determined using the SdNR and FOM as per the specified protocols and parts of extremities, and for the presence of prothesis. Conclusions: Retrospecting the ALARA (‘As Low As Reasonably Achievable’) principles, it is possible to optimize the Perth CT protocol by reducing the kV and mAs values and by changing the collimation and increasing the pitch factor. Advanced IR techniques were used in both protocols, and AEC was used in the optimized protocol. The effective dose of radiation can be reduced five times, and the image quality will be satisfactory. © 2024 by the authors.

[No abstract available]

Introduction/Objective Radiofrequency ablation (RFA) is a minimally invasive treatment modality for primary and metastatic liver tumors. It can be performed percutaneously or as a laparoscopic or open surgical procedure under ultrasound or computerized tomography guidance. The objective of the study was to evaluate the clinical outcome of the initial 16 patients with hepatocellular carcinoma (HCC) managed by percutaneous RFA at a tertiary institution and to assess the efficacy of this procedure in the management of selected patients with HCC. Method From June 2011 until December 2013, 16 patients with early-stage HCC were managed by percutaneous radiofrequency ablation at the Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade. All the patients were treated by the same team composed of an interventional radiologist and a liver surgeon. We analyzed the clinical outcome and the biologic effect of this treatment by comparing the pre- and post-treatment levels of alpha-fetoprotein (AFP). Results Post-treatment values of liver transaminase levels returned to the pre-treatment values from Day 3. Post-treatment hospital stay was two days. Post-procedural complications included mild pain in all patients, skin necrosis at the site of the electrode puncture in five patients, and transient hepatic decompensation in one patient. In all the patients the AFP level correlated with the findings of liver imaging (ultrasound and/or magnetic resonance imaging with liver-specific contrast agent) indicating viability of the treated tumor. Conclusion RFA is a feasible and effective procedure providing favorable clinical outcome in patients with early-stage HCC. © 2017, Serbia Medical Society. All rights reserved.

Background: Horseshoe kidney is a well-known congenital anomaly and the most common anomaly of the upper urinary tract. This condition is rarely associated with anomalous inferior vena cava (IVC). Polycystic horseshoe kidney is a very rare occurrence and however IVC anomalies common with polycistic disease are an increasingly recognized risk factor for iliofemoral deep venous thrombosis. Method: We present a case of 75-year-old patient with recurrent deep vein thrombosis (DVT) of right leg as a result of compression of large horseshoe kidney cysts in double inferior vena cava. Results: Large renal cyst were successful treated percutaneously punctured for the relief of compression and received injection of acidic solutions of 95% ethanol under ultrasound guidance for prevention against re-accumulation of cyst fluid. Conclusion: Percutaneous aspiration with ultrasound guidance with injection of sclerosing solutions as a relatively simple procedure and can be the method of choice for treatment of renal cysts. Also, any recurrent deep vein thrombosis on lower extremity requires additional evaluation in the form of an ultrasound or multidetector computed tomography examination of the abdomen. © The Author(s) 2022.

Introduction. Combined endovascular interventions on carotid and coronary arteries are rare. Stenting of the unprotected coronary left main stem is a high risk procedure. We presented hemodynamically unstable patient with combined carotid artery and left main stem coronary artery stenting. Case report. A 78-year-old female patient was admitted to our institution for right carotid endaterectomy. The patient had 80% stenosis of the right carotid artery and occlusion of the left carotid artery. Coronary angiography revealed 70% ostial left main stenosis, occlusion of the right coronary artery and the left circumflex artery, and 80% stenosis of the left anterior descending artery. Simultaneous carotid artery endaterectomy and coronary artery by-pass grafting were considered. Due to high perioperative risk, surgery was rejected, and the patient was treated endovascularly with stenting of arteries occluded. The procedure was completed without complications and the patient was hemodynamically stabilised. Conclusion. This report illustrates simultaneous coronary and carotid stenting as a successfull lifesaving procedure.

[No abstract available]

[No abstract available]

Background: The purpose of this observational cohort study was to assess patient and operator-dependent factors which could have an impact on total fluoroscopy time during ultrasound and fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD). Material/Methods: Between October 2016 and November 2020, 127 patients with malignant biliary obstruction underwent ultrasound- and fluoroscopy-guided PTBD with the right-sided intercostal approach. The initial bile duct puncture was ultrasound-guided in all patients, and the puncture angle was measured by ultrasound. Any subsequent steps of the procedure were performed under continuous fluoroscopy (15 fps). The patients were divided in 2 groups based on the puncture angle: £30° (group I) and >30° (group II). In a retrospective analysis, both groups were compared for inter- and intragroup variability, technical success, total fluoroscopy time, and complications. Results: In group II, the recorded total fluoroscopy time (232.20±140.94 s) was significantly longer than that in group I (83.44±52.61 s) (P<0.001). In both groups, total fluoroscopy time was significantly longer in cases with a lesser degree of bile duct dilatation, intrahepatic bile duct tortuosity, presence of liver metastases, and multiple intrahepatic bile duct strictures. Conclusions: The initial bile duct puncture angle was identified as an operator-dependent factor with the possible impact on total fluoroscopy time. The puncture angle of less than 30° was positively correlated with overall procedure efficacy and total fluoroscopy time reduction. © 2021 International Scientific Information, Inc.. All rights reserved.

Introduction Extremely rarely, the evolution of abdominal aortic aneurysm (AAA) includes the phase when extravasations of the blood from a ruptured aneurysm is contained by the surrounding tissue, referred to as chronic (contained) rupture of the AAA. Our aim was to call attention to this life-threatening condition, which is always challenging for diagnosis. Case outline A 58-year-old man reported to the Emergency Center for significant abdominal pain. Ultrasound examination showed an infrarenal aneurysm of the abdominal aorta. A computed tomography scan of the thorax, abdomen, and pelvis with iodine contrast in arterial phase was performed. A free gas collection was observed between the liver and the anterior abdominal wall that is traced to a ruptured inflamed diverticulum on the transversal colon. Immediately distal to the branching sites of the renal arteries, the abdominal aorta extended forward and aneurismatically expanded. Posterior left, along the psoas muscle, a rupture of the aortic wall was seen, with an organized hematoma that accompanied the muscle. Between the hematoma and the aortic aneurysm, erosions of the anterior and lateral part of the vertebral bodies L2 and L3 were discovered. The patient underwent endovascular AAA repair (EVAR) and recovered well. Conclusion Multidetector computed tomography angiography is a reliable, non-invasive, and necessary examination for localization and evaluation of the size of the AAA form, its chronic rupture, and complications such as vertebral body erosion. © 2019, Serbia Medical Society. All rights reserved.