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Thoracic perspective revisited in chronic liver disease

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Gastroenterology Report 2015年第3期3卷 194-200页

作者： Binit Sureka Kalpana Bansal Yashwant Patidar Sachin Kumar ankur arora Department of Radiology/Interventional Radiology Department of Pulmonary Medicine Institute of Liver and Biliary SciencesNew DelhiIndia

A variety of chest manifestations are seen in patients with chronic liver diseases,namely hepatopulmonary syndrome,portopulmonary hypertension,intrathoracic portosystemic collaterals,hepatic hydrothorax,infections,drug-induced changes,manifestations of hepatocellular carcinoma,gynecomastia,acute respiratory distress syndrome,autoimmune changes,aspiration pneumonitis and changes due to a1-antitrypsin *** and radiologists should be aware of these entities;knowledge of the imaging findings specific to each condition is of prime importance for managing such patients.

关键词： cirrhosis infection portosystemic portopulmonary computed tomography

Imaging panorama in postoperative complications after liver transplantation

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Gastroenterology Report 2016年第2期4卷 96-106,I0001页

作者： Binit Sureka Kalpana Bansal S Rajesh Amar Mukund Viniyendra Pamecha ankur arora Department of Radiology/Interventional Radiology Institute of Liver and Biliary SciencesVasant KunjNew DelhiIndia Department of Hepatobiliary Surgery Institute of Liver and Biliary SciencesVasant KunjNew DelhiIndia

The liver is the second most-often transplanted solid organ after the kidney,so it is clear that liver disease is a common and serious problem around the *** the advancements in surgical,oncological and imaging techniques,orthotopic liver transplantation has become the first-line treatment for many patients with end-stage liver ***,and Doppler are the most economical and cost-effective imaging modalities for evaluating postoperative fluid collections and vascular *** tomography(CT)is used to confirm the findings of ultrasound and look for pulmonary *** resonance imaging(MRI)is used for the diagnosis of biliary complications,bile leaks and neurological *** article illustrates the imaging options for diagnosing the various complications that can be encountered in the postoperative period after liver transplantation.

关键词： liver transplant postoperative complications imaging

Indeterminate liver lesions on gadoxetic acid-enhanced magnetic resonance imaging of the liver:Case-based radiologic-pathologic review

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World Journal of Hepatology 2021年第9期13卷 1079-1097页

作者： Jurate Noreikaite Dekan Albasha Vijay Chidambaram ankur arora Ashok Katti Department of Radiology Liverpool University Hospitals NHS Foundation TrustLiverpool L78XPUnited Kingdom

Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different *** is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing *** lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging *** enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver *** of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver *** imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent *** is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate *** this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.

关键词： Indeterminate liver lesions Magnetic resonance imaging Gadoxetic acid Hepatobiliary phase Hepatocellular carcinoma

Rare,spontaneous trans-splenic shunt and intra-splenic collaterals with attendant splenic artery aneurysms in an adult patient with compensated cirrhosis and portal hypertension

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Gastroenterology Report 2015年第2期3卷 162-166页

作者： Cyriac Abby Philips Lovkesh Anand K.N.Chandan Kumar Vivek Kasana ankur arora Department of Hepatology Institute of Liver and Biliary SciencesNew DelhiIndia Department of Radiology Institute of Liver and Biliary SciencesNew DelhiIndia

We present a rare case of spontaneous trans-splenic shunt and intra-splenic collaterals in a patient with liver cirrhosis and portal *** shunt and presence of cirrhosis and portal hypertension was incidentally detected by abdominal computed tomographic imaging during evaluation for abdominal *** has been a single report on the presence of trans-splenic shunt in two children with extra-hepatic portal venous obstruction but no cases that report intra-splenic collaterals:to the best of our knowledge,this is the first reported case of spontaneous trans-splenic shunt in the presence of intra-splenic collaterals and incidental multiple splenic artery aneurysms that developed in an adult with compensated cirrhosis and portal hypertension.

关键词： cirrhosis portal hypertension portosystemic shunts collateral pathways splenomegaly

Choledochocele with pancreas divisum:A rare cooccurrence diagnosed on magnetic resonance cholangiopancreatography

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World Journal of Radiology 2013年第7期5卷 264-266页

作者： Yashwant Patidar Nitesh Agarwal Shailesh Gupta ankur arora Amar Mukund S Rajesh Department of Radiology Institute of Liver and Biliary Sciences New Delhi 110070 India

We report a case of a 42-year-old male with symptomatic choledochocele and incidental pancreas divisum diagnosed with magnetic resonance cholangiopancreatography (MRCP). Small choledochocele is rare congenital malformation associated with non-specific symptoms and a delay in diagnosis. The coexistence of choledochocele and pancreas divisum is extremely rare with only two case reports published in literature. In both cases MRCP failed to diagnose any biliary or pancreatic abnormality. This case suggests that the patients with recurrent abdominal pain and pancreas divisum should not be presumed to be suffering from pancreatitis. Careful evaluated for additional anomalies in the biliary tree should be sought for refractory symptoms. MRCP is a useful one-stop-shop for diagnosing pancreatic and biliary ductal anomalies.

关键词： Choledochocele Pancreas divisum Magnetic resonance cholangiopan-creatography Pancreaticand biliary ductal anomalies Pancreatitis

Imaging and radiological interventions in extra-hepatic portal vein obstruction

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World Journal of Radiology 2016年第6期8卷 556-570页

作者： Sudheer S Pargewar Saloni N Desai S Rajesh Vaibhav P Singh ankur arora Amar Mukund Division of Interventional Radiology Department of RadiologyInstitute of Liver and Biliary Sciences Division of Diagnostic Radiology Department of RadiologyInstitute of Liver and Biliary Sciences

Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension(PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt(PSS) and revision of PSS.

关键词： Extrahepatic portal venous obstruction Portal cavernoma Portal hypertension Transjugular intrahepatic portosystemic shunt Splenic embolization

Xanthogranulomatous cholecystitis: What every radiologist should know

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World Journal of Radiology 2016年第2期8卷 183-191页

作者： Vaibhav P Singh S Rajesh Chhagan Bihari Saloni N Desai Sudheer S Pargewar ankur arora Division of Diagnostic and Interven- tional Radiology Department of Radiology Institute of Liver and Biliary Sciences Department of Pathology Institute of Liver and Biliary Sciences

Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.

关键词： Hypodense nodules Carcinoma gallbladder Xanthogranulomatous Cholecystitis Adenomyomatosis

Platelets in Kawasaki disease:Is this only a numbers game or something beyond?

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Genes & Diseases 2020年第1期7卷 62-66页

作者： Kanika arora Sandesh Guleria ankur Kumar Jindal Amit Rawat Surjit Singh Allergy Immunology Unit Department of PediatricsAdvanced Pediatrics CentrePostgraduate Institute of Medical Education and ResearchChandigarhIndia

Kawasaki disease(KD)is a medium vessel vasculitis with predilection to cause coronary artery *** is now the most common cause of acquired heart disease in developed *** is consistently found in patients with KD,usually in 2nd to 3rd week of *** has occasionally been reported in the acute phase of *** increase or decrease in platelet number in patients with KD was initially considered to be a benign ***,recent literature on platelet biology in KD has suggested that platelets are not only increasing but are rather *** phenomenon has been found to increase the risk of thrombosis in these *** a fall in platelet counts during acute stage of KD has also been found to be associated with increased severity of *** this review,we update on the current best understanding about pathogenic role of platelets in patients with KD.

关键词： Aspirin CD40 ligand Kawasaki disease Platelet derived microparticles Platelets Thrombosis

CCR5A32 mutation does not influence the susceptibility to HCV infection, severity of liver disease and response to therapy in patients with chronic hepatitis C

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World Journal of Gastroenterology 2006年第29期12卷 4721-4726页

作者： ankur Goyal PV Suneetha GT Kumar Deepak K Shukla Naveen arora Shiv K Sarin Department of Gastroenterology G.B.Pant Hospital New DelhiInstitute of Genomic and Integrative Biology(Formerly CBT)Mall RoadDelhiDr.Ambedkar Center for Biomedical ResearchUniversity of DelhiIndia Department of Gastroenterology G.B.Pant Hospital New DelhiIndia Division of Non-communicable Disease Indian Council of Medical Research Ansari NagarNew DelhiIndia Institute of Genomic and Integrative Biology (Formerly CBT) Mall RoadDelhiIndia

AIM： To study whether CCR5△32 mutation was associated with viral infection and severity of liver disease. METHODS： Two hundred and fifty two histologically proven, chronic HCV patients （mean age： 41±14 years; M/F： 164/88） were genotyped. PCR based genotyping of 32 bp deletion at the CCR5 locus was done. Fourhundred and eight matched healthy controls were studied to assess susceptibility to HCV infection. To assess correlation of immune gene polymorphism with severity of HCV related liver disease, patients with chronic HCV infection were divided into those with a fibrosis score of ≤ 2 （mild） or 〉 2 （severe） and histological activity index （HAI） of ≤ 5 or 〉 5. For correlation between CCR5△32 mutations and response to therapy, 129 patients who completed therapy were evaluated. RESULTS： The majority （89.4%） of the patients were infected with genotype 3. The frequency of homozygous CCR5△32 mutants was comparable to HCV patients as compared to the healthy controls （0.7% vs 0%, P = 0.1）. Further more, the frequency of CCR5△32 mutation was comparable in patients with mild or severe liver disease.（P = NS）. There was also no association observed with response to therapy and CCR5△32 mutation. CONCLUSION： CCR5△32 mutation does not have a role in disease susceptibility, severity or response to therapy in patients with chronic hepatitis C infection.

关键词： β-chemokine receptor 32 bp deletion CCchemokine ligand Human leukocyte antigen Histologicalactivity index