Delivering and Receiving Wasim Hakim ST 2 Clinical

Delivering and Receiving Wasim Hakim ST 2 Clinical Radiology Imperial College Healthcare NHS Trust

Wasim Hakim Dan West Simon Gill Mary Roddie Dominic Blunt Charing Cross Hospital Fulham Palace Road, London Correspondence: wasim. hakim@imperial. nhs. uk

Clinical information • 32 -year-old lady of Native Australian heritage • PC: Tiredness and a 7 -day history of black stools & abdominal pain • PMH: Nil • DH: Nil • SH: Non-smoker, minimal alcohol intake & looked after her infant and toddler full-time • FH: Nil

Contrast-enhanced CT - coronal reconstruction of the abdomen & pelvis taken in the portal venous phase

Is there anything to embolise?

Portal venous CECT – axial & coronal reconstruction 7 day follow-up

Diagnosis • In addition to the rapidly enlarging liver lesion, she had multiple lung lesions • 4 -months post-partum • Beta-h. CG 77, 000 IU/L Metastatic choriocarcinoma causing jejeunal intussuception

Discussion • Intussusception – when bowel receives itself by peristalsis, often with an intraluminal mass leading it.

Discussion (2) • • • Gestational trophoblastic disease Chorionic epithelium from preceding pregnancy Aggressive vascular tumours Metastases to brain, lung, bowel, pancreas Prone to bleeding – tends to be per vaginal • Chemotherapy is the mainstay of treatment, often with a prompt response • Charing Cross Hospital

Key Learning Points • Target sign of intussusception • In adults – must look for a tumour lead-point • Rare • Young lady, with aggressive bleeding metastases, the differential is small

References • • Radiopaedia. org Yokoi K, Tanaka N, Furukawa K et al. Male choriocarcinoma with metastasis to the jejunum: a case report and review of the literature. J Nippon Med Sch 2008; 75: 115 -117 Iyomasa S, Senda Y, Mizuno K et al. Primary choriocarcinoma of the jejunum: report of a case. Surg Today 2003; 33: 948 -951 Discussion images are free to use from wikipedia. org