Emergencies

Exploratory laparotomy – Multiple perforations in another patient with polyarteritis nodosa. Courtesy Dr. V. Penopoulos.

Exploratory laparoscopy – Distended, edematous small bowel loops with focal areas of ischemia. Courtesy Dr. V. Penopoulos.

a) Necrotizing vasculitis. Transmural inflammation of the vessel wall, with or without fibrinoid necrosis. b) Necrotizing vasculitis of a mesenteric artery, with panarterial necrosis and presence of fibrinoid necrosis of the vessel wall. Courtesy Dr. V. Penopoulos.

Exploratory laparotomy – Multiple perforations in another patient with polyarteritis nodosa. Courtesy Dr. V. Penopoulos.

Retroperitoneal computed tomography. Yellow arrows – Bilateral ureteral dilation. Courtesy Dr. V. Penopoulos.

Exploratory laparotomy – Multiple perforations in another patient with polyarteritis nodosa. Courtesy Dr. V. Penopoulos.

Immunohistochemical examination. Tumor cell embolization (Courtesy Dr. V. Penopoulos)

Fibroblast proliferation in the vascular intima, thrombosis, tumor cell embolization (Courtesy Dr. V. Penopoulos)

Alveolar hemorrhage (Courtesy Dr. V. Penopoulos)

Chest CT angiography. Red arrow - Marked dilatation of the pulmonary artery. No findings of pulmonary embolism (Courtesy Dr. V. Penopoulos)

Chest CT. Ground-glass opacities (Courtesy Dr. V. Penopoulos)

Cardiac echo. Right ventricular dilatation, a finding indicative of pulmonary hypertension (Courtesy Dr. V. Penopoulos)

ECG. Inverted T waves in leads V1-V4, indicative of right ventricular strain (Courtesy Dr. V. Penopoulos)

Peripheral blood smear. Red arrows - Schistocytes. Green arrow - Erythroblast (Courtesy Dr. V. Penopoulos)

Carcinomatous lymphangitis. Autopsy finding (Courtesy Dr. V. Penopoulos)

Carcinomatous lymphangitis. Autopsy finding (Courtesy Dr. V. Penopoulos)

Carcinomatous lymphangitis. Autopsy finding (Courtesy Dr. V. Penopoulos)

Poorly differentiated gastric carcinoma. Histopathological examination (Courtesy Dr. V. Penopoulos)

Carcinomatous lymphangitis. Autopsy finding (Courtesy Dr. V. Penopoulos)

Oesophageal ( green arrow ) and Thoracic Aorta ( red arrow ) stents in place (Courtesy Dr. V. Penopoulos)

A prosthetic mesh plug was inserted in the femoral canal. ( Courtesy Dr . V . Penopoulos ) (Courtesy Dr. V. Penopoulos).

The sac was reduced back into the abdomen. ( Courtesy Dr . V . Penopoulos ) (Courtesy Dr. V. Penopoulos).

The two limbs of the sac were freed and lifted. ( Courtesy Dr . V . Penopoulos ) (Courtesy Dr. V. Penopoulos).

The hernia sac was split into two parts (Courtesy Dr. V. Penopoulos).

The hernia sac lay in front of the femoral vessels. ( Courtesy Dr . V . Penopoulos ) (Courtesy Dr. V. Penopoulos).

Oesophageal ( green arrow ) and Thoracic Aorta ( red arrow ) stents in place (Courtesy Dr. V. Penopoulos)

Oesophageal ( green arrow ) and Thoracic Aorta ( red arrow ) stents in place (Courtesy Dr. V. Penopoulos)

Esophagography revealed contrast medium leakage from the mid-esophagus to the mediastinum ( green arrow ) . Aortic stent in place ( red arrow ) (Courtesy Dr. V. Penopoulos)

CT Scan 6th post-op day : increased accumulation of air is detected in the mediastinal haematoma ( red arrows ) (Courtesy Dr. V. Penopoulos)

CT Scan 3rd post-op day : Aortic stent in place ( red arrow ). Minimal air detected in the mediastinal haematoma ( green arrow ) (Courtesy Dr. V. Penopoulos)

Postoperative CT scan. Clear reduction of the hematoma. No signs of bowel obstruction or intestinal ischemia (Courtesy Dr. V. Penopoulos)

Angiography after embolization of the artery near the distal end of the pseudoaneurysm in the arterial arc of Riolan, demonstrating the coils in correct position. The sigmoid and superior rectal arteries were visualized while the pseudoaneurysm was not (Courtesy Dr. V. Penopoulos)

Angiography after embolization of the artery near the distal end of the pseudoaneurysm in the arterial arc of Riolan, demonstrating the coils in correct position. The sigmoid and superior rectal arteries were visualized while the pseudoaneurysm was not (Courtesy Dr. V. Penopoulos)

Angiography after embolization of the artery near the distal end of the pseudoaneurysm in the arterial arc of Riolan, demonstrating the coils in correct position. The sigmoid and superior rectal arteries were visualized while the pseudoaneurysm was not (Courtesy Dr. V. Penopoulos)

Post operative abdominal CT Scan . Regression of hematoma . No signs of bowel obstruction or ischemia (Courtesy Dr. V. Penopoulos)

CT Angio . Green arrow hematoma . Horizontal red arrow stent in the AAA . Vertical red arrow riolan arch pseudoaneurysm (Courtesy Dr. V. Penopoulos)

Post operative abdominal CT Scan . Regression of hematoma . No signs of bowel obstruction or ischemia (Courtesy Dr. V. Penopoulos)

Angiography after embolization of the artery near the distal end of the pseudoaneurysm in the Riolan atrial arch showing that the coils were in good position. The sigmoid colon artery and superior rectal artery were developed and the pseudoaneurysm was not developed (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination - CD31 (+) (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination - CD31 (+) (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination - CD31 (+) (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination - CD31 (+) (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination - CD31 (+) (Courtesy Dr. V. Penopoulos)

Epithelioid malignant cells, with evident cellular atypia and mitotic figures (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination - CD31 (+) (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination - CD31 (+) (Courtesy Dr. V. Penopoulos)

Drained abscess cavity – removal of necrotic material. Courtesy Dr. V. Penopoulos.

Red arrow — Displaced testis in the left inguinal region. Yellow arrow — Right testis within the scrotum (Courtesy Dr. V. Penopoulos)

Red arrow — Displaced testis in the left inguinal region. Yellow arrow — Right testis within the scrotum (Courtesy Dr. V. Penopoulos)

Red arrow — Displaced testis in the left inguinal region. Yellow arrow — Right testis within the scrotum (Courtesy Dr. V. Penopoulos)

Stage III finger varicosities (Courtesy Dr. V. Penopoulos)

Stage III finger varicosities (Courtesy Dr. V. Penopoulos)

Stage III finger varicosities (Courtesy Dr. V. Penopoulos)

Abdominal computed tomography – Thrombosis of the left branch of the portal vein. Courtesy Dr. V. Penopoulos.

Segment of excised round ligament. Courtesy Dr. V. Penopoulos.

Segment of excised round ligament. Courtesy Dr. V. Penopoulos.

Segment of excised round ligament. Courtesy Dr. V. Penopoulos.

Segment of excised round ligament. Courtesy Dr. V. Penopoulos.

Metastasis of cholangiocarcinoma to skeletal muscles (Courtesy Dr. V. Penopoulos)

The left lower extremity appears clearly larger, thicker, edematous, with numerous visible, prominently distended veins (Courtesy Dr. V. Penopoulos)

The left lower extremity appears clearly larger, thicker, edematous, with numerous visible, prominently distended veins (Courtesy Dr. V. Penopoulos)

The left lower extremity appears clearly larger, thicker, edematous, with numerous visible, prominently distended veins (Courtesy Dr. V. Penopoulos)

Asymmetry of the hand and digits. The left hand appears thicker and longer (Courtesy Dr. V. Penopoulos)

Left hemithorax larger than the right (Courtesy Dr. V. Penopoulos)

Complete healing 2 months after surgery (Courtesy Dr. V. Penopoulos)

Repair of the surgical wound. The central portion was left to heal by secondary intention (Courtesy Dr. V. Penopoulos)

En bloc excision of the inflammatory mass (Courtesy Dr. V. Penopoulos)

Perineural invasion of cholangiocarcinoma (Courtesy Dr. V. Penopoulos)

Perineural invasion of cholangiocarcinoma (Courtesy Dr. V. Penopoulos)

Umbilical metastasis (Sister Mary’s Joseph Nodule) (Courtesy Dr. V. Penopoulos)

Palpable metastases in the right iliac fossa (Courtesy Dr. V. Penopoulos)

Palpable metastases in the right iliac fossa (Courtesy Dr. V. Penopoulos)

CT of the abdomen. Metastatic foci in the skeletal muscles on the right (red arrows) (Courtesy Dr. V. Penopoulos)

Intraoperative view (after repair of the bladder perforation) (Courtesy Dr. V. Penopoulos)

Intraoperative view (after repair of the bladder perforation) (Courtesy Dr. V. Penopoulos)

Intraoperative view (after repair of the bladder perforation) (Courtesy Dr. V. Penopoulos)

Intraoperative view (after repair of the bladder perforation) (Courtesy Dr. V. Penopoulos)

Intraoperative view (after repair of the bladder perforation) (Courtesy Dr. V. Penopoulos)

Catheterization of the thoracic duct and glue injection (Courtesy Dr. V. Penopoulos)

Catheterization of the thoracic duct and glue injection (Courtesy Dr. V. Penopoulos)

Lymphangiography. Red arrow – Site of injury (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Red arrow – Ascites. Purple arrow – Spleen. Green arrow – Liver (Courtesy Dr. V. Penopoulos)

Metastasis of cholangiocarcinoma to skeletal muscles (Courtesy Dr. V. Penopoulos)

Perineural invasion of cholangiocarcinoma (Courtesy Dr. V. Penopoulos)

Metastasis of cholangiocarcinoma to skeletal muscles (Courtesy Dr. V. Penopoulos)

Umbilectomy (Courtesy Dr. V. Penopoulos)

Endoscopic image of the pouch. Presence of large quantities of mucus and pseudomembranes (Courtesy Dr. V. Penopoulos)

Yellow arrow – Biliary sludge. Red arrow – Thickened gallbladder wall (Courtesy Dr. V. Penopoulos)

Yellow arrow – Biliary sludge. Red arrow – Thickened gallbladder wall (Courtesy Dr. V. Penopoulos)

Thickened gallbladder wall and presence of biliary sludge (Courtesy Dr. V. Penopoulos)

Endoscopic image of the pouch. Presence of large quantities of mucus and pseudomembranes (Courtesy Dr. V. Penopoulos)

Macroscopic view of the excised rectum (Courtesy Dr. V. Penopoulos)

Vulvar varices (Courtesy Dr. V. Penopoulos)

Endoscopic images of idiopathic rectal varices (Courtesy Dr. V. Penopoulos)

Macroscopic view of the excised rectum (Courtesy Dr. V. Penopoulos)

Macroscopic view of the excised rectum (Courtesy Dr. V. Penopoulos)

CT Reconstruction. Complete bisection of left kidney

CT Scan. Laceration of left renal parenchyma and sizable retroperitoneal haematoma