Abdominal Computed Tomography Findings Research Articles

Acute Appendicitis in Children: Evaluation of the Diagnostic Efficacy of Ultrasonography and Computed Tomography.

Acute appendicitis (AA), the most common cause of acute abdomen in childhood, can result in significant morbidity and mortality if not diagnosed and treated in a timely manner. Diagnosis of AA is more difficult in children due to the limited communication skills, in comparison to adults. The aim of this study is to evaluate the diagnostic accuracy of abdominal ultrasonography (US) and computed tomography (CT) in the diagnosis of AA in children. Pediatric patients who were operated on with the diagnosis of AA between January 2016 and December 2021 were retrospectively reviewed. Preoperative abdominal US and CT findings of the patients and postoperative pathology results were recorded. A total of 263 patients with a mean age of 11.3 years were included in the study. There were 164 (62.3%) males and 99 (37.7%) females. Histopathology revealed AA in 215 (81.7%) patients. Preoperatively, US and CT were performed in 139 (52.8%) and 137 (54.5%), respectively. Both imaging methods were applied to 13 (5.1%) patients. US had a sensitivity and specificity rate of 77.2% and 52.6%, respectively. Positive predictive value (PPV) was found to be 81.2%, whereas negative predictive value (NPV) was 46.5% for US. The diagnostic accuracy rate of US was found as 70.5%. CT had a sensitivity and specificity rate of 88.1% and 57.1%, respectively.PPV was found to be 88.8%, whereas NPV was 55.1% for CT. The diagnostic accuracy rate of CT was found as 81.8%. In case of suspicion of AA, US may be the first choice because it is inexpensiveand easily accessible. However, considering patient incompatibility and subjective factors in children, US may sometimes be insufficient. We think that CT should be performed as an advanced examination method in cases where US is not compatible with the patient's condition, not clinic.

Non-occlusive mesenteric ischemia in critically ill patients.

Non-occlusive mesenteric ischemia (NOMI) is a life-threatening acute condition that has an overall in-hospital mortality rate of up to 75%. Critically ill patients are often admitted to intensive care units (ICUs) due to shock, and these patients are frequently at risk of developing NOMI. The objective of this study was to determine the clinical features of critically ill patients with NOMI and evaluate the risk factors for in-hospital mortality among these patients. We reviewed the electronic medical records of 7,346 patients who underwent abdominal contrast-enhanced computed tomography during their ICU stay at Samsung Medical Center (Seoul, Korea) between January 1, 2010 and December 31, 2019. After reviewing each patient's computed tomography (CT) scans, 60 patients were diagnosed with NOMI and included in this analysis. The patients were divided into survivor (n = 23) and non-survivor (n = 37) groups according to the in-hospital mortality. The overall sequential organ failure assessment (SOFA) score for the included patients upon admission to the ICU was 8.6 ± 3.1, and medical ICU admissions were most common (66.7%) among the patients. The SOFA score upon admission to the ICU was higher for the non-survivors than for the survivors (9.4 vs. 7.4; p = 0.017). Non-survivors were more often observed in the medical ICU admissions (39.1% vs. 83.8%) than in the surgical ICU admissions (47.8% vs. 10.8%) or the cardiac ICU admissions (13.0% vs. 5.4%). Laboratory test results, abdominal CT findings, and the use of vasopressors and inotropes did not differ between the two groups. In a multivariable analysis, SOFA scores >8 upon admission to the ICU (odds ratio [OR] 4.51; 95% 1.12-18.13; p = 0.034), patients admitted to the ICU with medical problems (OR 7.99; 95% 1.73-36.94; p = 0.008), and abdominal pain (OR 4.26; 95% 1.05-17.35; p = 0.043) were significant prognostic predictors for in-hospital mortality. The SOFA score >8 upon admission to the ICU, admission to the ICU for medical problems, and abdominal pain at diagnosis are associated with increased mortality among patients with NOMI.

Immunoglobulin G4-related disease diagnosed by prostate biopsy: a case report

BackgroundImmunoglobulin G4-related disease is characterized by swelling of various organs throughout the body and nodules/hypertrophic lesions. However, its cause remains unknown. We report a case of immunoglobulin G4-related disease that was diagnosed based on the histopathological findings of prostate biopsy.Case presentationA 72-year-old Japanese man had been treated by a nearby doctor for hypertension, but subsequently developed lower urinary tract symptoms and was prescribed an α1 blocker for 1 year. However, the patient was subsequently referred to our department because his symptoms did not improve. Prostate-specific antigen was 1.258 ng/ml; however, the nodule was palpable in the right lobe on digital rectal examination, and magnetic resonance imaging suggested Prostate Imaging and Reporting and Data System category 3. Therefore, transrectal prostate needle biopsy (12 locations) under ultrasound was performed. Histopathological examination revealed no malignant findings, although infiltration of lymphocytes and plasma cells, and partial fibrosis were observed. No remarkable findings of obstructive phlebitis were observed. Immunoglobulin G4-related disease was suspected, and immunoglobulin and immunoglobulin G4 immunostaining was performed. Immunoglobulin G4 positive plasma cells were observed in a wide range, immunoglobulin G4 positive cells were noted at > 10 per high-power field, and the immunoglobulin G4 positive/immunoglobulin G positive cell ratio was > 40%. Serum immunoglobulin G4 levels were high at 1600 mg/dl. Enhanced abdominal computed tomography findings suggested periaortitis. Additionally, multiple lymphadenopathies were observed around the abdominal aorta. The patient was accordingly diagnosed with immunoglobulin G4-related disease definite, diagnosis group (definite). We proposed steroid treatment for periaortic soft tissue lesions and lower urinary tract symptoms; however, the patient was refused treatment. A computed tomography scan 6 months after diagnosis revealed no changes in the soft tissue lesions around the aorta. Follow-up computed tomography examinations will be performed every 6 months.ConclusionIf immunoglobulin G4-related disease is suspected and a highly invasive examination is required for histopathological diagnosis, this can be performed by a relatively minimally invasive prostate biopsy for patients with lower urinary tract symptoms. Further evidence is needed to choose an optimal candidate for prostate biopsy for lower urinary tract symptoms patients with suspicion of immunoglobulin G4-related disease. For patients with lower urinary tract symptoms with immunoglobulin G4-related disease or a history, performing a prostate biopsy may avoid unnecessary treatment. However, if steroid therapy is ineffective, surgical treatment should be considered.

Pheochromocytoma with Takotsubo Syndrome and acute heart failure: a case report

BackgroundPheochromocytoma is a neuroendocrine tumor that can overproduce catecholamines. Heart failure and Takotsubo Syndrome (TTS) caused by excessive catecholamines are uncommon pheochromocytoma complications.Case presentationA 27-year-old woman was referred to our center for further preoperative assessment and adrenalectomy. She came to the emergency ward with the typical symptoms of acute coronary syndrome and heart failure, including chest stuffiness, dyspnea, epigastric pain, and diaphoresis. The high level of 24-hour urinary vanillylmandelic acid and abdominal computed tomography findings supported the diagnosis of pheochromocytoma. Transthoracic echocardiography showed diffuse hypokinesis of the left ventricular wall with an ejection fraction of 23%. All symptoms and left ventricular function recovered rapidly after left laparoscopic adrenalectomy. Histopathology findings confirmed the diagnosis of pheochromocytoma. Based on the above findings, we eventually diagnosed her with pheochromocytoma-induced TTS.ConclusionsThis is a rare case of pheochromocytoma without hypertension complicated by TTS and acute heart failure. A diagnosis of pheochromocytoma-induced TTS should be considered for patients presenting with uncommon heart failure, even in patients without hypertension. Standard treatment is the surgical removal of the adrenal mass.

Primary Appendicitis Epiploicae Mimicking Acute Abdomen

Inflammation of the appendix epiploica is called epiploic appendicitis, which can rarely cause acute abdomen. In this report, we present a case of appendagitis epiploica that required surgery for the clinical picture of acute abdomen and high fever. A 49-year-old male patient presented to the Kafkas University Faculty of Medicine Hospital's emergency department with right lower and upper quadrant pain, nausea, vomiting, and lack of appetite for the last day. The blood tests revealed increased CRP. The abdominal computed tomography findings were consistent with appendagitis epiploica of the ascending colon. The patient was prepared for surgery when acute abdomen findings and high fever were detected during follow-up. Findings consistent with appendagitis epiploica were observed in the ascending colon. The appendix epiploica was excised, and an appendectomy was performed. There was no postoperative complication. Conservative treatment should be the first option when appendagitis epiploica is detected. However, surgical treatment is required for patients with acute abdomen.

Initial Abdominal CT and Laboratory Findings Prior to Diagnosis of Crohn’s Disease in Children

PurposeTo identify initial abdominal computed tomography (CT) and laboratory findings prior to a diagnosis of Crohn’s disease (CD) in children.Materials and MethodsIn this retrospective study, patients (≤18 year-old) who were diagnosed with CD from 2004 to 2019 and had abdominal CT just prior to being diagnosed with CD were included in the CD group. Patients (≤18 years old) who were diagnosed with infectious enterocolitis from 2018 to 2019 and had undergone CT prior to being diagnosed with enterocolitis were included as a control group. We assessed the diagnostic performances of initial CT and laboratory findings for the diagnosis of CD using logistic regression and the area under the curve (AUC).ResultsIn total, 107 patients (50 CD patients, 57 control patients) were included, without an age difference between groups (median 13 years old vs. 11 years old, p=0.119). On univariate logistic regression analysis, multisegmental bowel involvement, mesenteric vessel engorgement, higher portal vein/aorta diameter ratio, longer liver longitudinal diameter, lower hemoglobin (≤12.5 g/dL), lower albumin (≤4 g/dL), and higher platelet (>320×103/µL) levels were significant factors for CD. On multivariate analysis, multisegmental bowel involvement [odds ratio (OR) 111.6, 95% confidence interval (CI) 4.778–2605.925] and lower albumin levels (OR 0.9, 95% CI 0.891–0.993) were significant factors. When these two features were combined, the AUC value was 0.985 with a sensitivity of 96% and specificity of 100% for differentiating CD.ConclusionMultisegmental bowel involvement on CT and decreased albumin levels can help differentiate CD from infectious enterocolitis in children prior to a definite diagnosis of CD.

Rectal Perforation: A Rare Complication Following Uncomplicated Vaginal Delivery.

Rectal perforation during vaginal delivery is an uncommon event. It can cause complications including pelvic abscess and other life threatening illnesses, if not treated early. We here report a 24 years lady presented with a week long history of abdominal pain and fever associated with rectal discharge three weeks after uncomplicated vaginal delivery. Abdominal computed tomography findings suggestive of rectal perforation and revealed a huge pelvic abscess. A pigtail catheter was inserted into the pelvic abscess under transrectal ultrasound guidance and drained successfully. The patient recovered uneventfully and discharged 5 days after admission. Keywords: Pelvic abscess; rectal perforation; uncomplicated vaginal delivery.

Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience.

BackgroundAbout 20% of COVID-19 patients can have digestive symptoms, apart from the typical chest-related symptoms, and 10% of patients may have only gastrointestinal (GI) symptoms during their entire disease course.Aim and objectiveThe purpose of this study was to describe the spectrum of abdominal computed tomographic (CT) findings in a cohort of 15 COVID-19 patients (confirmed on reverse transcription polymerase chain reaction (RT-PCR)) who presented with various GI presentations without preceding respiratory symptoms.Materials and methodsA total of 93 patients with COVID-19 (confirmed on RT-PCR) who underwent CT imaging (between September 28, 2020 and March 20, 2021) in our center were retrospectively searched from the existing database. Among those, 15 patients having index presentation with abdominal symptoms and underwent CT abdomen were further evaluated.ResultsBiliary stasis in the form of distended gallbladder and wall thickening was the most common finding, seen in 66.7% (n = 10) patients, followed by bowel wall thickening. Small bowel and large bowel thickenings were seen in 26.7% (n = 4) and 20% (n = 3) patients, respectively. Other findings include fluid-filled colon (n = 1), mesenteric venous thrombosis (MVT) (n = 2), paper-thin bowel wall and pneumatosis (n = 1), acute pancreatitis (n = 1), and ascites (n = 2). One patient who presented with abdominal pain did not show any obvious imaging findings on CT.ConclusionPatients with COVID-19 can present with initial GI symptoms preceding typical respiratory symptoms. CT imaging helps in identifying the GI involvement, to rule out alternate etiologies, and also aids in appropriate management planning.How to cite this articlePatel RK, Chandel K, Mittal S, et al. Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience. Euroasian J Hepato-Gastroenterol 2021;11(2):76–80.

COVID-19 infection initially presented by interstitial edematous pancreatitis and acute peri-pancreatic collection; the first CT case report in Egypt

BackgroundThe extra-pulmonary computed tomography (CT) findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19) have been described in the literature, including the neurologic, cardiac, and abdominal manifestations. Ischemic and inflammatory bowel changes were the most frequent abdominal CT findings. Acute pancreatitis was seldom found all over the world outside of China and described in case reports, but not in Egypt.Case presentationA 44-years-old female patient presented with severe abdominal pain, vomiting, and mild fever for six days. No respiratory symptoms were encountered till the time of the radiological investigation. Abdominal CT examination revealed interstitial edematous pancreatitis with acute peri-pancreatic fluid collection according to the revised Atlanta classification. No pancreatic necrosis or vascular complications were depicted. Secondary pyloro-duodenitis was noticed. The modified Balthazar CT-severity index was moderate (6/10). Basal chest scans showed bilateral variable-sized bronchocentric and sub-pleural consolidative pneumonic patches with mild bilateral pleural effusion. The patient was admitted to the intensive-care unit (ICU) for two weeks. The serum amylase and lipase titers were elevated and the polymerase chain reaction (PCR) test for COVID-19 was positive. She received pancreatic, circulatory, and pulmonary medical support, then she was discharged after stabilization of her condition.ConclusionThe authors provided this case report for the association between COVID-19 infection and acute pancreatitis, which is mostly the first in Egypt. It documented their Egyptian experience to be added to the international literature. It radiologically described their chest and abdominal CT findings in detail using the COVID-19 Reporting and Data System (CO-RADS) and the revised Atlanta classification with modified Balthazar CT-severity index (CTSI). This could eventually enrich the radiological point of view in addition to the previously published clinical case reports.

Laparoscopic resection of schwannoma in the hepatoduodenal ligament: a case report

BackgroundThe occurrence of schwannomas in the hepatoduodenal ligament is rare, and its preoperative accurate diagnosis is difficult. Only few cases have been treated with laparoscopic surgery.Case presentationA 54-year-old man visited our hospital following abnormal abdominal computed tomography findings. He had no complaints, and his laboratory investigations were normal. Abdominal contrast-enhanced computed tomography revealed a tumor with enhancement at the margin of the hepatoduodenal ligament. The abdominal magnetic resonance imaging findings of the tumor showed hypointensity on the T1-weighted images and mixed hypointensity and hyperintensity on the T2-weighted fat-suppression images. Positron emission tomography showed localized accumulation of fludeoxyglucose only in the hepatoduodenal ligament tumor. The patient underwent laparoscopic tumor resection for accurate diagnosis. Histopathologically, the tumor was mainly composed of spindle cells, which were strongly positive for S-100 protein on immunohistochemical staining. The patient was discharged without any postoperative complications on day 5.ConclusionsComplete tumor resection is essential for schwannomas to avoid recurrence. Laparoscopic surgery is useful for schwannomas occurring in the hepatoduodenal ligament and can be performed safely by devising an appropriate surgical method.

Unusual manifestation of gastric mucormycosis in a patient with rheumathoid arthritis

Introduction. Mucormycosis is a life-threatening opportunistic infection whose incidence has significantly risen during the last two decades. The gastrointestinal form is very rare, with the stomach as the most common site of infection, followed by the colon and ileum. Risk factors include uncontrolled diabetes mellitus, corticosteroid use, and organ transplantation. We report a patient with a history of rheumatoid arthritis who has developed gastrointestinal mucormycosis. To the best of our knowledge, this is the first such case reported in the literature. Case report. A 53-year-old female patient with a prior medical history of rheumatoid arthritis was admitted to the hospital due to persisting diarrhea. Physical examination revealed diffuse abdominal tenderness to palpation without meteorism and peritoneal signs. Laboratory results demonstrated systemic inflammation, so antibiotic therapy was administered. Abdominal computed tomography findings revealed inflammation of the rectum and the left colon. Colonoscopy findings were indicative of Crohn?s disease. Additionally, the patient had developed profuse rectal bleeding and consequently underwent emergency surgery. Subtotal colectomy with ileostomy and partial gastrectomy was performed. The patient?s condition rapidly worsened after the operation, and she died due to multi-organ failure. Histologic findings of resection specimens discovered chronic active colitis and extensive gastric necrosis associated with dense mixed inflammatory infiltration and numerous non-septate and 90-degree branching hyphae. Diagnosis of invasive gastric mucormycosis was obtained, but unfortunately, several days after the patient?s death. Conclusion. It is very important to obtain high awareness among clinicians of this deadly infection to achieve a prompt diagnosis and effective therapy.

Computed Tomography Findings as a Novel Predictor of Alcohol-Associated Hepatitis Outcomes.

Accurate prediction of outcomes for alcohol-associated hepatitis (AH) is critical, as prognosis determines treatment eligibility. Computed tomography (CT) features may provide prognostic information beyond traditional models. Our aim was to identify CT features that predict outcomes in AH. We studied 108 patients retrospectively with definite or probable AH, who underwent admission abdominal CT. A radiologist blinded to outcome evaluated eight CT features. The primary outcome was 90-day mortality. Twenty-five (23.2%) patients died within 90days. While traditional prognostic tools, including Maddrey discriminant function (DF), predicted 90-day mortality (OR 1.01 [1.00, 1.03], P = 0.02), abdominal CT findings were also accurate predictors. On abdominal CT, patients with severe AH had larger volume of ascites (moderate/large volume: 34.0 vs. 8.2%, P < 0.0001), longer liver length (17.1 vs. 15.1cm, P = 0.001), greater liver heterogeneity (moderate/severe: 21.3 vs. 8.2%, P = 0.007), and more likely to have splenomegaly (42.6 vs. 18.0%, P = 0.009) than those with mild AH. Univariate analysis revealed that ascites volume (OR 2.59 [1.35, 4.96], P = 0.004) predicted 90-day mortality. In multivariate analysis, degree of ascites predicted 90-day mortality when controlling for Maddrey DF (OR 2.36 [1.19, 4.69], P = 0.01) and trended toward significance when controlling for MELD score (OR 2.02 [0.95, 4.30], P = 0.07). CT findings in AH differentiate disease severity and predict 90-day mortality; therefore, the role of CT warrants further investigation as a tool in AH management.

A case of transpapillary removal of choledocholithiasis using a forward-viewing scope by the rendezvous method via the PTGBD route

A 75-year-old woman was referred to our department to be investigated for liver damage. Abdominal computed tomography findings revealed choledocholithiasis with an 11-mm stone. We attempted endoscopic lithotomy using a duodenoscope. However, it was impossible to pass the duodenoscope beyond a gastric deformity with duodenal ulcer scar. The intrahepatic biliary duct was not dilatated, so we performed percutaneous transhepatic gallbladder drainage (PTGBD). Although we attempted percutaneous removal of the stone via the PTGBD route, this was difficult due to the steep angle of the cystic duct junction. We finally succeeded in removing the stone by the rendezvous method via the PTGBD route, as a forward-viewing scope could reach the papilla of Vater. The rendezvous method via the PTGBD route was an effective option for a patient with choledocholithiasis.

Relationship between Smoking and Abdominal Aorta Calcification on Computed Tomography.

BackgroundCigarette smoking increases the risk of atherosclerosis, which often develops as vascular calcification on radiologic examinations. This study evaluated the relationship between smoking-related factors and incidental abdominal aorta calcification (AAC) detected by computed tomography (CT) among middle-aged and elderly men.MethodsWe assessed the abdominal CT findings of 218 men aged 40 to 81 years who underwent health check-ups. The associations between smoking factors and AAC were analyzed using logistic regression analysis to adjust for confounding variables such as age, lifestyle factors, and chronic diseases.ResultsAdjusting for confounding variables, the risk of AAC was significantly increased in association with smoking for at least 20 years (adjusted odds ratio [AOR], 5.22; 95% confidence interval [CI], 1.82–14.93), smoking 10+ pack-years (10–20 pack-years: AOR, 4.54; 95% CI, 1.07–5.68; >20 pack-years: AOR, 5.28; 95% CI, 2.10–13.31), and a history of smoking (former smoker: AOR, 2.10; 95% CI, 1.07–5.68; current smoker: AOR, 5.05; 95% CI, 2.08–12.26). In terms of the daily smoking amount, even a low smoking level increased the risk of AAC.ConclusionThese findings suggest that smoking for 20+ years, smoking 10+ pack-years, and even a low level of smoking daily increases the likelihood of developing AAC. Clinicians should recommend that patients quit smoking and stress the importance of smoking duration when promoting health in middle-aged and elderly patients.

Computed tomographic features of inflammatory myofibroblastic tumour of the stomach in adult patients: An analysis of five multicentre cases with literature review.

The aim of this study was to describe the clinical and computed tomography (CT) features of gastric inflammatory myofibroblastic tumour (IMT) in adult patients and provide a review of the literature. Five adult patients with surgically resected and pathologically confirmed gastric IMT were included in the study from four tertiary referral centres. Clinical history was assessed for determination of patient demographics and symptoms at presentation. All patients underwent contrast-enhanced abdominal CT, and two radiologists assessed the CT features by consensus. Also, abdominal CT findings from previous case reports of nine adult patients with gastric IMT were reviewed and summarised. Of five gastric IMTs, four (80%) appeared as a well-defined subepithelial mass and only one (20%) appeared as an irregular wall thickening. All of five gastric IMTs showed strong enhancement. When we analysed the CT features of nine cases from previously published literatures combined with our five cases, predominant imaging feature of gastric IMT was a well-defined subepithelial mass with strong enhancement. Perigastric infiltration or direct invasion of the neighbouring organs was rarely seen. Gastric IMT in adult patients appeared either as a well-defined subepithelial mass or irregular wall thickening, with mostly strong enhancement. Although rare, these imaging feature may be helpful for diagnosis of gastric IMT.

Abdominal computed tomography findings in patients with exudative ascites

Background: peritoneal cavity can be involved in inflammatory and malignant diseases and using computed tomography (CT) findings of exudative ascites may help in the differentiation.Objectives: 1-Describe CT features in patients with exudative ascites.2-Obtain useful CT findings to differentiate between tuberculous (TB) peritonitis and peritoneal carcinomatosis.Patients &amp;methods: A cross sectional study conducted in Medical City Teaching Complex from September 2009 to September 2010 studied patients with exudative ascites using CT scan and confirmed later with histopathology examination. CT scan results were presented according to cytology examination and biochemical analysis.Results: 35 patients with exudative ascites were studied, including 19 males &amp;16 females, age varied from 20 to73 years. While the amount of ascites(large or small) did not show statistically significant association with malignant disease, the density of ascitic fluid was slightly higher in TB[range(18-22)Hounsfield Unit(HU),mean is 20HU]compared to malignant ascites [range(15-20)HU ,mean is 18HU].Right subphrenic ascitic collections are associated with malignant disease (12 or 60% compared to 2 or 13.3% in TB) and pelvic ascitic collections were associated with TB disease (8 or 53.3% compared to 3 or 15% in malignant disease).Conclusion: In addition to omental cake &amp;thickened bowel wall, malignant exudative ascites on CT scan is likely to have lower density, located in the right subphrenic space than in the pelvic region compared to benign (tuberculous) exudative ascites&#x0D; المقدمة :هذه الدراسة للتفريق بين مسببات الاستسقاء النضحي الحميدة والخبيثة باستخدام المفراس الحلزوني.&#x0D; الاهداف: وصف مشاهدات المفراس الحلزوني في الاستسقاء النضحي، استخدام مشاهدات المفراس الحلزوني للتفريق بين مسببات الاستسقاء النضحي الحميدة والخبيثة&#x0D; المرضى والطرائق: لقد تم دراسة 35 مريض يعانون من استسقاء البطن عن طريق الاختيار العشوائي للمرضى في وحدة المفراس لمستشفيات مدينة الطب التعليمية للفترة من ايلول 2009 الى ايلول 2010, وتم تأكيد النتيجة من الفحص المختبري,هؤلاء المرضى مكونين من 19 ذكر و16 أنثى .وكانت أعمار المرضى تتراوح بين 20-73.&#x0D; النتائج: وجدنا ان كثافة سائل الاستسقاء كانت مرتفعة عند مرضى التدرن البريتوني (20 وحدة هاونسفيلد) بالمقارنة مع المسسببات الخبيثة للاستسقاء النضحي (15 وحدة هاونسفيلد)&#x0D; يكون تجمع الاستسقاء في الناحية تحت الحجاب اليمنى في المسببات الخبيثة (12 او 60% بالمقارنة مع 2 او 13.3% في المسببات الحميدة ) والتجمع في الناحية الحوضية اكثر في مرضى التدرن (8 او 53.3% بالمقارنة مع 3 او 15 % في المسببات الخبيثة).&#x0D; الاستنتاج: اضافة الى الكعكة الثربية والتثخن في جدار الامعاء, يكون الاستسقاء النضحي ذو المسببات الخبيثة بكثافة اقل ويكثر تواجده في الناحية تحت الحجاب اليمنى بالمقارنة مع المسببات الحميدة للاستسقاء

Analysis of computed tomographic findings according to gastroesophageal flap valve grade.

Background/AimsThe gastroesophageal junction is an important barrier against gastroesophageal ref lux. Endoscopic grading of gastroesophageal f lap valve is simple, reproducible, and may predict reflux activity. We investigated the correlation between gastroesophageal flap valve grade and the gastroesophageal junction’s structural properties using abdominal computed tomography.MethodsA total of 138 patients with early gastric cancer who underwent both pre-treatment esophagogastroduodenoscopy and water-distended stomach two-phase computed tomography were enrolled. Endoscopic gastroesophageal f lap valve grade and abdominal computed tomography findings were analyzed to assess anatomical factors including the gastroesophageal junction and related organs.ResultsThe angle of His increased significantly with gastroesophageal flap valve grade (grade I, 65.2˚ ± 19.6˚; grade II, 66.6˚ ± 19.8˚; grade III, 76.7˚ ± 11.9˚; grade IV, 120.0˚ ± 30.3˚; p < 0.001), as did the size of the diaphragmatic hiatus (grade I, 213.0 ± 53.8 mm2 ; grade II, 232.6 ± 71.0 mm2 ; grade III, 292.3 ± 99.2 mm2 ; grade IV, 584.4 ± 268.3; p < 0.001). The length of the abdominal esophagus decreased as gastroesophageal flap valve grade increased (grade I, 34.6 ± 5.8 mm; grade II, 32.0 ± 6.5 mm; grade III, 24.6 ± 7.8 mm; grade IV, –22.6 ± 38.2 mm; p < 0.001). There was no significant relationship between gastroesophageal flap valve grade and visceral and subcutaneous fat areas (p = 0.877 and p = 0.508, respectively).ConclusionsEndoscopic grading of the gastroesophageal flap valve is well correlated with anatomical changes around the gastroesophageal junction on abdominal computed tomography, and it can provide useful information about the anti-reflux barrier.

Hemobilia following laparoscopic cholecystectomy: computed tomography findings and clinical outcome of transcatheter arterial embolization.

Hemobilia following laparoscopic cholecystectomy (LC) can occur in the early or late postoperative course and poses a diagnostic and therapeutic challenge. To assess computed tomography (CT) findings and clinical outcomes after transcatheter arterial embolization (TAE) in patients presenting with hemobilia following LC. Fourteen patients treated for hemobilia following LC were included in the study. Three patients were diagnosed by endoscopy and 11 by abdominal contrast-enhanced CT. Coils or microcoils were superselectively deployed to occlude the bleeding vessel during TAE. Abdominal CT findings of hemobilia, and the success rate and complication of TAE were observed. Abdominal CT provided the following signs of hemobilia: hematoma within the abdominal cavity and gallbladder fossa, blood clots containing high attenuation within the bile duct, biliary dilatation, pseudoaneurysm of the right hepatic artery, contrast extravasation, enhancement of the bile duct wall, and hypoperfusion of the right lobe. The success rate of TAE was 100% and rebleeding did not occur in any patient. Post-embolization syndrome and hepatic ischemia occurred in nine patients, which was associated with age and the time interval between the LC and TAE. Abdominal CT provided direct signs that can aid in the diagnosis of hemobilia after LC. TAE allowed for successful treatment of hemobilia with minor complications.

Prevalence of Positive Abdominal and Pelvic CT Findings in the Elderly

Researchers retrospectively reviewed records for all adult patients who underwent emergency abdominal and pelvic computed tomography (CT) scans for suspected nontraumatic conditions at a single tertiary hospital in Canada from 2011 to 2013. The researchers compared the rate and relevance of positive findings between 462 patients aged 65 years …

Nonleukemic myeloid sarcoma presenting as intussusception of small bowel in a male patient: An unusual presentation

Myeloid sarcoma (MS) is an extramedullary tumor of the myeloid cells and usually develops in lymphoid organs, bones, skin, adipose tissue, and the central nervous system. Gastrointestinal or isolated mesenteric involvement is an extremely rare without bone marrow (BM) involvement. Only a few cases had reported before. In this paper, we report a case of a 37-year-old male who presented with small bowel intussusception due to mesenteric MS. Abdominal computed tomography findings revealed intussusception of the small bowel in the left lower quadrant of the abdomen and mesenteric masses. The patient underwent operation, and masses were excised with segmental small bowel and segmental colon resection because the masses were adjacent to the bowel wall. Histopathology and immunohistochemistry showed MS in mesentery. Patient received 2 cycles of cytosine arabinoside combined with idarubicin chemotherapy in the postoperative period and was doing well at 6 months of follow-up. MS in mesentery presenting as intussusception of small bowel without BM involvement is very rare and it should be considered in the differential diagnosis of intestinal obstruction.