Abdominal CT Findings Research Articles

Abdominal CT findings may suggest coeliac disease

Background. Coeliac disease is the most common gastrointestinal immunological disorder in the western countries. Many adult patients present non-specific symptoms and signs of malabsorption such as chronic diarrhoea, anaemia, weight loss and abdominal distention. In non-specific and doubtful conditions, computed tomography is often the first medical examination performed. In a clinical practice, a critical review of computed tomography signs is therefore mandatory. Aims. To evaluate the abdominal computed tomography findings, which are useful to suggest the presence of coeliac disease in adult patients. Patients and methods. The computed tomography studies of 28 coeliac patients were reviewed, looking for any intestinal and extraintestinal abnormality. The computed tomography findings evaluated were: abnormalities of intestinal fold pattern, bowel dilatation, fluid and air excess, duodenal abnormalities, intestinal intussusception, bowel wall thickening, lymphadenopathy, ascites, intestinal stenosis, mesenteric vascular changes. The abdominal computed tomography of a group of 30 normal subjects was also analysed. Results. Intestinal fold pattern abnormalities were seen in 23/28 patients. Intestinal dilatation was seen in 21/28. Fluid excess in 18/28 and lymphadenopathy was seen in 12/28 patients; engorgement of mesenteric vessels in 7/28. Bowel wall thickening was observed in 6/28 patients and transient intussusception was observed in 6/28 patients. Increased air content within the bowel in 4/28 and ascites in 2/28 patients. Bowel dilatation together with fluid excess was observed in 18/28 patients. None of the above mentioned abnormalities abnormalities were seen in normal subjects. Conclusions. Data of the present study show that several abdominal computed tomography findings may be seen in coeliac adult patients; these findings should be taken into consideration with a high in level of suspicion by radiologists, to avoid diagnostic delay and unnecessary diagnostic and therapeutic procedures.

A Case of Transomental Hernia Presenting Interesting Abdominal CT Findings

A Case of Transomental Hernia Presenting Interesting Abdominal CT Findings

Abdominal CT angiography before surgery as a predictor of postoperative death in acute aortic dissection.

The purpose of our study was to search for a relationship between postoperative death in acute aortic dissection and abdominal helical CT findings before surgery. We retrospectively included 48 patients admitted to our institution for emergent surgery of acute aortic dissection diagnosed with helical CT angiography. We recorded postoperative deaths and analyzed abdominal helical CT vessels and parenchymal abnormalities, including the presence of dissected abdominal aortic branches, a compressed aortic lumen, and low enhancement of the parenchyma in abdominal organs. Among the 48 patients, 11 died after surgery. Postoperative death occurred in one of five patients with low enhancement of the parenchyma in one abdominal organ and in seven of eight patients with low enhancement of the parenchyma in at least two abdominal organs. The postoperative death rates strongly correlated with the number of low-enhanced abdominal organs per patient (p < 0.00005) but did not correlate with the number of dissected abdominal aortic branches. The rate of abdominal organs with low enhancement of the parenchyma seen on CT before surgery is a strong factor in outcome in patients with acute aortic dissection. Additional analysis of low enhancement of the parenchyma in abdominal organs on CT might be a useful tool to detect, before surgery, patients at risk of postoperative death.

Metastatic Choriocarcinoma In Skeletal Muscle

Choriocarcinoma is an uncommon tumor which follows pregnancy, Abortion or molar pregnancy and non gestational choriocarcinoma are very rare. Choriocarcinoma metastasizes in various organs of body including lungs, heart, skin but no case has been reported so far in the skeletal muscle. This patient was presented to us with a non-tender swelling at the right shoulder region. Fine needle aspiration cytology showed it to be an infected epidermoid cyst but on excision biopsy it was metastatic choriocarcinoma. CASE REPORT A 26-year unmarried Indian female presented to the out patient department of surgery at our center. The lady presented with a gradually enlarging lump at the right shoulder region. On examination the lump was non tender, approximately 6 cm x 4 cm in the size, oval in shape; smooth surfaced, firm in consistency and with out any regional or generalized lymphadenopathy. Fine needle aspiration cytology showed it to be an infected epidermoid cyst. It was excised completely under local anesthesia. The mass was found intramuscularly in deltoid muscle and was completely free from skin and subcutaneous tissue. A few fibers of the deltoid muscle had to be removed to excise the mass completely. The mass was 6 cm x 4 cm in size, oval in shape, brown red in color with smooth surface, hard in consistency and friable in nature. Histopathology revealed it to be metastatic choriocarcinoma (Microphotograph HPF x 100). Patient did not have any complaint regarding genitourinary tract when she consulted for the swelling. Patient was thoroughly investigated for a primary site of Metastatic Choriocarcinoma when diagnosis was confirmed by excision biopsy. Figure 1 Clinically the patient was anemic. No other complaints or findings were present. The patient gave a history of pregnancy for 2 month and abortion 3 years previously. There was no other history of pregnancy or abortion. On investigation the Hemoglobin was 9.5 gm%, Blood group O+, Total leukocyte count15800, and Differential leukocyte countPolymorphs80, Leucocytes12, Monocytes7, and Eiosinophil1. In liver function test Total protein -6.7, Albumin-4.0, Globulin-2.7, Serum Bilirubin-3.7, alkaline phosphate-8.1, SGOT70, SGPT-85, and AŸHCG were 110.2 MIU/ml on ELISA test. Chest X-ray showed a rounded opacity at the left lung base. Ultrasonography revealed a large mass in the endometrial cavity with hemorrhage in that. Multiple metastases were present in the liver and peritoneal cavity. A large rounded Metastatic Choriocarcinoma In Skeletal Muscle 2 of 3 opacity was present at the left lung base and probably was malignant in nature. The findings of abdominal CT were consistent with Ultrasonography findings. Kidney and bone marrow were free from metastases. Histopathologically the findings were consistent with the diagnosis of Metastatic Choriocarcinoma. Microscopically tumor consisted of clusters and nests of cytotrophoblastic cells, separated by masses of syncitiotrophoblast, against hemorrhagic and necrotic background. Patient was admitted for treatment but later she refused treatment and follows up and fled from the hospital. Her relatives reported later that she died after 3 months of diagnosis. DISCUSSION Choriocarcinoma is not a common tumor. The majority of primary growth arises in the body of the uterus and develops first within the endometrial cavity2. The general metastasis develops early, the growth disseminates by way of the blood stream. Metastasis may occur on any organ of the body and deposits can be found in any organ of the body, the order of preference being lungs, Vagina, brain, liver, kidney and spleen1. But the review of the literature shows no case has been reported so far in the skeletal muscles. The rarity of this case led us to learn about the mode of presentation of a choriocarcinoma with absence of other signs and symptoms and not to ignore any lump or mass in the reproductive age group even if it may seems benign. The other issue of presenting this rare case is to take caution during diagnosis and management of various subcutaneous swellings like cysts, fibroma, lipoma, sarcoma, or neurofibroma. There is always a possibility of the presence of metastatic cancer, which will require appropriate treatment. CORRESPONDENCE TO Gajendra Singh, M.S. 6 Buckboard Court, Bolingbrook, IL 60490 USA Phone: 630-269-2726 E Mail- tonygaj_99@yahoo.com

Mucopolysaccharidosis: Abnormal Findings on Abdomen and Chest Excluding Musculoskeletal System

Purpose: Mucopolysaccharidosis (MPS) is a lysosomal storage disease that causes tissue distortion and dysfunction due to the infiltration of mucopolysaccharide in connective tissue. The purpose of this study was to evaluate the characteristic findings of abdominal CT and plain chest radiography in patients with MPS. Materials and Methods: Sixty-two children with MPS diagnosed by urine analysis were involved in this study; 24 of these underwent abdominal CT and the findings were reviewed by two radiologists, who reached a consensus. Organomegaly was classified as severe, moderate or mild. On chest PA radiographs of 42 of the children, the transverse diameter of the trachea was measured and compared with that of 42 normal controls. Student's t test was used for statistical analysis. Results: At abdominal CT, hepatomegaly was observed in 22 patients (92%; 2 severe, 15 moderate and 5 mild); and splenomegaly was present in 18 (75%; 2 severe, 4 moderate and 12 mild). Among eight patients (33%) with pancreatic enlargement, one had a severly enlarged pancreas, while in the remaining seven, enlargement was mild. Also present were inguinal hernia (n=15), umbilical hernia (n=12), undulation with thickening of the diaphragmatic crura (n=10), abnormalities related to the male genitalia (n=5) and vascular anomaly (n=3). In MPS patients, the mid-point diameter of the trachea (range, 5.6-9 mm; mean, 6.9 mm) was significantly less than in normal controls (range, 8-14 mm; mean, 10.8 mm) (p

CT findings in patients with familial Mediterranean fever during an acute abdominal attack

The aim of this study is to present the abdominal CT findings of patients with familial Mediterranean fever (FMF) examined during an acute abdominal attack. CT scans of 17 patients (10 women and 7 men; age range 11-45 years) were retrospectively reviewed. Attention was directed to mesenteric or peritoneal abnormalities and to the presence of appendiceal pathology. Patients were divided into two groups; group A (n=14) consisted of patients with an acute abdominal attack caused by FMF, and group B (n=3) consisted of patients whose attack proved to be owing to a separate pathology requiring surgery. Characteristic CT findings of acute abdomen in FMF included mesenteric pathology (n=12), mainly of engorged vessels with thickened mesenteric folds, mesenteric lymphadenopathy (n=6) and ascites (n=6). Signs of focal peritonitis were found in four patients. Radiologists should be familiar with such CT findings of peritoneal irritation in patients with FMF during an acute attack, and may suggest this clinical diagnosis in the proper clinical setting in a patient who has not been previously diagnosed. Alternatively, the radiologist should be aware of the possibility of a concurrent acute appendicitis or other acute abdominal pathology in patients with known FMF and should search for it.

Pulmonary Hyalinizing Granuloma with Hydronephrosis

A 49-year-old man was admitted for the evaluation of a bilateral mass shadow in his chest X-ray film. No definitive diagnosis was established either by brushing cytology or biopsy through bronchoscopy. No malignancies were suggested by general work-up. Both masses were surgically removed, and were diagnosed as pulmonary hyalinizing granuloma (PHG). Fifteen months later, low grade fever continued and the renal function decreased. Laboratory examinations revealed bilateral hydronephrosis with polyclonal hypergammaglobulinemia. The findings of abdominal CT and urography were compatible with retroperitoneal fibrosis. Steroid treatment completely reversed the initial abnormality in laboratory data and the symptoms disappeared.

Clinical microbiological case: refractory chest wall infection following reconstructive surgery in a patient with relapsed lung cancer

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The spectrum of abdominal venous CT findings in blunt trauma.

The Spectrum of Abdominal Venous CT Findings in Blunt TraumaJohn J. Hewett1, Kelly S. Freed1, Douglas H. Sheafor1, Steven N. Vaslef2 and Mark A. Kliewer1Audio Available | Share

Role of Chest CT in the Follow-Up of Ovarian Adenocarcinoma

We describe the prevalence of metastatic chest disease in ovarian adenocarcinoma as seen on CT. We sought to determine whether routine chest CT added any pertinent information to the follow-up examination of patients with ovarian adenocarcinoma. Retrospective review of our tumor registry yielded 96 patients with ovarian adenocarcinoma who had only a single primary malignancy and at least one CT scan of the chest, abdomen, and pelvis. CT scans were reviewed to assess the presence of metastatic chest disease in relation to disease activity in the abdomen and pelvis. Chest CT findings were correlated with the physical examination findings and CA-125 levels and were reviewed in consultation with a gynecologic oncologist to select only those patients with chest abnormalities attributable to metastatic disease. A total of 266 CT scans were obtained. Forty (41.7%) of the 96 patients had abnormalities attributable to metastatic chest disease on one or more scans. In the absence of disease progression in the abdomen and pelvis, chest disease progression was seen in only six (2.7%) of the 226 follow-up CT scans. Five of the six patients had rising CA-125 levels. Correlation of the findings of abdominal and pelvic CT with the physical findings and the CA-125 levels serves as effective follow-up in patients with ovarian adenocarcinoma. The contribution of additional chest CT in these patients is small.

Abdominal CT findings in nephropathic amyloidosis of familial Mediterranean fever

To evaluate the abdominal CT features of reactive amyloidosis, abdominal CT scans of 20patients with amyloidosis of familial Mediterranean fever (FMF) were reviewed and compared with abdominal CT scans of2 control groups: 22 patients with chronic renal failure (CRF) due to non-amyloidotic kidney diseases and 40 patients with normal kidney function. The kidney size of patients with amyloidosis of FMF were found to vary during the course of the disease from normal or slightly larger than normal at the proteinuric phase, to smaller than normal and comparable to kidney size in CRF, at the uremic stage. Compared to kidney disease of other causes, more patients with FMF-amyloidosis had dense kidneys with coarse parenchymal calcification and calcification in other abdominal organs. Patients with FMF-amyloidosis had fewer aortic calcifications than patients with non-amyloidotic kidney disease. These findings suggest that kidney disease of reactive amyloidosis may have abdominal CT findings distinguishing it from other types of kidney diseases.

Intramural Hypoattenuated Nodules in Thickened Wall of the Gallbladder: CT Features According to Their Primary Causes

According to published reports, a common feature of xanthogranulomatous chole-cystitis is the presence of intramural hypoattenuated nodules in thickened gallbladder wall. These nodules can, however, also be seen in pathological conditions such as acute cholecystitis, hyperplastic cholecystoses (cholesterolosis and adenomyomatosis), gallbladder cancer, and other inflammatory diseases such as tuberculosis. Retrospective review of the abdominal CT findings in 622 patients who for various reasons underwent cholecystectomy during a one-year period showed that intramural nodules were present in 60. In this pictorial essay we illustrate the imaging features of the many different pathological conditions which give rise to intramural hypoattenuated nodules in thickened wall of the gallbladder, correlating these features with the histopathological findings.

2. Diagnostic Utility of FDG-PET in the Clinical Management of Patients with Suspected Recurrent Pancreatic Carcinoma after Whipple Procedure

Purpose: We evaluated the usefulness of FDG-PET in the assessment of patients with suspected pancreatic carcinoma who have previously undergone a Whipple procedure.Methods and Materials: Attenuation-corrected FDG-PET was performed in 11 patients (5 males, 6 females, age range 52–76 years), with suspected recurrent pancreatic carcinoma after Whipple procedure. Recurrence was suspected based on clinical, laboratory (CA19-9 serum tumor marker level), or abdominal CT findings. Diagnostic validation was by histology in 2 patients and radiologic or clinical follow-up (5 to 48 months) in 9 patients. Changes in therapeutic management that were prompted by PET were tabulated.Results: PET was concordant with the findings of abdominal CT in 7 patients (6 true-positive, 1 true-negative). PET detected unsuspected lung lesions in 1 of these patients that was subsequently confirmed by a chest CT. PET was discordant with abdominal CT in 4 patients. PET detected tumor recurrence in 3 of 4 patients in this group (27% of total) who had non-diagnostic CT and elevated CA19-9 serology. Chemotherapy was initiated in 2 of these 3 patients (18% of total), while the other patient died shortly after the PET study from pneumonia and recurrent tumor was confirmed at autopsy. The remaining 1 of 4 patients in the discordant group had a false-positive PET study due to relatively high FDG localization in a displaced loop of bowel.Conclusion: PET is useful in localizing the tumor in post-Whipple patients with suspected recurrent pancreatic carcinoma and can impact their clinical management.

4562 Assessment of endoscopic ultrasound guided fine needle aspiration biopsy in the evaluation of pancreatic masses.

Background: Limited data comparing EUS FNA with other biopsy modalities for pancreatic masses are available. Aims: To compare the accuracy of EUS FNA with abdominal CT, ERCP and pathological findings at surgery in evaluating pancreatic masses. Methods: Retrospective patient chart review identified all patients (pts) with pancreatic masses who underwent EUS FNA between March 1994 and 1999. In total, 211 pts with pancreatic masses were evaluated with EUS FNA; 205 (97%) were evaluated with abdominal CT [65 had CT-guided biopsy before EUS], 93 (44%) were evaluated with ERCP [45 had brushings/biopsy before EUS]. Results: One patient suffered a complication post EUS FNA (mild pancreatitis, 0.5%, 95% CI 0-1%). CT completely failed to detect the pancreatic mass in 78 (38%) pts. There were 169 pts (80%) who had confirmed pancreatic malignancy on EUS FNA [155 adenocarcinomas, 12 neuroendocrine tumors (NETs), 2 lymphomas]. Of the 44 patients that proceeded to surgery 33 (75%) had malignancy [4 NETs]. Using surgical findings as the gold standard, sensitivity of EUS FNA is 88% (95% CI: 77%-99%); specificity is 100% (95% CI: 94%-100%) and accuracy is 91% (95% CI: 86%-96%). Of the 10 pts who had benign CT-FNA and went to surgery, 5 were found to have malignant disease (diagnostic accuracy, 50%). Similarly, of the 10 pts who had benign ERCP sampling and went to surgery, 5 were found to have malignant disease (accuracy also 50%). Of the 33 patients with malignancy who underwent surgery, 17 were resectable (6 correctly classified by CT, 16 by EUS) and 16 patients were unresectable (1 correctly classified by CT, 14 by EUS). For determining resectability/unresectability CT had a sensitivity of 35%, specificity of 100%, accuracy of 67% and EUS had sensitivity of 94%, specificity of 100%, accuracy of 97% (p=0.009). Of the 62 patients with negative CT-guided biopsies, 50 (80%) patients were subsequently identified to have malignancy on EUS FNA (23% agreement). Of the 40 patients with negative ERCP samples, 32 (80%) patients were subsequently identified to have malignancy on EUS FNA (18% agreement). Maximal tumor size as determined by EUS correlated strongly with size at surgery (Pearson correlation coefficient 0.8, p=0.002). Conclusion: Assuming the pathological findings at surgery are a gold standard, EUS FNA is a safe and superior diagnostic technique in the evaluation of pancreatic masses when compared to CT and ERCP. EUS is also superior in assessing tumor size and detecting resectability compared to CT.

Radiologic Findings of the Serous Cystadenomas of the Pancreas with Macro cystic or Unilocular Variants: Comparison with the Pathologic Findings

Purpose : To evaluate the radiologic findings of the serous cystadenomas of the pancreas with macrocystic or unilocular variants and to compare them with the pathologic findings. Materials and Methods : In eight patients(7 females and 1 male ranging in age from 26 to 49 [mean, 37] years) with surgically proven serous cystadenomas, the findings of abdominal CT(n=8), abdominal sonography(US, n=8), endoscopic retrograde pancreatography(ERCP, n=6), endoscopic sonography(EUS, n=3), and MRI(n=1) were evaluated. The location and size of tumors, lobulation, internal septa, solid component, calcification, communication with the pancreatic duct, dilatation of the proximal pancreatic duct, and contrast enhancement on CT were assessed and compared with the pathologic findings. Results : Tumors were located in the head(n=3), body(n=3) and tail(n=2), and their mean size was 4 (range, 1 -8) cm. Abdominal CT scanning revealed well-defined cystic masses composed of macrocyst(s) with calcifica-tion(n=3) and dilatation of the proximal duct (n=2). Three cases showed contrast enhancement of the cystic walls, the pathologic examination of which revealed fibrotic tissues. Four tumeurs were unilocular without septation or lobulation; these features, together with calcification, were depicted more clearly by US and EUS. ERCP revealed no communication between the cysts and pancreatic ducts. Imaging studies showed that macrocystic adenomas were superimposed on mucinous cystadenomas, and unilocular adenomas were indis-tinguishable from pseudocysts. Conclusion : Serous cystadenomas of the pancreas with macrocystic or unilocular variants are common in middle-aged women. Features present due to the existence of fibrotic tissues, and which may be reveled by contrast-enhanced CT, include internal septa, calcification, duct dilation, and prominent enhancement of the cystic wall. Serous cystadenoma should be included in the differential diagnosis of macrocystic or unilocular cystic lesions of the pancreas.

Imaging of mucocoele of the appendix with emphasis on the CT findings: A report of 10 cases

AIM: Mucocoele of the appendix denotes an obstructive dilatation of the appendiceal lumen due to abnormal accumulation of mucus. It is sometimes associated with pseudomyxoma peritonei, which predicts a malignant origin. We present the CT findings and additional imaging studies of 10 patients with neoplastic appendiceal mucocoele and discuss the clinical implications. MATERIALS AND METHODS: Abdominal CT findings from 10 patients with appendiceal mucocoele were reviewed. Barium enema, US and MRI were additionally performed in three patients. There were five men and five women aged 45–80 years. Special attention was directed to the shape and nature of the mass, its relation to the caecum and the presence of ascites or peritoneal implants, as well as possible additional ovarian tumours in female patients. RESULTS: The mucocoele was an incidental finding in five patients. They were either spherical or elongated cystic lesions, attached to the wall of the caecum, six of them with mural calcification. Ascites were present in six patients and hypodense large peritoneal implants representing pseudomyxoma peritonei in four. Pathologically the series included five cases of cystadenoma (in one, a malignant pseudomyxoma peritonei subsequently developed), four cases of cystadenocarcinoma and one villous adenoma (this patient later developed pseudomyxoma peritonei). Pseudomyxoma peritonei was found in five cases. Three women had associated ovarian cystic tumour. CONCLUSION: The appearance of an appendiceal mucocoele is quite characteristic and can be diagnosed on CT. CT can also depict additional findings suggesting pseudomyxoma peritonei. In women with an appendiceal mucocoele the ovaries should be examined closely for cystic tumour and vice versa.

Bile Duct Dilatation after Subtotal Gastrectomy in Stomach Cancer: Comparison with Gastroduodenostmy (BillothI) and Gastro Jejunosto my (Billoth II)

Purpose : To evaluate the incidence and degree of bile duct dilatation after partial gastrectomy due togastric cancer and to determine any differences between gastroduodenostomy (Billoth I) and gastrojejunostomy(Billoth II). Materials and Methods : We retrospectively analyzed the follow up abdominal CT findings in 113patients who had undergone partial gastrectomy without truncal vagotomy or cholecystectomy. In all cases,preoperative abdminal CT findings showed no evidence of bile duct dilatation. Among 113 patients, 41 underwentBilloth I surgery, and 72 underwent Billoth II. No case showed clinical or radiological evidence of obstructivecauses of bile duct dilatation. Among these patients, we decided the criteria for dilatation when this was noted.The grade was either mild (3 -4 mm), moderate (5 -8mm), or severe (over 9mm), as measured at the centralintra-hepatic duct. Extra-hepatic duct dilatation was graded as mild (6 -8mm), moderate (9 -12mm) or severe (over13 mm). We analyzed serum bilrirubin and alkaline phosphatase levels. Results : When the central intrahepatic ductwas measured, 78 of 113 patients(69 %) showed bile duct dilata-tion; 24 of 41 cases(58.5 %) were in the billoth Igroup and 54 of 72 (75 %) were the in Billoth II group. After measurement of the extra hepatic duct, 22 of41cases(53.6%) in the Billoth I group and 54 of 72 (75 %) in the Billoth II group were found to be dilated. Theresults showed a slightly increased incidence of bile duct dilatation in the Billoth, II group but this was notstatistically significant(p>0.05). In the laboratory, total, direct, and indirect bilirubin, as well as alkalinephosphatase levels, were measured. Higher levels were found in Billoth II than in Billoth I but all findings werewithin normal limits. Conclusion : Mild dilatation of the bile duct after partial gastrectomy was a not uncommonfinding, and there was no significant difference of incidence or degree of dilatation according to the procedureperformed. If a patient has no clinical symptoms, it appears that clinical it appears that clinical evaluationdoes not require fur-ther study.

GANGLIOCYTIC PARAGANGLIOMA ON THE SECOND PORTION OF DUODENUM-A CASE REPORT-

A 45-year-old man was found to have a large polyp in the desending colon, and was admitted to the hospital for resection at laparotomy. Preoperatic endoscopy revealed a submucosal polyp of Yamada type III in the second portion of duodenum. Abdominal CT findings were negative and an endoscopic biopsy did not show malignancy. Surgical resections for these tumors were performed on an one-step approach. Immunohistochemically NSE, chromogranin A and S-100 protein stainings of this duodenal tumor were positive. Histology revealed gangliocytic paraganglioma and no malignancy. Among duodenal submucosal tumors which are believed to be relatively rare, those arising in the second portion of duodenum are so rare that only 18 cases including ours have been reported in Japan.

A CASE REPORT OF DUODENAL LIPOMA

A 53-year-old woman who had been suffering from a gastric discomfort was admitted to the hospital for close examination of an elevated lesion in the duodenum which was defected at a medical check up. Upper GI series of a group examination showed a tumor (50×20mm in size) which developed from the duodenum. Hypotonic duodenography showed a pealike elevated lesion at the 2 nd portion of the duodenum. The tumor was transformed by the compression, that is, soft and its mobility was good. Abdominal CT findings showed a clear, round and low density lesion (28×21mm in size) in the duodenum. CT scan disclosed a tumor with a radiographic density similar to adipose tissue (100 HU of CT number). The duodenal lesion was correctly diagnosed as lipoma according to these findings. Judging from the form (no peduncle) and the size (large) of the tumor, endoscopic polypectomy was considered to be impossible because of the risk of perforation. An extirpation of the tumor with a duodenotomy was performed. The resected tumor was 50×30mm in size, widebased and covered with duodenal serosa. It means endoscopic polypectomy will come to perforation. The resected specimen was pathologically diagnosed as lipoma.

Cystic fibrosis: Spectrum of thoracic and abdominal CT findings in the adult patient

Cystic fibrosis (CF) is an autosomal recessive disorder that is characterized by an abnormality of exocrine gland function. Adult patients represent a rapidly growing percentage of the CF population. Pulmonary changes are seen in nearly every case and are the most serious complication of CF. In advanced lung disease, bronchiectasis, emphysematous bullae, and subpleural blebs can frequently develop. Although pulmonary disease is the most common cause of death and morbidity among CF patients, there also can be involvement of other organs, particularly in adults, which show characteristic signs on CT and spiral CT. Pancreatic abnormalities are present in 85–90% of CF patients. The degree of pancreatic involvement varies, ranging from accumulations of mucus in the small ducts to totally plugged ducts, which can cause atrophy of the exocrine glands and progressive fibrosis. Pancreatic dysfunction on CT is demonstrated as fatty replacement and fibrosis of the pancreas. However, there may be scattered foci of pancreatic calcifications that can be detectable on plain radiographs. Hepatobiliary involvement follows the same pattern as pancreatic abnormalities. Bile canaliculi are plugged by mucinous material and when this plugging is of long duration, biliary cirrhosis with diffuse hepatic nodularity may develop. Such severe hepatic involvement is seen in only about 2–5% of patients, although minor hepatic alterations, such as diffuse fatty changes, are fairly common. Hepatobiliary involvement is characterized by hepatic nodularity, compatible with cirrhosis, splenomegaly, and ascites. Complete obstruction of the ileum by meconium occurs in approximately 10% of newborns with CF. Intestinal findings on CT include obstruction, although this is more common in children. These CT signs should be evaluated carefully in adult patients since they may be suggestive of CF. Computed tomography offers unique information about organ involvement (other than pulmonary) that can alter diagnosis and patient management.