Abnormal Fluid Collections Research Articles

UNCOVERING SHADOWY SECRETS: HOW ULTRASOUND CHANGES HOSPICE CARE

BackgroundUltrasound identification of abnormal fluid collections is frequently required for patients with advanced disease who have little reserve to spend on investigational procedures. Current patient pathways via hospital radiology departments...

Computed Tomography of Adult Blunt Abdominal and Pelvic Trauma: Implications for Treatment and Interventions

Introduction Within the United States, trauma is the leading cause of death in children and adults between the ages of 1 and 44 years and the fourth largest cause of death across the entire US population. Blunt traumaticmechanisms account for 70% of all traumatic injury. Althoughmost blunt traumatic injury is related to motor vehicle collisions, blunt traumatic abdominal injury can also be seen in falls, assaults, and even medical techniques, such as the Heimlich maneuver or cardiopulmonary resuscitation. In blunt abdominal trauma, 3mechanisms are responsible for injury to abdominal organs and vasculature: deceleration, external compression, and crushing injuries. According to the American College of Radiology Appropriateness Criteria, patients who are hemodynamically unstable should not receive dedicated computed tomography (CT). In these patients, focused assessmentwith sonography for trauma (FAST) may be used in conjunction with chest and abdomen radiographs as part of a primary survey. FAST is useful in detecting abundant free intraperitoneal and pericardial fluid (blood) in hemodynamically unstable patients and can guide emergent surgery. Portable chest and abdomen radiographs typically complement FAST and serve to evaluate for abnormal gas or fluid collections, fractures, and position of lines and tubes in an unstable patient. Typically, unstable patients who do not respond to resuscitation undergo emergent surgical intervention without further imaging. However, in a hemodynamically stable patient (and increasingly, in a semistable patient), CT has become the standard for determining the extent of injury. Clinical examination and FAST notoriously underestimate intra-abdominal and pelvic injury, and missed injuries are a significant source of delayed morbidity and mortality. Nonsurgical management is the standard for all but

High prevalence of tuberculosis diagnosed during autopsy examination at Muhimbili National Hospital in Dar es Salaam, Tanzania.

The primary aims of tuberculosis (TB) control programmes is early diagnosis and prompt treatment of infectious cases to limit transmission. Failure to diagnose and adequately treat TB could lead to premature death and unrecognized transmission of Mycobacterium tuberculosis. The proportion of missed TB cases has not been reported in Tanzania. The objective of this study was to quantify the number of cases of TB identified by autopsy. Deceased morbid bodies from Muhimbili National Hospital were involved. Retrieval of admission, diagnostic and other important records used to manage the patient after admission was done. Demographic information, site and type of disease, past medical history, chest x-ray report, clinical diagnosis and cause of death reported upon death certification were recorded. Lung tissues, lymphnodes and blood clots for HIV testing were collected. Biopsy tissues were processed through Ziehl Nielsen staining and examined by microscopy. The study involved 74 deceased individuals where 56 (75.7%) were males. Information for duration of seeking health care before death was available for 41 (55.4%) subjects. Thirty-four (45.9%) cases received diagnosis before death. The main diagnoses were pneumonia 10 (13.5%), heart failure 6 (8.1%), AIDS-related illnesses 6 (6.8%) and malaria 5 (6.8%). The main clinical findings were wasting (51/74 (68.9%)) and abnormal fluid collection in different body cavities, 61 (50.8%). In 24 out of 71 (33.8%) biopsies acid fast bacilli (AFB) were detected. Records of lymphnodes examination were available in 63 cases and 22 of them had AFB. Twenty-two (34.9%) from the paratracheal and hilar lymphnodes were observed to have AFB. HIV was detected by ELISA in 19 (33.3%) out of 57 deceased, and 12 (63.2%) of the HIV positive deceased were co-infected with TB. Out of the 22 cases positive for AFB on tissue-biopsies 12 (54.5%) were HIV positive. There is a high number of TB cases diagnosed after death that could not be detected before they died. There is a need for increased awareness and to include post-mortem data in the annual statistics of TB for precise reporting of the magnitude of the TB burden in the country.

High Frequency of Adverse Local Tissue Reactions in Asymptomatic Patients With Metal-on-Metal THA

The key to successful management of patients with metal-on-metal (MOM) THAs is to diagnose adverse local tissue reactions (ALTRs) early. ALTRs have been described in asymptomatic patients with resurfacing arthroplasties. Whether this concerning finding applies to modular MOM THAs is unknown. We (1) determined the prevalence of ALTRs in asymptomatic patients with modular MOM THAs, (2) described any differences in the appearance of these lesions between symptomatic and asymptomatic patients, and (3) analyzed potential predictive factors for any associations with ALTR prevalence. We evaluated 114 patients with modular MOM THAs who had MRI with metal artifact reduction sequence software and metal ion laboratory results at a mean of 57 months postoperatively. There were 83 asymptomatic and 31 symptomatic patients. We defined ALTRs as abnormal fluid collections, solid or semisolid pseudotumors, or muscle or bone damage. Ion levels, lesion size, and cup abduction angles were analyzed. Twenty-six (31%) asymptomatic patients had ALTR lesions, all of which were in the greater trochanteric area. Most lesions in symptomatic patients also were in that location, but there was more diversity of location in this group. The cup position among patients with ALTRs was generally good; the average abduction angle for the asymptomatic patients with ALTRs was 40°. In 24 (92%) and 22 (85%) of 26 asymptomatic patients with ALTRs, respectively, chromium and cobalt levels were below the 7-ppb threshold. A 31% incidence of periarticular fluid collections in asymptomatic patients with modular MOM THAs is alarming and calls into question any algorithmic approach dependent on symptomatology. The presence of pain was insufficient to identify patients at risk for ALTRs. To determine whether routine cross-sectional imaging of all asymptomatic patients with MOM implants is necessary will require a larger study cohort, longer followup, and clearer understanding of the natural history of periarticular lesions in these patients.

English

The cystic swellings of scrotum are one among the common surgical problem in all age group. Objective of this study is to identify the cause, mode of presentation, various modalities of management and outcome of these with least complications. A total of 50 cases of cystic swellings of scrotum fulfilling the methodology criteria were subjected to preformatted study. Final diagnosis was made with clinical examination and ultrasound. All 50 cases were treated surgically. Most of the patients were in age group of 31-40 years (28%), common presenting feature being scrotal swelling in 60% of cases, majority of them were right sided(64%), most of them presented within a year of development of symptoms. Primary vaginal hydrocele was the commonest cystic swelling (60%), followed by epididymal cyst, sebaceous cyst, haematocoele, pyocoele. Most of the patients were discharged around 8th Post-operative day. All of the cystic swellings were treated surgically with good results. INTRODUCTION: Cystic swellings of the scrotum are a common problem encountered in surgery OPD. Cystic swellings of scrotum affect the physical well being of the patient and present with varied etiology. Since scrotum is placed outside the lower abdomen they are easily noticed by the patient himself and is also easily accessible for clinical examination by the treating doctor. This spectrum of disease consists of hydrocoele (commonest cause), epididymal cysts, spermatocoele, haematocoele, pyocoele, chylocoele, and sebaceous cysts. Cystic swellings of scrotum are usually painless and can attain a very big size without causing much discomfort to patient. Hydrocoele is an abnormal collection of serous fluid in some part of the processus vaginalis, usually the tunica1. It is divided into simple (scrotal) and communicating2. Secondary hydrocoele occur secondary to disease of the testes and epididymis and its management mainly consists of treatment of the underlying cause. Filarial hydrocoele and chylocoele account for

Cardiac tamponade in a woman with preeclampsia

AbstractPreeclampsia is associated with alterations in maternal vascular permeability and can thus cause intravascular volume depletion and pathologic extravascular fluid accumulation. Although typically manifesting as peripheral edema or, in more severe cases, non-cardiogenic pulmonary edema, preeclampsia-associated vascular abnormalities can theoretically cause abnormal fluid collection in any extravascular space, including the pericardium.We report the case of a 30-year-old gravida 1 female admitted at 31 weeks 4 days’ gestation with mild preeclampsia, tachycardia, and dyspnea, whose initial workup was only significant for a small pericardial effusion. Over the course of the next 4 weeks, however, the effusion evolved into early cardiac tamponade that required expeditious pericardiotomy and cesarean delivery. The effusion virtually resolved over the first month postpartum.The case describes a unique presentation of preeclampsia and suggests that echocardiography to evaluate for pericardial effusion be considered in cases of otherwise-unexplained cardiopulmonary symptoms in the setting of preeclampsia. If detected, cardiac tamponade should be managed in association with a multidisciplinary team familiar with the physiology of cardiac tamponade.

Optimized robust plasma sampling for glomerular filtration rate studies

In the presence of abnormal fluid collection (e.g. ascites), the measurement of glomerular filtration rate (GFR) based on a small number (1-4) of plasma samples fails. This study investigated how a few samples will allow adequate characterization of plasma clearance to give a robust and accurate GFR measurement. A total of 68 nine-sample GFR tests (from 45 oncology patients) with abnormal clearance of a glomerular tracer were audited to develop a Monte Carlo model. This was used to generate 20 000 synthetic but clinically realistic clearance curves, which were sampled at the 10 time points suggested by the British Nuclear Medicine Society. All combinations comprising between four and 10 samples were then used to estimate the area under the clearance curve by nonlinear regression. The audited clinical plasma curves were all well represented pragmatically as biexponential curves. The area under the curve can be well estimated using as few as five judiciously timed samples (5, 10, 15, 90 and 180 min). Several seven-sample schedules (e.g. 5, 10, 15, 60, 90, 180 and 240 min) are tolerant to any one sample being discounted without significant loss of accuracy or precision. A research tool has been developed that can be used to estimate the accuracy and precision of any pattern of plasma sampling in the presence of 'third-space' kinetics. This could also be used clinically to estimate the accuracy and precision of GFR calculated from mistimed or incomplete sets of samples. It has been used to identify optimized plasma sampling schedules for GFR measurement.

Microsurgical fenestration of retrocerebellar cysts as a treatment for syringomyelia

Abnormal posterior fossa cerebrospinal fluid (CSF) collections (PFC) are a constituent feature of several welldescribed disorders [1, 25]. These include retrocerebellar arachnoid cysts and the continuum of Dandy Walker pathology described by Barkovich and coworkers (including Dandy Walker malformation, Dandy Walker variant, and Blake’s pouch cyst) [4]. It is thought that similar to Chiari malformations, posterior fossa cysts adjacent to the foramen magnum can herniate and cause impaction of the foramen magnum. Although rare, such impaction may lead to secondary syringomyelia, probably secondary to obstruction of CSF flow between the posterior fossa and the cervical spinal subarachnoid space [2, 6, 9, 10, 15, 17, 19–21, 23, 24, 26–28]. We report our experience treating two children with PFC causing secondary syrinx and review the literature on this topic.

Management of hydrocele in adolescent patients

Hydrocele is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis. In the majority of affected adolescents, hydrocele is acquired and is idiopathic in origin. The pathogenesis of idiopathic hydrocele is thought to be an imbalance in the normal process of fluid production and reabsorption. The diagnosis is usually clinical. Taking a thorough history is essential to rule out any fluctuation in size, which is an indication of a patent processus vaginalis. Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration. Otherwise, open hydrocelectomy via a scrotal incision is the standard treatment of idiopathic hydroceles. The second most common cause of hydrocele in adolescents is varicocelectomy. The risk of hydrocele formation is higher with non-artery-sparing procedures or those performed without microsurgical aid, and in surgery requiring cord dissection. If hydrocele occurs after varicocelectomy, initial management should include observation with or without hydrocele aspiration. Large persistent hydroceles are best served by open hydrocelectomy.

Aneurysm of a Right-Sided Descending Thoracic Aorta With a Left-Sided Aortic Arch and Aberrant Right Subclavian Artery

We describe a rare case of an arteriosclerotic aneurysm in the right-sided descending thoracic aorta with a left-sided aortic arch and concomitant aberrant right subclavian artery. A 76-year-old woman, who was found to have an aneurysm of the right-sided descending thoracic aorta, was referred to our hospital for surgical treatment. Contrast computed tomography scan revealed a left-sided aortic arch with an aberrant right subclavian artery, a descending thoracic aorta passing downward behind the esophagus, and an aneurysm of the right-sided and distal (level between the 8th and 10th vertebral bodies) descending thoracic aorta. With a right posterolateral thoracotomy, the patient underwent descending thoracic aorta replacement using an 18-mm woven Dacron prosthesis. The patient had an uneventful postoperative course and was discharged 24 days after surgery. Histological microscopic examination of the resected aneurysmal wall revealed an arteriosclerotic aneurysm. The postoperative computed tomography scan 18 days after surgery revealed no anastomotic aneurysm or abnormal fluid collection.

Medical student responses to clinical procedure teaching in the anatomy lab

the teaching of gross anatomy to first-year medical students has progressed from a 'stand-alone' discipline to one with much clinical emphasis. The curriculum at Loma Linda University School of Medicine has had increasing clinical correlates in recent years. We decided to supplement this with procedure demonstrations early in the course, and measure the student response. clinical procedures were performed on cadavers in the anatomy lab. For example, pleural and pericardial effusions were simulated by placing bags of intravenous fluid in the pleural and pericardial cavities; pneumothorax and tension pneumothorax were simulated using an inflatable rubber bladder. Videos were made and then presented in sequence with gross anatomy lectures. The student response was evaluated with a survey sheet. the Student response was overwhelmingly positive, with all students stating that the presentations made anatomy more relevant, and most indicating that anatomy also became easier to learn. Feedback confirmed that first-year medical students have a strong clinical orientation, which can facilitate both the teaching and learning of gross anatomy. advantages of having clinicians present simulated procedures in the anatomy lab include: heightened student interest; mentoring and modelling for students; introduction to clinical concepts now encountered in basic science examinations; supplementation of the thinning ranks of qualified gross anatomy teachers. The use of intravenous fluid bags and distensible bladders to simulate abnormal collections of fluid and air in body cavities is simple, inexpensive, and can be replicated in any anatomy lab.

ACR Appropriateness Criteria® on Percutaneous Catheter Drainage of Infected Fluid Collections

Abnormal fluid collections occur throughout the body and represent a wide range of pathologies, including abscesses, pseudocysts, cysts, lymphoceles, seromas, bilomas, hematomas, urinomas, and infected neoplasms. Appropriate management often depends on clinical presentation, location, type of collection, early response to treatment, and the presence of complicating factors such as fistulas, septations, and increased viscosity. Physicians should carefully review clinical and imaging findings and make evidence-based recommendations for the best treatment, which may include antibiotics, needle aspiration, percutaneous drainage, endoscopic drainage, or surgical drainage. This paper addresses percutaneous catheter drainage and alternative treatment options for the management of fluid collections and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Interventional Radiology.

EUS-Guided In Vivo Microdialysis of Pancreas: A Novel Technique of Potential Diagnostic and Therapeutic Application

Background: Microdialysis has been used as an in vivo research and clinical diagnostic tool in diverse organs to to measure dynamic temporal variations in the extracellular or interstitial concentration of non-protein-bound substance which is undetectable or unstable in the systemic circulation. Thus, we undertook a pre-clinical study to test the technical feasibility of in vivo pancreatic microdialysis with a specially developed microdialysis probe to be inserted into the pancreatic parenchyma through a EUS-guided FNA needle. Methods: Eight beagle dogs were used. Echoendoscope was inserted into the dog stomach under anesthesia. With the scanning plane displaying the pancreas, a 19-gauge needle was punctured into the pancreatic parenchyma. The microdialysis probe (membrane length, 3mm; whole length, 2m; outer diameter, 0.22mm, Fig.) was threaded through the lumen of the 19-gauge puncture needle and probe tip was protruded about 5mm that had been set in advance. The probe was constantly perfused with saline at a flow rate of 1.0 μl/min via the inlet tube and the dialysate in the outlet tube was allowed to drain into 1ml polypropylene vials before and after a single bouls intravenous infusion (20mg/kg) of 5-fluorouracil (5-FU). 5-FU concentration in microdialysates were measured serially every 10 minutes. Results. Microdialysis was unsuccessful in two dogs because the probe tips were broken while insertion into pancreatic parenchyma. In the other six dogs, the concentration of 5-FU in all samples after infusion of 5-FU could be measured as more than 100 folds of the cut-off value. The concentration of 5-FU in the microdialysate increased rapidly and peaked within 10 min (13.9 μg/ml). The peak was followed by a gradual decline. No local bleeding or abnormal fluid collections were observed around the pancreas. Conclusion. EUS-guided pancreatic microdialysis is feasible and has multiple potential clinical applications such as focal pharmocokinetics and detecting new biomarkers of pancreatic carcinomas.

Treatment with OK-432 for persistent congenital chylothorax in newborn infants resistant to octreotide

Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. We are reporting the use of OK-432 for treatment of prolonged idiopathic congenital chylothorax in 2 newborn infants who failed to respond to conservative medical therapy, including octreotide injection.

Closure Versus Non-Closure of the Visceral Peritoneum (VP) in Patients with Gestational Hypertension—An Observational Analysis

Introduction: Caesarean section (CS) is one of the most frequently performed surgical procedures worldwide. Surgical variants include closure and non-closure of the peritoneum: in case of non-suturing the visceral peritoneum (VP), abnormal fluid collections such as blood clots may lead to formation of a hematoperitoneum. Material and Methods: In this retrospective, observational study we reviewed 1848 patients with gestational hypertension (GH) undergoing repeat and primary CS performed by non-closure of the visceral peritoneum (VP). Results: Six of these patients had major early post-CS complications: 5 patients experienced hypovolaemic shock that required urgent operative intervention. Four patients underwent repeat laparotomy and one patient was treated by laparoscopy. Conclusion: As an early major post-CS complication, hematoperitoneum occurs in cases with poor haemostasis and/or with haemodynamic disorders such as GH. A decrease in blood pressure (BP) during CS caused by spinal/epidural anaesthesia and the following BP increase in GH patients may favour bleeding complications. Closure of the VP may facilitate early detection of a subperitoneal hematoma. In contrast, hematoperitoneum may develop in cases of non-closure of the VP followed by hypovolemic shock. Early and aggressive intervention results in excellent prognosis of this complication.

Percutaneous drainage of psoas abscess under real-time computed tomography fluoroscopic guidance

The goal of our study was to determine the usefulness of percutaneous abscess drainage under guidance of computed tomography (CT) fluoroscopy. Our subjects were 21 patients (seven women, 14 men; mean age 64 years; age range 30-87 years) who had undergone percutaneous drainage of 26 psoas abscess lesions under CT fluoroscopic guidance between May 2001 and January 2008. Drainage methods involved a needle puncture, insertion of a guidewire, serial dilations, and the exchange of the needle with a drainage tube. The procedures were guided by use of a helical CT scanner that provided real-time fluoroscopic reconstruction. Percutaneous drainage under real-time CT fluoroscopic guidance was successfully performed in every procedure. Use of real-time CT fluoroscopy allowed rapid assessment of needle, guidewire, and catheter placement. No patient had serious complications related to the drainage procedure. The mean procedure time required to drain one lesion was 35.6 +/- 13.6 min. Mean period after the drainage procedure until complete disappearance of the abscess as confirmed by CT was 12.4 +/- 10.0 days (range 3-46 days). CT fluoroscopy is useful in achieving accurate and safe drainage of abnormal psoas fluid collections.

Giant hydrocele

Hydrocele: (Greek-sac) is abnormal fluid collection within the tunica vaginalis with or without patent processus vaginalis. It is a fairly common condition. Here, we are reporting a case of giant hydrocele associated with inguinal hernia highlighting how it affects the quality of patient life, local complications, infertility, effect on sexual performance and work aptitude. Keywords: scrotal, calcification, sac, infertility.Sudan Journal of Medical Sciences Vol. 3 (1) 2008: pp. 67-70

Imaging of Orbital Trauma

Assessing traumatic orbital injuries is an important challenge for radiologists; this assessment is even more difficult when the orbital injury is associated with injuries involving multiple organs. Common posttraumatic orbital injuries include anterior chamber injuries, injuries to the lens, open-globe injuries, ocular detachments, intraorbital foreign bodies, carotid cavernous fistula, and optic nerve injuries. Radiographic examination of the orbits is rarely performed. Ultrasonography (US) can be very useful for evaluating the globe and its contents; however, US is contraindicated if a ruptured globe is suspected. Magnetic resonance imaging may be difficult to perform emergently; it is contraindicated if there is a possibility that a metallic intraorbital foreign body is present. Computed tomography (CT) is considered to be the top choice for evaluating orbital trauma. The best protocol is to obtain thin-section axial CT scans, then to perform multiplanar reformation. When evaluating a patient with an orbital injury, the radiologist should do the following: (a) evaluate the bony orbit for fractures, note any herniations of orbital contents, and pay particular attention to the orbital apex; (b) evaluate the anterior chamber; (c) evaluate the position of the lens (the lens may be displaced, and it may be either completely or partially dislocated); (d) evaluate the posterior segment of the globe, look for bleeds or abnormal fluid collections, and evaluate for radiopaque or radiolucent foreign bodies; and (e) evaluate the ophthalmic veins and the optic nerve complex, especially the orbital apex.

Comparisons Between Heavily T2-Weighted MR and CT Myelography Studies in Two Patients with Spontaneous Intracranial Hypotension

Our previous study demonstrated that heavily T2-weighted magnetic resonance (MR) myelography could successfully detect abnormal cerebrospinal fluid (CSF) collections in patients with spontaneous intracranial hypotension (SIH); however, its ability to demonstrate ongoing CSF leakage sites is uncertain. Currently, computed tomographic (CT) myelography is still considered the study of choice for such a purpose. In this study, we compared the results of the two imaging modalities in two patients with SIH. CSF leakages, such as C1-2 extraspinal collections, CSF along nerve root sleeves, and epidural fluid collections were noted on both studies with minor discrepancies. CSF collection along nerve root sleeves demonstrated by MR myelography was the most likely ongoing leakage site in comparison with CT myelography. Targeted epidural blood patches in both patients resulted in complete headache resolution. Non-invasive, non-contrasted and time-saving MR myelography is a promising study for patients with SIH. Further large-scale validation studies are needed.

Early Ultrasonographic Findings after a Uterine Fibroid Embolization: The Value of Differentiate from Procedure-Related Uterine Infection

Purpose: To evaluate the early ultrasonographic (US) findings from the uterus and myoma after a uterine fibroid embolization (UFE). Materials and Methods: From March 2004 to January 2006, eleven patients (27-48 years, mean: 37 years) with UFE to treat symptomatic uterine myoma, were retrospectively reviewed. A serial follow up gray-scale and color Doppler US were performed from one day to two weeks following a UFE. The US findings were evaluated for the presence and distribution pattern of air, time of air loss, and presence of fluid collection in the uterine cavity and color Doppler (SD Comment: Doppler is name. Should perhaps be upper case) signal. Results: Numerous high echoes with reverberation artifacts (which suggest air), were observed within the myoma (in all cases), one day after UFE. A branching linear echo pattern was observed in 4 cases (36%), whereas scattered echoes were observed in 7 cases (64%). Progressive loss of air, within 7 days of a UFE, was observed in 9 cases (82%), whereas 2 cases (12%) were observed within 14 days of a UFE. Abnormal fluid collection in the uterine cavity and a color Doppler signal within the myoma was not observed for all cases. Conclusion: Branching or scattered echoes (suggesting air), are normally found within the myoma after a UFE, but these echoes disappeared within 2 weeks. These early US findings can be useful in differentiating from myoma infections after a UFE.