Cause Of Obstruction In Patients Research Articles

Comparative Assessment of Imaging Modalities in Biliary Obstruction

Introduction: Complete assessment of biliary obstruction requires the use of various imaging modalities to confirm the presence, level and cause of obstruction which can help in treatment planning. Commonly used procedures include Ultrasonography (USG), Computed Tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP). Objective: To determine the accuracy, sensitivity and specificity and to compare the diagnostic accuracy of USG, CT scan and MRCP in assessing the level and cause of obstruction in patients with obstructive jaundice. Materials and Methods: This cross sectional descriptive study in 50 patients who presented in the department of Radiology and Imaging, Combined Military Hospital (CMH), Dhaka with symptoms and signs of obstructive jaundice above the age 20 years was carried out during the period from 01 October 2012 to 30 April 2013. The accuracy, sensitivity and specificity of each modality in assessing the level and cause of obstruction were determined. Results: MRCP detected level of obstruction in 100%, CT scan in 95.8% and USG in 90% cases. For detection of cause of obstruction, MRCP had the highest sensitivity (96.2%); followed by CT scan (88.4%) and USG (62.5%). The diagnostic accuracy for detection of cause of obstruction was the highest for MRCP (93.1%); followed by CT scan (89.8%) and USG (66%). Conclusion: MRCP has highest diagnostic accuracy and sensitivity by detecting the level and cause of obstruction most accurately. JAFMC Bangladesh. Vol 17, No 1 (June) 2021: 10-13

USEFULNESS OF VARIOUS DYNAMIC AND STATIC PARAMETERS IN SLEEP MRI STUDIES -DO THEIR INCORPORATION IN ROUTINE REPORTING IN PATIENTS WITH OBSTRUCTIVE SLEEPAPNEA PROVE VALUABLE ?

Background: Sleep MRI is a new emerging non invasive modality in the preoperative evaluation of patients with obstructive sleep apnoea. Rather than subjective, the aim of the study is to evaluate the competency of certain dynamic and static parameters (variables and diemensions), that can be used in day to day reporting. Incorporating such parameters, may prove to be helpful in guiding surgical decision making. Materials and Methods: A retrospective analytical study included 27 subjects with OSA aged between 18 and 70 years using 1.5 T MRI . We measured variables such as the cross-sectional area and diameter of the retropalatal and retroglossal airway during the asleep and awakened states.We also measured comprehensive airway dimensions such as antero-posterior diameter of the tongue, midline saggital diameter of tongue, intermandibular rami distance, mentum spine distance and relative size of the tongue using the spine as the posterior border of the bony confines. Results: 21 patients had significant retropalatal airway compromise, and was evidenced by statistically significant variables in awakened and asleep states. The mean minimum anterior–posterior diameter (mm) of retropalatal airway during respiratory cycle was statistically significant measuring 3.1±1.5 mm in awaken state and 1.1±1.5 mm during asleep state (p- value 0.01). The mean minimum cross sectional area during respiratory cycle was statistically significant measuring 98±11 mm2 in awaken state and 63 ±12 mm2 during asleep state (p- value 0.04). 6 patients had significant retroglossal airway compromise, and was evidenced by statistically significant. The thickness of the soft palate and the relative size of the tongue (0.5± 0.01mm) was statistically significant in these patients (p- value 0.01). Conclusion: Our study shows that retropalatal airway is a significant cause of obstruction in patients with OSA, compared with retroglossal airway. We suggest that, when the compromise of the retroplatine aiway is to be evaluated, variables such as cross sectional area and antero-posterior diameter of the retropalatal airway during the respiratory phase in asleep and awakened states proves valuable and dimensions such as soft palate thickness as tool for objective measurement of OSA. When the compromise of the retroglossal aiway is to be evaluated, the relative size of the tongue , proves offers more advantage than the variables of airway compromise such as area and antero-posterior diameter.To further evaluate if some of our parameters correlate with the outcomes of the surgeries of OSA, a multivariate analysis would have been required.

Successful balloon valvuloplasty of a subpulmonic membrane associated with cor triatriatum dexter: a case report

BackgroundSubpulmonic membrane as a cause of right ventricular outflow tract obstruction in patients with concordant ventriculoarterial connection and intact ventricular septum is considered to be rare. Association with cor triatriatum dexter and success of subpulmonic balloon valvuloplasty have never been reported, at least to the best of our knowledge.Case presentationA 3-year-old Moroccan boy was referred to our tertiary care hospital with complaints of dyspnea on moderate exertion. A physical examination revealed parasternal lift, systolic thrill, and a 4/6 ejection systolic murmur, best heard over the left second intercostal space. His oxygen saturation was 99% on room air. Two-dimensional echocardiography showed a discrete circumferential membrane just below the pulmonic valve and a right atrial membrane. Continuous wave Doppler interrogation showed peak systolic pressure gradient of 85 mmHg across the subpulmonic membrane and no significant gradient across the right atrial membrane. Balloon dilation of the subpulmonic membrane was performed and the pressure gradient came down to 50 mmHg. During follow-up, he reported marked improvement in terms of exercise tolerance. Transthoracic echocardiography showed residual pressure gradient of approximately 40 mmHg across the membrane. Surgery resection of the two membranes was programmed, but he died after an extracardiac disease (appendicular peritonitis).ConclusionsSubpulmonic membrane as an isolated cause of right ventricular outflow tract obstruction is rare. Its association with cor triatriatum dexter is even less common. The result of percutaneous balloon valvuloplasty of subpulmonic membrane is an interesting alternative while waiting for surgery. Surgery is currently the preferred modality of treatment with the resection of both right atrial and subpulmonic membranes.

Comparative study of multidetector computed tomography and magnetic resonance cholangiopancreatography in obstructive jaundice

Background: Accurate diagnosis of the cause is crucial in the management of obstructive jaundice. Multidetector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP) play the pivotal roles in the diagnosis. Objective: The objective of this study is to evaluate the diagnostic accuracy of MDCT in determining the level and cause of biliary obstruction in patients with obstructive jaundice and correlates MDCT findings with that of MRCP. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis of a tertiary hospital in Manipur after obtaining the Institutional Ethical Committee approval. Fifty-seven patients with obstructive jaundice, age ranging 20–80 years, were subjected to MDCT and MRCP. Final definite diagnosis was made from operative or histopathological findings. Data and findings of MDCT and MRCP were correlated and statistically analyzed. Results: Maximum numbers of cases were seen to occur in the fourth to sixth decades. The female-to-male ratio was 1.4:1. Both MDCT and MRCP could correctly determine the level of obstruction in all the cases. The most common level of obstruction was at the suprapancreatic level. The most common cause of obstruction was choledocholithiasis (45.61%). Benign causes constituted 68% and malignant causes constituted 32%. MDCT could correctly determine the cause in 85.96% of cases, compared to 75.44% by MRCP. Kappa statistics showed fair agreement between MDCT and MRCP in diagnosing the cause of biliary obstruction. MDCT showed comparable sensitivity, specificity, and positive and negative predictive value, in diagnosing the causes of obstruction. Conclusion: Overall performance of the MDCT was comparable or better than that of MRCP.

Treves' field transmesenteric hernia causing acute small bowel obstruction in a 9-year-old girl

Abstract Intestinal obstruction usually occurs as a result of postoperative adhesion; only rarely have there been reports of Treves' field transmesenteric hernia as a cause of intestinal obstruction in patients without preceding abdominal surgery. A 9-year-old girl presented with recurrent episodes of abdominal pain and vomiting. A plain radiograph showed mechanical bowel obstruction, and abdominal CT failed to show a definitive etiology of the obstruction. Laparotomy revealed Treves' field transmesenteric herniation without bowel strangulation. Reduction and closure of the defect cured the patient. Recurrent obstructive symptoms and spontaneous resolution can be a presentation of Treves' field transmesenteric hernia in patients without predisposing factors of intraabdominal adhesion. Diagnosis could be aided by radiological examination, but prompt initiation of surgical exploration on the basis of clinical presentation is mandatory in suspected cases to avoid significant bowel injury.

Primary biliary tract malignancies: MRI spectrum and mimics with histopathological correlation.

Contrast-enhanced magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP), due to their excellent soft tissue contrasts, have become first-line noninvasive tests in the characterization and detection of both hepatic and pancreaticobiliary pathologies. MRCP is also helpful in detecting the level and cause of obstruction in patients presenting with jaundice. Cholangiocarcinoma (CCA) is the most common primary malignant tumor arising from the bile duct epithelium, with extrahepatic tumors presenting more often than with intrahepatic ones. However, the diagnosis and management of CCA is made more complex by a variety of malignant and benign conditions that resemble CCA, including hepatocellular carcinoma variants such as the fibrolamellar variant of hepatocellular carcinoma, cholangiocellular carcinoma, biliary metastases, hepatic inflammatory pseudotumor, lymphoepithelioma-like carcinoma, confluent fibrosis, primary sclerosis cholangitis, and the secondary sclerosing cholangitis complex. Consequently, knowledge of the underlying risk factors and imaging characteristics of these conditions is important in differentiating between neoplastic and non-neoplastic conditions in order to reach a definite diagnosis. Endoscopic retrograde cholangiopancreatography should be reserved for those patients who require intervention or biopsy for histopathological diagnosis.

Dynamic Contrast-Enhanced MR Renography for Renal Function Evaluation in Ureteropelvic Junction Obstruction: Feasibility Study

The purpose of this study was to evaluate split renal function, estimate single-kidney renal function, and identify cause of obstruction in patients with ureteropelvic junction (UPJ) obstruction by using contrast-enhanced dynamic MR renography (MRR). Seventeen patients with UPJ obstruction underwent MRR and diuresis nuclear renography. Nuclear renography assessment of split renal function and mechanical versus functional obstruction served as the reference standard. The Baumann-Rudin model for determining glomerular filtration rate (GFR) was applied to generate single-kidney renal function (SK-GFRMRR) from MRR cortical and medullary enhancement curves. MRR split renal function of the right kidney (SK-GFRMRR of the right kidney normalized to the sum of SK-GFRMRR of both kidneys) was compared with nuclear renography. The MRR estimate of total GFR (eGFRMRR) was compared with that derived from Modification of Diet in Renal Disease (MDRD) formula (eGFRMDRD). Renal pelvic rate of signal intensity change (PUR) was compared between functionally and mechanically obstructed kidneys. There was excellent correlation between MRR and nuclear renography measure of split renal function ratio (r = 0.87, p < 0.01), with mean difference of less than 10%. There was moderate correlation (r = 0.60, p = 0.01) between eGFRMRR and eGFRMDRD. eGFRMRR underestimated eGFRMDRD, with mean difference of 13.3 mL/min/1.73 m(2). PUR in mechanically obstructed units was significantly lower (0.39 ± 0.26 vs 2.0 ± 1.38 min(-1); p < 0.01) compared with functionally obstructed units. PUR discriminated mechanical from functional obstruction with accuracy of 89%. In patients with UPJ obstruction, MRR can measure split renal function, estimate eGFRMDRD with moderate correlation, and accurately discriminate mechanical from functional obstruction, thus potentially providing a "one-stop shop" examination.

A prospective comparative study of the role of CT and MRI-MRCP in the preoperative assessment of obstructive jaundice and their intraoperative corroboration

Background To compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging-magnetic resonance cholangiopancreatography (MRI-MRCP) in assessing the level and cause of obstruction in patients with obstructive jaundice, and to corroborate the preoperative diagnostic accuracy of MRI-MRCP and CT with operative findings.

Acquired nasopharyngeal stenosis in a patient with sarcoidosis

Acquired nasopharyngeal stenosis typically occurs as a result of surgery or irradiation of the nasopharynx. Sarcoidosis has numerous manifestations in the head and neck region, although an association with nasopharyngeal stenosis has not previously been reported. A 40-year-old man with sarcoidosis developed severe acquired nasopharyngeal stenosis. This was successfully managed with balloon dilatation, followed by pharyngoplasty with local pharyngeal flap reconstruction. This report is intended to prompt consideration of nasopharyngeal stenosis as a potential cause of nasal obstruction in patients with sarcoidosis, and to draw attention to the need to consider sarcoidosis in the differential diagnosis of patients with acquired nasopharyngeal stenosis. We also demonstrate the viability of pharyngoplasty in the management of nasopharyngeal stenosis in the setting of sarcoidosis.

Intestinal Radiation-Induced Stricture Favours Small Bowel Obstruction by Phytobezoar: Report of a Case

Bezoars represent the fifth most frequent cause of acute small bowel obstruction. Phytobezoar is the most common type of bezoar. It is a concretion of undigestible fibers derived from ingested vegetables and fruits. We report a case of a woman with a 1-year history of recurrent epigastric and periumbilical abdominal pain with intermittent vomiting caused by phytobezoar of the terminal ileum. After careful investigation of the case and review of literature, we identified the factor involved in bezoar formation as radiation-induced ileal stenosis due to previous treatment for a pelvic tumour. This report provides evidence to consider phytobezoar as a possible cause of small bowel obstruction in patients previously treated with abdominal radiotherapy.

Two Different Causes of Intestinal Obstruction in Lung Cancer

Summary Prompt and proper discovery of cause is important in lung cancer patients with signs and symptoms of in-testinal obstruction because approach for treatment may differ according to its etiology and emergency operation can often be required to prevent more severe complic-ations. In this report, we present two different causes of intestinal obstruction in lung cancer. Physicians need to be aware of these possibilities to differentiate the cause of intestinal obstruction in patients with lung cancer.

Preduodenal Portal Vein and Malrotation: What Causes the Obstruction?

Preduodenal portal vein is a rare congenital abnormality, and occurs either as a single malformation, in association with other malformations or as part of "polysplenia" syndrome. Preduodenal portal vein has seldom been reported as a cause of intestinal obstruction, however corrective surgery is nearly always performed. We conducted a 25-year retrospective study in a single centre to investigate the cause of obstruction in patients with preduodenal portal vein. Furthermore, we reviewed the literature on preduodenal portal vein. Over a period of 25 years, preduodenal portal vein was diagnosed in five patients. The diagnosis was made during surgery performed because of symptoms of high intestinal obstruction. All five patients had intestinal malrotation as well and, in all patients, another cause for high intestinal obstruction than preduodenal portal vein was found. Preduodenal portal vein is mainly asymptomatic. It is often associated with other intestinal congenital abnormalities more likely to cause high intestinal obstruction. Therefore, the (paediatric) surgeon should always be alert for another associated cause of intestinal obstruction. Because of the potential for technical problems from preduodenal portal vein during surgery, it nevertheless should be on the surgeon's mind during surgery when the patient has high intestinal obstruction.

Small bowel obstruction: an unusual cause.

A bezoar is a tightly packed collection of partially digested or undigested material. When this material is vegetable matter it is known as a phytobezoar, when it is hair it is a trichobezoar and when it is medication a pharmacobezoar. Phytobezoars are a known cause of small bowel obstruction in patients who have had previous gastric surgery. Two cases of small bowel obstruction caused by phytobezoars are discussed in patients with no risk factors. The cause, clinical features and management of phytobezoars is reviewed in an attempt to increase awareness of this unusual cause of small bowel obstruction.

Comparative assessment of imaging modalities in biliary obstruction

Background: Many imaging modalities are available today for the evaluation of patients with suspected biliary obstruction including Ultrasonography, Computed Tomography and Invasive cholangiography. Magnetic resonance cholangiopancreatography is a relatively new technique, which has gained popularity because of its excellent diagnostic capabilities in the evaluation of biliary obstruction. Aims: The aim of the present study was to compare the diagnostic accuracy of Ultrasonography, Computed Tomography, Endoscopic retrograde cholangiopancreatography/ Percutaneous transhepatic cholangiography and Magnetic resonance cholangiopancreatography in assessing the level and cause of obstruction in patients with obstructive jaundice. Patients & Methods: One hundred patients with clinical and laboratory features suggestive of biliary obstruction were included in this study. At least two imaging modalities were used in each patient. The level and cause of obstruction was evaluated by each modality. The findings were corroborated with the operative and/or histopathological findings. Results: Magnetic resonance cholangiopancreatography showed the best results in detecting the cause of obstruction and was second only to Endoscopic retrograde cholangiopancreatography in detecting the level of biliary obstruction. Conclusions: With its excellent diagnostic capabilities, Magnetic resonance cholangiopancreatography has certainly carved a niche for itself in the non-invasive evaluation of the patient with obstructive jaundice.

Magnetic Resonance Cholangiopancreatography in Obstructive Jaundice

To determine the ability of magnetic resonance cholangiopancreatography (MRCP) to diagnose the level and cause of obstruction in patients with obstructive jaundice. The limitations of available imaging modalities have led to the increasing use of MRCP, which is a noninvasive and highly accurate technique in evaluating patients with biliary obstruction. Thirty patients were included in this study. MRCP was done using a fat suppressed, heavily T2 weighted fast spin echo sequence. The MRCP findings were confirmed on surgical exploration or clinical follow-up. MRCP could correctly identify ductal dilatation and the level of obstruction in all cases, except one. All causes of obstruction, except three, were detected. It failed to detect a common bile duct calculus in a minimally dilated ductal system and misdiagnosed a case of focal chronic pancreatitis as carcinoma head pancreas and a small pancreatic head mass as cholangiocarcinoma. It had a sensitivity of 94.44%, specificity of 81.81%, positive predictive value of 89.47%, and negative predictive value of 90% for the detection of malignant causes. The overall diagnostic accuracy for detection of level and cause of obstruction was 96.3% and 89.65%, respectively. The high diagnostic accuracy of MRCP in evaluating patients with obstructive jaundice indicates that it has the potential to become the diagnostic modality of choice in such patients.

An echocardiographic study of the fluid machanics of obstruction in hypertrophic cardiomyopathy

Objectives. The goal of this study was to investigate the hydrodynamic cause of mitral-septal contact and obstruction in patients with hypertrophic cardiomyopathy.Background. Mitral-septal apposition has been shown to be the cause of obstruction in patients with hypertrophic cardiomyopathy. With obstruction, characteristic continuous wave Doppler tracings show an incresing acceleration of flow. (Tracing is concave to the left.)Methods. We studled 24 consecutive patients who had a Doppler echocardiographic pressure gradient ≥36 mm Hg. We pursued two lines of inquiry. 1) Before the onset of obstruction, we systematically measured the angle between the direction of left ventricular doppler color flow and the protruding mitral leaflet in early systole. 2) After the onset of obstruction, we qualitatively analyzed the concave contour of the continuous wave Doppler tracings in our patients and developed a hydrodynamic theory of tracings in our patients and developed a hydrodynamic theory of the obstruction phase to explain the characteristic tracings. We present a mathematic model to support this concept.Results. We measured 129 angles. Just before mitral-septal contact, the protruding mitral leaflet projects at a mean 40 ° and 45 ° relative to flow in the apical long-axis and apical five-chamber views, respectively. At mitral-septal contact, the obstructing leaflet projects at a mean 52 ° relative to flow in the same respective views. Even very early in systole, at leaflet coaptation, 11 of 23 patients had angles >15 ° relative to flow. After mitral-septal apposition, obstruction across a cowl-shaped orifice begins. During this stage, the obstructing leaflet projects at a mean 55 ° and 63 ° relative to flow. In 22 patients, the continuous wave Doppler tracing of the left ventricular outflow jet showed an increasing acceleration of flow.Conclusions. Just before mitral-septal contact, the protruding leaflets project at high angles relative to flow. At these high angles, flow drag, the pushing force of flow, is the dominant hydrodynamic force on the protruding leaflet and appears to be the immediate cause of obstruction. The high angle between flow direction and the protruding leaflet precludes significant Venturi effects. Even earlier in systole, at leaflet coaptation, flow drag is dominant in half of the patients, with angles relative to flow >15 °. Afterobstruction is triggered, it appears from our data and model that the leaflet is forced against the septum by the pressure difference across the orifice. The increasing acceleration of Doppler flow is explained by a time-dependent amplifying feedback loop in which the rising pressure difference across the orifice leads to a smaller orfice and a higher pressure difference.

Cranial computed tomography and real-time sonography in full-term neonates and infants.

The results of cranial ultrasonography (US) and computed tomography (CT) were compared in 52 full-term neonates and young infants. The chief indications for examination included: increasing head size, dysmorphic features, myelomeningocele, inflammatory disease, and asphyxia. Disorders detected included hydrocephalus, parenchymal abnormalities, intracranial hemorrhage, extraparenchymal fluid collections, and vascular and other developmental malformations. Hydrocephalus and subdural collections were seen in patients referred for all clinical indications, whereas diffuse parenchymal abnormalities, subarachnoid hemorrhage, and intraventricular hemorrhage occurred primarily in patients with hypoxia. CT and US essentially were equivalent in detecting hydrocephalus, moderate to large intraventricular hemorrhages or subdural collections, and large focal parenchymal lesions, although CT was somewhat better in determining the level and cause of obstruction in patients with hydrocephalus and characterizing parenchymal abnormalities. CT was more sensitive than ultrasound in detecting subarachnoid hemorrhage (100% vs. 0%), diffuse parenchymal abnormality (100% vs. 33%), and small intraventricular hemorrhages (100% vs. 0%) but these lesions often were not clinically significant. The results suggest that US should be used as the primary neuroradiological examination in term infants; CT probably should be reserved for further investigation after US in those patients with a history of hypoxia and progressive clinical deterioration.

The Aetiology, Presentation and Natural History of Extra-hepatic Portal Venous Obstruction

Extra-hepatic obstruction of the portal vein is a well known cause of hypertension in childhood and 55 out of the 97 patients (57 per cent) seen with this condition presented before they were 15 years old. However, nearly half our cases (43 per cent) presented in adult life. Haematemesis was the commonest mode of presentation in both the adult and childhood group although splenomegaly was common, especially in the children. The severity and frequency of haematemesis increased during puberty in the children. Twelve children and three adults have now not bled for between five and 30 years, 10 of them ceasing spontaneously and five following surgery. Intra-abdominal infection or septicaemia precipitated the portal venous obstruction in 38 patients (39 per cent), though the exact cause of such obstruction in patients who had no cirrhosis was obscure in about half the cases. Ascites was present in 18/51 (35 per cent) of the children and 24/35 (69 per cent) of the adults. Its presence was associated with an increased mortality (p less than 0.01). Nineteen out of 42 (45 per cent) patients with ascites also had portal-systemic encephalopathy. Twenty-four patients died, nine having presented during childhood, variceal haemorrhage was responsible for death in 19 and infection in five. Sixty-four patients underwent 114 operations for variceal haemorrhage. Mortality was greater in the surgical group compared with those managed conservatively. Surgery is therefore indicated only in the rare case where bleeding cannot be controlled by medical means.