Computed Tomography Reexamination Research Articles

A 41-Year-Old Man With an Abdominal Mass and Hepatomegaly

A 41-Year-Old Man With an Abdominal Mass and Hepatomegaly

Clinical Efficacy of Interventional Therapy on Lower Extremity Arteriosclerosis Obliterans and Prognostic Factors.

Objective This study was designed to analyse the clinical efficacy of interventional therapy on lower extremity arteriosclerosis obliterans (LEASO) and prognostic factors. Methods A total of 122 patients with LEASO diagnosed in our hospital from March 2017 to March 2019 were retrospectively analysed. Among them, 72 patients who received conservative therapy were assigned to a conservative group, and 50 patients who received interventional therapy additionally based on conservative therapy were assigned to an intervention group. The short-term (12 weeks after therapy) and long-term (3 years after therapy) clinical efficacies on the two groups were compared. Death, amputation, and vascular restenosis (vascular stenosis > 50% in computed tomography reexamination) were defined as unfavourable outcomes, and Cox regression was conducted to analyze the factors influencing the prognosis of patients. The incidence of adverse events in the two groups within 3 years was compared and statistically analyzed. Additionally, the hospital stay, therapy cost, claudication distance, and ankle brachial index were compared between the two groups. Results After therapy, the conservative group showed a notably lower total effective rate than the intervention group (P < 0.05), but the clinical efficacy after 3 years was similar between the two groups (P > 0.05). Additionally, the conservative group experienced notably longer hospital stay than the intervention group (P < 0.05), and cost less in treatment than the intervention group (P < 0.05). However, the conservative group experienced a notably shorter claudication distance and showed a notably lower ankle brachial index than the intervention group (P < 0.05). The two groups were not significantly different in mortality, amputation rate, and vascular restenosis rate (P > 0.05). Moreover, Cox regression analysis revealed that age and conservative therapy were independent risk factors for the prognosis of patients (P < 0.05). Conclusion Interventional therapy can substantially improve the short-term efficacy and prognosis of patients with LEASO, but the cost is high, so the therapeutic regimen should be selected according to the patient's economic condition.

Splenic Artery Embolization and Splenectomy for Spontaneous Rupture of Splenic Hemangioma and Its Imaging Features.

BackgroundSpontaneous splenic rupture (SSR) is a rare, often life-threatening, acute abdominal injury that requires immediate diagnosis and early treatment. SSR is mainly treated surgically or conservatively. A few cases of interventional embolization for SSRs have been reported.Case PresentationA 30-year-old male patient complaining mainly of left upper abdominal pain underwent emergency abdominal computed tomography (CT) and showed enlargement of the spleen with a massive mixed-density shadow approximately 10.0 × 8.0 × 12.5 cm in size. The boundary was unclear and showed obvious progressive enhancement. Considering the intrasplenic tumor lesions with rupture and hemorrhage, the possibility of vascular tumors was high, with intraperitoneal blood and fluid accumulation. Digital subtraction angiography of the splenic arteriography and embolization of the ruptured splenic artery branches were performed. Postoperative hemoglobin progressively decreased, inflammatory indicators, such as white blood cell counts, procalcitonin (PCT), and C-reactive protein (CRP) were significantly increased, and 2 days after embolization, the patient developed severe hypoxemia, shock, pulmonary edema, and acute respiratory distress syndrome. CT re-examination 9 days after embolization showed reduced lesion absorption. After stabilization of the condition, splenectomy was performed, and postoperative platelet count increase, anticoagulant improvement, and discharge were observed. Postoperative pathological examination revealed extensive hemorrhage and necrosis, vascular tissue with abnormal hyperplasia in the surrounding area, vascular tissue in the bleeding area and outer wall (elastic fiber staining +), and local myofibroblast hyperplasia. Immunohistochemistry showed actin (SM +) and Ki67 (10% +).ConclusionSSR caused by splenic hemangioma is rare, and the choice between surgical treatment or splenic artery embolization remains dependent on the patient's hemodynamic stability and imaging findings.

Surgical management strategy of slide tracheoplasty for infants with congenital tracheal stenosis.

The study objective was to evaluate the outcomes of slide tracheoplasty in infancy and identify predictors of adverse outcomes. We retrospectively reviewed the clinical data of infants aged less than 1year with congenital tracheal stenosis who underwent slide tracheoplasty at a single center from April 2010 to September 2020. Of 120 infants, 71.7% (86/120) had a pulmonary artery sling and 37.5% (45/120) had simultaneous intracardiac repairs. Additionally, 52.5% (63/120) of the patients had anomalous tracheobronchial arborization, and 17.5% (21/120) had diffuse tracheal stenosis. Six airway reoperations (5%) and 6 deaths (5%) occurred, and the mortality decreased annually. Multivariate analysis revealed that a low body weight, cardiovascular anomalies, and normal tracheobronchial arborization predicted a longer intubation duration. Univariate analysis revealed that a low body weight, preoperative invasive ventilation, a long cardiopulmonary bypass time, and granulation tissue were associated with death. After surgery, 26 patients had dysphagia, 24 of whom resumed oral feeding during follow-up. Ninety-two patients underwent chest computed tomography reexamination, and the trachea diameter had increased significantly from 2.32±0.72mm to 5.46±1.24mm. Nineteen and 29 patients underwent spirometry before and after surgery, respectively, and showed improvements in ventilation function, with the ratio of time to peak tidal expiratory flow to total expiratory time and ratio of volume to peak tidal expiratory flow to total expiratory volume values significantly improved from 19.80% (interquartile range, 16.90-23.80) and 23.10% (interquartile range, 21.10-25.90) to 26.80% (interquartile range, 21.20-34.40) and 30.20% (interquartile range, 25.00-34.50), respectively (P<.05). A tailored individual management strategy of slide tracheoplasty in infancy facilitates favorable clinical outcomes. Close postoperative follow-up and long-term functional evaluations including clinical symptoms and pulmonary function are still needed.

Characteristics, Management, and Prognosis of Spontaneous Coronary Intramural Hematoma.

Spontaneous coronary intramural hematoma (SCIH) was one type of spontaneous coronary artery dissection without obvious intimal tear, which is easy to misdiagnose. We aimed to study the characteristics, management, and prognosis of SCIH in our center. All the SCIH patients (n = 30) diagnosed by coronary angiography from January 1, 2012 to December 31, 2018 were enrolled. The demographic characteristics, history, therapy, and follow-up were collected. The mean age of the patients was 51.8 ± 9.5years. Most of the patients were females (66.7%) with hypertension. Patients with diffuse lesion, focal lesion, and multiple vessels were 70%, 13.3%, and 16.7%, respectively. Conservative treatment was the first choice (76.7%). The mean follow-up time was 29.3 ± 13.5months. None of the patients had unplanned readmission due to worsening symptoms. Nine patients underwent coronary artery computed tomography reexamination after 10.3 ± 7.5months, which showed complete recovery of SCIH. Eight patients were hospitalized for coronary angiography 6.4 ± 4.7months later, which did not show any sign of SCIH. Spontaneous coronary intramural hematoma was most common in post-menopausal women with hypertension. Possibly, antiplatelet drugs should be avoided in SCIH. Waiting for the hematoma to heal was preferable and had a good prognosis.

Pleural effusion as an indicator for the poor prognosis of COVID-19 patients.

BackgroundCoronavirus Disease 19 (COVID‐19) is a global health concern that has become a pandemic over the past few months. This study aims at understanding the clinical manifestations of COVID‐19 patients with pleural effusion.MethodsCOVID‐19 patients were retrospectively enrolled from the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. Pharyngeal swabs from patients were tested using real‐time polymerase chain reaction. Patients with COVID‐19 were divided into two groups based on their computed tomography (CT) scans for the presence of pleural effusion at admission. We compared the clinical features, laboratory findings, scans and clinical outcomes between the two groups.ResultsPleural effusion was observed in 9.19% of the patients. Patients with pleural effusion were more likely to be severe or critical cases. Moreover, patients with pleural effusion were associated with increased mortality. Of the 799 discharged patients, patients with pleural effusion had longer hospital stays and duration of viral shedding since the onset of symptoms as compared with that for patients without pleural effusion. After discharge, 217 patients visited for a follow‐up CT re‐examination at the Union Hospital. The CT scans showed that patients with pleural effusion required a longer time to resolve the lung inflammation after the onset of COVID‐19 as compared with the time required by patients without pleural effusion.ConclusionThis population of patients requires special attention and pleural effusion may be an indicator of poor prognosis in COVID‐19 patients.

COVID-19 and early-stage lung cancer both featuring ground-glass opacities: a propensity score-matched study.

BackgroundRadiological manifestations of coronavirus disease 2019 (COVID-19) featured ground-glass opacities (GGOs), especially in the early stage, which might create confusion in differential diagnosis with early lung cancer. We aimed to specify the radiological characteristics of COVID-19 and early lung cancer and to unveil the discrepancy between them.MethodsOne hundred and fifty-seven COVID-19 patients and 374 early lung cancer patients from four hospitals in China were retrospectively enrolled. Epidemiological, clinical, radiological, and pathological characteristics were compared between the two groups using propensity score-matched (PSM) analysis.ResultsCOVID-19 patients had more distinct symptoms, tended to be younger (P<0.0001), male (P<0.0001), and had a higher body mass index (P=0.014). After 1:1 PSM, 121 matched pairs were identified. Regarding radiological characteristics, patients with a single lesion accounted for 17% in COVID-19 and 89% in lung cancer (P<0.0001). Most lesions were peripherally found in both groups. Lesions in COVID-19 involved more lobes (median 3.5 vs. 1; P<0.0001) and segments (median 6 vs. 1; P<0.0001) and tended to have multiple types (67%) with patchy form (54%). Early lung cancer was more likely to have a single type (92%) with oval form (66%). Also, COVID-19 and early lung cancer either had some distinctive features on computed tomography (CT) images.ConclusionsBoth COVID-19 and early lung cancers showed GGOs, with similar but independent features. The imaging characteristics should be fully understood and combined with epidemiological history, pathogen detection, laboratory tests, short-term CT reexamination, and pathological results to aid differential diagnosis.

Is primary aldosteronism a potential risk factor for aortic dissection? A case report and literature review

BackgroundPrimary aldosteronism (PA) increases the risk of cardiovascular morbidity, including stroke, coronary artery disease, atrial fibrillation, and heart failure. The relationship between primary aldosteronism and aortic dissection has rarely been reported. We report a case of aortic dissection caused by secondary hypertension from PA and review similar cases in the literature.Case presentationA 56-year-old woman with a history of surgery for aortic dissection presented for follow-up of hypertension and a left adrenal mass. She had been diagnosed with hypertension and hypokalemia in 2003. Blood pressure had been controlled by antihypertensive medications. In 2009, she presented with chest and back pain; she was diagnosed with aortic dissection by computed tomography (CT). She underwent placement of an endovascular aortic stent graft. CT at that time showed a left adrenal mass with a diameter of 1 cm. In 2017, CT reexamination revealed that the left adrenal mass had grown to 3 cm in diameter. Laboratory data showed blood potassium 2.4 mmol/L (reference range: 3.5–5.3 mmol/L). The plasma aldosterone/renin ratio was elevated because of suppressed plasma renin and elevated serum aldosterone levels. Plasma aldosterone levels were not suppressed after taking captopril. Positron emission tomography/CT showed that the left adrenal tumor radiographic uptake was slightly increased (maximum standardized uptake value of 2.2), and metastasis was not detected. Laparoscopic adrenalectomy was performed, and an adrenocortical adenoma was confirmed histopathologically. After surgery, blood pressure and laboratory findings were within their reference ranges without any pharmacological treatment.ConclusionsOur patient and the literature suggest that PA is a potential cause of aortic dissection. Diagnosing PA in the early stages of the disease and early treatment are important because affected patients may be at increased risk of aortic dissection.

Preliminary recommendations for lung surgery during COVID-19 epidemic period.

Preliminary recommendations for lung surgery during COVID-19 epidemic period.

Clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt: a multicenter study.

The aim of this study was to evaluate the safety and efficacy of clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt. Records were reviewed of patients with gastric varices and concomitant gastrorenal shunts who underwent clip-assisted endoscopic cyanoacrylate injection at three tertiary centers between April 2016 and October 2018. The assessed outcomes were technical success rate, eradication of gastric varices, cyanoacrylate embolization, and all-cause rebleeding. A total of 61 patients were analyzed. The procedure was successful in all patients (100 %). Gastric varices were eradicated in 30 of 33 patients (90.9 %) according to contrast-enhanced computed tomography re-examination within 1 month after the procedure. No symptoms or signs of cyanoacrylate embolization related to the procedure were observed. Four patients (6.6 %) were lost to follow-up. All-cause rebleeding occurred in 13/57 patients (22.8 %) during a median follow-up period of 225 days (interquartile range 114 - 507 days). Clip-assisted endoscopic cyanoacrylate injection appeared to be a safe procedure that was convenient and efficacious in the treatment of gastric varices with concomitant gastrorenal shunt.

Computed tomography-guided percutaneous permanent iodine-125 implantation for patients with malignant osseous tumors.

In the present study, we evaluated the value of computed tomography-guided 125I implantation for malignant osseous tumors. Under computed tomography guidance, 125I seeds were implanted into malignant osseous tumors of 19 patients. The curative effect was evaluated according to the degree of ostealgia relief and the changes in radiological images. The 125I seeds were implanted successfully in all 19 cases. No complication was observed. Pain relief was obtained in 17 of the 19 malignant osseous tumor patients after implantation, and the effective rate was 89.5%. Follow-up computed tomography reexamination at 1, 2 and 6 months demonstrated that of the 25 lesions in 19 cases, obvious relief was obtained in 2, partial relief in 15, a slight decrease in 7, and a progressive decrease in 1. The response rate was 68%. Computed tomography-guided 125I implantation is a safe, effective and feasible method in the treatment of patients with malignant osseous tumors.

Splenic tuberculosis

A 24-year-old Indian man was admitted to our hospital on account of fever and epigastralgia. He lost 16 kg of his weight last year, and had been experiencing night sweats. Abdominal computed tomography (CT) (Figure 1A) and ultrasonography (Figure 1B) showed massive splenomegaly with multiple hypodense cysts, most of which were hypovascular. In addition, a few right upper lung nodules and striatum lymphadenopathy were also noted by chest CT. Blood tests were remarkable for C-reactive-protein (9.2 mg/dl [reference: 0.0-0.3]) and positive result of interferon-gamma-release-assay (IGRA). Bacterial screening (staining and culture of sputum, urine and blood) and serological examinations for HIV, Entamoeba histolytica, visceral leishmaniasis and Echinococcus all yielded negative results. After non-diagnostic bronchoscopy, CT re-examination showed a new osteolytic lesion of the right lower rib with surrounding nodule, from which we finally identified Mycobacterium tuberculosis by culture. We started the 4-drug regimen of anti-tubercular treatment (isoniazid/rifampicin/ethambutol/pyrazinamide). Both his symptoms and splenic lesion resolved completely without splenectomy (Figure 1C). Splenic tuberculosis occurs as part of miliary tuberculosis (Winternitz, 1912Winternitz M.C. Tuberculosis of the spleen.Arch Intern Med. 1912; 9: 680Crossref Scopus (14) Google Scholar), and manifest as isolated splenomegaly with nodules of various sizes, each of which seems to represent granulomas (Gulati et al., 1999Gulati M.S. Sarma D. Paul S.B. CT appearances in abdominal tuberculosis: a pictorial essay.Clin Imaging. 1999; 23: 51-59Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, Batra et al., 2000Batra A. Gulati M.S. Sarma D. Paul S.B. Sonographic appearances in abdominal tuberculosis.J Clin Ultrasound. 2000; 28: 233-245Crossref PubMed Scopus (32) Google Scholar, Akhan and Pringot, 2002Akhan O. Pringot J. Imaging of abdominal tuberculosis.Eur Radiol. 2002; 12: 312-323Crossref PubMed Scopus (145) Google Scholar). Although the splenectomy is the gold standard not only for diagnosis but also for treatment, our case is unique images of therapeutic course of splenic tuberculosis which was successfully treated without surgery. Conflicts of interest (COI): The authors have reported that no potential COI exist with any companies/organizations whose products or services may be discussed in this article. Ethics: We declare that all studies have been approved by the local ethics committee of Tohoku University, and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We would like to thank Editage (www.editage.jp) for the English language editing.

Severe pulmonary edema following hyperbaric oxygen therapy for acute carbon monoxide poisoning: a case report and clinical experience

Pulmonary edema following hyperbaric oxygen (HBO₂) therapy is a rare clinical phenomenon. This case report describes such a patient - a 56-year-old woman who suffered from severe pulmonary edema after HBO₂ therapy for carbon monoxide (CO) poisoning. Patient experienced ecphysesis and dyspnea suddenly after HBO₂ therapy (100% oxygen at 0.25 MPa, for 60 minutes with a five-minute air break and decompression at 0.01 MPa/minute). Post therapy her heart rate (HR), blood pressure (BP), respiratory rate (RR) and oxygen saturation (SO₂) were 140 bpm, 60/40 mmHg, 38 bpm and 84%, respectively. Diagnoses of acute pulmonary edema and shock were made. Various treatments including antishock, tracheal intubation, mechanical ventilation for respiratory support, a diuretic, dexamethasone, asthma relief, and acidosis correction were administered. Pulmonary computed tomography (CT) indicated significant pulmonary edema. Due to active treatment, the patient showed gradual improvement. Pulmonary CT re-examination showed pulmonary edema markedly improved. At the two-year follow-up, the patient reported no abnormal mental or neurological symptoms. Acute pulmonary edema is rare but can lead to serious side effects of HBO₂ therapy in patients with severe acute CO poisoning. This complication must be must considered when administering HBO₂ therapy to patients with severe CO poisoning.

Combined anterograde and retrograde method exposing porta hepatis for the treatment of intrahepatic cholangiocarcinoma invading porta hepatis

Objective To explore the surgical safety and clinical efficacy of combined anterograde and retrograde method exposing porta hepatis for the treatment of the intrahepatic cholangiocarcinoma invading porta hepatis. Methods The retrospective descriptive study was conducted. The clinicopathological data of 3 patients with left intrahepatic cholangiocarcinoma invading porta hepatis who were admitted to the Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from February 2015 to May 2016 was collected. All the 3 patients underwent left hemihepatectomy combined with caudate lobectomy after preoperative lab and imaging examinations and the evaluations of liver function and residual liver volume. The surgical procedures followed as: anterograde dissection of porta hepatis, exposure of hilar plate, left hemihepatectomy combined with caudate lobectomy, right artery resection and reconstruction, hilar cholangioplasty and bilioenteric anastomosis. Observation indicators included: (1) surgical situations: operation time, time of hepatic artery anastomosis and volume of intraoperative blood loss; (2) postoperative pathological examinations; (3) postoperative situations: postoperative complications (biliary fistula, hemorrhage, abnormal liver function, gastroplegia) and postoperative chemotherapy; (4) follow-up: postoperative patients′ survival and carcinoma occurrence. Follow-up was performed to by outpatient examination up to December 2016. The follow-up included clinical symptoms such as abdominal pain, chills, fever and jaundice, liver function and tumor marker examination, and color ultrasound Doppler or abdominal enhanced computed tomography (CT) was performed to detect carcinoma recurrence. Measurement data was represented as average (range). Results (1) Surgical situations: all the 3 patients underwent successful left hemihepatectomy combined with caudate lobectomy using combined antegrade and retrograde method exposing porta hepatis, including 1 combined with right hepatic artery resection and reconstruction, without perioperative death. The average operation time, average time of hepatic artery anastomosis and average volume of intraoperative blood loss of 3 patients were 493 minutes (range, 430-570 minutes), 11 minutes and 526 mL (range, 450-600 mL), respectively. (2) Postoperative pathological examination showed 3 patients were diagnosed with cholangio-carcinoma, 2 with nerve bundles invaded and 2 with No.12 lymph node metastasis, with negative margins of bile duct and hepatic artery. (3) Postoperative situations: 3 patients are not complicated with biliary fistula and gastroplegia. One patient with postoperative liver dysfunction after right artery resection and reconstruction underwent anti-infection, hepatoprotection and anti-hepatic encephalopathy therapies, and then was improved and discharged from hospital at 4 weeks postoperatively. The other 2 patients recovered steadily without complications such as hypohepatia, and then respectively discharged from hospital at 17 and 20 days postoperatively. All the 3 patients underwent chemotherapy of gemcitabine combined with S-1 for 8 courses at week 4 or 5 postoperatively. (4) Follow-up: all the 3 patients were followed up for 7-20 months, with good general conditions and normal liver function and without cholangitis symptoms. One patient received right artery reconstruction, and CT reexamination at postoperative month 3 showed fine imaging of right hepatic artery. There was no sign of carcinoma recurrence. Conclusion The combined anterograde and retrograde method exposing porta hepatis for the treatment of the intrahepatic cholangiocarcinoma invading porta hepatis can increase the radical resection rate and surgical safety. Key words: Biliary neoplasms, perihilar; Intrahepatic cholangiocarcinoma; Combined anterograde and retrograde method exposing porta hepatis; Artery reconstruction

Atlantoaxial Langerhans cell histiocytosis radiographic characteristics and corresponding prognosis analysis.

Background:Langerhans cell histiocytosis (LCH) may affect atlas and axis, and there were very few published cases describing a characteristic of LCH of atlantoaxial.Objective:The objective of the study is to investigate the image manifestations of atlantoaxial LCH to improve the in-depth comprehension on it.Materials and Methods:A retrospective study was done of computed tomography (CT) and magnetic resonance imaging in atlas and axis and prognosis was analyzed.Results:The study included 41 patients (average age 12.9 years and median age 8 years) diagnosed with LCH, with 75.6% under 15 years old. Eighty-four lesions of LCH were identified including 47 in the atlas and 37 in the axis. The osteolytic bone destructions in the atlas and axis were characterized, 22% accompanied by sclerotic margins. Thirteen patients had a compression fracture, 11 in the lateral mass of the atlas and 2 in the C2 vertebral body. Sixteen and three patients had atlantoaxial malalignment and dislocation, respectively. On T2-weighted images, 68.9% showed iso- or low-signal intensity, 27.6% showed hyperintensity signal, and 3.4% showed heterogeneous signal. On postcontrast images, 81.9% showed significant enhancement, 12.5% showed moderate enhancement, and 6.3% showed mild enhancement. CT reexamination of 14 patients indicated atlantoaxial bone destruction relatively repaired in 12 patients. Thirty-three patients were a follow-up, 81.8% had no significant symptoms and 18.2% with remaining symptoms.Conclusions:The atlas and axis were affected by LCH, mainly in children. The lateral mass was easily affected and compressed, destruction of the atlas and axis could lead to atlantoaxial joint instability. The prognosis was good in most of the patients.

Caudate lobe as the sole remnant liver following anatomical hepatectomy for the treatment of hepatolithiasis

Objective To investigate the safety and short-term effect of anatomical hepatectomy for the treatment of hepatolithiasis with the caudate lobe as the sole remnant liver. Methods The clinical data of 1 patient with hepatolithiasis combined with liver atrophy-hypertrophy syndrome who was admitted to the Hunan Provincial People's Hospital in April 2014 were retrospectively analyzed.The stones were located in the left and right liver, the involved liver became fibroatrophy, and the hepatic caudate lobe not containing stones became hypertrophy.The body surface area of the patient was 1.65 m2, standard total liver volume was 1 167.63 mL. According to the result of CT, expected residual liver volume after hepatectomy was 706.12 mL, and the ratio of residual liver volume over the standard total liver was 60.47%.The radio of residual liver volume over the body mass index was 1. 21%.The patient received the second exploration of common bile ducts, hepatectomy with the caudate lobe as the sole remnant liver and T tube drainage.The follow-up including recurrence of calculus was performed by outpatient examination and telephone interview up to April 2015. Results The patient underwent caudate lobe as the sole remnant liver following anatomical hepatectomy successfully without blood transfusion.The operation time and volume of intraoperative blood loss were 380 minutes and 350 mL.The peritoneal drainage tube was removed at postoperative day 2 and the patient was discharged at postoperative day 8 with a good recovery of liver function.The postoperative pathological examination showed that there were focal biliary epithelial papillary hyperplasia combined with light-medium atypical hyperplasia and no canceration.The T tube cholangiography two month later showed that there were unobstructed lower bile duct and no residual intra-and extra-hepatic stones. The liver function was normal.Then T tube was removed and patient resumed normal life.During the 1-year follow-up, no chills and fever, jaundice and abdominal pain occurred, no calculus was detected by Bultrasonography, and computed tomography reexamination showed that remnant liver volume was increased and no intra-and extra-hepatic bile duct stones were detected. Conclusion Anatomical hepatectomy for the treatment of hepatolithiasis with the caudate lobe as the sole remnant liver is safe and feasible, with a good curative effect. Key words: Hepatolithiasis; Anatomical hepatectomy; Surgical procedures, operative

Imaging characteristics of hepatic epithelioid hemangioendothelioma

Objective To summarize the imaging characteristics of the hepatic epithelioid hemangioendothelioma (EHE). Methods The clinical data of 6 patients with hepatic EHE who were admitted to the Yantaishan Hospital (3 patients), Zhangzhou Hospital of Traditional Chinese Medicine (2 patients) and Zhangqiu Hospital of Traditional Chinese Medicine (1 patient) between March 2007 and June 2014 were retrospectively analyzed. All the patients underwent plain scan and dynamic enhanced scan of computed tomography (CT), and the number, shape, size, location, density or signal, level and method of enhancement of the lesions were observed and analyzed. Six patients were followed up by outpatient imaging examination up to June 2014, and the changes of lesions were observed. Results Among the 6 patients, 1 solitary lesion and 5 multiple lesions were detected, and the total lesions were 125 including 1 patient with 75 lesions. The lesions were round or round-like and originated commonly from the right lobe of liver and hepatic subcapsular with a maximum diameter of 0.5-3.5 cm. Plain scan of CT showed that the lesions in 6 patients had low density with the clear boundary. MRI showed that low T1WI signal and high or slightly high T2WI signal of the lesions were detected in 4 patients. Two patients had liver capsular retraction sign. The ring-like enhancement of 1 lesion and homogeneous enhancement of 5 lesions were found by dynamic enhanced scan of CT in 6 patients and enhanced scan of MRI in 4 patients. Enhanced signal in all the lesions was detected in the delayed phase. Veins into or through lesions were found in 3 lesions, with normal or narrowing vascular cavity. One patient had visible lollipop sign. Of the 6 patients, 5 were confirmed as with metastatic carcinoma of liver, and 1 was suggested as with cholangiocarcinoma. Six patients were diagnosed with hepatic EHE by pathological examination using hepatic biopsy technique. Among the 2 patients with hepatic EHE who didn't receive antineoplastic treatment after the diagnosis, 1 patient received CT examination at year 2 after first visit, which showed capsular retraction sign, and then was diagnosed as with secondary hepatic cirrhosis by MRI at 4 years after first visit. Another patient was diagnosed as with hepatic cirrhosis by CT examination at year 6.5 after first visit. One patient was diagnosed with tumor recurrence of hepatic left lobe by CT reexamination at postoperative year 4, and underwent ultrasound-guided radio frequency ablation (RFA) treatment based on no enlargement of tumor during 1-year follow-up, and then returned a normal condition after half year follow-up. Other 3 patients undergoing operation were followed up at postoperative year 1 , 4, 5 with no recurrence and metastasis. Conclusions Intrahepatic single or multiple nodules and delayed reinforcement by dynamic enhanced scan of CT and MRI are the typical imaging performances of hepatic EHE. There are certain characteristics in the liver the lollipop sign, capsular retraction sign and veins into or through the lesions. Mutual fusion and fibrosis of lesions leading ultimately to secondary liver cirrhosis may be characteristics of EHE growth. Key words: Liver neoplasms; Epithelioid hemangioendothelioma; Tomography, X-ray computed; Magnetic resonance imaging

Development of a new biliary intraluminal irradiation stent and the primary results of clinical application

To evaluate the feasibility, safety and efficiency of a new biliary intraluminal irradiation stent system loaded with (125)I seeds. The study was approved by the institutional ethics committee of our hospital, and informed consent was obtained from each patient. Patients with malignant biliary obstruction were treated with a new biliary irradiation stent system loaded with (125)I seeds according to a treatment plan system. All of the biliary seeds carrying devices combined with the matched biliary stents were placed by the procedures of percutaneous transhepatic biliary puncture. After stents implantation, all patients were followed-up. The whole biliary stent systems loaded with (125)I seeds were successfully placed in 12 patients, no (125)I seeds exfoliation during the procedure and no radioactive leakage by general emission computed tomography reexamination during the follow-up were observed. The obstructive jaundice relived and the systemic conditions improved remarkably in all patients. There were no complications related to the stents, such as biliary perforation or hemobilia, were observed. And no significant change in the blood routine and immune parameters detected before and after operation during the follow-up were observed. The median survival period was 7.40 months (95%CI 6.204 - 8.596) and the mean survival period was 8.03 months (95%CI 6.142 - 9.909). Development of a new biliary intraluminal irradiation stent system loaded with (125)I seeds is technically feasible and safe, treatment of this stent system has potential benefits of extending survival, however the long-term clinical efficacy needs to be certificated by further follow-up observation and control trials.

Computed Tomography and Ultrasonography in the Diagnosis of Appendicitis

Relative merits and indications exist for ultrasonography (US) and computed tomography (CT) in the diagnosis of appendicitis. Prospective study. General community and tertiary care hospital. Ninety-nine patients (50 males and 49 females) were studied. Following consent, the initial disposition was recorded, designating the patient for operation, observation, or discharge from the hospital. Each patient was studied by CT and US. Studies were independently evaluated by 2 radiologists, and the results were designated as positive, negative, or equivocal. The surgeon reevaluated patients before and after learning the results of US and CT, recording whether the CT scan, US, or reexamination influenced the final disposition. Fifty patients had appendicitis; 6 appendixes were perforated. The initial clinical impression called for 44 operations, 49 observations, and 6 discharges. Thirty-four patients had their treatment plan changed from the initial disposition. Ultrasonography did not affect the initial impression. In contrast, 18 patients were rediagnosed solely on CT scan findings. Seven patients were rediagnosed by reexamination. Of 44 patients initially designated for operation, the CT scan and reexamination spared 6 females from surgery; the negative appendectomy rate potentially decreased from 50% to 17% (P =.03). The CT scan, US, or reexamination failed to spare 2 males from exploration with negative results. Of the 49 patients initially designated for observation, 23 were rediagnosed after reevaluation, 13 were discharged from the hospital, and 10 underwent expedient operation. One patient was spared from inappropriate discharge from the hospital. The reliability of the CT scan was good, with high sensitivities and specificities. Equivocal scan results lowered the diagnostic value. Selective use of a CT scan with a second examination can improve the diagnostic accuracy and management of suspected cases of appendicitis by (a) reducing the negative appendectomy rate in females, (b) moving patients from observation to earlier operation or discharge from the hospital, and (c) preventing inappropriate discharge of patients with appendicitis.

Stereotactic intracavitary irradiation of large cystic craniopharyngiomas

During the years 1988–1992, 50 patients with large cystic craniopharyngioma were treated with stereotactic injection of radionuclide. The patients aged from 3 to 69 (average 21) years. Of these patients, 36 were primary cases and 14 were recurrences after previous major surgery. The cyst volume of craniopharyngiomas was 28–126 cm 3 (average 38 cm 3). The Leksell stereotactic system was used for injection of radionuclides Au-198, P-32 and Y90. Eighty-four injections were performed in 50 patients; additional injections took place at intervals of 1–6 months. There were no operative deaths and no serious complications. The follow-up period ranged from 1 to 5 years (average 2.6 years). Eighty-six percent of patients improved clinically and computed tomography re-examination confirmed shrinkage of the cysts.