Contrast Computed Tomography Scan Research Articles

A Cross-Sectional Study on the Use of Computed Tomography Scan for Diagnosing Renal Masses in Pakistani Adults

Objective: The aim of this study is to assess the validity of Computed Tomography (CT) in evaluating solid renal masses by comparing CT findings with histopathological results.
 Methodology: This cross-sectional study involved 210 patients at the Department of Radiology PESSI Hospital Islamabad, spanning July 2022 to June 2023. Patients were selected based on predefined inclusion criteria, and their detailed medical histories were examined. Each patient underwent both non-contrast and contrast CT scans, and the radiological diagnoses were confirmed. The CT-based diagnoses were then compared with histopathological results, and measures such as positive predictive value (PPV), accuracy, sensitivity, specificity, and negative predictive value (NPV) of CT in diagnosing renal masses were calculated.
 Results: The mean age of the study participants was 48.00±810 years. Male to female ratio was 2:1. The majority of the study participants were belonging from the urban area and were under graduate. The results of the study further revealed the frequency of renal masses which was more in male (71.90%, n=151) as compared to female (28.09%, n=59). The study found that the right kidney was affected in 58.09% (n=122) of cases, the left kidney in 36.19% (n=76), and both kidneys in 5.71% (n=12). In our study, we observed variations in density among patients, with 39.06% exhibiting mixed density, followed by 23.80% with hypo-dense, 20.95% with hyper-dense, and 16.19% with iso-dense lesions. When it comes to enhancement, we found that 40.01% had a moderate degree, 24.76% had mild enhancement, 21.90% had intense enhancement, and 13.33% showed no enhancement.
 Conclusion: In this study, we found a strong correlation between histopathological diagnosis and computed tomography (CT) in identifying solid renal masses, with notably high validity test results. Given these robust validity parameters, we can confidently conclude that CT scans serve as an effective and reliable diagnostic modality for identifying and diagnosing renal masses.

Relationship between low relative muscle mass and aortic regional morphological changes in adults underwent contrast CT scans for cancer diagnostics

ObjectivesLow muscle mass is related to cardiovascular risk factors. This study aimed to investigate whether relative low muscle mass is related to the diameter and tortuosity of the aorta. MethodsWe performed a cross-sectional study of 208 adults without known cardiovascular disease who underwent Computed Tomography (CT) enhanced scan between 2020 and 2021. Skeletal muscle index (SMI) was estimated. The morphology of the aorta was measured by diameter and tortuosity using CT. We assessed the relationship between SMI and diameter and tortuosity of the aorta using Spearman correlation analysis and univariate and multivariate-adjusted regression models. ResultsOf all -individuals, 124 (59.6%) were male. The average age was 60.13 ± 16.33 years old. SMI was inversely associated with the diameter and tortuosity of the aorta (p < 0.05). Specifically, in a multivariable-adjusted model adjusting for potential confounders, a one-unit increase in the SMI was associated with a -13.56mm(95% confidence intervals (CI): −18.16 to −8.96, p < 0.001), −7.93 mm (95% CI: −10.85 to −5.02, p < 0.001), −8.01 mm (95% CI: −11.30 to −4.73, p < 0.001), −5.16 mm (95% CI: −7.57 to −2.75, p < 0.001) and −2.73 mm (95% CI: −5.18 to −0.27, p = 0.031) increase in L1-L5 diameter respectively, a −0.89 (95% CI: −1.14 to −0.64, p < 0.001) increase in the aorta tortuosity, a −0.48 (95% CI: −0.59 to −0.36, p < 0.001) increase in the descending thoracic aorta tortuosity, and a −0.44 (95% CI: −0.52 to −0.35, p < 0.001) increase in the abdominal aorta tortuosity. ConclusionsRelative muscle mass was negatively associated with the diameter and tortuosity of the aorta, suggesting muscle mass maintenance may play a role in preventing aortic morphological changes.

Management of Postgastric Bypass Jejuno-jejunal Anastomotic Leak: A Multicenter Retrospective Study

Abstract Introduction: Anastomotic leakage is one of the most critical complications following gastric bypass surgery. Leakage from jejuno-jejunal (JJ) anastomosis after Roux-en-Y gastric bypass occurs infrequently, and so there are fewer studies on its management. The JJ anastomotic leak (AL) has high morbidity and mortality; hence, early detection and timely management are critical to optimizing outcomes. Aims and Objectives: We evaluated all the treatment options for the patients experiencing JJ anastomosis leaks to propose an algorithm-based practical management guideline for these patients. Materials and Methods: During the early postoperative period, retrospective analysis using clinical findings, blood parameters, and contrast computed tomography scans were carried out, and patients were classified into various categories such as leak with/without septicemia and leak with or without extravasation of contrast. All the patients were managed differently based on the category they belonged to. Results: Over a period of 3 years, out of 1393 cases of gastric bypass, 11 patients (0.78%) were diagnosed with postoperative JJ AL within 6 weeks of the postoperative period. The earlier cases were extensively treated with diagnostic laparoscopy along with local lavage, insertion of a feeding jejunostomy tube, leakage site drainage, proximal drainage, and nasogastric decompression with or without intensive care, causing considerable hospital stay and increased morbidity. With experience, we realized that all patients with leaks do not require extensive management. We have eventually determined an algorithm to manage JJ ALs depending on clinical and radiological parameters. Conclusion: Our individualized and effective algorithm-based management protocol results in quicker recovery, optimizes the intervention, and minimizes hospital stay, morbidity, and mortality after postoperative JJ AL. It can potentially mitigate the cost burden in India while ensuring a better outcome. This retrospective pilot study can be a practical guideline for the optimal management of JJ ALs after gastric bypass.

Horseshoe kidney presenting as recurrent urinary tract infections with severe hydronephrosis in a 10-month-old baby: a case report

Introduction : Horseshoe kidney (HSK) is type of congenital anomalies of the kidneys and urinary tracts (CAKUT), which fusion anomalies happened in early embryonic period partially. One-third of the patients with horseshoe kidney are usually asymptomatic and diagnosed incidentally. It can be presented with other renal and extrarenal abnormalities. Here we report a case of horseshoe kidney in infant presenting as recurrent urinary tract infections with severe hydronephrosis. Case Presentation: A 10-months old boy with multiple congenital anomalies admitted with a history of recurrent urinary tract infection for 3-month and progressive abdominal enlargement. His physical examination revealed an abdominal distention, no-tender, dullness on percussion, a palpable mass on the right flank, and normal bowel sound. The genitalia examination revealed penile-type hypospadia and bilateral undescended testis. Further examination with a contrast computed tomography scan showed HSK with severe right hydronephrosis with thin parenchyma due to UPJO. The heminephrectomy procedure was performed successfully. There is no recurrent UTI and no deterioration in renal function after 3 years of evaluation. Conclusion: It is important to investigate renal abnormalities in patients with recurrent UTI. HSK is one of the prevalent findings. Therefore, proper diagnostic investigation tailored to the clinical presentation in a stepwise approach aiming for prompt and optimal patient care is essential.

Coronary artery disease in atrial fibrillation ablation: impact on arrhythmic outcomes.

Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.

Early small bowel obstruction as a complication of abdominal drain in colon cancer surgery: a case report and literature review

Introduction: Early postoperative small bowel obstruction (EPSBO) is an obstruction that occurs within 4 weeks after the initial surgery. Routine prophylactic abdominal drainage does not provide any benefit in colon cancer surgery. The cause of EPSBO due to the abdominal drainage tube is infrequent. Case presentation: A 72-year-old male patient was diagnosed with sigmoid carcinoma and underwent laparoscopic left colectomy. A surgical drain was placed in the pouch of Douglas through the incision of the right iliac fossa trocar site. On the fourth day, he began to flatus, and the abdominal pain decreased. However, on the ninth day after surgery, the patient had more abdominal pain, could not pass gas and defecate, and the abdomen was more distended. An abdominal computed tomography (CT) scan showed a dilated loop of the small intestine above the transition site with a drainage sonde and no dilation of the loop below the sonde. The patient was indicated to remove the sonde. He could pass gas and defecate the next day again and was relieved of the abdominal distention. Discussion: Once an EPSBO is considered, it is essential to think of the bowel obstruction caused by the drainage tube in the case of abdominal drainage. It is necessary to have a contrast CT scan to examine. Conclusion: EPSBO due to intra-abdominal drainage is a rare condition that presents a challenge in diagnosis and treatment. Diagnosis usually begins on the fourth postoperative day, mainly in operations in the lower transverse mesentery, including drainage placement after laparoscopic surgery.

Segmentation of renal structures based on contrast computed tomography scans using a convolutional neural network

Aim. Develop a neural network to build 3D models of kidney neoplasms and adjacent structures. Materials and methods. DICOM data (Digital Imaging and Communications in Medicine standard) from 41 patients with kidney neoplasms were used. Data included all phases of contrast-enhanced multispiral computed tomography. We split the data: 32 observations for the training set and 9 – for the validation set. At the labeling stage, the arterial, venous, and excretory phases were taken, affine registration was performed to jointly match the location of the kidneys, and noise was removed using a median filter and a non-local means filter. Then the masks of arteries, veins, ureters, kidney parenchyma and kidney neoplasms were marked. The model was the SegResNet architecture. To assess the quality of segmentation, the Dice score was compared with the AHNet, DynUNet models and with three variants of the nnU-Net (lowres, fullres, cascade) model. Results. On the validation subset, the values of the Dice score of the SegResNet architecture were: 0.89 for the normal parenchyma of the kidney, 0.58 for the kidney neoplasms, 0.86 for arteries, 0.80 for veins, 0.80 for ureters. The mean values of the Dice score for SegResNet, AHNet and DynUNet were 0.79; 0.67; and 0.75, respectively. When compared with the nnU-Net model, the Dice score was greater for the kidney parenchyma in SegResNet – 0.89 compared to three model variants: lowres – 0.69, fullres – 0.70, cascade – 0.69. At the same time, for the neoplasms of the parenchyma of the kidney, the Dice score was comparable: for SegResNet – 0.58, for nnU-Net fullres – 0.59; lowres and cascade had lower Dice score of 0.37 and 0.45, respectively. Conclusion. The resulting SegResNet neural network finds vessels and parenchyma well. Kidney neoplasms are more difficult to determine, possibly due to their small size and the presence of false alarms in the network. It is planned to increase the sample size to 300 observations and use post-processing operations to improve the model.

A Case Report of Successful Kidney Transplantation in a Patient With Autosomal Dominant Polycystic Kidney Disease Who Underwent Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

Autosomal dominant polycystic kidney disease (ADPKD) is associated with several cardiovascular disorders, including aortic dissection, which preferentially occurs at the thoracic or abdominal level. Because there are few case reports describing surgical repair for aortic dissection followed by renal transplantation in patients with ADPKD, kidney transplantation performed after repair for aortic dissection remains challenging. A 34-year-old Japanese man with end-stage renal disease secondary to ADPKD underwent thoracic endovascular aortic repair for complicated acute type B aortic dissection 12 months earlier. A contrast computed tomography scan before transplantation revealed an aortic dissection involving the descending aorta proximal to the common iliac arteries and confirmed multiple large bilateral renal cysts. After simultaneous right native nephrectomy, the patient underwent preemptive living-donor kidney transplantation obtained from his mother. Intraoperatively, we noted that dissection of the external iliac vessels was difficult because of dense adhesions. Arterial clamping was performed immediately below the bifurcation of the internal iliac artery to prevent further aortic dissection of the external iliac artery. After end-to-end anastomosis to the internal iliac artery was completed and the vascular clamp was released, the kidney began to produce urine immediately. This case suggests that kidney transplantation in patients undergoing endovascular aortic repair for aortic dissection can be performed by adequately applying a vascular clamp proximal to the internal iliac artery during vascular anastomosis.

CyTran: A cycle-consistent transformer with multi-level consistency for non-contrast to contrast CT translation

We propose a novel approach to translate unpaired contrast computed tomography (CT) scans to non-contrast CT scans and the other way around. Solving this task has two important applications: (i) to automatically generate contrast CT scans for patients for whom injecting contrast substance is not an option, and (ii) to enhance the alignment between contrast and non-contrast CT by reducing the differences induced by the contrast substance before registration.Our approach is based on cycle-consistent generative adversarial convolutional transformers, for short, CyTran. Our neural model can be trained on unpaired images, due to the integration of a multi-level cycle-consistency loss. Aside from the standard cycle-consistency loss applied at the image level, we propose to apply additional cycle-consistency losses between intermediate feature representations, which enforces the model to be cycle-consistent at multiple representations levels, leading to superior results. To deal with high-resolution images, we design a hybrid architecture based on convolutional and multi-head attention layers. In addition, we introduce a novel data set, Coltea-Lung-CT-100W, containing 100 3D triphasic lung CT scans (with a total of 37,290 images) collected from 100 female patients (there is one examination per patient). Each scan contains three phases (non-contrast, early portal venous, and late arterial), allowing us to perform experiments to compare our novel approach with state-of-the-art methods for image style transfer.Our empirical results show that CyTran outperforms all competing methods. Moreover, we show that CyTran can be employed as a preliminary step to improve a state-of-the-art medical image alignment method. We release our novel model and data set as open source at: https://github.com/ristea/cycle-transformer.Our qualitative and subjective human evaluations reveal that CyTran is the only approach that does not introduce visual artifacts during the translation process. We believe this is a key advantage in our application domain, where medical images need to precisely represent the scanned body parts.

Metallic nanoparticles for CT-guided imaging of tumors and their therapeutic applications

Nanoparticles (NPs) serve as the contrasting agent in the computed tomography (CT) guided interventional devices and processes. The high contrast imaging of the patient is critical for accurate and early diagnosis, and thereafter the elimination of the abnormality. A high contrast CT scan helps in the diagnosis of blood clots, broken bones, carcinogenic tumors, infections, internal injuries and bleeding, and cardiovascular diseases. Thereafter it helps in the determination of the precise location of surgery, biopsy, and monitoring conditions after surgery. Besides iodine, today radiologists are interested in high atomic number NPs like gold, tantalum, bismuth, silver, etc. The advancement in NP-based CT-guided imaging for a specific target is highly desirable for effective intervention processes like drainage by catheter, needle insertion, etc. In computed tomography (CT) guided interventional devices and procedures, NPs are known to act as contrasting agents. High-contrast imaging of the patient is essential for an accurate and prompt diagnosis, followed by the treatment of the diseased site. Blood clots, shattered bones, cancerous tumors, infections, internal injuries and bleeding, and cardiovascular disorders can be easily diagnosed with the use of a CT scan with high contrast. In addition, it aids in determining the precise surgical site, conducting biopsies, and monitoring postoperative conditions. Iodine-based contrast agents have been the conventional choice, but lately, radiologists are also interested in NPs with a high atomic number, such as gold, tantalum, bismuth, silver, etc. This review talks about recent research on metallic NPs and the usage of their conjugates for CT imaging of tumors, special attention has been given to gold NPs.

Kolokteral karsinomda histopatolojik düşük ve yüksek dereceli tümörlerin ayrımı için bilgisayarlı tomografi histogram analizinin tanısal etkinliği

Aim: Colorectal adenocarcinoma (CA) is the most common type of cancer worldwide and the third leading cause of cancer-related deaths. Primary pathological grade bears importance in the course of the disease. The possibility of non-invasive grading through radiology modalities is still an important issue. The present study aims to reveal whether a non-invasive grading similar to pathological grading can be performed using histogram analysis on computed tomography (CT) scan images.&#x0D; Material and Method: 58 patients operated and diagnosed with CA pathologically were included in the present study. As for medical protocol, abdominal intravenous contrast CT scan images obtained from TOSHIBA Alexion and TOSHIBA Aquilion ONE (Toshiba Medical Systems, Nasu, Japan) devices with 120 kVp tube voltage were set to a window width of 400 and a window level of 40. Patient images from retrospective scanning were evaluated on a workstation. For the evalution of mass, intraluminal air, necrotic areas, pericolonic fat tissue or intra-mass large feeding vessels were not included in the measurement range. Mass size was measured on the largest axis according to the longest axis. For histogram analysis, regions of interest were positioned. Parameters included in the histogram analysis were pixels, mean, standard deviation, minimum, maximum, median, variance, entropy, size L%, size U%, size M%, kurtosis, skewness, uniformity, percent01, percent03, percent05, percent10, percent25, percent75, percent90, percent95, percent97 and percentile 99.&#x0D; Results: Histogram analysis results obtained from three different measurements for each of 58 patients were not found to be statistically significant in the differentation of pathologically defined histological grading system. &#x0D; Conclusion: Although the use of a non-invasive method instead of an invasive one may offer an advantage, was not statistically significant in the prediction of histological grade.

Meckel’s diverticulitis with abscess presentation in an acute abdomen

The vitellointestinal/omphalomesenteric duct is embryonic structure connecting primary yolk sac to the embryonic midgut which obliterates by 10th week of gestation. It may persist or incompletely obliterate to form anomalies like Meckel’s diverticulum that is most common and is usually asymptomatic. Symptoms develop when Meckel’s diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. The modalities useful in diagnosing it are ultrasonography (USG) and computed tomography (CT), USG being more easily available, and radiation free is the first modality useful to suspect these anomalies. It can mimic close differentials such as appendicitis and urachal anomalies. In this case report, a 12-year-old male child presented with recurrent periumbilical pain who was screened on USG was suspected Meckel’s diverticulitis with abscess; the same was confirmed on contrast CT scan and managed surgically. This case shows the importance of USG and radiologist’s suspicion of Vitellointestinal duct anomalies in diagnosing and its associated complications.

Post-traumatic Liver Pseudoaneurysms: Rare but Serious Sequela

IntroductionThe liver is the most commonly injured organ after blunt abdominal trauma. Nonoperative management is the standard of care in stable individuals. Liver injuries, particularly high-grade injuries, can develop pseudoaneurysms (PSAs), which can rupture and cause life-threatening bleeding, even after hospital discharge. There is no consensus on whether patients should receive predischarge contrast computed tomography (CT) screening, or at what time interval after injury, nor which patients are at the highest risk for PSA. The purpose of this study was to identify the rates of PSA in our population and potential risk factors for their formation. MethodsThe trauma registry at our Level 1 urban trauma center was queried for patients admitted with liver injuries between 2015 and 2021. Demographic information was collected from the registry. Individual charts were then reviewed for timing of CT scans, CT findings, interventions, and complications. Liver injury grade was assessed using radiology reports or operative findings. The frequency of PSAs was then analyzed using descriptive statistics using Microsoft Excel and SPSS for odds ratio. ResultsA total of 172 patients were admitted with liver injuries during the study period. 130 patients received a CT scan diagnosing liver injury, 42 were diagnosed with liver injury intraoperatively. Of the 130 patients (59.9%) which received follow-up CT scans, six (6.5%) developed PSA, four of which being from penetrating injuries (odds ratio, 6.95). ConclusionsThis study demonstrated a low incidence of PSA consistent with the known literature. We found the majority of the PSA developed following penetrating injury. This may represent a significant indication for follow-up imaging regardless of grade. A larger study will be necessary to identify those most at risk for PSA formation and determine the best PSA screening algorithm.

Planning Head and Neck radiotherapy in contrast CT: viability for AAA and AcurosXB

Background and purpose: many radiotherapy services execute two computed tomography (CT) scans for the treatment of head and neck (H&amp;N) tumors: with (contrast CT) or without contrast (non-contrast CT), for dose calculation and target volume delineation, respectively. However, performing two CT scans brings problems such as unnecessary exposure of the patient to radiation and errors in CT images fusion. Therefore, the objective of this study was to verify the possibility of performing only the contrast CT as the routine for dose calculation with AAA and AcurosXB. Materials and methods: contrast and non-contrast CT scans from 77 patients were retrospectively analyzed and the Hounsfield Unit (HU) values ​​of the target volume and some organs at risk (as well as dosimetric values ​​were evaluated and compared. Statistical analysis was performed by calculating the intraclass correlation coefficient (ICC), assuming a significance level of 5%. Results: there is a correlation between the values ​​obtained for both HU and dosimetric data between the CT scans since the ICC was close to 1 and the p-value was lower than 0.05 for all cases. Conclusion: it is possible to perform only the contrast CT in the simulation routine for the treatment of patients with head and neck tumors. &#x0D; Keywords: Radiotherapy; Computed tomography; Contrast Agent; Dose Calculation; AAA; AcurosXB; VMAT; IMRT

Airway Obstruction from Intralaryngeal Extension of Thyroglossal Duct Cyst in an Elderly Man: A Case Report

&#x0D; &#x0D; &#x0D; &#x0D; ABSTRACTObjective: To report an unusual presentation of thyroglossal duct cyst causing airway obstruction in an elderly man.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Training Hospital&#x0D; Patient: One&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Results: A 71-year-old man with an anterior neck mass was brought to the Emergency Room due to progressive difficulty of breathing. A smooth, non-ulcerating right supraglottic mass obstructed the airway. Following an emergency high tracheotomy, contrast computed tomography scan of the neck revealed a hypodense mass with peripheral rim enhancement in the right supraglottis and an extralaryngeal component. Intra-operatively, a dumbbell- shaped cystic mass with a tract connected to the hyoid bone led to a Sistrunk procedure. Final histopathology findings were consistent with thyroglossal duct cyst.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: It is possible for an elderly patient with impending upper airway obstruction, dysphonia, and neck mass to still have a benign and congenital thyroglossal duct cyst with intralaryngeal extension.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Portomesenteric venous thrombosis as a rare complication of acute appendicitis in pediatric patient: a case presentation and literature review

BackgroundAppendicitis is one of the most common paediatric surgical emergencies, however complication with acute portomesenteric venous thrombosis is rare. Our aim is to report a case in our locality and review the clinical features and management of such rare complication.Case presentationA 12-year-old boy presented with a 5-day history of fever, periumbilical and right lower quadrant abdominal pain, blood-stained diarrhea and vomiting. Physical examination showed tenderness and guarding over right upper quadrant. Laboratory tests showed elevated inflammatory markers and deranged liver function. Contrast computed tomography scan showed acute appendicitis and superior mesenteric vein thrombosis. Our patient was treated with laparoscopic appendicectomy, antibiotics, and anticoagulant, with gradual improvement of thrombus observed.ConclusionOur patient and seventeen pediatric case reports regarding the condition since 1990 were included. Atypical presenting symptoms were noted, including RUQ pain (n = 10, 56%), diarrhea (n = 8, 44%), fever (n = 16, 89%), deranged liver function (n = 13, 72%). Patient presenting with RLQ pain were only seen in 22% (n = 4). Diagnosis was made by USG (n = 1, 5%) and computer tomography (n = 15, 83%). Surgical intervention includes early (n = 9, 50%) or interval (n = 4, 22%) laparoscopic or open appendicectomy, laparotomy etc. The most common causative organisms were Escherichiae coli and Bacteroides fragilis. Anticoagulant use and its duration remained controversial. Anticoagulant was used in 14 patients with a mean treatment duration of 7 months, while 4 cases reporting resolution of thrombus without anticoagulant use. A high index of suspicion is needed to diagnose patient with acute appendicitis complicated by portomesenteric thrombosis.

A Mysterious Case of Abdominal Pain

A Mysterious Case of Abdominal Pain

A case of pathological complete response with liposomal irinotecan + 5-FU/LV for unresectable locally advanced pancreatic cancer

BackgroundPancreatic cancer has one of the worst prognoses of any all cancers. 5-FU/leucovorin + irinotecan + oxaliplatin (FOLFIRINOX), gemcitabine (GEM) plus nab-paclitaxel regimens have been recognized as global-standard, first-line treatments for patients with advanced pancreatic cancer. The liposomal irinotecan (nal-IRI) + 5-FU/LV regimen is now included in treatment guidelines as a recommended and approved option for use in patients with metastatic pancreatic cancer that has progressed after GEM-based therapy and who have a suitable performance status and comorbidity profile. There is no report that nal-IRI + 5-FU/LV regimen was significantly effective, and we will report it because we experienced this time.Case presentationA 69-year-old man presented with epigastric pain, and a contrast computed tomography (CT) revealed an enhanced mass lesion measuring 33 × 27 mm on the pancreatic body with encasement of the common hepatic artery (CHA) and the splenic vein. An endoscopic ultrasound-guided fine needle aspiration was performed and demonstrated cytology consistent with adenocarcinoma. Therefore, we diagnosed the patient with unresectable locally advanced pancreatic cancer. The patient received the GEM and S-1 regimen; however, the adverse event was relatively severe. Then, 11 cycles of nal-IRI + 5-FU/LV regimen were administered. A CT scan revealed that the tumor had shrunk to 18 × 7 mm in diameter with encasement of the CHA. The encasement of the splenic vein had disappeared, without any distant metastases. From this post-chemotherapy evaluation and intraoperative frozen section of around the celiac artery, gastroduodenal artery and pancreas stump confirmed absence of tumor cells, we performed distal pancreatectomy with celiac axis resection. A histological examination of the surgical specimen revealed no evidence of residual adenocarcinoma, consistent with a pathological complete response to treatment.ConclusionsWe present the first case of a pathological complete response with nal-IRI + 5-FU/LV for unresectable, locally advanced pancreatic cancer. In the future, nal-IRI may become a key drug for pancreatic cancer treatment.

Expect the unexpected – sinonasal papillary intestinal adenocarcinoma – A case report

Intestinal-type adenocarcinoma (ITAC) is the second most frequent sinonasal adenocarcinoma. High incidence of these tumors was seen among workers with occupational wood dust exposure, particularly of hardwood dusts. Furthermore, ITACs associated with dust exposure were diagnosed mostly in men (85–95%) and predominantly in the ethmoid sinus. This contrasts with sporadic ITACs that are more frequent in women and often arise in the maxillary antrum. ITAC had striking histomorphologic and immunophenotypic similarities with colorectal adenocarcinomas, but on the level of molecular pathologic mechanisms, these tumors have their own specific features different from gastrointestinal tumors. A 58-year-old female came with the chief complaints of difficulty in breathing and left-sided nasal obstruction for the past 1 month. On local examination, nasal septum was deviated to the right side on visualizing the left nasal cavity showed a polypoidal growth occupying the entire nasal cavity. Paranasal sinuses with contrast computed tomography (CT) showed a chronic granulomatous lesion in the left nasal cavity with surrounding inflammatory changes involving the ipsilateral sinuses. This patient was planned for functional endoscopic sinus surgery and specimen was sent for histopathological diagnosis. Contradictory to CT scan result, on gross and histopathology, the lesion was diagnosed to be intestinal type of sinonasal adenocarcinoma.

Cellular schwannoma of the posterior tongue: a rare case report with a literature review

Introduction: Schwannoma is a gradually growing encapsulated benign tumor arising from the Schwan cells of the peripheral nerve sheath. This study aims to report a rare case of tongue cellular schwannoma. Case presentation: A 15-year-old boy presented with a swelling of the posterior part of the tongue that had started 2 years prior. On examination, a large mass was seen in the posterior part of the tongue. It was smooth, mobile, and nontender on palpation. A contrast computed tomography scan of the neck revealed an irregular, ill-defined, thick-walled cystic lesion. Magnetic resonance imaging demonstrated a well-circumscribed, enhancing mass measuring about 5×4.56×4.59 cm and causing compression upon the oropharyngeal airway. Histopathologic examination revealed a cellular schwannoma. Discussion: Histologically, all schwannoma tumors are encapsulated. Under the capsule, there are 2 specific patterns associated together, but they can be easily differentiated from each other. The first one is made up of firmly aggregated Schwan cells arranged in rows with palisade and enlarged nuclei which are known as Antoni type-A. The second one is the Antoni type-B that consists of weakly packed Schwann cells. Conclusion: Tongue schwannoma is regarded as a solitary encapsulated benign tumor that may cause complications like difficulty in phonation. The primary treatment modality usually is transoral excision.