Contrast-enhanced Computed Tomography Of Abdomen Research Articles

Traumatic Spigelian Hernia Due to Blunt Trauma in Elderly with Delayed Presentation – An Unusual Case Report

Abstract Traumatic abdominal wall hernia (TAWH) is an unexpected clinical diagnosis. Amongst them, traumatic Spigelian hernia is the rarest form where contrast-enhanced computed tomography (CECT) abdomen is the imaging of choice. Treatment options include exploratory open or minimally invasive surgery with or without the use of prosthetic mesh. Non-operative treatment can be an option in selected patients. Almost all the cases reported in the past show preponderance of TAWH in young male patients with immediate manifestation requiring emergency laparotomy. We present our experience of successfully managing a 65-year-old woman who had delayed presentation after blunt trauma abdomen who was diagnosed with Spigelian hernia on CECT abdomen and underwent an elective mesh hernioplasty. The patient was followed up till 3 months post-operatively with an uneventful course. Traumatic Spigelian hernia is an unexpected clinical condition and is mostly missed during the initial presentation. It should be suspected in cases having abdominal protrusion following blunt trauma. Treatment is tailored according to the patient’s mode of injury, presentation and associated comorbidities. Presentation in elderly females with delayed symptoms days after the trauma is unreported yet.

Diffuse pulmonary hemorrhage as a rare presentation of pheochromocytoma: a case report with review of the literature

A 37-year-old male patient with a past history of fluctuating hypertension and insulin-treated diabetes mellitus presented to our clinic with a 1-year history of sudden-onset cough, dyspnea, and frank hemoptysis. Examination showed asthenia, moderate anemia, uncontrolled blood pressure, and a past history of one admission for management of hemoptysis and cardiac failure. The evaluation showed mild anemia, azotemia, low ejection fraction, contrast-enhanced computed tomography (CECT) of the chest, and sputum suggestive of pulmonary hemorrhage. Investigation during current admission revealed proteinuria, left suprarenal mass on USG, and clear lung parenchyma on chest X-ray and CECT. Autoimmune workup for vasculitis was negative and 24-h urinary catecholamine levels were elevated with CECT abdomen confirming pheochromocytoma. His blood pressure was controlled and he underwent laparoscopic left adrenalectomy with confirmation on histopathology. Postoperatively he is doing well with minimal requirement of antihypertensive, and diabetes is controlled with diet and exercise only. This case highlights diffuse alveolar hemorrhage as a rare presentation of pheochromocytoma. This case also highlights that secondary cause of hypertension should always be ruled out in case of uncontrolled hypertension in young patients to prevent devastating complications.

Primary Disseminated Peritoneal Hydatidosis: A Rare Presentation of Common Infectious Disease

Introduction: Human hydatidosis, being caused by the larvae of Echinococcus granulosus, rarely presents as disseminated peritoneal disease which can be either primary or secondary. Iatrogenic secondary peritoneal echinococcosis is more common while primary form of infection is found occasionally. Radiological imaging including ultrasonography or computed tomography (CT) scan is considered the most essential diagnostic modality. The mainstay of treatment for localized hydatid cysts or infected cysts and multiple septations is the surgical management in the form of excision. Disseminated hydatid disease presents with varied manifestations involving multiple organs. However, primary peritoneal hydatidosis is being rare entity, accounting for only 2% of cases of abdominal hydatidosis. The dissemination to multiple organs usually occurs through either lymphatic or systemic circulation. Case Report: In this case report, we present an uncommon presentation of primary disseminated peritoneal hydatidosis. On further evaluation, the patient was diagnosed to have peritoneal hydatidosis with hepatic and lung hydatid cyst involvement on contrast-enhanced CT abdomen. The patient was managed conservatively with oral tablet albendazole 400 mg twice a day during his 1st admission and later presented again with acute abdomen, and then, radical surgery in the form of pericystectomy was carried out but patient developed large gastric perforation, for which again surgery was attempted, but patient succumbed to his illness. In this case, the rare presentation of primary disseminated peritoneal hydatidosis as acute abdomen was observed. Conclusion: Primary disseminated peritoneal hydatidosis as the presentation of acute pain abdomen is rare entity. This case emphasizes an atypical presentation of hydatidosis.

Effect of Nonionic Iodinated Contrast Media on Blood Pressure during Contrast-enhanced Computed Tomography of Abdomen Examination: A Cross-sectional Study

ABSTRACT Introduction: Computed tomography (CT) scan has high sensitivity and specificity for numerous conditions. The images produced by a CT scanner can be enhanced using iodinated contrast media. Significant hemodynamic changes are seen with rapid intravenous contrast media injection. The average acceptable blood pressure (BP) value is 120/80 mmHg. Many studies have related hypertensive crises with high-osmolar contrast media, whereas its relation with low-osmolar contrast media is still unclear. This study aims to evaluate the effect of nonionic iodinated contrast media on BP during contrast-enhanced CT (CECT) of the abdomen. Materials and Methods: A cross-sectional study was conducted from April 2022 to August 2023. A total of 146 subjects (73 males and 73 females were included in the study). Statistical analysis of data was done using SPSS 23.0. A comparison of systolic BP and diastolic BP across the three periods was done using repeated measures of ANOVA. A between-group comparison was performed by unpaired t-test. The level of significance was set as 5%. All subjects underwent a CECT abdomen, including a plain, arterial, and venous phase. A bolus of 80 mL of Ultravist was administered. BP was measured before the contrast injection (baseline value), between the arterial and venous phases, and 3 min after the contrast injection. Results: Injection of nonionic contrast media caused a decrease in BP among subjects. The mean systolic BP readings before contrast injection in males and females were 127.5 ± 8 mmHg and 122.8 ± 8.4 mmHg, respectively. The mean diastolic BP before contrast injection was 79.2 ± 6.4 and 76 ± 6.4 mmHg among males and females, respectively. For systolic, these values decreased to 123 ± 10.3 mmHg in males and in females to 115 ± 14.6 mmHg when measured between arterial and venous phases. Similarly, for diastolic BP, the mean values recorded between the arterial-venous phase reduced to 76.7 ± 9.3 mmHg and 72.3 ± 10 mmHg, respectively. The BP readings, however, increased near baseline value when measured 3 min after the injection. The mean systolic BP measured 126.1 ± 8.5 mmHg and 124.9 ± 11.8 mmHg for males and females at 3 min after injection. Similarly, the mean diastolic BP values taken after 3 min of contrast injection were 78.3 ± 6.5 mmHg and 76.2 ± 7 mmHg in males and females, respectively, P < 0.001. BP in both male and female groups was affected similarly. Conclusion: Bolus administration of 80 mL of Ultravist reduced BP. This reduction was short-term and got back to normal within a few minutes. The contrast media similarly affected both genders. The BP changes had no clinical significance.

Urinary bladder involvement in IgG4-related disease: A case-based review.

Immunoglobulin G4-related disease (IgG4-RD) is an immune-driven fibroinflammatory disease that presents as tumefactive lesions that not only commonly affects the pancreas, lacrimal and salivary glands, lung, liver and kidney but can also affect any organs. However, involvement of the urinary bladder in IgG4-RD is rarely reported. We describe a case of IgG4-RD involving the urinary bladder mimicking carcinoma and review the published literature-a 39-year-old male presented with complaints of dysuria, urgency and hesitancy. Ultrasound revealed a hyperechoic lesion protruding from the anterior of the urinary bladder wall with partial obstruction to bladder outflow, likely to be a pedunculated bladder mass with high suspicion for malignancy. A contrast-enhanced computed tomography abdomen showed a large irregular lobulated heterogeneously enhancing lesion involving the anteroinferior wall of the urinary bladder extending from mid-body up to the neck region with significant perivesical fat stranding and multiple ill-defined perivesical deposits along with hypodense soft tissue lesion in the perigastric region at the level of the body of the stomach. CT-guided perigastric and ultrasound-guided biopsy from the urinary bladder mass confirmed the diagnosis of IgG4-RD. The patient was treated with glucocorticoids. He is doing well after a 1-year follow-up without recurrence, and a repeat ultrasound showed a significant reduction in the size of the urinary bladder mass. The diagnosis of IgG4-RD should be considered in the differential diagnosis of a urinary bladder mass. High index of suspicion and prompt initiation of therapy are required to minimise residual damage and the need for surgical intervention.

Pancreatic Parenchymal Atrophy and Pancreatic Fat Accumulation Measured by Multidetector Computed Tomography as a Stable Marker of Chronic Progressive Type 2 Diabetes Mellitus-A Cross Sectional Observational Study.

Background The most crucial step in the management of type 2 diabetes is identifying its pathogenesis and progression. Fat accumulation in the pancreas and decreased parenchymal volume can influence pancreatic function due to insulin resistance or β-cell dysfunction. This study aims to find out the difference in pancreatic volume and fat content by using contrast-enhanced computed tomography (CECT) between normal subjects and patients with different durations of type 2 diabetes mellitus (T2DM). Methods This was a cross-sectional study. Patients who underwent CECT abdomen for the evaluation of conditions other than pancreatic origin were included. The study group was divided into three subgroups according to the duration of diabetes as <5 years, 5 to 10 years, and >10 years. In total, 40 nondiabetic controls were included. Pancreatic fat volume and parenchymal volume were measured in cm 3 using CECT. Correlation between pancreatic parenchymal and fat volume with the duration of T2DM as well as with levels of hemoglobin A1c, random blood sugar, serum triglyceride, low-density lipoproteins, and high-density lipoproteins was done. Results T2DM patients had significantly ( p < 0.001) lower pancreatic parenchymal volume (mean value of 57.08 ± 8.26 cm 3 in diabetics and 72.23 ± 3.41 cm 3 in controls) and higher pancreatic fat volume (mean value of 3.08 ± 1.90 cm 3 in diabetics and 0.67 ± 0.27cm 3 in controls) as compared to nondiabetic controls. In patients with T2DM, as the duration of T2DM increased, pancreatic parenchymal volume decreased and pancreatic fat volume increased. Conclusion Reduction in pancreatic volume and fat deposition may have a role in the onset and progression of diabetes. Determining the pancreatic volume and fat content would be useful for identifying high-risk patients and determining the pathogenesis of the development of diabetes.

'Testicular masquerade': a case report of testicular malignancy with persistent Müllerian duct syndrome and transverse testicular ectopia.

Persistent Müllerian duct syndrome (PMDS) is a rare sexual development disorder. It is even more rarely associated with transverse testicular ectopia (TTE), a rare form of testicular ectopia, in which both testes descend through a single inguinal canal and are present in the same hemiscrotum. PMDS with TTE is associated with 18%-33% malignant transformation. Here we report the case of a 48-year-old man who presented with a large right inguinoscrotal swelling and on evaluation was found to have a large right testicular mass with complete right inguinal hernia, undescended left testis and a central abdominal mass. On evaluation with contrast-enhanced computed tomography abdomen and pelvis and image-guided biopsy he was diagnosed with mixed germ cell tumour of the right testis (predominantly a seminoma) with a retroperitoneal nodal mass and absent left testis, for which he received chemotherapy. Post-chemotherapy he underwent surgery and was diagnosed intraoperatively with PMDS along with TTE and testicular malignancy arising from the ectopic left testis. Postoperative recovery and follow-up were uneventful. Most cases of PMDS are diagnosed early in life. They present clinically with unilateral or bilateral undescended testis with inguinal hernia. In adults, PMDS is usually associated with male infertility. However, TTE is associated with an increased risk of testicular tumours if undiagnosed until adulthood. In adults PMDS with TTE is usually an intraoperative finding and is commonly associated with malignancy in the ectopic/undescended testis.

Role of diagnostic laparoscopy in comparison with CT scan finding of patients presenting with abdominal trauma-A cross-sectional study

Background: Trauma is a critical and urgent surgical condition that we encounter on a regular basis. Blunt trauma mechanisms account for 78.9–95.6% of all injuries, with the abdomen being affected in 6.0–14.9% of all traumatic injuries. Diagnostic laparoscopy (DL) for blunt abdominal trauma (BAT) is safe and feasible. Prerequisites are the hemodynamic stability of the patient and surgical expertise in advanced laparoscopy. Aims and Objectives: To find out the role of DL in the diagnosis and management of abdominal trauma patients. Effect on the length of hospital stay and rate of reduction of non-therapeutic laparotomy in the patients with trauma abdomen. Materials and Methods: This cross-sectional study was conducted with 50 patients of abdominal trauma with pre-structured pro forma and Written informed consent. A contrast-enhanced computed tomography (CECT) scan of the abdomen was done in hemodynamically stable patient and injury was noted. Patients meeting the inclusion criteria underwent DL. Results: The duration of hospital stay was lower in laparoscopically managed patients than in laparotomy patients. Most of the patients were managed conservatively 37 (74%) and thus by reducing non-therapeutic laparotomy. Overall recovery was 86% which signifies the reduction in mortality rate with the use of DL. In this study, clear diagnosis was obtained in 88% of the cases, so the efficacy is 88%. Conclusion: Laparoscopy and CECT abdomen has an effective diagnostic and management role in patients with BAT. The therapeutic value of DL is also accepted, well appreciated, and it cannot be underestimated.

Not every twist is ovarian torsion: a case report of isolated torsion of the fallopian tube in a child.

A 15-year-old girl presented with complaints of sudden onset left lower quadrant pain, nausea, and vomiting. There was tenderness in the left iliac fossa. Ultrasonography revealed inconclusive findings and contrast-enhanced computed tomography of the abdomen and pelvis suggested possible left adnexal torsion. Hence, she underwent a diagnostic laparoscopy which revealed a twisted, edematous, and congested left fallopian tube. The diagnosis of isolated left fallopian tube torsion was made and she was managed with unilateral salpingectomy. Women of the reproductive age group are usually affected by this condition. The common presentations are abdominal pain, nausea, and vomiting. The physical examination may reveal abdominal and cervical motion tenderness. Per abdominal ultrasound is the first go-to modality in children. Magnetic resonance imaging, if available, is advised in children if the ultrasound is inconclusive because of the absence of radiation. However, it may require sedation. Therefore, contrast-enhanced computed tomography abdomen gives an added advantage in such scenarios as in our case. This condition is managed by surgery with salpingectomy or tube detorsion with preservation of the tube, depending on the intraoperative findings. Clinicians should be aware of the condition given the rarity and challenges in the diagnosis of isolated fallopian tube torsion.

Rapunzel Syndrome in a Boy

Background: Trichobezoar is a rare phenomenon where a ball of swallowed hair collects in the stomach. When its tail extends beyond the pylorus in to the small intestine, it is termed Rapunzel syndrome. The condition is most commonly seen in females with psychological disturbances, many of whom have trichotillomania and or trichophagia. We report Rapunzel syndrome condition in a young boy having no overt mental disturbances. Clinical Description: A 5½-year-old male child presented with complaints of vomiting for 20 days, associated with dull aching epigastric pain over 1 year. A lump had been noticed in the abdomen which was increasing in size for the past 5 months and decreased appetite for past 1 month. Besides pica, the child had no other significant medical or surgical illness. On examination, the child was underweight with pallor, with dry, lusterless, easily pluckable hair. His abdomen revealed a palpable lump in epigastrium, with ultrasonography showing a large gastric mass with air foci. Contrast-enhanced computed tomography abdomen revealed a large, well-circumscribed, nonhomogeneous lesion in the lumen of the stomach suggestive of bezoar. The patient underwent exploratory laparotomy, which confirmed trichobezoar with a long tail of hair extending through the pylorus into the small bowel. After successful removal of the trichobezoar, the patient was discharged with no postoperative complication and advised follow up in surgery, pediatrics, and psychiatry department. Conclusion: This case creates awareness of the possibility of the rare, bizarre entity of trichobezoar in a toddler presenting with nothing more than the usual common symptoms as seen in this age group. After ruling out common causes, when there is persistence of symptoms, with some clinical clues like pica, anemia, and behavior abnormalities, pediatricians may suspect an underlying atypical diagnosis like trichobezoar, even in a male child.

Gangrenous Gallbladder Perforation: Varied Presentation, Management, and Treatment Outcome

Abstract Introduction: Gangrenous cholecystitis (GC) is a serious complication associated with cholecystitis and usually presents with greater mortality than uncomplicated cholecystitis. It may be associated with cholelithiasis or can be due to acalculous cholecystitis. Acalculous cholecystitis is usually associated with elderly age and or associated with comorbidities such as diabetes mellitus (DM), coronary artery disease, and chronic debilitated bedridden patients. Since these patients are elderly, have other symptomatology of chronic illnesses, and usually suffer from peripheral neuropathy, the diagnosis can be missed in initial stages. We present here a case series of five patients with GC who presented in whom the diagnosis was missed initially and subsequent surgical intervention resulted in rapid recovery. Material and Methods: The aim of this study was to emphasize on the importance of keeping index of suspicion and early surgical intervention in such cases to prevent morbidity and mortality. Patients studied in this case series were initially admitted to the medical ward and surgical consult was sought later. Delay in seeking surgical consult ranged from 1 to 4 days. All of them underwent cross-sectional imaging in form of contrast-enhanced computed tomography abdomen and subsequent open cholecystectomy based on imaging findings of perforated gallbladder, intraoperatively these patients were found to have perforated gallbladder secondary to GC. Results: Out of the five patients studied, 3 (60%) were female and 2 (40%) were male, with a mean age of 64.5 (55–73) years. DM constitute most frequently accompanying medical issues (80%). Surgical site infection was seen as the most common postoperative complication. Longer delay time before diagnosis was determined as independent risk factor affecting morbidity and mortality.

SURVEY OF COMPUTED TOMOGRAPHY PRACTICE IN UKRAINE AND ESTABLISHMENT OF NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR MOST COMMON CT EXAMINATIONS OF ADULTS.

This study reports results of the first nationwide survey of computed tomography (CT) practice in Ukraine and proposed national diagnostic reference levels (DRLs) for common CT examinations. The collected data included characteristics of CT scanners, frequency of CT exams per anatomical region, dose indices CTDIvol and dose-length product (DLP). National DRLs were proposed at the 75th percentile of median dose indices distributions for four common CT protocols: head without contrast (brain examinations for stroke and trauma), routine chest without contrast, single-phase contrast-enhanced CT of abdomen and pelvis and oncology protocol (chest-abdomen-pelvis). The results showed 4- to 9-fold variations of median dose indices between CT scanners for the same type of examination. The following values of the CTDIvol and DLP were proposed as national DRLs: 59mGy and 1130mGy•cm for head, 14mGy and 492mGy•cm for chest, 22mGy and 845mGy•cm for abdomen/pelvis and 2120mGy•cm for oncological protocol.

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis.

Introduction Acute appendicitis is a common surgical emergency. Clinical assessment plays a major role; however, subtle clinical features in early stages and atypical presentation makes diagnosis challenging. Ultrasonography (USG) of the abdomen is ausual investigation that aids in diagnosis, however, it is operator dependent. A contrast-enhanced computed tomography (CECT) of the abdomen is more accurate; however, it exposes the patient to hazardous radiation. The study aimed to combine clinical assessmentandUSG abdomen in the reliable diagnosis of acute appendicitis. Objectives The objective of this study was to assess the diagnostic reliability of the Modified Alvarado Score and ultrasonography of the abdomen in acute appendicitis. Material and methods All patients with right iliac fossa pain, clinically suspected of having acute appendicitis, admitted to the department of general surgery, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, between January 2019 and July 2020, who gave consent were included. Clinically, Modified Alvarado Score (MAS) was calculated, after which patients were subjected toUSG abdomen, where findings were noted and a sonologic score wascalculated. The study groupwas the patients who needed appendicectomy (n=138). Operative findings were noted. Histopathological diagnosis of acute appendicitis was deemed as confirmatory in these cases and was correlated with MAS andUSG scores to determine diagnostic accuracy. Results A combined clinicoradiological (MAS + USG) score of seven showed a sensitivity of 81.8% and a specificity of 100%. The specificity of score seven or above was 100%; however, the sensitivity at 81.8%. The diagnostic accuracy of the clinicoradiological was 87.5%. The negative appendicectomy rate was 4.34%, with a diagnosis of acute appendicitis being confirmed for 95.7% of patients upon histopathological examination. Conclusion The MAS andUSG of the abdomen, which is an affordable and non-invasive tool, showed increased diagnostic reliability, and hence it can help reduce the use of CECT abdomen, as CECT abdomen is considered as a gold standard for confirmation or exclusion of diagnosis of acute appendicitis. Use of the combined scoring system of MAS andUSG abdomen can be used as a cost-effective alternative.

Study Protocol of the Bladder Adjuvant RadioTherapy (BART) Trial: A Randomised Phase III Trial of Adjuvant Radiotherapy Following Cystectomy in Bladder Cancer

AimsTo assess the efficacy and safety of adjuvant radiotherapy in patients with high-risk muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC) and chemotherapy. Materials and methodsThe BART (Bladder Adjuvant RadioTherapy) trial is an ongoing multicentric, randomised, phase III trial comparing the efficacy and safety of adjuvant radiotherapy versus observation in patients with high-risk MIBC. The key eligibility criteria include ≥pT3, node-positive (pN+), positive margins and/or nodal yield <10, or, neoadjuvant chemotherapy for cT3/T4/N+ disease. In total, 153 patients will be accrued and randomised, in a 1:1 ratio, to either observation (standard arm) or adjuvant radiotherapy (test arm) following surgery and chemotherapy. Stratification parameters include nodal status (N+ versus N0) and chemotherapy (neoadjuvant chemotherapy versus adjuvant chemotherapy versus no chemotherapy). For patients in the test arm, adjuvant radiotherapy to cystectomy bed and pelvic nodes is planned with intensity-modulated radiotherapy to a dose of 50.4 Gy in 28 fractions using daily image guidance. All patients will follow-up with 3-monthly clinical review and urine cytology for 2 years and subsequently 6 monthly until 5 years, with contrast-enhanced computed tomography abdomen pelvis 6 monthly for 2 years and annually until 5 years. Physician-scored toxicity using Common Terminology Criteria for Adverse Events version 5.0 and patient-reported quality of life using the Functional Assessment of Cancer Therapy – Colorectal questionnaire is recorded pre-treatment and at follow-up. Endpoints and statisticsThe primary endpoint is 2-year locoregional recurrence-free survival. The sample size calculation was based on the estimated improvement in 2-year locoregional recurrence-free survival from 70% in the standard arm to 85% in the test arm (hazard ratio 0.45) using 80% statistical power and a two-sided alpha error of 0.05. Secondary endpoints include disease-free survival, overall survival, acute and late toxicity, patterns of failure and quality of life. ConclusionThe BART trial aims to evaluate whether contemporary radiotherapy after standard-of-care surgery and chemotherapy reduces pelvic recurrences safely and also potentially affects survival in high-risk MIBC.

Urinary tract infection with renal abscess

Renal abscess is very rare among intra-abdominal abscesses in children. Ascending infection is the most common cause in children compared to hematogenous spread in adults and Escherichia coli is the main pathogen. Persisting high-grade fever is an alarming sign to intervene and has to be taken care of. Here, we are presenting the case of a 3-year-old boy with Klebsiella urinary tract infection and E. coli renal abscess of 4 cm size. Contrast-enhanced computed tomography abdomen helped in early intervention and management. The child responded very well to parenteral antibiotics and ultrasound-guided percutaneous aspiration.

The first case reported in Southeast Asia of Huge Frantz’s Tumor

Introduction: Solid pseudopapillary pancreatic tumor (Frantz’s Tumor) is a low-grade malignancy, that lacks clinical symptomatology. It was treatable with a favorable prognosis. Case presentation: A young female patient presented with increasing abdominal pain three years ago. Abdominal examination revealed a lump palpable. Contrast-enhanced Computed Tomography abdomen reported a solid mass measuring 13.9 cm x 13.2 cm x 8.9 cm from the pancreas with an enhancing cystic component. Fine-needle aspiration biopsy yielded a cellular sample comprising pseudopapillary neoplasm of the pancreas. A distal pancreatectomy was performed; she was discharged in satisfactory condition.

Assessment of Abdominal Aorta Diameter on Contrast-enhanced Computed Tomography: A MDCT-based Observational Study

Introduction: Average size of the abdominal aorta is less than 3 cm which variates with time. The increase in abdominal aortic dimensions more than 3 cm can result in the presence of ectasia which can further convert into an aneurysm. The expansion rate can also lead to aortic dissection and rupture. Its increasing dimensions can influence to give rise to numerous other abdominal aortic conditions and be fatal due to the aortic wall stress. Monitoring the variation in the abdominal aorta is now possible with the various advancements in imaging techniques including Computed Tomography (CT). Aim: To measure the Anteroposterior (AP) and Right-Left (RL) diameters of the abdominal aorta on Contrast-enhanced Computed Tomography (CECT) abdomen and to analyse its variation with age and gender. Materials and Methods: A cross-sectional observational study was conducted in the Department of Radiodiagnosis at KS Hegde Charitable Hospital, Deralakatte, Mangaluru, Karnataka, India. The duration of the study was 11 months, from April 2020 to March 2021. A total of 81 patients referred for CECT abdomen divided into two age groups of 20-40 years and 41- 80 years. The scan was performed using 16-slice Multidetector Computed Tomography (MDCT). On the reconstructed axial images, the abdominal aortic diameters were measured at the level of T12-L1. The non parametric Mann-Whitney U test was used to compare the RL and AP diameters with respect to age groups. Unpaired t-test was used to compare the RL and AP diameters with respect to gender. Paired t-test was used to compare AP diameter on contrast and non contrast scans. Results: The mean age of study participants was 47±14.83 years and were divided into two age groups between 20-40 years and 41-80 years. Out of the 81 cases, 31 (38%) were in the age group of 20-40 and 50 (62%) were in the age group of 41-80 years. There was a significant increase in the AP and RL abdominal aortic diameter with age (p-value &lt;0.001) and also males were found to have significantly higher abdominal aorta diameter than females (p-value &lt;0.001) in both the age groups of 20-40 and 41-80 years. Also, the abdominal aorta diameter measurements on Non Contrast Computed Tomography (NCCT) and CECT abdomen showed no notable difference. Conclusion: The present study concluded that, there was a remarkable variation in the diameter of the abdominal aorta with age and gender. Besides, the abdominal aorta diameter measurements on NCCT and CECT abdomen showed no notable difference.

Massive Right-sided Pleural Effusion due to Pancreaticopleural Fistula: A Rare Case Report

Pancreaticopleural Fistula (PPF), a rare occurrence, is characterised by an abnormal connection between pleural and peritoneal cavity. It forms usually due to the rupture of pancreatic pseudocyst. Pancreatic pseudocyst is formed due to the repeated episodes of acute or chronic pancreatitis. Most pancreatic pathologies, such as acute and chronic pancreatitis, cause clinically insignificant effusions that resolve with disease control, whereas PPF causes massive effusion and is thus rarely considered as a cause of massive pleural effusion due to its low incidence. PPF are most common in middle-aged alcoholic males and typically present as massive recurrent left-sided pleural effusions. In the present case, a 50-year-old male presented to the Department of Respiratory Medicine with the complaint of right-sided chest pain, progressive breathlessness, abdominal pain and loss of appetite. Patient was labourer by occupation, chronic alcoholic, non diabetic. Contrast Enhanced Computed Tomography (CECT) thorax with abdomen showed massive right-sided pleural effusion and pancreatitis. A diagnosis of PPF was confirmed as its cause. Pleural fluid analysis for elevated amylase, confirms the diagnosis and investigations such as CECT thorax and abdomen, Endoscopic Retrograde Cholangiopancreatography (ERCP), or Magnetic Resonance Cholangiopancreatography (MRCP) may be used to establish the fistulous communication between the pancreas and the pleural cavity. PPF should always be considered as a differential diagnosis while finding a cause for right-sided pleural effusion.

Evaluation of Diagnostic Accuracy of Contrastenhanced Computed Tomography in Acute Abdomen: A Cross-sectional Study

Introduction: Acute abdomen is one of the most frequent causes of presentation to the Emergency Department (ED). The clinicians favour radiological examinations to reach the proper final diagnosis after thorough physical examinations, lab investigations, and clinical interpretation. Contrast-enhanced Computed Tomography (CECT) imaging aids in preventing delayed necessary treatment or unnecessary surgery. Aim: To investigate the specificity and sensitivity of CECT in cases of the acute abdomen using histopathological, clinical, and intraoperative surgical findings as gold standards. Materials and Methods: A cross-sectional study was conducted in the Department of Radiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from September 2020- 2022. Evaluation of 115 patients was done based on inclusion (Patients presenting with clinical symptoms of acute abdomen and undergoing CECT Abdomen, followed by a clinical, biochemical, surgical, or histopathological examination) and exclusion criteria. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy of CECT was calculated. The data was analysed using Statistical Package for Social Sciences (SPSS) version 22. Results: The study included 115 patients with ages ranging from 9-88 years. An increased incidence in males was observed, M:F ratio of 1.4:1. The most common age group was 31-40 years (n-25; 21.7%), followed by 41-50 years (n-20; 17.4%). Cholecystitis was the most common cause of acute abdomen, accounting for 22.6% (n-26) of total cases followed by appendicitis. The overall accuracy rate of CECT was 93% with an accuracy of 98-99% in cases of cholecystitis appendicitis, pancreatitis, ovarian cyst, and bowel obstruction. Conclusion: CECT shows higher sensitivity and specificity in identifying different aetiology of acute abdomen. It also helps in optimal decision-making for management and improved outcomes.

Delayed Presentation of Malrotation: Case Series and Literature Review.

Intestinal malrotation is a congenital anomaly resulting from abnormal or incomplete rotation and fixation of the midgut during embryogenesis. It commonly presents in the neonatal period (75%) with sudden onset bilious vomiting and rarely beyond infancy (<10%). The aim of the study was to highlight the clinical features, radiological findings, and treatment outcomes of patients with malrotation presenting beyond infancy. Eleven consecutive cases of delayed presentation of malrotation presented over a period of 5 years (2017-2021). Data were analyzed retrospectively. Out of the 11 patients, four were female and seven were male. The age of patients ranged from 14 months to 18 years. Patients beyond infancy present usually with diffuse pain abdomen compared to neonates which present with sudden onset bilious vomiting and therefore difficult to diagnose. Five patients had associated abnormalities such as intussusception or nutcracker syndrome or mesenteric cyst or jejunal stricture or mesenteric lymphadenopathy along with malrotation. Patients underwent ultrasonography, upper gastrointestinal contrast study, and contrast-enhanced computed tomography abdomen to confirm the diagnosis. All patients underwent the Ladd procedure with four requiring resection anastomosis and one requiring excision of the mesenteric cyst. Eight out of eleven patients had favorable outcomes, two develop adhesive intestinal obstruction and required re-exploration, and one had persistent complaints of hematochezia. Malrotation beyond infancy is a rare diagnosis. Malrotation in older children is usually not suspected because of the wide range of symptoms. A high index of suspicion on ultrasound or computed tomography is required to demonstrate the reversal of superior mesenteric artery and superior mesenteric vein position and related conditions. Early intervention and treatment can prevent catastrophic events such as intestinal volvulus and intestinal ischemia in these patients.