Follow-up Abdominal Computed Tomography Scan Research Articles

Endovascular treatment of traumatic pseudoaneurysm of the ileal branch of the superior mesenteric artery in a 9-year-old girl: Case report and literature review.

Visceral artery aneurysm is a rare and potentially fatal vascular condition that typically affects the superior mesenteric or inferior mesenteric arteries, the splenic, hepatic, and celiac arteries, as well as their branches. Visceral artery aneurysms can usually be treated using endovascular intervention, open surgery, or percutaneous thrombin injection. A 9-year-old girl was admitted to our trauma center with abdominal and bilateral leg pain after a car accident involving a head-on collision. Abdominal computed tomography (CT) showed bowel herniation through a muscle defect in the left lateral abdominal wall. There was a small amount of fluid around the liver and spleen, mild thickening of the small bowel wall, and infiltration in the small bowel mesentery, indicating the possibility of small bowel injury. Emergent exploratory laparotomy was performed. After resection of the ischemic parts of the terminal ileum and sigmoid colon, intestinal continuity was reestablished. Primary repair was performed on a traumatic left lateral abdominal wall hernia. She recovered well postoperatively without any complications. A follow-up abdominal CT scan after 2 months showed a pseudoaneurysm of the ileal branch of the superior mesenteric artery. Despite the absence of any gastrointestinal symptoms, the pseudoaneurysm was treated by endovascular intervention using numerous coils because of the significant risk of delayed rupture or massive bleeding. Follow-up abdominal CT scan after 6 months showed complete occlusion and resorption of the pseudoaneurysm. Although it is technically challenging, endovascular coil embolization may be a feasible technique in children with traumatic visceral artery pseudoaneurysms without complications.

Delayed splenic pseudoaneurysm identification with surveillance imaging.

Recent studies have shown that nonoperative management of patients with splenic injury has up to a 90% success rate. However, delayed hemorrhage secondary to splenic artery pseudoaneurysm occurs in 5% to 10% of patients with up to 27% of patients developing a pseudoaneurysm on delayed imaging. The goal of our study was to evaluate the safety and utility of delayed computed tomography (CT) imaging for blunt splenic injury patients. A retrospective evaluation of all traumatic splenic injuries from 2018 to 2020 at a single level 1 trauma center was undertaken. Patients were subdivided into four groups based on the extent of splenic injury: grades I and II, grade III, grade IV, and grade V. Patient injury characteristics along with hospital length of stay, imaging, procedures, and presence/absence of pseudoaneurysm were documented. A total of 588 trauma patients were initially included for evaluation, with 539 included for final analysis. Two hundred ninety-seven patients sustained grades I and II; 123 patients, grade III; 61 patients, grade IV; and 58 patients, grade V splenic injuries. One hundred twenty-nine patients (24%) underwent either emergent or delayed (>6 hours) splenectomy with an additional six patients having a splenorrhaphy on initial operation. Of the patients who were treated nonoperatively, 98% of grade III, 91% of grade IV, and 100% of grade V splenic injury patients underwent follow-up CT imaging. The mean ± SD time from admission to follow-up abdominal CT scan was 5 ± 4.4 days. Twenty-two pseudoaneurysms were identified including grade III (10 of 84), grade IV (7 of 22), and grade V (2 of 5) patients; of these patients, 33% of grade III and 30% of grade IV required subsequent splenectomy. Routine follow-up CT imaging after high-grade splenic injury identifies splenic artery pseudoaneurysm in a significant proportion of patients. Standardized surveillance imaging for high-grade splenic trauma promotes prospective identification of pseudoaneurysms, allowing for interventions to minimize delayed splenic injury complications. Therapeutic/Care Management; level IV.

Bilateral Renal Hypoperfusion Following Motor Vehicle Accident.

Renal hypoperfusion noted on abdominal computed tomography (CT) scan without any underlying comorbid condition is a rare finding. Most reported cases of renal hypoperfusion have an association with an underlying cardioembolic problem, such as atrial fibrillation, endocarditis, cardiomyopathies, or artificial valve thrombi. We present a case of transient renal hypoperfusion evident on abdominal CT scan following blunt trauma. An 18-year-old male without any significant past medical history presented to the emergency department with the complaint of abdominal pain. The patient reported history of motor vehicle accident 1 week prior to his presentation. He was a front seat passenger wearing a seatbelt when the car went into a ditch. Airbags were deployed and the patient briefly lost consciousness. He presented 1 week later with complaints of generalized abdominal pain, more on the left side that started a few days after his accident, nonradiating, constant, 4/10 intensity. He denied dysuria, hematuria, groin pain, fever, chills, nausea, vomiting, abdominal pain, diarrhea, constipation, decreased oral intake, joint pain, leg swelling, or redness. He denied any medication use or any history of intravenous drug abuse. There was no reported family history of kidney disease or blood clots. Initial laboratory tests, including complete blood count, basic metabolic panel, erythrocyte sedimentation rate, and urinalysis were unremarkable except trace protein on the urinalysis. Contrast-enhanced CT of the abdomen showed multiple, confluent, focal areas of hypoperfusion of the renal parenchyma bilaterally. Given the CT findings of bilateral renal hypoperfusion, the patient was admitted to the hospital and an extensive workup was performed to rule out cardioembolic etiology. Echocardiogram, renal ultrasound, magnetic resonance angiogram of the abdomen, vasculitis panel, and hypercoagulable workup was unremarkable. The CT findings of renal hypoperfusion were considered secondary to transient hypoperfusion from blunt trauma. Abdominal pain resolved with nonsteroidal anti-inflammatory drugs and he was discharged to home. Follow-up abdominal CT scan with contrast obtained a few months later showed normal kidneys with resolution of previously noted renal hypoperfusion. Our case highlights a benign incidental finding of bilateral renal hypoperfusion following motor vehicle accident (with airbag injury), which resolved on follow-up imaging. On literature search, such CT scan findings of transient renal hypoperfusion of unclear significance have not been previously reported. Even though our patient underwent extensive workup to rule out cardioembolic etiology, it may be reasonable to forego such workup following blunt abdominal trauma.

Radiation recall gastritis secondary to combination of gemcitabine and erlotinib in pancreatic cancer and response to PPI - a case report

BackgroundRadiation recall gastritis is rare but can be induced after concurrent chemoradiation for pancreatic cancer. We report a patient with pancreatic cancer who developed radiation-recall gastritis related to a combination of gemcitabine and erlotinib.Case presentationA 54-year-old female with unresectable pancreatic cancer received gemcitabine in combination with radiation therapy followed by chemotherapy with gemcitabine and erlotinib. After completing 2 cycles of chemotherapy, the patient had epigastric pain, nausea, and vomiting. Abdominal computed tomography (CT) scan revealed diffuse wall thickening of the stomach, and esophagogastroduodenoscopy (EGD) showed multiple gastric ulcers. The patient was treated with proton pump inhibitors (PPI) and was continued on maintenance chemotherapy. Two months later, the patient presented with the similar symptoms and persistent gastric ulcers were observed during subsequent EGD. Nevertheless, the patient’s symptom had resolved with PPI therapy. Thus, the patient underwent maintenance chemotherapy with gemcitabine and erlotinib for additional 4 cycles. Eventually, follow-up abdominal CT Scan and EGD at 6 months demonstrated resolution of the gastric ulcers.ConclusionsPhysicians should be aware of the possibility of radiation recall gastritis associated with a combination of gemcitabine and erlotinib. Administration of PPIs may mitigate the adverse effects of gemcitabine and erlotinib in the presence of radiation recall gastritis; however further studies are warranted.

Isolated spleen recurrence in a patient with lung adenocarcinoma: A case report.

Spleen metastasis is extremely rare in patients with lung cancer. However, recent improvements in imaging modalities may enable the antemortem diagnosis of spleen metastasis. The present study reports the case of a female patient with lung adenocarcinoma and spleen metastasis. The patient developed isolated spleen metastasis in the postoperative course. This rare metastasis was detected in a follow-up abdominal computed tomography (CT) scan without any symptoms, and was confirmed by fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan. Although very rare, chest physicians and thoracic surgeons should be alert to the possibility of spleen metastasis development when evaluating the follow-up abdominal CT scan. FDG-PET/CT scanning and an interventional approach should be considered to clarify the possibility of spleen metastasis.

Acute ileo-ileal intussusception due to intestinal metastatic melanoma

Abstract Introduction Although gastrointestinal tract is a fairly frequent site of melanoma metastases, reports of small bowel intussusception caused by melanoma metastasis are very rare. Aim To describe a rare complication of metastatic melanoma and to expose the difficulties to screen digestive metastases of melanoma. Case study We report the case of a 69-year-old woman who was admitted for abdominal pain, melanoma and anemia. She had a history of surgery for a malignant vulval melanoma one year earlier and had been treated with adjuvant interferon α. Computed tomography (CT) concluded to a small bowel intussusception. Exploratory laparoscopy revealed a large tumor arising from the proximal small bowel. Jejunal resection with an end-to-end anastomosis was performed. Histological examination showed a metastasis of malignant melanoma. Regular postoperative follow-up did not show any sign of recurrence. Results and discussion Gastrointestinal metastases are a vicious site of distant localization of melanoma, difficult to diagnose and life-threatening due to their potential complications. Symptoms are often nonspecific. Rarely complications such as intussusception can be the first clinical presentation. CT, CT enteroclysis, fluorodeoxyglucose-positron emission tomography scan and capsule endoscopy may result as very useful for detecting gastrointestinal metastases. Conclusions Any gastrointestinal symptom in patients previously treated for cutaneous melanoma should lead to accurate research for metastases. We propose to use at follow-up abdominal CT scan in asymptomatic patients when the primary tumor has poor prognostic factors such as advanced stage or incomplete resection.

Acute appendicitis with superior mesenteric vein septic thrombophlebitis

Septic thrombophlebitis of the superior mesenteric vein (SMV) is rarely caused by acute appendicitis. The clinical symptoms of SMV thrombophlebitis are varied and atypical, so the diagnosis is commonly delayed, resulting in a reported mortality rate of 30%–50%. We report a case of SMV septic thrombophlebitis caused by acute appendicitis in which the patient was successfully treated with surgical intervention, appropriate antibiotics, and anticoagulation therapy. A follow-up abdominal computed tomography scan after 3 months of treatment showed that the SMV thrombosis had been resolved.

Successful Endovascular Treatment of a Splenic Artery Aneurysm in a Patient with Ehlers-Danlos Syndrome

Successful Endovascular Treatment of a Splenic Artery Aneurysm in a Patient with Ehlers-Danlos Syndrome

Laparoscopic Resection of a Hepatocellular Carcinoma Arising from an Ectopic Liver

Ectopic livers are rarely seen intra-abdominal lesions. Ectopic hepatocellular carcinoma (HCC) can be defined as an HCC arising from hepatic parenchyma located in an extrahepatic organ or tissue. The authors report a case of a primary, well-differentiated HCC arising from ectopic liver tissue in the left subphrenic space at the upper portion of the gastrorenal ligament that was successfully treated by laparoscopic resection. A 59-year-old man was referred to our department for the management of an intra-abdominal mass, which was incidentally found in a follow-up abdominal computed tomography scan for splenic laceration. The preoperative diagnosis suggested that it was a nonspecific stomach mass of maximal diameter 4.5 cm, such as, a gastrointestinal stromal tumor, located between the diaphragm and spleen. A computed tomography scan identified no mass in the liver. Laparoscopic resection was performed, and the final pathologic result confirmed that it was a HCC. The patient's postoperative course was unremarkable. This is the first reported case of a laparoscopically treated ectopic HCC. Moreover, laparoscopic resection was found to be safe and reliable in this case.

Endovascular Repair of a Common Iliac Artery Aneurysm Using the Cook Zenith Abdominal Aortic Aneurysm Endovascular Graft Converter

Isolated common iliac artery aneurysm is a rare condition that is treated aggressively because of its high risk of rupture. Endovascular abdominal aortic aneurysm (AAA) repair has recently been extended to the clinical management of the iliac artery aneurysm. Stent grafts have been used successfully to exclude iliac artery aneurysms. Successful graft deployment and aneurysm exclusion require adequate seal and fixation at the proximal and distal attachment sites. This article presents a high-risk surgical patient whose 6.8-cm-diameter iliac artery aneurysm was repaired with a Zenith AAA Endovascular Graft Converter (Cook, Bloomington, Indiana). This device is normally used to convert an aortobiiliac endograft to an aortouniiliac endograft during AAA repair. The tapered 80-mm-long graft has diameters of 24 mm proximally and 12 mm distally. Completion arteriogram demonstrated exclusion of the iliac artery aneurysm with no evidence of endoleak. No postoperative complications occurred. No endoleak was seen on the follow-up abdominal computed tomography scan.