Positive Abdominal Findings Research Articles

Comparison between abdominal CT findings in intensive care unit (ICU) and non-ICU patients with Covid-19: experience from a tertiary care hospital.

16-66% of COVID-19 positive patients may have abdominal symptoms and findings in abdominal CT. The yield of abdominal CT scan in patients having abdominal complaints is not known. The aim of this study was to explore the various abdominal imaging manifestations of COVID-19 and COVID-19 associated Mucormycosis (CAM) and to identify the relevant clinical and laboratory features associated with severity of the symptoms. A retrospective single centre observational study was performed at a tertiary care hospital in Northwest India. All consecutive patients who had COVID positive RT-PCR report and had undergone abdominal Computed Tomography scan from March 2020 to November 2021 for various abdominal complaints were included. Demographic data, CT images and reports and all relevant lab parameters were collected. Out of 75 patients, positive abdominal findings were seen in 65 patients. Hepatobiliary findings were seen in 41.3% (31 of 75; OR=1.9) and bowel abnormalities were found in 37.3% (28 of 75; OR=2.1) of COVID-19 patients. 7 patients who had renal infarcts or bowel ischemia were found to have COVID-19 associated Mucormycosis on histopathology. Chest CT severity score was positively correlated with most of the abdominal manifestations in patients requiring ICU admission. Elevated D-dimer levels were significantly associated with abdominal symptoms.

Abdominal Imaging Findings in Laboratory-Confirmed COVID-19 Patients: A Retrospective Observational Study.

Coronavirus disease 2019 (CO-VID-19) is known to predominantly present with respiratory symptoms; however, a significant proportion of patients present with digestive symptoms. These symptoms are often non-specific and as such prompt the treating physician to request further imaging evaluation. Understanding the abdominal imaging findings in COVID-19 and their possible associations is thus crucial to direct patient care and prevent misdiagnosis.The aim of this study was to describe abdominal imaging findings on both computed tomography (CT) and ultrasound scans in cases with positive COVID-19 polymerase chain reaction (PCR) tests performed at our institution, and also, to evaluate the reason for requesting these imaging studies, and to correlate these findings with patients' demographics. A retrospective observational study was conducted at Salmaniya Medical Complex, Bahrain, between February 2021 and March 2022. We examinedthe abdominal CT and ultrasound data for PCR-confirmed COVID-19 patients. The demographic data, reason for requesting imaging and imaging findings were gathered by reviewing the hospital's electronic health records and picture archiving and communicating system (PACS). The study included 97 patients, with the majority being male (57.7%). The most common reason for imaging was abdominal pain, as seen in over half of the patients (60.8%), followed by deranged liver enzymes (18.6%). More than 75% of imaging studies showed positive abdominal findings with the majority (19.6%) showing non-specific inflammatory findings, followed by gallbladder disease (13.4%). The CT studies were more likely to yield positive findings as compared to ultrasound, with only 7 (11.3%) CT scans yielding normal findings (χ2 = 14.65; P < 0.01). To our knowledge, the research conducted on the abdominal manifestations of COVID-19 is still limited, especially in our region. Our study showed that there are variable presentations of abdominal organ involvement in COVID-19 cases, and as such more data is required to direct choice of imaging study, protocol, and interpretation of findings to better guide patient management.

High Frequency of Intrabdominal Lung Cancer Metastases Justifies EUS As Test of Choice in a Specific Patient Subset: An Evidence-Based Staging Algorithm

Background: Lung cancer (LC) staging is performed to determine whether aggressive local therapy should be undertaken. Institutional variability in lung cancer staging algorithms is often due to differences in local expertise and availability of advanced diagnostics such as EUS, endobronchial ultrasound (EBUS), mediastinoscopy, interventional radiology and PET imaging. In our regional referral center EUS is employed for patients with known or suspected LC with EUS-accessible mediastinal adenopathy (MA) or abdominal findings suspicious for metastases. When imaging demonstrates only MA, EUS of the abdomen is always performed to evaluate for unsuspected metastases. EUS-FNA is performed to confirm metastases suggested by CT or PET as well as those discovered unexpectedly by EUS. Patients not meeting these criteria are staged by other means as suggested in our algorithm. Design: Retrospective chart review was conducted of 137 consecutive patients who underwent EUS for evaluation or staging of known or suspected, and ultimately confirmed, LC with imaging suggesting MA or abdominal metastases. EUS-FNA was performed on all suspicious MA and abdominal findings. Results: Intrabdominal metastases were confirmed by FNA in 33/137 (24%), most commonly the left adrenal (10%) and liver (9%). Intrabdominal metastasis were unexpected based on pre-EUS CT or PET in 12/33 (36%). Small cell cancer (SCC) metastasized to the abdomen more commonly than non-small cell cancer (NSCC) (15/42 vs. 18/95, p = 0.08). Unsuspected abdominal metastasis were more commonly found in SSC (7/42) than NSCC (5/95), (p = 0.04). In four patients, EUS-FNA of an enlarged adrenal gland identified by CT(3) or PET (1) was benign resulting in subsequent curative-intent therapy. Conclusion: Based on our experience, patients with LC and MA have a high frequency of intrabdominal metastases. Many of these are not suggested by pre-EUS imaging. Such patients would be inaccurately staged by mediastinoscopy or EBUS alone. Although infrequent, false positive abdominal findings suspicious for metastases that are not histologiclly confirmed can deprive patients of potentially curative treatments. We therefore propose EUS as the test of choice in patients with CT or PET scan of the chest suggesting LC and demonstrating EUS-accessible MA or abdominal abnormalities. We previously reported the incidence of abdominal metastases in an earlier, similar cohort. This updated report includes an additional 36 patient accrued over the subsequent 10 months, demonstrates a consistent frequency of intrabdominal metastases, and emphasizes, in graphic depiction, our staging algorithm.

Lymphangioleiomyomatosis: abdominopelvic CT and US findings.

To describe the abdominal computed tomographic (CT) and ultrasonographic (US) findings in patients with thoracic lymphangioleiomyomatosis (LAM) and to relate the prevalence of the findings to the severity of pulmonary disease. Eighty patients with LAM underwent chest and abdominopelvic CT and abdominopelvic US. The images were reviewed prospectively by one radiologist, and the abdominal findings were recorded and correlated with the severity of pulmonary disease at thin-section CT. Sixty-one (76%) of 80 patients had positive abdominal findings. The most common abdominal findings included renal angiomyolipoma (AML) in 43 patients (54%), enlarged abdominal lymph nodes in 31 (39%), and lymphangiomyoma in 13 (16%). Less common findings included ascites in eight (10%), dilatation of the thoracic duct in seven (9%), and hepatic AML in three (4%). A significant correlation (P =.02) was observed between enlarged abdominal lymph nodes and increased severity of lung disease. There are characteristic abdominal findings in patients with LAM that, in conjunction with the classic thin-section CT finding of pulmonary cysts, are useful in establishing this diagnosis.

67Ga-scintigraphy for evaluation of AIDS-related intestinal infections

This study was designed to evaluate the role of 67Ga-scintigraphy in AIDS-related intestinal infections. Seventeen out of twenty-five HIV-positive patients (68%) primarily investigated with 67Ga-scans to screen for opportunistic pneumonia presented pathologic abdominal 67Ga-uptake which was, in most cases, due to proven opportunistic intestinal infection (cytomegalovirus, atypical mycobacteria, cryptosporidiosis etc.). The correlation of abdominal with pulmonary findings has shown that AIDS-related intestinal infections and opportunistic pneumonia may occur concomitantly in the majority cases (11/17). In 6/17 patients positive abdominal findings were observed without opportunistic pneumonia at the same time. Gallium imaging of the abdomen has shown to identify successfully the most common extrapulmonary sites of HIV-related infections. Thus, abdominal imaging or whole body scintigraphy should be a mandatory part of each 67Ga-scan in patients with HIV infection, even if it was primarily performed to screen for opportunistic pneumonia only. Knowledge of multilocular opportunistic infections, usually caused by different pathogens, is clinically important for further diagnostic and therapeutic management.

Laparotomy findings in lymphangiogram-staged I and non-Hodgkin's lymphomas.

Ninety patients with Stage I or II, including extranodal (E), presentations of non-Hodkin's lymphoma were investigated by laparotomy, either for the definitive staging of patients with peripheral presentations or for diagnosis of abdominal disease. Sixty-eight patients had staging laparotomies after extensive work-up, which included lymphangiography and bone marrow biopsy. The remaining 22 patients had laparotomies for diagnosis of abdominal symptoms or for management of unrelated surgical problems, with lyphoma being found incidentally. The incidence of positive abdominal findings in the 68 patients who had staging laparotomies depended on histologic subtype. In nodular lymphoma patients, abdominal disease was found in 17 of 28 (61%) and in diffuse lymphoma patients, in 9 of 40 (22.5%). For patients with nodular lymphomas upstaged by laparotomy, the positive findings tended to cluster around an axis consisting of the celiac, porta-hepatic, para-aortic, and root of the mesentery lymph nodes. In addition, 64% of these patients had splenic involvement. For the diffuse lymphoma upstaged by laparotomy, the distribution of positive findings was similar to that of the nodular lymphoma group; however, only 1 patient had splenic involvement. By contrast, in approximately half of the diffuse lymphoma patients who had laparotomies for diagnosis, the gastrointestinal tract was found to be involved in addition to the previously cited lymph nodes.

Influence of staging celiotomy in localized presentations of Hodgkin's disease.

Staging celiotomy was performed in 139 previously untreated patients with lymphogram negative Stage I and II Hodgkin's disease. Sixteen additional patients received definitive radiotherapy for symptomatic relief of upper torso disease prior to abdominal exploration. The overall incidence of positive abdominal findings for these two groups was 34.5% and 31.2%, respectively. Further analysis of the 139 previously untreated cases revealed notable differences in incidence of positive abdominal findings for stage, presentation, and specific histology. Stage I patients with upper cervical or inguinal presentations or a lymphocytic predominance classification had negative celiotomies, as contrasted with a 43% incidence of positive abdominal findings in patients with supraclavicular presentations. In Stage II disease, the incidence of positive findings was related to the status of the mediastinum. For mediastinal presentations, the incidence was 33.3%, as compared to 48% for nonmediastinal presentations. To date, the number of relapses in celiotomy Stage I and II patients has been low regardless of whether or not prophylactic irradiation was administered to the major lymph-node-bearing regions of the upper and lower torso. Of 9 patients with progression, extranodal spread occurred as the first evidence of new disease in 4 patients. The implication of this finding is considered in a discussion on the influence of staging celiotomy in the management of Stage I and II patients with Hodgkin's disease.