Fat stranding adjacent to thickened bowel wall seen at computed tomography (CT) in patients with acute abdominal pain suggests an acute process of the gastrointestinal tract, but the differential ...diagnosis is wide. The authors observed "disproportionate" fat stranding (ie, stranding more severe than expected for the degree of bowel wall thickening present) and explored how this finding suggests a narrower differential diagnosis, one that is centered in the mesentery: diverticulitis, epiploic appendagitis, omental infarction, and appendicitis. The characteristic CT findings (in addition to fat stranding) of each of these entities often lead to a final diagnosis. Diverticulitis manifests with mild, smooth bowel wall thickening and no lymphadenopathy. Epiploic appendagitis manifests with central areas of high attenuation and a hyperattenuated rim, in addition to its characteristic location adjacent to the colon. In contrast, omental infarction is always centered in the omentum. The most specific finding of appendicitis is a dilated, fluid-filled appendix. Correct noninvasive diagnosis is important because treatment approaches for these conditions range from monitoring to surgery.
Anecdotal experience has suggested that back pain in radiologists may result from extensive wearing of lead aprons. To investigate this possibility, we sent questionnaires to 688 radiologists in ...various subspecialties whose use of lead aprons varied from none to moderate to extensive. The questionnaire included both objective items that quantitated apron use and back pain and subjective items that asked, for example, if the respondent believed that lead aprons were responsible for his or her back pain. We received 236 responses (34% response rate). Objective data from those radiologists who had experienced no back pain before wearing a lead apron (179 radiologists, 26% of those surveyed) were tabulated; respondents were grouped according to age, time spent wearing a lead apron, and degree of back pain. Odds ratios were calculated. Answers to subjective questions for all respondents were tabulated. Back pain was reported by 52% of those who estimated their lead apron use at greater than or equal to 10 hr per week, the mean response, as opposed to 46% of those who wore lead aprons fewer than 10 hr a week. These and related results were not statistically significant. Our study does not prove that wearing a lead apron is a significant risk factor for the development of back pain.
Computed tomography (CT) was used to guide percutaneous fine-needle biopsy in 150 cases of difficult thoracic lesions; in 76 cases, nondiagnostic bronchoscopy (n = 62) and fluoroscopic biopsy (n = ...14) had previously been performed. CT was indicated for guidance when the pulmonary or pleural lesions were small (0.3-2.5 cm); in a juxta-vascular location, either hilar or mediastinal; not seen or poorly visualized on conventional radiographs; or considered inaccessible. A diagnosis was made in 124 of 150 cases (82.7%) (107 of 124 malignant and 17 of 26 benign lesions), including 86 of 107 lung nodules (80.4%), 28 of 31 mediastinal lesions (90.3%), and ten of 12 pleural masses (83.3%). Complications included pneumothorax (n = 64), hemoptysis (n = 5), hemothorax (n = 2), and pericarditis (n = 1). The high rate of pneumothorax, its treatment, and advantages of its immediate radiologic management are discussed. Use of CT guidance considerably expands the scope of thoracic lesions amenable to percutaneous biopsy.
To determine the benefit of screening ultrasonography for parenchymal abnormalities as well as free fluid during screening abdominal ultrasonography in patients with blunt trauma.
A total of 2693 ...patients with blunt trauma who were triaged to a level 1 trauma center underwent screening abdominal ultrasonography in the resuscitation suite. Examinations were performed by experienced sonographers and included a screen for free intraperitoneal fluid and evaluation of the abdominal organ parenchyma and heart for traumatic injury. Screening ultrasonographic findings were reviewed and compared with findings from autopsy, laparotomy, diagnostic peritoneal lavage, computed tomography, repeated ultrasonography, cystography, and clinical outcome. Imaging studies of all patients with confirmed or suspected injuries were reviewed to identify those in whom parenchymal findings aided diagnosis.
One hundred seventy-two patients were found to have evidence of abdominal injury due to blunt trauma on the basis of clinical data, imaging, laparotomy, or autopsy. Forty-four of these patients had no sonographic evidence of hemoperitoneum at the time of initial ultrasonography. Screening ultrasonographic findings were positive for injury in 19 of 44 patients on the basis of parenchymal findings or small retroperitoneal collections of fluid thought to be indicative of trauma. In the remaining 25 patients, screening ultrasonography showed no abnormalities, and injuries were detected by repeated ultrasonography, subsequent computed tomography, or diagnostic peritoneal lavage performed for suspected occult injury on the basis of clinical parameters. In addition, 47 of 126 injured patients with sonographically detected free fluid had parenchymal findings that helped localize injury. Sixteen of those patients were taken to the operating room on the basis of clinical and sonographic findings without undergoing computed tomography.
The inability to show injuries with no hemoperitoneum or with delayed hemoperitoneum has been shown to be a limitation of ultrasonography in patients with blunt trauma. In our series, 26% of all patients with documented injuries had no free fluid visible on screening ultrasonography Attention to findings other than free fluid allowed detection in 43% of injured patients without sonographic evidence of hemoperitoneum.
To retrospectively identify and describe the imaging features that represent perivascular fatty infiltration of the liver.
The institutional review board approved the study and waived informed ...consent. The study complied with the Health Insurance Portability and Accountability Act. Ten patients (seven women, three men; mean age, 78 years; range, 31-78 years) with fatty infiltration surrounding hepatic veins and/or portal tracts were retrospectively identified by searching the abdominal imaging teaching file of an academic hospital. The patients' medical records were reviewed by one author. Computed tomographic (CT), magnetic resonance (MR), and ultrasonographic (US) imaging studies were reviewed by three radiologists in consensus. Fatty infiltration of the liver on CT images was defined as absolute attenuation less than 40 HU without mass effect and, if unenhanced images were available, as relative attenuation at least 10 HU less than that of the spleen; on gradient-echo MR images, it was defined as signal loss on opposed-phase images compared with in-phase images; and on US images, it was defined as hyperechogenicity of liver relative to kidney, ultrasound beam attenuation, and poor visualization of intrahepatic structures. Perivascular fatty infiltration of the liver was defined as a clear predisposition to fat accumulation around hepatic veins and/or portal tracts. For multiphase CT images, the contrast-to-noise ratio was calculated for comparison of spared liver with fatty liver in each imaging phase.
Fatty infiltration surrounded hepatic veins in three, portal tracts in five, and both hepatic veins and portal tracts in two patients. Six of the 10 patients had alcoholic cirrhosis, two reported regular alcohol consumption (one of whom had acquired immunodeficiency syndrome and hepatitis B), one was positive for human immunodeficiency virus, and one had no risk factors for fatty infiltration of the liver. In three of the 10 patients, fatty infiltration was misdiagnosed as vascular or neoplastic disease on initial CT images but was correctly diagnosed on MR images.
Perivascular fatty infiltration of the liver has imaging features that allow its recognition.
Percutaneous Abscess Drainage: Update vanSonnenberg, Eric; Wittich, Gerhard R.; Goodacre, Brian W. ...
World journal of surgery,
March 2001, Letnik:
25, Številka:
3
Journal Article
Recenzirano
During the approximately 20 years that percutaneous abscess drainage (PAD) has been an extant procedure and as the millennium begins, PAD has become, by consensus, the treatment of choice for ...abscesses. Indications for PAD continue to expand, and currently almost all abscesses are considered amenable. On occasion, PAD is an adjunctive procedure that provides a beneficial temporizing effect for the surgeon who eventually must operate for a coexisting problem such as a bowel leak. Simple unilocular abscesses are cured almost uniformly by PAD; more complicated abscesses, such as those with enteric fistulas (e.g., diverticular abscess) or pancreatic abscesses, have cure rates ranging from 65% to 90%. Various catheters and insertion techniques have proven effective. Ultrasonography, computed tomography, and fluoroscopy are the staple modalities that guide PAD. PAD is the prototype interventional radiology procedure, providing detection of the abscess by imaging, needling for diagnosis, and catheterization for therapy.
The authors describe the technical results in 127 patients who underwent diagnostic gallbladder puncture and percutaneous cholecystostomy. The procedures were performed for a variety of indications ...including treatment of acute calculous or acalculous cholecystitis, drainage of obstructive jaundice or gallbladder perforation, percutaneous removal or dissolution of gallstones, diagnostic cholecystocholangiography, and gallbladder biopsy. Successful completion of the intended procedure was achieved in 125 of 127 patients (98.4%). Major complications occurred in 11 patients (8.7%); these included bile peritonitis, bleeding, vagal reactions, hypotension, catheter dislodgement, and acute respiratory distress. Minor complications were noted in five patients (3.9%). The 30-day mortality rate was 3.1% (four patients); the deaths were due to the underlying diseases. The data help support percutaneous cholecystostomy as a primary interventional radiologic procedure that has an extremely high likelihood of technical success. Recommendations to minimize or avoid complications are presented.
The aims of this study were to identify (1) the normal range of the appendix on computed tomography (CT), (2) the correlation of patient age and sex with the visibility and appearance of the appendix ...on CT, and (3) the normal variations in wall thickness, intraluminal content, and location of the appendix. Three hundred seventy-two outpatients underwent abdominopelvic CT. The scans were reviewed on the picture archiving and communication system and appendiceal outer-to-outer wall diameter, wall thickness, location, content and its correlation with appendix diameter were analyzed. The appendix was visualized in 305/372 patients. Its location relative to the cecum was highly variable. The diameter range was 3-10 mm; in 42% of cases the diameter was greater than 6 mm. When the intraluminal content (185/305) was visualized, the diameter was slightly superior to the mean (p=0.0156). In 329 CT scans in which oral contrast material was given, the appendix was filled by contrast material in 74/329 patients. The appendix wall thickness was measurable in 22/305 patients (average 0.15 cm). There is significant overlap between the normal and abnormal CT appearance of the appendix. Consequently the diagnosis of acute appendicitis should be based not only on the appearance of the appendix but also on the presence of secondary signs.
We studied ultrasound-guided percutaneous cryoablation for treatment of prostate carcinoma.
Our series includes 83 individuals who underwent transrectal ultrasound-guided transperineal percutaneous ...cryoablation of the prostate. Prostate specific antigen levels, biopsy results and complications were assessed at 3 months.
Of 61 biopsies 8 (13.1 percent) were positive for carcinoma (half showed stage D disease). Of patients with stages T1 to T3 cancer 92.6 percent were free of disease at 3 months. Prostate specific antigen levels were significantly decreased by an average of 1.90 ng./ml. (p less than 0.05). Major complications were infrequent, including bladder perforation in 1 patient, urethral strictures in 3, bladder outlet obstruction in 2 and partial incontinence in 2. Impotence was frequent but transient.
Transrectal ultrasound-guided transperineal percutaneous cryoablation of the prostate produces few major complications and appears at 3 months to be effective in eradicating local prostate tumors. Longer followup is required to test the original hypothesis.
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