We have reviewed 38 patients with brucellosis who were admitted to the Chaim Sheba Medical Center between 1955 and 1977, i.e. during a 23-year period. The clinical manifestations varied greatly. Diagnosis was easy when brucellosis was suspected, as in cases presenting with fever of unknown origin. In nine of the 38 cases diagnosis was difficult and delayed for several weeks since brucellosis was not suspected. Some of these cases will be described in detail. The diagnosis was established in 16 patients by isolating Brucella melitensis and in the other 22 by serological tests. There were no relapses in the 26 patients treated with a combination of streptomycin and tetracycline; two of the 12 patients treated with tetracycline alone relapsed. Brucellosis should be considered when clinical manifestations are puzzling.

Adolescent↗

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Urinomas caused by ureteral injuries: CT appearance.

BACKGROUND: We report the computed tomographic (CT) features of urinomas caused by ureteral injuries which are often not clinically suspected, causing delay in diagnosis. METHODS: CT studies of 12 patients with ureteral injury were reviewed. Ureteral injuries were iatrogenic in 9 patients and traumatic in the remaining three. CT was performed between 2 and 139 days (average = 33 days) after the insult. The most common presenting symptoms were severe abdominal pain and fever. All CT studies were performed before and after intravenous contrast administration. In 11 of 12 cases, delayed scanning was added 15 min to 5 h later. RESULTS: The sites of injury were the proximal ureter in two patients, the middle ureter in three, the distal ureter in two, and the ureteral anastomosis in five. The urinomas appeared as confined water-density fluid collections in seven patients, as free fluid (urinary ascites) in two, and as both in three. Extravasation of contrast from the ureter was observed on early scans in six patients and on delayed scanning only in the other six. The density of the opacified urinoma measured 80-200 HU. Ipsilateral hydronephrosis was observed in seven patients. Ureteral injuries were treated conservatively in eight patients and surgically in four. CONCLUSION: Ureteral injuries after iatrogenic or penetrating trauma often are diagnosed with considerable delay. The presence of ascites or localized fluid collections in symptomatic patients after abdominal surgery or penetrating trauma should raise the possibility of a ureteral injury and prompt delayed scanning.

Adolescent↗

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Perforations of the rectosigmoid colon induced by cleansing enema: CT findings in 14 patients.

BACKGROUND: We report the computed tomographic (CT) features of colorectal perforations caused by cleansing enema. METHODS: We reviewed the medical records and CT studies of all patients with colorectal perforations caused by a cleansing enema. RESULTS: Fourteen patients (10 men, four women; average age = 80 years) were included in the study. The most common presenting symptoms were severe abdominal pain and fever. CT was performed within 48 h after the event in most patients. Extraluminal air in the perirectal fat was the most frequent finding on CT and was present in all patients. Additional findings were extraperitoneal ( n = 9), intraperitoneal ( n = 3) and /or subcutaneous ( n = 3) air, free fluid ( n = 9), extraluminal feces ( n = 8), and focal bowel wall thickening ( n = 4). No leak of contrast from the rectum was observed in any patient including the one patient in whom contrast was administered rectally. Ten patients were treated by surgery; five recovered and the other five died. The other four patients were treated conservatively and all four died. CONCLUSION: The diagnosis of colorectal perforation can be made on CT. Because the diagnosis is not always suspected by the clinician, the radiologist may be the first to suggest it. Therefore, the radiologist should be familiar with the CT features of a potentially lethal, rectally induced perforation.

Abdominal Pain↗

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Granulomatous appendicitis presenting as right lower quadrant pain: CT findings.

BACKGROUND: We present the computed tomographic (CT) findings of granulomatous appendicitis. METHODS: Five of 652 (0.9%) patients who had undergone appendectomy for clinically suspected acute appendicitis over a 19-month period proved to have granulomatous appendicitis. One patient had surgery based on a clinical diagnosis of acute appendicitis. Four patients (three men and one woman; age range = 14-39 years) underwent abdominal CT. The CT findings were retrospectively reviewed with special attention to the appendiceal abnormalities. RESULTS: All four patients presented with subacute clinical presentation. Enlarged appendices of 4.5 and 2 cm in diameter with thickened walls of soft tissue density were found in two patients, and periappendicular inflammatory masses were found in the other two. Enlarged mesenteric lymph nodes and right lower quadrant fat stranding was seen in all four patients. Histopathology showed numerous granulomas within the inflamed appendix. CONCLUSION: Radiologists should be familiar with the rare entity of granulomatous appendicitis in patients examined by CT for suspected acute appendicitis. An insidious clinical presentation with CT findings of an exceptionally large appendix and associated periappendiceal inflammatory changes should raise the possibility of granulomatous appendicitis or carcinoma or lymphoma of the appendix.

Abdominal Pain↗

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IVC anomalies and right renal aplasia detected on CT: a possible link?

BACKGROUND: We report the occurrence of congenital anomalies of the inferior vena cava (IVC) and right renal aplasia in three patients as detected on computed tomography (CT). METHODS: The medical records and imaging studies of three patients with congenital anomalies of the IVC and right renal aplasia were studied. We also reviewed eight reported cases with such an association. RESULTS: Eleven patients, nine adults and two girls, were included in the series. Indications for imaging included deep vein thrombosis (n = 5), hypertension (n = 2), failure to advance a femoral vein catheter cranially (n = 1), dilated veins along the abdominal wall (n = 1), endstage renal failure (n = 1), and jaundice (n = 1). CT was performed in seven patients, and venography, aortography, and other imaging modalities were performed in four. IVC anomalies included partial or complete absence of the IVC in nine patients and a double vena cava in two. The azygos vein was very prominent in all patients in whom the IVC was absent. The right kidney was absent or very small in all patients. CONCLUSION: The association between IVC anomalies and absence of the right kidney as detected on CT probably was not incidental. Although most patients had symptoms deriving from the anomalies, these might have been clinically silent. The radiologist should be aware of the possible association between these anomalies, which can be detected on CT.

Adolescent↗

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Small bowel obstruction secondary to Crohn disease: CT findings.

We investigated the computed tomographic (CT) findings in patients with small bowel obstruction (SBO) and Crohn disease (CD). Fourteen patients, seven men and seven women (mean age, 41.3 years), were retrospectively reviewed. All presented with clinical symptoms and signs of SBO. Eleven had a history of CD, whereas three experienced the bowel obstruction as the first manifestation of the disease. On CT, features of complete SBO were seen in nine patients, whereas incomplete obstruction was found in the other five. One patient had CT findings of an adhesive obstruction. The other 13 were diagnosed as having CD-related SBO; a markedly stenotic bowel segment caused the obstruction in one patient, and a thickened-wall small bowel segment with luminal narrowing was evident at the transition zone in the other 12. The mural thickening had a target appearance in seven and homogeneous thickening in the other five. Additional thickened bowel segments were found in five patients and mesenteric involvement was found in 10. Five patients were treated conservatively, and the other nine underwent surgery (one with adhesiolysis only). Resection of the stenotic bowel was performed in six patients and stricturoplasty was done in the other two, with associated intestinal biopsy in one of these two patients. Histopathology revealed findings of active on chronic disease in all. CT is frequently performed for suspected SBO, so radiologists should be aware of the diagnosis of CD, because SBO may be its first manifestation. Alternatively, radiologists can accurately diagnose a CD-related obstruction in a patient with known CD and differentiate it from an obstruction due to adhesions. Patient management in these cases, however, is based most often on the clinical condition.

Adult↗

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Postoperative pneumoperitoneum as detected by CT: prevalence, duration, and relevant factors affecting its possible significance.

BACKGROUND: To determine the prevalence and duration of postoperative pneumoperitoneum as detected on computed tomography (CT) and to evaluate factors that influence postoperative pneumoperitoneum. METHODS: One hundred three CT examinations of 89 patients performed after abdominal surgery for various indications were prospectively collected and reviewed. The presence and volume of free air were noted and correlated with patients' sex, age, and habitus, with the time interval between surgery and CT, with the type of surgery, and with the presence of drains. RESULTS: Pneumoperitoneum was seen in 44% of examinations performed in the first 3 days after surgery and in 30% between the 4th and 18th postoperative days. The prevalence and volume of free air decreased with the time interval between surgery and CT. It was not detected in any of the 11 examinations performed beyond the 18th postoperative day. The volume of free air in the majority of examinations did not exceed 10 mL and ranged from 0.2 to 10 mL in 19 patients (66% of patients with free air). Larger volumes of free air, ranging from 10 to 20 mL and from 20 to 40 mL, were observed in 5 (17%) and 4 (14%) patients, respectively, and only one patient had more than 40 mL of free air. Free air was found significantly more often in male and in asthenic patients; age had no significant effect. Free air was more prevalent in the presence of drains. The type of surgery did not significantly influence the prevalence of postoperative pneumoperitoneum, although it was noted slightly less often after laparoscopic surgery than after open laparotomy. CONCLUSIONS: Pneumoperitoneum is a common phenomenon after abdominal surgery, decreasing in frequency with time. The air is most often residual and not a sign of disruption of the gastrointestinal tract. Obesity, female sex, and occurrence of free air several weeks after surgery are factors suggestive of a leak, but the significance of a postoperative pneumoperitoneum on CT should be determined mainly by the clinical setting.

Abdomen↗

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Widespread abdominal venous thrombosis in paroxysmal nocturnal hemoglobinuria diagnosed on CT.

Paroxysmal nocturnal hemoglobinuria is a rare disorder characterized by pancytopenia. One of the main manifestations of this disease is development of widespread life-threatening venous thrombosis, which may involve multiple abdominal veins. We describe two patients with paroxysmal nocturnal hemoglobinuria with clinically unsuspected portal, splenic, and mesenteric venous thromboses that were diagnosed on computed tomography. This complication should be clinically suspected in patients suffering from paroxysmal nocturnal hemoglobinuria who present with abdominal pain, and it should be sought by the radiologist on pre- and postcontrast computed tomography.

Abdomen↗

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Iliopsoas abscess: a report of 24 patients diagnosed by CT.

BACKGROUND: We wanted to define the role of computed tomography (CT) in the diagnosis, etiology, and treatment of iliopsoas abscess. METHODS: Twenty-four patients (18 men, six women; age range = 17-86 years) with iliopsoas abscesses diagnosed over 8 years were retrospectively reviewed. All presented with fever and elevated white blood cell counts. Twenty-one had abdominal, flank or pelvic pain and nine had specific psoas signs suggesting the diagnosis. RESULTS: Seventeen of the abscesses were right-sided. Twenty were regarded as secondary to various underlying causes that were clearly demonstrated on CT and related to gastrointestinal (n = 12), skeletal (n = 5), or urinary tract (n = 3) diseases. All patients received appropriate antibiotic treatment. Thirteen also had their abscesses drained and eight had definitive surgical procedures. CONCLUSION: CT is an effective imaging technique for diagnosing iliopsoas abscess, even when classic clinical signs are absent. Treatment by percutaneous drainage under CT guidance is another advantage. When a psoas abscess is a complication of Crohn's disease, resection of the affected bowel segment is recommended in addition to drainage because drainage alone even in conjunction with appropriate medical therapy is usually not effective.

Adult↗

PubMedDate not supplied

Urinary excretion of orally ingested gastrografin on CT.

Renal excretion of orally ingested gastrografin has rarely been reported on computed tomography (CT). We studied the unenhanced scans of 82 patients with bowel disorders or perforation to assess the prevalence of urinary contrast material (CM) in various bowel diseases. We also assessed the clinical significance of this sign. In addition, we reviewed the unenhanced CT scans of 100 randomly selected patients without bowel diseases as a control group. Twenty-nine of the 58 patients with bowel diseases, six of nine with free perforation, and one of 15 with covered perforation had CM in the urinary tract. None of the 100 without bowel disease showed urinary CM. Statistical analysis was done by using the Fisher's exact test. The prevalence of urinary CM was highest in inflammatory bowel disease, radiation enteritis, and free perforation (p < 0. 0001). This study shows that the CT finding of orally ingested gastrografin in the urinary tract differentiates patients with bowel disease from those without.

Administration, Oral↗

PubMedDate not supplied

Polysplenia syndrome detected in adulthood: report of eight cases and review of the literature.

BACKGROUND: To present the computed tomographic (CT) features of the abdominal anomalies consistent with polysplenia syndrome in adults. Awareness of these abnormalities may avoid misdiagnosing characteristic findings as separate pathological processes. METHODS: Imaging studies, mainly abdominal CT scans, of eight patients were reviewed. Attention was directed to the location of the multiple spleens, stomach, and liver and to the possible presence of a short pancreas, malrotation of the intestine, and venous anomalies. We also reviewed the CT findings of 15 adult patients described in the literature. RESULTS: Three men and five women underwent CT for various unrelated conditions. The most common findings were multiple spleens along the greater curvature of the stomach, which were located in the right upper quadrant in six patients. The inferior vena cava was seen on the left side in seven subjects, with azygos/hemiazygos continuation in six. A preduodenal portal vein was present in seven subjects. The liver was in the midline in four patients and on the left side in two. A short pancreas was seen in four patients, intestinal nonrotation in five, and dextrocardia in two. The prevalence of these anomalies was similar to that of the reviewed cases. CONCLUSIONS: CT proved to be an excellent imaging modality in the diagnosis of the abdominal anomalies. Some of these (a short pancreas, multiple spleens, and azygos continuation) can simulate pathological processes. Hence the importance of recognizing these CT findings as part of a syndrome.

Abnormalities, Multiple↗

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Post-traumatic reactive and resorptive lesions of the medial end of the clavicle.

Three soldiers presented with a painful swelling of the sternoclavicular area. Computed tomography (CT) studies showed sclerosis as well as lysis of the medial end of the clavicle with adjacent soft-tissue swelling. Bone biopsy revealed new bone formation and inflammatory reaction; cultures were negative, no tumor cells were found. The patients recovered after antibiotic treatment. Although the CT findings cannot completely rule out a malignant lesion, these changes in the medial end of the clavicle in young people may suggest trauma as the etiology.

Clavicle↗

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Cytokine genotypes in kidney, heart, and lung recipients: consequences for acute and chronic rejection.

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Acute Disease↗