CT of a thickened-wall gall bladder.
This pictorial article reviews the various clinical entities that may cause mural thickening of the gall bladder encountered on contrast enhanced CT.
Cholecystitis↗
Biomedical subjects
R Zissin
Publications and source records attributed to R Zissin.
Congenital anomalies of the inferior vena cava revealed on CT in patients with deep vein thrombosis.
OBJECTIVE: We describe a possible relationship between inferior vena cava anomalies and extensive thrombosis of the inferior vena cava and the iliac and femoral veins. CONCLUSION: An anomaly of the inferior vena cava should be considered in young patients who present with deep vein thrombosis of the femoral and iliac veins. Coagulation abnormalities, frequently found in these patients, may be a contributory factor.
Adult↗
Extrapleural hematoma as an unexpected finding on a follow-up chest X-ray after coronary surgery.
We present two cases of an extrapleural hematoma, on a follow-up chest X-ray after coronary artery bypass surgery using an internal mammary artery (IMA). In both cases, the finding was disclosed on a routine chest film obtained 1 month post-operatively, in a patient who was either asymptomatic or had nonspecific symptoms. Follow-up chest films showed spontaneous resolution in both patients. We emphasize the recognition and significance of such a self-limited post-operative radiological finding.
Aged↗
Pictorial review. CT of duodenal pathology.
This pictorial review presents the CT findings in different pathological entities of the duodenum. The aim of the article is to demonstrate the contribution of a common imaging modality, i.e. abdominal CT, in the diagnosis of various duodenal disorders.
Adult↗
Pictorial review: adult intussusception--a CT diagnosis.
Intussusception, usually thought of as a childhood condition, may be encountered in adults as well, and is then more often associated with underlying pathology. While the condition is mostly unsuspected clinically, as patients present with non-specific abdominal pain that is often of long duration, CT findings are characteristic. Examples are shown of intussusception both in the small bowel and colon. Awareness of these findings allows the radiologist to make the correct diagnosis.
Adult↗
CT diagnosis of afferent loop syndrome.
OBJECTIVE: To report the computed tomography (CT) features of afferent loop syndrome which is often clinically unsuspected. MATERIALS AND METHODS: The CT studies of five patients with afferent loop syndrome were reviewed. These patients had undergone gastroenterostomy and other surgical procedures, for malignant neoplasms in four and for peptic ulcer in one. Patients presented between 4 months and 15 years (average 5.5 years) after surgery. Symptoms were acute in all patients, the most common symptom being abdominal pain. In addition three of the patients had chronic symptoms including recurrent episodes of abdominal pain, recurrent ascending cholangitis, jaundice and bilious vomiting. RESULTS: The obstructed afferent loop appeared on CT as a fluid-filled tubular mass with an average diameter of 5.3cm. Valvulae conniventes were identified in all, and small intraluminal air bubbles in four. The dilated afferent loop was opacified with oral contrast material in only one patient. The loop was located in the subhepatic area in three patients and crossed the midline between the aorta and the superior mesenteric vessels in the other two. Additional findings included biliary dilatation in all five patients and signs of pancreatitis in one. Treatment was surgical in four patients (delayed for four months in one) and conservative in one. CONCLUSION: A fluid-filled tubular structure containing small air bubbles in the right upper quadrant or crossing the midline on CT in symptomatic patients after gastroenterostomy is characteristic of a dilated, possibly obstructed, afferent loop. The diagnosis is often not suspected clinically since patients may present many years after the initial surgery. Recognition of the characteristic CT findings will avoid both inappropriate procedures such as aspiration or drainage of an obstructed afferent loop and delay in treatment.
Abdominal Pain↗
CT findings of the chest in adults with aspirated foreign bodies.
The aim of this study was to assess the imaging findings in adult patients with tracheobronchial foreign body aspiration. Nineteen patients (11 men and 8 women; age range 26-89 years) with foreign-body aspiration were retrospectively reviewed. Nine patients were outpatients with non-specific symptoms and ten were hospitalized with nonresolving pneumonia (n = 6), after detection of a dental fragment on a chest radiograph following intubation (n = 3), and there was one mentally retarded patient with empyema. An aspirated dental fragment was seen on a chest radiograph in 3 patients and an endobronchial foreign body on CT in 16, appearing as a dense structure within the bronchial lumen. The foreign body was right sided in 14 cases and left sided in 5. Three cases were missed at first interpretation. Associated findings on CT were volume loss, hyperlucency with air trapping and bronchiectasis in the affected lobe. Thirteen patients were managed with bronchoscopy, whereas 2 needed thoracotomy. In 1 patient bronchoscopy failed to detect a foreign body, indicating a false-positive CT diagnosis. One patient expelled an aspirated tablet and two refused invasive procedure. The foreign bodies found mainly were bones and dental fragments. A high clinical suspicion is necessary to diagnose a foreign body. Since CT is often used to evaluate various respiratory problems in adults, it may be the first imaging modality to discover an unsuspected aspirated foreign body in the bronchial tree.
Adult↗
Renal duplication with associated complications in adults: CT findings in 26 cases.
AIM: To review the computed tomography (CT) findings in 26 adult patients with complicated renal duplication, and to assess whether the complications were anomaly-related or superimposed by acquired disease. MATERIALS AND METHODS: Fifteen women and 11 men, aged 17-83 years took part in the study. All CT studies were reviewed to define the moieties affected. RESULTS: The duplication was unilateral in 18 cases and bilateral in six, one patient had a single left kidney and the remaining one a horseshoe kidney. In 14 patients the pathology was related only to the anomaly. Upper pole abnormalities were seen in 13 patients (seven related to the anomaly) and lower pole abnormalities in five (all related to duplication). Both systems were affected in eight cases, six of them by pathological processes unrelated to duplication. Hydronephrosis of the affected collecting system was the most common imaging finding. CONCLUSION: Computed tomography is often used to evaluate abdominal conditions in adults and may therefore be the first imaging modality to reveal a duplex kidney complicated by a pathological process. Involvement of only one moiety was frequently related to the duplication, with a predilection for the upper moiety, while involvement of both systems was used unrelated to the duplication. Zissin, R. (2001). Clinical Radiology, 56, 58-63.
Adolescent↗
Primary serous papillary carcinoma of the peritoneum: CT findings.
AIM: To describe the computed tomography (CT) findings of primary serous papillary carcinoma of the peritoneum. MATERIAL AND METHODS: The clinical data and imaging studies of 36 women aged 37-85 years with primary papillary serous carcinoma of the peritoneum were retrospectively evaluated. Twenty-seven patients presented with general abdominal complaints; all had elevated levels of CA-125. Thirty-two women were post-menopausal, four had had bilateral salpingo-oophorectomy. RESULTS: The most common findings on pre-operative abdominal CT, performed in 30 patients, were a variable amount of ascites (n = 29), omental involvement (n = 28), irregular parietal peritoneum thickening (n = 22) and mural thickening of the sigmoid colon (n = 10). Thoracic findings included enlarged cardiophrenic nodes (n = 15) and pleural effusion (n = 11). Six patients had unilateral or bilateral adnexal masses of soft tissue density, which proved to be surface serous papillary carcinoma. CONCLUSION: Diffuse peritoneal disease on CT in patients with normal-sized ovaries or following bilateral salpingo-oophorectomy, with elevated level of serum CA-125, but without an identifiable primary tumour, should suggest the diagnosis of primary serous papillary carcinoma of the peritoneum. Associated adnexal masses or focal bowel wall thickening may be seen, representing surface involvement by this tumour.
Adult↗
Minimal pelvic fluid in blunt abdominal trauma in children: the significance of this sonographic finding.
PURPOSE: The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid after blunt abdominal trauma in children as a predictor of an abdominal organ injury. METHODS: The clinical and imaging data of 183 children with blunt abdominal trauma were reviewed retrospectively. All children had an abdominal sonography as the primary screening study. The ultrasound results were divided into 3 groups: group A, normal examination; group B, pelvic fluid only; group C, peritoneal fluid outside the pelvis. The results of the initial ultrasound examinations were compared with the findings of the CT scan, or a second ultrasound examination or the clinical course during the hospitalization. RESULTS: Group A included 87 children; group B, 57, and group C, 39. Four abdominal organ injuries were missed by the ultrasound examination. The sensitivity and specificity of the ultrasound examinations to predict organ injury in presence of peritoneal fluid outside the pelvis were, respectively, 89.5% and 96.6%; the positive and negative predictive value were 87.2% and 97.3%. No statistically significant difference was seen between group A and group B, whereas the presence of peritoneal fluid outside the pelvic cavity (group C) was associated strongly with an organ injury (P <.001). CONCLUSIONS: A normal ultrasound examination or the presence of pelvic fluid are associated with a low probability of an organ injury. In the presence of peritoneal fluid outside the pelvis, the probability of an organ injury is very high.
Abdominal Injuries↗
Pyelocalyceal diverticulum: the imaging spectrum with emphasis on the ultrasound features.
Clinical and imaging data of 11 patients with pyelocalyceal diverticulum were retrospectively examined. Four patients suffered from ipsilateral flank pain, one from recurrent urinary tract infection and the other six from unrelated symptoms. All patients underwent ultrasound as the initial imaging study. In two cases ultrasound was the only examination performed. Additional imaging studies were obtained in the other nine patients (abdominal radiography in six cases, intravenous urography (IVU) in five and CT in four). Ultrasound suggested the diagnosis of pyelocalyceal diverticulum in eight cases owing to the presence of echogenic and mobile material within the cyst-like lesion. In three cases the ultrasound appearance was similar and indistinguishable from a simple cyst and the diagnosis was made by another imaging study IVU in two cases and CT in one). We suggest that ultrasound examination is the best imaging method for the diagnosis of a pyelocalyceal diverticulum, and no further imaging modalities are required when mobile echogenic material is seen. In uncertain cases, another relatively inexpensive imaging study should be added such as abdominal radiography or IVU.
Abdominal Pain↗
Torsion of a normal ovary in a post-pubertal female: unenhanced helical CT appearance.
This case report presents the CT features of torsion of normal adnexa in an adult woman. Unenhanced helical CT, initially performed for clinically suspected acute ureterolithiasis, established the diagnosis.
Acute Disease↗
CT findings in congenital anomalies of the spleen.
There is a wide range of congenital anomalies of the spleen. Some are common, such as splenic lobulation and accessory spleen. Other less common conditions, such as wandering spleen and polysplenia, have particular clinical significance. Radiologists need to be aware of the various congenital variants of the spleen in order to recognize clinically important anomalies and to avoid mistaking less significant ones for an abnormality. In this pictorial review, the embryology of congenital anomalies of the spleen as well as their appearance on CT are described, diagnostic pitfalls are identified and complications of the anomalies are discussed.
Choristoma↗
Strangulated small bowel obstruction related to chronic torsion of an epiploic appendix: CT findings.
The role of CT in the evaluation of patients with small bowel obstruction, with emphasis on the findings of strangulating obstruction, has been extensively described in the literature. We report a rare case of small bowel volvulus related to a heterogeneous abdominal mass detected on CT. On microscopic examination the mass proved to be a chronically torted epiploic appendix.
Aged↗
[Pseudomembranous colitis: clinical, endoscopic and radiological correlation--a 2-year experience].
The incidence rates of pseudomembranous colitis are rising. Early diagnosis and treatment are required for management of this potentially life-threatening disease. This report outlines our 2-year experience (1997-1998) at the gastrointestinal institute with 43 patients diagnosed with pseudomembranous colitis and describes the clinical course and imaging studies. The group consisted of 25 women and 18 men, aged 34-93 years (mean: 67). Thirty-nine patients were treated with antibiotics. Twelve patients were referred directly to an endoscopic examination with a presumed clinical diagnosis of pseudomembranous colitis (diarrhea, fever and abdominal pain) that was confirmed by colonoscopy. Thirty-one were referred to colonoscopy following abdominal imaging performed to clarify cause of fever and abdominal pain. Twenty-nine patients had an abdominal CT, one had an US and one a barium follow-through. The CT finding suggesting pseudomembranous colitis included colonic mural thickening in 28 patients (71% diffuse versus 29% segmental colitis), with an average wall thickness of 16 mm. Sixteen patients (59%) had pericolonic fat changes and 15 patients (51%) had ascites. All of these patients, except one, had endoscopic findings consistent with pseudomembranous colitis. Five patients (11.6%) died due to the severe PMC. To conclude, as an abdominal CT is often performed in the acutely ill patient, it may arouse the diagnosis of pseudomembranous colitis in the proper clinical setting. Such a suspected diagnosis justifies endoscopic evaluation, which is the most reliable diagnostic examination.
Adult↗
Computerized tomography findings of abdominal tuberculosis: report of 19 cases.
BACKGROUND: Abdominal tuberculosis usually presents with general symptoms and obscure abdominal complaints for which computerized tomography is often the first imaging study. OBJECTIVE: To evaluate the CT findings of abdominal tuberculosis. METHODS: The CT scans of 19 patients (10 men and 9 women aged 20-85 years) with proven abdominal tuberculosis were retrospectively reviewed to define the location and extent of the disease. The patients were referred for the study mainly with general systemic symptoms. Additional abdominal complaints were present in four, including acute abdomen in one. Two had symptoms deriving from the urinary tract. Nine patients had recently arrived from high prevalence countries; five of them and two others were positive for human immunodeficiency virus. Three patients had a family history of tuberculosis; one had previously been treated for tuberculosis and four others had an underlying chronic disease. The diagnosis of tuberculosis was established by standard microbiological and histological techniques. RESULTS: We divided the disease manifestations into intraperitoneal (n = 13) and genitourinary involvement (n = 6). Peritoneal tuberculosis was fairly common, characterized by ascites, omental and mesenteric infiltration, and smooth thickening of the parietal peritoneum. One oncology patient had a false positive Tc-99m CEA isotope scanning, suggesting tumor recurrence. Genitourinary disease manifested mainly as hydronephrosis and calcifications. Three patients had pulmonary tuberculosis as well. CONCLUSION: The CT findings of abdominal tuberculosis may mimic various diseases, mainly diffuse peritoneal malignancy. We emphasize the need to consider tuberculosis in the differential diagnosis in patients with obscure abdominal symptoms, especially with multi-organ involvement. A high degree of clinical suspicion and familiarity with the abdominal CT manifestations allow early diagnosis of this treatable disease.
Adult↗
Elastofibroma dorsi: CT appearance.
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Aged↗