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PubMed1992

Guidelines for rapid assessment of abdominal pain indicative of acute surgical abdomen.

Abdominal pain is one of the most frequently described reasons for ambulatory visits. The complaint of abdominal pain requires an orderly and thorough approach because even mild or non-specific pain can denote a potentially life-threatening intra-abdominal pathology. The majority of patients with acute abdomen can be diagnosed by a direct and concise history, and a thorough physical examination supplemented by simple laboratory and radiologic testing. This article includes key history, physical and clinical indicators that should suggest to the clinician the need for immediate surgical intervention. When an acute abdomen is suspected, the goal of patient management is to rapidly and accurately diagnose the patient preoperatively, and to provide a timely referral to the appropriate surgeon or gynecologist.

Abdomen, Acute↗
PubMed2003

B-flow, a non-Doppler technology for flow mapping: early experience in the abdomen.

B-flow imaging is a non-Doppler technology for blood flow imaging that was introduced on high-frequency transducers at the end of the last decade. It has only recently become available on convex array and sector transducers suitable for abdominal examination. B-flow technology is not plagued by some of the troublesome pitfalls often encountered during color and power Doppler flow imaging, and appears promising as an adjunct to Doppler evaluation of blood flow in the abdomen. This article introduces the author's early experience using B-flow in the abdomen, and illustrates the potential advantages this technique offers relative to Doppler flow mapping.

Abdomen↗
PubMed2005

Neurological manifestations of an acute abdomen in children.

The acute abdomen in the pediatric age group is not infrequently fraught with diagnostic pitfalls. The younger the patient, the more problematic the presentation can be. Among the more unusual manifestations of an acute abdomen is an apparent encephalopathic picture. We present 2 cases which serve to illustrate the diagnostic difficulties encountered.

Abdomen, Acute↗
PubMed2006

Multishot diffusion-weighted PROPELLER magnetic resonance imaging of the abdomen.

OBJECTIVE: The objective of this study was to evaluate the feasibility of using multishot PROPELLER for diffusion-weighted imaging (DWI) of the abdomen. MATERIALS AND METHODS: Diffusion-weighted abdominal imaging was performed in 9 healthy volunteers and 3 patients using both single-shot DW-SE-EPI and multishot DW-PROPELLER (BLADE sequence). We compared ADC measurements in phantoms, liver and pancreatic tissues and performed qualitative comparisons of the diffusion-weighted images and ADC maps provided by these 2 techniques. RESULTS: DW-PROPELLER significantly improved image quality (P < 0.05) with reduced geometric distortion and artifact. The ADC values of phantoms and abdominal organs measured by DW-PROPELLER were generally greater than those measured by single-shot DW-SE-EPI. The ADC values measured by both DWI techniques were significantly different for liver tissues but not for pancreatic tissues (P < 0.05). Preliminary patient studies demonstrated clearly distinguished lesion areas from surrounding normal liver tissues in the DW-PROPELLER images. DW-PROPELLER offers the potential for high-resolution DWI of the abdomen. CONCLUSIONS: The multishot DW-PROPELLER sequence is a promising technique for DWI of abdominal organs. Future clinical studies will evaluate the use of DW-PROPELLER technique for abdominal oncologic imaging applications.

Abdomen↗
PubMed1991

The effect of subcutaneous injection site on absorption of human growth hormone: abdomen versus thigh.

OBJECTIVES: To investigate whether growth hormone (GH) absorption is site dependent. DESIGN AND MEASUREMENTS: Human growth hormone (hGH, Norditropin) 4 IU, was injected subcutaneously on two separate occasions: into the thigh on one occasion and into the abdomen on a second occasion. Blood was sampled for GH, insulin, glucose, non-esterified fatty acids and glycerol at baseline and hourly for 12 hours. Serum insulin-like growth factor I was measured at baseline, and after 12 and 24 hours. SUBJECTS: Eleven healthy young adults (8 M, 3 F). RESULTS: Following the injection serum GH had risen by 1 hour and peaked by 3-6 hours. The peak GH and growth hormone area under the curve were significantly higher after injection in the abdomen compared with the thigh (GH peak (mean +/- SEM) 103 +/- 20 vs 41 +/- 8 mU/l, P = 0.002 and GH area 528 +/- 86 vs 239 +/- 34 mU/l h, P = 0.003 respectively). Serum insulin-like growth factor I at 12 and at 24 hours showed a significant rise from the baseline level, but no significant difference was observed between the two injection sites. No significant difference in plasma insulin, glucose, non-esterified fatty acids or glycerol was observed between the two methods of injection. CONCLUSION: Subcutaneously injected GH is better absorbed from the abdominal site than from the thigh.

Abdomen↗
PubMed1994

Lymphoma syndrome leukemia revealed interesting finding on brain CT and ultrasound scan of abdomen at the initial presentation.

This paper reports on a patient with lymphoma syndrome leukemia (LSL) who showed interesting findings on brain computed tomography (CT) and ultrasound scans of the abdomen at the initial presentation. The patient was a 5 year old girl. When she was admitted to our hospital, there were many lymph nodes palpable. The abdomen was distended and the liver and spleen were palpable below the umbilicus. Hematologic examinations revealed a leukocyte count of 275,800/microL with 98% lymphoblasts. Chest X-ray film revealed a mediastinal mass. The diagnosis of LSL was made. Her brain CT scan showed a low density area in the right thalamic region without contrast enhancement; infarction was suspected. Furthermore, her abdominal ultrasound scan showed hepatosplenomegaly, kidney swelling with increasing echogenicity and hydronephrosis and stones in the renal pelvis and bladder. These findings are unprecedentedly rare in cases of childhood acute lymphoblastic leukemia (ALL), much less in LSL.

Abdomen↗
PubMedDate not supplied

Normal cross-sectional anatomy of the feline thorax and abdomen: comparison of computed tomography and cadaver anatomy.

Computed tomographic images of two adult domestic short-haired cats were obtained with a whole body scanner. Images of the thorax and abdomen were compared with cross-sectional anatomy cadaver specimens from the same two cats. Anatomic structures were first identified on the cadaver specimens with the aid of numerous anatomy texts and references and were then identified and labeled on the computed tomographic images. Results from this project provide an atlas of normal cross-sectional gross and CT anatomy of the feline thorax and abdomen that can be used in the interpretation of any cross-sectional imaging modality.

Abdomen↗
PubMedDate not supplied

Magnetic resonance imaging of the normal feline abdomen: an anatomic reference.

Magnetic resonance images of two adult domestic short-haired cats were obtained with a whole body scanner. Images of the abdomen were compared with cross-sectional anatomy cadaver specimens from the same two cats. Anatomic structures were first identified on the cadaver specimens with the aid of anatomy texts and references and were then identified and labeled on the magnetic resonance images. Results from this project provide an atlas of normal cross-sectional MRI anatomy of the feline abdomen.

Abdomen↗
PubMedDate not supplied

Evaluation of the abdomen using ultrasound following a ventral midline celiotomy.

Over the last 20 years, ultrasound has become a useful diagnostic tool in veterinary medicine. The purpose of this study was to use ultrasonographic examinations to determine if intra-abdominal contents could be visualized. Nineteen dogs, ranging from 8 months to 18 years of age were included. Each animal was evaluated sonographically prior to surgery, 24 h after surgery, and then 2-6 weeks following the surgical procedure. The results of our study suggest that ultrasound is an effective means for evaluation of the abdomen and surgery site following surgery. Both the abdomen and surgery site were clearly visualized in all dogs. In addition, subjective evaluation of the intra-abdominal contents was performed. The limiting factor in this study was not the presence of air, as was expected. Rather the limiting factor for appropriate visualization was pain. The information obtained could prove to be useful to surgeons and radiologists in assessing a patient's status postoperatively.

Abdomen↗
PubMed1993

Acoustic impedance of the maternal abdomen.

Contact sensors to monitor fetal heart, breathing, and movement sounds with increased sensitivity and bandwidth are under development. To understand the inherent acoustical properties of the maternal abdomen and its interaction with these sensors, the driving-point impedance Z(j omega) was measured in nine women during their last trimester of pregnancy. An electromechanical shaker with a contact area of 2.85 cm2 produced abdominal vibrations between 10 and 500 Hz, and the resulting force and acceleration were measured. After digitally integrating the acceleration signal to obtain the velocity and removing the massive effects of the coupling between the shaker and the abdomen, Z(j omega) was estimated using spectral techniques. The imaginary part of Z(j omega) depicted a dominant compliance effect at low frequencies, a resonance at a frequency of 28 +/- 16 Hz (mean +/- s.d.), and a dominant mass effect at higher frequencies. The real part of Z(j omega) increased steadily with frequency. A series resistance-mass-compliance (R-M-C) circuit modeled these characteristics of Z(j omega) well when R was allowed to exactly mimic the frequency dependence of the real part of Z(j omega). Estimated element values of 6.6 +/- 2.2 x 10(-3) kg for M, 2.1 +/- 1.4 x 10(-3) m/N for C, and roughly 10 Ns/m for R (at resonance) were similar to those estimated for other body tissues such as the thigh but quite different from that of the often-studied chest wall.

Abdomen↗
PubMed1995

Areas of increased echogenicity in the fetal abdomen: diagnosis and significance.

Areas of increased echogenicity in the fetal abdomen are defined as abnormally bright areas with an echogenicity similar to that of surrounding bones. Such areas are encountered in various normal and abnormal processes. When increased echogenicity is discovered in the fetal abdomen, a careful search should be made for a potential cause. The causes to be considered depend on the location of the areas of increased echogenicity, which can be classified as intestinal, peritoneal, hepatic, retroperitoneal, and parietal. In each case, vascular, ischemic, infectious, tumoral, metabolic, and chromosomal abnormalities should be included in the differential diagnosis before considering the finding a normal variant. Therefore, in utero detection of fetal abdominal areas of increased echogenicity requires a complete sonographic survey of the fetus and placenta along with close sonographic follow-up, evaluation of familial factors, and testing for possible associated cystic fibrosis, infection, or a chromosomal anomaly. The prognosis depends more on the underlying disease than on the extent of the increased echogenicity.

Abdomen↗
PubMed2004

Sixteen-detector row CT of abdomen and pelvis: study for optimization of Z-axis modulation technique performed in 153 patients.

PURPOSE: To retrospectively determine the optimal noise indexes required to obtain diagnostically acceptable computed tomographic (CT) images of the abdomen and pelvis with z-axis modulation. MATERIALS AND METHODS: Ninety-five patients underwent 16-section multi-detector row CT of the abdomen and pelvis with z-axis modulation at noise indexes of 10.5, 11.0, 11.5, and 12.0 HU with 10-380 mA. Subsequently, 58 patients were scanned at noise indexes of 12.5 and 15.0 HU with 75-380 mA. The weights of all subjects were recorded, and transverse and anteroposterior diameters were measured. The CT images were evaluated for abnormalities and graded for image quality in terms of noise and diagnostic acceptability by using a five-point scale. Objective noise in the liver parenchyma was measured, and the tube current was recorded at each section in all 153 patients. Statistical analyses were performed to determine the appropriate noise index and to assess the effect of patient weight and abdominal diameters on image noise and diagnostic acceptability at different noise indexes. Tube current-time products (in milliampere seconds) at various noise indexes were compared with those at CT previously performed without z-axis modulation. RESULTS: No significant difference in subjective image noise or diagnostic acceptability was found at noise indexes of 10.5-15.0 HU (P =.14), and objective noise was significantly inferior only at a noise index of 15.0 HU (P =.009). Compared with CT scanning at a 10.5-HU noise index, CT scanning at 12.5- and 15.0-HU noise indexes yielded, respectively, 10.0% and 41.3% reductions in radiation exposure. Patient weight and abdominal diameters affected subjective image quality. CONCLUSION: Use of a 15.0-HU noise index at 75-380 mA results in acceptable subjective image noise and diagnostic acceptability but significantly greater objective image noise at routine abdominal-pelvic CT. For greater image quality demands, a noise index of 12.5 HU results in acceptable image quality and a 19.6% reduction in radiation exposure.

Abdomen↗
PubMed2005

Fungus-infected fluid collections in thorax or abdomen: effectiveness of percutaneous catheter drainage.

PURPOSE: To retrospectively evaluate the effectiveness of percutaneous catheter drainage in the treatment of fungus-infected fluid collections in the thorax or abdomen and to identify any factor that may be predictive of a poor clinical outcome. MATERIALS AND METHODS: Approval for this study was obtained from the hospital ethics subcommittee on human studies. Because the study was retrospective, patient informed consent was not required. This study was compliant with the Health Insurance Portability and Accountability Act. Retrospective analysis was performed of cases of fungus-infected fluid collections in the thorax or abdomen treated by using percutaneous catheter drainage in 60 patients (36 male and 24 female patients; mean age, 57 years; range, 2 months to 91 years) during 5 years. The patient medical records were reviewed to identify recognized factors for predisposition to fungal infection. The details of percutaneous catheter drainage and microbiologic findings were recorded. The technical success (ability of catheters placed to drain collections treated) and the clinical success (ability of patients to recover fully without surgery) of percutaneous catheter drainage were determined. A multifactor logistic regression analysis was performed to identify any clinical or microbiologic factor predictive of a poor clinical outcome. RESULTS: Seventy-three fungus-infected fluid collections were drained in 60 patients. The collections originated from the pleura (n = 6), mediastinum (n = 2), liver (n = 3), pancreas (n = 5), obstructed biliary or urinary tract (n = 9), gallbladder (n = 1), and abdominopelvic area (n = 47). The technical success rate for catheter drainage was 79% (41 of 52 patients); the clinical success rate, 57% (34 of 60 patients). Twenty (33%) patients died from all causes during hospital admission. Multifactor logistic regression analysis was used to identify predictors of a poor clinical outcome; complexity of collection, history of malignancy, and admission to intensive care unit were significant (P < .03) and independent predictors. CONCLUSION: Despite a moderately high technical success rate with percutaneous catheter drainage of fungus-infected fluid collections, clinical success rate was much lower. Both imaging appearance (complexity of collection) and clinical factors (history of malignancy, admission to intensive care unit) influenced prognosis.

Abdomen↗
PubMed2005

CT fluoroscopy-guided biopsy of the lung or upper abdomen with a breath-hold monitoring and feedback system: a prospective randomized controlled clinical trial.

PURPOSE: To prospectively determine the clinical effectiveness of a breath-hold monitoring and feedback system in computed tomographic (CT) fluoroscopy-guided biopsies in which respiratory motion is a problem. MATERIALS AND METHODS: Institutional review board approval and oral and written informed consent were obtained. This study was HIPAA compliant. A bellows-based system was used to monitor respiration and provide patient feedback. A randomized controlled clinical trial compared intermittent mode CT fluoroscopy-guided biopsies of the lung or upper abdomen performed with (n = 56) and without (n = 57) the bellows system. Inclusion criteria for 113 patients were lesions 6 cm or smaller in maximum dimension that were not affixed to the chest or abdominal wall. Primary outcome measurements were CT fluoroscopy exposure time and patient dose. Wilcoxon rank sum, chi(2), and Fisher exact tests were used for statistical analysis. RESULTS: Median CT fluoroscopy exposure time was 12.6 seconds (range, 2.4-44.4 seconds) for the bellows group and 18.0 seconds (range, 6.0-118.0 seconds) for the nonbellows group (P = .004). Patient dose was decreased in the bellows group (median dose, 29.5 mGy; range, 4.7-135.8 mGy) versus the nonbellows group (median, 41.3 mGy; range, 11.8-155.9 mGy) (P = .01). Lesions were accessed successfully with one needle puncture attempt in 43 of 56 patients (77%) in the bellows group and 30 of 57 patients (53%) in the nonbellows group (P = .007). Pneumothorax developed in 11 of 50 patients (22%) in the bellows group who underwent lung biopsy compared with 16 of 50 (32%) patients in the nonbellows group. CONCLUSION: A breath-hold monitoring and feedback system allows depiction of mobile target lesions throughout CT fluoroscopy-guided biopsy of the lung and upper abdomen.

Abdomen↗
PubMed1988

Motion artifact reduction in MR imaging of the abdomen: gradient moment nulling versus respiratory-sorted phase encoding.

Two currently available methods of reducing motion-induced artifact on magnetic resonance (MR) images, respiratory-sorted phase encoding (RSPE) and gradient moment nulling (GMN), were compared in images of the upper abdomen obtained with long repetition and long echo times. For ten subjects, two series of axial MR images were obtained with identical parameters except that RSPE was used in one and GMN in the other. Images were evaluated by three independent radiologists, and region-of-interest measurements were obtained to calculate signal-difference-to-noise ratios (SD/Ns) for liver versus gallbladder and liver versus the right kidney. Maximum ghost intensity and the standard deviation of motion-induced noise were also calculated. GMN was superior to RSPE for motion artifact reduction in all ten cases. The SD/N for liver versus both gallbladder and right kidney was significantly higher with GMN. Presaturation pulses applied outside the volume of interest reduced aortic and inferior vena cava signal and virtually eliminated artifact from these vessels but did not noticeably affect signal from intrahepatic vessels. GMN combined with presaturation pulses is a highly effective method of motion artifact reduction in the upper abdomen.

Abdomen↗
PubMed1991

Three-dimensional time-of-flight MR angiography: applications in the abdomen and thorax.

The application of three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiographic techniques to the vasculature of the abdomen and thorax has not, to the authors' knowledge, been previously reported; this is possibly due to the large amount of physiologic motion in these regions along with the anticipated sensitivity of the 3D acquisition scheme to image degradation caused by motion artifact. The authors describe an asymmetric short-echo velocity-compensated 3D TOF technique that minimized the effects of physiologic motion on image quality and provided rapid high-resolution 3D MR arteriograms of the abdomen and thorax. Contiguous 3D volumes were often combined to provide sufficient anatomic coverage. Benefits include high spatial resolution and minimization of signal loss; limitations include sensitivity to motion artifact and progressive spin saturation.

Abdomen↗
PubMed1993

Prospective comparison of T2-weighted fast spin-echo, with and without fat suppression, and conventional spin-echo pulse sequences in the upper abdomen.

PURPOSE: To evaluate use of fast spin-echo (FSE) magnetic resonance imaging with and without fat suppression in the liver and upper abdomen. MATERIALS AND METHODS: Conventional spin-echo (SE) T2-weighted, FSE T2-weighted, and fat-suppressed FSE T2-weighted images from 37 patients strongly suspected to have focal hepatic lesions were evaluated. RESULTS: Quantitative analysis demonstrated that fat-suppressed FSE imaging had the highest lesion-liver contrast-to-noise ratio; conventional SE imaging, the lowest. In a qualitative analysis, FSE imaging was preferred. In a rank order analysis, FSE imaging was preferred 83% of the time and fat-suppressed FSE imaging 17% of the time as regards overall image quality; fat-suppressed FSE imaging was preferred 64% of the time, FSE imaging 23% of the time, and conventional SE imaging 13% of the time as regards signal abnormality detection. CONCLUSION: FSE imaging with and without fat suppression is a potentially useful pulse sequence for evaluating the upper abdomen.

Abdomen↗
PubMed1999

Evaluation of a 10-minute comprehensive MR imaging examination of the upper abdomen.

PURPOSE: To determine whether a 10-minute magnetic resonance (MR) imaging examination of the upper abdomen provides sufficiently comprehensive information to replace a longer MR protocol. MATERIALS AND METHODS: Images obtained with selected breathing-independent and breath hold MR sequences, with 2 minutes of total acquisition time and an estimated 10 minutes of total study time, in consecutive MR examinations of the upper abdomen in 72 patients (age range, 23-87 years) were retrospectively reviewed in a blinded fashion by two separate interpreters. Determination was made of major and minor findings, and the two separate retrospective interpretations and the prospective clinical interpretation were correlated by using kappa statistics. Surgical and clinical findings were also correlated with imaging findings. RESULTS: In 61 patients, all major and minor findings were identical in the original clinical interpretation and the two retrospective readings. In 66 patients, the major findings were identical in these three readings. Close agreement was present between the two separate retrospective readings and the prospective clinical interpretation (kappa = 0.49-1.00). CONCLUSION: The findings suggest that the diagnostic information provided by a shortened MR imaging protocol that includes breath-hold and breathing-independent sequences is in close agreement with lengthier MR protocols. The advantages of a shortened protocol include increased patient throughput and decreased study cost.

Abdomen↗