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PubMed1993

CT in abdominal and pelvic trauma.

Computed tomography (CT) is valuable in the evaluation of the abdomen and pelvis in victims of blunt trauma and stab wounds to the back if their condition is stable or if results of their physical examination are unreliable (eg, due to altered mental status). The appearance of blood at CT depends on window width, hematocrit, physical state of blood, use of intravenous contrast material, and attenuation of adjacent organs. Rapid infusion of contrast material improves visualization of hematoma. CT is most useful in evaluating injuries to the spleen, liver, pancreas, kidney, duodenum, and small and large bowel. Although CT can be accurate in demonstrating lacerations and hematoma, radiologists must beware of pitfalls in the CT diagnosis of splenic injuries (normal lobulation or cleft within the spleen, elongation of the left hepatic lobe, adjacent unopacified bowel loop, previous splenic infarct), hepatic injuries (beam-hardening artifact from adjacent ribs, air-contrast level in the stomach), and pancreatic injuries (streak artifacts from nasogastric tubes, folding of the pancreas, misinterpretation of adjacent structures, pancreatic contusion or hematoma, intrinsic elasticity of the pancreas). Delayed scanning or scanning with slow infusion rates may also obscure hematoma. Knowledge of the various appearances of the posttraumatic abdomen and pelvis on CT scans is essential for prompt and effective treatment of patients.

Abdominal Injuries↗
PubMedDate not supplied

Transcatheter arterial chemoembolization for hepatocellular carcinoma: anatomic and hemodynamic considerations in the hepatic artery and portal vein.

Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver. Although several therapeutic options have been advocated, transcatheter arterial chemoembolization (TACE) in particular has been widely performed in the treatment of HCC. Still, hepatic arteriography and portography are mandatory for evaluation of (a) the resectability and multiplicity of HCCs and (b) the hemodynamic status of the portal vein. Thereafter, TACE can be considered as the initial therapeutic modality. The possibility of nontarget organ complications during TACE (eg, ischemic cholecystitis, splenic infarction, gastrointestinal mucosal lesions, pulmonary embolism and infarction, spinal cord injury, ischemic skin lesions) should be taken seriously. A thorough understanding of the anatomic variants and hemodynamic features of the hepatic artery and portal vein is the first step in performing effective and safe TACE for HCC.

Antineoplastic Agents↗
PubMed1992

Gaucher disease: abdominal MR imaging findings in 46 patients.

Abdominal magnetic resonance imaging findings were reviewed in 46 patients with Gaucher disease. All patients had hepatosplenomegaly at the time of initial imaging. Splenic nodules were present in 14 patients (30%) and varied in signal intensity. These nodules were isointense on T1-weighted and hypointense on T2-weighted images. Splenic infarcts were seen in 15 patients (33%), and four of these patients (9%) also had subcapsular fluid collections. Both nodules and infarcts were present in the spleen in four patients (9%). Pathologic correlation was performed with specimens from two patients who underwent partial splenectomy. Focal areas of abnormal signal intensity were noted in the liver in nine patients (20%). They were either stellate or segmental, and may represent fibrotic septa with ischemic changes associated with aggregates of Gaucher cells. No changes were noted in the kidneys or abdominal lymph nodes.

Adolescent↗
PubMed1996

Acute mesenteric ischemia: diagnosis with contrast-enhanced CT.

PURPOSE: To evaluate the accuracy of dynamic, contrast material-enhanced computed tomography (CT) in the diagnosis of acute mesenteric ischemia. MATERIALS AND METHODS: Reviewers blinded to patient diagnoses retrospectively compared the CT scans in a study group with those in a control group. The study group comprised 39 consecutive patients (23 men, 16 women; aged 55-88 years) with surgically proved acute mesenteric ischemia. The control group comprised 24 patients (13 men, 11 women; aged 50-82 years) with suspected acute mesenteric ischemia that was disproved at surgery. RESULTS: For the diagnosis of acute mesenteric ischemia, each of the following findings had a specificity of more than 95% and a sensitivity of less than 30%: arterial or venous thrombosis, intramural gas, portal venous gas, focal lack of bowel-wall enhancement, and liver or splenic infarcts. When CT was used in the diagnosis of suspected acute mesenteric ischemia, the detection of at least one of these signs resulted in a sensitivity of 64% (25 of 39; confidence interval, 0.49, 0.79), a specificity of 92% (22 of 24; confidence interval, 0.81, 1.00), and an accuracy of 75% (47 of 63; confidence interval, 0.64, 0.86). CONCLUSION: Dynamic, contrast-enhanced CT is a valuable tool in the diagnosis of and determination of prognosis in acute mesenteric ischemia.

Acute Disease↗
PubMed1995

bcr-abl hybrid messenger RNA in a patient with Philadelphia-negative essential thrombocythemia.

We describe a case of Philadelphia-negative essential thrombocythemia in whom bcr-abl hybrid messenger RNA was detected. The patient suffered from frequent splenic infarctions and myelofibrosis. Interestingly, a transformation to acute leukemia which was commonly seen in patients with bcr-abl-positive chronic myelogenous leukemia did not occur until he died from heart failure due to severe anemia 8 years after the diagnosis. The heterogeneity of bcr-abl-positive thrombocythemia is emphasized.

Fusion Proteins, bcr-abl↗
PubMed2005

Visceral leishmaniasis: diagnosis by ultrasound-guided fine needle aspiration of an axillary node.

A 77-year-old woman presented with fever up to 39 degrees C and acute pain in the left upper quadrant and renal fossa. Full blood count and biochemical screen revealed a haemoglobin (Hb) of 9.8 g dl(-1), an increased erythrocyte sedimentation rate and an elevated lactate dehydrogenase, all other parameters were normal. Thoracic and abdominal CT demonstrated two enlarged lymph nodes in the left axilla, and splenic infarcts. Ultrasound-guided fine needle aspiration of one of the axillary lymph nodes revealed macrophages filled with leishmanias.

Aged↗
PubMed1991

Left-sided pleural effusion secondary to splenic vein thrombosis. A previously unrecognized relationship.

The association of left-sided pleural effusion and subcapsular splenic hematoma was reported in 1980. We describe a patient in whom a left-sided pleural effusion resulted from splenic vein thrombosis, a relationship not previously reported. Splenectomy was performed, demonstrating the spleen to be enlarged and hemorrhagic. The pleural effusion did not recur after splenectomy. The three effusions due to splenic hematomas reported previously cleared only after splenectomy, suggesting splenectomy may be necessary to prevent reaccumulation. We propose possible pathophysiologic mechanisms and recommend that splenic vein thrombosis be considered in the differential diagnosis of unexplained left-sided pleural effusions.

Aged↗
PubMed1994

Aortic mural thrombus presenting as pseudovasculitis.

Three months after splenic infarct, a 50-year-old woman underwent arteriography for persistent low-grade fever and abdominal complaints. After 5 months of corticosteroid therapy for "polyarteritis nodosa," another arteriogram confirmed embolic disease; transesophageal echocardiography (TEE) showed a pedunculated mobile thrombus in the aortic arch. We suggest this represents "pseudovasculitis" from an aortic thrombus.

Aorta, Thoracic↗
PubMed2004

Gastric wall necrosis from organo-axial volvulus as a late complication of laparoscopic gastric banding.

We present a case of massive gastric wall necrosis associated with volvulus of the stomach occurring 17 months after laparoscopic gastric banding. The 19- year-old female was admitted to our hospital with acute abdominal pain with rapid deterioration from massive necrosis of a distended stomach which perforated distal to the gastric band, accompanied by splenic infarction. Total gastrectomy and spenectomy were required. We present this very rare complication which should be recognized and treated early, so that a less drastic operation is possible.

Adult↗
PubMed1996

Nonbiliary laparoscopic gastrointestinal surgery: role of CT in diagnosis and management of complication.

OBJECTIVE: Laparoscopic techniques are evolving for a wide range of surgical procedures outside the biliary tree. We describe the CT findings of important complications detected after nonbiliary laparoscopic gastrointestinal surgery and the role of CT in their management. MATERIALS AND METHODS: Over a 3-year period, 209 patients had nonbiliary gastrointestinal laparoscopic procedures (partial or total colectomy, splenectomy, Nissen fundoplication, lymph-node dissection, herniorrhaphy, appendectomy, and exploratory laparoscopy). Thirty-seven abdominopelvic CT studies were performed on 18 (9%) of these patients for complications after surgery. In all cases CT findings were reviewed and correlated with follow-up surgical, clinical, or interventional radiologic findings. RESULTS: Fourteen major complications were detected on CT in 12 of 18 (67%) patients who had undergone partial or total colectomy (6/25, 24%), splenectomy (4/41, 10%), appendectomy (1/15, 7%), or lymph-node dissection (1/43, 2%). These complications included seven abscesses (three of the splenic bed, two of the pelvis, one of the liver, and one of the abdominal wall). The remaining complications were four hematomas (two in the abdominal wall caused by trocar site bleeding, one intraperitoneal, and one retroperitoneal), one case of colon perforation, one case of pancreatitis, and one case of splenic infarction. Percutaneous abscess drainage was performed successfully in seven patients, using CT guidance in six. Six patients had negative CT studies. CONCLUSION: Major complications may occur after complex nonbiliary laparoscopic procedures and are probably related to lack of experience with new surgical techniques. In this study, such complications occurred most often after laparoscopic colectomy and splenectomy. CT valuable in their diagnosis and in the management of abscess collections.

Adult↗
PubMed2006

Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus.

CASE DESCRIPTION-An 8-year-old castrated male German Shepherd Dog was evaluated because of abdominal distension, retching, and vomiting. CLINICAL FINDINGS-Gastric dilatation-volvulus was suspected on the basis of the dog's signalment, history, clinical signs, and results of clinicopathologic analyses and abdominal radiography. Celiotomy was performed, and gastric dilatation-volvulus was confirmed along with splenomegaly. Gastric invagination was performed over an area of gastric necrosis. The dog was reevaluated 21 days later after an episode of collapse. Findings of physical examination and clinicopathologic analyses were suggestive of internal hemorrhage. Abdominal ultrasonography and subsequent celiotomy revealed severe gastric ulceration at the gastric invagination site, splenic torsion, and a focal splenic infarct. TREATMENT AND OUTCOME-Splenectomy and gastrectomy of the necrotic tissue were performed. The dog was discharged from the hospital, and the owner was instructed to administer gastroprotectants and feed the dog a bland diet. The dog was reported to be healthy 3.25 years after surgery. CLINICAL RELEVANCE-Findings suggest that complications associated with the gastric invagination procedure include severe gastric ulceration that may require subsequent surgery. Prolonged treatment with gastroprotectants following gastric invagination surgery may be necessary to avoid gastric ulceration in dogs.

Animals↗
PubMed1995

Babesiosis in Wisconsin: a potentially fatal disease.

Babesiosis is emerging as an important tick-borne zoonosis in the United States. Most reported cases of this parasitic disease have been acquired in the Northeast. To date, only two clinical cases of Babesia microti infection acquired in the upper Midwest have been described. We report eight more cases. Most if not all of the 10 total cases probably were acquired in northwestern Wisconsin. Three cases (30% of 10) we now report were fatal and occurred in elderly patients (65-75 years old) who died after complicated hospital courses. One patient probably had had a latent Babesia infection that activated because of immunosuppression attributable to high-dose corticosteroid therapy and to splenic infarctions caused by cholesterol emboli. All three fatal cases were diagnosed incidentally and highlight the importance of considering the diagnosis of babesiosis in febrile patients who have been in babesiosis-endemic areas; examining their blood smears carefully; and treating promptly with clindamycin and quinine, and, if indicated, exchange transfusion. Medical personnel should be knowledgeable about this zoonosis, which is not limited to the northeastern United States, and is potentially serious, sometimes fatal.

Aged↗
PubMed2001

Pathology of brucellosis in bison from Yellowstone National Park.

Between February 1995 and June 1999, specimens from seven aborted bison (Bison bison) fetuses or stillborn calves and their placentas, two additional placentas, three dead neonates, one 2-wk-old calf, and 35 juvenile and adult female bison from Yellowstone National Park (USA) were submitted for bacteriologic and histopathologic examination. One adult animal with a retained placenta had recently aborted. Serum samples from the 35 juvenile and adult bison were tested for Brucella spp. antibodies. Twenty-six bison, including the cow with the retained placenta, were seropositive, one was suspect, and eight were seronegative. Brucella abortus biovar 1 was isolated from three aborted fetuses and associated placentas, an additional placenta, the 2-wk-old calf, and 11 of the seropositive female bison including the animal that had recently aborted. Brucella abortus biovar 2 was isolated from one additional seropositive adult female bison. Brucella abortus was recovered from numerous tissue sites from the aborted fetuses, placentas and 2-wk-old calf. In the juvenile and adult bison, the organism was more frequently isolated from supramammary (83%), retropharyngeal (67%), and iliac (58%) lymph nodes than from other tissues cultured. Cultures from the seronegative and suspect bison were negative for B. abortus. Lesions in the B. abortus-infected, aborted placentas and fetuses consisted of necropurulent placentitis and mild bronchointerstitial pneumonia. The infected 2-wk-old calf had bronchointerstitial pneumonia, focal splenic infarction, and purulent nephritis. The recently-aborting bison cow had purulent endometritis and necropurulent placentitis. Immunohistochemical staining of tissues from the culture-positive aborted fetuses, placentas, 2-wk-old calf, and recently-aborting cow disclosed large numbers of B. abortus in placental trophoblasts and exudate, and fetal and calf lung. A similar study with the same tissue collection and culture protocol was done using six seropositive cattle from a B. abortus-infected herd in July and August, 1997. Results of the bison and cattle studies were similar.

Abortion, Veterinary↗
PubMed1999

[Primary myelofibrosis with fatal mesenteric arterial thromboembolism caused by antiphospholipid syndrome].

A 60-year-old woman was admitted to our hospital in February 1993 due to dizziness, dyspnea, abdominal pain, and high susceptibility to bleeding. Physical examination revealed livedo reticularis of the foot, but did not detect hepatosplenomegaly. Examination of the peripheral blood detected pancytopenia, leukoerythroblastosis, and tear-drop erythrocytes. Primary myelofibrosis (PMF) was diagnosed on the basis of bone marrow biopsy findings. Antiphospholipid syndrome (APS) was confirmed by positive response to anti-cardiolipin antibody and recurrent splenic infarction. Because of factor XIII deficiency, the patient experienced severe gingival bleeding after tooth extraction. Her condition was complicated by mesenteric arterial thromboembolism and she died of sepsis 5 years after onset. Although the incidence of immunopathy in PMF patients is high, few studies to date have focused on APS patients presenting with a variety of severe embolic symptoms. Our patient required careful monitoring due to bleeding tendency and thromboemboli.

Antiphospholipid Syndrome↗
PubMed1999

Cutaneous manifestation of left atrial myxoma.

A 53-year-old woman had a left hemiplegia with suspicion of cerebral metastases. Thoracic and abdominal computed tomography revealed renal and splenic infarction features and she presented violaceous papulosis on her fingers corresponding to thrombosis of dermal vessels. Echocardiography showed a left atrial tumor evoking myxoma. The clinical features of left atrial myxomas are intracardiac obstruction, extracardiac embolism and general symptoms. Cutaneous manifestations are frequently reported and can correspond to cutaneous manifestations of emboli, symptoms related to auto-immune disorders and specific cutaneous findings that suggest atrial myxoma as part of more complex syndromes.

Female↗
PubMed2000

[Differential diagnosis and therapy of acute abdomen in sickle cell crisis. A rare case in visceral surgery].

Surgical therapy of the acute abdomen often allows only limited time for differential diagnosis to confirm the indication for surgery. Under consideration of clinical aspects and case history both common and rare causes of an acute abdomen should be investigated without undue loss of time. Differential diagnostic considerations and eventual therapy are presented in the following case of a 25-year-old Afro-american who developed multiorgan failure after an initial course of lower-back pain. In addition to the clinical setting of an acute abdomen the patient presented with acute respiratory failure and laboratory signs of severe hemolysis in combination with newly detected splenomegaly. The indication for splenectomy was made following CT-proven complete splenic infarction due to repeated acute squestration. Histologic examination of the spleen together with hemoglobin electrophoresis confirmed the clinical assumption of unusually late primary manifestation of a sickle cell crisis. In the underlying case, the hemoglobinopathy was in fact the less common form of combined sickle-cell-beta-thalassemia. A ten-day course of intensive care therapy was necessary to treat ongoing multiorgan failure due to persistent sickle cell crisis. Current diagnostic and therapeutic procedures in connection with sickle cell crisis as a rare cause of an acute abdomen with the necessity for surgical intervention are presented.

Abdomen, Acute↗