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PubMed2001

Adult neuroblastoma of the retroperitoneum and abdomen: clinicopathologic distinction from primitive neuroectodermal tumor.

Adult neuroblastoma (ANB) is a rare and poorly recognized entity among a histologically defined group of small, round-cell tumors arising in the retroperitoneum and abdomen. Eight cases of ANB were compared with seven cases of primitive neuroectodermal tumor (PNET) in these locations to identify clinicopathologic features that could be used to distinguish between the two lesions. The ANB study group included four men and four women 22-74 years of age (mean 38 years). Five patients with ANB presented with inflammatory symptoms or elevated levels of catecholamines and their metabolites. Five of the ANB tumors were classified as undifferentiated and three as poorly differentiated with a background of neuropil. These cases often showed immunoreactivity for multiple neural markers such as CD56, chromogranin A, synaptophysin, neurofilament, and neuron-specific enolase, but were negative for CD99, cytokeratins, desmin, myogenin, smooth muscle actin, muscle-specific actin, CD34, S-100 protein, and CD45. In contrast, all of the PNETs were positive for CD99, and four (57%) were also positive for cytokeratins. Two cases of ANB of the undifferentiated subtype had ultrastructural features characteristic of neuroblastoma and lacked a chimeric transcript (EWS-FLI1or ERG), which is specific for PNET. All five patients with the undifferentiated subtype of ANB and six of the seven patients with PNET died of their disease within 3 years of discovery of the lesion. Our results show that ANB, although rare, should be considered in the differential diagnosis of patients with small, round-cell tumors in the retroperitoneum and abdomen. Appropriate immunohistochemical studies and laboratory examination enable pathologists to distinguish ANB from other differential diagnoses, especially PNET.

Abdominal Neoplasms↗

PubMed1998

Use of pedicled flaps and tissue expanders to reconstruct burn scars of the skin of the anterior abdomen and chest.

Extensive scarring of the skin of the abdomen and chest is sometimes encountered postburn. It is possible to excise the burn scar serially and replace it with unburned skin from areas such as the lower abdomen by means of various advancement flaps. Expanders may be inserted to facilitate coverage as indicated. We report 9 patients (3 males and 6 females) in whom such staged procedures were carried out. Original burn size ranged from 4% to 52%, with a mean total body surface area of 23.8%. No major complications or blood loss requiring transfusion were encountered.

Burns↗

PubMed1986

Delayed complications from fine-needle biopsies of solid masses of the abdomen.

A prospective study was conducted from 1977 through 1983, to determine the incidence of complications, particularly bleeding, after fine needle biopsy for suspected malignancy of the abdomen and pelvis. Hematocrits before and after the biopsy procedure, medical record follow-up, and review by a coagulation specialist were used to identify bleeders. We performed 395 biopsies on 360 patients. Thirteen percent of the patients had bothersome pain either during or after the biopsy. Hematocrit drops of 3% or more were found in 51 (12.7%) of the patients; nine were determined to be a direct result of the biopsy procedure. Our results and review of the literature suggest that there are complications, including delayed bleeding, yet few are life threatening. We caution, however, that adequate follow-up to identify bleeders is very important in patients having fine-needle biopsies of solid masses of the abdomen.

Abdominal Neoplasms↗

PubMed1984

Improved MR imaging of the upper abdomen with glucagon and gas.

Magnetic resonance (MR) imaging studies of the upper abdomen have been difficult to interpret due to the frequent inability to differentiate between various structures, especially between the gastrointestinal tract and adjacent normal and pathological structures. Utilizing effervescent granules and intravenous glucagon, gas in the stomach and duodenum provides excellent contrast and results in improved MR imaging of the upper abdomen. This technique is useful in demonstrating both gastric and pancreatic morphology.

Glucagon↗

PubMedDate not supplied

Visual survey of cancer dissemination: classic patterns on helical CT. Abdomen and pelvis.

Helical CT evaluation of the abdomen and pelvis can be challenging in the cancer patient. This pictorial essay illustrates the important sites of neoplastic dissemination in the abdomen and pelvis. We will emphasize the classic CT appearance of several selected sites and indicate, where appropriate, the primary lesions usually associated with each.

Abdominal Neoplasms↗

PubMed1989

Occult diaphragmatic injury from stab wounds to the lower chest and abdomen.

Ninety-five patients with stab wounds to the lower chest and abdomen underwent routine abdominal exploration. Eighteen of these patients had diaphragmatic injury and in five patients it was the only injury found. Isolated diaphragmatic injury in asymptomatic patients cannot be reliably delineated by either serial physical examination or peritoneal lavage. Delayed recognition of incarcerated diaphragmatic hernia after stab wounds to the lower left chest and upper abdomen has an associated mortality rate of 36%. The anatomic area of concern can be defined as stab wounds that penetrate the left side of the chest below the fourth intercostal space anteriorly, the sixth intercostal space laterally, and the tip of the scapula posteriorly. Exploratory laparotomy is necessary in these patients until a reliable nonoperative method is established that can exclude injuries to the diaphragm.

Abdominal Injuries↗

PubMed1991

Ballistic trauma to the abdomen: shell fragments versus bullets.

Two-hundred ninety-nine patients who sustained penetrating ballistic trauma to the abdomen were divided into two groups: Group A consisted of 133 patients with shell fragment injuries from mortar artillery and Group B of 166 patients with bullet injuries from rifles and automatic or semiautomatic weapons. Both groups were analyzed retrospectively in order to compare the extent of injury and outcome. In Group A, the findings at laparotomy were negative in 15 of 133 patients (10%) compared with 9 of 166 patients (5%) in Group B (p less than 0.05). The most commonly injured abdominal organs in Group A were the colon (42%), liver (22%), small bowel (20%), stomach (14%), diaphragm (11%), spleen (10%), major vessels (40%) [corrected], and kidney (9%). The abdominal organs commonly injured in Group B were the colon (50%), small bowel (41%), liver (33%), major vessels (20%), diaphragm (17%), stomach (15%), spleen (15%), and kidney (15%). Associated extra-abdominal injuries were present in 26% of Group A patients and in 21% of Group B patients (p greater than 0.05) [corrected]. Major postoperative complications occurred in 7.5% and 8.4% of the patients in Group A and Group B, respectively (p less than 0.05). Perioperative mortality was 2.3% in Group A versus 7.2% in Group B (p less than 0.01). Our data suggest that high energy bullets to the abdomen cause higher tissue penetration and a greater blast effect than shell fragments.

Abdominal Injuries↗

PubMed1999

Preload assessment in patients with an open abdomen.

BACKGROUND: Intra-abdominal hypertension and abdominal compartment syndrome cause significant morbidity and mortality in surgical and trauma patients. Maintenance of intravascular preload and use of open abdomen techniques are essential. The accuracy of pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) in patients with intra-abdominal hypertension has been questioned. METHODS: Twenty surgical and trauma patients with intra-abdominal hypertension requiring open abdominal decompression were monitored using volumetric thermodilution pulmonary artery catheters. Hemodynamic, oxygenation, inspiratory, and intravesicular pressure measurements were collected prospectively. PAOP, CVP, and right ventricular end-diastolic volume index (RVEDVI) were compared as estimates of preload status. RESULTS: Multiple regression analysis demonstrated that cardiac index correlated significantly better with RVEDVI (r = 0.69) than with PAOP (r = -0.27) or CVP (r = -0.28) during resuscitation after open abdominal decompression (p < 0.0001). CONCLUSION: RVEDVI is superior to PAOP and CVP as an estimate of preload status in patients with an open abdomen.

Adolescent↗

PubMed1994

Chronic abdominal pain as the initial manifestation of pancreatic injury due to remote blunt trauma of the abdomen.

Three patients were admitted with severe abdominal pain that began after an asymptomatic latent period following blunt trauma to the abdomen. During initial medical evaluation 3 months to 1 year after the trauma, serum amylase levels were normal or minimally elevated, and computed tomography scanning revealed edema and/or pseudocyst formation in the tail of the pancreas. Pancreatography showed ductal stenosis or obstruction in the midbody of the pancreas in each patient. At surgery, chronic pancreatitis in the tail was clearly demarcated from the normal head of the gland. Distal pancreatectomy was curative. Blunt traumatic pancreatic ductal injury may occur without typical immediate posttraumatic acute pancreatitis. Chronic distal pancreatitis following an asymptomatic latent period may culminate in delayed admission months to years after the initial injury. Endoscopic retrograde cholangiopancreatography should be considered for evaluation of patients with chronic abdominal pain and prior blunt trauma to the abdomen.

Abdominal Injuries↗

PubMed2004

Sensibility of the abdomen after abdominoplasty.

Abdominal skin hypesthesia may occur after abdominoplasty. The purpose of this study was to find out (1) which sensibility modalities are decreased and (2) which areas of the abdominal wall are affected, so that patients can be warned preoperatively about this condition. Forty patients were divided in two groups of 20 patients each. In the control group, patients had no previous abdominal incisions. The sensibility evaluation of patients from the experimental group was made from 12 to 60 months after abdominoplasty, with an average of 31.5 months. These patients were divided into two groups of 10 patients each, a short-term follow-up group (12 to 30 months postoperatively) and a long-term follow-up group (31 to 60 months postoperatively). The abdominal skin was divided into 12 areas; nine were above the abdominoplasty incision and three were below it. Sensibility to superficial touch, superficial pain, and hot and cold modalities was recorded as positive in all areas by a variable number of patients of the experimental group. However, in area 8 (hypogastric area), a statistically significant number of patients had decreased sensibility in all sensibility modalities (Fisher's test and t test). Patients in the experimental group also showed decreased sensibility to hot and cold temperature in area 11 (pubic area). Sensibility to pressure decreased significantly in all areas of the abdomen when compared with the control group (t test). When patients of the short-term follow-up group were compared with those of the long-term follow-up group, there was no statistically significant difference for all modalities of sensibility in the areas studied, except for area 5. In this area it was found that long-term follow-up patients recovered sensibility to cold and hot temperatures. These findings help plastic surgeons to orient their patients about possible risk of exposure to injuries in the areas with decreased sensibility after abdominoplasty. Most importantly, as these patients have decreased sensibility to pressure and hot temperature in a more extensive area of the abdomen, they are exposed to a higher risk of burn injury.

Abdominal Wall↗

PubMed2003

Regional differences in ultrasonic assessment of subcutaneous fat thickness in the abdomen: effects on the TRAM flap.

The authors describe the results of fat thickness patterning of the abdominal sites in 50 patients, all of whom required breast reconstruction with a transverse rectus abdominis musculocutaneous flap. The thickness of the abdominal fat was measured at 12 anatomic locations with an ultrasonic instrument. The highest value of the subcutaneous fat thickness was 29.0+/-10.0 mm at a site 2 cm below the umbilicus at the center of the rectus abdominis muscle. The lowest value of the subcutaneous fat thickness was 17.8+/-7.6 mm at a site 2 cm above the umbilicus on the anterior superior iliac spine. Average subcutaneous fat thickness over the abdomen of 50 patients was 24.0+/-9.4 mm. There were 13 patients (group 1) who had an abdominal fat thickness of more than 30 mm, 19 patients (group 2) with an abdominal fat thickness less than 30 mm and more than 20 mm, and 18 patients (group 3) with an abdominal fat thickness less than 20 mm. Complications occurred in 12 of 50 flaps (24%). Among groups 1, 2, and 3 there was no significant difference (p<0.01) in the overall flap complications (15.4: 36.8: 16.7). In summary, subcutaneous fat thickness showed the higher value at the center of the abdomen and the lower value at the lateral site. Abdominal fat thickness is not a risk factor for necrosis of pedicled transverse rectus abdominis musculocutaneous flaps in patients who are thin, average, or mildly obese. Preoperative examination of the abdominal subcutaneous fat thickness should provide useful information for detailed simulation of a reconstructive operation.

Abdominal Muscles↗

PubMed2006

Radiation injury: imaging findings in the chest, abdomen and pelvis after therapeutic radiation.

Radiation may be used as adjuvant or primary therapy in a variety of tumors in the chest, abdomen and pelvis. Therapeutic radiation affects not only malignant tumors but also surrounding normal tissues. The risk of injury depends on the size, number and frequency of radiation fractions, volume of irradiated tissue, duration of treatment, and method of radiation delivery. Concomitant chemotherapy can act synergistically to produce injury. Other predisposing factors include infection, prior surgery and chronic illness like hypertension, diabetes mellitus and atherosclerosis. Radiation changes vary, based on the target organ and the time from completion of therapy. While most serious complications related to radiotherapy are relatively uncommon, given the number of patients that are treated and the relatively long latency period for development of radiation changes, follow-up imaging studies frequently have findings that should be recognized as radiation related. Familiarity with the spectrum of imaging findings after radiation injury permits differentiation from other etiologies such as recurrent malignancy. The following will discuss imaging findings that may be seen during imaging surveillance in patients with malignancy affecting the chest, abdomen and pelvis.

Abdominal Neoplasms↗

PubMed1998

Case report: Steatonecrosis in the upper abdomen following transcatheter arterial embolization for hepatocellular carcinoma.

A 66-year-old female with liver cirrhosis was treated by transcatheter arterial embolization (TAE) for a small hepatocellular carcinoma. She developed steatonecrosis with tenderness which occurred in the upper abdomen after TAE. The hepatic falciform artery from the middle hepatic artery was detected by arteriography. Necrosis in the upper abdomen was considered to be due to ischaemic changes caused by micromaterials for embolization of this artery, injuries of hepatic arterial endothelia slowly caused by carcinostatics, and chemotoxicity. It was considered that such complication as observed in this patient should be taken into consideration when performing TAE.

Aged↗

PubMed1992

In-utero sound levels when vibroacoustic stimulation is applied to the maternal abdomen: an assessment of the possibility of cochlea damage in the fetus.

OBJECTIVE: To measure sound pressure level in utero while a vibro acoustic stimulator is applied to maternal abdomen and to calculate whether the estimated effect on fetal cochlea cilia vibration would be hazardous. DESIGN: Prospective descriptive study. SETTING: Labour ward, National University Hospital, Singapore. SUBJECTS: Eight women undergoing induction of labour. INTERVENTION: A hydrophone was introduced via the cervix into the uterus and placed under ultrasound guidance near the fetal ear. Sound pressure was recorded when a vibroacoustic stimulator was applied directly to the maternal abdomen and also when separated by 2 cm of air. MAIN OUTCOME MEASURES: Sound pressure levels in utero. RESULTS: The sound level recorded from the vibrator diaphragm in air was 107 dB at 2 cm and 74 dB at 1 m. The mean sound pressure level in utero was 90.7 dB (range 75-96 dB) when the vibrator was in contact with the abdominal wall and 80.1 dB (range 70-88 dB) when separated by 2 cm of air. CONCLUSIONS: Analysis of factors affecting displacement of cochlear sensing cilia in utero show that, for equal sound pressures, sound intensity and sound vibration are about 4000 times less in amniotic fluid, compared to that produced in air. Further protection is provided by viscous and hydrodynamic features of the ear. The estimated effect on cilia vibration by the mean sound pressure registered in utero, about 90 dB, corresponds to that produced postnatally by an airborne sound registering about 40 dB, which would not be hazardous.

Cochlea↗

PubMed2004

Nationwide Evaluation of X-ray Trends survey of abdomen and lumbosacral spine radiography.

Results of the 1995 Nationwide Evaluation of X-ray Trends (NEXT) survey of facilities that perform diagnostic radiographic examinations of the abdomen and lumbosacral spine were compared with those of previous NEXT surveys conducted in 1987 and 1989. A clinically validated radiographic phantom was used in the 1995 survey to capture data about radiation exposure and image quality. Additional data were obtained regarding clinical techniques, facility workloads, x-ray beam quality, film processing quality, and darkroom fog. Mean skin-entrance air kerma for the abdomen examination dropped from 3.2 mGy (in 1987) to 2.8 mGy at hospitals and from 3.4 mGy (in 1989) to 3.0 mGy at nonhospital facilities. Mean skin-entrance air kerma also decreased for the lumbosacral spine examination from 3.7 mGy (in 1987) to 3.3 mGy at hospitals and from 3.8 mGy (in 1989) to 3.2 mGy at nonhospital facilities. The quality of film processing improved, although 58 (18.3%) of 317 surveyed facilities did not meet the Mammography Quality Standards Act standard for film processing quality, compared with 185 (5.9%) of 3,120 mammography facilities inspected in 1995. Finally, 181 (58.0%) of 312 surveyed facilities had darkroom fog levels greater than the Mammography Quality Standards Act standard, compared with 1,426 (16.6%) of 8,605 mammography facilities inspected in 1995.

Health Care Surveys↗

PubMed2001

Penetrating stab wounds to the abdomen: use of serial US and contrast-enhanced CT in stable patients.

PURPOSE: To evaluate the usefulness of computed tomography (CT) and ultrasonography (US) for the initial assessment of penetrating abdominal stab wounds in patients who presented to the emergency department without indication for immediate laparotomy. MATERIALS AND METHODS: During 36 months, 32 patients with a penetrating stab wound to the abdomen were examined with serial US (at admission and 12 hours later) and helical CT, with contrast material administered orally, intravenously, and rectally. Presence of hemoperitoneum and integrity of solid and hollow viscera were evaluated with both methods. Sonograms were interpreted by the radiologist who performed the examination, and CT images were independently evaluated by two radiologists. Findings of both techniques were compared with clinical outcome and/or surgical findings. RESULTS: One (3.1%) of 32 patients required surgery: Surgical findings were massive hemoperitoneum and an extensive hepatic laceration. Both US and CT depicted these abnormalities. Thirty-one (96.9%) patients were treated conservatively, without surgery, and remained asymptomatic during 28 days of clinical follow-up after discharge from the hospital. US and/or CT showed intraperitoneal abnormalities in 21 of these patients. In 11 patients, both methods showed no evidence of visceral injury or hemoperitoneum, and none of these patients required surgery. CONCLUSION: Serial US and CT help guide treatment for stable patients with penetrating stab injuries to the abdomen.

Abdominal Injuries↗

PubMedDate not supplied

Gallery of medical devices: part 2: devices of the head, neck, spine, chest, and abdomen.

This gallery of medical devices illustrates a multitude of common devices in the head, neck, spine, chest, and abdomen that are found in daily radiologic practice (orthopedic devices for the extremities and pelvis were illustrated in Part 1). All these medical devices have been more thoroughly discussed in the previous articles in this medical devices series and in other detailed references. The present article is a comprehensive overview of these devices and provides a quick reference for identifying an unfamiliar device. It is intended to allow the reader to identify a device generically and to understand its purpose. It is important to recognize the presence of a device, understand its purpose and proper function, and recognize the complications associated with its use. Knowing the specific or proper brand name of every device is not important and frequently not possible. New devices are constantly being introduced, although most of them are variations of a previous device. Sometimes, so many devices are used in a patient's treatment that they obscure important anatomy and pathologic conditions (Fig 1). Herein, we present an overview of the many medical devices frequently used in the head, neck, and spine, including a halo device, aneurysm clips, spinal fusion devices, deep brain electrodes, sacral nerve stimulator, and vertebroplasty (Figs 2-9). We also illustrate numerous chest medical devices that are seen daily by almost all radiologists. These devices include a multitude of extrathoracic and intrathoracic apparatus, ranging from intravenous catheters to oxygen tubing and electrocardiographic leads, central venous catheters, chest tubes, endotracheal and feeding tubes, cardiac valves, coronary artery bypass stents, pacemakers, internal cardiac defibrillators, ventricular assist devices, and total artificial hearts (the latter two devices are frequently encountered in many large medical centers) (Figs 10-26). We also present medical devices of the abdomen and pelvis, which can be grouped into four major categories: intestinal tubes, genitourinary apparatus, postoperative apparatus, and vascular devices (Figs 27-47). For a detailed discussion of a particular device, the reader should refer to the appropriate references cited.

Equipment and Supplies↗

PubMed2002

Multiple HPV-positive basal cell carcinomas on the abdomen in a young pregnant woman.

Basal cell carcinoma (BCC) is the most common malignant skin tumour. In the last few years, the incidence of multiple BCC has also increased in young patients. We describe the clinical case of a young 29-year-old woman who developed 7 BCC on her abdomen during her first pregnancy and 4 other similar tumours 2 years later during her second pregnancy, all located on the abdomen. Polymerase chain reaction revealed the presence of numerous human papillomavirus DNA sequences. To our knowledge, such a clinical presentation has not been previously reported. Different physiopathological considerations are discussed.

Basal Cell Carcinoma↗