False-positive liver-lung scan caused by intraperitoneal free air.
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Gallium-67 distribution in normal patients is well known; it is also known that the concentration in some tissues may vary according to an individual physiologic stimulus. In this report, the case of a young woman is presented who was studied 15 days after a cesarean section and showed physiologic and pathologic Ga-67 accumulation.
The use of combined hepatobiliary-lung imaging in the diagnosis and evaluation of a subphrenic process is described.
Fifty-eight consecutive cases of peridiaphragmatic fluid collections were correctly localized by computed tomography. The key to accurate localization of peridiaphragmatic fluid is identification of the hemidiaphragms. Pulmonary consolidation and pleural fluid collections lie adjacent and peripheral to the convexity of the hemidiaphragms. Free pleural fluid distends the posterior pleural recesses, important anatomic landmarks beneath the bases of the lungs. Intra-abdominal fluid collections lie adjacent and central to the convexity of the hemidiaphragms. On the right side intraperitoneal fluid is restricted from contact with the bare area of the liver by the coronary ligaments. It is concluded that peridiaphragmatic fluid collections can generally be readily identified if one is familiar with normal cross-sectional anatomy.
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Laparoscopic cholecystectomy is now the gold standard procedure for the treatment of symptomatic gall bladder stones. Spillage of gall bladder stones into the peritoneal cavity may occur due to inadvertent iatrogenic gall bladder perforation during dissection of the gall bladder. We report a case of a 66 year old woman who had to return to theatre three times over two years to deal with complications from retained intra-peritoneal gallstones that were spilt at her initial laparoscopic cholecystecomy.
A review of the indications for, and technique of, abdominal drainage is presented. An analysis is made of the physical characteristics of the commonly used types of drains. Evidence is presented that abdominal drains, although sometimes life-saving, are potentially harmfully and should be used only when a clear indication is present. When drainage is employed, it should be of the most efficient, closed type, and the drain should be removed at the earliest safe time after operation.
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Case reports of transdiaphragmatic fistulas connecting subphrenic collections and empyemas are uncommon. We report the rare complication of a fistulous connection between a subphrenic collection and the bronchial tree.
Thoracic actinomycosis is an uncommon disease and often presents difficulty in diagnosis. Two cases are presented in which thoracic actinomycosis produced fistulae between the thoracic and abdominal cavities. Surgical drainage and high dose penicillin for at least 4-6 months was the treatment of choice.
Flexible fiberoptic endoscopes are being used increasingly for direct visualization and biopsy of lesions in the upper gastrointestinal tract. Contrary to earlier expectations, however, the incidence of complications has not diminished despite the technical advantages of modern flexible instruments over semirigid endoscopes; indeed, the mortality of fibergastroscopic perforation has almost quadrupled compared to standard gastroscopy. The authors cite their experience with the spectrum of complications associated with fiberoptic esophagoscopy and gastroscopy. Radiological recognition and evaluation of these iatrogenic incidents is of paramount importance.
Care in identifying the diaphragm on longitudinal sonograms through the liver allows differentiation of subpulmonic effusions from subphrenic fluid collections.
Use of a Delta scanner has resulted in delineation of neoplastic, obstructive and inflammatory renal diseases, hepatic tumors, and other abdominopelvic mass lesions. Of 47 patients examined, 32 had proved mass lesions. Computed tomography provided unique information about the complete delineation and nature of lesions and detected unrecognized lesions. Technical problems and solutions are discussed.
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