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Histiocytic lymphoma of the abdomen: radiographic spectrum.

Abdominal manifestations of histiocytic lymphoma were reviewed in 112 patients who had at least a 2-year follow-up period or had died. In 70% abdominal histiocytic lymphoma was found and in 29% histiocytic lymphoma was initially limited to the abdomen. Localized abdominal histiocytic lymphoma presented as (1) intrinsic disease of the stomach, (2) pancreatic/peripancreatic masses, (3) high aortic lymphadenopathy, (4) mesenteric masses associated with small bowel infiltration, and (5) intrinsic ileocolic masses. When all patients with abdominal histiocytic lymphoma are considered, computed tomography was positive in 87%, lymphography in 86%, upper gastrointestinal barium examination in 50%, excretory urography in 38%, and barium enema in 25%. The extent of abdominal histiocytic lymphoma was more accurately assessed with computed tomography than any other radiologic examination including lymphography. Computed tomography seems to be the radiologic examination of choice in the staging of abdominal histiocytic lymphoma; the other examinations should be used when specific symptoms are present or when the computed tomographic findings are equivocal.

Abdominal Neoplasms↗

The bare area of the spleen: a constant CT feature of the ascitic abdomen.

On computed tomographic (CT) scans of the abdomen in patients with ascites, there is one consistently recognizable area of the spleen that is not surrounded by fluid. This area, designated the bare area of the spleen, is related anatomically to the upper anterior part of the left kidney, specifically the Gerota fascia. Awareness of this relation enables differentiation of intraperitoneal fluid from pleural fluid on cross-sectional CT images.

Aged↗

Dynamic MR imaging of the abdomen with gadopentetate dimeglumine: normal enhancement patterns of the liver, spleen, stomach, and pancreas.

To show the normal contrast enhancement patterns of the upper abdominal organs, dynamic gadopentetate dimeglumine-enhanced MR imaging of the upper abdomen was performed in 48 patients. Although all patients were originally examined for focal hepatic lesions, none of them had diffuse parenchymal disease of any of the examined organs. Dynamic gadopentetate dimeglumine-enhanced MR imaging was done by using a heavily T1-weighted gradient-echo sequence (100/5 [TR/TE], 80 degrees flip angle) performed before, and repeatedly for a period of 10 min after, an IV bolus injection of gadopentetate dimeglumine (0.1 mmol/kg). Signal enhancement in each of the organs was calculated by measuring the signal intensity before and after administration of contrast medium. All organs showed signal enhancement within the first 2 min (p less than .001) and a continuous decline thereafter. The enhancement of the pancreas, liver, stomach wall, spleen, and renal cortex reached peaks of 75%, 78%, 96%, 144%, and 216%, respectively, 45 sec after administration of contrast medium. Liver and pancreas showed a homogeneous enhancement pattern throughout the examination. The spleen appeared heterogeneous during the first 60 sec and homogeneous thereafter. Two zones could be distinguished on the contrast-enhanced images of the stomach wall: an enhanced inner zone and an unenhanced outer zone. We conclude that homogeneous enhancement of the liver and pancreas, early heterogeneous enhancement of the spleen, and enhancement of the inner gastric wall are normal patterns on dynamic gadopentetate dimeglumine-enhanced MR images.

Contrast Media↗

CT of the chest and abdomen in patients on mechanical pulmonary ventilators: quality of images made at 0.6 vs 1.0 sec.

OBJECTIVE: Chest and abdominal CT scans using 1.0-sec scan times are often limited by motion in patients who are unable to hold their breath. With our scanner we can obtain images in 0.6 sec (partial scan) that use data from 225 degrees instead of the 360 degrees used for 1.0-sec scans. The purpose of this study was to assess whether the quality of images of the chest and abdomen in patients on mechanical pulmonary ventilators who could not breath-hold could be improved if images were taken using a scan time of 0.6 sec rather than 1.0 sec. MATERIALS AND METHODS: Thirty patients who were being treated with mechanical pulmonary ventilation with indications for chest or abdominal CT or both were scanned with a scan time of 1.0 sec. At the end of the examination, additional 0.6-sec images were taken at three or four levels. Images obtained with these two scan times were filmed at similar levels and windows, and anatomically matched levels were compared. The images were masked and independently evaluated by three radiologists for motion, noise, artifact, and overall image quality. Each parameter was rated using a scale of 1 to 4. Using Kendall's tau correlation, there was no significant difference between the radiologists in the grading of individual parameters or of overall image quality. Therefore, the average of the scores of the three radiologists was used. Statistical analysis was done using repeated measures multivariate analysis of variance. RESULTS: Images obtained in 0.6 sec had significantly less motion (p < .001) but more noise (p < .001) than those obtained in 1.0 sec. We found no statistically significant difference in artifacts between the two scan times. Overall image quality was judged to be significantly better on scans obtained in 0.6 sec than on scans obtained at 1.0 sec (p < .001), in spite of the greater noise on 0.6-sec images. The higher quality of 0.6-sec images was most noticeable for lung window settings. CONCLUSION: Our results indicate that scans taken in 0.6 sec (partial scans) provide better quality images than those obtained in 1.0 sec in patients being treated with mechanical pulmonary ventilation who cannot breath-hold. This technique may be useful not only in this population but in all patients who are unable to cooperate with breath-holding instructions.

Contrast Media↗

Desmoplastic small round cell tumor in the abdomen and pelvis: report of CT findings in 11 affected children and young adults.

OBJECTIVE: Our objective was to evaluate the CT features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis in pediatric and young adult patients. CONCLUSION: Characteristic CT features of DSRCT include bulky intraabdominal soft-tissue masses that involve omental and serosal surfaces, without a distinct organ of origin; solid, dominant, heterogeneous pelvic masses in the retrovesical or rectouterine spaces; and concurrent metastases, common at the time of diagnosis, particularly those involving lymph nodes and liver.

Abdominal Neoplasms↗

[Bronchogenic cyst of the abdomen].

A bronchogenic cyst is a rare congenital anomaly that appears in the thorax, usually the lungs or the mediastinum, being much rarer in the retrosternal space, within the pericardium or the diaphragm, as well as in the neck, while localisation within the abdomen is extremely rare, with only about 30 reported cases. We present the case of a 68-year-old woman. During an investigation for an epigastric pain, a cystic lesion in the area of the body and tail of the pancreas was found. During open surgery, a cystic lesion, spanning 95 x 75 x 70 mm, above the body and tail of the pancreas was excised. The wall of the cyst was 8-12mm thick; it contained viscous fluid, the culture of which stayed sterile. Histology determined that it was a bronchogenic cyst. After an early uneventful recovery, the patient developed a left colonic fistula, which healed spontaneously within 3 weeks, probably because of the unnoticed operative damage to the splenic flexure of the colon during splenectomy, which was adherent to the cystic mass and impossible to save during excision. Six months after surgery, the patient continued to remain symptom free.

Aged↗

Techniques, clinical applications and limitations of 3D reconstruction in CT of the abdomen.

Enhanced z-axis coverage with thin overlapping slices in breath-hold acquisitions with multidetector CT (MDCT) has considerably enhanced the quality of multiplanar 3D reconstruction. This pictorial essay describes the improvements in 3D reconstruction and technical aspects of 3D reconstruction and rendering techniques available for abdominal imaging. Clinical applications of 3D imaging in abdomen including liver, pancreaticobiliary system, urinary and gastrointestinal tracts and imaging before and after transplantation are discussed. In addition, this article briefly discusses the disadvantages of thin-slice acquisitions including increasing numbers of transverse images, which must be reviewed by the radiologist.

Adult↗

Transplantation of an eight-organ multivisceral graft in a patient with frozen abdomen after complicated Crohn's disease.

To report an extended multivisceral transplantation (MVTx) including right kidney and ascending colon in a patient with complicated Crohn's disease (CD). A 36-year old female suffering from short bowel syndrome and frozen abdomen due to fistulizing CD after multiple abdominal operations underwent MVTx of eight organs including stomach, pancreatoduodenal complex, liver, intestine, ascending colon, right kidney, right adrenal gland, and greater omentum in November 2003. Immunosuppression consisted of alemtuzumab, tacrolimus and steroids. The patient was off parenteral nutrition by postoperative wk 3. She experienced one episode of pneumonia. The patient recovered completely and discharged 2.5 mo and was doing well 30 mo after MVTx. This is one of the very rare cases in which a complete mulitivisceral graft of eight abdominal organs was transplanted orthotopically.

Adrenal Glands↗

Helical CT applications in the thorax and abdomen.

The past few years have witnessed a massive explosion in clinical applications for computed tomography (CT) as a result of exponential advances in technology. Most clinical practitioners have a limited understanding of the complexities and dynamics of modern CT, and even many radiologists are unable to keep up with the rapid evolution in refinements. In this article, Dr Rappaport summarizes some of the most recent advances in use of helical, or spiral, CT to diagnose diseases of the thorax and abdomen.

Angiography↗

An intrahepatic abscess as a rare complication of a pelvic fracture from blunt trauma to the abdomen.

An otherwise healthy young male sustained a non-displaced fracture of the pelvis in a blunt trauma from a motor vehicle accident. A fever developed on his second post injury day which led to discovery of an intrahepatic abscess by CAT scan. After blunt trauma to the abdomen, one must consider not only a retroperitoneal hematoma but also, subphrenic, subdiaphragmatic and intrahepatic abscess as its complication.

Abdominal Injuries↗

[Technique and pathophysiology of isolated hypoxic perfusion of the abdomen].

Isolated hypoxic perfusion (IHP) is a commonly used technique in the treatment of abdominal malignancies. During a phase II-study the pathophysiology of this technique was explored in patients with advanced pancreatic cancer. Twenty perfusions of the abdomen were performed in 17 patients. Under general anesthesia, femoral vessels were dissected and two balloon catheters were inserted into aorta and vena cava cranial the celiac trunk and the hepatic veins. After instillation of 40 mg of Mitomycin C (MMC) into the running perfusion system, the perfusion was maintained for further 20 minutes. Blood samples were taken in 5-minute intervals to determine pH value, blood gases as well as concentrations of electrolytes, lactate and MMC in the arterial blood. Simultaneously, blood samples were taken from the perfusion blood via a side-port of the extracorporeal perfusion system. Additionally, perfusion pressures, arterial and central venous pressure, heart rate, and the pressure in the aorta distal the balloon catheter were registered continuously. All 20 perfusions had been undertaken without perioperative mortality. After inflating the balloon catheters, blood pressure and heart rate increased rapidly. Within 5 minutes of perfusion an increase in pCO2 and the concentrations of K+ and lactate in the perfusate were registered, while pH and pO2 decreased. Fifteen minutes after instillation of MMC, concentrations of MMC in arterial and perfusion blood were equal. Twenty-four hours after the perfusion all parameters had returned to normal values. IHP was well feasible in 20 consecutive perfusions without major technical problems. A distinct but tolerable combined acidosis resulted from IHP. Despite the exact positioning and control of the balloon catheters a complete isolation was not possible.

Acid-Base Equilibrium↗

Diagnosis of hydatid disease of abdomen and thorax by ultrasound guided fine needle aspiration cytology.

Five cases of hydatid disease of abdomen and thorax were diagnosed by fine needle aspiration cytology (FNAC) under ultrasound guidance. The age of patients ranged from 25-50 years, with a median age of 37 years. Male to female ratio was 2:3. None of the cases were clinically diagnosed as hydatid disease, but ultrasonography raised suspicion in two cases. The location of cyst in four cases was liver and one aspiration was done from lung. Smears from all cases showed features consistent with hydatid disease. None of the patients showed any untoward allergic reaction following FNAC.

Adult↗

Effect of pharmaceuticals on radiographic appearance of selected examinations of the abdomen and thorax.

Pharmacologic agents may have a significant effect on the outcome of radiographic interpretation in small animal imaging. Alterations in the abdomen and thorax may represent artifactual or transient changes or changes reflecting cytotoxicity. Examples of agents that may influence the appearance of radiographs include anticonvulsants, sedatives, anesthetics, analgesics, antiinflammatories, gastrointestinal prokinetic drugs, antineoplastics, and hormones such as megestrol acetate. Radiographic studies may be part of a disease-monitoring process. It is important to understand how pharmaceuticals (e.g., chemotherapeutics or therapy for an underlying medical condition) affect the radiographic appearance. Caution should be exercised in the interpretation of radiographic studies because the findings may relate to the drug therapy rather than the underlying condition.

Animals↗

Gastric mucosal lacerations from blunt trauma to the abdomen.

A 17-year old, Caucasian male, high school student sustained gastric mucosal lacerations from blunt trauma to the abdomen during a football game with associated severe upper gastrointestinal bleeding. The lacerations were diagnosed by endoscopy and treated conservatively with uneventful, rapid and complete recovery.

Abdominal Injuries↗

[Laparoscopy in the diagnosis and treatment algorithm for an acute surgical diseases and trauma of abdomen].

Laparoscopy was performed in 1977 patients in an acute surgical diseases and the abdominal cavity (AC) injuries, the curative one--in 895. In patients with clinical signs of the AC organs acute disease or trauma it is possible the four-variants diagnostic and curative program application: radial methods of investigation and laparocentesis--for diagnosis, laparoscopy and laparotomy--for diagnosis and treatment. The laparoscopy application is indicated even if the "acute abdomen" clinical features presence are confirmed the radial diagnosis and laparocentesis result. If necessary the diagnostical laparoscopy is transformed into curative procedure, which is used with the miniinvasive access application, resulting in low operative risk.

Abdominal Injuries↗

Surgical treatment of severe necrotizing pancreatitis by the method of "open abdomen"--early and long-term results.

The aim of our study was the evaluation of "open abdomen" method (OAM) in treatment of severe acute pancreatitis. Fifty patients were treated by this technique in our Department from 1983 to 1999 year. Patients were retrospectively classified into 3 groups: with sterile pancreatic necrosis (SPN), pancreatic abscess(PA) and infected pancreatic necrosis(IPN). Early results embraced: number of local and general complications and a lot of parameters, which let to recognise objectively efficiency of management(time of hospital and intensive care unit stay, time of total parenteral nutrition, number of reoperations and others). These results were compared with analogical groups, in which used other management. Long-term results embraced the pancreatic efficiency tests in 24 patients in period 2-16 years after surgical treatment of OAM. Based on these results three groups of patients were separated: 12 persons (50%) recognised healthy, 4 (17%) with exocrine insufficiency of pancreas and 8 (33%) with exocrine and endocrine insufficiency of pancreas. Our results prove that OAM is the efficient treatment of IPN, but it shouldn't be used in cases of PA or SPN. Patients after OAM need prospective monitoring of exocrine and endocrine pancreatic function due to serious risk of this organ dysfunction.

Abscess↗

[Dynamic MR imaging of the upper abdomen: timing optimization and pulse sequence selection].

Since breath-hold gradient-echo MR imaging was introduced, dynamic MR study has played an important role in the MR investigation of the upper abdomen. In this article, the importance of tailoring imaging delay in each individual patient is stressed, with special attention given to a logical aspect of setting delay time based upon the bolus transfer time obtained by test injection. Also discussed is the importance of selecting types and parameters of pulse sequence to maximize the enhancement effect. It should be noted that alteration of gadolinium concentration in vivo following intravenous injection could result in a large change in signal intensity change on one sequence but little change on another. Double-dose 3DFISP with tailored delay time utilizing the test injection method, which is currently used for dynamic MR imaging in our institute, is presented.

Carcinoma, Hepatocellular↗

[Desmoid tumor of rectus muscle of abdomen in a young woman].

The paper presents a case of 28-year-old woman operated at the Department of General Surgery University School of Medicine in Poznań because of desmoid tumor of rectus muscle of abdomen. The patient was incorrectly diagnosed a year earlier. The authors emphasize diagnostic problems leading to a delayed diagnosis.

Adult↗