[Contrast-enhanced computed tomography is the required minimum in the diagnosis of abdominal and retroperitoneal space-occupying lesions]

OBJECTIVE

to determine the advantages of contrast-enhanced computed tomography (CT) over contrast-free studies in the differential diagnosis of hepatic, renal, and pancreatic space-occupying lesions. MATERIAL AND METHODS. A team of experienced radiologists retrospectively used CT data of patients with different space-occupying lesions of the abdomen and retroperitoneal space (liver, kidney, and pancreas).

RESULTS

The diagnostic value of CT of the liver, kidney, and pancreas substantially decreases without using radiopaque contrast agents; at the same time not only the differential diagnosis, but also visualization of some neoplasms are frequently impossible.

CONCLUSION

The potential benefit of contrast-enhanced CT virtually always outweighs the risks associated with the injection of a contrast agent.

[Comparative survey of radiation doses to patients in computed tomography in a federal hospital]

OBJECTIVE

to analyze radiation exposure due to computed tomography (CT) of brain, chest, abdomen and pelvis in a large multi-field federal hospital and feasibility of low-dose CT-examinations.

MATERIAL AND METHODS

Retrospective analysis was performed using data from electronic patient records and PACS from a single multi-field hospital. Data were obtained from 1626 records of patients (794 men, 832 women; age range 17-93) scanned with 3 MDCT during one year. CT-examinations of good quality were selected, volumetric CT dose index (CTDI) and dose-length product (DLP) were collected for each of them. The effective doses (ED) were calculated using the normalized coefficients according to Russian Guidance. RESULTS. Number and structure of CT-examinations for the years 2012-2014 in a multi-field hospital were analyzed. The mean effective dose (M ± m) values with/without contrast medium (respectively), according to anatomical areas were as follows: brain--2.34 ± 0.03/3, 52 ± 0.23, chest--4.83 ± 0.11/11.02 ± 0.82, abdomen-pelvis--9.81 ± 0.40/36.6 ± 1.17, chest-abdomen-pelvis - 12.41 ± 0.79/35.63 ± 1.81 mSv. CONCLUSION. Results of this study give an example of CT dose values and distribution in a multi-field hospital. They are compa- rable with reference levels published of other authors. This expe- rience should be expanded for creation of CT national reference values and for co-operation with international initiatives (EUROSAFE projects).

[EXPERIENCE OF TREATMENT OF PREGNANT WOMEN WITH ACUTE SURGICAL DISEASES OF THE ABDOMINAL CAVITY]

This article describes a generalized experience in the treatment of pregnant women with acute surgical diseases of the abdominal cavity.

[SURGICAL TREATMENT MANAGEMENT OF ABDOMEN GUNSHOT INJURIES]

The medical records of 100 patients with gunshot abdomen injuries were analysed. The damaging nature of the projectile, the nature of the damage and the combination with damage to other body parts were studied. The anesthesiologist--resuscitator and surgeon actions after hospitalisation of injured persons were postulated. The emergency victim examination was reduced to ultrasound and SCT. The indications for laparotomy in abdominal gunshot injuries were defined. Three most common variants of gunshot abdomen injuries were found. In surgical treatment we applied "damage control" strategy included the initial (abbreviated) operation, resuscitative therapy and final operation. The postoperative complications, couse of deaths was investigated.

Left-sided transmesocolic herniation of small bowel in an otherwise unaffected abdomen

Transmesocolic hernia is an uncommon type of internal hernia with incidence ranging from approximately 5-10%. To the best of our knowledge, this is the first reported case of a transmesocolic hernia through a gap within the descending mesocolon presenting clinically as an intestinal obstruction. A 75-year-old man was admitted with clinical features of intestinal obstruction. An abdominal X-ray showed multiple small bowel loops with air fluid levels. Contrast-enhanced CT of the abdomen revealed small bowel obstruction not only on the right, but also on the left side of the collapsed descending colon. Emergency surgery was performed. Strangulated bowel loops with gangrenous changes were resected and double-barrel ileostomy was carried out. The postoperative period was uneventful. Restoration of bowel was performed after 6 weeks. Preoperative diagnosis of bowel obstruction caused by a transmesocolic hernia remains difficult despite the currently available imaging techniques. Prompt surgery can prevent serious complications such as peritonitis and sepsis.

Anatomical confirmation of computed tomography-based diagnosis of the atherosclerosis discovered in 17th century Korean mummy

In the present study on a newly discovered 17th century Korean mummy, computed tomography (CT) revealed multiple aortic calcifications within the aortic wall that were indicative of ancient atherosclerosis. The CT-based findings were confirmed by our subsequent post-factum dissection, which exhibited possible signs of the disease including ulcerated plaques, ruptured hemorrhages, and intimal thickening where the necrotic core was covered by the fibrous cap. These findings are strong indicators that the mummy suffered from aortic atherosclerosis during her lifetime. The present study is a good example of how CT images of vascular calcifications can be a useful diagnostic tool in forming at least preliminary diagnoses of ancient atherosclerosis.

Optimizing working space in laparoscopy: CT-measurement of the effect of neuromuscular blockade and its reversal in a porcine model

OBJECTIVE

The objective of this paper was to determine the effect of neuromuscular blockade (NMB) on working space in a porcine laparoscopy model.

BACKGROUND

Conflicting results on the effect of NMB on laparoscopic working space are found in literature. Almost all studies are limited by absence of objective assessment of working space or use surrogate outcomes.

METHODS

In a standardized porcine laparoscopy model, laparoscopic working-space dimensions with and without NMB were investigated in 16 animals using computed tomography at intra-abdominal pressures of 0, 5, 10, and 15 mmHg during multiple runs of abdominal insufflation.

RESULTS

No statistically significant effect of NMB on abdominal dimensions and laparoscopic working-space volume was found during CO2 pneumoperitoneum. In contrast, the effect of pre-stretching of the abdominal wall by a previous abdominal insufflation was found to be significant.

CONCLUSIONS

This experimental study confirms the results from several clinical studies that NMB does not influence laparoscopic working space. Studies dealing with working space during laparoscopy should take note of pre-stretching bias.

Perigastric appendagitis: CT and clinical features in eight patients

AIM

To describe perigastric appendagitis (PA) on CT as a new and distinct clinical entity to enable recognition and prevent additional unnecessary investigation or intervention.

MATERIALS AND METHODS

Institutional review board approval was obtained and informed consent was waived. Retrospective review of the clinical data and CT findings in eight patients with PA encountered over 10 years at one institution was performed. The English literature was reviewed and summarized. Two experienced abdominal radiologists reviewed the CT images by consensus.

RESULTS

Seven of eight patients had moderate to severe epigastric pain for 1–7 days. All eight patients (four men, four women; mean age 44 years, range 33–81 years) had no fever or leukocytosis. All underwent abdominal CT which showed ovoid fat inflammation along the course of the perigastric ligaments (gastrohepatic, gastrosplenic, and falciform). Two had gastric wall thickening. Although the inflammation was correctly described, the specific diagnosis was not made on initial interpretation in five patients. Subsequently, they underwent further diagnostic testing [an upper gastrointestinal examination and hepatobiliary iminodiacetic acid (HIDA) cholescintigraphy, an upper endoscopy and MRI examination, HIDA cholescintigraphy, another CT, and an MRI examination, respectively]. The HIDA cholescintigraphy, upper GI examination, and upper endoscopy examinations were normal. No repeated examination was performed on the other three patients. Pain resolved spontaneously in all within two days.

CONCLUSION

Perigastric appendagitis can present with an acute abdomen, which is safely managed conservatively if diagnosed correctly. Radiologists should be aware of the entity to avoid unnecessary intervention, and recognize the CT findings of ovoid fat inflammation in the distribution of the perigastric ligaments.

[Differential diagnosis and treatment of complex renal cysts detected by ultrasound screening of the abdominal cavity organs]

Ultrasound screening of the abdominal cavity organs was performed in 98 patients, and renal cysts were revealed in 31 patientsare. 11 (26,6%) of 31 patients had renal cysts with complex structure. In 4 patients, complex cysts were located in parapelvic zone, in 7 patients - in different parts of the renal parenchyma. Pharmaco-Doppler sonography and computed tomography with bolus contrast enhancement in 7 patients with complex parenchymal cysts had revealed indirect signs of a malignant process - septums, thickening of the walls of cysts and septums, foci of calcination, increased blood circulation in the thickened renal cyst walls, venous stasis on the periphery of cysts and renal medulla, increasing the density of the thickened walls. Results of morphological studies have confirmed the presence of a malignant process in 5 of these 7 patients. In 4 patients with parapelvic cysts malignant process in ectomized layers was not revealed.

[Modern approach to diagnosis and treatment of acute mesenteric ischemia]

It was proposed the medical and diagnostic tactic in patients with acute mesenteric ischemia on basis of efficiency results of modern laboratory markers and instrumental methods. Positive laboratory D-dimer-test with computed tomography of abdominal organs or abdominal aorta and its branches CT-angiography led to diagnose thrombosis or embolism of mesenteric arteries at early terms and to reduce preoperative period. The authors presented the variant of isolated endovascular intervention in case of superior mesenteric artery thrombosis. This technique may be regarded as the method of choice in the treatment of patients with acute mesenteric ischemia.

Differentiating between abdominal tuberculous lymphadenopathy and lymphoma using multidetector computed tomography (MDCT)

OBJECTIVE

To evaluate the specific computed tomography (CT) imaging criteria for differentiating abdominal tuberculous lymphadenopathy from lymphoma by using abdominal multidetector computed tomography (MDCT).

MATERIAL AND METHOD

A retrospective review of 31 patients with abdominal tuberculous lymphadenopathy and 85 patients with untreated lymphoma was conducted from abdominal CT scan reports in a single center; Siriraj Hospital, Mahidol University, Bangkok Thailand. CT scan was independently reviewed by two expert radiologists who were blinded to the patient's history, treatment outcome, and final diagnosis. The anatomical site, anatomical distribution, CT enhancement patterns, size of lymphadenopathy, amount and density of ascites, abdominal solid organ involvement, bowel involvement, and lung involvement were recorded

RESULTS

MDCT showed that abdominal tuberculous lymphadenopathy involved predominately the mesenteric, upper and lower para-aortic, periportal, and pancreaticoduodenal regions. Untreated lymphoma affected mainly the upper and lower para-aortic, iliac, periportal, pancreaticoduodenal, and gastrohepatic regions. Mesenteric and periportal lymph nodes were involved more often in patients with abdominal tuberculous lymphadenopathy than in those with untreated lymphoma (p = 0.04). Iliac and inguinal lymph nodes were involved more often in patients with lymphoma than in those with tuberculosis (p = 0.01). Anatomical distributions were significantly different between the two groups (p< 0.01): confluence distribution was noted more often in tuberculous lymphadenopathy. The enhancement patterns had significant difference between the two groups. Peripheral enhancement was seen significantly more often in tuberculous lymphadenopathy, whereas homogeneous enhancement was found more often in lymphoma. The maximum size of enlarged lymph nodes also showed statistical difference between two groups by using t-test (p = 0.01). The mean diameters were 2.95 cm in tuberculous lymphadenopathy and 4.10 cm in lymphoma. Ascites was found significantly more often in tuberculous lymphadenopathy than in lymphoma (p = 0.03). However; the attenuation of ascites on pre-contrast images did not show statistical difference. Small bowel and large bowel thickening were demonstrated more often in tuberculous lymphadenopathy than lymphoma (p < 0.01, p = 0.01), which mostly showed target sign enhancement in tuberculosis and homogeneous enhancement in lymphoma. The presence of hepatomegaly and splenomegaly were not different between the two groups. The diagnostic interpretations of two readers showed high sensitivity (93.5%) and high specificity (98.8% by reader 1 and 97.6% by reader 2).

CONCLUSION

The present study indicates that the anatomical site, anatomical distribution, enhancement patterns, and size of lymphadenopathy, persistent ascites, and small and large bowel involvement seen on contrast-enhanced MDCT is useful in differentiating between tuberculosis and untreated lymphomas.

Patient doses using multidetector computed tomography scanners in Kenya

Assessment of patient dose attributed to multislice computed tomography (CT) examination. A questionnaire method was developed and used in recording the patient dose and scanning parameters for the head, chest, abdomen and lumbar spine examinations. The patient doses due to brain, chest and abdomen examination were above the international diagnostic reference levels (DRLs) by factors of between one and four. The study demonstrated that the use of multislice CT elevates patient radiation dose, justifying the need for local optimised scanning protocols and the use of institutional DRL for dose management without affecting diagnostic image quality.

Maltese CT doses for commonly performed examinations demonstrate alignment with published DRLs across Europe

This work recommends dose reference levels (DRLs) for abdomen, chest and head computerised tomography (CT) examinations in Malta as the first step towards national CT dose optimisation. Third quartiles volume CT dose index  values for abdomen: 12.1 mGy, chest: 13.1 mGy and head: 41 mGy and third quartile dose-length product values for abdomen: 539.4, chest: 492 and head: 736 mGy cm(-1) are recommended as Maltese DRLs derived from this first Maltese CT dose survey. These values compare well with DRLs of other European countries indicating that CT scanning in Malta is consistent with standards of good practice. Further work to minimise dose without affecting image quality and extending the establishment of DRLs for other CT examinations is recommended.

[Comparative capacities of radiation studies in the diagnosis of circumscribed peritonitis in case of duodenal microperforation at different stages of emergency medical care]

The results of ultrasound (US) and X-ray studies were retrospectively studied in the diagnosis of circumscribed peritonitis in case of microperforation from duodenal ulcers at different stages of emergency medical care. Analysis of the findings has demonstrated that on admission and in its first hours the most effective diagnostic method is plain radiography that enables free gas accumulation to be found under the diaphragm and US study is of low informative value. Repeat targeted US study using expert-class scanners, with the well stated task based on clinical laboratory findings, is a high-informative diagnostic technique for circumscribed peritonitis in case of duodenal perforations.

[CT manifestation of abdomen and its pathology of patients with chronic schistosomiasis]

OBJECTIVE

To understand the abdominal CT manifestation and its pathology of patients with chronic schistosomiasis.

METHODS

The plain + enhanced CT scanning was performed in 42 patients with chronic schistosomiasis, and their tissues of biopsy and surgical resection were examined pathologically.

RESULTS

Among the 42 patients, schistosomiasis cirrhosis of liver was found in 36 cases, left lobe enlarged was found in 21 cases, and calcification was found in 32 cases. Portal vein and its tributaries calcification were found in 14 patients, and one of them was accompanied with transplanted hepatocellular carcinoma, 12 patients with stones in gallbladder, and 5 patients with ascites. Among the 19 patients with splenomegaly, 7 patients were accompanied with calcification. Intestinal wall thickening with linear and tram-like calcification was seen in 21 cases. Descending colon, sigmoidcolon, and rectum calcifications were found in 8 cases, and rectosigmoid calcification was found in 9 cases, rectum calcification was seen in 2 cases, and 2 patients were accompanied with colon carcinoma. The pathological examination showed fibrosis and calcified ova in liver, large intestine and gallbladder of the patients, but there were no ova in spleen.

CONCLUSION

Abdominal CT manifestation of patients with chronic schistosomiasis presents the damage of multiple organs in abdomen, and various calcifications are the main image characteristics.

[MDCT features and anatomic-pathological basis of the diseases in central thoracic-abdominal junctional region]

This paper is to determine relationship between MDCT features and anatomic-pathology of the diseases in central thoracic-abdominal junctional region. 3 cadavers were cut transversely and another 3 vertically to observe the anatomy of thoracic-abdominal junctional zone. 93 patients with diseases in central thoracic-abdominal junctional zone were scanned with MDCT. The correlation between MDCT features of the diseases in central thoracic-abdominal junctional region and the anatomic-pathology of the diseases in this region was evaluated. On cadaver sections, central thoracic-abdominal junctional region was an area between anterior chest wall and dorsal spine in vertical direction. The region was separated into upper and lower sections by diaphragm. The upper section mainly contains heart and pericardium, while the lower contains broad ligament and left lobe of liver. The hiatus of diaphragm are vena caval foramen, esophageal foramen and aortic foramen in anterior-posterior turn. In the present study, 23 patients had portal hypertension, 18 had dissection of aorta, 8 got diseases in inferior vena cava, 9 had lymphoma, 12 got diseases in multiple vertebrae, 7 had lower thoracic esophageal carcinoma accompanied with metastasis in upper abdominal lymph nodes, 9 had carcinoma of abdominal esophagus and/or gastric cardia, 4 had esophageal hiatal hernia and 3 patients had neurogenic tumor in posterior mediastinum and/or superior spatium retroperitoneale. The MDCT features and distribution of the diseases in central thoracic-abdominal junctional region influence the anatomic-pathology characteristics in this region.

Primitive neuroectodermal tumor arising in the abdominopelvic region: CT features and pathology characteristics

BACKGROUND

We analyze the computed tomography (CT) findings of a peripheral primitive neuroectodermal tumor (pPNET) arising in the abdominopelvic cavity and to improve understanding of the CT images of the tumor.

MATERIALS AND METHODS

Twelve cases of pPNET confirmed by histopathology were analyzed retrospectively. Image characteristics of CT scanning were analyzed and compared with the pathology of the tumors.

RESULTS

There were 8 males and 4 females with mean age of 34.5 years. Unenhanced CT images showed large heterogeneous and ill-defined or well-defined masses with multiple patchy hypodense areas. The average diameter was 9.8 cm (range 4.0-17.2 cm). Contrast-enhanced CT images showed variable heterogeneous contrast enhancement with multiple non-enhancement areas. 3 cases revealed metastasis and 4 cases invaded into adjacent organs. Pathology showed areas of degeneration and necrosis in all tumors. Cluster of differentiation 99 and neurone specific enolase were detected positive in 11 and 12 cases, respectively.

CONCLUSIONS

In conclusion, pPNET in the abdominopelvic cavity likely affects young adults with a slight male preponderance and tend to be large and aggressive. Although CT findings are nonspecific and variable, a large ill-defined or well-defined heterogeneous mass with multiple patchy hypodense areas reflecting their cystic degeneration and necrosis on pathology examination may suggest the diagnosis of pPNET.

[Extraperitoneal ligation herniorraphy by the acute infectious diseases of the abdominal cavity in children]

Surgery on the reason of the "acute abdomen" in children often reveals the persisting vaginal peritoneal defects, which further lead to hernia formation. 23 children (aged 4-15 years) were operated on the acute uncomplicated appendicitis (n=10), acute mesadenitis (n=3), appendicular local and pelvioperitonitis (n=9) and ovary apoplexia (n=1). Inguinal hernia was revealed in all patients during laparoscopy. After videoendoscopic sanation of the abdomen and appendectomy (if it was necessary) the extraperitoneal ligation herniorraphy in author's modification was performed. The were no cases of abdominal complications as well as hernia recurrence among the treated patients.

[The miniinvasive treatment of the aseptic fluid collections by the acute necrotizing pancreatitis]

The study aimed to state the indications to punctures and draining of the aseptic fluid collections by the acute necrotizing pancreatitis. Data of 82 patients were analyzed. The miniinvasive treatment proved to be preferable to the conservative treatment only in cases of the internal organs compression. Punctures and draining didn't provide the decrease of septic complications and pseudocyst formation. Poor result of miniinvasive procedures predict the high risk of pseudocyst formation.