Ascites and oedema in liver disease

Improved subcutaneous edema segmentation on abdominal CT using a generated adipose tissue density prior

PURPOSE

Edema, or swelling, is a common symptom of kidney, heart, and liver disease. Volumetric edema measurement is potentially clinically useful. Edema can occur in various tissues. This work focuses on segmentation and volume measurement of one common site, subcutaneous adipose tissue.

METHODS

The density distributions of edema and subcutaneous adipose tissue are represented as a two-class Gaussian mixture model (GMM). In previous work, edema regions were segmented by selecting voxels with density values within the edema density distribution. This work improves upon the prior work by generating an adipose tissue mask without edema through a conditional generative adversarial network. The density distribution of the generated mask was imported into a Chan-Vese level set framework. Edema and subcutaneous adipose tissue are separated by iteratively updating their respective density distributions.

RESULTS

Validation results on 25 patients with edema showed that the segmentation accuracy significantly improved. Compared to GMM, the average Dice Similarity Coefficient increased from 56.0 to 61.7% ([Formula: see text]) and the relative volume difference decreased from 36.5 to 30.2% ([Formula: see text]).

CONCLUSION

The generated adipose tissue density prior improved edema segmentation accuracy. Accurate edema volume measurement may prove clinically useful.

Successful treatment of refractory edema with traditional herbal medicine: A case report

RATIONALE

Refractory edema is characterized by persistent swelling which does not react to diuretic use and sodium restriction. Traditional herbal medicine, Gwack Rhyung Tang and Chunggan extract effectively treated refractory lower limb edema caused by cirrhosis and improved liver function.

PATIENT CONCERNS

A 64-year-old male patient with a history of hypertension, diabetes mellitus, hepatic encephalopathy, and cellulitis presented lower limb edema which did not react to diuretics for more than 7 months.

DIAGNOSES

Refractory edema caused by cirrhosis.

INTERVENTIONS

The patient was treated for 25 days using Gwack Rhyung Tang and Chunggan extract.

OUTCOMES

Loss of body weight, decrease in circumferences of both lower limb and improvement of liver function biochemistry results are checked. There was no recurrence or aggravation of the condition up to 3 weeks of follow-up periods.

LESSONS

Traditional herbal medicine can be an effective alternative for refractory edema due to cirrhosis with improving liver function.

Gastrointestinal edema in cirrhotics. Radiographic manifestations and pathogenesis with emphasis on colonic involvement

The radiologic manifestations of gastrointestinal edema observed as a complication of liver cirrhosis are described. We reviewed 22 consecutive patients with colonic and small bowel edema and present forms of intestinal involvement previously not reported. The pathophysiology of bowel edema is discussed and an attempt is made to correlate several factors. Our studies suggest that the production of intestinal edema is the result of a complex mechanism involving multiple factors on both sides of the capillary membrane. What appears crucial is not the absolute level of any disruptive force, but rather, the combination of several factors: 1. the ability of the lymphatic system to handle excessive flow; 2. the oncotic pressure; 3. the hydrostatic pressure and portal hypertension with or without venous collaterals. In this context, portal hypertension seems to play a dominant role since it correlates best with intestinal edema and explains its usual distribution.

Posthypoxic ascites: a cause of post-traumatic abdominal distention

A previously unreported etiology for post-traumatic abdominal distention was observed in a 5-year-old girl who suffered only head trauma and a prolonged period of hypoxemia. When there is a rapid accumulation of peritoneal fluid containing a high concentration of protein but negative for amylase, no evidence of blood loss, plus abnormal serial liver enzyme studies and the need for placement of large volumes of fluid, posthypoxic ascites should be suspected. Peritoneal aspiration confirmed the diagnosis and treatment was supportive. Because early operative intervention is necessary in pancreatic ascites and treatment is supportive for posthypoxic ascites, it is imperative to differentiate them.