Marjorie Hertz

Intussusception in adults: CT diagnosis

PURPOSE Intussusception in adults is nowadays usually diagnosed on computed tomography (CT), as CT is often the first modality for the investigation of prolonged abdominal pain from which these patients suffer. We wish to present the CT, clinical and pathological findings of 16 adult patients with intussusception seen over a 5-year period. MATERIALS AND METHODS The abdominal scans of 16 patients with intussusception were reviewed. Special attention was directed to the location of the mass, its shape and fat content, possible underlying pathology and dilatation of the bowel proximally. The findings were correlated with clinical and pathological data. RESULTS Eight men and eight women, aged 34-81 years, were studied. The most frequent indication for CT was prolonged abdominal pain. CT findings included an inhomogeneous soft tissue mass, target or sausage-shaped, depending on the angle of the CT beam vs. the intussusception, with a fatty component in 14 of the 16. Intussusception was enteroenteric (six), ileocolic (three), or colocolic (seven). Complete small bowel obstruction was present only in one case and some bowel dilatation in three. The underlying pathology could be diagnosed on CT in only two cases of lipoma. Nine patients had an underlying malignant process, eight of them unsuspected. Of the other five, two had coeliac disease, two were classified as idiopathic and one had a necrotic polyp of undetermined pathology. CONCLUSION Intussusception on CT presented a characteristic mass lesion containing fat stripes in almost all patients. Obstruction was rarely seen. Malignant lesions were the most common cause and therefore early diagnosis and prompt intervention are essential.

Polysplenia syndrome detected in adulthood: report of eight cases and review of the literature.

Abstract.Background: To present the computed tomographic (CT) features of the abdominal anomalies consistent with polysplenia syndrome in adults. Awareness of these abnormalities may avoid misdiagnosing characteristic findings as separate pathological processes. Methods: Imaging studies, mainly abdominal CT scans, of eight patients were reviewed. Attention was directed to the location of the multiple spleens, stomach, and liver and to the possible presence of a short pancreas, malrotation of the intestine, and venous anomalies. We also reviewed the CT findings of 15 adult patients described in the literature. Results: Three men and five women underwent CT for various unrelated conditions. The most common findings were multiple spleens along the greater curvature of the stomach, which were located in the right upper quadrant in six patients. The inferior vena cava was seen on the left side in seven subjects, with azygos/hemiazygos continuation in six. A preduodenal portal vein was present in seven subjects. The liver was in the midline in four patients and on the left side in two. A short pancreas was seen in four patients, intestinal nonrotation in five, and dextrocardia in two. The prevalence of these anomalies was similar to that of the reviewed cases. Conclusions: CT proved to be an excellent imaging modality in the diagnosis of the abdominal anomalies. Some of these (a short pancreas, multiple spleens, and azygos continuation) can simulate pathological processes. Hence the importance of recognizing these CT findings as part of a syndrome.

Iliopsoas abscess: a report of 24 patients diagnosed by CT

AbstractBackground: We wanted to define the role of computed tomography (CT) in the diagnosis, etiology, and treatment of iliopsoas abscess. Methods: Twenty-four patients (18 men, six women; age range = 17–86 years) with iliopsoas abscesses diagnosed over 8 years were retrospectively reviewed. All presented with fever and elevated white blood cell counts. Twenty-one had abdominal, flank or pelvic pain and nine had specific psoas signs suggesting the diagnosis. Results: Seventeen of the abscesses were right-sided. Twenty were regarded as secondary to various underlying causes that were clearly demonstrated on CT and related to gastrointestinal (n= 12), skeletal (n= 5), or urinary tract (n= 3) diseases. All patients received appropriate antibiotic treatment. Thirteen also had their abscesses drained and eight had definitive surgical procedures. Conclusion: CT is an effective imaging technique for diagnosing iliopsoas abscess, even when classic clinical signs are absent. Treatment by percutaneous drainage under CT guidance is another advantage. When a psoas abscess is a complication of Crohns disease, resection of the affected bowel segment is recommended in addition to drainage because drainage alone even in conjunction with appropriate medical therapy is usually not effective.

CT findings of the chest in adults with aspirated foreign bodies.

Abstract The aim of this study was to assess the imaging findings in adult patients with tracheobronchial foreign body aspiration. Nineteen patients (11 men and 8 women; age range 26–89 years) with foreign-body aspiration were retrospectively reviewed. Nine

Urinomas caused by ureteral injuries: CT appearance

AbstractBackground: We report the computed tomographic (CT) features of urinomas caused by ureteral injuries which are often not clinically suspected, causing delay in diagnosis. Methods: CT studies of 12 patients with ureteral injury were reviewed. Ureteral injuries were iatrogenic in 9 patients and traumatic in the remaining three. CT was performed between 2 and 139 days (average = 33 days) after the insult. The most common presenting symptoms were severe abdominal pain and fever. All CT studies were performed before and after intravenous contrast administration. In 11 of 12 cases, delayed scanning was added 15 min to 5 h later. Results: The sites of injury were the proximal ureter in two patients, the middle ureter in three, the distal ureter in two, and the ureteral anastomosis in five. The urinomas appeared as confined water-density fluid collections in seven patients, as free fluid (urinary ascites) in two, and as both in three. Extravasation of contrast from the ureter was observed on early scans in six patients and on delayed scanning only in the other six. The density of the opacified urinoma measured 80–200 HU. Ipsilateral hydronephrosis was observed in seven patients. Ureteral injuries were treated conservatively in eight patients and surgically in four. Conclusion: Ureteral injuries after iatrogenic or penetrating trauma often are diagnosed with considerable delay. The presence of ascites or localized fluid collections in symptomatic patients after abdominal surgery or penetrating trauma should raise the possibility of a ureteral injury and prompt delayed scanning.

Gossypiboma in the Early Post-operative Period: A Diagnostic Problem

A gossypiboma (a retained surgical sponge) usually has the characteristic appearance on CT of a soft tissue mass with air-bubbles and a whirl-like pattern. This finding may be confused in the early post-operative period with an abscess, especially when a fistula is present. We describe two patients, in whom this diagnosis was initially missed. A soft tissue mass containing air-bubbles in the early post-operative period with or without a fistula should include a retained pad, in the differential diagnosis.

Bezoars in the stomach and small bowel--CT appearance.

AIM The aim of this study was to present the computed tomography (CT) appearance of trichobezoars, phytobezoars and other unusual ingested material. MATERIALS AND METHODS Seven patients diagnosed on CT with bezoars in the stomach or small intestine were reviewed with special attention on the characteristics of the intraluminal mass and the presence of proximal dilatation. RESULTS There were six women and one man aged 14-81 years. CT was performed because of abdominal pain and a palpable abdominal mass. In none of the cases was the diagnosis suspected clinically. Four patients had a trichobezoar occupying the entire lumen of the stomach. It appeared as a concentric inhomogeneous mass with entrapped air, surrounded by contrast material. In the other three patients the bezoar was confined to the small intestine and was composed respectively of vegetable fibres, ingested toilet paper and an olive stone. The first two had a mottled appearance whereas the last one was small, spherical and well defined. Variable proximal dilatation of the small bowel was present in all three. CONCLUSION With the increased use of CT in the evaluation of patients with non-specific abdominal pain, it is important to recognize the CT appearance of bezoars, as this diagnosis is often not suspected clinically.

Echinococcus of the urinary tract: Radiologic findings

Echinococcal involvement of the urinary tract is extremely rare. We present 11 such cases, 10 with renal and 1 with bladder involvement. Clinical and laboratory findings were nonspecific. Calcification was present in all but 1 case. The excretory urogram and retrograde pyelogram demonstrated parenchymal soft-tissue masses causing pressure on and dilatation of the collecting system. Angiography in 3 cases showed the masses to be avascular. The ultrasound findings of a multicystic lesion with mixed echogenicity were typical of echinococcal cysts, while a CT scan in 1 patient showed a cyst with densely calcified border.The combined findings of these different modalities aid greatly in establishing the correct diagnosis.

IVC anomalies and right renal aplasia detected on CT: a possible link?

AbstractBackground: We report the occurrence of congenital anomalies of the inferior vena cava (IVC) and right renal aplasia in three patients as detected on computed tomography (CT). Methods: The medical records and imaging studies of three patients with congenital anomalies of the IVC and right renal aplasia were studied. We also reviewed eight reported cases with such an association. Results: Eleven patients, nine adults and two girls, were included in the series. Indications for imaging included deep vein thrombosis (n = 5), hypertension (n = 2), failure to advance a femoral vein catheter cranially (n = 1), dilated veins along the abdominal wall (n = 1), endstage renal failure (n = 1), and jaundice (n = 1). CT was performed in seven patients, and venography, aortography, and other imaging modalities were performed in four. IVC anomalies included partial or complete absence of the IVC in nine patients and a double vena cava in two. The azygos vein was very prominent in all patients in whom the IVC was absent. The right kidney was absent or very small in all patients. Conclusion: The association between IVC anomalies and absence of the right kidney as detected on CT probably was not incidental. Although most patients had symptoms deriving from the anomalies, these might have been clinically silent. The radiologist should be aware of the possible association between these anomalies, which can be detected on CT.

Crossed renal ectopia: Clinical and radiological findings in 22 cases

The clinical and radiological features of 22 patients with crossed ectopic kidneys are reported, including a case with unusual mobility of an unfused ectopic kidney. In some cases the anomaly was an incidental finding. However, complications were frequent and included seven hydronephrotic and three non-functioning kidneys, two of the latter were found to be obstructed by a calculus. Vesico-ureteral reflux was demonstrated in three of the five children in whom the examination was performed. Anomalous blood supply was present in all patients who underwent renal arteriography or surgery. Skeletal anomalies were present in 11 patients, one of whom had in addition coarctation of the aorta, and another atrial septal defect and anal atresia.