Peter Hübsch

Update: Abdominal tuberculosis — Unusual findings on CT

To update our knowledge of abdominal tuberculosis as manifested on computed tomography (CT), we reviewed the CT scans of 12 patients with proven abdominal tuberculosis. The nature, range and extent of abdominal involvement was determined. The CT findings were compared to those reported in the literature. The aetiologic agent was Mycobacterium tuberculosis in all patients. One patient had an increased risk because of AIDS. In nine patients, tuberculosis was limited to the abdomen, and three patients had previously unknown thoracic tuberculous disease. Characteristic features in our patients included low density ascites and uncommon patterns of adenopathy. Findings reported to be typical in abdominal tuberculosis were present in only five of our 12 patients. Unusual findings in our patients included solitary and multiple pelvic, adrenal, splenic and hepatic lesions. In six of 12 patients, those findings mimicked malignancy. We conclude that knowledge and early recognition of these unusual manifestations of abdominal tuberculosis should help to optimize clinical management of the disease and avoid misdiagnosis.

Case report: benign solitary schwannoma of the greater omentum: a rare cause of acute intraperitoneal bleeding--diagnosis by CT.

We report a case of a 64-year-old man presenting with shock and a pulsating mass in the lower abdomen. Emergency computerized tomography revealed a mass in the left lower abdomen, with associated bleeding. Surgery confirmed that the mass was a benign schwannoma located in the greater omentum. Neither solitary benign schwannoma of the greater omentum, nor the complication of intraperitoneal bleeding caused by omental schwannoma, have been previously described in the literature.

Venous contrast fluid level in computed tomography

OBJECTIVE To evaluate the clinical significance of a venous contrast fluid level during computed tomography (CT). METHODS An incidentally found contrast fluid level in the left internal jugular vein during CT in an otherwise healthy patient was the reason for investigation of this phenomenon. We collected data over a 4-year period at our institution and reviewed the case notes of seven patients exhibiting this CT finding. We also performed conventional radiography, CT, venography and colour-coded Doppler sonography to rule out an underlying pathology in those patients. Additional in-vitro CT studies were performed to define conditions of flow leading to a contrast fluid level. Flow dynamics in the internal jugular veins were studied in vivo by using colour-coded Doppler sonography in 20 normal volunteers. RESULTS In addition to our first patient, we found seven patients with a venous contrast fluid level among a total of 58400 contrast-enhanced CT examinations performed in our institutions. The investigations were performed on various CT-units, with different scan protocols, injection rate, dose and manufacturer of non-ionic contrast agent. The contrast fluid level was encountered unilaterally in the left internal jugular vein in seven patients and in the inferior vena cava in one patient. All patients were free of symptoms and the outcome of all other examinations was unremarkable. In-vitro and in-vivo studies showed that pure contrast agent entering a vessel (in case of the internal jugular vein due to physiological flow and/or stasis) can produce a contrast fluid level. CONCLUSION The occurrence of a venous contrast fluid level during contrast enhanced CT is an incidental finding of no pathological significance and need not initiate costly further examinations.