Stan L. Weiss

CT in upper gastrointestinal tract perforations secondary to peptic ulcer disease

Computed tomographic (CT) scans of 11 patients with perforations of the stomach or duodenum were reviewed to determine the variety and relative conspicuity of findings. Five patients had de novo presentation due to perforation of peptic ulcers, two had perforations at ulcer repair sites, and the remaining four patients had ulcer perforations following unrelated surgery. CT allowed recognition of at least one component of bowel perforation, such as extragastroinestinal gas and/or contrast, in most patients. In only three patients (27%), however, could these findings be specifically related to a perforation of the stomach or duodenum from the CT scans alone.

MR fat suppression technique in the evaluation of normal structures of the knee.

The chopper fat suppression (CFS) pulse sequence, which is a phase sensitive implementation of the Dixon fat suppression method and the spin echo (SE) pulse sequence, was used in the evaluation of anatomic structures of the normal knee using 48 sets of imaging sequences in six volunteers using a repetition time/echo time combination of 1,500/30, 60 ms. A demonstration of the CFS technique in 10 patients with suspected knee pathology is also presented. A semiquantitative grading scale was established to rate anatomic visualization and used to compare CFS and SE pulse sequence techniques. The results in normal subjects demonstrate that hyaline cartilage is significantly better visualized by fat suppression pulse sequence than by conventional SE pulse sequence in the coronal and sagittal planes of imaging (p < 0.001). The preliminary results from patient studies suggest that CFS imaging may be useful in the evaluation of meniscal tears, in the differentiation of hyaline cartilage from joint fluid, and in the detection of both soft tissue and bone injuries.

Successful medical management of emphysematous gastritis with concomitant portal venous air: a case report

IntroductionThe causes of diffuse abdominal pain following pelvic surgery are numerous. We present a rare case of acute abdominal pain in a woman in the post-partum period.Case presentationA 25-year-old Caucasian woman with neurofibromatosis type 1 presented to our hospital with diffuse abdominal pain immediately after a cesarean section. The patient was acutely ill and toxic with a fever of 38.8°C, a pulse of 120 beats per minute and a distended abdomen with absent bowel sounds. A computed tomography scan showed air in the wall of the stomach and portal venous system. The patient was successfully treated with intravenous antibiotics, bowel rest and total parenteral nutrition.ConclusionIt is rare for a case of emphysematous gastritis associated with portal venous air to be treated successfully without surgery. To the best of our knowledge, to date there has been no reported association of emphysematous gastritis with neurofibromatosis.

Comparative imaging of gallbladder cancer

We reviewed various imaging approaches in 22 patients with gallbladder cancer. Nineteen had had ultrasonography and nine computed tomography performed. A gallbladder mass or diffuse wall thickening was seen by ultrasonography in 42% and computed tomography in 33% of patients. A significant number of patients had no gallbladder wall abnormality detected by ultrasonography (37%) or computed tomography (56%). Performing both ultrasonography and computed tomography improved the diagnostic rate; in this subgroup the detection rate was 51%. Cholelithiasis, dilated biliary ducts, the liver metastases were associated findings. Percutaneous cholangiography in jaundiced patients revealed the level of bile duct occlusion and often suggested the diagnosis. Radionuclide hepatobiliary imaging simply revealed non-visualization of the gallbladder.

Sonographic examination of the abdominal aorta through the left flank: a prospective study.

Ultrasonographic evaluation of the abdominal aorta is most often done with the patient in the supine position. The right lateral decubitus position, which views the aorta through the left flank has, until now, been considered unsatisfactory for aortic evaluation. One hundred consecutive patients were prospectively examined for visualization of the aorta both through the left flank and the anterior abdomen. Twenty‐one patients were then comparatively examined from the right coronal and left coronal approach. These studies showed that the aorta was clearly visualized using the left flank approach in the majority of patients (96 per cent). The combined approach yielded 99 per cent satisfactory visualization, and in a few select cases (13 per cent) the left flank was actually superior. The left flank approach was superior when directly compared with the right flank in 42 per cent of patients and comparable in 48 per cent. The right flank approach was superior in only 10 per cent.

Mirizzi syndrome simulating a tumor by ERC

SummaryERC was initially performed on a patient with right upper quadrant pain and jaundice. The filling defect in the CHD was felt to be a tumor. A correct preoperative diagnosis of Mirizzis syndrome was made by CT.

Ultrasound evaluation of urachal abscess in a young infant.

Abstract The urachus is a tubular structure extending from the dome of the bladder to the umbilicus. Normally, this allantoic and cloacal remnant obliterates into a fibrous band by late fetal development. Urachal abnormalities include a patent urachus, urachal cyst, umbilical urachal sinus, and a vesicourachal diverticulum. These abnormalities are most often asymptomatic and only come to clinical attention when associated with infection. A 2-month-old male infant presented to our tertiary pediatric hospital with several days of intermittent fevers and a focal region of swelling and erythema over the umbilicus. On physical examination, a tender mass was palpated in the umbilical region. Ultrasound revealed a long tubular structure coursing from the dome of the bladder anteriorly and superiorly to the subumbilical region. This tubular structure was fluid filled with internal echoes suggestive of infection with abscess formation. The urachal abscess was drained surgically, at which time a patent urachus was also excised. This case demonstrates the importance of having a thorough understanding of urachal anomalies when evaluating infants presenting with umbilical pathology.