Toshio Yamaguchi

Acute mesenteric ischemia:ct and plain radiographic analysis of 26 cases

The purpose of this study was to assess the computed tomography (CT) and plain radiographic findings of acute mesenteric ischemia, in an effort to elucidate its poor prognostic signs. The study group consisted of 26 cases with pathologically or angiographically proven mesenteric ischemia. The pathologically proven longitudinal extent of the bowel ischemia was graded using six degrees, and correlated with the radiographic findings. The mortality of the patients depended primarily on the extent of infarctions and the age of the patient. Patients with bowel dilation or abnormal gas in the bowel wall or portal system were prone to have wider extents of ischemia.

Extrarenal multiorgan metastases of collecting duct carcinoma of the kidney: a case series.

IntroductionCollecting duct carcinoma is a rare type of renal cell carcinoma. The primary is difficult to diagnose on imaging, and metastases are often present on initial presentation. Extensive multiorgan metastases can result in complex presentations that can be difficult to diagnose.Case presentationWe present two case reports of multiorgan metastases of collecting duct carcinoma that were autopsy confirmed. The first case was a 55-year-old man who presented with fever and abdominal pain. Abdominal computed tomography showed enlargement of the right kidney. Pyelonephritis was considered on the basis of laboratory test results and imaging findings. However, multiple cavitary lesions were found on routine chest radiography. These lesions were biopsied, resulting in a histological diagnosis of metastatic adenocarcinoma. A renal tumor was considered. Transitional cell carcinoma was suspected, which proved to be misdiagnosed and chemotherapy was given accordingly. However, this was not effective and the patient died after 2 months. Autopsy demonstrated the primary tumor to be collecting duct carcinoma, with metastases to lung, liver, spleen, bone marrow, right adrenal gland, and para-aortic lymph node. Computed tomography done while the patient was alive detected lung, liver, and para-aortic lymph node metastases. The second case was a 77-year-old man who presented with fever. Pyelonephritis was considered on the basis of the laboratory test results and imaging findings. Antibiotic therapy improved his symptoms and laboratory indicators of inflammation. One year later, he developed backache. Computed tomography revealed a progressively enlarging right renal lesion, multiple liver masses, enlargement of the para-aortic lymph nodes, and multiple osteoblastic and osteoclastic lesions. A renal tumor with multiple metastases was diagnosed. Chemotherapy was given without effect, and the patient died of cardiac failure 1 year later. Autopsy revealed a primary tumor of collecting duct carcinoma with metastases to the liver, right adrenal gland, right upper ureter, bone marrow, para-aortic and mediastinal lymph nodes, and bone.ConclusionWe present the radiological findings of lung, liver, lymph node, and bone metastases in two patients with collecting duct carcinoma.

Significance of incidental pericardial effusion on computed tomography in cardiac trauma: A report of two cases

We describe computed tomographic (CT) findings in two patients with cardiac injury who required emergency surgery. Chest CT revealed an unexpected low-density area, indicating pericardial effusion. We emphasize that, given the situation of trauma, an incidental low-density area covering more than two slices along the inferior border of the heart suggests pericardial effusion, which may be caused by cardiac injury.

Vertebral artery injury and delayed midbrain infarction after unusual fracture of transverse foramen of C3 noted by bone scintigraphy

Vertebral artery dissection and thrombosis propagation causing neurologic sequelae is a rare complication of minor neck injury. Partial fracture of the transverse foramen of the third cervical vertebral body (C3) is uncommon. The authors report a case of vertebral artery injury and delayed midbrain infarction after an unusual fracture of only the upper half of the transverse foramen of C3, noted initially by bone scintigraphy. No other fracture was noted. A minor penetrating skin wound of the neck was not thought to be related to the fracture of the transverse foramen. The right lateral inferior edge of C2 was believed to have compressed the upper half of the transverse foramen of C3 by lateral hyperflexion. Innate laxity of the cervical spine at the level of C2 with respect to C3 in pediatric patients supports this belief.

Emergent endovascular treatment for leg ischemia complicating acute aortic dissection

We describe a patient with acute aortic dissection involving the right iliac artery and causing right lower leg ischemia that was successfully treated by Wallstent placement. Emergent endovascular treatment may be the treatment of choice in the patient with acute leg ischemia caused by the involvement of the iliac artery by aortic dissection.