Tze-Yu Lee

Gas-containing liver abscess: radiological findings and clinical significance

Sixty-two cases of verified gas-containing pyogenic liver abscess were reviewed to study the radiological and clinical prognostic factors. A mortality rate of 37.1% (23 cases) was observed. Among these patients, the survival time of 13 patients with alveolar gas pattern or pneumoperitoneum (6.15±7.36 days) was significantly shorter than that of the other 10 patients (17.70±13.32 days) despite immediate diagnosis and aggressive treatment. The poor radiological prognostic signs were: (1) alveolar gas pattern and pneumoperitoneum as viewed on radiographs; and (2) globular configuration, shaggy margin, alveolar internal structure, and total gas content on computed tomographic (CT) scans. High serum creatinine and glucose levels and a short time to diagnosis were the poor clinical prognostic factors. The aggressive treatment did not change the outcome. We conclude that, in addition to the clinical evaluation, meticulous radiological study of the abscess morphology should be done in cases of gas-containing liver abscess in an effort to provide further aggressive treatment for those patients with poor radiological prognostic signs.

Variations of the middle and inferior right hepatic vein: application in hepatectomy.

We evaluated the anatomic variations of the middle right hepatic vein (MRHV) and inferior right hepatic vein (IRHV) and their clinical application to the possibility of right subtotal hepatectomy. In 400 of normal livers studied with ultrasound, the IRHV was found to drain segment 6 of the liver and flow into the inferior vena cava (IVC) in 72 (18%) cases. In 22 (5.5%) cases, the MRHV was found to drain segment 5 of the liver and flow into the IVC. The size of the IRHV ranged from 0.1 cm to 0.8 cm with an average of 0.46 cm. For the MRHV, the sizes ranged from 0.1 cm to 0.9 cm with an average of 0.34 cm. In 10/79 (12.6%) cases the IRHV and in 4/22 (18.1%) cases the MRHV were bigger than the right hepatic vein (RHV). The distance between the RHV and IRHV ranged from 3 cm to 5 cm with an average of 3.7 cm. The distance between the RHV and MRHV ranged from 3 cm to 3.3 cm with an average of 3.1 cm. A hyperechoic edge, similar to that of the portal vein, was observed at the wall of the hypertrophic IRHV and was 0.3 cm or larger in size. Preoperative delineation of this complex venous anatomy is very important. It provides vital information in the preoperative evaluation needed before performing a right subtotal hepatectomy with preservation of segment 6 or segment 5 of the liver, and with RHV resection. Prior to undertaking a right hepatectomy, clamping the hypertrophic MRHV and IRHV electively may minimize intra‐operative blood loss and extrahepatic spread of the malignancy.

Sonography and computed tomography of a gossypiboma and in vitro studies of sponges by ultrasound case report

A case of retained surgical sponge was imaged by ultrasound and computed tomography (CT). Sonography revealed a hypoechoic mass with areas of high echoes and acoustic shadowing. An experiment revealed that the high echoes were attributed partly to the presence of numerous interfaces of sponges. The sonographic detection of a mass with high echoes casting acoustic shadows should alert radiologists to the possibility of retained surgical sponges even if there is no gas or calcification on CT scans.

Mesenteric cystic lymphangioma with myxoid degeneration: unusual CT and MR manifestations.

We report an unusual case of mesenteric cystic lymphangioma presenting as a large multilocular mass with a well-enhanced solid component and a central cleft, which were were pathologically correlated to the prominent stromal myxoid degeneration interspersed with abundant capillaries and the central fibrosis, respectively. The findings of computed tomography and magnetic resonance imaging are illustrated. Recognition of the multilocular configuration of the enhanced stroma may help to make the correct preoperative diagnosis.

Ultrasound and CT findings of a cecal lymphangioma presenting with intussusception

A rare case of cecal lymphangioma which presented as intussusception was reported. The patient was a 28-year-old female who suffered from vomiting, abdominal pain and mass for 6 days. Ultrasonography revealed a multilocular cyst that measured 7 cm in maximal diameter, and an adjacent target-like mass with concentric layering in the right abdomen. Computed tomography confirmed the sonographic findings with fatty component in the target-like mass. Intussusception in adults is a diagnostic challenge to a physician due to its vague and nonspecific presentations. Laparatomy is indicated because of underlying pathology in a vast majority of cases. Diagnosis can be established by the characteristic findings mentioned above.

Retroperitoneal actinomycosis with intraperitoneal spread stellate pattern on CT

We report a case of pathologically proved actinomycosis that presented unusual computed tomographic (CT) features: a soft-tissue retroperitoneal mass encasing the adjacent ureter resulting in hydronephrosis and spreading into the intraperitoneal space with a stellate pattern. The role of CT in monitoring the response to antibiotic treatment is also discussed.

Solitary hepatic Burkitt lymphoma presenting as acute pancreatitis

A 14-year-old boy was admitted with a 3-week history of worsening postprandial epigastralgia. On physical examination, there were epigastric tenderness and hepatosplenomegaly. The serum amylase, lipase, alkaline phosphatase and the Cam/Ccr ratio were abnormally high. Sonography revealed a solitary hypoechoic mass in the right lobe of the liver; the pancreas was hypoechoic and swollen with dilatation of the pancreatic duct. The CT after contrast (Fig. 1) confirmed the sonographic findings. Celiac angiography showed mass effect with few tumor vessels (Fig. 2). Exploratory laparotomy followed by right-hepatic lobectomy was performed. The liver specimen revealed a well-encapsulated and grayish white tumor mass 17 cm in maximal diameter. The pathologic diagnosis was Burkitt lymphoma. After surgery, the symptoms subsided, and subsequent ultrasound and serum enzyme levels indicated the resolution of acute pancreatitis. The patient was followed at clinic for further work-up and chemotherapy.

Mucin-hypersecreting papillary cholangiocarcinoma presenting as abdominal wall abscess: CT and spiral CT cholangiography.

Abstract. We describe CT findings of a case of mucin-hypersecreting papillary cholangiocarcinoma (MHPC), with extrahepatic bile leakage to the rectus abdominis muscle via the ligamentum teres hepatis forming an abdominal wall abscess. Endoscopic retrograde cholangiography was unsatisfactory. Spiral three-dimensional CT cholangiography was helpful in assessing the resectability of MHPC by offering anatomic details of the uninvolved biliary tree.

Dissection of retroesophageal aortic diverticulum and descending aorta in a patient with right aortic arch: Magnetic resonance demonstration

An acute aortic dissection involved the retroesophageal aortic diverticulum (RAD) and descending thoracic aorta in a patient with right aortic arch. The RAD, which was separated into false and true lumens by an intimal flap—the classic diagnositc sign of aortic dissection—was overlooked on transesophageal echocardiography and computed tomography but was clearly depicted on magnetic resonance imaging (MRI). It was found that MRI can delineate the anatomy of a congenital arch anomaly complicated by great vessels disease.

Symptomatic giant müllerian duct cyst in an infant: radiographic and CT findings

We report an unusual case of Müllerian duct cyst in an 8-month-old infant who presented with frequent vomiting and recurrent urinary tract infections. Computed tomography showed a midline giant cyst in the pelvic floor. Delayed enhanced computed tomography demonstrated contrast filling of the cyst, indicating a communication with the urotract. Subsequent cystourethrogram and surgery confirmed a giant Müllerian duct cyst.