Plain film findings of gastric volvulus herniating into the chest.

When confronted with a chest radiograph demonstrating two large air-fluid levels, one in the retrocardiac mediastinum and the other beneath the left hemidiaphragm, the possibility of gastric volvulus herniating into the thorax should be strongly considered. These patients should have an immediate contrast study for further evaluation.     

Triple fluid level due to gastric volvulus complicating bilateral paraesophageal hernia: Case report

Paraesophageal hernia is the second most type of hiatal hernias. It is a known predisposing factor for gastric volvulus. When acute gastric volvulus occurs, early diagnosis before strangulation and incarceration will be life-saving.We are presenting a case with paraesophageal hernia and gastric volvulus with unusual radiologic findings. The patient came to emergency room with acute symptoms. The diagnosis was made with multidetector computed tomography (MDCT). Three spherical gas bubbles were seen in the chest X-ray. Two of them were intrathoracic and the third one was intraabdominal. MDCT showed that most of the stomach was in the chest alongside the esophagus. Gas in the portal veins and gastric wall was also seen. The patient was treated with surgery.     

伴有脊柱后突的不可复性食管裂孔疝--胸部平片与CT、MRI对照观察

目的 加深对伴有脊柱后突的不可复性食管裂孔疝影像表现的认识,并探讨此类食管裂孔疝形成的机制。材料与方法 对照分析８例经钡餐造影确诊的伴有脊柱后突的不可复性食管裂孔疝的胸片与ＣＴ、ＭＲ影像表现。结果 ８例均为老年人,以女性居多,胸片与ＣＴ、ＭＲ影像表现均见疝囊在心脏之后呈肿块状,内含气体或气－液面,并有食管裂孔增宽、膈肌后份变平、后肋膈角变浅、贲门位于膈上而食管不短;均见脊柱胸腰段后突,该水平胸廓前     

Gastric volvulus: acute and chronic presentation

Diaphragmatic hernia may be congenital or traumatic in origin. Traumatic hernia may menifest immediately or several months/years after the incident. Congenital hernia usually manifests in the early years of life. Diaphragmatic hernia may be complicated by gastric volvulus. Acute gastric volvulus is surgical emergency where as chronic gastric volvulus presents with nonspecific abdominal symptoms. Diagnosis of gastric volvulus is difficult and is based on imaging studies. We describe four cases of diaphragmatic hernia complicated by gastric volvulus, diagnosed on imaging and managed surgically.     

Duodenogastric reflux in a hiatal hernia seen as retrocardiac activity on 99mTc-tetrofosmin cardiac SPECT raw-data images

We present a patient with a large hiatal hernia resulting in duodenogastric reflux that was seen as abnormal activity below and behind the heart (retrocardiac) on SPECT images and on (99m)Tc-tetrofosmin cardiac SPECT raw-data projection images. Incidental findings such as extra- and retrocardiac activity in the thorax and abdomen should be included on all comprehensive cardiac SPECT reports.     

Diagnostic significance of periesophageal fat pad in ultrasonography for sliding hiatal hernias: sonographic fat pad sign

The aim of the present study was to investigate the diagnostic significance of visualization of periesophageal fat pad in ultrasonography or computed tomography for sliding hiatal hernias. Forty-six controls and 21 esophageal hiatal hernia patients were compared in terms of sonographic and tomographic esophageal diameters. We suggest that absence of periesophageal fat pad sign in ultrasonography or computerized tomography is a noteworthy finding that calls for further investigation for the diagnosis of sliding hiatal hernias.     

Congenital paraesophageal hernia with gastric outlet obstruction in a neonate with Cornelia de Lange Syndrome

We describe a case of a newborn being treated for encephalopathy and seizures, whose radiographs since the first day of life demonstrate a persistent ovoid lucency over the central lower chest. A CT performed confirmed a type IV hiatal hernia, which is defined as a paraesophageal type hernia containing a portion of the abdominal viscera. This infant''s hernia included the distal stomach, pylorus, and proximal duodenum. There was no volvulus or ischemic change at surgery. The patient underwent successful reduction, fundoplication, and gastrostomy placement with hospital discharge after further stabilization of additional medical problems. Genetic testing later confirmed Cornelia de Lange Syndrome Type V, which has been associated with gastrointestinal manifestations and congenital diaphragmatic hernias.     

Gastric-emptying scintigraphy of type III hiatal hernia: a case report

We present the case of a 76-y-old man with mixed (type III) paraesophageal hernia confirmed by endoscopy and CT of the chest who underwent a radionuclide gastric-emptying study that showed accumulation of the radiotracer in the herniated stomach and esophagus in the thorax and accelerated gastric emptying. A scintigraphic gastric-emptying study may be an option for noninvasively demonstrating gastroesophageal accumulation of tracer in patients with hiatal hernia.     

老年性食管裂孔疝囊并囊内结石的X线诊断(附7例报告)

目的:探讨老年性食管裂孔疝并疝囊内结石的X线诊断要点及其形成机制。方法:回顾性研究7例老年性食管裂孔疝合并结石的气钡双重造影X线表现特点。结果:由于老年性疝囊两端的A环、C环在长期慢性炎症的刺激下纤维化而狭窄,使疝囊膨胀表现为"吹气球征",7例疝囊上下两端狭窄。7例疝囊内结石未服用产气粉前表现为与疝囊同等大小且边缘光滑的充盈缺损,充盈缺损的长轴与食道长轴方向基本一致,呈现"食管疝囊铸型征"。钡剂沿着充盈缺损的疝囊周壁进入膈下胃腔,多方位旋转显示疝囊轮廓边缘十分光滑且完整,其内充盈缺损与疝囊壁之间存在薄而完整的钡线影。3例充盈缺损的上缘表现为"尖顶征",4例"圆顶征"。服用产气粉后,表现为结石与疝囊形成"套圈征"。结论:老年性食管裂孔疝并疝囊内结石在X线表现上有其特有的征象,能够做出准确诊断。     

Radiological features of acute gastric volvulus in adult patients

ObjectiveTo evaluate the radiological features of acute gastric volvulus in adults and correlate these features with operative findings.Materials and MethodsThe clinical, radiological and operative findings of five adult patients (four males and one female with mean age of 50.4 years) who presented or referred to King Abdullah University hospital over 4 year’s period with symptoms of acute gastric volvulus were reviewed retrospectively. All patients underwent upper gastrointestinal barium study and two of them had computed tomographic (CT) scans preoperatively. The radiological features demonstrated on upper gastrointestinal barium exams and CT scans were analyzed and compared with operative findings.ResultsRadiological and operative findings revealed organo-axial gastric volvulus in all patients in our study. All of them had associated diaphragmatic defect or hiatal hernia. The upper gastrointestinal barium studies demonstrated the classic radiological features of organo-axial volvulus. CT done on two of our patients confirmed the diagnosis.ConclusionUpper gastrointestinal barium study is an accurate way to diagnose and characterize acute gastric volvulus in adult patients. CT scan can also be used to diagnose this clinical entity.     

Case report: benign gastric ulcer erosion leading to a gastropericardial fistula in a patient with no known risk factors

A 53-year-old homeless male presented to the emergency department with sudden onset chest pain and was found to have a large pneumopericardium on chest X-ray. The patient had no history of surgery, hiatal hernia, or ulcer disease. A contrast-enhanced computed tomography scan demonstrated the pneumopericardium and raised concern for possible gastropericardial fistula from a benign gastric ulcer. An esophagogastroduodenoscopy confirmed the fistula, as did surgery, and intraoperatively vegetable particular matter was removed from the anatomic space continuous with the pericardium.     

Primary ileal volvulus in neonates: radiologic findings in two cases

Two cases of primary small bowel volvulus in neonates are presented. On abdominal plain radiographs pseudotumor sign was seen in both cases. CT showed intensely distended fluid-filled small bowel loops on the right side of the abdomen and diffuse distention of the proximal small bowel loops with air-fluid levels. US also showed distended fluid-filled loops containing echogenic foci without peristalsis. We consider that CT and US can play important roles in the diagnosis of small bowel volvulus in neonates.     

Small bowell volvulus - combined radiological findings]

PURPOSE: We retrospectively evaluated the radiological findings observed at plain abdominal film, abdominal sonography and abdominal CT performed in 66 patients with surgically proven small bowel volvulus. MATERIAL AND METHODS: Sixty-six patients (35 women and 31 men, ranging in age 38-77 years) with surgically proven small bowel volvulus were submitted to plain film, sonography and CT of the abdomen. Abdominal plain film was performed in the upright position (postero-anterior view) in 46 cases, and in the supine position in 20 cases. On plain abdominal film we evaluated the following findings: bowel loops dilatation, air-fluid levels and site of obstruction. At abdominal US, performed with 3.5 e 7.5 MHz probes, we retrospectively searched for: bowel loop dilatation, bowel wall thickening, peristalsis alteration, extraluminal fluid. CT was performed with a helical unit (thickness 4 mm, reconstruction interval 4 mm, pitch 1.5), after intravenous contrast agent (120 ml) infusion (3 ml/s, 55 s acquisition delay from bolus starting) and using a power injector. The following CT findings were searched for: whirl sign, beak sign, extraluminal fluid, bowel loop dilatation, bowel wall thickening, bowel wall or mesenteric alterations. RESULTS: Plain abdominal film showed the following findings: air-fluid levels (92.4% of cases), bowel loops dilatation (71.2%), site of obstruction (42.4%). Abdominal sonography demonstrated bowel loop dilatation (48.5%), extraluminal fluid (48.5%), peristalsis alteration (27.3%), bowel wall thickening (27.3%). The most frequent CT findings were: bowel loop dilatation (95.5%), bowel wall thickening (78.8%), beak sign (69.7%), mesenteric alterations (66.7%), extraluminal fluid (54.5%), whirl sign (13.6%). CONCLUSIONS: Air-fluid levels and bowel loop dilatation were the most frequent radiological findings in our series. Plain abdominal film allowed us to identify signs of obstruction, whereas signs of bowel wall necrosis were accurately shown by abdominal CT.     

Gastric volvulus through a Morgagni hernia: multidetector computed tomography diagnosis

Hernia through the foramen of Morgagni (HM) is uncommon in adults, accounting for only 3% of all treated diaphragmatic hernias. We report a very rare case of acute gastric volvulus producing within this type of hernia. It was found in an 81-year-old man presenting with symptoms of acute gastric outlet obstruction. The diagnosis was first suspected on plain abdominal and chest radiographs, but a safe and complete anatomic preoperative diagnosis was clearly achieved with multidetector computed tomography (MDCT). The paper refers to the basic anatomy, clinical symptoms, diagnostic, and therapeutic considerations for HM and emphasizes the major advantages of MDCT in acute surgical conditions implicating the thoracic abdominal junction.     

Early diagnostic clues in neonatal chronic gastric volvulus

Purpose

Neonatal gastric volvulus (GV) is a rare clinical entity with a challenging diagnosis. In this study, we aimed to identify clinical and radiological findings to aid in early diagnosis in neonatal GV.

Materials and methods

The medical records of all neonates with GV were retrospectively reviewed. Diagnosis was made based on clinical findings and radiological images, and was documented by an upper gastrointestinal (UGI) contrast study.

Results

A total of eight neonates were included in the study. The most common clinical presentations were non-bilious vomiting and epigastric distention. The findings highly suggestive for GV in plain radiographs include gastric double bubble, abnormal gastric distention despite a nasogastric tube, distended stomach lying in a horizontal plane and an air-fluid level in the epigastrium.

Conclusion

GV should be suspected in any newborn with non-bilious vomiting and epigastric distention. It is also important to focus on the clues in the plain radiographs. Gastric double bubble, abnormal gastric distention despite a nasogastric tube, distended stomach lying in a horizontal plane and an air-fluid level in the epigastrium must alert the physicians to the possibility of GV.     

Large hiatal hernia with floppy fundus: clinical and radiographic findings

OBJECTIVE: The purpose of this study was to compare the clinical and barium radiographic findings for 17 patients with large hiatal hernias and a floppy fundus with those for 61 patients with large hiatal hernias but no floppy fundus. CONCLUSIONS: Patients with large hiatal hernias can develop a floppy fundus, which has a characteristic appearance on barium studies because it droops below the most superior portion of the herniated gastric body. Distortion of the gastric anatomy in patients with this type of hernia can cause mechanical symptoms that usually resolve after surgical repair of the hernia. Radiologists should be aware of the barium radiographic findings associated with a floppy fundus and of the potential role of surgery in the treatment of patients with symptoms.     

Communicating intrathoracic hydrocele

Tense ascites may cause herniation of parietal peritoneal reflection into the mediastinum at the gastroesophageal junction. This may produce a mass visible on chest radiograph and computed tomography (CT). This communicating intrathoracic hydrocele may occur in the absence of hiatal hernia and may be confused with other middle mediastinal fluid collections including necrotic tumor, abscess, cyst of foregut origin, or pancreatic pseudocyst. Recognition of this entity in patients with ascites should prevent diagnostic confusion and unnecessary further evaluation.     

The lesser curvature fold: a new plain film finding for diagnosing a paraesophageal hernia

This case report describes a new plain film X-ray finding for a paraesophageal hernia. A plain film of the chest containing a new finding for a paraesophageal hernia was later confirmed by barium study. This new finding was a horizontal fold traversing the air-filled diaphragmatic hernia sac, with the fold representing the opposed sides of the stomach's lesser curvature. Recognition of this finding can hasten the diagnosis of this potentially life-threatening type of hiatal hernia.     

婴幼儿反复性呕吐的上消化道钡餐造影检查

目的通过X线检查分析引起婴幼儿反复性呕吐的原因,重点探讨上消化道钡餐造影对婴幼儿反复性呕吐的诊断价值。方法收集我院2004年6月至2006年6月临床表现为反复性呕吐遂行X线检查的病例48例,均经手术证实或临床保守治疗痊愈。结果 48例中：先天性食管闭锁6例,食管驰缓症5例,胃扭转7例,幽门肥厚性狭窄20例,中肠旋转异常3例,幽门痉挛3例,食管裂孔疝4例。结论对婴幼儿反复性呕吐,传统X线检查仍是一种首要的检查方法,简便、无创,能为临床诊断和治疗提供可靠的依据。     

Evaluation of an automated adaptive unsharp masking technique in digital chest radiographs]

We are developing a fully automated adaptive unsharp masking technique with parameters that depend on the regional image features of digital chest radiographs. Regions such as the lung fields, retrocardiac area, and spine have extremely different texture patterns and optical densities on chest radiographs. Therefore, it is necessary to enhance the image contrast of each region by an optimum parameter for the regional image. In this study, a chest radiograph was automatically divided into three segments (lung field, retrocardiac area, and spine) by histogram analysis of pixel values. Then, the lung field and retrocardiac area were selectively enhanced with a small mask size and mild weighting factors that had been previously determined as optimum parameters. The spine was enhanced with a large mask size and adequate weighting factors. An observer performance test indicated that this technique provides excellent diagnostic accuracy for simulated nodules over the mediastinum and diaphragm without sacrificing diagnostic accuracy for nodules over the lung field. We believe that this adaptive processing technique may have the potential to be a useful aid for the diagnosis of chest radiographs.