Confined gastric perforation: Ultrasound and computed tomographic diagnosis

A case of confined gastric perforation due to a penetrating antral ulcer diagnosed on ultrasound and computed tomography is presented. Air bubbles were visualized adjacent to the anterior gastric and bulbar wall, associated with small amounts of fluid in the subhepatic region and in the omental bursa. Careful examination of the subhepatic region and upper abdominal cavity in a patient with acute epigastric pain may lead to a correct diagnosis of such confined perforations.     

Detection of liver and gallbladder calcification

Although abdominal radiographs have been the standard method for demonstrating right upper quadrant calcifications, recent evidence shows that ultrasound and computed tomography are equally sensitive, if not more so. Liver and gallbladder calcifications from many causes have been detected by ultrasound and computed tomography. In some of these cases, plain films of the abdomen have been normal. This observation suggests that the plain radiograph is no longer adequate for evaluating possible calcifications in the upper abdomen.     

Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome

Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Abdominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of “recurrent characteristics of the complaints” that can be learned by a careful history, may be helpful in diagnosis.     

Fitz‐Hugh‐Curtis syndrome without salpingitis: Should contrast‐enhanced computed tomography be a routine diagnostic procedure?

Fitz‐Hugh‐Curtis syndrome should be suspected in sexually active young women presenting with acute right upper quadrant pain even in the absence of lower abdominal pain. The risk of radiation exposure associated with computed tomography should also be considered while making a diagnosis of abdominal pain in young patients.     

Diverticulitis of the jejunum: Clinical and radiological features

This article describes three cases of jejunal diverticulitis in elderly women, who had presented with pain and tenderness in the periumbilical region or the left side of the abdomen, lowgrade fever, anemia, and weight loss. The findings were initially attributed to possible inflammatory or neoplastic lesions of the colon. However, gastrointestinal barium studies and computed tomography (CT) of the abdomen proved crucial in establishing the preoperative diagnosis of jejunal diverticulitis and its associated abscess in the adjacent mesentery or abdominal wall. The clinical and radiological manifestations of this uncommon entity are herein presented along with a brief review of the pertinent literature.     

Computed tomography of the abdomen: Initial experience

Computed tomography has provided a new dimension in the roentgenologic evaluation of the abdomen. Normal structures not visible on conventional examinations are clearly identified. Abnormalities are recognized by their alterations in anatomic form or by their effect on tissue absorption values. Our early experience suggests that in the abdomen computed tomography will be most valuable in detecting lesions in those sites least accessible to conventional roentgenographic methods such as the liver, spleen, pancreas and retroperitoneum.     

Intraperitoneal splenosis: Diagnosis by ultrasound and computed tomography

Splenosis is an unusual complication of abdominal trauma. We report a case of splenosis identified on ultrasonography (US) and computed tomography (CT). Usually it is a latent disease and an incidental finding, but it may be diagnosed by US and CT.     

Bowel obstruction: comparison between multidetector-row CT axial and coronal planes

Acute obstruction of bowel is a common reason for presentation to the emergency department. Causes of obstruction are multiple (tumorous, inflammatory, postoperative, or congenital), but the clinical presentation is usually not specific. The abdominal radiographs are sometimes inconclusive, and cause of obstruction is rarely detected. Computed tomography (CT) has been shown to be useful in revealing the site and the cause of obstruction. Although radiologists are skilled in the interpretation of CT scans in the axial plane, the development of multidetector-row CT coupled with fast reconstruction hardware and software has stimulated interest in viewing abdomen in coronal plane. In the evaluation of small bowel obstruction, coronal plane serves as a useful adjunct for the identification of the point of transition from dilated to decompressed bowel. On the other hand, in the evaluation of large bowel obstruction, coronal planes could replace axial images in the evaluation of the site and cause of obstruction, although the best values of confidence level in the diagnosis are reached when interpreting axial combined with coronal images.     

Diagnostic value of contrast-enhanced ultrasonography in mediastinal leiomyosarcoma mimicking aortic hematoma: A case report and review of literature

BACKGROUNDPrimary mediastinal leiomyosarcomas are extremely rare. We report a case of leiomyosarcoma around the thoracic and abdominal aorta, mimicking an aortic hematoma, and discuss the diagnostic value of ultrasound. CASE SUMMARYA 63-year-old female was hospitalized for abdominal pain. Initial computed tomography angiography revealed an enhanced mass around the lower thoracic and upper abdominal aorta. Aortic hematoma was strongly suspected, and stents were placed by interventional surgery. About 1 mo postoperatively, the patient was re-hospitalized because of progressive abdominal pain. Ultrasound showed that the mass had a heterogeneous echo. In contrast-enhanced ultrasound, the hyperechoic regions were filled with contrast medium after the aortic region was, indicating that the blood supply was abundant but had no direct connection with the aorta. There was no obvious contrast medium-filling in the hypoechoic area. These findings were similar to those of malignant tumors with liquefaction and necrosis. Positron emission tomography/computed tomography confirmed that the mass had a high metabolic signal similar to that of a malignant tumor. Leiomyosarcoma was confirmed by postoperative pathology. CONCLUSIONSymptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma. Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.     

A rare case of gastric fundus tuberculosis with nonspecific abdominal pain

A 53-year-old patient who experienced recurring upper abdominal pain and discomfort for 4 years was admitted to our hospital. Gastroscopy was performed to identify the location of the pain and evaluate the characteristics of a mass in the abdomen. Endoscopic ultrasonography (EUS) and abdominal computed tomography (CT) revealed a space-occupying lesion in the gastric fundus, suggestive of a submucosal tumor and highly likely of stromal origin. Surgical resection of the lesion was performed for identification; however, postoperative histopathological examination of the lesion revealed gastric fundus tuberculosis (TB). Gastric TB is relatively rare; therefore, clinicians should be highly suspicious of patients with abdominal symptoms from regions with a high incidence of TB to prevent treatment delay caused by misdiagnosis.     

Subdiaphragmatic bronchogenic cyst with gastric communication

Upper gastrointestinal series and computed tomography of the abdomen in an elderly women demonstrated a large multiloculated mass in the left subphrenic space that communicated with the fundus. The resected specimen showed histopathological features of bronchopulmonary foregut malformation.     

Epiploic appendagitis and omental infarction: pitfalls and look-alikes

Epiploic appendagitis and omental infarction are benign self-limiting conditions that are more frequent than generally assumed. Both disorders frequently mimic symptoms of an abdominal surgical emergency, often leading to clinical misdiagnosis of appendicitis or diverticulitis. Because a misdiagnosis can result in an unnecessary laparotomy, a correct diagnosis is of great importance. Ultrasound and computed tomography can be used to make a reliable diagnosis. This pictorial essay illustrates the various ultrasonographic and computed tomographic appearances of epiploic appendagitis and omental infarction and focuses on their radiologic differential diagnoses and pitfalls. Received: 22 February 2001/Accepted: 18 April 2001     

Comparison of axial reconstructed ultrasonographic images from three-dimensional data volumes and computed tomographic scans in the documentation and detection of liver lesions.

OBJECTIVE: To compare axial reconstructed ultrasonographic images from three-dimensional data volumes and conventional computed tomographic scans in documentation and detection of liver lesions. METHODS: The livers of 23 patients were examined by a multifrequency curved array transducer to acquire three-dimensional data volumes and by conventional computed tomography The ultrasonographic device was equipped with three-dimensional ultrasonographic technology allowing for real-time parallel movement in every plane within an acquired data volume. Axial ultrasonographic images reconstructed from three-dimensional data volumes were compared with conventional computed tomographic scans. RESULTS: When both methods were taken together, a total of 51 different liver lesions could be detected. Reconstructed ultrasonographic images depicted 44 (86%) of 51 lesions, and computed tomographic scans showed 46 (90%) of 51 lesions. Compared with computed tomography, ultrasonography depicted 5 additional lesions in 3 of the patients (4 hemagiomas and 1 unspecified lesion), whereas 7 lesions were missed in another 4 patients (4 metastases, 2 calcifications, and 1 cyst). The Pearson correlation coefficient between ultrasonography and computed tomography was r = 0.84 (P < .001). CONCLUSIONS: Our study shows that ultrasonographic images can be effectively reconstructed from three-dimensional data volumes. With respect to documentation and detection of liver lesions, the results obtained by three-dimensional ultrasonography appear comparable with those obtained by conventional computed tomography. However, several technical and procedural limitations have to be respected.     

Magnetic resonance imaging of Morgagni hernia

A case of a Morgagni hernia is demonstrated by magnetic resonance imaging (MRI). The correct diagnosis was facilitated by the ability to image directly the anteromedial diaphragmatic defect in the coronal and sagittal planes. The findings from MRI, computed tomography, and radiographic studies are correlated.     

Gastric intramural pseudocyst: Computed tomographic diagnosis

The authors describe a case of pancreatic pseudocyst presenting as an intramural gastric mass on upper gastrointestinal examination (UGI) and computed tomography (CT) of the abdomen. The correct diagnosis of this rare entity was suggested preoperatively on the basis of the radiographic findings presented herein.     

Accessory spleen: Presentation as a large abdominal mass in an asymptomatic young woman

Accessory spleen hypertrophy is usually related to hematologic, lymphomatous, and rheumatoid diseases. We describe here the case of an 18-year-old asymptomatic woman who presented with a very large accessory spleen occupying the lower abdomen. Its appearance on abdominal sonogram, computed tomogram, and hepatosplenic scintigraphy is correlated with the resected specimen.     

Mesenteric vein thrombosis: Early CT and US diagnosis and conservative management

We report a case of isolated superior mesenteric vein thrombosis with acute ischemic bowel disease, diagnosed early by a screening ultrasound scan of the upper abdomen and definitively assessed by computed tomography and angiography.This report stresses the contribution of crosssectional techniques in the early diagnosis and management of venous occlusive disease of the small bowel.     

Abdominal ultrasound in patients with acute right upper quadrant pain

Ultrasonography was performed as the first imaging procedure in 100 patients who presented with acute right upper quadrant pain suggestive of cholecystitis or cholelithiasis. In the final analysis 46 patients were found to have gallbladder disease (40 patients with cholelithiasis, 5 with acalculous cholecystitis, and 1 with a cholesterol polyp in the gallbladder). In 22 of 54 patients with a normal gallbladder, other abdominal disease was found. The error rate for ultrasound was 5%, and in 4 patients ultrasound was not the suitable procedure for the diagnosis. In 91 patients the ultrasonographic diagnosis was correct.     

Torsion of Wandering Spleen: A Case Report

BackgroundWandering spleen is defined as the localization of the spleen in the lower parts of the abdomen or the pelvic region, rather than the left upper quadrant. The torsion of wandering spleen is a rare clinical condition.Case ReportWe evaluate a case diagnosed with torsion of wandering spleen and underwent splenectomy in our hospital and discuss it in light of the literature. A 26-year-old man presented to the emergency department with abdominal pain and abdominal distention. The patient was diagnosed with the torsion of wandering spleen based on computed tomography scan results.Why Should an Emergency Physician be Aware of This?The torsion of wandering spleen is rare in patients presenting with acute abdominal pain, but it is an important condition that should be considered in the differential diagnosis. The diagnosis of wandering spleen should be made before the development of potentially life-threatening complications. Emergency surgery should be undertaken in patients with splenic infarction.     

中孕期胎儿超声筛查切面的规范化探讨

目的探讨在中孕期胎儿筛查中规范超声检查的重要性及操作程序。方法根据临床工作中的体会，应用9个标准切面进行中孕期胎儿筛查，即小脑横径切面，唇面部冠状切面，脊柱纵切面，心脏四腔心切面，左右室流出道长轴切面，双肾横切面，左右侧脐动脉起始段彩色血流，双上肢及双下肢切面。结果对2111例中孕期妇女进行超声筛查，检出211例胎儿异常，其中严重畸形胎儿83例，包括颅脑、中枢神经系统畸形22例，心脏畸形14例，唇腭裂13例，消化系统畸形8例，胎儿水肿综合征6例，单脐动脉13例，肢体畸形2例，泌尿系统畸形1例，膈疝1例，肺分离征1例，骶尾部肿块1例，右下腹肿块1例。超声检查结果与病理解剖相符。结论中孕期胎儿超声筛查切面的规范化是早期发现异常胎儿，减少漏诊的重要措施，对减少围产期死亡率，提高出生人口质量具有重要意义。