急性胰腺炎累及左肾上腺的螺旋CT表现

目的 探索左肾上腺受累是否为急性胰腺炎(acute pancreatitis,AP)一种有价值的CT表现.方法 回顾性分析115例连续性AP病例的CT资料,观察左侧肾上腺的形态、密度变化等CT表现特征.同时对照观察正常腹部100例的左侧肾上腺的CT表现.结果 115例AP的CT表现中,左侧肾上腺前缘受累(轻度,68/115,59%),左侧肾上腺前缘受累合并周围脂肪组织水肿及其局部密度及形态异常(重度,12/115,11%).结论 左侧肾上腺受累是急性胰腺炎CT表现中的一个有价值的征象.     

A case of ganglioneuroma of the adrenal gland

Computerized tomography accidentally revealed a huge retroperitoneal mass in a 53-year-old male. The mass was located between the liver and the right kidney. Laboratory tests including endocrinological studies were done but the diagnosis was not clearly confirmed before operation. The specimen weighed 410 g, was 12.5 X 8 X 5 cm and did not show any evidence of malignant degeneration histologically. Fourteen cases of the ganglioneuroma of the adrenal gland including our were accumulated from the Japanese literature. A review of the literature showed that cases of this tumor widely ranged from 1 to 65 years of ages, and its incidence was over twice higher in females than in males. Mainly the abdominal mass was the only symptom in these cases. The tumors were generally so well encapsulated that they could be removed completely.     

A rare cavernous hemangioma of the adrenal gland

INTRODUCTION

Cavernous hemangiomas of the adrenal gland are rare. We report a case of a cavernous hemangioma of the adrenal gland presenting as an adrenal incidentaloma suspicious for adrenal cortical carcinoma (ACC).

PRESENTATION OF CASE

A 78 year old woman was admitted after a fall. Abdominal computed tomography revealed a large right adrenal lesion with features suspicious for adrenal cortical carcinoma (5.4 cm × 3.3 cm, unilateral, tumor calcifications, average Hounsfield units 55). The tumor was removed intact by a laparoscopic approach and pathology revealed a cavernous hemangioma of the adrenal gland.

DISCUSSION

Adrenal incidentalomas are found in up to 10% of patients undergoing abdominal imaging. Differential diagnosis includes both benign and malignant lesions. Guidelines for removal of adrenal incidentalomas recommend surgery based on functional status, size, and presence of concerning features on diagnostic imaging. Cavernous hemangiomas are rare, benign vascular malformations which can be challenging to distinguish pre-operatively from malignant lesions such as ACC.

CONCLUSION

Cavernous hemangiomas of the adrenal gland are exceedingly rare. These benign tumors have imaging features which may be suggestive of adrenal cortical carcinoma. The treatment of choice is surgical excision due the difficulty of excluding malignancy.     

Endoscopic correction of crural venous blood flow

A technique of subfascial electrocoagulation of the communicating shin veins through an endoscope in 53 patients with varicose dilatation of the lower extremity veins and postthrombophlebitis syndrome is described. The technique is not complicated and gives good cosmetic results.     

Nonuniform blood flow in the canine left ventricle

In order to investigate the relationship between coronary perfusion pressure and blood flow distribution in the left ventricle (LV), we measured myocardial blood flow in small regions using radioactive microspheres in six anesthetized, open-chest dogs. Mean coronary perfusion pressure (CPP) was controlled with a femoral artery to left main coronary artery shunt which included a pressurized, servo-controlled blood reservoir. In each dog, we measured flow in 192 regions of the LV free wall (mean weight per region = 206 +/- 38 mg) at different perfusion pressures. At CPP = 80 mm Hg, blood flow to individual regions varied fourfold (0.30 to 1.18 ml/min/g; relative dispersion (RD) = 21.8 +/- 2.3%). At CPP = 50 mm Hg, flow varied over sevenfold (0.08 to 0.60 ml/min/g; RD = 42.8 +/- 10%; P less than 0.01 vs 80 mm Hg). This relationship between flow variability and CPP was present within individual LV layers as well between layers and is much higher than the error associated with the microsphere technique. We conclude that blood flow to small regions of the LV is markedly nonuniform. This heterogeneity becomes more profound at lower CPP. These findings suggest that (1) global measurements of coronary flow must be interpreted with caution, and (2) even in hearts with normal coronary arteries some regions of the LV are more susceptible to ischemia than others. In addition, these findings may help explain the patchy nature of myocardial damage that occurs following periods of low coronary pressure or inadequate myocardial protection during cardiopulmonary bypass.     

Myelolipoma of the adrenal gland

Adrenal myelolipomas are rare, nonfunctioning, benign neoplasms of the adrenal gland. The authors describe their experience of a case and they report the review of the literature. They illustrate what's etiopathogenetic theories, modern diagnostic technology "of imaging" and different surgical approaches need to be adapted to the excision of the adrenal myelolipomas.     

Myelolipoma of the adrenal gland

We report the 14th case of myelolipoma of the adrenal gland. Recommendations for appropriate diagnostic and therapeutic methods are made. Myelolipoma of the adrenal gland is a rare nonfunctioning tumor composed of lipoid and hematopoietic elements. The most consistent complaint is abdominal pain caused by hemorrhage within the tumor. We identified an association with obesity and hypertension. Ultrasound combined with computed tomography is useful in diagnosis. With expanded use of these studies, myelolipoma will be recognized more frequently. Definitive diagnosis and treatment are accomplished by simple excision; radical surgery is unnecessary.