Transient mega-esophagus in a neonate with congenital diaphragmatic hernia

Esophageal dilatation (ED) in neonates is rare. In the present case, ED was detected in a chest radiograph following repair of congenital diaphragmatic hernia (CDH) in a term neonate. A roentgenographic swallow study on the seventh day of life demonstrated ED and a sub-diaphragmatic stomach. The infant thrived adequately on enteral feeding. A swallow study on the twentieth day of life showed a normal-width esophagus with gastroesophageal reflux and small hiatus hernia. The longstanding herniated stomach in the fetus apparently caused kinking, edema, and obstruction of the gastroesophageal junction. This led to a significant ED and concealment of gastroesophageal reflux. We aim to arouse awareness about the occurrence of ED with CDH, and about its benign course under conservative management. Received: 12 May 2000 Revised: 3 August 2000 Accepted: 4 August 2000     

Giant congenital intrapericardial left atrial aneurysm diagnosed by contrast-enhanced computed tomography

A left atrial aneurysm is a rare cardiac anomaly. The etiology is usually congenital, but it can also occur as an acquired pathology secondary to mitral valve disease or a degenerative process. We report a case which, on routine PA chest radiography, presented as cardiomegaly with a bulge on the left cardiac contour. Further evaluation by contrast-enhanced computed tomography proved it to be caused by a large left atrial aneurysm.     

高血压患者左房扩大意义与心房纤颤的相关性研究

目的：观察原发性高血压（EH）患者左心房内径变化的临床意义及其与心房纤颤（房颤）发生的关系。方法：360例EH患者应用彩色多普勒超声心动图仪及三导心电图仪，动态心电图仪，测定患者左房内径（LAD）、左室舒张末内径（LVDd）、左室后壁厚度（LVPWT）、室间隔厚度（IVST）、射血分数（EF）值、E／A比值及房颤的检出。结果：EH组LAD较正常对照组显著增加。高血压伴左室肥厚（LVH）者LAD较高血压无LVH及对照者显著增加（P〈0．05），LAD与EF值呈显著负相关（P〈0．05）。EH患者伴左房扩大者中62．2％发生心房纤颤，EH伴心房纤颤患者中左房扩大者占97．53％。结论：EH患者LAD较正常者增加，35．0％EH患者伴有左房（LA）扩大。LA扩大与EH伴LVH及心功能减退有关，LA扩大与心房纤颤的发生有关。LA扩大可能是EH病情进展、心功能减退及心房纤颤发生的危险标志。     

Handlebar hernia: a case report

A 36-year-old man fell from his bicycle and struck his lower abdomen on the end of the handlebar. Computed tomography (CT) showed a small bowel loop protruding into the subcutaneous fat layer of the abdominal wall. We present this case of handlebar hernia, a rare type of traumatic abdominal wall hernia, and the usefulness of CT in diagnosing such injuries.     

左心房折叠手术对二尖瓣病变合并巨大左心房患者围术期NT-proBNP影响

目的评估左心房折叠手术对二尖瓣病变合并巨大左心房患者围术期NT-proBNP的影响。方法选取沈阳军区总医院2014年11月至2016年5月收治的70例行二尖瓣置换手术患者作为研究对象,将其随机分为A组(行左心房折叠手术)和B组(不行左心房折叠手术),每组35例患者。收集所有患者术前、术中、术后及随访的临床数据,并比较NT-proBNP的变化情况。结果 A组患者体外循环时间[(71.92±14.17)min比(65.08±10.11)min]及主动脉阻断时间[(44.28±12.15)min比(36.71±9.68)min]显著多余B组,但呼吸机辅助时间[(14.16±5.41)h比(17.20±6.97)h]和ICU停留时间[(29.47±10.84)h比(36.02±12.9)h]显著少于B组,两组间比较,差异均有统计学意义(P<0.05)。术后,NT-proBNP显著增高,在术后1 d达到高峰,而后逐渐降低;A组患者术后7 d的NT-proBNP仍高于B组,直到术后6个月,NT-proBNP下降至显著低于术前水平。两组患者NT-proBNP在术前及术后1、3、7 d比较,差异均无统计学意义(P>0.05);但在术后6个月,A组NT-proBNP水平显著低于B组(P<0.05)。结论左心房折叠手术有益于二尖瓣置换术后恢复,减少术后呼吸机时间及ICU停留时间,并可以显著降低术后远期NT-proBNP水平。     

Left atrial appendage closure guided by 3D computed tomography printing technology: A case control study

BackgroundWe sought to evaluate the additional value of left atrial appendage (LAA) 3D printing derived from computed tomography (CCT) in determining the size for LAA occlusion (LAAO) devices as compared to standard measurement by using occurrence of LAA leak as endpoint.MethodsWe evaluated 6 patients with LAA leak (cases) and 14 matched patients without LAA leak (controls) after LAAO. For each group, a patient-specific 3D printed model of LAA was manufactured using CT pre-operative images. The size recommended by the 3D printed model was compared with the size of the implanted device.ResultsCompared to the 3D printed model, 55% of the devices were underestimated, the two sizing approaches agreed in 35% of the patients, while the 3D printed model overestimated the size in 10% of patients. The prevalence of LAA leak was significantly higher in the subset of patients with underestimation of prosthesis implanted with the standard approach as compared to the other patients (p = 0.019).Conclusion3D printing of the LAA may provide additional value to standard practice for LAAO device prosthesis sizing with the potential impact to reduce LAA leak.     

CT demonstration of a ureterosciatic hernia

Ureterosciatic herniation is probably not as uncommon as a literature review would suggest. It rarely produces symptoms and is usually an incidental finding on urogram. The posterior position of the ureter passing beyond the medial wall of the bony pelvis is easily detected on intravenous urography with ipsilateral oblique films and can be confirmed tomographically. This ectopic course of the ureter can be depicted clearly on pelvic computed tomograms.     

Small bowel obstruction due to a paracecal hernia: computerized tomography diagnosis

The role of computerized tomography (CT) in evaluating patients with small bowel obstruction (SBO) has been extensively described in the current literature. We report a rare case of SBO related to a surgically proven paracecal hernia, diagnosed on an abdominal CT scan preoperatively.     

左心室舒张功能不全联合左房容积指数预测急性ST段抬高型心肌梗死患者血运重建后持续性房颤的发生风险

 目的 通过心脏超声多普勒检测左心房容积指数(left atrial volume index,LAVI)和左心室舒张功能来预测急性ST段抬高型心肌梗死(ST-segment elevated myocardial infarction, STEMI)患者血运重建术后的持续性房颤(atrial fibrillation,AF)发生风险。方法 纳入2013-01至2017-12因STEMI入武警陕西总队医院心血管内科行初次经皮冠状动脉介入(percutaneous coronary intervention,PCI)手术的患者256例。多普勒超声心动图检测PCI术后患者左房容积和LAVI。随访时间2年,主要终点事件定义为2年内新诊断的持续时间大于7 d的持续性心房颤动。受试者工作曲线(receiver operation curve,ROC)确定左房内径的最佳截断值。logistics分析终点事件发生的独立预测因素。结果 LAVI大于31 ml/m²患者2年内发生主要终点事件风险增高,预测敏感度0.89,特异度0.60,约登指数0.49。具有左心室舒张功能不全(left ventricular diastolic dysfunction,LVDD)的患者2年内的主要终点事件发生风险显著增高,预测敏感度0.76,特异度0.74,约登指数0.50。同时合并LVDD和左心房容积指数增大预测2年内主要终点事件发生风险敏感度为0.85,特异度为0.89,约登指数0.74。Logistics多元回归模型发现随访期内再发ACS事件,左前降支病变,LVDD和左心室容积指数增大均为2年内主要终点事件发生的独立危险因素。结论 左心房增大和LVDD是STEMI患者血运重建后发生持续性房颤的独立预测因子。PCI术后LAVI联合左心室舒张功能可预测患者持续性房颤的发生风险。     

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 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.     

Spontaneous internal hernia through a defect in the hepatogastric ligament

Transomental internal hernias are a rare cause of intestinal obstruction and most commonly iatrogenic, resulting from previous surgical interventions, abdominal trauma or inflammation. Occasionally, they may occur spontaneously. We report the case of a 44-year-old healthy male admitted to the emergency room with acute abdominal pain and vomiting, consistent with intestinal obstruction. An internal hernia of small bowel in the lesser sac was suspected after performing a computed tomography (CT) scan and emergent laparotomy confirmed herniation of a jejunal loop through a defect in the hepatogastric ligament, resulting in strangulation and requiring enterectomy. The patient had a favourable outcome and was discharged a few days after surgery. Both radiologists and surgeons must be aware of rare internal hernia subtypes, to avoid delays in diagnosis and treatment. Abdominal CT is the first-line imaging of choice, providing useful diagnostic hallmarks. Nevertheless, surgical exploration is typically essential to confirm the diagnosis, identify the defect and assess bowel viability.     

Rare late-presentation congenital diaphragmatic hernia mimicking a tension pneumothorax

Congenital Diaphragmatic Hernia (CDH) is due to a defect in the diaphragm and is usually detected soon after birth. However, in rare cases, asymptomatic CDHs can be missed and present later in life. Late-presentation CDH can be misdiagnosed as tension pneumothorax leading to iatrogenic complications. We report a case of a 10-year-old boy who presented with non-specific symptoms of vomiting and occasional breathlessness, but was subsequently diagnosed as late-presentation CDH. This case highlights the role of imaging in the diagnosis and management of late-presenting CDH. The role of CT imaging as an invaluable tool to further evaluate equivocal radiographic findings in CDH is discussed.     

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.