Computed tomography imaging of abdominal wall metastases after laparoscopy]

We report a case of abdominal wall metastases which occurred after diagnostic laparoscopy in a 64-year-old man presenting with gallbladder carcinoma and peritoneal carcinomatosis. CT showed enhancing masses along the laparoscopic tracts, suggesting metastatic seeding at the time of the surgery. This unusual complication fuels the current debate regarding indications of laparoscopic surgery in patients with malignancy.     

Computed tomography in abdominal tuberculosis.

The diagnosis of abdominal tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory investigations. In the abdomen, tuberculosis may affect the intestinal tract, lymph nodes, peritoneum and solid viscera in varying combinations. CT, with its ability to provide a comprehensive overview of abdominal structures, is the imaging modality of choice for evaluation of such patients. This pictorial review illustrates the spectrum of CT appearances of abdominal tuberculosis which includes intestinal, lymph nodal, peritoneal, mesenteric, hepatic, splenic and pancreatic disease.     

Computed tomography of life-threatening complications of abdominal aortic aneurysm. The disrupted aortic wall

A localized disruption of the conspicuity of the wall of the aorta was noted on intravenous contrast-enhanced computed tomography (CT) scans of ten patients with ruptured abdominal aortic aneurysm (n = 6) or aortoenteric fistula (n = 4). Subsequently, we reviewed 84 scans of patients with uncomplicated aneurysm (n = 70) or aneurysm graft repair (n = 14) to determine if a disrupted wall has diagnostic implications. In this control group, the wall of the aneurysm was conspicuous throughout in 95% of 64 patients who received iodinated contrast material intravenously and in 55% of 20 patients who did not. In the proper clinical setting, CT scans performed with intravenous administration of iodinated contrast material can provide direct evidence of disruption of the wall of an abdominal aortic aneurysm. In selected cases, this may be important for the diagnosis of rupture. Disrupted conspicuity of the wall, in combination with effacement of the fat plane between an aneurysm and the juxtaposed intestine, increases the accuracy of CT for the diagnosis of aortoenteric fistula.     

Computed tomography of joint injuries

CT has become the imaging modality of choice in most acute and chronic injuries involving the articular surfaces. Today's technology allows high resolution, fast scanning, and rapid reformatting, all of which contribute to prompt orthopedic evaluation and decision making. Our orthopedic colleagues have come to rely on high-quality CT scans in order to evaluate calcaneal and tibial plateau fractures, stress fractures, osteochondritis dissecans, acute and chronic shoulder trauma, and problems of the painful wrist--especially the distal radioulnar joint.     

Computed tomography of spinal injuries

Computed tomography images are free of superpositional effects. Therefore, today CT represents the most effective method of evaluating spinal fractures. Clear imaging of the vertebral elements provides a sufficient analysis of stability in most cases. Moreover, in the polytraumatized patient, every region of the body can be evaluated without new positioning. Thus, the sequence of therapy may become obvious within a reasonable amount of time. The 3-column theory has proved to be very effective for evaluation of the remaining stability in spinal fractures.     

Computed tomography of projectile injuries

Computed tomography (CT) is a gold standard in clinical imaging but forensic professions have been slow to embrace radiological advances. Forensic applications of CT are now exponentially expanding, replacing other imaging methods. As post-mortem cross-sectional imaging increases, radiologists will fall under increasing pressure to interpret complex forensic cases involving both living and deceased patients. This review presents a wide variety of weapon and projectile types aiding interpretation of projectile injuries both in forensic and clinical practice.     

Computed tomography of traumatic serosanguineous cysts

Two patients developed traumatic peripelvic serosanguineous cysts, following pelvic fracture. A serosanguineous cyst develops when shearing forces cause separation of the skin and subcutaneous fat from the deep fascia and muscle. The space thus created is filled with serious fluid and blood, and clinically presents as soft cystic masses, appearing usually within a day or so, or rarely, after several weeks or months. Most of these lesions resolve spontaneously, or following aspiration; however, some may persist, necessitating surgical resection. Computed tomography is the modality of choice for detection and, in those cysts requiring surgery, it is helpful in revealing the exact size and location of these lesions.     

Computed tomography of blunt abdominal trauma

Experience with over 500 cases at this institution and reports from other institutions have established CT as an accurate and clinically useful tool in the evaluation of patients with blunt abdominal trauma. Careful attention to technique is essential since artifacts may simulate or obscure traumatic lesions. CT is highly sensitive and specific for parenchymal lacerations and for hematomas of solid and hollow abdominal viscera throughout the peritoneal and retroperitoneal spaces. CT has important advantages over radionuclide scintigraphy, angiography, and ultrasonography and has replaced these imaging techniques in acute evaluation of blunt abdominal trauma at some centers. The use of nontherapeutic exploratory laparotomy and diagnostic peritoneal lavage may also be substantially reduced.     

Computed tomography of abdominal carcinoid tumour

Ten patients with pathologically proven abdominal carcinoid tumour were assessed by computed tomography (CT). Post-mortem examination correlation was obtained in two cases. Computed tomography demonstrated the extent of intra-abdominal tumour well and is, therefore, a useful staging technique for patients being treated with adjuvant therapy. The appearances of metastatic carcinoid within the mesentery on CT are characteristic and can enable a pre-operative diagnosis to be made.     

Computed tomography of abdominal carcinoid tumors

Computed tomographic (CT) scans were obtained in 20 patients with primary and/or metastatic abdominal carcinoid tumors. The primary tumors were seen rarely on CT. Mesenteric involvement was seen in eight of the 20 patients, usually as a soft-tissue mass surrounded by fat and radiating soft-tissue strands. Enlarged retroperitoneal lymph nodes were seen in seven patients, but rarely were they the only manifestation of intraabdominal disease. The most common finding was liver metastases (13 of 20 patients). CT is helpful in evaluating the extent of tumor before surgical exploration and in following the progression of disease once the diagnosis has been established.     

Computed tomography of abdominal carcinoid tumor

Computed tomography of the abdomen was performed in 10 patients with pathologically proven carcinoid tumor. In four patients numerous tiny punctate and radiating densities were seen in the mesentery. Two of these patients also had rounded mesenteric masses, 2.5-5 cm in diameter. The presence of punctate or radiating mesenteric densities reflecting desmoplastic reaction, when combined with rounded mesenteric masses or liver metastases, is highly suggestive of carcinoid tumor. The CT appearance of the hepatic metastases in this group of patients was also assessed and found to be nonspecific.     

Computed tomography in the evaluation of abdominal trauma.

Four patients with blunt abdominal trauma underwent computed tomography (CT) as part of their diagnostic evaluation. In each case CT accurately demonstrated the pathology and the extent of injury. The results suggest that routine use of CT scanning may be an effective screening modality in the traumatized patient. It is perhaps more specific than radioisotope scanning and may eventually reduce the need for invasive techniques such as angiography.     

Computed tomography of chest wall masses

The authors argue that CT is superior to other imaging techniques for the examination of the bones and soft tissues of the chest wall. They also note the importance of CT in planning therapy for lesions involving these structures. In support of these theses they present computed tomograms showing 26 different types of lesion involving the chest wall ranging from sternal fracture to malignant fibrous histiocytoma. Malignant neoplasms involving the chest wall by metastasis or direct extension from the breast, lung or mediastinum are emphasized.