Caecal herniation through the foramen of Winslow

Caecal herniation through the foramen of Winslow is a rare cause of intestinal obstruction and the preoperative diagnosis is rarely made. A patient with caecal herniation through the foramen of Winslow is presented and differentiation from caecal volvulus is stressed. In caecal herniation through the foramen of Winslow the "hilum" of the kidney shaped loop of bowel points towards the foramen of Winslow rather than the right iliac fossa.     

Cardiac herniation and volvulus: radiographic findings

Cardiac herniation with volvulus is a catastrophic complication of right intrapericardial pneumonectomy. This case illustrates diagnostic radiographic findings that may be essential for early diagnosis and survival, since the clinical signs are nonspecific.     

儿童腹部脏器外囊性占位的CT影像分析

目的探讨儿童腹部脏器外囊性占位病变的CT表现特点。方法回顾性分析经临床手术病理证实的13例儿童腹部脏器外囊性病变的CT表现。9例行平扫与增强检查,4例行平扫检查。结果肠源性囊肿3例、肠系膜淋巴管瘤2例、大网膜囊肿3例、囊性畸胎瘤3例、腹腔脓肿2例。并发系膜扭转1例、网膜扭转2例、囊肿出血2例、肠穿孔和右侧胸腔疝各1例。结论儿童腹部脏器外囊性病变主要为良性病变,不同类型囊性病变,各具有一定的CT特征。但对于少见类型囊性病变,术前定性诊断仍有一定的困难。     

Scintigraphic imaging of an unusual liver displacement

The authors present a patient with a mass in the right lung due to a partial herniation of the liver.     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.     

联合应用髓核切吸与胶原酶盘内注射术治疗腰椎间盘突出症

目的：探讨提高经皮穿刺腰椎间盘髓核切吸术疗效的有效途径,方法：对50例腰椎间盘突出症病人行经皮穿刺腰椎间盘髓核切吸术后再注射胶原酶于椎间盘内。结果：有48例患者术后均获得满意疗效,其中包括10例有部分髓核组织脱入椎管的病人。结论：经皮穿刺腰椎间盘髓核切吸术后再注入胶原酶能明显提高疗效。对于突出程度较重的病人联合应用髓核切吸与胶原酶盘内注射术是一种有效的治疗方法。     

Blunt traumatic rupture of the pericardium with cardiac herniation: two cases diagnosed using computed tomography

Traumatic ruptures of the pericardium with cardiac herniation are infrequent, and their radiological pattern little familiar, so that they are often missed preoperatively. Few reports have emphasised the use of a CT scan as a tool for diagnosis and CT scan signs have not been well documented. We report on two cases of traumatic herniation of the heart for which a CT scan brought a major contribution for diagnosis. We describe the presence of an empty pericardial sac on CT slices which allowed us to diagnose the cardiac herniation. These observations demonstrate that CT scans can contribute to the diagnosis of pericardial rupture with cardiac herniation.     

Antral infracolic volvulus of the stomach.

Two cases of antral infracolic volvulus of the stomach are presented. The etiology of gastric volvulus and the difference between the organo-axial and mesentero-axial volvulus are discussed. Further subdivision into partial or complete volvulus and the relationship between the transverse colon and the stomach during gastric volvulus is emphasized. Awareness and understanding of gastric volvulus may allow roentgen diagnosis.     

Target sign of intussusception versus whirlpool sign of midgut volvulus

We report the case of a 2-month-old boy who presented with emesis and was initially thought to have an intussusception based on ultrasound findings, but was later found to have malrotation with midgut volvulus. He was surgically detorsed before any bowel necrosis occurred, but later developed recurrent volvulus due to a surgical adhesion acting as an anchor point. The aim of this report is to highlight the imaging similarities and differences between intussusception and the more serious midgut volvulus in order to expedite proper care and preserve bowel. Malrotation with midgut volvulus is a pediatric surgical emergency involving twisting of a congenitally shortened mesentery around the superior mesenteric artery, leading to rapid vascular compromise and ischemic necrosis of small bowel. Prompt diagnosis is critical but difficult, as imaging findings in volvulus can appear similar to those in intussusception. Treatment with a Ladd procedure can safely and effectively reduce the volvulus and prevent recurrence.     

The radiology of ileosigmoid knot

The findings on the radiographs of 14 cases of ileosigmoid knot are presented and analysed. The clinical features and pathology of the condition are briefly described. The key radiological features consist of a dilated loop of pelvic colon, evidence of small intestinal obstruction and retention of faeces in an undistended proximal colon. The dilated loop usually lies in the right side of the abdomen and the limbs taper inferiorly into the right lower quadrant. Medial deviation of the distal descending colon is an inconsistant but highly specific finding. The radiographs readily permit distinction from primary volvulus of the small intestine and from non-obstructive surgical emergencies such as perforated viscus and ruptured ectopic pregnancy. The combination of radiographic findings may however be simulated by volvulus of the right colon, closed loop small intestinal obstruction and by volvulus of the pelvic colon complicated by peritonitis. The differential diagnosis is discussed and the value of sigmoidoscopy, rather than barium enema, emphasised.     

Radiologic features of closed loop obstruction: analysis of 25 confirmed cases

The obstruction of a segment of bowel at two points results in a closed loop obstruction. Progression to strangulation is not an invariable component of this entity when surgical intervention is delayed. Enteroclysis is increasingly being used to evaluate obstruction of the small intestine. The authors retrospectively analyzed 25 surgically confirmed cases of closed loop obstruction and noted four enteroclysis features suggestive of the diagnosis: (a) crossing defects obstructing two segments of a loop of bowel secondary to dense adhesive bands (14 patients), (b) focal fixation of two limbs or twisting of the folds at the point of obstruction suggestive of volvulus (three patients), (c) abdominal wall herniation with obstruction (six patients), and (d) focal intraperitoneal segregation of a loop of bowel with tight obstruction suggestive of internal herniation (two patients). Recognition of the different patterns allows prompt preoperative radiologic diagnosis prior to strangulation.     

Midgut volvulus in infants: diagnosis with US. Work in progress

The authors present findings from ultrasound (US) studies that can alert sonologists to the possibility of midgut malrotation complicated by volvulus in neonates and infants. A fluid-filled, distended duodenum seen at US examination in infants is a nonspecific sign of duodenal obstruction, as well as one of the signs of midgut malrotation. In addition, dilated, thick-walled bowel loops, mainly to the right of the spine, and peritoneal fluid were found at abdominal US examinations of three infants with midgut malrotation complicated by volvulus. In one infant with uncomplicated midgut malrotation, only signs of duodenal obstruction were present. The findings at US of duodenal obstruction associated with thickened bowel loops to the right of the spine and peritoneal fluid should lead the sonologist to suspect midgut malrotation complicated by volvulus, a potentially fatal condition, and an upper gastrointestinal series should then be performed to confirm the diagnosis.     

急诊CT中肠系膜漩涡征的临床意义

目的探讨急性腹痛患者肠系膜漩涡征的临床意义。方法回顾性分析30例急性腹痛而全盆腹腔CT平扫病例。以肠系膜血管伴或不伴肠管绕轴旋转角度至少大于90°作为漩涡征的判断标准,分别观察漩涡征角度、位置、方向以及伴随征象,并比较肠扭转及非肠扭转病例组中漩涡征各项特征的差异性。结果①肠扭转组漩涡征角度为(494.00±123.58)°,非肠扭转组漩涡征角度为(160.91±63.16)°,两者存在统计学差异(t=5.30,P<0.05);②肠系膜漩涡征作为肠扭转诊断标准的准确度为35.48%,当漩涡征旋转角度大于和等于300°时,诊断肠扭转敏感性为83.35%,特异性为90%,准确度为71.43%;③小肠扭转漩涡征多位于中线或偏右侧中上腹部,乙状结肠扭转位于左下腹。而非肠扭转病例的漩涡征可出现在下腹部、腹腔边缘等不典型区域。结论肠系膜漩涡征大部分并不指向肠扭转,当漩涡征旋转角度越大越倾向于肠扭转,小肠扭转多位于中腹部或右上腹部,下腹部出现漩涡征需想到阑尾炎的可能。     

24例镰刀综合征心血管造影征象分析

笔者分析了２４例镰刀综合征心肺血管病变的造影征象及其病理生理意义，并与手术（１４例）和尸解（４例）资料对照。２４例心血管造影示全部或部分右肺静脉异常引流，分别为１７例和７例。异常引流静脉近端局限性狭窄９例，其中２例异常和正常引流静脉间有侧支吻合，右下肺异常体动脉侧支供血１８例。并存各种心脏病变者１８例，马蹄肺６例，右下肺肺隔离症３例，下腔静脉闭锁和狭窄分别为２和１例。右下肺异常体动脉侧支和心脏病变是患者严重症状和肺动脉高压的主要因素。除肺隔离症外，经导管栓塞异常体动脉侧支可使用者明显受益。异常引流静脉狭窄具有限制血液分流的作用。     

Herniation of the spinal cord 38 years after childhood trauma

We report an unusual post-traumatic spinal cord herniation, which became symptomatic 38 years after the trauma. A 44-year-old man presented with a 2-year history of increasing impotence, neuropathic bladder dysfunction and dissociated sensory loss below the level of T6. At the age of 6 years he had a severe blunt spinal injury with transient paraparesis. MRI revealed right lateral and ventral displacement of the spinal cord at the T5/6 level. The spinal cord was surgically exposed and found to herniate through a ventral defect of the arachnoid membrane and the dura mater. As there were no other events that could have precipitated spinal cord herniation the reported blunt trauma in childhood is the most likely cause for the spinal cord herniation in this patient.     

A spontaneous strangulated transomental hernia: Prospective and retrospec-tive multi-detector computed tomography findings Camera L,De Gennaro A,Longobardi M,Masone S,Calabrese E,Del Vecchio W,Persico G,Salvatore M简

Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography (CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.     

Osteoid osteoma: elevation of cardiac and respiratory rates at biopsy needle entry into tumor in 10 patients

PURPOSE: To evaluate changes in cardiac and respiratory rates in a consecutive series of patients who underwent percutaneous treatment for lesions presumed to be osteoid osteoma in whom general anesthesia was established. MATERIALS AND METHODS: Changes in cardiac and respiratory rates were evaluated after establishment of stable general anesthesia in 14 patients who underwent needle biopsy and radio-frequency treatment. Cardiac and respiratory rates were recorded at penetration of skin, muscle, periosteum, cortex, and tumor. Treatment was performed before the biopsy report was available. RESULTS: Biopsy results revealed osteoid osteoma in 10 patients, chondroblastoma in one, and a herniation pit in one. Results in the two remaining patients were nondiagnostic and were excluded. Puncture of skin, muscle, and periosteum caused no detectable change. However, in the 10 patients with biopsy-proved osteoid osteoma, puncture of the tumor caused the mean cardiac rate to increase an average of 26 beats per minute (40%) to 91 (range, 62-114; P <.001) and the mean respiratory rate to increase an average of 12 breaths per minute (50%) to a mean of 37 (range, 25-52; P <.001). These changes occurred within seconds of tumor puncture and were often the first indication to the surgeon that the tumor had been entered. In the two patients with other diagnoses at biopsy, no such change was apparent. CONCLUSION: Mean cardiac and respiratory rates increase significantly at needle puncture of osteoid osteoma.     

经皮腰椎间盘旋切术:影像学表现与疗效分析

目的 分析腰椎间盘突出症的影像学表现与经皮腰椎间盘旋切术(PLD)临床疗效的关系。方法 应用PLD术治疗腰椎间盘突出症52例，包括单纯性包容性腰椎间盘突出40例，椎间盘后缘及后纵韧带钙化4例，真空症并伴严重的腰椎退行性变3例，伴椎间隙狭窄2例，椎间盘突出伴轻微脱垂2例，椎间盘脱出1例。结果 总有效率为84．6％，其中显效50．0％，有效34.6％，无效15．4％。结论 PLD术是一种有效、安全、可靠的治疗腰椎问盘突出症的方法，影像学的表现有助于PLD适应证的选择和疗效估计。     

The gastric bubble: roentgen observations

The appearance of the stomach bubble provides many clues to underlying thoracoabdominal disorders. Illustrated in this article are (1) the major complications of large hiatal hernias: intrathoracic gastric volvulus and ulceration; (2) diaphragmatic abnormalities including inversion of the hemidiaphragm and intrathoracic displacement of abdominal contents because of diaphragmatic laceration or congenital herniation; (3) extrinsic displacement of the stomach bubble by splenomegaly (the occurrence of which in association with radiographic abnormalities in the chest--cardiomegaly, interstitial lung disease, mediastinal or hilar adenopathy--helps form a differential diagnosis); and (4) situs abnormalities for the analysis of which a simplified schema is presented.     

The posteroanterior chest radiograph in depressed sternum

The posteroanterior and lateral chest radiographs of 72 consecutive patients with sternal depression, together with 72 age- and sex-matched controls, have been reviewed. We assessed size and position of the cardiac silhouette, mediastinal contour, radio-opacity in the right lower zone and rib configuration. The degree of depression was determined from the lateral radiograph. The most significant signs of sternal depression on the posteroanterior chest radiograph are a straight left heart border, displacement of the cardiac silhouette to the left and an indistinct right heart border. These three signs have a high specificity for sternal depression and are significantly more commonly seen with increasing severity of depression. The presence of any three, or of more than three, of the described signs was 95.5% specific. However, despite this high specificity, the sensitivity and positive predictive value even for a combination of signs are low. Sternal depression is a relatively common chest deformity and the radiologist should be aware of the changes on the posteroanterior chest radiograph to avoid pitfalls in diagnosis.