Tumor thrombosis of the inferior vena cava due to retroperitoneal germ cell tumor

Three patients (2 males and 1 female), aged 17–28 years, with tumor thrombosis of the inferior vena cava due to retroperitoneal germ cell tumor are reported. Diagnostic and therapeutic implications of this condition are discussed.     

Spectral and color Doppler sonography.

Color Doppler sonography has become an integral part of modern hepatic sonography. Color Doppler can enhance the conspicuity of focal lesions and bile ducts in jaundiced patients by illuminating normal vessels with flow. Spectral and color Doppler may prove useful in limiting the sonographic differential diagnosis of focal liver lesions. Color flow sonography effectively evaluates pseudoaneurysms, A-V fistulae, collaterals, and flow reversal in portal hypertension, venous clot and tumor invasion, Budd-Chiari syndrome, hereditary hemorrhagic telangiectasis, and many other hepatic vascular lesions. We have found it invaluable in evaluating cirrhotic and liver transplant patients.     

Accuracy of CT in estimating extent of pancreatic necrosis

The objective of this study was to determine whether nonenhancing pancreatic lesions are accurate in estimating pancreatic necrosis. Twenty-six consecutive abdominal computed tomography (CT) examinations performed over a 3-year period that met the CT criteria for pancreatic necrosis were reviewed. Follow-up CTs in three of 26 patients demonstrated pancreatic enhancement, indicating viable parenchyma, within the previously nonenhancing regions. All three patients had undergone surgical debridement in that area. Twenty-three cases demonstrated either no change or enlargement of the nonenhancing pancreatic lesions. Follow-up ranged from 1 week to 26 months. While CT is accurate in diagnosing pancreatic necrosis, lack of enhancement in CT may occasionally overestimate the extent of necrosis. Nonenhancing, viable but at-risk tissue may be present adjacent to frankly necrotic tissue. Surgical debridement may facilitate recovery of this viable tissue, which may enhance normally on follow-up CT.     

Septic thrombosis of the portal vein: CT and clinical observations

The CT and clinical findings were reviewed in seven patients with septic thrombosis of the portal vein (STPV). Of the seven patients, five had associated pyogenic liver abscesses. Five of seven patients presented de novo with STPV without a clinically obvious extrahepatic source of intraabdominal infection. All seven patients were successfully managed nonsurgically with intravenous antibiotics and in two patients percutaneous drainage of hepatic abscesses. Serial follow-up examinations in five patients demonstrated complete resolution of portal venous thrombus in three patients and progression to cavernous transformation in two. When diagnosed early by CT or sonography, STVP may have a more benign clinical course following appropriate antibiotic therapy.     

Gallbladder wall thickening: patients without intrinsic gallbladder disease

Retrospective analysis of 22 patients with increased gallbladder wall thickness (4--10 mm) in the absence of gallbladder disease revealed that 19 were hypoalbuminemic (albumin less than 3.6 g/dl). To test the hypothesis that hypoalbuminemia was a causal factor, gallbladder wall thickness was measured in 40 patients selected prospectively solely on the basis of hypoalbuminemia. This group was compared to 25 normal volunteers. Hypoalbuminemic patients had significantly thickened gallbladder walls compared to volunteers (p less than 10(-9)). This thickening was associated not only with hypoalbuminemia, but also with increased main portal vein diameter, which reflects portal venous blood pressure. Gallbladder wall thickening unrelated to intrinsic gallbladder disease seems to be influenced by the same parameters as ascites formation--plasma colloid oncotic pressure and portal venous pressure.     

Prospective evaluation of the sonographic murphy sign in suspected acute cholecystitis

The sonographic Murphy sign, the presence of maximal tenderness elicited over a sonographically localized gallbladder, has been considered useful in the evaluation of patients with suspected acute cholecystitis. We prospectively evaluated this sign in 427 consecutive patients referred for evaluation of acute cholecystitis. The overall accuracy of the sonographic Murphy sign in the 219 patients with sufficient confirmation to be included in the statistical analysis was 87.2%. Sensitivity was 63% and specificity was 93.6%. The predictive value of a positive sign was 72.5%, while the predictive value of a negative sign was 90.5%. The sonographic Murphy sign is a useful, albeit imperfect, adjunct in the assessment of patients with suspected acute cholecystitis.     

Tumoral calcinosis: sonographic sedimentation sign

We present the sonographic findings of tumoral calcinosis in two patients compared with conventional radiography, CT, and MRI. Sonography in both patients demonstrated fluid-sedimentation levels, with more echogenic debris layering dependently. This appearance has been referred to as the "sedimentation sign" on conventional radiography and results from dependent layering of hydroxyapatite crystals within cystic spaces of the lesion. There are only three reported cases in the world literature of sonographic findings in patients with tumoral calcinosis. We describe the first two cases of sonography demonstrating the "sedimentation sign," which may aid in the diagnosis of tumoral calcinosis.     

Robotic resection of recurrent pediatric lipoblastoma

This case demonstrates successful resection of a rare, recurrent presacral‐pelvic lipoblastoma in a 19‐year‐old female patient. Because of the anatomical location of the mass and its proximity to vital structures, the robotic approach allowed for both optimal visualization and effective debulking of the mass. Furthermore, with the use of an articulating laparoscopic camera, key visualization of the posterior lateral pelvis was possible. Using a wide breadth of technologies and resources is essential to broadening the surgical armamentarium and achieving resectability in otherwise challenging cases.