Focal splenic lesions: US findings

Ultrasound (US) imaging of the spleen was considered of little use in the past and was performed only to distinguish between cystic and solid lesions. However, in the last decade due to experience acquired and the introduction of second-generation contrast agents, this technique has been re-evaluated as contrast-enhanced US (CEUS) allows detection and characterization of most focal lesions of the spleen with a high sensitivity and a good specificity. Gray-scale US presents a low specificity in splenic infarctions with a high rate of false negative cases, whereas specificity reaches 100 %, if the examination is performed using US contrast agents. Gray-scale US can provide a correct diagnosis in simple cysts, whereas CEUS is useful when cystic lymphangioma is suspected. In the study of splenic lesions, the most important problem is to differentiate between angioma, hamartoma, lymphoma, and metastasis. CEUS reaches a good specificity in the differentiation of benign from malignant splenic lesions, as hypo-enhancement in the parenchymal phase is predictive of malignancy in 87 % of cases. In conclusion, Gray-scale US and particularly CEUS are at present widely indicated in the study of focal splenic lesions.     

Blunt chest trauma and suspected aortic rupture: reliability of chest radiograph findings

The chest radiographs of 86 patients with suspected aortic rupture from blunt chest trauma were reviewed. Seventy-three patients had no evidence of aortic rupture on aortography or surgical exploration, and 13 patients had surgically confirmed rupture. Sixteen radiographic findings were analyzed for sensitivity and specificity in detecting aortic rupture. The following findings were not statistically significant: hemothorax on either side; rib fractures on either side; pneumothorax on either side; lung contusion; widened left paravertebral stripe; and widening of the mediastinum, along with an increased ratio of mediastinal width to chest width. The most helpful findings leading to suspicion of aortic rupture included nasogastric tube or tracheal deviation to the right at the T4 level; depression of the left mainstem bronchus; and loss of the aortic contour or knob and left apical cap. False positives and false negatives occurred with each radiographic sign, indicating that there is no single finding that is absolutely reliable in predicting or excluding significant injury in every patient with suspected aortic rupture. Analysis of combinations of findings found that when the aortic contour and knob are normal and the nasogastric tube and trachea are not deviated, there was no case of aortic rupture in four consecutive years of experience. These four signs can be used to exclude aortic rupture.     

脾动脉栓塞的临床应用

本文采用经皮导管脾动脉部分栓塞的方法，对门脉高压并脾亢、原发性血小板减少性紫癜、溶血性贫血及外伤性脾破裂进行了栓塞治疗（３１例３３次栓塞），取得了良好效果。并发症为１６．１％，死亡率为３．３％，均较国内（３０％与２０％）国外（２１％与１５．８％）同类水平为低。该方法扩大了栓塞治疗的应用范围，达到了内科久治不愈，病情难以控制，需要外科切脾的目的，既保证了人体解剖的完整性，又保留了脾的免疫功能，具有肯定的临床应用价值。     

Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma

BACKGROUND: A very rare case of retroperitoneal bleeding due to spontaneous rupture of a large adrenal myelolipoma in a 62-year-old woman is reported. METHODS/RESULTS: She consulted the emergency room of the Nagano Red Cross Hospital with a complaint of sudden left flank pain. A computerized tomography (CT) scan revealed a tumor with areas of fat density and hematoma in the left retroperitoneal space. After her general condition improved, an operation was performed. The tumor strongly adhered to the left kidney and a left nephrectomy with the tumor was curative. Histologic diagnosis was adrenal myelolipoma. No blood transfusion was required. CONCLUSIONS: A CT scan is very useful in the pre-operative diagnosis of adrenal myelolipoma with retroperitoneal hemorrhage. Watch and wait treatments before operation and nephrectomy with adhered tumor are safe and curative.     

急性心肌梗塞后室间隔破裂X线诊断评价

目的：评价平片对心肌梗塞后室间隔破裂（ＰＩＶＳＲ）的应用价值。方法：本文对２６例ＰＩＶＳＲ患者的平片（包括后前立位及床旁胸片）并结合临床表现，心电图、超声及手术或／和尸检结果进行回顾性分析。分成存活与非存活两组，比较肺血增多、肺瘀血，右心功能及年龄等情况并对室壁瘤征象进行分析。本文还强调了平片质量及客观细致阅片的重要性。结果：根据原始报告，诊断率仅１５％，提高本病认识仔细阅片，可达５０％，合并室壁瘤占７０％。非存活与存活组比，前者年龄大，右心功能差，下、后壁心梗多，及肺血增多不明显等，有显著性差异。结论：平片对约半数ＰＩＶＳＲ能作出诊断，室壁瘤征象对诊断亦有帮助。平片对左心功能评值有较大价值，对ＰＩＶＳＲ的预后评估亦可能有一定意义     

Streamlined flow in the portal vein: demonstration with MR angiography

PURPOSE: To demonstrate whether streamlining of the portal vein flow exists by evaluating the relative distribution of blood flowing from the superior mesenteric vein (SMV) and splenic vein (SV) into the portal venous system. MATERIALS AND METHODS: Fifteen healthy adult volunteers underwent MR angiography of the main portal vein (PV) and portal vein branches after an overnight fast. Transverse two dimension time-of-flight gradient echo sequences were obtained three times, in suspended expiration and inspiration, respectively, as follows: 1) No presaturation slab, 2) presaturation slab across the SMV, 3) presaturation slab across the SV. Signal intensity (SI) measurements were obtained for all acquisitions. using regions of interest traced manually within the PV and portal branches. RESULTS: After presaturation of the SMV and SV during expiration, the overall SI average in the PV decreased by 47% +/- 8 (mean +/- SD) and 17% +/- 9, respectively. Right to left portal branch SI ratio and right-anterior to left-posterior SI ratio in the PV were 0.91 +/- 0.09 and 1.02 +/- 0.08 at baseline, respectively. They decreased significantly (P < 0.05) to 0.87 +/- 0.09 and to 0.95 +/- 0.09 after saturation of the SMV, and increased significantly to 0.95 +/- 0.08 and to 1.07 +/- 0.10 after saturation of the SV. CONCLUSION: MR angiography with selective saturation of the SMV and SV provided reproducible assessment of the respective contributions of the SMV and SV to portal flow, and allows demonstration that streamlining of splanchnic blood occurs in the portal vein of normal subjects.     

间接暴力致肝门部放射状损伤

目的　探讨腹部闭合性损伤致肝门部放射状肝破裂的形成机制、临床特点及治疗特点。方法　回顾性总结了 1990年 8月～ 2 0 0 2年 9月间 8例闭合性腹部外伤致肝门部放射状肝破裂及合并伤的临床表现、治疗方法和结果。结果　 8例病人全部经手术治疗痊愈 ,对胆囊撕脱伤及胆管裂伤患者随访 2～ 3年 ,无不良反应。结论　肝门部放射状肝破裂由间接暴力所致 ,可伴有胆囊撕脱伤 ,肝门胆管、血管及第三肝门裂伤。主要表现为失血性休克 ,修补肝破裂的同时 ,注意合并伤的处理。     

Patho-mechanical comparative morpho-characterization of contre-coup injuries of liver by cadaveric experimental simulation for medico-legal and forensic implications

BackgroundLiver is the most common organ to get injured in cases of blunt force trauma to the abdomen (BFTA). It is the 2nd commonest organ after brain to sustain injuries out of all the trauma related fatalities. However, the literature about contre-coup injuries to the liver due to BFTA is scarce in-spite of the high mortality rates seen out of injury to this particular organ.PurposeThe authors intended to systematize the characteristic morphogenesis of the contre-coup injuries of the liver on the basis of the patho-mechanics involved in various types of BFTA.MethodologyOne hundred and sixty three cases of BFTA were identified, and interpretation was attempted for the contre-coup rupture of the liver seen in twenty out of all the trauma related fatalities that presented for post-mortem examination during the study period. However, the mechanics of the pattern of the rupture injuries to the liver were indiscernible. This motivated the authors to conduct the comparative characterization of injuries to the liver by experimental simulation of BFTA after necessary permission via inflicting pre-calculated forces on unclaimed cadavers.ResultsThe patterns of contre-coup rupture/s of liver were established in all the twenty out of one sixty-three cases of BFTA. The rupture depicted patterns of injury in the situations of - 1) strong hits with a limited surface trauma, 2) very strong hits with a generalized surface trauma, 3) and collision with a solid surface resulting due to fall onto the side of the abdomen. The causative mechanism discerned was deformation of the liver, followed by its parenchymal rupture due to the shear and strain types of force/s consequent upon tissue compression. The minimum force and energy of impact required for the liver to rupture was estimated to be 2000 N and 141.5 J.ConclusionThis series of the simulation experiments revealed two variants of liver rupture in the contre-coup impact zone. The pattern of injury was maintained in cases, those studied at post-mortem examinations, but the relief ruptures were found to vary depending upon the overall mechanics of the traumatic forces involved in the simulation experiments performed on the cadavers. The anti-shock ruptures were formed during shock trauma, and shockproof ruptures were not seen in cases of underlying compressive forces. The morphogenetic characterization of the relief rupture surface of the liver was also delineated in relation to its surface orientation to the spine on the basis of the terms “large” and “very large” depicting the quantum of force/s delivered out of an impact or blow.