scholarly journals A199 SEVERE COLITIS FOLLOWING PELVIC RADIOTHERAPY: CASE REPORT AND REVIEW OF THE LITERATURE

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 223-224
Author(s):  
M Gozdzik ◽  
S Murthy
Keyword(s):  
Ct Scan ◽  
Flexible Sigmoidoscopy ◽  
Gastrointestinal Disease ◽  
Vaginal Vault ◽  
Deficiency Anemia ◽  
Watery Diarrhea ◽  
Pelvic Radiotherapy ◽  
Systemic Corticosteroids ◽  
Repeat Endoscopy ◽  
Work Up

Abstract Background Mild-to-moderate proctocolitis is a well-known complication of pelvic radiation therapy, occurring in 43% and 6% of patients following external beam radiotherapy (EBRT) and brachytherapy (BT), respectively. This typically presents as recurrent painless rectal bleeding, diarrhea, urgency, and/or iron-deficiency anemia. Severe ulcerating proctocolitis is a less common complication of pelvic radiotherapy and is rare following BT. We report two cases of severe ulcerating proctocolitis mimicking inflammatory bowel disease (IBD) following pelvic radiotherapy in patients without known IBD, including an elderly male undergoing EBRT, and an elderly female undergoing vaginal vault BT. Aims To describe two cases of severe ulcerating proctocolitis, mimicking IBD, following pelvic radiotherapy. Methods Case descriptions and literature review. Results A 71-year-old male without antecedent gastrointestinal disease developed bloody diarrhea 3 months following EBRT for treatment of prostate cancer. Infectious work-up was negative. Blood work showed anemia and an elevated CRP. CT scan showed distal large bowel inflammation concerning for proctocolitis. Flexible sigmoidoscopy revealed severe proctosigmoiditis with circumferential thickening and nodularity of the mucosa and multiple ulcers. Biopsies showed ulcer tissue with fibrinopurulent exudate. He was treated with systemic corticosteroids and symptoms gradually resolved. Repeat colonoscopy 8 months later showed healed inflammation with scarring and residual radiation proctosigmoiditis. A 74-year-old female without antecedent gastrointestinal disease developed watery diarrhea 2 weeks after initiating low dose vaginal vault BT for treatment of endometrial cancer. Infectious work-up was negative. Blood work showed an elevated CRP and CT scan revealed proctocolitis extending to the descending colon. Flexible sigmoidoscopy revealed severe ulcerating proctosigmoiditis with tram tracks of denuded mucosa. Biopsies showed moderate diffuse chronic active colitis with crypt abscesses and apoptotic bodies. She was treated with systemic corticosteroids followed by infliximab and methotrexate, with mild symptomatic improvement. However, repeat endoscopy revealed persistent severe ulceration. Unfortunately, she developed a sigmoid perforation with pelvic abscess, leading to bacteremia and fungemia, and subsequently passed. Conclusions While rare, severe ulcerating proctocolitis mimicking IBD can occur following pelvic radiotherapy, including BT. The decision to manage these patients as IBD using immunosuppressive therapy should be weighed against the risks of these therapies, considering a patient’s age and underlying health, and in collaboration with a patient’s health care team. Careful assessment for risk factors and pathological findings from biopsy specimens may help in predicting the likelihood of IBD in such patients. Funding Agencies None

scholarly journals Challenge in diagnosis of late onset necrotizing enterocolitis in a term infant: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gunadi ◽  
Dian Nirmala Sirait ◽  
Aditya Rifqi Fauzi ◽  
Ninditya Nugroho ◽  
Fadil Fahri ◽  
...  
Keyword(s):  
Ct Scan ◽  
Necrotizing Enterocolitis ◽  
Intestinal Inflammation ◽  
Late Onset ◽  
Gastrointestinal Disease ◽  
Early Recognition ◽  
Ileocecal Valve ◽  
Abdominal Distention ◽  
Clinical Deterioration ◽  
Wall Thickening

Abstract Background Necrotizing enterocolitis (NEC) is a common devastating inflammatory gastrointestinal disease and frequently occurs in premature infants. Here, we reported a case of late-onset NEC in a term neonate with good outcome after surgery for long-term follow-up. Case presentation Ten-week-old male came to emergency unit due to prolonged diarrhea and abdominal distention. He was born at gestational age of 40 weeks with birth weight and Apgar score of 2800 g and 7/8, respectively. He had no history of formula feeding. Two weeks before admitted to the hospital, the patient had frequent diarrhea with fever. He was found lethargic with abdominal distention, absence of bowel sounds and abdominal tenderness. Plain abdominal x-ray and CT scan showed gastric and intestinal dilatation and gasless colon, suggesting a small bowel obstruction, and bowel wall thickening indicating peritonitis, without any free subdiaphragmatic air (pneumoperitoneum). Moreover, the patient did not have a congenital heart disease. While in intensive medical treatment, he showed a continuous clinical deterioration. All findings were suggestive of intestinal inflammation with clinical deterioration, and we decided to perform an emergency exploratory laparotomy and found an ischemia along the jejunoileal with a perforation at 25 cm above the ileocecal valve. Subsequently, we performed a double-barrel ileostomy through a separate incision from the laparotomy. Histopathological findings confirmed the diagnosis of NEC. We closed the stoma at postoperative day 43. The patient was discharged uneventfully a month after stoma closure. Conclusion Abdominal CT scan might be useful to establish an early recognition of late-onset NEC; thus, immediate surgical intervention might be performed to decrease its morbidity and mortality. Moreover, late-onset NEC in term neonates might occur without any risk factors or significant co-morbidities.

scholarly journals Dual-tracer (68Ga-DOTATOC and 18F-FDG-)-PET/CT scan and G1-G2 non-functioning pancreatic neuroendocrine tumors: A single-center retrospective evaluation of 124 non-metastatic resected cases

2021 ◽  
Author(s):  
Salvatore Paiella ◽  
Luca Landoni ◽  
Sarah Tebaldi ◽  
Michele Zuffante ◽  
Matteo Salgarello ◽  
...  
Keyword(s):  
Ct Scan ◽  
Neuroendocrine Tumors ◽  
Fdg Pet ◽  
Pancreatic Neuroendocrine Tumors ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Work Up ◽  
Pet Ct Scan ◽  
Dual Tracer

Introduction:The combined use of 68Gallium [68GA]-DOTA-peptides and 18Fluorine-fluoro-2-deoxyglucose [18F-FDG] PET/TC scans in the work-up of pancreatic neuroendocrine tumors (PanNETs) is controversial. This study aimed at assessing both tracers’ capability to identify tumors and to assess its association with pathological predictors of recurrence. Methods:Prospectively collected, preoperative, dual-tracer PET/CT scan data of G1-G2, non-metastatic, PanNETs that underwent surgery between January 2013 and October 2019 were retrospectively analyzed. Results:The final cohort consisted of 124 cases. There was an approximately equal distribution of males and females(50.8%/49.2%), and G1 and G2 tumors(49.2%/50.8%). The disease was detected in 122(98.4%) and 64(51.6%) cases by 68Ga-DOTATOC and by 18F-FDG PET/CT scans, respectively, with a combined sensitivity of 99.2%. 18F-FDG-positive examinations found G2 tumors more often than G1 (59.4% versus 40.6%;p = 0.036), and 18F-FDG-positive PanNETs were larger than negative ones (median tumor size 32 mm, IQR 21 versus 26 mm, IQR 20;p = 0.019). The median Ki67 for 18F-FDG-positive and -negative examinations was 3(IQR 4) and 2(IQR 4), respectively, (p = 0.029). At least one pathologic predictor of recurrence was present in 74.6% of 18F-FDG-positive cases (versus 56.7%;p = 0.039), whereas this was not found when dichotomizing the PanNETs by their dimensions (≤/> 20 mm). None of the two tracers predicted nodal metastasis. ROC curve analysis showed that 18F-FDG uptake higher than 4.2 had a sensitivity of 49.2%, and specificity of 73.3% for differentiating G1 from G2 (AUC=0.624, p=0.009). Conclusion: The complementary adoption of 68Ga-DOTATOC and 18F-FDG tracers may be valuable in the diagnostic work-up of PanNETs despite not being a game-changer for the management of PanNETs ≤ 20 mm.

Effect of age on the performance of a diagnostic strategy based on clinical probability, spiral computed tomography and venous compression ultrasonography

2005 ◽  
Vol 93 (03) ◽  
pp. 605-609 ◽  
Author(s):  
Francis Couturaud ◽  
Florence Parent ◽  
Guy Meyer ◽  
Philippe Girard ◽  
Grégoire Le Gal ◽  
...  
Keyword(s):  
Ct Scan ◽  
Older Patients ◽  
Age Groups ◽  
Spiral Ct ◽  
Diagnostic Strategy ◽  
Clinical Probability ◽  
Venous Compression ◽  
Negative Findings ◽  
Work Up ◽  
Effect Of Age

SummaryAs the prevalence of PE increases with age, the effect of age on the diagnostic work-up in front of a clinical suspicion of PE deserves exploration. In this retrospective analysis, we used the data from 1041 consecutive suspected PE patients. The patients were divided into three groups according to tertiles of age: under 54 years, 54 to 73 years and above 73 years. The prevalence of PE in patients with respectively low, intermediate and high pretest clinical probability was expressed within each age group. We studied the effect of age on the results observed in three main groups of patients, after performing CT scan and ultrasonography (CUS): (1) patients with inconclusive results; (2) patients with negative findings on both exams and non high pretest clinical probability;(3) patients with positive findings. The prevalence of PE increased significantly with age, in overall, as well as in patients with low or intermediate pretest clinical probability. An analysis according to the three main diagnostic groups showed that: (1) the distribution of inconclusive spiral CT or CUS examinations was not different between age groups;(2) no thromboembolic event occurred in untreated patients with low or intermediate clinical probability aged under 54 years of age, whereas 7 events were diagnosed in patients aged over 73 years (p< 0.001); (3) a higher proportion of older patients had a positive result at both spiral CT and CUS examinations. The percentage of positive CT scans in the case of negative or inconclusive CUS results was not different between age groups; conversely, in the case of a negative or inconclusive CT scan, the percentage of positive CUS was higher in older patients. In conclusion, management of elderly suspected PE patients appears to be different from both the work-up and the outcome perspectives.

scholarly journals Modified Whitaker test: a novel diagnostic for nephroptosis

2020 ◽  
Vol 13 (4) ◽  
pp. e235108
Author(s):  
Ralph Grauer ◽  
Mikel Gray ◽  
Noah Schenkman
Keyword(s):  
Emergency Department ◽  
Ct Scan ◽  
Renal Colic ◽  
Flank Pain ◽  
Voiding Cystourethrogram ◽  
Diuretic Renography ◽  
Initial Work ◽  
Whitaker Test ◽  
Contrast Ct ◽  
Work Up

A 77-year-old woman presented with right flank pain radiating to the ipsilateral groin and associated nausea, consistent with renal colic. In the emergency department, a non-contrast CT scan revealed severe right-sided hydronephrosis but failed to demonstrate a calculus or ureteropelvic obstruction. The patient improved with fluids and followed up with a community urologist. Initial work-up with cystoscopy and ureteroscopy, voiding cystourethrogram and diuretic renography failed to deduce a diagnosis. At our hospital, we used a modified dynamic (supine and upright) Whitaker test in a novel fashion to diagnose nephroptosis, a rare hypermobility condition of the kidney.

Utility of PET/CT as initial staging work up for early pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 183-183
Author(s):  
Gopi Kesaria Prithviraj ◽  
Nishi Kothari ◽  
Binglin Yue ◽  
Jongphil Kim ◽  
Gregory M. Springett ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Ct Scan ◽  
Metastatic Disease ◽  
Treatment Plan ◽  
Borderline Resectable ◽  
Pet Ct ◽  
Borderline Pancreatic Cancer ◽  
Work Up ◽  
Pet Ct Scan ◽  
Initial Staging

183 Background: In pancreatic cancer, early detection and complete surgical resection with negative margins offers the only cure for the disease. Work up to evaluate resectability includes triple phase helical scan CT of the pancreas and endoscopic ultrasound (EUS). A paucity of data exists in using PET/CT scan as staging work up in early resectable pancreatic cancer. The objective of our study was to determine if PET/CT prevents futile laparotomy by detecting occult metastatic disease in patients with resectable/borderline pancreatic cancer. Methods: We looked at our institutional PET/CT data base incorporating National Oncologic PET Registry (NOPR) with diagnosis of resectable or borderline pancreatic cancer from 2005-2012. Clinical, radiographic, and pathologic follow-up was evaluated, including age, gender, evidence of metastatic disease, and initial CA 19–9 levels. The impact of PET/CT on patient management was estimated by calculating the percentage of patients whose treatment plan was altered due to PET/CT. The confidence interval was computed using the exact binomial distribution. The effect on the change was evaluated by the multiple logistic regression model. The final model was selected using the backward elimination method. Results: 287 patients with early stage (resectable or borderline) pancreatic cancer who received PET/CT as part of initial staging workup were identified. Upon initial work up (CT + EUS), 62% of patients were considered resectable and 38% were borderline resectable. However, PET/CT findings changed the management in 11.9% (n=34) of patients (95% CI: 0.084 – 0.162). 33 patients were upstaged to stage IV and 1 patient was upstaged to stage III. Median time from CT to PET/CT was 5 days. Metastatic lesions were confirmed with biopsy in 21 patients. The proportion in the change in treatment plan is significantly higher in patients who were borderline resectable (p=0.005; OR=2.94; 95% CI: 1.38 – 6.26). In 204 patients who were taken to surgery, 17.7% (n=36) were found to have metastatic disease intraoperatively. Conclusions: PET/CT helped improve detection of occult metastases, ultimately sparing these patients a potentially unnecessary operation. The role of PET/CT scan should be validated in prospective study.

scholarly journals MON-344 Uncommon Etiology of Hypophosphatemia and Secondary Hyperparathyroidism: Ferric Carboxymaltose Infusion

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sakine Sever
Keyword(s):  
Vitamin D ◽  
Secondary Hyperparathyroidism ◽  
Spinal Stenosis ◽  
Side Effect ◽  
Deficiency Anemia ◽  
Ferric Carboxymaltose ◽  
Left Femur ◽  
T Score ◽  
Fgf 23 ◽  
Work Up

Abstract Background: Hypophosphatemia has been recognized as one of the side effect of intravenous ferric carboxymaltose infusion. This effect is thought to be secondary to fibroblast growth factor 23 (FGF 23) mediated renal phosphate wasting and associated with calcitriol deficiency and secondary hyperparathyroidism. Clinical Case: A 76 years old male patient with medical problems including hypertension, type 2 diabetes mellitus, hyperlipidemia, paroxysmal atrial fibrillation, nephrolithiasis, spinal stenosis and chronic anemia was referred to endocrinology clinic for osteoporosis management. Bone density scan showed left femur neck T-score of -2.5 and L1-L4 lumbar spine T-score of 1.4. He reported pain on back and bilateral posterior thighs, difficulty with ambulation which were partly attributed to severe spinal stenosis that he was planned to have surgery for. Muscle strength was normal on examination. Laboratory studies were obtained for osteoporosis work up and showed: Calcium: 8.9 mg/dL (8.8-10.2 mg/dL), Creatinine: 0.77 mg/dL (0.74-1.35 mg/dL), GFR: 88 mL/min/BSA, Albumin 4.5 g/dL (3.5-5.0 g/dL), 25-Hydroxy vitamin D: 26 ng/mL, Magnesium 1.8 mg/dL (1.7-2.3 mg/mL), 1,25 Dihydroxy Vitamin D 24 pg/mL (18-64 pg/mL), Phosphorus: 1 mg/dL (2.5-4.5 mg/dL), PTH 163 pg/mL (15-65 pg/mL), Hemoglobin 12.9 mg/dL (13.2-16.6 mg/dL). Due to hypophosphatemia tumor induced osteomalacia diagnosis was entertained and further work up was considered in this regard however later noted that patient received ferric carboxymaltose 750 mg infusion two times within last 3 weeks for iron deficiency anemia. Hemoglobin level was 8.6 mg/dL before the infusions. After oral phosphate replacement the phosphate level improved to 2.4 mg/dL. Serum FGF 23 level was measured and it was normal at 108 RU/mL (&lt;180 RU/mL). He was then started on bisphosphonate treatment for osteoporosis. Conclusion: Hypophosphatemia and secondary hyperparathyroidism can be seen after ferric carboxymaltose infusion due to FGF-23 mediated mechanism. In literature various presentations were reported from transient- asymptomatic hypophosphatemia to severe acute symptomatic hypophosphatemia along with persistent hypophosphatemia with osteomalacia and fragility fractures due to recurrent ferric carboxymaltose infusions. Thus, one should keep this possible side effect in mind during evaluation of hypophosphatemia and osteoporosis. References: 1. Wolf M, Chertow GM, Macdougall IC, Kaper R, Krop J, Strauss W. Randomized trial of intravenous iron-induced hypophosphatemia. JCI Insight. Dec 6 2018;3(23):e124486 2. Fang W, McMahon LP, Bloom S, Garg M. Symptomatic severe hypophosphatemia after intravenous ferric carboxymaltose. JGH Open. October 2019, volume 3, issue 5, P 438-440

scholarly journals The Grave Hematologic and Hepatic Effects of Hyperthyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A959-A959
Author(s):  
Sara Miriam Ahmad ◽  
Bryan Jiang
Keyword(s):  
Iron Deficiency ◽  
Blood Cell ◽  
Total Bilirubin ◽  
Parvovirus B19 ◽  
Hepatic Disease ◽  
Deficiency Anemia ◽  
Cholestatic Liver Disease ◽  
Close Monitoring ◽  
Cell Counts ◽  
Work Up

Abstract Background: Hyperthyroidism can present with a myriad of symptoms including some rare, but morbid systemic manifestations. Here we present the case of a patient who presented with thyrotoxicosis, pancytopenia and cholestatic liver disease. Clinical Case: A 37 year-old Hispanic female with no significant past medical history presented with weight loss, fatigue, jaundice and irregular menstrual cycles ongoing for 10 months. Upon presentation, vitals were notable for mild tachycardia. She had significant jaundice and a visibly enlarged thyroid gland, while no thyroid eye disease was noted. The patient was found to have a hemoglobin level of 6.5 g/dL (12.0 - 16.0 g/dL), white blood cell level of 2.3 K/uL (4.5 - 11.0 K/uL) and platelet count of 82 K/uL (150 - 400 K/uL). Alkaline phosphatase was elevated to 214 U/L (34.0 - 104.0 U/L) and total bilirubin was 8.7 mg/dl (0.2 - 1.2 mg/dL) with direct bilirubin of 5.4 mg/dL (0.0 - 0.2 mg/dL). Thyroid panel revealed an undetectable TSH and a free T4 of 5.58 ng/dL (0.61 - 1.18 ng/dL). Hematological work-up was negative for malignancy but did note severe iron deficiency. Hepatitis B and C virus, parvovirus B19 serology, magnetic resonance cholangiopancreatography, and autoimmune disease work-up all returned normal. Thyroid uptake scan showed diffuse uptake without nodular disease and a 24-hour uptake of 57% (normal 7-32%). Thyroid stimulating antibodies were positive at 115 IU/L (0.00-0.55 IU/L). Since all other work up was negative, it was concluded that her pancytopenia and cholestatic pattern of liver injury were likely due to hyperthyroidism with plan to do a bone marrow biopsy if she does not have improvement in blood cell counts. Patient was treated with radioactive iodine (RAI) ablation. A week after treatment she had further elevation in total bilirubin, whereas her blood counts had improved. It was decided to initiate methimazole with close monitoring of her liver function tests. Two months after treatment, her thyroid function improved and she was eventually transitioned to levothyroxine for post-ablative hypothyroidism. Bilirubin improved to normal range and her pancytopenia resolved without additional intervention. She had complete resolution of jaundice and started having regular menses 2 months after her RAI treatment. Conclusion: The etiology of pancytopenia has been thought to be multifactorial with consumption of nutrients (including iron, manifesting as iron deficiency anemia), stimulation of erythropoiesis and sequestration of blood cells due to splenomegaly. Thyroid associated hepatic dysfunction has been proposed to be secondary to relative hypoxia in the perivenular regions and the direct toxic effect of thyroid hormone on hepatic tissue. In patients with concurrent hepatic disease and thyrotoxicosis, it is reasonable to consider treatment with thionamides with close monitoring, if other etiologies for hepatic disease are ruled out.

scholarly journals 1323 Assessment of The Appropriate Use of Imaging and Reporting in Acute Pancreatitis in A Secondary Care Setting

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Kirchhoff ◽  
T J Omokehinde ◽  
P Achunine ◽  
C Marshall ◽  
C Ikechi ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Ct Scan ◽  
Care Setting ◽  
Gastrointestinal Disease ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Abdominal Ultrasound ◽  
Computerised Tomography ◽  
Secondary Care Setting

Abstract Aim Acute pancreatitis is the world's most common gastrointestinal disease requiring hospital admission. Our audit aim was to assess the timeframe within which Abdominal Ultrasound Scans (USS) and Computerised Tomography (CT) were performed, reported indications for CT and the prognostic factors noted in imaging reports. Method A retrospective search included admissions with acute pancreatitis between 01/09/19 to 30/11/19, collecting demographics, admission time & date, time and date of both radiological investigations and imaging reports. Patients under the age of 18 were excluded. Results This search identified 75 patients (M:F, 40:35) with a median age of 53 (18-95) years. USS were performed within 24 hours of admission in 40.0% (n = 30) of cases. Out of the patients (n = 44) who received a CT scan, 15.9% (n = 7) were scanned after more than 72 hours of onset of symptoms and 84.1% (n = 37) were scanned within less than 72 hours. Furthermore, 88.6%(n = 39) of CT request indications were in keeping with our standards. The average length of hospital stay was 6.1 days when scanned within 72 hours and 11.8 days when scanned after more than 72 hours. Conclusions Only 17.3% (n = 13) of the patients audited met all our standards and were managed according to the guidelines. The average length of hospital stay was half in those who had a CT scan after more than 72 hours of admission and this was also used to monitor disease progression/regression.

scholarly journals The value of ultra sonogram in the diagnosis of ovarian dermoid cysts

2014 ◽  
Vol 3 (1) ◽  
pp. 26-31
Author(s):  
Sujan Pradhan
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Cystic Teratoma ◽  
Clinical Practices ◽  
Adnexal Masses ◽  
Ultrasonographic Diagnosis ◽  
Preoperative Work Up ◽  
Work Up ◽  
Ultrasound Features

Mature cystic teratoma often referred to as dermoid cysts have been diagnosed using all imaging modalities. Dermoid cysts present various and complex ultrasonographic aspects. At times diagnosis may be difficult and lead to confusion due to its complex solid and cystic nature. The specificity for diagnosis of fat and calcification makes computed tomography (CT) scan the modality of choice. But CT scan is high technique equipment, expensive and may not be affordable or available at all places. Advances in the quality of USG machines, better experiences of ultrasound operators and thorough analysis of all ultrasound features that characterise dermoid cysts have resulted in an increased accuracy of exact ultrasonographic diagnosis of dermoid cysts in the vast majority of the cases and now used as the first preoperative work-up method of choice for the assessment of adnexal masses in clinical practices. DOI: http://dx.doi.org/10.3126/jkmc.v3i1.10920Journal of Kathmandu Medical CollegeVol. 3, No. 1, Issue 7, Jan.-Mar., 2014, Page: 26-31

Sign in / Sign up

Export Citation Format

Share Document