scholarly journals Rapidly Growing Pancreatic Adenocarcinoma Presenting as an Irreducible Umbilical Hernia

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Deepti M. Reddi ◽  
Kathryn P. Scherpelz ◽  
Angelica Lerma ◽  
Jabi Shriki ◽  
Jeffrey Virgin
Keyword(s):  
Computed Tomography ◽  
Pancreatic Adenocarcinoma ◽  
Umbilical Hernia ◽  
Clinical Laboratory ◽  
Computed Tomography Scan ◽  
Intravenous Contrast ◽  
Hernia Sac ◽  
Occult Malignancy ◽  
Noncontrast Computed Tomography ◽  
Tomography Scan

Hernia sacs are a common anatomic pathology specimen, which rarely contain malignancy. We present a case of rapidly growing pancreatic adenocarcinoma, which initially presented as metastasis to an umbilical hernia sac. The patient was a 55-year-old male with a two-year history of umbilical hernia. Two months prior to herniorrhaphy, the hernia became painful and the patient experienced nausea and weight loss. The gross examination did not reveal distinct lesions. Microscopically, the hernia sac was diffusely infiltrated by moderately differentiated adenocarcinoma, which was positive for CK7 and pancytokeratin and negative for TTF-1, CK20, PSA, and CDX2. Clinical laboratory tests found elevated levels of CA 19-9 and CEA. Computed tomography scan with intravenous contrast showed a 5 cm ill-defined and hypoattenuating mass involving the pancreatic tail and body, as well as numerous ill-defined lesions in the liver and peritoneal carcinomatosis. The patient had an earlier noncontrast computed tomography scan four months prior to the surgery, which did not detect any lesions in the abdomen. This case highlights the importance of intravenous contrast with computed tomography for the evaluation of pancreatic lesions and also emphasizes the importance of thorough histologic evaluation of hernia sacs for the detection of occult malignancy.

scholarly journals Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

2015 ◽  
Vol 100 (6) ◽  
pp. 984-988 ◽  
Author(s):  
Giulia Montori ◽  
Giacomo Di Giovanni ◽  
Zeineb Mzoughi ◽  
Cedric Angot ◽  
Sophie Al Samman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Laboratory ◽  
Left Thigh ◽  
Left Colon ◽  
Colon Perforation ◽  
Emergency Laparotomy ◽  
Computed Tomography Scan ◽  
End Colostomy ◽  
Retroperitoneal Perforation ◽  
Tomography Scan

Left colon perforation usually occurs in complicated diverticulitis or cancer. The most frequent signs are intraperitoneal abscess or peritonitis. In cases of retroperitoneal colonic perforation, diagnosis may be difficult. A 59-year-old woman presented with left thigh pain and with abdominal discomfort associated with mild dyspnea. Computed tomography scan showed air bubbles and purulent collection in the retroperitoneum, with subcutaneous emphysema extending from the left thigh to the neck. Computed tomography scan also revealed portal vein gas and thrombosis with multiple liver abscesses. An emergency laparotomy revealed a perforation of the proximal left colon. No masses were found. A left colectomy was performed. The retroperitoneum was drained and washed extensively. A negative pressure wound therapy was applied. A second-look laparotomy was performed 48 hours later. The retroperitoneum was drained and an end colostomy was performed. Intensive Care Unit postoperative stay was 9 days, and the patient was discharged on the 32nd postoperative day. Pneumoretroperitoneum and pneumomediastinum are rare signs of colonic retroperitoneal perforation. The diagnosis may be delayed, especially in the absence of peritoneal irritation. Clinical, laboratory, and especially radiologic parameters might be useful. Surgical treatment must be prompt to improve prognosis.

scholarly journals A rare interesting case of fatal air embolism after intravenous contrast during computed tomography

2021 ◽  
Vol 17 (4) ◽  
pp. 93-96
Author(s):  
Naved Y. Hasan ◽  
Asiah Salem Rugaan
Keyword(s):  
Computed Tomography ◽  
Fatal Case ◽  
Pulseless Electrical Activity ◽  
Air Embolism ◽  
Sudden Onset ◽  
Radiology Department ◽  
Computed Tomography Scan ◽  
Intravenous Contrast ◽  
Shock State ◽  
Tomography Scan

We are reporting a fatal case of air embolism. Although minor cases of air embolism may go unnoticed, this is a case of fatal air embolism after intravenous entry of air, which presented with sudden onset of pulseless electrical activity during a computed tomography scan in the radiology department, requiring cardiopulmonary resuscitation for 15 min. Subsequently, after admission to the intensive care unit, we achieved return of spontaneous circulation. The patient was intubated and ventilated in a shock state. He remained in refractory shock despite of supportive care. Cardiaс arrest was registered again in the catheterization lab and the patient could not be revived after 4 h from the initial cardiac arrest. А computed tomography scan was reported to reveal a significant amount of intra-cardiac air, which was the likely cause patient’s death. The case is a rare condition, which highlights the importance of early diagnosis and delivers a message to the medical staff to have a high index of suspicion in patients who have risk factors, and who develop sudden shock with hypoxemia, in order to treat this potentially life-threatening condition effectively in a timely manner.

scholarly journals The first experience of partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis

2021 ◽  
Vol 26 (3) ◽  
pp. 97-103
Author(s):  
A. V. Shabunin ◽  
V. V. Bedin ◽  
P. A. Drozdov ◽  
O. N. Levina ◽  
V. A. Tsurkan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Liver Cirrhosis ◽  
Postoperative Period ◽  
Primary Liver Cancer ◽  
Abdominal Cavity ◽  
Early Postoperative Period ◽  
Computed Tomography Scan ◽  
Intravenous Contrast ◽  
Viral Hepatitis C ◽  
Tomography Scan

Aim. To assess the efficacy and safety of interventional endovascular partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis.Material and methods. From September 2019 to March 2020, 5 partial spleen embolizations were performed at the surgical clinic of the Botkin Hospital. The indication was the impossibility of conducting courses of regional chemotherapy for primary liver cancer in 2 patients with cirrhosis, portal hypertension, hypersplenism, thrombocytopenia, in 3 patients – the impossibility of conducting adequate antiviral therapy with cirrhosis as a result of chronic viral hepatitis C. The platelet count was < 25 thousand/μl (19.34 ± 1.34 thousand/μl) in all patients at the time of the procedure. The median spleen volume was 1967.54 ± 476.13 (1324.34–2163.54) cm3 . We used Progreat® Terumo 2.8 Fr microcatheter 130 cm for catheterization branches of the splenic artery. Endovascular embolization was performed with microspheres 600 ± 75 nm – 2 ml before occlusion. Computed tomography scan of abdominal cavity with intravenous contrast enhancement and laboratory test of platelet levels were performed. Follow up of patients was carried out at 1, 3 and 6 months after this intervention.Results. The postoperative period in all patients was uncomplicated. Postembolization syndrome (pain, hyperthermia) developed in the early postoperative period in all patients on the next day after the procedure. Computed tomography scan of the abdominal cavity revealed areas of an irregular shape of low density that did not accumulate a contrast agent. The duration of hospitalization was 7.63 ± 3.32 (5–11) days. There were not in-hospital and 30-day mortality in our study.Conclusion. The first experience of endovascular partial spleen embolization showed its safety and efficacy in the correction of thrombocytopenia in patients with liver cirrhosis.

Is surveillance without immediate treatment an option for newly diagnosed testicular germ-cell cancer patients with borderline size retroperitoneal lymph nodes on computed tomography scan?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 560-560
Author(s):  
Nadav Milk ◽  
Ilan Leibovitch ◽  
Daniel Keizman ◽  
Hadas Dresler ◽  
Itay Sternberg
Keyword(s):  
Computed Tomography ◽  
Lymph Nodes ◽  
Clinical Laboratory ◽  
Cell Cancer ◽  
Tumor Board ◽  
Tumor Type ◽  
Computed Tomography Scan ◽  
Tomography Scan ◽  
Undetermined Significance

560 Background: The AJCC TNM Staging System for Testicular Cancer (TC) does not set a minimal diameter to define positive lymph nodes (LN) on computed tomography scan. It is common to refer to LN ≥ 1 cm in diameter as positive, even though benign LN in the borderline size of 1-1.5cm are common. Our goal is to describe the outcome of TC patients with borderline size retroperitoneal LN of undetermined significance managed initially with surveillance. Methods: We retrospectively reviewed the medical records of all TC patients treated at our institution during 2006-2016. Demographic, clinical, laboratory, imaging, pathological, treatment and surveillance data were obtained. Results: Of a total of 109 TC patients, 25 patients (22.7%) with borderline size LN were assigned to an active surveillance protocol by our tumor board. Median age at the time of orchiectomy was 37.2 years (IQR, 23.9-40.3). With a median follow-up of 3.9 years (IQR 1.7-6.5), overall survival rate in the group was 100%. Nine of 25 patients (36%) relapsed and were treated within a median of 4.9 months (IQR 2.2-5.5). Median follow-up for 16 patients who did not relapse was 3.4 years (IQR 1.5-5.4). Relapse-free survival was 71% (95% CI 48-85), and 61% (95% CI 38-77) at one and two years, respectively. Orchiectomy pathology included pure seminoma in 18/25 (72%), and a nonseminomatous tumor in 7/25 (28%). Tumor type was not associated with likelihood of relapse (p = 0.66). The median LN diameter at the time of diagnosis was 11 mm (IQR 9-12, mean 10.4). LN diameter was not associated with likelihood of relapse (p = 0.34). Patients who relapsed during follow-up were significantly younger at the time of TC diagnosis than patients who did not relapse (Median age 23.9 years [IQR 19.6-35.2] and 39.2 years [IQR 34.3-47.9] respectively, p = 0.0056). Conclusions: Surveillance alone for TC patients with borderline size LN of undetermined significance at diagnosis is a possible option and may help avoid overtreatment in 60% of these patients.

Case of Infected Urachal Cyst in an Adult Presenting as an Incarcerated Umbilical Hernia

2021 ◽  
pp. 000313482110604
Author(s):  
Jenalee Corsello ◽  
Mariah Morris ◽  
David Denning ◽  
Semeret Munie
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Umbilical Hernia ◽  
Urachal Cyst ◽  
Review Of Literature ◽  
Computed Tomography Scan ◽  
Urachal Carcinoma ◽  
Tomography Scan

The urachus is a remnant of the allantois. Failure to obliterate can result in one of four anomalies, urachal cyst being most common. Urachal cysts are relatively rare, especially in adults. This paper presents a patient with an umbilical hernia and a ruptured urachal cyst. A 39-year-old male presented with concern for umbilical hernia, but he also noted drainage. Computed tomography scan showed a urachal cyst and umbilical hernia. The urachal cyst was excised and umbilical hernia closed primarily. The incidence of an urachal cyst is unknown, but persists in roughly 2% of adults. Diagnosis is with ultrasound or CT scan. Management is excision due to risk of urachal carcinoma, which is present in over 50% of specimens. Review of literature did not reveal any other cases of a patient with both an urachal cyst and an umbilical hernia, thus making this case a unique presentation for this condition.

scholarly journals Aortoenteric Fistulae: Present-Day Management

2011 ◽  
Vol 96 (3) ◽  
pp. 266-273 ◽  
Author(s):  
Konstantinos Xiromeritis ◽  
Ilias Dalainas ◽  
Michalis Stamatakos ◽  
Konstantinos Filis
Keyword(s):  
Computed Tomography ◽  
Endovascular Repair ◽  
Surgical Techniques ◽  
Aortoenteric Fistula ◽  
Computed Tomography Scan ◽  
Intravenous Contrast ◽  
Safe Method ◽  
Life Threatening ◽  
Diagnostic Modalities ◽  
Tomography Scan

Abstract An aortoenteric fistula (AEF) is a communication between the aorta and an adjacent loop of the bowel. The three most useful diagnostic modalities for detecting AEF are abdominal computed tomography scan with intravenous contrast, esophagogastroduodenoscopy, and arteriography. The treatment of AEFs has improved in recent years, but despite the multiple surgical techniques reported, many of the patients do not survive or are left debilitated after treatment. Endovascular repair is an efficient and safe method to stabilize patients with life-threatening AEFs. The aim of this study is to provide a comprehensive and synthetic review of the latest advantages on the diagnosis and management of primary and secondary AEF.

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