Diagnostic Accuracy of Intra-abdominal Fluid Collection Characterization in the Era of Multidetector Computed Tomography

2012 ◽  
Vol 78 (2) ◽  
pp. 185-189 ◽  
Author(s):  
Brian C. Allen ◽  
Huiman Barnhart ◽  
Mustafa Bashir ◽  
Christopher Nieman ◽  
Steven Breault ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Ct ◽  
Imaging Finding ◽  
Fluid Collection ◽  
Ct Guided ◽  
High Attenuation ◽  
Institutional Review ◽  
Imaging Characteristics ◽  
Fluid Collections ◽  
Ct Density

The purpose of this study was to test the hypothesis that with improved technology, the presence of abscess in a postoperative fluid collection may be prospectively made. This is an Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective review of computed tomography (CT)-guided intra-abdominal fluid collection drainages. The diagnostic CT scans of 95 consecutive patients performed on 16- and 64-multidetector CT (MDCT) were reviewed by four readers with varying abdominal imaging expertise. Readers were asked to determine fluid content, to document whether infection was present, and to rate reader confidence for infection. A fifth radiologist reviewed the collections for imaging characteristics. The gold standard for presence of infection was microbiological Gram stain and culture. The logistic regression model showed that both fluid collections containing gas or high attenuation fluid (average CT density 20 or greater Hounsfield units) are significant predictors of infection ( P = 0.001). The average sensitivity over the four readers for determining presence of infection was 83.4 per cent and specificity was 39.3 per cent. Even in the era of MDCT, the ability to predict whether or not a fluid collection is infected or not, based on imaging findings alone, is limited. Presence of gas is a strong indicator of infection, but no imaging finding is characteristic of a sterile fluid collection.

Further Experience Utilizing the Gildenberg Technique for Computed Tomography-guided Stereotactic Biopsies

Neurosurgery ◽  
1986 ◽  
Vol 19 (3) ◽  
pp. 386-400 ◽  
Author(s):  
Dennis E. Bullard ◽  
Dennis Osborne ◽  
Peter C. Burger ◽  
Blaine S. Nashold
Keyword(s):  
Computed Tomography ◽  
Wide Spectrum ◽  
Target Selection ◽  
Low Density ◽  
Primary Tumors ◽  
Ct Guided ◽  
Imaging Characteristics ◽  
Stereotactic Frame ◽  
Peripheral Areas ◽  
Stereotactic Biopsies

Abstract Initial experience using the Gildenberg technique for computed tomography-guided stereotactic biopsies is reviewed. Of 50 patients, adequate tissue was obtained in 49. In one patient, the stereotactic frame was unable to reach the selected biopsy site. In 32 of 49 patients, the diagnosis was obtained with one biopsy: in the remainder, two to five samples were required. In 4 cases, a subsequent craniotomy was performed: these provided similar histopathological tissue and in no case was the diagnosis altered. The lesions were categorized by CT as ring-enhancing lesions (REL), enhancing lesions with surrounding low density (ELLD), and low density lesions with and without peripheral areas of enhancement. Of the REL, 21 of 23 were primary tumors. Of the ELLD, 5 of 13 were primary tumors: the remainder had a wide spectrum of disease. Of the low density lesions without enhancement, 6 were primary tumors and 1 was an inflammatory process. Three patients had low density lesions with peripheral areas of enhancement and proved to have malignant primary tumors. The remaining patients had multiple lesions with both primary and metastatic disease. Twelve RELs were biopsied in multiple sites. An accurate diagnosis was best obtained by performing the first biopsy in the enhancing rim with additional biopsies as needed in the low density center. Homogeneous lesions could be biospied with target selection based upon a primary regard for safety rather than imaging characteristics. Three patients had transiently increased hemiparesis and one had a transient decrease in level of consciousness after biopsy. There were no patients with long-term morbidity in this series. From our experience, we believe this technique offers a safe, accurate, and relatively inexpensive alternative for performing-CT-guided intracranial biopsies.

scholarly journals Dropped Gallstones Causing a Perihepatic Abscess and Empyema

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
J. R. Robinson ◽  
J. K. Wright ◽  
S. K. Geevarghese
Keyword(s):  
Computed Tomography ◽  
Laparoscopic Cholecystectomy ◽  
Fluid Collection ◽  
Surgical Operation ◽  
Initial Operation ◽  
Iatrogenic Perforation ◽  
Abdominal Exploration ◽  
Night Sweats ◽  
Fluid Collections ◽  
Gallstone Spillage

Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy is a well-known occurrence; however, the consequences of spillage of gallstones in the peritoneum and particularly intrathoracic complications are less defined. We describe the delayed development of a perihepatic abscess and empyema in a patient five years following laparoscopic cholecystectomy secondary to dropped gallstones. A 53-year-old man with medical history significant for a laparoscopic cholecystectomy five years prior to acute cholecystitis presented with purulent cough, hemoptysis, night sweats, and right-upper quadrant (RUQ) pain. Computed tomography (CT) scan revealed 5.4 cm right-sided subpulmonic and 5.9 cm perihepatic fluid collections with an 8 mm focal radiopaque density within the perihepatic fluid collection. Open intra-abdominal exploration resulted in retrieval of a 1 cm intraperitoneal gallstone. Laparoscopic cholecystectomy is a common surgical operation during which gallstone spillage can occur, causing both intra-abdominal and intrathoracic complications, presenting even years after surgery. This necessitates an attempt to retrieve all free intra-abdominal gallstones during the initial operation.

scholarly journals Of multidetector computed tomography (MDCT) in evaluation of lung nodule with histopathological correlation

2021 ◽  
Vol 52 (3) ◽  
pp. 193-198
Author(s):  
Jagmohan Gupta ◽  
Parul Gupta ◽  
Suresh Gupta ◽  
Amit Tak
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Lymph Nodes ◽  
Diagnostic Accuracy ◽  
Multidetector Ct ◽  
Histopathological Examination ◽  
Lung Nodule ◽  
Invasive Procedure ◽  
Histopathological Analysis ◽  
Ct Guided

Background: Lung cancer is the most common and lethal cancer around the world. Computed tomography (CT) is an integral imaging technique for staging the lung cancer. Aim of this study was to correlate the multidetector CT (MDCT) findings of lung nodule with histopathological examination, as well as to assess the diagnostic accuracy of MDCT in evaluation of suspected lung nodule. Methods: One hundred patients with clinical or radiological suspicion of lung nodule referred for CT scan of thorax were included in the study. Histopathological analysis was performed. The location of the lesion was analysed and nodules were classified. Fine needle aspiration cytology (FNAC) was done with spinal needle under all aseptic precautions. The results obtained by MDCT were analysed and compared with histopathological findings done by CT guided FNAC. Results: Average age of patients was 65 years, 25 % were females and 75 % were males. Among all the patients 66 % of lesions were located in right side lung and 34 % of lesions were left in location. Of all, 2 % patients had lesions less than 3 cm, 11 % patients had lesion between 3-4 cm, 19 % patients had lesion between 4-5 cm, 26 % patients had lesion between 5-7 cm and 42 % patients had lesion greater than 7 cm. Many of these patients also presented with enlarged lymph nodes, most commonly mediastinal (73 %) followed by subcarinal (51 %), hilar (44 %) and supraclavicular (4 %) lymph nodes. The most common histological findings of lung nodules analysis were adenocarcinoma (41 %). Among the 100 patients 58 % had lesions located peripherally while 42 % had central lesions. CT was a highly sensitive (95.45 %) and moderately specific (75 %) test and also had a high positive predictive value (96 %) to diagnose malignant lung nodule. Conclusion: CT guided FNAC of lung nodule is a safe, minimal invasive procedure with a high diagnostic accuracy. The use of CT-guided FNAC in hilar and mediastinal nodules can avoid unnecessary exploratory surgery for staging and also diagnosis could be made with lesser cost.

scholarly journals Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259701
Author(s):  
Koki Maeda ◽  
Naohisa Kuriyama ◽  
Yuki Nakagawa ◽  
Takahiro Ito ◽  
Aoi Hayasaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Fluid Collection ◽  
Intervention Group ◽  
Postoperative Pancreatic Fistula ◽  
Optimal Management ◽  
Duration Of Hospitalization ◽  
Pancreatic Fistulas ◽  
Fluid Collections

Peripancreatic fluid collections have been observed in most patients with postoperative pancreatic fistula after distal pancreatectomy; however, optimal management remains unclear. This study aimed to evaluate the management and outcomes of patients with postoperative pancreatic fistula and verify the significance of computed tomography values for predicting peripancreatic fluid infections after distal pancreatectomy. We retrospectively investigated 259 consecutive patients who underwent distal pancreatectomy. Grade B postoperative pancreatic fistula patients were divided into two subgroups (B-antibiotics group and B-intervention group) and outcomes were compared. Predictive factor analysis of peripancreatic fluid infection was performed. Clinically relevant postoperative pancreatic fistulas developed in 88 (34.0%) patients. The duration of hospitalization was significantly longer in the B-intervention (n = 54) group than in the B-antibiotics group (n = 31; 41 vs. 17 days, p < 0.001). Computed tomography values of the infected peripancreatic fluid collections were significantly higher than those of the non-infected peripancreatic fluid collections (26.3 vs. 16.1 Hounsfield units, respectively; p < 0.001). The outcomes of the patients with grade B postoperative pancreatic fistulas who received therapeutic antibiotics only were considerably better than those who underwent interventions. Computed tomography values may be useful in predicting peripancreatic fluid collection infection after distal pancreatectomy.

scholarly journals Management and outcome of spontaneous subaponeurotic fluid collections in infants: the Hospital for Sick Children experience and review of the literature

2016 ◽  
Vol 18 (4) ◽  
pp. 442-447 ◽  
Author(s):  
Shelly Wang ◽  
James Drake ◽  
Abhaya V. Kulkarni
Keyword(s):  
English Language ◽  
Fluid Collection ◽  
Infectious Complications ◽  
Unknown Etiology ◽  
Laboratory Findings ◽  
Imaging Characteristics ◽  
History Of ◽  
Sick Children ◽  
Fluid Collections ◽  
Age Range

OBJECTIVE Spontaneous subaponeurotic fluid collection (SSFC) is an uncommon and newly described entity of unknown etiology, observed in infants less than 1 year of age. The authors report on series of infants who presented to the Hospital for Sick Children (HSC) with SSFC, focusing on the natural history of this condition. METHODS Data from the Hospital for Sick Children were retrospectively reviewed for the period between January 2004 and June 2015. Patient age and sex, birth history, medical history, laboratory findings, and symptoms were reviewed. SSFC location, imaging characteristics, management, and outcome were also analyzed. A MEDLINE and Embase literature search was performed on the condition, yielding previously reported cases of SSFC in the English language. RESULTS Nine cases involving patients who presented with SSFC during the study period were identified. The patients were 4 male and 5 female infants (age range 5 weeks to 11 months). All cases of SSFC developed spontaneously over a period of days, and the infants had no history of injuries, trauma, or hair manipulation in the immediate period preceding the development of the subgaleal collections. Six patients underwent remote forceps- or vacuum-assisted instrumented births, although none of the patients developed scalp collections or skin discoloration immediately after birth. All of the cases were managed conservatively on an outpatient (6 cases) or inpatient (3 cases) basis. In 1 case, the size of the fluid collection fluctuated over 4 months, but in all of the cases, the collections resolved spontaneously without structural or infectious complications. CONCLUSIONS This is the largest series describing SSFC to date and summarizes 9 cases managed at a large academic neurosurgical center. Although the specific pathophysiology of SSFC remains unknown, in some cases the condition may be associated with a remote history of instrumented delivery. SSFC occurs spontaneously without immediate preceding trauma, and an extensive hematology or child abuse workup is not necessary. A conservative approach with outpatient follow-up is advocated.

scholarly journals A complication of a dropped appendicolith misdiagnosed as Crohn’s disease

2011 ◽  
Vol 93 (6) ◽  
pp. e117-e118 ◽  
Author(s):  
S Sarkar ◽  
L Douglas ◽  
AA Egun
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Unusual Complication ◽  
Abdominal Abscess ◽  
X Rays ◽  
Surgical Drainage ◽  
Past Medical History ◽  
Ct Guided ◽  
High Attenuation ◽  
The Past

Appendicoliths are formed by calcium salts and faecal debris layered and lodged within the appendix. They are detected on unenhanced x-rays in less than 10% of patients with appendicitis. When an appendicolith is found extraluminally, it is pathognomonic for perforation of the appendix. Moreover, retained appendicoliths act as a nidus for infection and are likely to be the source of a postoperative intraperitoneal abscess. However, this is very rare with only 30 reported cases of intra-abdominal abscess secondary to an appendicolith in the literature over the past 40 years. Retained, or dropped, appendicoliths most commonly present as an area of high attenuation less than 1cm in diameter with an associated abscess close to the caecum or Morrison’s pouch on computed tomography (CT). A study published in 2006 showed that although there is initial success with CT-guided drainage of abscesses secondary to faecaliths, all will recur and formal surgical drainage with removal of the appendicolith is required. This case report highlights not only an unusual complication of a retained appendicolith but also the importance of taking a thorough history and interpreting investigations in the context of the patient’s past medical history so as to produce a differential diagnosis and prevent treatment of incorrect conditions.

scholarly journals Results of Percutaneous Computed Tomography-Guided Biopsy of Adrenal Lesions and Spectrum of Computed Tomography Findings

2020 ◽  
Vol 10 ◽  
pp. 16
Author(s):  
Sriharsha Gunna ◽  
Zafar Neyaz ◽  
Eesh Bhatia ◽  
Rungmei S Marak ◽  
Richa Mishra ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Ct ◽  
Diagnostic Yield ◽  
Major Complication ◽  
Malignant Neoplasms ◽  
Safe Procedure ◽  
Ct Scanner ◽  
Ct Guided ◽  
Guided Biopsy ◽  
Ct Guided Biopsy

Objective: Adrenal enlargement occurs in various conditions such as infections, benign, and malignant neoplasms. Percutaneous computed tomography (CT)-guided adrenal biopsy is a safe method for obtaining tissue specimen in cases where diagnosis cannot be established on imaging and biochemical grounds. The study aims to evaluate diagnostic yield, accuracy, and complications of percutaneous CT-guided adrenal biopsies. Furthermore, CT findings of various adrenal lesions have been described. Materials and Methods: Data of CT-guided adrenal biopsies performed from September 2009 to May 2019 were analyzed. Biopsies were performed on a 64-slice or a 128-slice multidetector CT scanner using a coaxial technique. Pathological and microbiological reports were retrieved from the hospital information system. Clinical details were obtained from clinical case records. Results: CT-guided adrenal biopsies were performed in 48 patients, 37 males and 11 females. Adrenal insufficiency was present in 31 (64%) cases and bilateral adrenal glands were affected in 35 (73%). Biopsy yielded a diagnosis in 35 cases (72.9%). The final diagnosis was achieved in 43 (90%) cases. Combined accuracy of CT-guided biopsy for identifying malignancy and infection was 88.3%. Adrenal histoplasmosis (AH) was the most common entity diagnosed (44%). After combining histopathology and microbiology results, the sensitivity for diagnosing AH was 100%. One (2%) patient had a major complication in the form of intra-abdominal hemorrhage requiring transfusion. Local hematoma and mild stable pneumothorax were noted in one patient each. Conclusion: Percutaneous CT-guided biopsy is a safe procedure for the diagnosis of adrenal lesions. It has good accuracy for diagnosing adrenal conditions such as infections and malignancies. However, the specific diagnosis of benign adrenal lesions was difficult to make. AH, tuberculosis, and metastasis have overlapping imaging findings.

Computed tomography-guided preoperative localization of small lung nodules with indocyanine green

2017 ◽  
Vol 59 (7) ◽  
pp. 830-835 ◽  
Author(s):  
Keisuke Nagai ◽  
Keiko Kuriyama ◽  
Atsuo Inoue ◽  
Yuriko Yoshida ◽  
Koji Takami
Keyword(s):  
Computed Tomography ◽  
Indocyanine Green ◽  
Pulmonary Nodules ◽  
Preoperative Localization ◽  
Lung Nodules ◽  
Complication Rates ◽  
Ct Guided ◽  
Institutional Review ◽  
Small Pulmonary Nodules ◽  
Age Range

Background Small, deep-seated lung nodules and sub-solid nodules are often difficult to locate without marking. Purpose To evaluate the success and complication rates associated with the use of indocyanine green (ICG) to localize pulmonary nodules before resection. Material and Methods This retrospective study was approved by our institutional review board. Informed consent for performing preoperative localization using ICG marking was obtained from all patients. Thirty-seven patients (14 men, 23 women; mean age = 63.1 years; age range = 10–82 years) with small peripheral pulmonary nodules underwent computed tomography (CT)-guided ICG marking immediately before surgery between March 2007 and June 2016. The procedural details and complication rates associated with ICG marking are described. Results The average nodule size and depth were 9.1 mm (range = 2–22 mm) and 9.9 mm (range = 0–33 mm), respectively. Marking was detected at the pleural surface in 35 patients (95%). Three cases of mild pneumothorax (8%), five cases of cough (14%), and one case of mild bloody sputum (3%) with no clinical significance were noted. There were no severe complications. The average duration required to perform the marking was 19.4 min (range = 12–41 min). Conclusion Our results indicate that CT-guided ICG marking is safe and useful for detecting the location of small pulmonary nodules preoperatively.

scholarly journals Diagnosis of Infectious Fluid Collections in Implant-Based Breast Reconstruction: The Role of Ultrasound

2019 ◽  
Vol 1 (4) ◽  
pp. 310-315
Author(s):  
Joseph Banuelos ◽  
Zerelda Esquer-Garrigos ◽  
M Rizwan Sohail ◽  
Amjed Abu-Ghname ◽  
Wendaline M VanBuren ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Sensitivity And Specificity ◽  
Breast Implant ◽  
Fluid Collection ◽  
Retrospective Chart Review ◽  
Silicone Implants ◽  
Implant Infection ◽  
Institutional Review ◽  
Us Findings ◽  
Fluid Collections

Abstract Objective Implant-based breast reconstruction after mastectomy remains the most common reconstructive modality worldwide. Infection is a frequent complication that negatively affects the reconstructive outcome and increases health-care costs. The aim of this study is to evaluate the accuracy of ultrasonography in identifying fluid collections in patients with breast implant infection. Methods After receiving institutional review board approval, a retrospective chart review was performed on patients who presented with breast implant infection after breast reconstruction, during the period 2009–2017. To estimate the sensitivity and specificity of ultrasound (US) in detecting fluid collections, only patients with US evaluation and surgery during the same admission were included. Results In total, 64 patients with 64 infected implants met the inclusion criteria. Infected devices included 44 (69%) tissue expanders, and 20 (31%) implants, of which 40 (62%) were placed in the subpectoral and 24 (38%) prepectoral positions. Periprosthetic fluid was identified by US preoperatively in 45 (70%) of the patients, and a fluid collection was found in 61 (95%) of the patients during surgery. Sensitivity and specificity of US were 74% and 100%, respectively. Inaccurate US results were more likely in patients with silicone implants than patients with saline expander implants. Conclusion Caution should be exercised in interpreting negative US findings in patients with silicone implants in the setting of infection. Other imaging modalities should be explored if US results are negative in cases with high clinical suspicion.

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