SUN-180 A Case of Deoxycorticosterone-Producing Malignant Adrenocortical Tumor

Abstract Background: Hypermineralocorticism (hypertension, hypokalemia, and low plasma renin activity) due to deoxycorticosterone (DOC) excess associated with adrenocortical carcinoma is extremely rare. DOC-producing tumors cause primary aldosteronism-like symptoms presenting low plasma aldosterone with very high DOC levels, and due to weak hormonal DOC activity, its diagnostic is done lately. Generally, malignant cases are progressive with a dismal prognosis. Clinical case: A 61-year-old woman was admitted to our hospital presenting lumbar pain and weight loss of 8 kg, in 2018. Previously, arterial hypertension was diagnosed in 2015, showing a satisfactory control with two classes of antihypertensive drugs. Physical exam: The patient presented no features of Cushing syndrome, but a palpable abdominal mass was noticed in the right flank. Blood pressure was 160x100 mmHg, with sustained high levels, despite regular treatment. Laboratory data: a hypokalemia (K 2.4 mEq/L, nr 3.5 -5.0 mEq/L) and hypernatremia (Na 146 mEq/L, nr 135 to 145 mEq/L), with metabolic alkalosis (venous pH 7.46 and serum bicarbonate 32 mmol/L, nr 23-27 mmol/L) was confirmed. Hormonal tests excluded hypercortisolism and pheocromocytoma. Serum aldosterone and renin were suppressed. Mineralocorticoid precursors dosage was extremely high, DOC (654 ng/dL, nr < 25 ng/dL) and progesterone (5.0 ng/mL, nr <0.89 ng/mL), as well 11-deoxycortisol (7.2 ng/mL, nr <0.5 ng/mL). Radiological imaging: abdominal CT showed a heterogeneous hypervascular adrenal mass (13.0x13.0x21.0 cm) exhibiting central necrosis, suggesting malignancy. FDG-PET/CT scan showed a hypermetabolic adrenal mass (SUVmax=13.8). Also, two metabolically active pulmonary nodules (SUVmax=3.7) measuring 0.7 and 0.4 cm were detected. The patient underwent right adrenalectomy, and the tumor was removed (24x13x13 cm). According to Weiss criteria (8/9) and modified Weiss criteria (5/7), the tumor was considered an adrenocortical carcinoma. Immunohistochemistry revealed a low Ki-67 index (10%). After the surgical procedure, all adrenal steroid levels normalized, and mitotane was prescribed as adjuvant therapy. Although the pulmonary nodules were stable at the four-month follow-up, the abdominal CT-scan revealed a heterogeneous nodule (3.7cm) in the left adrenal gland, which was suspicious of metastasis. Conclusion: DOC-producing adrenocortical tumors are heterogeneous regarding tumor size, clinical behavior, hormonal and metabolites secretion, and disease-free and overall survival; however, it is common hypokalemia, hypertension, and other symptoms as abdominal pain, due to tumor growth, and weight loss. The association of arterial hypertension with hypokalemia and elevated 11-deoxycortisol, with normal aldosterone and renin, lead to the need for mineralocorticoid precursors evaluation in patients with adrenocortical tumor.

Download Full-text

TRAUMA GINJAL

Jurnal Radiologi Indonesia ◽

10.33748/jradidn.v4i1.89 ◽

2020 ◽

Vol 4 (1) ◽

pp. 52-57

Author(s):

Noflih Sulistia ◽

Bambang Soeprijanto ◽

Indrastuti Normahayu ◽

Lenny Violetta

Keyword(s):

Ct Scan ◽

Pediatric Patients ◽

Radiological Examination ◽

Renal Trauma ◽

Abdominal Ct ◽

Abdominal Ct Scan

Renal trauma in children is more common than in adults. Clinically in pediatric patients with renal trauma do not always describe the degreeof trauma. Radiological examination, especially abdominal CT-scan with contrast, can help evaluate the damage to the kidneys so that it candetermine the degree of trauma.

Download Full-text

Study on the Radiation Dose of Abdominal CT Scan Using Dual Energy

Korean Society of Computed Tomographic Technology ◽

10.31320/jksct.2018.20.2.123 ◽

2018 ◽

Vol 20 (2) ◽

pp. 123-132

Author(s):

Dae-hyun Park ◽

Young-Kyoon Kim ◽

Jong-Ho Ahn ◽

Kwang-Hyun Chang ◽

Yoon-Chul Nam ◽

...

Keyword(s):

Radiation Dose ◽

Ct Scan ◽

Dual Energy ◽

Abdominal Ct ◽

Abdominal Ct Scan

Download Full-text

Splenic abscess caused by Streptococcus anginosus bacteremia secondary to urinary tract infection: a case report and literature review

Open Medicine ◽

10.1515/med-2020-0117 ◽

2020 ◽

Vol 15 (1) ◽

pp. 997-1002

Author(s):

Hao Wu ◽

Rui Zheng

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Ct Scan ◽

Splenic Abscess ◽

Low Density ◽

Abdominal Ct ◽

Streptococcus Anginosus ◽

Abdominal Ct Scan ◽

Tract Infections

AbstractOrgan abscesses caused by Streptococcus anginosus are relatively rare. We report the case of an elderly woman with splenic abscess caused by S. anginosus bacteremia after urinary tract infection. An 82-year-old woman had a history of frequency of urination, urgency, and fever with chills for over 10 days prior to admission. An abdominal computed tomography (CT) scan performed in the emergency room revealed a low-density lesion in the spleen, kidney cysts, some exudation around the kidney, and cystitis should be valued. She was treated with ceftriaxone and imipenem/cilastatin. After admission, the blood culture yielded positive results for S. anginosus. A contrast-enhanced abdominal CT scan showed that the low-density lesion previously found in the spleen was smaller than before. After percutaneous drainage of the splenic abscess and treatment with piperacillin/tazobactam based on the antibiotic sensitivity pattern, repeated abdominal CT scan revealed a significant reduction in the low-density lesion. The patient was discharged without recurrence or complications. A systematic review of organ abscess caused by S. anginosus bacteremia was performed. To our knowledge, there has been no report of splenic abscess caused by S. anginosus bacteremia secondary to urinary system tract infection, although urinary tract infections are also an important source.

Download Full-text

Small intestine duplication cyst with recurrent hematochezia: a case report and literature review

BMC Gastroenterology ◽

10.1186/s12876-021-01627-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhicheng Zhang ◽

Xiaowei Huang ◽

Qian Chen ◽

Demin Li ◽

Qi Zhou ◽

...

Keyword(s):

Small Intestine ◽

Case Report ◽

Literature Review ◽

Ct Scan ◽

Duplication Cyst ◽

Abdominal Ct ◽

Case Presentation ◽

Abdominal Ct Scan ◽

Capsule Endoscopes

Abstract Background Small intestine duplication cysts (SIDCs) are rare congenital anatomical abnormalities of the digestive tract and a rare cause of hematochezia. Case presentation We describe an adult female presented with recurrent hematochezia. The routine gastric endoscope and colonic endoscope showed no positive findings. Abdominal CT scan indicated intussusception due to the "doughnut" sign, but the patient had no typical symptoms. Two subsequent capsule endoscopes revealed a protruding lesion with bleeding in the distal ileum. Surgical resection was performed and revealed a case of SIDC measuring 6 * 2 cm located inside the ileum cavity. The patient remained symptom-free throughout a 7-year follow-up period. Conclusion SIDCs located inside the enteric cavity can easily be misdiagnosed as intussusception by routine radiologic examinations.

Download Full-text

Comparative analysis of the radiation shield effect in an abdominal CT scan

Journal of the Korean Physical Society ◽

10.3938/jkps.64.929 ◽

2014 ◽

Vol 64 (6) ◽

pp. 929-935

Author(s):

Seon-Chil Kim ◽

Young-Jae Kim ◽

Joon-Seok Lee ◽

Kyung-Rae Dong ◽

Woon-Kwan Chung ◽

...

Keyword(s):

Comparative Analysis ◽

Ct Scan ◽

Radiation Shield ◽

Abdominal Ct ◽

Abdominal Ct Scan

Download Full-text

Selective non-operative management of anterior abdominal stab wounds with emphasis on the value of follow-up abdominal CT scanning

Trauma ◽

10.1177/1460408617706389 ◽

2017 ◽

Vol 20 (3) ◽

pp. 194-202

Author(s):

El Yamani Fouda ◽

Alaa Magdy ◽

Sameh Hany Emile

Keyword(s):

Ct Scan ◽

Ct Scanning ◽

Operative Management ◽

Abdominal Ct ◽

Management Group ◽

Abdominal Ct Scan ◽

Laparotomy Group ◽

Abdominal Stab Wounds ◽

Non Operative Management

Background and aim Selective non-operative management of patients with penetrating abdominal stabs is the preferred treatment strategy. The present study aimed to assess the efficacy and safety of non-operative management with emphasis on the value of follow-up abdominal CT scanning in management of patients with penetrating anterior abdominal stab. Patients and methods This is a retrospective chart review of stable patients with anterior abdominal stab wounds. Patients were divided in terms of initial decisions into two groups: laparotomy group and non-operative management group. Abdominal CT scan was performed for patients in the non-operative management group on admission and follow-up CT scanning was performed in cases of clinical and/or biochemical deterioration. Results The laparotomy group included 82 patients and 68.2% of them had unnecessary laparotomies. The non-operative management group comprised 97 patients and 90.7% of them did not require subsequent laparotomy. Abdominal CT scan had a sensitivity of 88.9% and specificity of 100% in detection of intra-abdominal injuries. Follow-up CT scanning detected bowel injuries missed by initial CT scan in three patients. The non-operative management group had significantly lower post-operative complication rate than the laparotomy group (4.1% vs. 18.3%), with a significantly shorter length of stay. Conclusions Non-operative management is the optimal management strategy for stable patients with penetrating anterior abdominal stab to decrease unnecessary laparotomy rates, hospital stay and costs. Follow-up abdominal CT scanning facilitated the decision making for patients selected for non-operative management and is highly sensitive in the diagnosis of patients who require subsequent exploration.

Download Full-text

False-negative abdominal CT scan in a cocaine body stuffer

The American Journal of Emergency Medicine ◽

10.1016/s0735-6757(99)90166-3 ◽

1999 ◽

Vol 17 (7) ◽

pp. 702-704 ◽

Cited By ~ 30

Author(s):

Janet G.H Eng ◽

Steven E Aks ◽

Rachel Waldron ◽

Christopher Marcus ◽

Stuart Issleib

Keyword(s):

Ct Scan ◽

False Negative ◽

Abdominal Ct ◽

Abdominal Ct Scan ◽

Body Stuffer

Download Full-text

EP.FRI.390 Improving care for patients with acute bowel obstruction: A closed loop audit

British Journal of Surgery ◽

10.1093/bjs/znab312.065 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Benjamin Clayphan ◽

Anna Fairclough ◽

Jeff Lim ◽

Roderick Alexander

Keyword(s):

Ct Scan ◽

Patient Outcomes ◽

Bowel Obstruction ◽

Care Pathway ◽

Imaging Modality ◽

Ct Scans ◽

Abdominal Ct ◽

Retrospective Audit ◽

Raising Awareness ◽

Time To Diagnosis

Abstract Aims Acute Bowel Obstruction (ABO) accounts for 10% of emergency surgical admissions and when surgery is required mortality can exceed 10%. Early diagnosis is associated with improved patient outcomes and timely acquisition of abdominal CT scans can help prevent delays. The NCEPOD 2020 report on ABO identified ‘delays in imaging’ as a key area for improvement in the care of these patients, with these delays being exacerbated if an abdominal X-ray (AXR) was performed as well as an abdominal CT. This study looks at ways to expedite the diagnosis of patients presenting with ABO. Methods A retrospective audit of 77 patients admitted from A&E or SAU with ABO from April 2019 to February 2020 was conducted. Imaging modality, time-to-CT scan and time-to-diagnosis was recorded. Results and recommendations were presented locally and an evidence based ABO care pathway was implemented and publicised. 20 patients were audited prospectively, post care pathway implementation. Results 70.1% of patients from the initial audit received a CT-scan and 42% of these patients received an AXR before their eventual CT-scan. The average wait for a definitive radiological diagnosis was 27.8hr. After implementation of the pathway only 18% of patients audited received both modes of imaging and the average time to diagnosis has been reduced to 10.7hr. Conclusions Raising awareness of the appropriate and timely use of CT-scans in the diagnosis of ABO has reduced the number of concomitant AXR for these patients, expediting the making of a definitive diagnosis and improving patient outcomes.

Download Full-text

Infected Renal Cyst as a Complication of Dropped Gallstones during Laparoscopic Cholecystectomy

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/2478245 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Chelsea Kennedy-Snodgrass ◽

Vivian Keenan ◽

Douglas S. Katz

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Ct Scan ◽

Renal Cyst ◽

Early Recognition ◽

Common Complication ◽

Abdominal Ct ◽

Abdominal Ct Scan ◽

Substantial Morbidity

Dropped gallstones are a relatively common complication, occurring in 3% to 32% of laparoscopic cholecystectomies performed, depending on various intraoperative risk factors. However, complications arising from dropped gallstones are relatively rare, occurring in fewer than 1% of such patients, and can include abscesses and inflammatory masses confined to the subhepatic space, presenting days to years later. We report a patient who developed an infected renal cyst as a result of dropped gallstones, which created a fistula from the duodenum to a previously simple right renal cyst, which was initially identified on an abdominal CT scan. Dropped gallstones can result in substantial morbidity in a minority of patients following cholecystectomy performed for cholecystitis, and a high clinical as well as radiological index of suspicion may be required for accurate early recognition and treatment.

Download Full-text