A case of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) with thrombosis of the superior mesenteric artery after ChAdOx1 nCov-19 COVID-19 Vaccine

We describe the case of a 64 years-old woman admitted to the Emergency Department of the ASST-Spedali Civili of Brescia with fever and gastrointestinal symptoms 10 days after the first dose of ChAdOx1 nCov-19 vaccine. Laboratory investigations showed severe thrombocytopenia and high D-dimer, while an abdominal CT scan reported a partially occluding thrombosis of the superior mesenteric artery. Following treatment with fondaparinux, immunoglobulins and high dosage steroid therapy, we observed a rapid improvement of patient’s conditions. An ELISA assay showed the presence of antibodies against heparin PF4-complex. Subsequent abdominal CT-scan showed the superior mesenteric artery thrombosis resolution, and the patient was finally discharged after 12 days of hospitalization. Several reports pointed to the venous system as the main district affected by Vaccine-Induced Thrombotic Thrombocytopenia (VITT), while a peculiar feature of this report is the involvement of the mesenteric arterial system. Further investigation of VITT’s pathophysiological mechanisms is mandatory to develop preventive strategies and effective treatments.

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P56 Gastrointestinal manifestations of COVID-19: a retrospective analysis

BJS Open ◽

10.1093/bjsopen/zrab032.055 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Osamah Niaz ◽

Aaliya Uddin ◽

Sangeetha Thomas ◽

Katherine Harries ◽

Sarah-Jane Walton ◽

...

Keyword(s):

Ct Scan ◽

Retrospective Analysis ◽

Gastrointestinal Symptoms ◽

District General Hospital ◽

Chest Ct ◽

Ct Scans ◽

Abdominal Ct ◽

Angiotensin Converting Enzyme 2 ◽

Gastrointestinal Manifestations ◽

Abdominal Ct Scan

Abstract Introduction Emerging data suggests that SARS-CoV-2 acts via the angiotensin-converting-enzyme-2 (ACE2) receptors in the cells, also present in the gastrointestinal and liver cells, resulting in gastrointestinal manifestations of COVID-19. It is challenging to diagnose COVID-19 in patients presenting with only gastrointestinal symptoms, with early suspicion and visualisation of the lung bases on computerised tomography(CT) abdomen scans being helpful. Methods Single-centre retrospective analysis of abdominal/chest CT scans was conducted within a District General Hospital. From the 6000 CT scans between March and April 2020, 1557(26%) were abdominal, 230 of which had chest CT scans with COVID-19 positive changes. 49 patients with CT abdomen and a positive CT Chest were shortlisted. All recorded documentation was assessed using online clinical portal and tabulated using Microsoft Excel®. Subdivision into 3 groups was: 1) primary gastrointestinal symptom, normal CT abdomen, 2) common COVID-19 symptoms with gastrointestinal symptoms, normal CT abdomen 3) gastrointestinal symptoms, abdominal pathology on radiology. Results COVID-19 related changes were seen on CT scans with no abdominal pathology noted in 33% (n = 16) patients with primary gastrointestinal symptoms. Further 18% (9 patients) presented with gastrointestinal symptoms alongside other common COVID-19 symptoms, however abdominal CT scan was normal. CT abdomen of these 25 patients were studied by a consultant radiologist, who examined the lung bases on the abdominal CT scan for COVID-19 related changes, which was seen in 92% patients. In 8% of the cases where the lung bases on the CT abdomen were normal, COVID-19 related changes were apparent on the CT chest. Conclusions CT scans of the abdomen should be supplemented with CT scans of the chest, when appropriate, for early accurate diagnosis, early treatment and triage to the correct wards, especially at the height of the pandemic.

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ACUTE OBSTRUCTION OF THE INFERIOR MESENTERIC ARTERY DIAGNOSED BY ENHANCED ABDOMINAL CT SCAN-REPORT OF A CASE-

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.65.2237 ◽

2004 ◽

Vol 65 (8) ◽

pp. 2237-2241

Author(s):

Hideaki NAKAZAWA ◽

Takayuki MORITA ◽

Akihiko MURATA ◽

Motoi KOYAMA ◽

Ayako ISHIGURO ◽

...

Keyword(s):

Ct Scan ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Acute Obstruction ◽

Abdominal Ct ◽

Abdominal Ct Scan

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Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽

10.1024/0301-1526/a000154 ◽

2011 ◽

Vol 40 (6) ◽

pp. 495-498 ◽

Cited By ~ 1

Author(s):

Rajkovic ◽

Zelic ◽

Papes ◽

Cizmek ◽

Arslani

Keyword(s):

Atrial Fibrillation ◽

Small Intestine ◽

Abdominal Pain ◽

Ct Scan ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Abdominal Cavity ◽

Celiac Axis ◽

Contrast Administration ◽

Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patients condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

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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.

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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

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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.

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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.

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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

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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.

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