Preoperative sonographic diagnosis of McSwain type V appendiceal intussusception: A case report (with video).

RATIONALE: Appendiceal intussusception is a rare disease. The definite preoperative diagnosis of appendiceal intussusception is rare and challenging. Here, we present a case of McSwain type V appendiceal intussusception in a 10-year-old boy. To our best knowledge, this is the first case report of a type V appendiceal intussusception that was preoperatively confirmed with sonography. Here, we have described in detail the ultrasound features and differential diagnosis of this rare disease. PATIENT CONCERNS: A 10-year-old boy presented with 3 days of recurrent intermittent mild abdominal pain. The result of ultrasonography suggested an ileocolic intussusception and a therapeutic air-contrast enema was requested to reduce the intussusception but failed at a local hospital. DIAGNOSES: Physical exam revealed mild tenderness in the lower right quadrant of the abdomen. However, ultrasonography showed a target-sign in cross section and a finger-like appearance in the longitudinal view. A diagnosis of McSwain type V appendiceal intussusception was made. INTERVENTIONS: The patient underwent an appendectomy after successful manual reduction on laparotomy. The appendix was successfully resected. OUTCOMES: Intraoperatively, the appendix was completely inverted in the cecum, and the preoperative sonographic findings were confirmed. During follow-up, there were no signs of recurrence. LESSONS: Pre-operatively, on ultrasound a type V appendiceal intussusception is usually misdiagnosed as an ileocolic intussusception. Radiologists must execute caution to avoid over reliance on the sonographic findings of intussusception, especially when there is a mismatch with clinical symptoms. It is especially important to accurately understand the surgical-anatomic configuration of type V appendiceal intussusception that creates a "target-sign" and a "finger-like" layout on ultrasonography.

[Evaluation of the myocardial systolic function and ventricular remodeling of rats with experimental myocardial infarction by strain/strain rate imaging and MMP-9].

OBJECTIVE: To evaluate the myocardial systolic function and ventricular remodeling in heart failure rat induced by myocardial infarction (MI) with S/SRI and MMP-9. METHODS: A total of 70 male SD rats were randomly assigned to 4 groups: 4 weeks and 8 weeks MI (anterior descending branch of left coronary artery were ligated), sham operation (thoracotomy without ligation of coronary artery) and non-operated control group. The regional myocardial systolic function of rats was quantified with S/SRI. The myocardial MMP-9 expression was detected by Western blot. RESULTS: In the 4 weeks MI group, all segment's Ssys, SRsys, the strain of end-systole were reduced while PSI was increased compared to sham and non-operated group with the exception of the inferior wall. These changes were more significant in 8 weeks MI group compared to the 4 weeks MI group. In the 4 weeks MI group, the expression of MMP-9 was significantly upregulated than the sham operation group and this upregulation was more significant at 8 weeks post MI. CONCLUSIONS: S/SRI can quantitative evaluate the regional systolic function of heart failure rat induced by myocardial infarction. Progressive upregulation of myocardial MMP-9 expression paralleled the deterioration of regional systolic function in this heart failure rat model.