Retropsoas positioned bowel: incidence and clinical relevance.

PURPOSE: Our goal was to assess the incidence of retropsoas positioned large or small bowel in the population and to examine factors predisposing to its formation. METHOD: The presence of retropsoas positioned bowel was retrospectively studied in 1,852 abdominal CT examinations of 1,055 men and 797 women, 648 younger and 1,204 older than 50 years. All examinations were considered normal or demonstrated findings that were unrelated to the position of the bowel. RESULTS: Retropsoas positioned colon (RPC) was observed in 51 (2.8%) cases for the ascending and 45 (2.3%) for the descending colon. RPC appeared more frequently in younger (< 50 years) than older patients and in individuals with decreased amount of retroperitoneal fat. Retropsoas position of small bowel loops was observed in 11 (0.6%) patients, all exhibiting paucity of retroperitoneal fat. CONCLUSION: Because of its prevalence, retropsoas positioned bowel should be considered when performing percutaneous diskectomy or other interventional procedures in the posterior retroperitoneum.

CT evaluation of mesenteric panniculitis: prevalence and associated diseases.

OBJECTIVE: This study was undertaken to assess the prevalence of mesenteric panniculitis on CT and to describe its appearance and associated diseases. SUBJECTS AND METHODS: A total of 7620 consecutive abdominal CT examinations were prospectively evaluated for features common to mesenteric panniculitis such as a well-delineated inhomogeneous hyperattenuated fatty mass at the mesenteric root, envelopment of mesenteric vessels, and no evidence of invasion of the adjacent small-bowel loops that may be displaced. RESULTS: CT findings of mesenteric panniculitis were seen in 49 patients (0.6%). We found a female predominance. Mesenteric panniculitis coexisted with malignancy in 34 patients and with benign disorders in 11 patients. In the remaining four patients, mesenteric panniculitis, verified on histology, was considered to be responsible for the patients' clinical manifestations; no other abnormality was identified. Soft-tissue nodules (n = 39) and a fatty halo surrounding vessels and nodules (n = 42) were observed in most patients. Follow-up abdominal CT examinations in 29 of the 49 patients showed changes in only one patient. CONCLUSION: CT findings of mesenteric panniculitis may be seen in patients undergoing abdominal CT for various symptoms.

Miliary hepatic tuberculosis not associated with splenic or lung involvement. A case report.

Miliary hepatic involvement is a frequent finding on autopsy in patients with disseminated tuberculosis. Imaging studies may reveal hepatosplenomegaly and/or parenchymal inhomogeneity and, in a minority of cases, focal lesions, invariably associated with miliary lung disease. An unusual case of disseminated tuberculosis with manifestations of miliary hepatic involvement, abdominal and neck lymphadenopathy on US and CT without any evidence of active disease in the lungs, spleen or other organ, is described.

Determination of normal splenic volume on computed tomography in relation to age, gender and body habitus.

The purpose of our study was to examine variations in normal splenic size in relation to age, gender and body habitus in vivo, and to determine normative data for splenic volume on CT. The width (W), length (L), thickness (Th), cross-sectional areas and volume (Vol) of the spleen were obtained from abdominal CT examinations of 140 patients who underwent CT for indications unrelated to splenic disease. Splenic volume did not vary significantly (-0.04 < r < 0.05, p > 0.10) with the patient's age, gender, height, weight, body mass index or the diameter of the first lumbar vertebra, the latter considered as representative of body habitus on CT. The mean value of the measured splenic volume (S Vol) was 214.6 cm3 with a range from 107.2 to 314.5 cm3. S Vol correlated well with all the linear and the maximal cross-sectional area measurements and could be calculated using the formula: S Vol = 30 + 0.58 (W x L x Th.). Employing the same formula splenic volume was reliably assessed in 47 patients with clinically evident splenomegaly. Quantitative assessment of splenic volume might be of value in assessing mild variations in splenic size, because splenomegaly is the most common manifestation of splenic involvement in many disorders.

Variation in the appearance of the normal sacroiliac joint on pelvic CT.

OBJECTIVE: To describe the CT appearance of the ageing sacroiliac joints (SJ) and correlate the radiological findings with patients' gender, body mass index (BMI) and, in women, parity. MATERIALS AND METHODS: The study population included 288 consecutive patients who underwent pelvic CT for various indications not related to SJ diseases. Patients were stratified by age, BMI and parity in women. The joint space and subchondral sclerosis were assessed and the presence of osteophytes, ankylosis, erosions, subchondral cysts and vacuum phenomena were noted on bone window settings. RESULTS: The widths of the SJ space and of the subchondral sclerosis on the iliac and sacral sides were 2.3+/-0.4mm, 2.5+/-1.6mm and 1.4+/-0.5mm, respectively, in patients younger than 40 years of age and 1.9+/-0.2 mm, 3.6+/-2.1 mm and 2.3+/-1.1 mm, respectively, in patients older than 40 years of age. The joint space tends to become narrow and less uniform with advancing age, while subchondral sclerosis appeared to be wider and less uniform in the elderly. Osteophytes were present even in younger patients and their prevalence increased with advancing age. Ankylosis and erosions were rare findings, observed only after the fifth decade of life. A higher prevalence of asymmetric non-uniform SJ space, ill-defined, non-uniform, extensive subchondral sclerosis and ankylosis was observed in women, obese and multiparous mothers than the age matched men, normal weighted individuals and non-multiparous women, respectively. CONCLUSION: Conventional pelvic CT can provide valuable information concerning the SJ, when reviewed on bone window settings. The CT appearance of the SJ is closely related to patients age, gender, BMI and, in women, parity. Knowledge of the spectrum of radiological findings observed in the normal population may be useful when interpreting examinations of patients with SJ disease.

Atypical CT findings of cervical lymphadenopathy due to Hodgkin's disease. A case report.

We describe a case of Hodgkin's disease with cervical lymphadenopathy which may easily be confused with a granulomatous process both radiologically and pathologically.

Acute abdomen due to torsion of wandering spleen: CT diagnosis.

Two adults and a child with acute abdomen and surgically confirmed torsion of wandering spleen are presented. Computed tomography provided a spectrum of findings including an ovoid or comma-shaped abdominal mass, hypertrophy of the liver's left lobe, a whirled appearance of hyperdense, nonenhancing splenic vessels, and an enlarged spleen, exhibiting minimal or no enhancement. Computed tomography also indicated the point of torsion and the viability of splenic parenchyma.

Malignant peritoneal mesothelioma presenting with respiratory symptoms.

Malignant peritoneal mesothelioma is a rare disease associated with mild, nonspecific abdominal symptoms and a wide spectrum of imaging findings, with thickened mesentery and peritoneum being the most common ones. A case of a malignant peritoneal mesothelioma presenting with manifestations of pulmonary disease is reported. Imaging evaluation revealed pleural, lung and pericardial involvement together with retroperitoneal lymphadenopathy, little ascites and extensive omental, but only subtle, mesenteric thickening.

Splenic involvement in lymphomas. Evaluation on serial CT examinations.

PURPOSE: To prospectively evaluate changes in splenic volume (SV) on serial CT of patients with lymphoma and correlate them with other indicators of the disease process. MATERIAL AND METHODS: SV was calculated in 290 abdominal CT examinations of 58 consecutive adults with lymphoma (42 non-Hodgkin's lymphoma, 16 Hodgkin's disease). Each patient had one CT investigation before, 2 during chemotherapy and 2 post-chemotherapy. The changes in SV were correlated with clinical, laboratory and other imaging indicators of the disease process. RESULTS: Three groups of patients were identified. Group A (n=20) presented no changes in SV, showed no splenic parenchymal abnormalities and had normal SV and serum lactic dehydrogenase (S-LDH). Group B (n=25) presented a decrease in SV during treatment suggesting response to therapy. Splenic parenchymal abnormalities (n=5) and other subdiaphragmatic sites of involvement (n=20) underwent remission during treatment. Eighteen patients with high S-LDH at presentation showed normal values during therapy. Group C (n=12) showed an increase in SV post-therapy associated with manifestations of disease recurrence. The S-LDH levels were elevated in 10 patients at the same time. CONCLUSION: Quantitatively assessed splenic size on CT may serve as an indicator of splenic involvement in the course of lymphomas.

Emphysematous cystitis after orchiectomy.

A 59-year-old man developed emphysematous cystitis 3 weeks after undergoing left orchiectomy because of suppurative epididymitis. The case is presented because of its unusual cause and to emphasize the high degree of suspicion required for the diagnosis.

Computed tomography of the normal appendix and acute appendicitis.

The aim of this article is to present pictorially the spectrum of appearances of the appendix and appendicitis on CT. The images presented were selected from the database of our hospitals. The various appearances of the normal appendix on CT are shown. Appendicitis can be divided into four categories on the basis of CT findings. Examples of each category are shown.

Retractile mesenteritis presenting as fever of unknown origin and autoimmune haemolytic anaemia.

Retractile mesenteritis is an extremely rare disease characterised by a non-specific inflammatory and fibrotic process of the mesenteric adipose tissue, which is usually accompanied by pain and a variety of other abdominal symptoms. We describe here the case of a patient with retractile mesenteritis presenting with prolonged high-grade fever and autoimmune haemolytic anaemia without abdominal symptoms. The patient's illness was complicated by chylous ascites. Diagnosis was suspected by computed tomography and confirmed histologically following exploratory laparotomy. The patient was treated with prednisone and azathioprine, and he had a rapid improvement in anaemia and fever relief, but no substantial change in the mesenteric lesions. Our case adds autoimmune haemolytic anaemia to the wide spectrum of manifestations of retractile mesenteritis and implies the possible involvement of immune mechanisms in the pathogenesis of the disease.