RESUMO
We report a rare case of small bowel obstruction of a 45-year-old female which was caused by internal hernia of the terminal ileum and cecum through the foramen of Winslow. The patient presented to the emergency department with acute abdominal pain, distention, and nausea, suggesting an intestinal obstruction. The complete unambiguous preoperative diagnosis was achieved by a 64-row multi-detector computed tomography. This report enlightens the utility and performances of high-quality computed tomography multiplanar reconstructions combined with vascular volume rendering analysis for the diagnosis of internal hernia.
Assuntos
Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Intestino Delgado , Ceco/diagnóstico por imagem , Colectomia , Meios de Contraste , Diagnóstico Diferencial , Feminino , Hérnia Abdominal/cirurgia , Humanos , Íleo/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To describe early chest imaging abnormalities in patients with acute Puumala virus infection. MATERIALS AND METHODS: This retrospective study (2005-2017) comprised 64 patients who were admitted to the emergency department of a Belgian hospital. These patients were diagnosed with serologically confirmed acute Puumala virus infection and had at least one chest X-ray (CRX). Imaging studies were evaluated by two experienced chest radiologists reaching agreement by consensus, and abnormalities were reported according to the Fleischner Society glossary of terms for thoracic imaging. When a patient underwent multiple CRX, only the findings of the first were recorded. Six patients underwent chest high-resolution computed tomography (HRCT). RESULTS: CRX showed abnormal findings in 33 patients (51.5%). Most common findings were linear atelectasis (29.7%) and small pleural effusion (20.3%). HRCT showed interlobular septal thickening in four patients and crazy-paving pattern with consolidations in one patient with adult respiratory distress syndrome. CONCLUSIONS: Early CRX commonly showed linear atelectasis and small pleural effusion in Puumala virus infected patients above 30 years of age. Chest HRCT most frequently showed atelectasis and smooth interlobular septal thickening. While uncommon, early and severe pulmonary involvement can be associated with Puumala virus infection, albeit these findings are not specific.