ABSTRACT
Teaching Point: Chronic pulmonary schistosomiasis should be suspected in symptomatic patients with an endemic background presenting with migrating pulmonary lesions on high resolution computed tomography scan.
ABSTRACT
A subset of patients with Covid-19 presents with negative RT-PCR screening but suspect CT findings. Using four commercially available anti-SARS-CoV-2 IgG immuno-assays, we found this subset constituted 9.2% of all consecutively admitted outpatients with Covid-19 in our hospital. Clinical specificity for Covid-19 of some N protein-based immuno-assays was suboptimal, as positive results were observed in control patients with recent common human coronavirus, influenza B and adenovirus infections.
Subject(s)
COVID-19 Testing/standards , COVID-19/diagnosis , Enzyme-Linked Immunosorbent Assay/statistics & numerical data , SARS-CoV-2/immunology , Adenovirus Infections, Human/diagnosis , Adenovirus Infections, Human/immunology , Adenovirus Infections, Human/virology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/immunology , COVID-19/virology , Child , Child, Preschool , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/virology , Cross Reactions , False Positive Reactions , Female , Humans , Infant , Influenza, Human/diagnosis , Influenza, Human/immunology , Influenza, Human/virology , Male , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , Sensitivity and Specificity , Tomography, X-Ray ComputedSubject(s)
Cardiac Surgical Procedures/methods , Endocarditis, Bacterial/complications , Enterococcus faecalis/isolation & purification , Gram-Positive Bacterial Infections/complications , Heart Aneurysm/complications , Heart Rupture/etiology , Surgical Flaps , Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Echocardiography , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Follow-Up Studies , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Heart Aneurysm/diagnosis , Heart Aneurysm/surgery , Heart Rupture/diagnosis , Heart Rupture/surgery , Heart Ventricles , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Even though internal hernia (IH) after a laparoscopic Roux-en-Y gastric bypass (LRYGB) is a well-known entity for bariatric surgeons and radiologists, accurate diagnosis remains difficult. The aim of this study was to evaluate the sensitivity and specificity of ten different CT findings in patients with a proven internal hernia after a LRYGB. METHODS: A retrospective analysis of all LRYGB patients who underwent an explorative laparoscopy for abdominal pain has been performed. Preoperative CT scans were individually reviewed by two radiologists specialized in abdominal CT imaging in a randomized blind way. These results were compared with the operative reports. RESULTS: Between 2004 and 2013, 7,328 patients underwent a LRYGB. One hundred sixty nine of these patients underwent an explorative laparoscopy for abdominal pain after a LRYGB, 131 of which had a preoperative CT scan. Of these 131 patients, 72 suffered from an IH. Fifty-nine patients had no IH and served as control group. Mesenteric swirl was the best predictor with for reader 1 a sensitivity of 68% and specificity of 86% and for reader 2 a sensitivity of 89% and specificity of 63%. Other signs had an even larger interobserver variability. CONCLUSIONS: A CT scan can help in confirming the diagnosis of an IH, especially if a mesenteric swirl is present. However, since the presented sensitivities are variable and do not reach 100%, IH might be missed, implicating that a high index of suspicion with a low threshold for explorative laparoscopy/-tomy remains the cornerstone of appropriate treatment.
Subject(s)
Gastric Bypass/adverse effects , Hernia, Abdominal/etiology , Obesity, Morbid/diagnostic imaging , Obesity, Morbid/surgery , Abdominal Pain/diagnostic imaging , Abdominal Pain/epidemiology , Abdominal Pain/etiology , Adult , Female , Gastric Bypass/methods , Hernia, Abdominal/diagnostic imaging , Hernia, Abdominal/epidemiology , Humans , Intraoperative Period , Laparoscopy , Male , Mesentery/pathology , Mesentery/surgery , Middle Aged , Obesity, Morbid/epidemiology , Postoperative Complications/diagnostic imaging , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Preoperative Period , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed/methodsABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of digital tomosynthesis in comparison with digital radiography in the detection of urinary stones with MDCT as the reference standard. SUBJECTS AND METHODS: Fifty consecutively enrolled patients (32 men, 18 women; mean age, 51.5 years; range, 19-83 years) referred for unenhanced MDCT of the abdomen with suspicion of urinary stones also underwent digital tomosynthesis and digital radiography (anteroposterior and bladder inlet views). Images from all examinations were randomly read by three blinded radiologists. The mean effective doses for digital tomosynthesis, digital radiography, and low- and high-dose MDCT were measured on a male phantom. Free-response receiver operating characteristics and receiver operating characteristics analyses were used to compare the diagnostic performance of digital radiography with that of digital tomosynthesis. RESULTS: Both types of analysis showed significantly better performance of tomosynthesis over digital radiography for all urinary stones (p < 0.05). No such improvement was found for ureteral stones. The gain in sensitivity with tomosynthesis was largest for stones between 2 and 5 mm in diameter. The mean effective dose was 0.5 mSv for digital radiography, 0.85 mSv for tomosynthesis, 2.5 mSv for low-dose MDCT, and 12.6 mSv for high-dose MDCT. CONCLUSION: Use of digital tomosynthesis of the abdomen results in improved detection of urinary stones in general over digital radiography with only a slight increase in effective dose. Use of tomosynthesis, however, was not associated with major improvement in the diagnosis of ureteral stones. The technique has potential as an alternative imaging technique in the detection and follow-up of urinary stones.
