Giant cystic degeneration of a uterine leiomyoma in a patient with autosomal dominant polycystic kidney disease.

OBJECTIVE: To report the management of a large uterine leiomyoma with diffuse cystic degeneration in a patient with autosomal dominant polycystic kidney disease (ADPKD). DESIGN: Case Report. SETTING: Cleveland Clinic Florida, Department of Gynecology, Section of Minimally Invasive Gynecologic surgery, Weston Florida. PATIENTS: A 52-year old woman with ADPKD with a large abdominal mass, abnormal uterine bleeding and symptomatic anemia. Imaging revealed a giant intramural cystic lesion of the uterus compressing the inferior vena cava. INTERVENTIONS: Uterine artery embolization and blood transfusion followed by a computed tomography guided cyst aspiration were performed on admission to alleviate anemia and abdominal pain and distension. Total laparoscopic hysterectomy with bilateral salpingectomy was performed in an outpatient setting. MAIN OUTCOME MEASURES: Management of large cystic degeneration of leiomyoma. RESULTS: Normal recovery from definitive surgery. Surgical pathology confirmed a benign, cystically dilated leiomyoma. CONCLUSION: This case demonstrates the management of giant intramural cyst lesion of the uterus using a minimally invasive surgical approach, as opposed to emergency surgery via laparotomy. CAPSULE: Large uterine leiomyoma with diffuse cystic degeneration in a patient with autosomal dominant polycystic kidney disease, in which step-wise treatments allows successful minimally invasive hysterectomy.

Mitral valve prolapse: evaluation with ECG-gated cardiac CT angiography.

OBJECTIVE: The purpose of our study was to evaluate the feasibility of detecting mitral valve prolapse with ECG-gated 64-MDCT angiography in comparison with the reference standard, transthoracic echocardiography. MATERIALS AND METHODS: The charts of patients consecutively referred for clinically indicated 64-MDCT angiography were reviewed. The study cohort consisted of patients who had undergone transthoracic echocardiography. Two experienced radiologists performed blinded consensus review of the MDCT angiograms of 20 patients, and the findings were compared with those of transthoracic echocardiography, which was the reference standard. RESULTS: With the findings on each anterior and posterior leaflet as separate data points, sensitivity was calculated to be 69.2-84.6% and specificity, 100%. The positive and negative predictive values were estimated to be 100% and 87.0-93.1%. CONCLUSION: ECG-gated cardiac 64-MDCT angiography can be used reliably to detect mitral valve prolapse.

Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography.

Degenerative aortic valve stenosis (AS) has an incidence of 2-7% in the Western European and North American populations over 65 years of age. The aim of this study was to perform a meta-analysis of the published literature evaluating the accuracy of CT planimetry to measure the aortic valve area. The PUBMED and OVID databases were searched up to May 2008. Major criteria for article inclusion was the use of (a) multi-detector computed tomography as a diagnostic test for the assessment of AVA in patients with AS, and (b) TTE as the reference standard. Nine studies were included in the analysis with 175 women and 262 men. The mean AVA as measured by CT was 1.0 +/- 0.1. The mean AVA measured by TTE was 0.9 +/- 0.1. The correlation between CT and TTE AVA measurements was r = 1.45. The mean difference was 0.03 +/- 0.05. The results of our meta-analysis suggest that multi-detector CT is an accurate method for obtaining AVA measurements in patients with AS.

Esophageal perforation during laparoscopic gastric band placement.

Esophageal perforation is a serious complication that requires prompt recognition and treatment. We present the case of a patient with lower esophageal perforation that apparently resulted from orogastric calibration-tube passage during laparoscopic placement of a gastric band. The complication was diagnosed early postoperatively, and was able to be successfully treated by laparoscopy,debanding, drainage, and parenteral nutrition.