CT imaging of gastric and hepatic complications after ingestion of glacial acetic acid.

OBJECTIVE: To document the computed tomographic (CT) image features of gastric and hepatic complications after ingestion of glacial acetic acid. MATERIALS AND METHODS: There were 5 patients (2 men and 3 women; age range, 2-84 years) who had ingested glacial acetic acid to commit suicide or accidentally. Their abdominal and chest CT scans were retrospectively reviewed to detect and evaluate visceral organ injury. Clinical and laboratory data were also reviewed. RESULTS: Diffuse edematous wall thickening of esophagus and stomach was observed in all patients. Three patients showed nonenhancing, wedge-shaped low densities in the liver on portal venous phase abdominal CT scans. These 3 patients also showed laboratory findings to indicate hepatic failure, hemolysis, metabolic acidosis, and disseminated intravascular coagulation. Two of these patients died despite vigorous supportive treatment. CONCLUSIONS: Wedge-shaped low densities can be seen in the liver on CT scans after ingestion of glacial acetic acid. They may represent hepatic necrosis caused by the direct effect of toxic materials absorbed into portal circulation.

Value of high-resolution ultrasound in detecting a pneumothorax.

This study was designed to compare the detectability of high-resolution ultrasound (HRUS) and bedside chest radiography (CR) for a pneumothorax. During the last 14 months, 97 consecutive patients who were admitted to our institute to undergo a transthoracic needle aspiration and biopsy (TNAB) of the lung were included. Both HRUS and CR were performed immediately after the TNAB procedure. The HRUS images were saved in sequence using the cine-review mode and displayed as an animation on a workstation. Four radiologists independently analyzed both HRUS images and a soft copy of the CR on a diagnostic monitor and identified the pneumothorax. With CT as the reference standard, statistical parameters were calculated. From 97 patients, 35 pneumothorax cases were found on CT after the TNAB. The sensitivities in detecting the pneumothorax were 80 and 47% in HRUS and CR, respectively. The specificities were 94 and 94%. The diagnostic accuracies were 89 and 77%. The inter-observer agreement was excellent (kappa=0.85) in the HRUS images and moderate (kappa=0.49) in the CR. The results of this study suggest that HRUS is a more sensitive and confident method for diagnosing a pneumothorax when compared to bedside chest radiography.