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Imaging post bariatric surgery is becoming more common over the past decade due to increasing incidence of obesity in the population and subsequent treatment. In recent years, the use of topical haemostatic agents and bioabsorbable prostheses has increased leading to higher likelihood of encountering these agents on post-operative imaging. Imaging in the post-operative period is occasionally performed to assess for complications such as obstruction, leak and abscess formation. Familiarity with these agents is crucial in preventing incorrect diagnosis. Laparoscopic Roux-en-Y gastric bypass (RYGB) is favoured over the open approach as it is safer and more effective, with a mortality rate of 0.5% and morbidity around 7-14 %. The main cause of late post-RYGB complications is the development of internal hernias such as a Petersen's hernia. During the procedure, a space between the alimentary loop of the small bowel and the transverse mesocolon is created and is called the Petersen's defect. Subsequently, a part of the small bowel can herniate through this orifice. As this operation is becoming more common, the incidence of internal herniation has been increasing. This case report describes a new bariatric surgical technique and the associated post-operative radiological appearances on CT. The surgical technique has been pioneered in Sydney, Australia and involves a laparoscopic RYGB using bioabsorbable prosthesis with ï¬brin glue ï¬xation to prevent a Petersen's space hernia.
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A ruptured gastric artery aneurysm is a rare but important possible cause of massive intra-abdominal or gastrointestinal haemorrhage, and carries a high risk of mortality. Although aneurysms of the gastric arteries are uncommon, emergency radiologists and clinicians should be familiar with the clinical presentation, imaging findings and pathophysiology. We present two cases of massive intra-abdominal haemorrhage and haemodynamic shock secondary to acute rupture of previously occult gastric artery aneurysm and review the relevant anatomy, imaging findings and pathophysiology of gastric and other visceral artery aneurysms. By virtue of its location in the lesser omentum, a ruptured gastric artery aneurysm may result in a typical pattern and distribution of adjacent haematoma in the upper abdomen. Our description of imaging findings highlights a characteristic epicentre of intraperitoneal haemorrhage, and its typical mass effect displacement of surrounding viscera, to aid the emergent diagnosis of gastric artery aneurysm rupture.
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Internal herniae are rare, those involving the falciform ligament even rarer. To the best of our knowledge, there have been approximately 20 cases of herniae involving the falciform ligament previously reported. Of these cases, only one previously reported case involves herniation of the greater omentum through the falciform ligament. We present a second case of an adult man who presented with a 48-hour history of epigastric pain and was found on contrast multidetector CT to have a strangulated transfalciform greater omental hernia. The hernia was repaired laparoscopically and the patient recovered uneventfully.
Assuntos
Hérnia Abdominal/diagnóstico , Dor Abdominal/etiologia , Diagnóstico Diferencial , Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico por imagem , Hérnia Abdominal/cirurgia , Humanos , Ligamentos/cirurgia , Masculino , Pessoa de Meia-Idade , Omento/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction - both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.
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OBJECTIVE: A range of measurement techniques have been described which may be used to calculate uterine fibroid volume. A commonly-reported method involves application of a formula for the volume of an ellipsoid sphere to three orthogonal axes of a fibroid as measured on cross-sectional images. We aimed to compare this method and a second method, that of software-computed parallel planimetric uterine fibroid computation on MRI images, to a gold standard: the volume of objects measured by water displacement. We also compared these methods in volume estimation of patient fibroids using MRI data. STUDY DESIGN: Mixed observational study and blinded cross-sectional analysis of imaging data. RESULTS: Large inter-observer variability was noted when using the ellipsoid formula method, which was also inaccurate when compared to the gold standard. Conversely, the parallel planimetric method showed excellent interobserver correlation and a high degree of correlation with gold standard volume measurements. CONCLUSION: We conclude that the parallel planimetric method, although a more complex and time consuming technique, is the more accurate and therefore preferred method for measuring uterine fibroid volume.
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Leiomioma/patologia , Neoplasias Uterinas/patologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética/métodos , Variações Dependentes do Observador , Tamanho do ÓrgãoAssuntos
Edema/etiologia , Hemartrose/diagnóstico , Hemartrose/etiologia , Fraturas do Rádio/complicações , Fraturas do Rádio/diagnóstico , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/etiologia , Adulto , Artralgia/diagnóstico , Artralgia/etiologia , Diagnóstico Diferencial , Edema/diagnóstico , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Tomografia Computadorizada por Raios X/métodos , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnósticoRESUMO
BACKGROUND: The extent of vascular invasion is a key factor determining the resectability of non-metastatic pancreatic adenocarcinoma. The purpose of this study is to determine the diagnostic accuracy of computed tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) in the pre-operative evaluation of vascular invasion in pancreatic adenocarcinoma, with surgery as the reference standard. METHODS: A search of the MEDLINE database for relevant articles in the English language published between January 2000 and February 2009 was performed. From each study, 2 × 2 tables were obtained, and pooled sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and diagnostic odds ratios were calculated for each modality, along with a summary receiver operating characteristics (SROC) curve. RESULTS: 16 studies with a total of 797 patients who had surgical assessment of vascular invasion were included in the analysis. Several studies evaluated more than one imaging modality, allowing 24 datasets to be obtained in total. Sensitivity was highest for CT (0.73, 95% CI 0.67 - 0.79), followed by EUS (0.66, 95% CI 0.56 - 0.75) and MRI (0.63, 95% CI 0.48 - 0.77). The specificity for all three imaging modalities was comparable. The diagnostic odds ratios for CT, EUS and MRI were 45.9 (95% CI 18.0 - 117.4), 23.0 (95%CI 9.4 - 56.6), 23.9 (95% CI 5.4 - 105.1) respectively. CONCLUSION: CT was more accurate than EUS and MRI in the evaluation of vascular invasion in pancreatic adenocarcinoma and should be the first line investigation in pre-operative staging.
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BACKGROUND: This research investigates whether modifications to the magnetic resonance-guided focused ultrasound ablation of uterine fibroid (MRgFUS) system used resulted in improved treatment volumes of uterine fibroids, while maintaining safety. METHODS: This study is a prospective cohort analysis of 34 women undergoing the ExAblate 2100 MRgFUS treatment for their uterine fibroids. RESULTS: The percentage of non-perfused volume (NPV) achieved with the ExAblate 2100 system was 54.92% compared with 50.49 % with the ExAblate 2000 system over the preceding year (p = 0.543). The ExAblate 2100 system resulted in a greater NPV in hyper-intense fibroids compared with the ExAblate 200 system (43.20% versus 36.33%, p = 0.005). There have been no recorded hospital admissions, no skins burns, and no reported major adverse events since the introduction of this new system. CONCLUSION: Overall, the new system has thus far shown an encouraging safety record and an improvement in non-perfused volumes achieved, especially in hyper-intense fibroids.
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A persistent sciatic artery is a rare developmental anomaly which may predispose to a range of vascular complications. We report a 60-year-old woman presenting with right lower limb ischemia. Computed tomography angiography revealed an aneurysmal right-sided sciatic artery occluded by thrombus. An aberrant right subclavian artery and anomalous common carotid origins were also incidentally discovered. It is unknown whether an association exists between a persistent sciatic artery and other congenital arterial abnormalities. This is the first case report, so far as we are aware, describing both such arterial anomalies coexisting in a patient.
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Anormalidades Múltiplas , Aneurisma/complicações , Aorta Torácica/anormalidades , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Trombose/complicações , Malformações Vasculares/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Aorta Torácica/diagnóstico por imagem , Artéria Carótida Primitiva/anormalidades , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Pessoa de Meia-Idade , Veia Safena/transplante , Artéria Subclávia/anormalidades , Trombectomia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/cirurgiaAssuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Embolia Paradoxal/diagnóstico por imagem , Forame Oval Patente/cirurgia , Trombectomia/métodos , Trombose Venosa/tratamento farmacológico , Angiografia/métodos , Aspirina/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estado Terminal/terapia , Ecocardiografia Transesofagiana , Embolia Paradoxal/etiologia , Embolia Paradoxal/cirurgia , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Seguimentos , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Medição de Risco , Trombectomia/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologiaRESUMO
Idiopathic pulmonary haemosiderosis (IPH) is a rare condition that usually presents as a triad of haemoptysis, iron deficiency anaemia and pulmonary infiltrates. We report a case of IPH diagnosed in a 7 year old boy who had recurrent hospital admissions with severe chest infections and haemoptysis from his first few months of life. He was found to have microcytic hypochromic anaemia, diffuse infiltrate shadowing on his chest X-ray (CXR) and ground-glass opacification on his computed tomogram (CT). Perl's Prussian blue staining of his bronchoalveolar lavage fluid revealed haemosiderin-laden macrophage infiltration. After exclusion of infective, cardiac, immunological and glomerular causes, he was diagnosed with idiopathic pulmonary haemosiderosis. He has since been treated intermittently with steroids, which have failed to control his symptoms fully.
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Hemossiderose/diagnóstico por imagem , Hemossiderose/patologia , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/patologia , Anemia Hipocrômica/etiologia , Líquido da Lavagem Broncoalveolar , Criança , Diagnóstico Diferencial , Hemoptise/etiologia , Hemossiderose/complicações , Humanos , Pneumopatias/complicações , Masculino , Radiografia Torácica , Recidiva , Infecções Respiratórias/etiologia , Tomografia Computadorizada por Raios X , Hemossiderose PulmonarRESUMO
We present a case of stent-assisted coil embolization of a wide-necked renal artery aneurysm performed at our institution. The technique involved a stent being delivered over the neck of the aneurysm. Subsequently a catheter was placed into the aneurysm through the stent mesh and the aneurysm was then filled with detachable coils. Complete aneurysm occlusion was obtained and there was no evidence to suggest renal infarction on a follow-up contrast CT scan 6 months later. Our preliminary experience suggests that stent-assisted coil embolization of wide-necked renal artery aneurysms is a technically challenging but potentially effective renal-sparing endovascular approach.
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The 2007 New South Wales/Queensland Royal Australian and New Zealand College of Obstetricians and Gynaecologists Annual Scientific Meeting convened a panel to discuss multidisciplinary perspectives on the management of placenta accreta, percreta or increta. While it was anticipated that this panel would stimulate discussion, the cohesion between the approaches was underestimated. This document represents an integration of the perspectives of the invited speakers at this presentation, with backgrounds in maternal-fetal medicine, gynaecological oncology, radiology and general obstetrics and gynaecology.