Lung cancer mimicking lung abscess formation on CT images.

PATIENT: Male, 64 FINAL DIAGNOSIS: Lung pleomorphic carcinoma Symptoms: Cough • fever MEDICATION: - Clinical Procedure: - Specialty: Oncology. OBJECTIVE: Unusual clinical course. BACKGROUND: The diagnosis of lung cancer is often made based on computed tomography (CT) image findings if it cannot be confirmed on pathological examinations, such as bronchoscopy. However, the CT image findings of cancerous lesions are similar to those of abscesses.We herein report a case of lung cancer that resembled a lung abscess on CT. CASE REPORT: We herein describe the case of 64-year-old male who was diagnosed with lung cancer using surgery. In this case, it was quite difficult to distinguish between the lung cancer and a lung abscess on CT images, and a lung abscess was initially suspected due to symptoms, such as fever and coughing, contrast-enhanced CT image findings showing a ring-enhancing mass in the right upper lobe and the patient's laboratory test results. However, a pathological diagnosis of lung cancer was confirmed according to the results of a rapid frozen section biopsy of the lesion. CONCLUSIONS: This case suggests that physicians should not suspect both a lung abscesses and malignancy in cases involving masses presenting as ring-enhancing lesions on contrast-enhanced CT.

Comparison between laparotomy first versus angiographic embolization first in patients with pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan Trauma Data Bank.

BACKGROUND: A common dilemma in the management of pelvic fractures is recognizing the presence of associated abdominal injury. The purpose of this study was to determine the association between initial therapeutic intervention (laparotomy or transcatheter arterial embolization (TAE)) and mortality. METHODS: This was a cohort study using the Japan Trauma Data Bank between 2004 and 2010, including blunt trauma patients with pelvic fractures and positive Focused Assessment with Sonography in Trauma (FAST) results. Eligible patients were restricted to those who underwent laparotomy or TAE/angiography as the initial therapeutic intervention. Crude and adjusted odds ratio (AOR) for in-hospital mortality were compared between the laparotomy first and TAE first groups (reference group). Multiple logistic regression analysis and propensity score adjusted analysis were used to adjust for clinically relevant confounders, including the severity of injury. RESULTS: Of the 317 participants, 123 patients underwent laparotomy first and 194 patients underwent TAE first. The two groups were similar in terms of age, although the laparotomy first group had higher mean Injury Severity Scores (ISS) and higher mean scores based on the abdominal Abbreviated Injury Scale (AIS), as well as lower mean pelvic AIS and systolic blood pressure (SBP). Half of the patients who were hypotensive (SBP < 90 mmHg) on arrival underwent TAE first. The laparotomy first group had a significantly higher crude in-hospital mortality (41% vs. 27%; P < 0.01). After adjusting for confounders, the choice of initial therapeutic intervention did not affect the in-hospital mortality (AOR, 1.20; 95% Confidence Interval (CI), 0.61-2.39). Even in the limited subgroup of hypotensive patients (SBP 66-89 mmHg and SBP < 65 mmHg subgroup), the effect was similar (AOR, 1.50; 95% CI, 0.56-4.05 and AOR, 1.05; 95% CI, 0.44-3.03). CONCLUSIONS: In Japan, laparotomy and TAE are equally chosen as the initial therapeutic intervention regardless of hemodynamic status. No significant difference was seen between the laparotomy first and TAE first groups regarding in-hospital mortality.

[Postoperative refractory chylothorax which was improved by octreotide acetate].

A 77-year-old male with chronic hepatitis and liver cirrhosis underwent a right middle-lower lobectomy and lymph node dissection because of non-small cell carcinoma of the lung. On the 1st post-operative day (POD1), a large quantity of chylous pleural effusion was recognized after he initiated oral intake. The diagnosis was postoperative chylothorax. Conservative therapy including a medium chain tryglyceride diet and total parental nutrition were not effective. Considering of the patient's past history, we decided to continue conservative therapy using octreotide acetate on POD7. After administration of the octreotide acetate, the volume of chylous pleural effusion gradually decreased. The chest tube was removed on POD19. Octeotide acetate should be a choice for the conservative treatment of postoperative refractory chylothorax.

Multiple abdominal granuloma caused by spilled gallstones with imaging findings that mimic malignancy.

Multiple abdominal granulomas caused by spilled gallstones during a laparoscopic cholecystectomy are a rare complication. The images of the granuloma mimicked malignancy.

Hepatocellular carcinoma in a patient with primary biliary cirrhosis and seronegativity for markers of hepatitis B virus and hepatitis C virus: report of a case.

We report a case of hepatocellular carcinoma (HCC) arising in a patient with primary biliary cirrhosis (PBC) in whom both hepatitis B virus (HBV) and hepatitis C virus (HCV) serological tests were negative. A 72-year-old woman was found to have HCC 10 years after a diagnosis of PBC. All serological tests for HBV and HCV were negative. Preoperative liver biopsy findings suggested moderately differentiated HCC. Dynamic computed tomography (CT) showed hypervascular tumors in segments IV and VII. At laparotomy, a 30-mm tumor was palpated in segment VII and a wedge resection was performed. The second tumor, which measured 10 mm in diameter, was detected in segment IV by abdominal ultrasound, and microwave coagulation therapy was done. HCC arising in hepatitis virus marker-negative PBC is rare and past reports do not clarify whether HBV or HCV infections are associated with HCC.