Chylous ascytis causing abdominal distension after laparoscopic radical nephrectomy.

OBJECTIVE: To report a case of large chylous ascytis as a late complication of a laparoscopic nephrectomy for renal tumor. METHODS: A 62 year old patient was admitted with general deterioration and abdominal distension due to chylous ascites. Abdominal ultrasound and CT led to the diagnosis. Paracentesis confirmed the presence of a large peritoneal chylous fluid effusion. RESULTS: The patient was treated by punction and placement of a percutaneous drainage. A large amount of lymphatic fluid was obtained after punction with a progressive decrease. Medical treatment included low sodium and low fat diet, together with medium chain fast absorbing triglycerides, protein supplements, diuretics and somatostatin analogues (octeotride). The patient's progress was satisfactory after several days of treatment. CONCLUSIONS: Chylous ascites is a rare complication of laparoscopic nephrectomy, but it has a favorable course if managed conservatively. Meticulous clipping of the retroperitoneal lymph vessels is recommended to prevent the formation of chylous ascites, especially when discharging the renal vascular pedicle during nephrectomy or extensive lymphadenectomy.

Ascitis quilosa tras neferctomia radical laparascopica que provoca distensión abdominal / Chylous ascytis causing abdominal distension after laparoscopic radical nepherectomy

OBJETIVO: Comunicar un caso de ascitis quilosa masiva como complicación tardía tras la realización de una nefrectomía laparoscópica por tumor renal. MÉTODOS: Presentamos el caso de un varón de 62 años que ingresó por distensión abdominal importante, y malestar general motivado por ascitis quilosa. El diagnóstico realizado mediante ecografía y TAC abdominal con paracentesis confirmó la presencia de abundante acumulo intraperitoneal del liquido lechoso. RESULTADOS: El paciente fue tratado con punción y drenaje peritoneal percutáneo que recogió abundante cantidad de linfa en las primeras horas y disminución del débito de forma progresiva. El tratamiento médico consistió en dieta hiposódica y baja en grasa, triglicéridos de cadena media de absorción rápida, suplementos de proteínas, diuréticos, y análogos de la somatostatina (octeotride). El enfermo evolucionó de forma satisfactoria al cabo de unos días. CONCLUSIONES: La ascitis quilosa es una complicación rara tras la nefrectomía laparoscópica y suele evolucionar bien con tratamiento conservador. Para prevenir su aparición se recomienda un clipaje meticuloso del tejido linfático retroperitoneal sobre todo al realizar la disección del pedículo vascular renal en el caso de nefrectomías o linfadenectomías extensas

OBJECTIVE: To report a case of large chylous ascytis as a late complication of a laparoscopic nephrectomy for renal tumor. METHODS: A 62 year old patient was admitted with general deterioration and abdominal distension due to chylous ascites. Abdominal ultrasound and CT led to the diagnosis. Paracentesis confirmed the presence of a large peritoneal chylous fluid effusion. RESULTS: The patient was treated by punction and placement of a percutaneous drainage. A large amount of lymphatic fluid was obtained after punction with a progressive decrease. Medical treatment included low sodium and low fat diet, together with medium chain fast absorbing triglycerides, protein supplements, diuretics and somatostatin analogues (octeotride). The patient’s progress was satisfactory after several days of treatment. CONCLUSIONS: Chylous ascites is a rare complication of laparoscopic nephrectomy, but it has a favorable course if managed conservatively. Meticulous clipping of the retroperitoneal lymph vessels is recommended to prevent the formation of chylous ascites, especially when discharging the renal vascular pedicle during nephrectomy or extensive lymphadenectomy

CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice.

Computed tomography (CT)-guided biopsy of the spine is considered a safe, accurate, and relatively inexpensive examination technique. Our purpose was to determine the diagnostic accuracy of CT-guided biopsies exclusively for vertebral osteomyelitis. A retrospective study was performed from a consecutive series of 72 patients with confirmed vertebral osteomyelitis with 46 CT-guided biopsies performed in 40 patients. Biopsy specimens were sent for bacteriologic and cytologic analysis. An adequate specimen for microbiologic examination was not obtained in one case and not enough sample for additional pathologic examination in 17 cases. The mean age of patients was 58 years, with a range of 1-88 years, including 24 men and 16 women. The level of spinal biopsy was thoracic in 18 (40%) and lumbar in 28 (60%). The analysis revealed the infection agent in 20 cases (43% sensitivity). Diagnostic rates obtained in patients with previous antibiotic treatment were significantly lower (23% vs. 60%, p = 0.013). Computed tomography-guided fine-needle aspiration biopsy is an important tool in the diagnostic evaluation of vertebral osteomyelitis. However, this technique yields a lower diagnostic rate than previously reported biopsy of neoplastic vertebral lesions, especially if performed in patients with previous antibiotic treatment.

Imaging findings of pulmonary infection caused by Scedosporium prolificans in a deep immunocompromised patient.

Scedosporium prolificans is an emerging fungus that causes rapid progressive and disseminated infections in immunodepressed patients. We present a case of a 34-year-old woman with chronic myelogenous leukemia who received a bone marrow transplantation and suffered a sudden respiratory failure in +67 day. Chest radiographies showed growing bilateral patchy condensations. Computed Tomography depicted bilateral nodular condensation of alveolar space. S. prolificans was detected from sputum, but the patient died 72 h later. Imaging findings of lung scedosporiosis are nonspecific, but CT may provide a prompter diagnosis and allow to add newer antifungal treatments. This report presents the first imaging report of lung scedosporiosis.

Migrating intrathoracic gallstone: imaging findings.

We present the case of a 76-year-old man referred to our hospital with a round stone in central mediastinum and pneumomediastinum in chest radiography and computed tomography. He had a previous history of attempt of endoscopic retrievement of a gallstone that had caused a gastric outlet obstruction (Bouveret syndrome). To our knowledge, this is the first imaging description of mediastinal gallstone caused by esophagus perforation during complicated endoscopic lithotomy.

Necrotizing fasciitis secondary to diverticulitis.

Necrotizing fasciitis is a rare, rapidly progressive infectious process primarily involving the fascia and the subcutaneous tissue, with thrombosis of the cutaneous microcirculation. We present a case of necrotizing fasciitis secondary to diverticulitis in an immunosuppressed patient with rheumatoid arthritis.