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1.
J Comput Assist Tomogr ; 43(6): 863-869, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31688246

RESUMO

PURPOSE: The purpose of this study was to evaluate the features of sclerosing angiomatoid nodular transformation (SANT) in spleen on the imaging of computed tomography (CT) and magnetic resonance (MR). MATERIALS AND METHODS: From July 2006 to April 2017, 12 patients with SANT confirmed by pathology were evaluated in a retrospective study. Eight patients were with CT imaging only, 2 patients were with MR imaging only, and 2 patients were with both CT and MR. Three professional senior radiologists analyzed the imaging features on CT and MR. The main characteristic analysis included size, margin, density, signal intensity, and enhancement pattern. The significant enhancement was defined as the degree of enhancement of lesion that is higher than the surrounding spleen parenchyma, and the mild enhancement was defined as the degree of enhancement of lesion that is lower than the surrounding spleen parenchyma. RESULTS: All the 12 patients (5 men, 7 women; mean age, 45.8 years; age range, 21-62 years) presented as single lesion without special clinical symptoms. The range of lesions on diameter was from 25 to 80 mm. On CT images, 9 (90%) of 10 presented as hypodense in comparison with the parenchyma of spleen, 1 (10%) of 10 presented as isodense, and calcification was observed in 4 (40%) of 10 cases. On MR images, 4 (100%) of 4 manifested heterogeneous hypointensity on in-phase sequence and 3 (75%) of 4 performed as isointensity on out-of-phase sequence of T1-weighted. On the sequences of T2-weighted and diffusion-weighted image, 4 (100%) of 4 showed hypointensity. On CT and MR enhancement images, the number of significant enhancement and mild enhancement was 2 and 10, respectively. Seven (58%) of 12 showed progressive enhancement with the pattern of "spoke-wheel." CONCLUSIONS: Imaging features on CT and MR have a high diagnostic value for SANT, especially when CT combined with MR examination.


Assuntos
Histiocitoma Fibroso Benigno/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Baço/patologia , Adulto , Feminino , Histiocitoma Fibroso Benigno/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Estudos Retrospectivos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Clin Nucl Med ; 44(12): 998-1000, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689285

RESUMO

A 39-year-old previously healthy woman presented possible hematuria. An ultrasound examination showed right adrenal mass and suggested pheochromocytoma. A Tc-HYNIC-TOC SPECT/CT was performed, which incidentally detected situs inversus totalis and suspicion of polysplenia without definite normal spleen in the right upper abdomen. In order to differentiate the polysplenia from other etiologies, a heat-damaged Tc RBC scintigraphy was performed. The images showed significant activity in the multiple soft tissue nodules in the posterior right abdomen, consistent with ectopic polysplenia.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Eritrócitos/metabolismo , Feocromocitoma/diagnóstico por imagem , Cintilografia , Situs Inversus/diagnóstico por imagem , Baço/anormalidades , Tecnécio/metabolismo , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Marcação por Isótopo , Baço/diagnóstico por imagem , Ultrassonografia
3.
Medicine (Baltimore) ; 98(47): e17961, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764798

RESUMO

To assess the utility of spleen stiffness as a diagnostic tool in individuals with human immunodeficiency virus (HIV) and non-cirrhotic portal hypertension (NCPH).The Philips EPIQ7, a new point shearwave elastography (pSWE) technique, was used to assess liver and spleen stiffness in 3 patient groups. Group 1: HIV and NCPH (n = 11); Group 2: HIV with past didanosine (ddI) exposure without known liver disease or NCPH (n = 5); Group 3: HIV without known liver disease or ddI exposure (n = 9).Groups were matched for age, HIV chronicity, and antiretroviral treatment (including cumulative ddI exposure in Groups 1 and 2). Differences in liver and spleen stiffness (in kPa) between groups were analyzed using the Mann-Whiney U test.Liver and spleen stiffness were both significantly higher in NCPH versus ddI-exposed (P = .019 and P = .006) and ddI-unexposed controls (P = .038 and P < .001). Spleen stiffness was more effective than liver stiffness at predicting NCPH, area under receiver operating characteristic (AUROC) 0.812 versus 0.948. Combining the 2 variables improved the diagnostic performance, AUROC 0.961. The optimal cut-off for predicting NCPH using splenic stiffness was 25.4 kPa, with sensitivity 91%, specificity 93%, positive predictive value (PPV) 91%, negative predictive value (NPV) 93%, positive likelihood ratio 12.73, negative likelihood ratio 0.10. Spleen and liver stiffness scores were strongly correlated (P = .0004, 95% confidence interval [CI] 18, 59).Elevated spleen stiffness is observed in HIV with NCPH and can be quantified easily using pSWE with high diagnostic accuracy. Novel strategies such as pSWE for longitudinal monitoring of patients with HIV and NCPH should be considered.


Assuntos
Técnicas de Imagem por Elasticidade , Hipertensão Portal/diagnóstico por imagem , Baço/diagnóstico por imagem , Estudos Transversais , Feminino , Infecções por HIV/complicações , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Baço/fisiopatologia
4.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(4): 418-422, 2019 Jul 24.
Artigo em Chinês | MEDLINE | ID: mdl-31612679

RESUMO

OBJECTIVE: To understand Leishmania infections among employees of China Petroleum First Construction Corporation returning from Uzbekistan, and take timely actions to prevent the spread of the epidemic. METHODS: Questionnaire survey was conducted to collect screening subjects'information. Palpation of the liver, spleen and superficial lymph nodes was performed by a physician, and the lesions on the frequently exposed skin were detected by a dermatologist. In addition, the liver and spleen sizes were measured using B-mode ultrasonography, and serum samples were collected to be subjected to an rK39-based rapid diagnostic test for detection of visceral leishmaniasis. Leishmania was detected using microscopy in the specimens sampled from the lesioned skin, and the parasites species was identified using molecular assays in parasitologically positive specimens. RESULTS: Among the 181 employees screened, enlarged cervical lymph nodes were palpable in 6 subjects, and skin lesions were found in 12 cases. B-mode ultrasonography displayed hepatosplenomegaly in 5 cases, and rK39 test were positive in 3 serum samples. Two classical lesioned skin specimens were sampled, and Leishmania was detected in one specimen. The promastigote DNA was extracted and two fragments of 120 bp and 350 bp in sizes were amplified using PCR assay with K13A/K13B and L5.8S/LITSR primers specific to Leishmania. The two amplification products were 90% and 98% homologous to the corresponding sequences of L. major (GenBank accession numbers: EU370906.1 and FN677342.1). CONCLUSIONS: Six patients with cutaneous leishmaniasis were screened, including 2 uncured cases. One uncured case was diagnosed as imported cutaneous leishmaniasis caused by L. major infection.


Assuntos
Doenças Transmissíveis Importadas , Leishmania , Leishmaniose Cutânea , China/epidemiologia , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/parasitologia , DNA de Protozoário , Epidemias , Humanos , Leishmania/genética , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/epidemiologia , Fígado/diagnóstico por imagem , Linfonodos/patologia , Reação em Cadeia da Polimerase , Baço/diagnóstico por imagem , Inquéritos e Questionários , Ultrassonografia , Uzbequistão
6.
Korean J Parasitol ; 57(4): 405-409, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31533407

RESUMO

In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.


Assuntos
Hemorragia/etiologia , Malária Vivax/complicações , Esplenopatias/etiologia , Adulto , Angiografia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemorragia/diagnóstico por imagem , Humanos , Masculino , Baço/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Med Ultrason ; 21(3): 315-326, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31476212

RESUMO

Ultrasound elastography including transient elastography (TE), point shear wave elastography, (pSWE) and two (three)- dimensional shear wave elastography (2D-SWE) have been introduced mainly for the evaluation of the liver. All the techniques are also feasible for the examination of spleen, whereas pSWE and 2D-SWE can be used for the assessment of the pancreas, kidney, gastrointestinal tract and other organs. Strain elastography also plays a role for non-liver applications. The aim of the current report is to highlight unique features and techniques for the elastographic examinations in children and to report initial results in non-liver applications.


Assuntos
Encéfalo/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Trato Gastrointestinal/diagnóstico por imagem , Rim/diagnóstico por imagem , Fígado/diagnóstico por imagem , Baço/diagnóstico por imagem , Criança , Humanos
9.
Med Ultrason ; 21(3): 356-358, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31476218

RESUMO

We present the case of splenogonadal fusion in a 53-year-old male patient assessed by ultrasound and MRI, confirmed by pathologic examination. In addition to B-mode and colour-coded Doppler ultrasound, shear wave elastography and CEUS were performed and are presented in detail. Splenogonadal fusion is a rare congenital anomaly presumably caused by an abnormal attachment of splenic tissue to the gonad during gestation. Diagnosis is challenging for clinicians and in unclear cases splenogonadal fusion might cause unnecessary orchiectomies with benign pathologic results. Ultrasound is the first-line imaging modality in the diagnosis of testicular pathologies. This case report summarizes all available modern ultrasound imagingtechnologies and highlights the possibilities for the diagnosis of splenogonadal fusion.


Assuntos
Meios de Contraste , Gônadas/anormalidades , Gônadas/diagnóstico por imagem , Aumento da Imagem/métodos , Baço/anormalidades , Baço/diagnóstico por imagem , Ultrassonografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Humanos , Masculino , Pessoa de Meia-Idade
10.
Ghana Med J ; 53(2): 142-149, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31481810

RESUMO

Introduction: Oesophageal variceal (OV) bleeding is a potentially fatal consequence of portal hypertension in patients with liver cirrhosis. Upper GI endoscopy is recommended for screening for varices in cirrhotics for early detection and treatment, however, this is invasive. The purpose of this study was to assess the predictive values of the noninvasive tests in detecting the presence of OV. Methods: A cross-sectional hospital-based study involving 149 patients with liver cirrhosis was carried out at the Korle-Bu Teaching Hospital from 1st November 2015 to 25th November 2016. Relevant clinical parameters assessed included Child-Pugh class, ascites and splenomegaly. Full blood count and liver function tests, abdominal ultrasound and gastroscopy were done for all the participants. Receiver operating characteristic curve was generated to determine the cut-off values for the best sensitivity, specificity, negative and positive predictive values of the variables (serum albumin, platelet count (PC), aspartate aminotransferase (AST)/alanine aminotransferase (ALT), PC/Spleen diameter( SD)) with regard to the presence of OV. Results: On gastroscopy, 135 (90.60%) had OV and 14 patients (9.40%) had no OV. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices. The overall mean of serum albumin, PC and PC/SD were not significant predictors of the presence of OV. However, the overall mean of AST/ALT significantly predicted the presence of OV. A PC/SD cut off value of ≤833.3 had 72.62% diagnostic accuracy for diagnosing all OV. Conclusion: PC/SD cut-off could be used to screen cirrhotics for OV and treatment initiated in geographical areas lacking endoscopy facilities. Funding: None declared.


Assuntos
Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Varizes Esofágicas e Gástricas/epidemiologia , Cirrose Hepática/metabolismo , Adulto , Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas/etiologia , Feminino , Gana , Hospitais de Ensino , Humanos , Fígado/diagnóstico por imagem , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Curva ROC , Albumina Sérica/metabolismo , Baço/diagnóstico por imagem , Esplenomegalia/diagnóstico por imagem , Esplenomegalia/epidemiologia , Ultrassonografia
13.
BMC Gastroenterol ; 19(1): 144, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416435

RESUMO

BACKGROUND: Splenic nodules are uncommon entities that occur rarely in the general population. Although an infectious etiology (primarily bacteria, followed by mycobacteria) is usually found, noninfectious diseases, including malignancies and autoimmune disorders, can also be involved. For instance, in course of inflammatory bowel diseases (IBDs), in particular Crohn's Disease, aseptic splenic abscesses have been reported in patients with a long history of illness, or in those unresponsive to medical treatments, while are only anecdotally reported in the early phase of the disease. Hence, we presented the case of aseptic splenic nodules as a first manifestation of Crohn's Disease. CASE PRESENTATION: A 21-year-old woman with a silent medical history was admitted to the Emergency Department of our hospital complaining of fever of 38-39 °C (mainly in the evening) for the past 10 days and left flank abdominal pain, accompanied by sweating and fatigue. An abdominal computed tomography showed multiple splenic nodules of unknown origin. Because of the absence of clinical improvement after several antibiotic therapiesand a positron emission tomography (PET) with hypercaptation strictly localized to spleen, she underwent splenectomy, in suspicion of lymphoma. For persistence of symptoms after splenectomy, she underwent many instrumental examination, including a colonoscopy with bowel and intestinal biopsies that poses diagnosis of Crohn's disease. A second PET confirmed this diagnosis showing this time also the gastrointestinal involvement. CONCLUSION: An unusual onset of Crohn's disease with multiple splenic nodules is reported. This case suggests that in light of splenic nodules of unknown etiology attention should be paid to all possible diagnoses of aseptic abscesses, including IBDs (primarily Crohn's Disease).


Assuntos
Abscesso Abdominal , Doença de Crohn , Intestinos/patologia , Linfoma/diagnóstico , Baço , Esplenectomia/métodos , Esplenopatias , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Biópsia/métodos , Colonoscopia/métodos , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Tomografia por Emissão de Pósitrons/métodos , Baço/diagnóstico por imagem , Baço/patologia , Baço/cirurgia , Esplenopatias/diagnóstico , Esplenopatias/etiologia , Esplenopatias/cirurgia , Adulto Jovem
15.
Transplant Proc ; 51(7): 2446-2450, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405739

RESUMO

AIM OF THE STUDY: Liver transplantation is widely applied as a standard and effective management of end-stage liver diseases, hepatocellular carcinoma, and acute liver failure. Investigation of morphologic and functional changes in the transplanted graft, gastrointestinal system, and spleen after transplantation is an important ground for assessment of post-transplantation results, early changes related to complications, and evaluation of response to treatment modalities. The aim of this study was to investigate the dynamics of changes in elastography of the liver graft and spleen after living-related liver transplantation. MATERIAL AND METHODS: The study included 14 cirrhotic patients after living-related liver graft transplantation. Stiffness of the spleen and liver was evaluated before transplantation and at 1, 3, and 6 months after transplantation with a Supersonic Aixplorer Multi Wave device. Each procedure consisted of measuring the density in 10 points (spots) of the organ. The final result was calculated as the mean value of successful measurements (must have been > 60% of all measurements) and expressed in kilopascals. RESULTS: The mean value of the liver and spleen stiffness before transplantation was 27 kPa (14-31 kPa) and 51 kPa (38-92 kPa), respectively. The stiffness of the spleen gradually reduced after transplantation to 40.3, 35.4, and 24.1 kPa (P = .001) at 1, 3, and 6 months. The stiffness of the liver graft in patients without complications was stable at 4-5 kPa, whereas the same value in patients with complications was increased (≥ 7.5 kPa). In 5 patients, endoscopic investigation confirmed the significant reduction of varicose veins after surgery. CONCLUSION: Elastography of the liver graft and spleen after liver transplantation can be recommended as a useful-for-patient 1-off method of investigation.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Transplante de Fígado/métodos , Fígado/diagnóstico por imagem , Baço/diagnóstico por imagem , Transplantes/diagnóstico por imagem , Adulto , Doença Hepática Terminal/complicações , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Fígado/patologia , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Baço/patologia , Transplantes/patologia , Resultado do Tratamento
16.
Vet Radiol Ultrasound ; 60(6): 717-728, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31368224

RESUMO

Ultrasonography and radiography are standard diagnostic tests for cats with suspected splenic disease, however published information on outside sources of variation are currently lacking. The purpose of this prospective, randomized, crossover group study was to evaluate effects of common sedative drugs on the sonographic and radiographic characteristics of the spleen in healthy cats. Fifteen healthy adult research cats were randomly assigned into one of three groups corresponding to different sequences of administration of five sedative drugs/drug combinations (acepromazine; butorphanol; dexmedetomidine; midazolam and butorphanol (MB); and dexmedetomidine, butorphanol, and ketamine (DBK)), administered at 1-week intervals. At each visit, three-view abdominal radiographic and ultrasonographic examinations were performed prior to sedation and repeated 15-30 min and 2-3 h post sedation. Two board-certified radiologists (one ACVR and one ACVR/ECVDI) evaluated the anonymized and randomized images. Acepromazine resulted in significantly increased sonographic and radiographic splenic measurements from baseline, which remained significantly increased 2-3 h post sedation. The mean magnitude of this change ranged from 0.9 mm (tail height, SD 1.4 mm) to 1.8 mm (body height, SD 1.7 mm) for ultrasound, and was 2.2 mm (ventrodorsal width, SD 2.3 mm) for radiographs. With butorphanol, there was no significant change in splenic size. For dexmedetomidine, MB, and DBK, there was a trend toward increased splenic size from baseline to the first post-sedation timepoint, which was statistically significant for radiographic measurements, although not for ultrasound. Findings indicated that acepromazine should be avoided prior to imaging while butorphanol may be used when sedation is needed in cats presenting for potential splenic disease.


Assuntos
Gatos/fisiologia , Sedação Consciente/veterinária , Hipnóticos e Sedativos/administração & dosagem , Baço/diagnóstico por imagem , Animais , Estudos Cross-Over , Esquema de Medicação/veterinária , Quimioterapia Combinada/veterinária , Feminino , Masculino , Estudos Prospectivos , Valores de Referência , Ultrassonografia/veterinária
17.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451478

RESUMO

Spontaneous splenic rupture (SSR) is a rare but potentially life-threatening entity. It can be due to neoplastic, infectious, haematological, inflammatory and metabolic causes. An iatrogenic or an idiopathic aetiology should also be considered. Depending on the degree of splenic injury and the haemodynamic status of the patient, it can be managed conservatively. A 61-year-old man presented to the emergency department with an acute abdomen, hypovolaemic shock and clotting abnormalities. However, his focused assessment with sonography for trauma showed no evidence of an aortic aneurysm, rupture or dissection. Further investigation with a CT angiogram aorta confirmed a subcapsular splenic haematoma with free fluid in the pelvis and a mass in the superior pole of the spleen. He was diagnosed with an SSR. He was initially managed non-operatively. However, his repeat CT showed an enlarging haematoma and he underwent embolisation of his splenic artery. Ultrasound-guided core biopsy of his splenic mass confirmed the diagnosis of diffuse large B-cell lymphoma. This paper will discuss the clinical presentation, differential diagnosis and management of SSR. Furthermore, it provides an important clinical lesson to maintain a high index of clinical suspicion for splenic injury in patients presenting with left upper quadrant abdominal pain radiating to the shoulder. This case also reinforces the importance of close observation and monitoring of those individuals treated conservatively for signs of clinical deterioration.


Assuntos
Abdome Agudo , Linfoma Difuso de Grandes Células B , Baço , Neoplasias Esplênicas , Ruptura Esplênica , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Testes de Coagulação Sanguínea/métodos , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Humanos , Biópsia Guiada por Imagem/métodos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/fisiopatologia , Ruptura Espontânea/terapia , Choque/diagnóstico , Choque/etiologia , Baço/diagnóstico por imagem , Baço/patologia , Baço/cirurgia , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/terapia , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologia , Ruptura Esplênica/fisiopatologia , Ruptura Esplênica/terapia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
18.
Ulus Travma Acil Cerrahi Derg ; 25(4): 369-377, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297785

RESUMO

BACKGROUND: In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations. METHODS: In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods. RESULTS: The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001). CONCLUSION: Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.


Assuntos
Traumatismos Abdominais/diagnóstico , Exame Físico , Ferimentos não Penetrantes/diagnóstico , Cavidade Abdominal , Traumatismos Abdominais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/lesões , Lacerações , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Baço/lesões , Tomografia Computadorizada por Raios X , Ultrassonografia , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto Jovem
20.
Am J Surg ; 218(3): 579-583, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31284948

RESUMO

BACKGROUND: Multi-detector computed tomography imaging is now the reference standard for identifying solid organ injuries, with a high sensitivity and specificity. However, delayed splenic hemorrhage (DSH), defined as no identified injury to the spleen on the index scan but delayed bleeding from a splenic injury, has been reported. We hypothesized that the occurrence of DSH would be minimized by utilization of modern imaging techniques. METHODS: Data was retrospectively collected from 2006 to 2016 in 12 adult Level I and II trauma centers. All patients had an initial CT scan demonstrating no splenic injury but subsequently were diagnosed with splenic bleeding. Demographic, injury characteristics, imaging parameters and results, interventions and outcomes were collected. RESULTS: Of 6867 patients with splenic injuries, 32 cases (0.4%) of blunt splenic hemorrage were identified. Patients were primarily male, had blunt trauma, severely injured (ISS 32 (9-57) and with associated injuries. Injuries of all grades were identified up to 16 days following admission. Overall, half of patients required splenectomy. All index images were obtained using multi-detector CT (16-320 slice). Secondary review of imaging by two trauma radiologists judged 72% (n = 23) of scans as suboptimal. This was due to poor scan quality primary from artifact(23), single phase contrast imaging (16), and/or poor contrast bolus timing or volume (6). Notably, only 28% of scans in patients with DSH were performed with optimal scanning techniques. CONCLUSION: This is the largest reported series of DSH in the era of modern imaging. Although the incidence of DSH is low, it still occurs despite the use of multi-detector imaging and when present, is associated with a high rate of splenectomy. Most cases of DSH can be attributed to missed diagnosis from suboptimal index imaging and ultimately be avoided.


Assuntos
Hemorragia/etiologia , Baço/diagnóstico por imagem , Baço/lesões , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Feminino , Hemorragia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
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