Abdominal imaging
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We report computed tomographic findings of two unusual cases of sudden cardiac arrest. The imaging features documented include reflux of contrast into the abdomen as indicated by opacification of renal veins, hepatic veins, inferior vena cava, and hepatic and renal parenchyma. The reflux of contrast into the portal vein in one patient has not been described in the literature. The thoracic findings were reflux of contrast into the coronary sinus, nonopacificaton of the left ventricle with intravenous contrast, and lack of cardiac motion artifact.
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We evaluated the computed tomographic (CT) features of small bowel (SB) ischemia and necrosis and correlated the findings with clinical outcome or patient prognosis. Sixty-eight surgically or angiographically proved cases of SB ischemia were retrospectively reviewed. The CT features of intestinal ischemia were divided into three groups: (A) thinned bowel wall with poor enhancement, intramural gas, or portal venous gas; (B) thickened SB wall without superior mesenteric vein thrombosis; and (C) thickened SB wall with superior mesenteric vein thrombosis or intussusception. ⋯ Only intramural gas was accompanied with a higher mortality (six of eight, 75%). Intramural gas of a thinned bowel wall and poor mucosal enhancement of a thickened small bowel wall are useful signs of bowel necrosis. Intramural gas would indicate poor patient prognosis.
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We evaluated the magnetic resonance (MR) features of right colonic diverticulitis. ⋯ Our results suggest that MR imaging can be useful in the diagnosis of right colonic diverticulitis. An inflamed diverticulum with adjacent colonic wall thickening and surrounding inflamed fat are characteristic MR signs. MR imaging can be a valuable alternative to CT in young or pregnant patients who have suspected appendicitis and an equivocal US result.
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We investigated whether limited abdominal magnetic resonance imaging (MRI) is as effective as transabdominal ultrasound (US) in evaluating patients presenting with acute right upper quadrant pain. ⋯ Limited MRI is equivalent to US in diagnosing gallstones, gallbladder wall thickening, pericholecystic fluid, and acute cholecystitis in patients presenting with symptoms of acute right upper quadrant pain. Especially in sonographically challenging patients, limited MRI may provide a faster, easier method of diagnosis.
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Case Reports
Celiac plexus block: evaluation of injectate spread by three-dimensional computed tomography.
We describe a case of pancreatic cancer in which the spread pattern of injectate during neurolytic celiac plexus block was evaluated by three-dimensional helical computed tomography. Three-dimensional images provide excellent visualization of the spread patterns of injectate in a target site, which appears to provide patients with effective relief from intractable pain.