Abdominal imaging
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We present the computed tomographic findings in a case of left-sided acute appendicitis associated with midgut malrotation, which is a rare anomaly. The inflamed appendix was visualized as a tubular, fluid-filled, enhancing structure in the left lower quadrant. ⋯ The presence of a superior mesenteric vein rotation sign ascertained the presence of midgut malrotation. Computed tomography is useful not only in providing accurate diagnosis of left-sided appendicitis but also in detecting associated rotational anomalies, which may require separate surgical correction.
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Two cases are described in which portal venous gas (PVG) was detectable by ultrasound, but the liver appeared normal on computed tomography (CT). The finding of PVG was associated with ischemic bowel in one case but was a benign finding in the other case. ⋯ First, ultrasound may detect gas within the portal venous system when CT is negative. Second, when PVG is detected on ultrasound, urgent clinical assessment followed by contrast-enhanced CT is indicated to assess for associated intestinal ischemia.
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Information technology is becoming a vital component of all health care enterprises, from managed care services to large hospital networks, that provides the basis of electronic patient records and hospital-wide information. The rationale behind such systems is deceptively simple: physicians want to sit down at a single workstation and call up all information, both clinical data and medical images, concerning a given patient. Picture archiving and communication systems (PACS) are responsible for solving the problem of acquiring, transmitting, and displaying radiologic images. ⋯ With the changes in economics and the shift toward managed and capitated care, the teleradiology component of PACS is rapidly gaining momentum. In allowing remote coverage of multiple sites by the same radiologists and remote consultations and expert opinion, teleradiology is in many instances the only option to maintain economically viable radiologic settings. The technical evolution toward more integrated systems and the shift toward Web-based technology is rapidly merging the two concepts of PACS and teleradiology in global image management and communication systems.
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Comparative Study
Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy.
The purpose of this study was to describe our experience in the conservative management of large rectus sheath hematoma (RSH) in patients undergoing anticoagulation therapy. ⋯ RSH must be suspected in women of advanced age undergoing treatment with anticoagulants who present the clinical triad of acute abdominal pain, infraumbilical mass, and anemic syndrome. CT is the examination of choice for the diagnosis of RSH. Early diagnosis of RSH permits conservative management, even in the case of large hematomas with hemodynamic repercussions and avoids unnecessary surgical intervention.
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Endoscopic retrograde cholangiopancreatography with sphincterotomy has become an important technique in the diagnosis and treatment of biliary and pancreatic diseases. Serious complications, although rare, may occur, and their early recognition and treatment are of the utmost importance. We encountered several such cases. This study reviews the imaging findings in patients with retroperitoneal perforation detected after the procedure. ⋯ Retroperitoneal perforation during endoscopic sphincterotomy is a rare complication, which occurred in 1.13% of our patients. It can be usually clearly recognized radiographically by an abdominal film and in doubtful cases by CT. We emphasize the importance of recognizing this potentially serious complication with imaging studies.