Rapid progression of massive hepatic calcification visible by CT : the case of a dialyzed patient

Background: There have been single reported cases of patients with diffuse hepatic calcifications revealed 4-36 months after the first examination in the course of hemodialysis-treated renal failure, severe heart failure, shock liver, primary amyloidosis, or corticosteroid administration. In the presented case, many different factors for liver calcification and dynamic tomographic manifestation are seen. Case Report: A 23-year-old man who was on hemodialysis because of acute renal failure after a motor vehicle accident (multiorgan trauma) with occurrence of hypovolemic shock was admitted to the hospital's intensive care unit presenting with clostridial infection of the lower extremities. During his stay at a prior hospital, ultrasonography did not reveal hepatic lesions. He underwent 22 sessions of treatment with hyperbaric oxygen as well as several necrectomies and amputation of both lower limbs. Abdominal CT performed three weeks after the accident demonstrated diffuse hepatic calcification which was later confirmed during autopsy. Liver parenchymal calcifications may be related to elevated calcium-phosphorus products in the uremic state and after multiple bone fractures and possible ischemic liver injury. Although a definitive explanation for the unusually short time of the appearance of liver calcification was not obtained, it may be related to many factors acting synergistically. Hyperbaric oxygen treatment is of unknown significance in this process. Conclusions: CT plays a basic role in detecting and assessing liver calcifications forming both diffuse lesions and those with well-defined borders. Diffuse calcifications revealed by CT must be analyzed together with the patient's history, especially considering renal and heart failure, bone fractures, states of shock, and treatment. Diffuse liver calcifications in these patients after respiratory therapy and transfusions when no subcapsular hematoma is found should be considered of metabolic origin

Gallstone ileus : a rare complication of cholecystolithiasis : a case report

Background: Gallstone ileus is a rare, serious and usually specific to elderly age complication of cholecystolithiasis associated with very high mortality. It occurs when a concrement from the gallbladder becomes incarcerated in the lumen of the digestive tract. In this report, a case of gallstone ileus is presented, where a concrement moved through a cholecystoduodenal fistula to the lumen of the small intestine. Case report: A 80-year-old woman who suffered from cholecystolithiasis and diabetes mellitus was admitted to hospital with abdominal pain, flatulence and loss of appetite which lasted a few days. In ultrasonography of the abdomen, a gallbladder hydrops was found and the patient was qualified to cholecystectomy. The night before the planned surgery, the patient reported her abdominal complaints to more intense, and vomiting occurred. Abdominal ultrasonography was repeated, revealing wide intestinal loops with the gallbladder poorly visible; the examiner also noticed a hyperechogenic shadow in the stomach and in conclusions suggested the possibility of perforation. In CT imaging, one concrement in the jejunum and several ones in the colon were found to confirm the diagnosis. During the surgery, perforations of the gallbladder and pylorus were found and a gallstone wedged in the lumen of the jejunum blocking the passage. Conclusions: Cholecystolithiasis, as a disorder common in our population, should be considered in differential diagnosis of intestinal obstruction. Gallstone ileus as a rare but highly dangerous complication of cholecystolithiasis is more often seen in elderly patients with rich medical past. None of radiological methods used separately is able to give a full diagnosis - only their combination leads to an accurate diagnosis. That is why only rapid and well selected path of imaging diagnostics (ultrasonography, plain abdominal radiogram, CT imaging), good anamnesis and cooperation with a clinician is the way to obtain a therapeutic success

Śluzowy guz jajnika o granicznej złośliwości: opis przypadku i spostrzeżenia diagnostyczne

Borderline ovarian tumors represent about 10% of all epithelial ovarian cancers, but in contrast to epithelial ovarian cancers, they constitute a group of tumors with a much better prognosis. An assessment of clinical presentation, physical examination, radiological and biochemical findings is necessary to tailor management strategies for patients with ovarian tumors. The article, which is based on a case report, describes different approaches for preoperative diagnosis as well as discusses approaches that might bring some insights on tumor histology. Furthermore, it raises a question about which imaging techniques should be proposed for a reliable diagnosis of borderline ovarian tumors to ensure safe surgery planning.Guzy o granicznej złośliwości stanowią około 10% nabłonkowych nowotworów jajnika, ale w porównaniu z rakami jajnika charakteryzują się lepszym rokowaniem. Analiza obrazu klinicznego, badania fizykalnego, badań radiologicznych i biochemicznych jest niezbędna, by pacjentkę z guzem jajnika skierować na odpowiednie leczenie. W artykule na podstawie przedstawionego przypadku opisano podejścia diagnostyczne do przedoperacyjnego rozpoznania, a także poddano dyskusji badania pozwalające na wgląd w histologię guza oraz kwestię, jakie badania obrazowe powinno się zaproponować, aby z dużym prawdopodobieństwem potwierdzić obecność guzów o granicznej złośliwości i bezpiecznie zaplanować operację

Microbiological, Clinical and Radiological Aspects of Diabetic Foot Ulcers Infected with Methicillin-Resistant and -Sensitive Staphylococcus aureus

Diabetic foot ulcer (DFU) is one of the most common chronic complications of diabetes. This study aimed to assess the factors with an impact on the infection of diabetic foot ulcers by methicillin-resistant S. aureus and to evaluate the influence of methicillin resistance on the frequency of osteitis (based on classic X-ray images). A total of 863 patients suffering from DFU were analyzed during the study period. Out of 201 isolated S. aureus cases, 31 (15.4%) were methicillin-resistant (MRSA). MRSA infections were associated with a higher incidence of osteitis compared to MSSA infections (p << 0.0001), both the occurrence of smaller (<50%)) and greater (>50%) inflammatory bone changes (p << 0.0001). Furthermore, MRSA occurred significantly more frequently in men than in women (p < 0.01) and more often among patients with type 2 diabetes than among patients with type 1 diabetes (p < 0.05). MRSA were isolated statistically less often in overweight patients than in patients with normal BMI (p < 0.05). DFUs infected with MRSA were significantly more frequently associated with the presence of Pseudomonas sp. and other non-fermenting bacilli than those infected with MSSA (p < 0.05). To conclude, osteitis incidence is related to MRSA infection in patients with diabetic foot ulcers; thus, patients infected by S. aureus should be closely monitored in the course of using antibiotics and treated with narrow-spectrum antibiotics

Mucinous borderline ovarian tumor: a case report with diagnostic insights on ultrasound findings

Borderline ovarian tumors represent about 10% of all epithelial ovarian cancers, but in contrast to epithelial ovarian cancers, they constitute a group of tumors with a much better prognosis. An assessment of clinical presentation, physical examination, radiological and biochemical findings is necessary to tailor management strategies for patients with ovarian tumors. The article, which is based on a case report, describes different approaches for preoperative diagnosis as well as discusses approaches that might bring some insights on tumor histology. Furthermore, it raises a question about which imaging techniques should be proposed for a reliable diagnosis of borderline ovarian tumors to ensure safe surgery planning