A rare cause of acute abdomen in the ED: Chemotherapy-induced pneumatosis intestinalis

WOS: 000424190600008PubMed: 29464220Pneumatosis intestinalis (PI) and portomesenteric venous gas (PVG) refers to the presence of air within the intestinal wall and portomesenteric vessels. Most of the time, it is associated with mesenteric ischemia that requires immediate surgical intervention as it has high mortality rate. It may also be seen secondary to various conditions, including infections, surgeries, and some chemotherapeutic drugs. A 61-year old-male was admitted to our emergency department complaining of abdominal pain after chemotherapy. Radiological evaluation of the patient demonstrated massive PVG and PI. Patient underwent urgent surgery due to the possibility of intestinal ischemia and infarction, but no necrosis was identified Chemotherapeutic drug-induced PI and PVG was the final diagnosis. Although PI and PVG are signs of mesenteric ischemia and intestinal necrosis most the of time, chemotherapeutic drugs may also cause PI and PVG rarely. Recent history of chemotheraphy and absence of any mesenteric vascular occlusion may be the diagnostic clue. Copyright (C) 2017 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license

A rare cause of acute abdomen in the ED: Chemotherapy-induced pneumatosis intestinalis

Pneumatosis intestinalis (PI) and portomesenteric venous gas (PVG) refers to the presence of air within the intestinal wall and portomesenteric vessels. Most of the time, it is associated with mesenteric ischemia that requires immediate surgical intervention as it has high mortality rate. It may also be seen secondary to various conditions, including infections, surgeries, and some chemotherapeutic drugs. A 61-year old-male was admitted to our emergency department complaining of abdominal pain after chemotherapy. Radiological evaluation of the patient demonstrated massive PVG and PI. Patient underwent urgent surgery due to the possibility of intestinal ischemia and infarction, but no necrosis was identified Chemotherapeutic drug-induced PI and PVG was the final diagnosis. Although PI and PVG are signs of mesenteric ischemia and intestinal necrosis most the of time, chemotherapeutic drugs may also cause PI and PVG rarely. Recent history of chemotheraphy and absence of any mesenteric vascular occlusion may be the diagnostic clue. Keywords: Pneumatosis intestinalis, Portomesenteric venous gas, Acute abdomen, Antineoplastic agents, Computed tomograph

Discrimination of oncocytoma and chromophobe renal cell carcinoma using MRI

WOS: 000462163200001PubMed ID: 30644365PURPOSE We aimed to evaluate magnetic resonance imaging (MRI) features, including signal intensities, enhancement patterns and T2 signal intensity ratios to differentiate oncocytoma from chromophobe renal cell carcinoma (RCC). METHODS This retrospective study included 17 patients with oncocytoma and 33 patients with chromophobe RCC who underwent dynamic MRI. Two radiologists independently reviewed images blinded to pathology. Morphologic characteristics, T1 and T2 signal intensities were reviewed. T2 signal intensities, wash-in, wash-out values, T2 signal intensity ratios were calculated. Sensitivity and specificity analyses were performed. RESULTS Mean ages of patients with oncocytoma and chromophobe RCC were 61.0 +/- 11.6 and 58.5 +/- 14.0 years, respectively. Mean tumor size was 60.6 +/- 47.3 mm for oncocytoma, 61.7 +/- 45.9 mm for chromophobe RCC. Qualitative imaging findings in conventional MRI have no distinctive feature in discrimination of two tumors. Regarding signal intensity ratios, oncocytomas were higher than chromophobe RCCs. Renal oncocytomas showed higher signal intensity ratios and wash-in values than chromophobe RCCs in all phases. Fast spin-echo T2 signal intensities were higher in oncocytomas than chromophobe RCCs. CONCLUSION Signal intensity ratios, fast spin-echo T2 signal intensities and wash-in values constitute diagnostic parameters for discriminating between oncoytomas and chromophobes. In the excretory phase of dynamic enhanced images, oncocytomas have higher signal intensity ratio than chromophobe RCC and high wash-in values strongly imply a diagnosis of renal oncocytoma