Ингвино-скротална хернија на мочен меур

Herniation of urinary bladder through the inguinal canal is a rare disease that requires surgery. The resulting combination of failure of the abdominal wall and an increase in intra-abdominal pressure occurs prolapse of the urinary bladder in the inguinal canal and the occurrence of ingvino-scrotal hernia. This phenomenon is very rare and often misdiagnosed. It occurs more often in older men with increased body weight and symptoms of distal urinary obstruction and urinary infections. The symptoms usually are mild to moderate, associated with hindered urination and urinary infections, and if this condition promptly left untreated can lead to serious health problems, to renal failure. CT reconstruction in three planes is the method of choice in the diagnosis of ingvino-scrotal hernia of the bladder. This method provides a clear display of herniated part of the urinary bladder, and allows detection of the contents of the hernial sac.Хернијацијата на мочниот меур преку ингвиналниот канал е ретка болест која бара хируршка интервенција. Како резултат на комбинација на слабост на абдоминалниот ѕиди зголемување на интраабдоминалниот притисок се јавува пролапс на мочниот меур во ингвиналниот канал и појава на ингвино-скротална хернија. Оваа појава е многу ретка и често погрешно се дијагностицира. Се јавува почесто кај постари мажи со зголемена телесна тежина и со симптоми на опструкција на дисталните уринарни патишата и уринарни инфекции. Симптомите вообичаено се од благи до умерени, поврзани се со отежнатото мокрење и уринарни инфекции, а доколку оваа состојба навремено не се лекува може да доведе до посериозни здравствени проблеми, па се до бубрежна инсуфициенција. CT со реконструкција во три рамнини е метода на избор во дијагностиката на ингвино-скроталните хернии на мочниот меур. Оваа метода овозможува јасен приказ на хернираниот дел од мочниот меур, а овозможува и детекција на содржината на килната кеса

Компјутеризирана томографија базични принципи и протоколи

Книгата се состои од два дела, теортски дел и практичен дел, од 35 поглавја на вкупно 326 страници. Веднаш после воведот изнесени се основните физички принципи на рендгенските зраци, бидејки абсорпцијата на ртг. зраците е од особена важност за компјутризираната томографија (CT). Објаснета е конвенционалната, линеарна томографија како претходник на CT. Дадени се историските податоци во развојот на CT и првиот апарат за CT. Наведени се принципите за CT, започнувајки од геометријата на снопот, слабеењето на снопот, широчината на пресекот, детекторите на ртг. зраците, основните параметри и протокол на снимање. Објаснето е секвенционалното и спирално скенирање и добивање на слика со реконструкција и прикажана е градбата на новите повеќеслојни скенери. Објаснето е што претставува pixel, што е voxel, што претставува дензитетот и како се одредува. Објаснета е градбата на апаратот за CT. Изнесено е како се добиваат сигналите и обработката на податоците, како се добива CT слика, што е CT број, што е мрежа или матрикс на податоци, што е прозорец (windowing) и негово одредување на CT сликата. Објаснет е начинот на довбивање на CT слика, реконструкцијата со помош на пост процесинг. Прикажан е системот за CT и факторите од кои зависи квалитетот на CT сликата (шум, резолуција, контраст). Најчести артефакти на CT сликата и зошто се јавуваат. Прикажани се сите пет генерации на CT скенери и во што се состои разликата меѓу нив. Објаснети се основните принципи на работа со CT скенерот и користењето на тастатурата, глушецот, користење на работните прозорци и контролни кутии, како и картите со задачи, менија и алатки како дел од совтферскоот пакет кој го поседува секој CT скенер. Објаснет е протоколот на работа со CT скенерот од вклучување па се до исклучување на системот. Објаснет е потоколот за CT снимање на сите делови и органи од човечкото тело, индикациите за прегледот, како и предностите и недостатоците од прегледот. Изнесени се протоколите за преглед на секог дел од телото на човекот и параметрите на скенирањето кои се од особена важност за добивање на квалитетен преглед и кавлитетна CT слика. Сето тоа е пропратено со богата илустрација. На крајот е дадена најчестата CT терминологија и користената литература

CT Diagnosis of Rare Case of Morgagni Hernia in an Adult

1.1. Introduction: Morgagni’s hernia is the rarest of the congenital diaphragmatic defects with a reported frequency of 1% to 5.1% Morgagni hernias are more commonly seen on the right side and it occurs more commonly in females. However, most patients remain asymptomatic and the majority of cases are discovered incidentally while investigating unrelated problems. 1.2. Aim: The aim of this paper is to present a rare case of Morgagni hernia in adults and to emphasize the significant role of CT imaging in reaching the exact diagnosis of this condition. 1.3. Case report: We present a rare case of 46 years old female with an incidentally detected congenital diaphragmatic hernia on the right side. CT scan is the investigation of choice for diagnosis of Morgagni’s hernia as it allows clear visualization of the defect, and its contents. The diagnosis is established by the presence of a retrosternal mass of herniated omentum or by a transverse colon. Surgical treatment options include a transabdominal or transthoracic repair, but in the case of larger defects, a mesh may be necessary. 1.4. Conclusion: Most asymptomatic cases were found in adults by chest radiography for unrelated problems. The diagnosis in the suspected case can be confirmed by a CT scan

Инванзивен карцином на колон со метастаза на желудник

The stomach is a very rare location of metastatic deposits. We present a case of a gastric metastatic deposit from primary colon cancer. Computed tomography (CT) indicated primary colon cancer, but also revealed presence of cancer in the region of the gastric greater curvature and gastric antrum. With the progression of primary cancer and the creation of an extraluminal tumor mass, the process progresses in the manner that the primary transversal colon tumor merges into the metastatic deposit located in the stomach. The patient underwent subtotal gastrectomy and D2 lymphadenectomy, as well as partial resection of the transversal colon, thus the tumor mass of the stomach and the one in the transversal colon being removed in a single act. Pathohistological analysis of the tumor mass and immunohistochemical tests revealed a primary neoplastic infiltrative process in the colon metastasing into the stomach.Желудникот е многу ретка метастатска локализација. Прикажуваме случај на метастатски депозит на желудник од карцином на колон. Kомпјутеризираната томографија (КT) укажуваше на примарен карцином на дебелото црево, но истовремено се детектира и карцином во предел на големата кривина и антрумот на желудникот. Со прогресија на примарниот карцином исоздавање на екстралуминална туморскамаса, процесот прогредира при што доаѓа до спојување на примарниот тумор на трансверзалниот дел на колонот со метастатскиот депозит во желудникот. Кај пациентот беше извршена субтотална гастректомија и Д2 лимфаденектомија, како и парцијална ресекција на колонот, при што, во еден акт е отстранета туморскатамаса на желудникот и трансверзалниот дел од колонот. Со патохистолошка анализа на туморот и со имунохистохемиски испитувања се утврди дека станува збор за примарен неоинфилтративен процес на колонот со метастаза на желудникот

A rare case of Amyand’s hernia with acute appendicitis in a 69- year-old woman: a case report

Introduction: Amyand’s hernia is an extremely rare and atypical hernia that is difficult to diagnose clinically characterized by the herniation of the appendix into the inguinal sac. The aim of this report is to describe a case of Amyand’s hernia and highlights the importance of early CT scanning in reaching the exact and early diagnosis of Amyand’s hernia. Case report: We present a rare case of a 69-year-old female patient with a history of intermittent pain in the right inguinal region is see at the emergency surgical clinic. The patient underwent a CT scan of the abdomen and a small pelvis, and an inflamed appendix was diagnosed. The inflamed appendix is herniated in the inguinal hernia sac. Computed tomography was the only modality to diagnose the hernia sac contents preoperatively. Discussion: The reported incidence of Amyand’s hernia is less than 1% of all adult inguinal hernia cases. Acute appendicitis in Amyand’s hernia is even less common, with 0,1% of all cases of acute appendicitis. This hernia may be present without symptoms until the inflammation of the appendix may lead to incarceration, strangulation, necrosis, perforation, or rupture. Early symptoms include tenderness and inguinal swelling. Conclusions: Computer tomography helps make an accurate and timely diagnosis of Amyand’s hernia, thus avoiding complications from delayed surgery

Evaluation of Knee Sport Injuries with Magnetic Resonance Images

Introduction: The knee is one of the major weights bearing joint that provides not only mobility and stability during physical activity, but also balance while standing. Sport injuries are injuries caused by sports activities and may lead to severe pain and disability. Magnetic Resonance Imaging (MRI) is established as the leading modality for noninvasive evaluation of the sports knee injuries with its multiplanar capabilities and excellent soft-tissue contrast. The aim of the study: To investigate the accuracy of MRI in assessment of sport related knee injuries. Materials and methods: This is a prospective study which includes 50 patients with knee injuries during sport activities from period of May 2020 to September 2021. All patients came to department of traumatology at University clinic for Surgery “St. Naum Ohridski “-Skopje, and after physical examination were sent for MRI examination at the department of radiology at the same clinic. In all patients Magnetic Resonance Images (MRI) was performed at 1.5 T MR in SAG T2 weighted images, SAG Proton Density (PD) weighted images, COR STIR weighted images, COR T1 weighted images, AX PD weighted images and additional weighted images if it is needed for evaluating the anterior cruciate ligament. The results from MRI were evaluated and also compared with the results from arthroscopy or surgery. Results: 50 patients with knee sport injuries were included in study, from them 35 male and 15 female from age of 16 to 35. Depending on the sport which cases the injury 20 patients get knee injury while preforming handball, 10 football, 7 patients during ski activities, 3 patients during running and jumping, and the rest 10 patients from bicycling and other different sport activities. Depending on the MRI results: in 33 patient lesion of Anterior Cruciate Ligament (ACL) was detected on MRI, from which 7 patients were with complete lesion and 26 were with partial lesion. 3 patients have founding of bone edema and cartilage injuries. 2 patients have retinaculum lesions, 7 patients have meniscal lesion and 5 patients were with combined injuries of meniscal lesion and lesion of ACL. With comparison of the results from MRI finding with arthroscopy or surgery findings which were taken as a gold standard we get the accuracy of MRI in 66.7% of finding the meniscal complete lesion and 85.7% of meniscal incomplete lesion. The accuracy of MRI in detection the ACL lesion was 85.7% in complete ACL lesion and 80.8% for detection the ACL partial lesion. 100% for bone edema and cartilage lesion and also 100% for retinaculum lesion. Conclusion: MRI is noninvasive diagnostic tool with high accuracy and it is the primary approach in sport knee injuries. Thus MRI is superior to the diagnostic arthroscopy and we recommend MRI as the primary diagnostic tool for the evaluation of sports knee injuries. This study has shown total accuracy of MRI in finding the sport knee injuries at 87%, which makes it valuable noninvasive diagnostic tool for primary sport injuries

Cutaneous Metastases as an Initial Presentation of Neo Infiltrative Process in the Lungs: Case Report and Literature Review

Cutaneous metastases are a rare clinical entity with a representation of about 0.8% as a secondary MS deposit originating from another tissue/organ. Most often, skin metastases are associated with a high degree of malignancy and a poor prognosis. Our case report is a 72-year-old male patient who was referred to CT because of a large soft-tissue cutaneous lesion of the upper right hemithorax, somewhere below the right shoulder joint. At the radio diagnostics department, an MDCT native series and series after i.v. contrast was performed, which allowed us to detect a neo infiltrative process of the lung and secondary deposits in the lung itself, liver, left adrenal gland and along the seventh rib on the left. It was recommended to perform bronchoscopy and biopsy of the lung tissue, for the purpose of further differentiation and further treatment. A pathohistological analysis of the skin change itself was carried out, with an answer for a finding that corresponds to a deposit of a malignant neoplasm with spinous differentiation

Inflammatory breast cancer with brain metastases – case report

Inflammatory breast cancer sometimes metastasizes (spreads) to the brain. (1) This condition is commonly referred to as “secondary breast cancer in the brain”. (2) Brain metastases in breast cancer patients have a poor prognosis, with average survival ranging from 2 to 25,3 months despite the treatment (3) They are a major cause of mortality, associated with progressive neurological deficits resulting in reduced quality of life. Researchers found that people diagnosed HER2-positive or triplenegative inflammatory breast cancer in stage IV, have major risk of brain metastases, than people with other subtypes of inflammatory breast cancer. (3,9) Generally, women with inflammatory breast cancer present at younger age are more likely to have metastatic disease in diagnosis and have shorter survival than women with non-inflammatory breast cancer. (10

Ingvino-Scrotal Urinary Bladder Hernias

Хернијацијата на мочниот меур преку ингвиналниот канал е ретка болеÑÑ‚ која бара хируршка интервенција. Како резултат на комбинација на ÑлабоÑÑ‚ на абдоминалниот ѕид и зголемување на интраабдоминалниот притиÑок Ñе јавува Ð¿Ñ€Ð¾Ð»Ð°Ð¿Ñ Ð½Ð° мочниот меур во ингвиналниот канал и појава на ингвино-Ñкротална хернија. Оваа појава е многу ретка и чеÑто погрешно Ñе дијагноÑтицира. Се јавува почеÑто кај поÑтари мажи Ñо зголемена телеÑна тежина и Ñо Ñимптоми на опÑтрукција на диÑталните уринарни патишата и уринарни инфекции. Симптомите вообичаено Ñе од благи до умерени, поврзани Ñе Ñо отежнатото мокрење и уринарни инфекции, а доколку оваа ÑоÑтојба навремено не Ñе лекува може да доведе до поÑериозни здравÑтвени проблеми, па Ñе до бубрежна инÑуфициенција. CT Ñо реконÑтрукција во три рамнини е метода на избор во дијагноÑтиката на ингвино-Ñкроталните хернии на мочниот меур. Оваа метода овозможува јаÑен приказ на хернираниот дел од мочниот меур, а овозможува и детекција на Ñодржината на килната кеÑа.Herniation of urinary bladder through the inguinal canal is a rare disease that requires surgery. The resulting combination of failure of the abdominal wall and an increase in intra-abdominal pressure occurs prolapse of the urinary bladder in the inguinal canal and the occurrence of ingvino-scrotal hernia. This phenomenon is very rare and often misdiagnosed. It occurs more often in older men with increased body weight and symptoms of distal urinary obstruction and urinary infections. The symptoms usually are mild to moderate, associated with hindered urination and urinary infections, and if this condition promptly left untreated can lead to serious health problems, to renal failure. CT reconstruction in three planes is the method of choice in the diagnosis of ingvino-scrotal hernia of the bladder. This method provides a clear display of herniated part of the urinary bladder, and allows detection of the contents of the hernial sac

Atypical Localizations of Hydatid Disease: US and CT Evaluation

Abstract: Hydatid disease (HD) is a unique parasitic disease which is endemic in Macedonia, most frequent localized in liver and lungs. It appears in the form of solitary or multiple cysts, different in size, homogenous, clearly defined, sometimes accompanied by complications. In this research, we present our experience with atypical localizations of HD: kidney, brain, muscle-skeletal system, spleen, peritoneum, rectum, uterus, ovary, and breast. The patients were examined by using conventional radiologic and other imaging methods such as ultrasound (US) and computed tomography (CT). Renal echinococcosis was found in 7 patients, a brain in 3, skeletal in 2, spleen in 3, gallbladder in 2, peritoneal in 3, muscular in 1, ovarian in 2 and breast in one patient. Native radiograms showed multilayer calcifications and a soft tissue shadow, while contrast radiograms of the abdomen showed signs of intraperitoneal, extraluminal expansion, pressing the surrounding structures. Intravenous urography (IVU) gives pictures of a repressed channel system by a tumor formation, with signs of obstruction and hydronephrosis. US imaging has a great value in HD screening, being also cheap easily available, simple and with great diagnostic accuracy. CT imaging gives precise topographic and morphologic characteristics of the pathological process, highly sensitive, specific and also accurate. We can conclude that imaging methods have a great diagnostic value in HD with atypical localization. Keywords: echinococcosis, hydatid disease, hydatid cyst, atypical localisations, US and C