Oleothorax

An 84-year-old woman presented with exertional dyspnoe, productive cough, but absence of chills, night sweats, or fever. Physical examination was unremarkable except for dullness and auscultatory absence of breath sounds over the right upper hemithorax. The patient’s previous medical history revealed the diagnosis of pulmonary tuberculosis at the age of 21. At that time, she was treated successfully with right artificial pneumothoraces and finally with “antiseptic oil”, but the patient was lost to follow-up thereafter

A primer to common major gastrointestinal post-surgical anatomy on CT—a pictorial review

The post-operative abdomen can be challenging and knowledge of normal post-operative anatomy is important for diagnosing complications. The aim of this pictorial essay is to describe a few selected common, major gastrointestinal surgeries, their clinical indications and depict their normal post-operative computed tomography (CT) appearance. This essay provides some clues to identify the surgeries, which can be helpful especially when surgical history is lacking: recognition of the organ(s) involved, determination of what was resected and familiarity with the type of anastomoses used

Hepatic adenomatosis: MR imaging features

Hepatocellular adenomas are rare benign liver neoplasms that commonly occur in women with a history of oral contraceptives intake for more than 2 years. Hepatic adenomatosis is characterized by the presence of multiple adenomas, arbitrarily > than 10, involving both lobes of the liver, without any history of steroid therapy or glycogen storage disease. Although the adenomas in liver adenomatosis are histologically similar to other adenomas, liver adenomatosis appears to be a separate clinical entity. Adenomas in hepatic adenomatosis may be of the inflammatory, hepatocyte nuclear factor 1alpha-mutated, or beta-catenin-mutated subtype, and accordingly show variable imaging appearances. Hepatic adenomatosis carries the risk of impaired liver function, hemorrhage and malignant degeneration. We report a case with the inflammatory subtype of hepatic adenomatosis in a 39-year-old woman with liver steatosis. The magnetic resonance imaging features using extracellular gadolinium chelates and hepatocyte-targeted contrast agents are described

Noninvasive multidetector computed tomography enterography in patients with small-bowel Crohn\u27s disease: is a 40-second delay better than 70 seconds?

BACKGROUND: Multidetector computed tomography (MDCT) enterography combines neutral enteric contrast with intravenously administered contrast material. The optimal intravenous (IV) contrast material protocol has still not been established. PURPOSE: To determine the optimal delay time to image patients with small-bowel Crohn\u27s disease during MDCT enterography. MATERIAL AND METHODS: After oral administration of 1350 ml of neutral contrast medium, 26 patients with small-bowel Crohn\u27s disease underwent MDCT enterography;scans were obtained 40 s (enteric phase) and 70 s (parenchymal phase) after IV administration of 100 ml of iodinated contrast material. Three radiologists, blinded to clinical and pathological findings, independently and retrospectively evaluated each scan in two separate reading sessions for the presence or absence of CT features of Crohn\u27s disease activity. The interobserver agreement was evaluated, and the efficacy of each phase in detecting active disease in the terminal ileum for each reader was determined. The gold standard was pathology (n=13), endoscopy (n=3), and clinical evaluation (n=10). RESULTS: No statistically significant difference was present between the enteric and the parenchymal phase for each reader in each segment regarding the presence or absence of CT features of Crohn\u27s disease. The interobserver agreement for the presence of five main features of active Crohn\u27s disease in the terminal ileum ranged from poor to excellent.The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for active Crohn\u27s disease in the terminal ileum ranged from 40 to 90%, 88 to 100%, 70 to 94%, 44 to 100%, and 69 to 96%, respectively. There was no statistical difference between the two phases for each reader. CONCLUSION: MDCT enterography in patients with suspected active Crohn\u27s disease can be obtained at either 40 s or 70 s after IV contrast material