Multislice computed tomography (MSCT) of blunt abdominal trauma: incidental findings related to the genitourinary tract

Background: MSCT is currently the imaging modality of choice in the assessment of hemodynamically stable patients with blunt abdominal trauma. Widespread use of this modality can reveal incidental findings that vary in their importance, from trivial lesions to findings that may alter the management of these trauma patients. Objective: To determine the frequency of incidental findings related to the genitourinary tract at MSCT of blunt abdominal trauma and the effect of these findings on subsequent patient’s management. Material and Methods: MSCT examinations of blunt abdominal trauma in 151 consecutive patients within two years (2008-2009) were retrospectively reviewed. Demographic data and incidental findings related to the genitourinary tract were recorded. The subsequent management of these findings was reviewed from patient’s case note. Results: Twenty one (13.9%) patients had incidental findings related to the genitourinary tract in 151 cases reviewed. Majority of them (n=18) do not require surgical intervention. However, in 3 of these 21 patients, surgical intervention was needed. Conclusion: Incidental findings related to the genitourinary tract in MSCT of blunt abdominal trauma were common. However, those requiring a surgical intervention are rare

CT imaging of blunt splenic injury: a pictorial essay

Nonsurgical management has become the standard care for hemodynamically stable patients with splenic injury from blunt abdominal trauma. To attempt nonsurgical management, it is important to identify and characterize not only the splenic injury but also the concurrent injury to solid viscera, bowel and mesentry, or retroperitoneum that may require surgery. The ability of multi-detector row computed tomography (MDCT) to obtain high resolution images has made MDCT the primary imaging modality for the evaluation of these patients. The CT features of splenic injury include lacerations, subcapsular or parenchymal hematomas, active hemorrhage and vascular injuries. A variety of CT grading systems have been proposed to grade splenic injury following trauma. Radiologists should be familiar with the splenic injury grading system to facilitate communication with the managing surgical team and for research purposes. In Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, from January 2008 to December 2009 there were 42 cases of splenic injuries out of 154 cases of blunt abdominal trauma, which underwent CT assessment. We reviewed all 42 cases of splenic injury and illustrated the spectrum of CT findings based on American Association for the Surgery of Trauma (AAST) classification

Miracle of imaging: the truth is out there!

Introduction In medical practice, we encounter many diseases, which can manifest in different ways. Most of the time, careful history taking and meticulous clinical examination can easily direct the clinician towards an accurate diagnosis. While with others, they may need further supporting evidence either from laboratory investigations or imaging. Likewise, the radiologists face daily challenges of analyzing and interpreting high volume of images in a timely manner. Appropriate diagnosis or differential diagnosis can be derived from cases with good clinical correlation. However, it can be misleading for the radiologists when interpreting images in cases where the history or clinical presentation is unclear although meticulous image assessment for high quality diagnostic and patient care are indeed paramount. Case series We retrospectively reviewed cases where discrepancies existed between the indications for the imaging with findings detected during these investigations. The subsequent management or outcome of the patients is briefly described. Conclusion Thorough history and good clinical assessment can guide radiologists in the analysis and interpretation of the radiological images in most patients. Our illustration of cases will be a good reminder for radiologists to always be meticulous when interpreting images to minimize errors or missed abnormalities as misleading history or clinical presentation is bound to happen

Accidental and non-accidental head injury in children. Is there a difference in Tomography (CT) presentation?

Introduction: Differentiation between accidental and non-accidental head injury particularly with intracranial haemorrhages in children is a common medical & legal dilemma. Previous studies & research based on surgical, radiological & autopsy data suggest that different types of brain injuries tend to occur with accidental versus non-accidental trauma. Published data showed that CT brain findings of subdural bleed are more frequently encountered with nonaccidental causes of head injury. Objective: To see if there is any significant difference in the types of intracranial hemorrhages seen on computed tomography (CT) brain between accidental and nonaccidental head injury in children admitted to Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang. Methodology: All CT brain of children (newborn to 18 yrs of age)admitted to HTAA from September 2009 until September 2010 which demonstrated intracranial bleed,traced from the CT scan registration book and from the PACS/RIS systems (Picture Archiving and Communication System / Radiology Information System)were included in this study. Patient’s clinical notes were traced from HTAA’s Record Office. The causes of non-accidental and accidental head injury were determined. All the CT images were interpreted independently by 2 radiologists who were blinded to the indication of the CT examination. Statistical analysis were done using SPSS version 12. Conclusion: Although limited by a small number of patients with non-accidental injury, our data showed that CT brain findings of subdural haemorrhage has a statistically significant association with non-accidental injury. This is similar with other published data in the literature

Endovascular embolisation in acute arterial haemorrhage cases and hypervascular lesions: a single institution experience

Introduction Endovascular embolisation had played a major role in the acute management of acute arterial haemorrhage. It had proven benefits in acute upper and lower gastrointestinal haemorrhage, massive haemoptysis, bleeding visceral pseudoaneurysms and arteriovenous malformations. It also had played a major role in the preoperative embolisation of hypervascular lesions such as paraganglioma, meningioma, juvenile angiofibroma and other hypervascular lesions, with proven reduction in blood loss intraoperatively. Purpose of Study The purpose of this study is to evaluate our single institution experience in endovascular embolisation of acute arterial haemorrhage cases and preoperative embolisation of hypervascular lesions. Materials and Methods All cases which undergo endovascular embolisation from June 2009 until March 2011 were included in this series. Patient’s demography, preembolisation studies, embolisation studies and clinical followup post procedure were recorded. Results For a period of 22 months, there were a total of 10 cases of acute arterial haemorrhage and 4 cases of hypervascular lesions which undergo endovascular embolisation (n=14). The acute arterial haemorrhage cases ranging from lung lesions with haemoptysis, renal artery pseudoaneurysm, hepatic artery pseudoaneurysm, left gastric artery pseudoaneurysm, renal artery arteriovenous malformation and gluteal arteriovenous malformation. The hypervascular lesions include carotid body paraganglioma, parapharyngeal tumour, renal cell carcinoma, and renal cell carcinoma metastases. Various embolic materials were used ranging from glue, gelfoam, coils and PVA. All cases of acute arterial haemorrhage had cessation of haemorrhage immediately post embolisation. For preoperative embolisation of hypervascular lesions, all cases had marked reduction in the intraoperative blood loss. Conclusion In this limited series, endovascular embolisation had shown to be effective in controlling acute arterial haemorrhage and also reducing intraoperative blood loss in hypervascular lesions

Melioidotic prostatic abscess in Pahang

Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative bacillus. Melioidosis can affect many organs, including the prostate. However, prostatic abscess due to melioidosis is uncommon. We describe five cases of melioidosis with prostatic abscess. Four of five patients had diabetes mellitus and had more than one organ involvement. The diagnosis of prostatic abscess in our patients was only made with computed tomography of the abdomen and pelvis. None of our patients underwent surgical drainage and all remained well after treatment with antibiotics, except for one mortality secondary to severe septicaemia

Hepatic steatosis among chronic hepatitis C infected patients selected for treatment - a retrospective analysis

Hepatic steatosis is a common feature of chronic hepatitis C (CHC). It is caused directly by the virus (genotype 3)or host metabolic factors. We analyzed liver biopsy results among all patients selected for the treatment. Methods: We retrospectively looked into CHC patients selected for treatment from 2005 - 2007,Kuantan Hospital, Malaysia. Fifteen patients were identified between the ages of 19 - 58 years. Blood results for HCV RNA viral load, genotyping, lipid profile, liver biopsy (Ishak et al score) and body mass index (BMI) were documented pretreatment. Results: Seven patients were genotype 1, 6 patients were genotype 3 and 1 patient each for genotype 2 and 6 respectively. Majority of patients had mild hepatic steatosis, 60% (n=9/15) pretreatment and highest were among genotype 1, 33.3% (n=5/15), followed by genotype 3, 20% (n=3/15) and genotype 2, 6% (n=1/15). Among them, 8 out of 15 (53.3%) patients had normal trigliseride (TG) level, 5 out of 15 (33.3%) patients had BMI <25 and 6 out of 15 (40%) patients had high viral load (HVL, >400,000 iu/ml). Conclusions: We observed that the majority of patients with CHC had mild hepatic steatosis, 60% (n=9/15) with normal TG, 53.3% (n=8/15) and amongst genotype 1, 33.3% (n=5/15). Higher viral load might have an influence in the development and progression of steatosis in CHC

Usefulness of CT colonography after incomplete or failed colonoscopy

OBJECTIVE To evaluate the clinical usefulness of CT Colonography after an incomplete or failed colonoscopy. MATERIALS AND METHODS After incomplete or failed colonoscopy, seventeen patients underwent CT Colonography before and after intravenous injection of iodinated contrast agent, in supine and prone positions. Two-dimensional multiplanar reformatted images and three-dimensional endoluminal images were analyzed. The endoluminal navigations were performed from rectum to caecum, in both retrograde and antegrade directions in order to visualize both sides of haustral folds. We analyzed reasons for incomplete colonoscopy as well as colonic and extracolonic findings. RESULTS Reasons for incomplete colonoscopy includes stenosing or constricting tumour (5 patients), redundant colonic segments or difficulty in manipulating the endoscopes (8 patients), and unable to tolerate the pain (1 patient). Failed CT Colonography for 3 patients were due to intolerable pain. Proximal colon and undiagnosed colonic lesions on colonoscopy were assessed via CT Colonography, making it a useful tool for this group of patients. Additional findings of tumour invasion, nodal and liver metastasis were also identified in this study, apart from other extracolonic findings like ovarian tumour, cholelithiasis and inguinal hernias. DISCUSSION Colonoscopy is regarded as the gold standard for the evaluation of the colon for colorectal tumors, but it may be incomplete due to tumor obstruction, difficult manipulation or patient’s intolerance. Failure to visualize the entire colonic surface occurs in 5-10% of colonoscopy examinations (1). In these instances, further evaluation is necessary. Many reports described the ability of CT colonography to show the colon proximal to occlusive cancer, and in evaluation of entire colon in incomplete or failed colonoscopy cases (1-5). The results of CTC in occlusive colorectal tumors are encouraging and evaluation of the whole colon by CTC is reportedly effective. CTC not only provide knowledge of whole colorectal lesions, but accurate tumor localization and tumor extent, tumor/nodal staging, and extra-colic abnormalities can also be assessed, which are critical for the proper management of patients with colorectal tumors (5). CONCLUSION CT colonography is a rapid, well-tolerated technique that provides useful colonic and extracoIonic informations and should be considered for all patients who undergo incomplete colonoscopy or failed colonoscopy. This preliminary data suggest that CT colonography has an adjunctive role in this group of patients

Imaging of CT colonography : a pictorial review

Computed Tomography Colonography (CTC), also referred to as virtual colonoscopy is a new diagnostic technique that uses special software to simulate conventional endoscopy. CTC uses data from Computed Tomography (CT) to generate two- and fly-through endoluminal three-dimensional images of the colon and rectum. CTC is an alternative to colonoscopy for diagnostic purposes in symptomatic patients with contraindications to conventional colonoscopy, and when the colonoscopy cannot be completed due to some reasons. The common imaging features of CTC were presented in this pictorial review