Two cases of blunt mesenteric injury were presented. In both cases, contrast-enhanced CT of the a... more Two cases of blunt mesenteric injury were presented. In both cases, contrast-enhanced CT of the abdomen showed contrast extravasation in the intraperitoneal cavity (indicating injury of the superior mesenteric artery), bowel Wall thickening, hemoperitoneum and mesenteric hematoma. Under impression of mesenteric injury, emergency laparotomy was performed in both of the patients: two lacerations of the jejunal mesentery were identified in patient I and one laceration of the ileal mesentery was found in patient 2. Bowel resection was carried out in both of the patients. The course was uneventful during the 12 days and 11 days of hospitalization for patients 1 and 2 respectively
A 77-year-old male farmer sustained severe abdominal cramping pain for one hour. Contrast-enhance... more A 77-year-old male farmer sustained severe abdominal cramping pain for one hour. Contrast-enhanced multidetector computed tomography (MDCT) showed a 5.2 cm, oval lesion with interior mottled gas and slightly hyperdense component in the small bowel loop causing distension of the proximal small bowel loop. CT diagnosis of a bezoar in the small bowel causing bowel obstruction was made. Exploratory laparotomy disclosed a foreign body of soft texture in the jejunum located at 150 cm from the ligament of Treitz. A whole, undigested shiitake mushroom was noted after incision of the bowel. The patient had an uneventful course during the 9 days of hospitalization. The patient had recalled that he did not have any teeth and did not use dentures during eating, and accidentally swallowed the shiitake mushroom 2 days before the incident occurred.
International Journal of Medical Reviews and Case Reports, 2021
A 53-year-old male patient presented with chest pain and tightness for one hour. Frontal chest ra... more A 53-year-old male patient presented with chest pain and tightness for one hour. Frontal chest radiograph showed a tortuous aorta and a subtle aortic nipple at the left aspect of the aortic arch; the azygos vein shadow was not seen. Contrast-enhanced multi-detector row computed tomography (MDCT) showed absent azygos vein and prominent left superior intercostal vein communicating the accessory hemiazygos vein to the left brachiocephalic vein. Clinical improvement was noted. The patient was then discharged from the emergency department.
Gaoxiong yi xue ke xue za zhi = The Kaohsiung journal of medical sciences, 1995
Calcification in malignant lymphoma before treatment is rare. Here we report a case of low grade ... more Calcification in malignant lymphoma before treatment is rare. Here we report a case of low grade non-Hodgkin lymphoma of sclerosing type presenting as a retroperitoneal calcified mass. The calcification was demonstrated with various imaging modalities, including conventional radiographs, sonography, computed tomography (CT) and magnetic resonance (MR) imaging. This case and other isolated reports show that radiographical examinations may, rarely, reveal calcification in lymphoma prior to treatment.
A 58-year-old woman suffered from dyspnea, epigastric pain, and abdominal fullness for 1 day. She... more A 58-year-old woman suffered from dyspnea, epigastric pain, and abdominal fullness for 1 day. She was overweight, with a body mass index (BMI) of 27.8 kg/m^2. Laparoscopic cholecystectomy had been performed 2 months prior for cholelithiasis and acute cholecystitis. The blood analysis revealed elevated liver enzymes (glutamic oxaloacetic transaminase, 199 μ/L; glutamic pyruvic transaminase, 125 μ/L). Contrast-enhanced multidetector row computed tomography (MDCT) of the abdomen showed a short segment of the small bowel loop incarcerated inside the umbilicus causing a closed-loop obstruction and dilatation of the proximal small bowel loop, a segment of the transverse colon herniated through the esophageal hiatus into the posterior mediastinum, with the gastroesophageal junction and stomach in the normal intra-abdominal location. Therefore, CT diagnosis of incarcerated umbilical hernia and isolated colonic hiatal hernia was established. Emergent laparotomy was performed with segmental r...
Trauma is the leading cause of nonobstetric maternal mortality, affecting up to 8% of pregnancies... more Trauma is the leading cause of nonobstetric maternal mortality, affecting up to 8% of pregnancies and representing a significant cause of fetal death. A 34-year-old patient with a 17-week pregnancy was a restrained front seat passenger in a head-on motor vehicle crash. Emergency computed tomography (CT) of the abdomen and pelvis with intravenous contrast administration revealed a hyperdense nodule in the right adrenal gland, a lack of contrast enhancement in a significant area of the placenta, retroplacental hyperdensity, hyperdense amniotic fluid, and a displaced parietal skull fracture of the fetus. A right adrenal hemorrhage, placental abruption, and an intrauterine fetal skull fracture were diagnosed by CT; the latter two CT findings were confirmed in the emergency cesarean section. This case emphasizes that CT is the proven modality of choice for the evaluation of injured pregnant patients and the gravid uterus. Following the CT evaluation, immediate action should be taken to r...
Sixteen patients with traumatic injury to the knees were surveyed with magnetic resonance (MR) ma... more Sixteen patients with traumatic injury to the knees were surveyed with magnetic resonance (MR) machines with field strength of either 0.5 Tesla (T) using head coil (10 cases) or 1.5 T using dedicated knee coil (6 cases). Tears of the anterior cruciate ligament (ACL) were found in eight cases. The other eight cases had injuries of the other ligaments, meniscus or bone with intact ACL. All cases were proved by arthroscopy. Primary and secondary signs of the ACL tears were evaluated by MR imaging. Primary signs included the status of ACL. Secondary signs consisted of bone bruise in the posterolateral tibial plateau, in the lateral femoral condyle, or both (so-called kissing bone bruise), fracture at the posterolateral tibial plateau, Segond fracture, anterior dislocation of the tibia (> 5 mm), buckled posterior cruciate ligament (PCL), positive PCL line and the deep lateral femoral notch (> 1.5 mm). Of the eight cases of the ACL tears, 5 cases (62.5%) revealed thickening and edem...
The purpose of this study is to review the com-puted tomography(CT)appearances of the lung dis-ea... more The purpose of this study is to review the com-puted tomography(CT)appearances of the lung dis-eases including carcinoma, non-cancerous dis-eases and pulmonary tuberculosis. Thirty one patients with 15 cases of lung carcinoma and 16 cases of non-cancerous diseases(including 10 cases of tuberculosis) were evaluated based on the CT findings of mass(or large nodule), consolidation, intralesional cavitation, intralesional necrosis, nodular opacities, lober or segmental distribution, extension to the mediastinum, encasement of great vessels, mediastinal lymphadenopathy and pleural effusion. The results were compared between lung carcinoma and non-cancerous disease and between lung carcinoma and tuberculosis using Fisher's Exact test. Our results show that mass(or large nodule) and necrosis are more common in lung car-cinoma while consolidation and cavitation are more frequently found in non-cancerous diseases and tuberculosis. Nodular opacities are more specific for tuberculosis. We ...
International Journal of Case Reports and Images, 2016
Introduction: The detection of pelvic masses with an elevated blood cancer antigen 125 (CA-125) l... more Introduction: The detection of pelvic masses with an elevated blood cancer antigen 125 (CA-125) level is highly suggestive of ovarian cancer. However, various benign and inflammatory gynecological conditions and non-gynecological processes, such as liver and pulmonary diseases, may be associated with an elevated serum CA-125 level, especially in premenopausal women. Case Report: An 18-year-old female patient with lower abdominal pain for three days presented to our hospital. No fever was noted. Blood cancer antigen 125 (CA-125) level was elevated (660 U/mL; normal value, <35 U/mL), while the levels of other tumor markers (α-fetoprotein, carcinoembryonic antigen, β-human chorionic gonadotropin, and CA-199) were within normal limits. Transabdominal ultrasonography showed multicystic lesions with interior septation in the adnexal regions on both sides, suggesting the presence of cystic masses in both ovaries. Contrast-enhanced magnetic resonance imaging (MRI) revealed dilated and tu...
Gaoxiong yi xue ke xue za zhi = The Kaohsiung journal of medical sciences, 1995
A case of mandibular arteriovenous malformation (AVM) is presented. Prompt diagnosis and appropri... more A case of mandibular arteriovenous malformation (AVM) is presented. Prompt diagnosis and appropriate management are essential due to massive bleeding or even death after dental extraction or biopsy. Angiography remains the gold standard in detecting the lesion. Magnetic resonance (MR) imaging with spin-echo sequences reveals the vascular malformation as signal-void. MR angiography can demonstrate the nidus, dilated artery and vein. MR imaging and MR angiography can supplement angiography in the diagnosis of mandibular AVM.
Internal hernia is a rare cause of small bowel loop obstruction. Hernia through a defect of the b... more Internal hernia is a rare cause of small bowel loop obstruction. Hernia through a defect of the broad ligament is extremely rare. A female patient who had received laparoscopic oocyte retrieval 20 years ago suffered from intermittent lower abdominal cramping pain and vomiting. Internal hernia through the defect of the broad ligament is confirmed through a series of imaging studies and surgical exploration. To the best of our knowledge, this is the first case of internal hernia through a defect of the broad ligament in which the small bowel loop inside the herniated sac is collapsed rather than dilated, as noted on the computed tomography and surgical finding.
Internal abdominal herniation is infrequent, accounting for approximately 4.1% of small bowel obs... more Internal abdominal herniation is infrequent, accounting for approximately 4.1% of small bowel obstructions. Pericecal herniation, which constitutes 10-15% of all internal abdominal herniations, may be congenital, because of herniation of a segment of the small bowel loop through one of the several pericecal recesses, or acquired, because of an adhesion band. A 70-year-old woman experienced severe right upper abdominal pain and vomiting for 1 day. Tenderness was noted in the right upper abdomen. Results of blood and urine analyses were normal. She had undergone an appendectomy 30 years previously. On the basis of computed tomography (CT) findings, a preoperative diagnosis of pericecal hernia was obtained. Immediate surgical exploration revealed an adhesion band between the appendiceal stump and the omentum; a 70-cm-long portion of the jejunum had herniated through the acquired defect. Preoperative recognition of the specific CT signs of pericecal hernia may prompt immediate surgery t...
Purpose: 80% of salivary gland tumors are of parotid origin; of these, 80% are benign and 20% are... more Purpose: 80% of salivary gland tumors are of parotid origin; of these, 80% are benign and 20% are malignant. Metastases are rarely found in the parotid gland. Nasopharyngeal carcinoma (NPC) metastasis to the parotid gland is even rarer. We present a case of a parotid mass as an initial manifestation of NPC metastasis. Material and methods: A 68 year-old male patient suffered from a tender, firm and palpable mass and numbness in right infra-auricular region for one month. Contrast-enhanced computed tomography (CT) showed diffuse contrast enhancement of the right parotid gland, bilateral neck level II enlarged lymph nodes, and a subtle bulging lesion at the nasopharynx. Ultrasonography (US) demonstrated hypoechoic lymph nodes in right parotid gland and right neck level II area. Endoscopy disclosed a bulging lesion in the nasopharynx. Results: US-guided fine-needle aspiration biopsy (FNAB) for the lymph node in right intraparotid region showed positive malignant cells. Excision of the right parotid gland mass revealed lymphoepithelial carcinoma. Biopsy of the nasopharyngeal mass demonstrated undifferentiated nasopharyngeal carcinoma. Therefore, NPC metastasis to the parotid gland was confirmed. Conclusion: A preoperative FNAB of the parotid mass plays a key role in the treatment decision-making process. When associated with a subtle bulging nasopharyngeal lesion on CT, the possibility of NPC with parotid gland metastasis, although rare, should be kept in mind because such findings may have a major impact on the patient management
International Journal of Surgery and Medicine, 2018
Pneumatosis intestinalis in association with gas in the superior mesenteric and hepatic portal ve... more Pneumatosis intestinalis in association with gas in the superior mesenteric and hepatic portal vein (portomesenteric venous gas) is typically due to bowel infarction and carries an ominous outcome. Much less commonly, it may be the result of nonischemic etiologies. We present a rare case of acute perforated appendicitis associated with pneumatosis intestinalis of the small bowel loop, and portomesenteric venous gas. Materials and methods: A 79-year-old male patient suffered from diffuse abdominal pain and cold sweating in the morning of the admission. Mild fever, tachycardia, diffuse abdominal distension and tenderness were noted. The blood analysis showed leukocytosis. A plain abdominal radiograph revealed distension of the bowel loop. CT of the abdomen showed swollen appendix with periappendiceal fluid, distension of small bowel loop, bowel wall gas in a segment of small bowel loop, and portomesenteric venous gas. Therefore, a CT diagnosis of acute perforated appendicitis, and probably bowel infarction was made. Results: Emergency exploratory laparotomy was performed. Fecal material was seen surrounding the cecum, and the appendix showed gangrenous change and perforation. Appendectomy was done. A 30 cm segment of ileum disclosed hyperemic change and marked distension, and decompression was performed. Two days later, second-look laparotomy showed no bowel ischemia. Due to persistent post-operative fever and turbid discharge from the surgical site, the patient's family asked for a transfer to the other hospital on the 15th postoperative day. The patient was finally discharged after infection control at the other hospital for a 43-day period of the second hospitalization. No bowel ischemia was noted during the second course of the hospitalization. Conclusion: The mechanism of pneumatosis intestinalis and portomesenteric gas may be due to increased intraluminal pressure and associated mucosal disruption of the small bowel, leading to gas entering the bowel wall, through the superior mesenteric vein and subsequently to the hepatic portal vein. The clinical outcome is determined by the underlying disease and not just the presence of superior mesenteric and portal venous gas. KEYWORDS acute appendicitis, pneumatosis intestinalis, portomesenteric venous gas Figure 1 (A,B) (A) CT topogram of the abdomen showed distended small bowel loop. (B) Non-contrast-enhanced CT showed the swollen appendix (arrow) with a diameter of 0.9 cm and with periappendiceal infiltration and minimal fluid accumulation.
Male breast cancer is rare, accounting for about 1% of all breast cancers. Hepatocellular carcino... more Male breast cancer is rare, accounting for about 1% of all breast cancers. Hepatocellular carcinoma (HCC) is associated with liver cirrhosis in 70%e80% of cases; serum alpha-fetoprotein level is normal in less than half of HCC cases. We describe an 80-year-old male patient who experienced nausea and abdominal pain after food intake. On physical examination, a large, protruding, lobulated, and hard mass with skin discoloration was observed in the area of left breast. The serum alpha-fetoprotein level was normal. Ultrasonography (US) of the abdomen showed findings compatible with cholelithiasis, acute cholecystitis, liver cirrhosis, and a mixed-echoic tumor in segment 6 (S6) of the liver. Contrast-enhanced computed tomography (CT) with arterial and portal venous phases demonstrated the typical findings of cholelithiasis and acute cholecystitis; it also revealed a nodular liver surface, and a hypervascular liver tumor with an early washout pattern. Therefore, liver cirrhosis and HCC in S6 of the liver were suspected. A huge, irregular, lobulated mass with interior septation, solid and fluid components, and an enhanced solid component was also found in the subareolar region of the left breast. US-guided biopsy of the liver tumor was performed and a diagnosis of HCC was established. Laparoscopic cholecystectomy and an excision of the left breast mass were performed. The breast mass was pathologically confirmed to be infiltrating ductal carcinoma not otherwise specified and with predominantly cystic degeneration. The patient received chemotherapy with tamoxifen for the breast cancer, and transarterial chemoembolization for the HCC. Concomitant breast cancer and HCC in a male patient were rarely reported in the literature. Herein, we have discussed the possible relationship of these two disease entities.
The purpose of this study was to evaluate the need for clinical information and intravenous iodin... more The purpose of this study was to evaluate the need for clinical information and intravenous iodine contrast administration for disease diagnosis in patients undergoing emergent abdominal computed tomographic (CT) examination. A total of 150 patients (85 males and 65 females; mean age = 52.4 years) who were examined by emergent abdominal CT scanning were evaluated prospectively during a 3.month period. Nonenhanced and contrast-enhanced contiguous images were obtained with a helical CT scanner. Film interpretation was provided by three radiology specialists. The diagnoses were made separately in three phases by all three radiologists: (1) nonenhanced images with no clinical information provided; (2) nonenhanced images with clinical information; and (3) combined enhanced images with clinical information. The interobserver difference was analyzed by a chi-square test. The
Ectopic pelvic kidney is a rare developmental anomaly. Ectopic pelvic kidney can present without ... more Ectopic pelvic kidney is a rare developmental anomaly. Ectopic pelvic kidney can present without the characteristic symptoms associated with the urinary tract pathology. Ectopic pelvic kidney is usually unknown, and nonspecific vague abdominal comfort maybe the only symptom. Early detection and recognition of an ectopic kidney can prevent long-term complications. We report a 3-year-5-month-old girl with ectopic pelvic kidney who experienced intermittent episodes of lower abdominal pain for about 1 month. Abdominal ultrasound, computed tomography, and intravenous pyelography demonstrated a pelvic kidney. Thereafter, the urinalysis showed pyuria (white blood cell 20/high power field), and urine culture grew Escherichia coli. We emphasize that pelvic kidney should be considered in patients presenting unexplained vague abdominal pain, especially in pediatric patients who had intermittent recurrent episodes.
Two cases of blunt mesenteric injury were presented. In both cases, contrast-enhanced CT of the a... more Two cases of blunt mesenteric injury were presented. In both cases, contrast-enhanced CT of the abdomen showed contrast extravasation in the intraperitoneal cavity (indicating injury of the superior mesenteric artery), bowel Wall thickening, hemoperitoneum and mesenteric hematoma. Under impression of mesenteric injury, emergency laparotomy was performed in both of the patients: two lacerations of the jejunal mesentery were identified in patient I and one laceration of the ileal mesentery was found in patient 2. Bowel resection was carried out in both of the patients. The course was uneventful during the 12 days and 11 days of hospitalization for patients 1 and 2 respectively
A 77-year-old male farmer sustained severe abdominal cramping pain for one hour. Contrast-enhance... more A 77-year-old male farmer sustained severe abdominal cramping pain for one hour. Contrast-enhanced multidetector computed tomography (MDCT) showed a 5.2 cm, oval lesion with interior mottled gas and slightly hyperdense component in the small bowel loop causing distension of the proximal small bowel loop. CT diagnosis of a bezoar in the small bowel causing bowel obstruction was made. Exploratory laparotomy disclosed a foreign body of soft texture in the jejunum located at 150 cm from the ligament of Treitz. A whole, undigested shiitake mushroom was noted after incision of the bowel. The patient had an uneventful course during the 9 days of hospitalization. The patient had recalled that he did not have any teeth and did not use dentures during eating, and accidentally swallowed the shiitake mushroom 2 days before the incident occurred.
International Journal of Medical Reviews and Case Reports, 2021
A 53-year-old male patient presented with chest pain and tightness for one hour. Frontal chest ra... more A 53-year-old male patient presented with chest pain and tightness for one hour. Frontal chest radiograph showed a tortuous aorta and a subtle aortic nipple at the left aspect of the aortic arch; the azygos vein shadow was not seen. Contrast-enhanced multi-detector row computed tomography (MDCT) showed absent azygos vein and prominent left superior intercostal vein communicating the accessory hemiazygos vein to the left brachiocephalic vein. Clinical improvement was noted. The patient was then discharged from the emergency department.
Gaoxiong yi xue ke xue za zhi = The Kaohsiung journal of medical sciences, 1995
Calcification in malignant lymphoma before treatment is rare. Here we report a case of low grade ... more Calcification in malignant lymphoma before treatment is rare. Here we report a case of low grade non-Hodgkin lymphoma of sclerosing type presenting as a retroperitoneal calcified mass. The calcification was demonstrated with various imaging modalities, including conventional radiographs, sonography, computed tomography (CT) and magnetic resonance (MR) imaging. This case and other isolated reports show that radiographical examinations may, rarely, reveal calcification in lymphoma prior to treatment.
A 58-year-old woman suffered from dyspnea, epigastric pain, and abdominal fullness for 1 day. She... more A 58-year-old woman suffered from dyspnea, epigastric pain, and abdominal fullness for 1 day. She was overweight, with a body mass index (BMI) of 27.8 kg/m^2. Laparoscopic cholecystectomy had been performed 2 months prior for cholelithiasis and acute cholecystitis. The blood analysis revealed elevated liver enzymes (glutamic oxaloacetic transaminase, 199 μ/L; glutamic pyruvic transaminase, 125 μ/L). Contrast-enhanced multidetector row computed tomography (MDCT) of the abdomen showed a short segment of the small bowel loop incarcerated inside the umbilicus causing a closed-loop obstruction and dilatation of the proximal small bowel loop, a segment of the transverse colon herniated through the esophageal hiatus into the posterior mediastinum, with the gastroesophageal junction and stomach in the normal intra-abdominal location. Therefore, CT diagnosis of incarcerated umbilical hernia and isolated colonic hiatal hernia was established. Emergent laparotomy was performed with segmental r...
Trauma is the leading cause of nonobstetric maternal mortality, affecting up to 8% of pregnancies... more Trauma is the leading cause of nonobstetric maternal mortality, affecting up to 8% of pregnancies and representing a significant cause of fetal death. A 34-year-old patient with a 17-week pregnancy was a restrained front seat passenger in a head-on motor vehicle crash. Emergency computed tomography (CT) of the abdomen and pelvis with intravenous contrast administration revealed a hyperdense nodule in the right adrenal gland, a lack of contrast enhancement in a significant area of the placenta, retroplacental hyperdensity, hyperdense amniotic fluid, and a displaced parietal skull fracture of the fetus. A right adrenal hemorrhage, placental abruption, and an intrauterine fetal skull fracture were diagnosed by CT; the latter two CT findings were confirmed in the emergency cesarean section. This case emphasizes that CT is the proven modality of choice for the evaluation of injured pregnant patients and the gravid uterus. Following the CT evaluation, immediate action should be taken to r...
Sixteen patients with traumatic injury to the knees were surveyed with magnetic resonance (MR) ma... more Sixteen patients with traumatic injury to the knees were surveyed with magnetic resonance (MR) machines with field strength of either 0.5 Tesla (T) using head coil (10 cases) or 1.5 T using dedicated knee coil (6 cases). Tears of the anterior cruciate ligament (ACL) were found in eight cases. The other eight cases had injuries of the other ligaments, meniscus or bone with intact ACL. All cases were proved by arthroscopy. Primary and secondary signs of the ACL tears were evaluated by MR imaging. Primary signs included the status of ACL. Secondary signs consisted of bone bruise in the posterolateral tibial plateau, in the lateral femoral condyle, or both (so-called kissing bone bruise), fracture at the posterolateral tibial plateau, Segond fracture, anterior dislocation of the tibia (> 5 mm), buckled posterior cruciate ligament (PCL), positive PCL line and the deep lateral femoral notch (> 1.5 mm). Of the eight cases of the ACL tears, 5 cases (62.5%) revealed thickening and edem...
The purpose of this study is to review the com-puted tomography(CT)appearances of the lung dis-ea... more The purpose of this study is to review the com-puted tomography(CT)appearances of the lung dis-eases including carcinoma, non-cancerous dis-eases and pulmonary tuberculosis. Thirty one patients with 15 cases of lung carcinoma and 16 cases of non-cancerous diseases(including 10 cases of tuberculosis) were evaluated based on the CT findings of mass(or large nodule), consolidation, intralesional cavitation, intralesional necrosis, nodular opacities, lober or segmental distribution, extension to the mediastinum, encasement of great vessels, mediastinal lymphadenopathy and pleural effusion. The results were compared between lung carcinoma and non-cancerous disease and between lung carcinoma and tuberculosis using Fisher's Exact test. Our results show that mass(or large nodule) and necrosis are more common in lung car-cinoma while consolidation and cavitation are more frequently found in non-cancerous diseases and tuberculosis. Nodular opacities are more specific for tuberculosis. We ...
International Journal of Case Reports and Images, 2016
Introduction: The detection of pelvic masses with an elevated blood cancer antigen 125 (CA-125) l... more Introduction: The detection of pelvic masses with an elevated blood cancer antigen 125 (CA-125) level is highly suggestive of ovarian cancer. However, various benign and inflammatory gynecological conditions and non-gynecological processes, such as liver and pulmonary diseases, may be associated with an elevated serum CA-125 level, especially in premenopausal women. Case Report: An 18-year-old female patient with lower abdominal pain for three days presented to our hospital. No fever was noted. Blood cancer antigen 125 (CA-125) level was elevated (660 U/mL; normal value, <35 U/mL), while the levels of other tumor markers (α-fetoprotein, carcinoembryonic antigen, β-human chorionic gonadotropin, and CA-199) were within normal limits. Transabdominal ultrasonography showed multicystic lesions with interior septation in the adnexal regions on both sides, suggesting the presence of cystic masses in both ovaries. Contrast-enhanced magnetic resonance imaging (MRI) revealed dilated and tu...
Gaoxiong yi xue ke xue za zhi = The Kaohsiung journal of medical sciences, 1995
A case of mandibular arteriovenous malformation (AVM) is presented. Prompt diagnosis and appropri... more A case of mandibular arteriovenous malformation (AVM) is presented. Prompt diagnosis and appropriate management are essential due to massive bleeding or even death after dental extraction or biopsy. Angiography remains the gold standard in detecting the lesion. Magnetic resonance (MR) imaging with spin-echo sequences reveals the vascular malformation as signal-void. MR angiography can demonstrate the nidus, dilated artery and vein. MR imaging and MR angiography can supplement angiography in the diagnosis of mandibular AVM.
Internal hernia is a rare cause of small bowel loop obstruction. Hernia through a defect of the b... more Internal hernia is a rare cause of small bowel loop obstruction. Hernia through a defect of the broad ligament is extremely rare. A female patient who had received laparoscopic oocyte retrieval 20 years ago suffered from intermittent lower abdominal cramping pain and vomiting. Internal hernia through the defect of the broad ligament is confirmed through a series of imaging studies and surgical exploration. To the best of our knowledge, this is the first case of internal hernia through a defect of the broad ligament in which the small bowel loop inside the herniated sac is collapsed rather than dilated, as noted on the computed tomography and surgical finding.
Internal abdominal herniation is infrequent, accounting for approximately 4.1% of small bowel obs... more Internal abdominal herniation is infrequent, accounting for approximately 4.1% of small bowel obstructions. Pericecal herniation, which constitutes 10-15% of all internal abdominal herniations, may be congenital, because of herniation of a segment of the small bowel loop through one of the several pericecal recesses, or acquired, because of an adhesion band. A 70-year-old woman experienced severe right upper abdominal pain and vomiting for 1 day. Tenderness was noted in the right upper abdomen. Results of blood and urine analyses were normal. She had undergone an appendectomy 30 years previously. On the basis of computed tomography (CT) findings, a preoperative diagnosis of pericecal hernia was obtained. Immediate surgical exploration revealed an adhesion band between the appendiceal stump and the omentum; a 70-cm-long portion of the jejunum had herniated through the acquired defect. Preoperative recognition of the specific CT signs of pericecal hernia may prompt immediate surgery t...
Purpose: 80% of salivary gland tumors are of parotid origin; of these, 80% are benign and 20% are... more Purpose: 80% of salivary gland tumors are of parotid origin; of these, 80% are benign and 20% are malignant. Metastases are rarely found in the parotid gland. Nasopharyngeal carcinoma (NPC) metastasis to the parotid gland is even rarer. We present a case of a parotid mass as an initial manifestation of NPC metastasis. Material and methods: A 68 year-old male patient suffered from a tender, firm and palpable mass and numbness in right infra-auricular region for one month. Contrast-enhanced computed tomography (CT) showed diffuse contrast enhancement of the right parotid gland, bilateral neck level II enlarged lymph nodes, and a subtle bulging lesion at the nasopharynx. Ultrasonography (US) demonstrated hypoechoic lymph nodes in right parotid gland and right neck level II area. Endoscopy disclosed a bulging lesion in the nasopharynx. Results: US-guided fine-needle aspiration biopsy (FNAB) for the lymph node in right intraparotid region showed positive malignant cells. Excision of the right parotid gland mass revealed lymphoepithelial carcinoma. Biopsy of the nasopharyngeal mass demonstrated undifferentiated nasopharyngeal carcinoma. Therefore, NPC metastasis to the parotid gland was confirmed. Conclusion: A preoperative FNAB of the parotid mass plays a key role in the treatment decision-making process. When associated with a subtle bulging nasopharyngeal lesion on CT, the possibility of NPC with parotid gland metastasis, although rare, should be kept in mind because such findings may have a major impact on the patient management
International Journal of Surgery and Medicine, 2018
Pneumatosis intestinalis in association with gas in the superior mesenteric and hepatic portal ve... more Pneumatosis intestinalis in association with gas in the superior mesenteric and hepatic portal vein (portomesenteric venous gas) is typically due to bowel infarction and carries an ominous outcome. Much less commonly, it may be the result of nonischemic etiologies. We present a rare case of acute perforated appendicitis associated with pneumatosis intestinalis of the small bowel loop, and portomesenteric venous gas. Materials and methods: A 79-year-old male patient suffered from diffuse abdominal pain and cold sweating in the morning of the admission. Mild fever, tachycardia, diffuse abdominal distension and tenderness were noted. The blood analysis showed leukocytosis. A plain abdominal radiograph revealed distension of the bowel loop. CT of the abdomen showed swollen appendix with periappendiceal fluid, distension of small bowel loop, bowel wall gas in a segment of small bowel loop, and portomesenteric venous gas. Therefore, a CT diagnosis of acute perforated appendicitis, and probably bowel infarction was made. Results: Emergency exploratory laparotomy was performed. Fecal material was seen surrounding the cecum, and the appendix showed gangrenous change and perforation. Appendectomy was done. A 30 cm segment of ileum disclosed hyperemic change and marked distension, and decompression was performed. Two days later, second-look laparotomy showed no bowel ischemia. Due to persistent post-operative fever and turbid discharge from the surgical site, the patient's family asked for a transfer to the other hospital on the 15th postoperative day. The patient was finally discharged after infection control at the other hospital for a 43-day period of the second hospitalization. No bowel ischemia was noted during the second course of the hospitalization. Conclusion: The mechanism of pneumatosis intestinalis and portomesenteric gas may be due to increased intraluminal pressure and associated mucosal disruption of the small bowel, leading to gas entering the bowel wall, through the superior mesenteric vein and subsequently to the hepatic portal vein. The clinical outcome is determined by the underlying disease and not just the presence of superior mesenteric and portal venous gas. KEYWORDS acute appendicitis, pneumatosis intestinalis, portomesenteric venous gas Figure 1 (A,B) (A) CT topogram of the abdomen showed distended small bowel loop. (B) Non-contrast-enhanced CT showed the swollen appendix (arrow) with a diameter of 0.9 cm and with periappendiceal infiltration and minimal fluid accumulation.
Male breast cancer is rare, accounting for about 1% of all breast cancers. Hepatocellular carcino... more Male breast cancer is rare, accounting for about 1% of all breast cancers. Hepatocellular carcinoma (HCC) is associated with liver cirrhosis in 70%e80% of cases; serum alpha-fetoprotein level is normal in less than half of HCC cases. We describe an 80-year-old male patient who experienced nausea and abdominal pain after food intake. On physical examination, a large, protruding, lobulated, and hard mass with skin discoloration was observed in the area of left breast. The serum alpha-fetoprotein level was normal. Ultrasonography (US) of the abdomen showed findings compatible with cholelithiasis, acute cholecystitis, liver cirrhosis, and a mixed-echoic tumor in segment 6 (S6) of the liver. Contrast-enhanced computed tomography (CT) with arterial and portal venous phases demonstrated the typical findings of cholelithiasis and acute cholecystitis; it also revealed a nodular liver surface, and a hypervascular liver tumor with an early washout pattern. Therefore, liver cirrhosis and HCC in S6 of the liver were suspected. A huge, irregular, lobulated mass with interior septation, solid and fluid components, and an enhanced solid component was also found in the subareolar region of the left breast. US-guided biopsy of the liver tumor was performed and a diagnosis of HCC was established. Laparoscopic cholecystectomy and an excision of the left breast mass were performed. The breast mass was pathologically confirmed to be infiltrating ductal carcinoma not otherwise specified and with predominantly cystic degeneration. The patient received chemotherapy with tamoxifen for the breast cancer, and transarterial chemoembolization for the HCC. Concomitant breast cancer and HCC in a male patient were rarely reported in the literature. Herein, we have discussed the possible relationship of these two disease entities.
The purpose of this study was to evaluate the need for clinical information and intravenous iodin... more The purpose of this study was to evaluate the need for clinical information and intravenous iodine contrast administration for disease diagnosis in patients undergoing emergent abdominal computed tomographic (CT) examination. A total of 150 patients (85 males and 65 females; mean age = 52.4 years) who were examined by emergent abdominal CT scanning were evaluated prospectively during a 3.month period. Nonenhanced and contrast-enhanced contiguous images were obtained with a helical CT scanner. Film interpretation was provided by three radiology specialists. The diagnoses were made separately in three phases by all three radiologists: (1) nonenhanced images with no clinical information provided; (2) nonenhanced images with clinical information; and (3) combined enhanced images with clinical information. The interobserver difference was analyzed by a chi-square test. The
Ectopic pelvic kidney is a rare developmental anomaly. Ectopic pelvic kidney can present without ... more Ectopic pelvic kidney is a rare developmental anomaly. Ectopic pelvic kidney can present without the characteristic symptoms associated with the urinary tract pathology. Ectopic pelvic kidney is usually unknown, and nonspecific vague abdominal comfort maybe the only symptom. Early detection and recognition of an ectopic kidney can prevent long-term complications. We report a 3-year-5-month-old girl with ectopic pelvic kidney who experienced intermittent episodes of lower abdominal pain for about 1 month. Abdominal ultrasound, computed tomography, and intravenous pyelography demonstrated a pelvic kidney. Thereafter, the urinalysis showed pyuria (white blood cell 20/high power field), and urine culture grew Escherichia coli. We emphasize that pelvic kidney should be considered in patients presenting unexplained vague abdominal pain, especially in pediatric patients who had intermittent recurrent episodes.
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Papers by Kwok Wan Yeung