1/24. Purulent pericarditis presenting as acute abdomen in children: abdominal imaging findings.Purulent pericarditis is rapidly fatal if untreated [1,2]. With increased development of bacterial resistance to antibiotics, severe bacterial infections in children are becoming more frequent [3,4]. We report two children with purulent pericarditis who presented in a 1-month period for evaluation of acute abdominal distention and signs of sepsis. In both, one evaluated with computed tomography (CT) and one with ultrasound, abdominal findings included periportal edema, gallbladder wall thickening, and ascites secondary to right heart failure from cardiac tamponade. Radiologists should be aware that children with purulent pericarditis may have a normal heart size on radiographs, present with acute abdominal symptoms, and demonstrate findings of right sided heart failure on abdominal imaging.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
2/24. Small intestinal infarction: a fatal complication of systemic oxalosis.Primary hyperoxaluria is a rare genetic disorder characterised by calcium oxalate nephrolithiasis and nephrocalcinosis leading to renal failure, often with extra-renal oxalate deposition (systemic oxalosis). Although ischaemic complications of crystal deposition in vessel walls are well recognised clinically, these usually take the form of peripheral limb or cutaneous ischaemia. This paper documents the first reported case of fatal intestinal infarction in a 49 year old woman with systemic oxalosis and advocates its consideration in the differential diagnosis of an acute abdomen in such patients.- - - - - - - - - - ranking = 5keywords = fat (Clic here for more details about this article) |
3/24. Omental infarction as a delayed complication of abdominal surgery.Omental infarction, an uncommon cause of acute abdominal pain, is the result of compromised perfusion to the greater omentum. Although its etiology remains uncertain, predisposing factors include obesity [Surg. Today 30 (2000) 451], strenuous activity [N. Z. Med. J. 111 (1998) 211], trauma, and idiopathic omental torsion. Often confused with acute appendicitis or cholecystitis on clinical grounds [Surg. Today 30 (2000) 451], its diagnosis has traditionally been one of exclusion, based on intraoperative and pathologic findings. This diagnosis can be made radiologically based on the characteristic findings of an inflammatory mass containing fat and fluid. We describe a case of right lower quadrant omental infarction temporally related to bowel surgery.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
4/24. capnocytophaga canimorsus sepsis presenting as an acute abdomen in an asplenic patient.Acute abdominal symptoms are frequently caused by surgical intra-abdominal problems. However, the differential diagnosis also includes several internal diseases. Overwhelming infections may present with acute abdominal signs, particularly in the immunocompromised host. Asplenic patients are highly susceptible to infections with encapsulated bacteria such as streptococcus pneumoniae, haemophilus influenzae and neisseria meningitidis. Severe infections due to capnocytophaga canimorsus (DF2), are also common in this group. C. canimorsus is a Gram-negative rod, present as a commensal organism in cat and dog saliva. We describe the atypical presentation of a fatal C. canimorsus-sepsis in a 46-year-old man, who underwent traumatic splenectomy two decades earlier.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
5/24. Primary epiploic appendagitis: MRI findings.Primary epiploic appendagitis (PEA) occurs secondary to inflammation of an epiploic appendage, and is considered to be a rare cause of acute abdomen. In this case report, we describe the magnetic resonance imaging (MRI) findings of PEA correlated with computed tomographic (CT) findings. MRI findings included an oval shaped fat intensity mass with a central dot on T1- and T2-weighted images, which possessed an enhancing rim on postgadolinium T1-weighted fat saturated images. The lesion was best visualized on postcontrast T1-weighted fat saturated images. MRI findings of PEA should be considered in the differential diagnosis with the other causes of acute abdominal pain.- - - - - - - - - - ranking = 3keywords = fat (Clic here for more details about this article) |
6/24. Fulminant ischaemic colitis with atypical clinical features complicating sickle cell disease.Clinically significant ischaemic bowel injury is an exceedingly rare complication of sickle cell disease. It manifests as acute surgical abdomen and may respond to conservative treatment. An unusual fatal case of ischaemic colitis with minimal abdominal findings in a young male during a sickle cell vaso-occlusive pain crisis is described. This case demonstrates that an acute surgical abdomen should be considered in such patients who fail to respond to conservative management as untreated this condition may be fatal.- - - - - - - - - - ranking = 2keywords = fat (Clic here for more details about this article) |
7/24. CT findings of omental torsion and infarction: case report and review of the literature.A 37-year-old woman presented with progressive diffuse abdominal pain. Computed tomography (CT) showed diffuse streaking of the greater omentum with a mass of fat density located anteriorly just below the umbilicus, showing a whirling pattern of concentric streaks. Surgery and pathology revealed torsion and infarction of the greater omentum. Because of its rarity and nonspecific clinical features, the diagnosis is seldom made preoperatively. We describe a patient with characteristic CT findings of omental torsion. Preoperative diagnosis is important since conservative management has been suggested.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
8/24. Small intestinal angiosarcoma leading to perforation and acute abdomen: a case report and review of the literature.A 76-year-old man presented to the emergency room with abdominal pain and fatigue. The patient had a history of gastrointestinal bleeding. An abdominal computed tomographic scan showed collections of free air in the abdomen with obstruction of the distal small intestine and multiple masses in the liver. laparotomy revealed a widespread malignant neoplasm in the abdomen, with multiple tumor nodules in the ileal wall, mesentery, and liver. The ileal wall was perforated within the area of one of the tumors. Pathologic examination of the lesion showed a neoplasm composed of solid sheets of spindle and undifferentiated cells, forming interlacing delicate vascular channels with atypical endothelial cells. The tumor cells were positive for the endothelial marker CD31, whereas reactivity for a broad panel of epithelial and other endothelial markers was negative. This case demonstrates that although angiosarcomas of the gastrointestinal tract are rare, they should be considered in cases of intestinal perforation or severe bleeding, especially in the elderly. A broad panel of immunochemical markers might be necessary to establish the pathologic diagnosis.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
9/24. Intraperitoneal fat focal infarction of the lesser omentum: case report.Intraperitoneal fat focal infarction (IFFI) represents a relatively rare acute abdominal condition essentially characterized by infarction and/or torsion of the greater omentum or an epiploic appendage. The spontaneous clinical evolution is favorable under medical treatment, and the imaging findings have been proved sufficiently typical to avoid unnecessary surgery in the great majority of cases. To our knowledge, we report the first case of IFFI of the lesser omentum. Despite the absence of definitive histologic proof, the diagnosis was possible through typical imaging findings extremely similar to those of more classic cases of IFFI but also through the spontaneous benign evolution.- - - - - - - - - - ranking = 5keywords = fat (Clic here for more details about this article) |
10/24. Computed tomography findings in fatal cases of enormous hepatic portal venous gas.AIM: To assess the computed tomography (CT) findings in the patients with hepatic portal venous gas (HPVG) who presented with a short fatal clinical course in our hospital in order to demonstrate if there was any sign for prediction. methods: Between January 1997 and December 2000, CT scan of the abdomen was performed on 949 patients with acute abdominal pain in our emergency department. Five patients were found having HPVG. The CT images and clinical presentations of all these five patients were reviewed. RESULTS: In reviewing the CT findings of the cases, HPVG in bilateral hepatic lobes, abnormal gas in the superior mesenteric veins, small bowel intramural gas, and bowel distension were observed in all patients. Dry gas in multiple branches of the mesenteric vein was also revealed in all cases. All the patients expired due to irreversible septic shock within 48 h after their initial clinical presentation in emergency room. Two patients had acute pancreatitis with grade D and E Balthazar classification and they expired within 24 h due to progressing septic shock under aggressive medical treatment and life support. Two patients with underlying end stage renal disease expired within 48 h even though emergent surgical intervention was undertaken. The excited bowels revealed severe ischemic change. One patient expired only a few hours after the CT examination. CONCLUSION: HPVG is a diagnostic clue in patients with acute abdominal conditions, and CT is the most specific diagnostic tool for its evaluation. The dry mesenteric veins are the suggestive fatal sign, especially for the deteriorating patients, with the direct effect on gastrointestinal perfusion.- - - - - - - - - - ranking = 6keywords = fat (Clic here for more details about this article) |
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