[Spontaneous splenic rupture secondary to infectious mononucleosis]

Splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. We report the case of an 18-year-old woman, who presented a 7-day history of abdominal pain, sudden temporary loss of consciousness and fever. Admission blood tests showed anemia, and lymphocytosis. Computed tomography of the abdomen and pelvis demonstrated extensive hemoperitoneum and numerous cervical, mesenteric and inguinal enlarged lymph nodes. Laparoscopy was performed and abundant hemoperitoneum with blood clots along the left parietocolic gutter were observed. The spleen was completely decapsulated and surrounded by a hematoma and the subcapsular tissue was bleeding. Total splenectomy was performed without complications. Splenic histology demonstrated white pulp attenuation and expansion of the red pulp with focal hemorrhage and necrosis. IgM anti-viral capsid antigen of Epstein Barr virus was positive. The patient had a satisfactory recovery.

Computed tomography imaging of complications of acute cholecystitis

Acute cholecystitis (AC) is a frequent complication of biliary cholelithiasis. Although ultrasound is the first diagnostic imaging procedure, frequently the initial imaging modality is computed tomography (CT). Therefore, familiarization of CT findings in AC and potential related complications are extremely important. This pictorial essay reviews a broad spectrum of complications related to AC and its key findings in CT.

CT findings of the main pathological conditions associated with horseshoe kidneys

Horseshoe kidney (HSK) is the most common renal fusion anomaly, with a prevalence of 0.25% among the general population. It consists of kidney fusion across the midline. HSK can be present as an isolated condition in 30%, but there is a wide variety of associated abnormalities. The most frequent include ureteropelvic obstruction, lithiasis and infections. There is also a higher risk of kidney lesions in trauma and an increased incidence of malignancies. Awareness of embryology and anatomy is essential to assess and understand the complications affecting HSK. CT is an excellent method for identification of its main findings.

Laparoscopic Resection of an Extra-adrenal Pheochromocytoma

Extra-adrenal pheochromocytomas are of rare occurrence. Since first reported laparoscopic adrenalectomy has become the gold standard in the treatment of adrenal tumors, the feasibility of laparoscopic adrenalectomy in the setting of pheochromocytoma has also been established given a careful preoperative planning. Literature on the laparoscopic treatment of extra-adrenal pheochromocytomas is lacking. We report a hypertensive 54-year-old male patient (body mass index, 26.2) with elevated urinary catecholamines and a 6-cm solid mass under the right renal hilum diagnosed after a magnetic resonance. The patient underwent complete transperitoneal laparoscopic excision of the tumor. Recovery was uneventful and final histopathologic examination showed an extra-adrenal pheochromocytoma. We believe that transperitoneal laparoscopic excision of extra-adrenal pheochromocytoma is a feasible and reproducible technique that allows for complete removal of tumoral tissue with low morbidity, shorter hospital stay, and minimal convalescence.

[Primary epiploic appendicitis: clinical and radiological diagnosis]

BACKGROUND

Torsion of appendices epiplocae leads to an ischemic infarct of surrounding adipose tissue, causing a syndrome, called "primary epiploic appendagitis" characterized by acute abdominal pain that can simulate a surgical clinical picture.

AIM

To describe the clinical picture, ultrasonographic and computed tomographic features of primary epiploic appendagitis.

MATERIAL AND METHODS

A report of patients with acute abdominal pain whose diagnosis was a primary epiploic appendagitis, diagnosed and treated in a period of 48 months.

RESULTS

Fifty five patients (45 males) aged 16 to 76 years old are reported. Their clinical presentation was acute abdominal pain in the left abdominal quadrant in 48, pain in the right lower quadrant in 4 and epigastric pain in two. Two had mild fever and 12 had nausea. Ten perform physical activities prior to the onset of pain. Imaging examinations showed a 1.5 to 5 cm diameter, uncompressible small mass of adipose origin, located anteriorly and anterolaterally, between the colon and the abdominal wall. There were inflammatory phenomena surrounding the lesion and thickening of the neighboring parietal peritoneum. In all cases, the mass gradually subsided with medical treatment.

CONCLUSIONS

Primary epiploic appendagitis is a relatively frequent cause of spontaneously resolving abdominal pain. It is diagnosed by ultrasound or CT scanning.

[Diagnostic role of the combination of computerized tomography and angiography in traumatic injuries of the thoracic aorta]

AIM

To assess the diagnostic value of the combination of computed tomography and angiography in patients with blunt thoracic trauma and suspicion of aortic injury.

PATIENTS AND METHODS

Retrospective analysis of six patients, aged 22 to 72 years old, with traumatic thoracic aorta injury secondary to severe trauma, specially car accidents, seen between 1985 and 1994.

RESULTS

An early diagnosis was done in three patients. One patient, in whom diagnosis was delayed, died before surgery. In three cases, CAT scan showed indirect evidence of aortic rupture, consisting in alterations of aortic outline. In other three patients, it showed hemomediastinum, associated to a left hemothorax in one case. Angiography confirmed the diagnosis, localized and characterized the injury in all patients.

CONCLUSIONS

The delay in the diagnosis of aortic injury may be fatal. The combination of CAT scan and angiography has a high sensitivity and specificity to localize and characterize lesions of the aorta or its branches or associated organs, essential step for surgical planning. CAT scan restricts the use of angiography, avoiding false negative studies, but cannot be used as the sole diagnostic procedure.

[Computed tomography guided fine needle aspiration biopsies]

Computed tomography (CT) allows the performance of fine needle aspiration biopsies in situations in which ultrasound or conventional X rays do not correctly visualize the lesion or the needle tract. One hundred four patients with a clinical suspicion of neoplasia were subjected to CT guided percutaneous aspiration biopsies in a lapse of 6 years. The most frequently biopsied organs were the lung (39.5%), liver and gallbladder (20.2%) and pancreas (15.4%). Forty nine percent of procedures were performed in the thorax and 51% in the abdomen. Of 51 patients with suspicion of thoracic cancer, there was only one false negative and no false positive results, with an overall accuracy of 98%. For abdominal procedures, there were no false positive results, although there were 6 false negative results, specially for pancreatic or retroperitoneal lesions. Overall accuracy for abdominal procedures was 88%. It is concluded that CT guided fine needle biopsy is a safe and accurate method for the diagnosis of thoracic and abdominal lesions.