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Clinical Imaging Sep 2023The greater omentum is a unique anatomical structure that serves a critical function in the containment of inflammatory and infectious processes within the abdominal... (Review)
Review
The greater omentum is a unique anatomical structure that serves a critical function in the containment of inflammatory and infectious processes within the abdominal cavity. It is also a common site of involvement by metastases, as well as the primary location for various pathologic lesions of clinical significance. Its fibroadipose composition, large size, and position in the most anterior aspect of abdomen allow accurate visualization of the greater omentum on CT and MR images. Careful evaluation of the greater omentum can provide important clues to the diagnosis of the underlying abdominal disorder. The aim of this article is to present the normal appearance of the greater omentum, and the wide spectrum of its pathological features as demonstrated on CT and MRI of the abdomen.
Topics: Humans; Omentum; Tomography, X-Ray Computed; Mesentery; Magnetic Resonance Imaging; Adipose Tissue
PubMed: 37290177
DOI: 10.1016/j.clinimag.2023.05.014 -
European Journal of Obstetrics,... Jul 2021Extragonadal teratomas (EGTs) are rare and the commonest intra-abdominal subtype is omental. We present two cases: 1) a parasitic omental teratoma likely secondary to... (Review)
Review
INTRODUCTION
Extragonadal teratomas (EGTs) are rare and the commonest intra-abdominal subtype is omental. We present two cases: 1) a parasitic omental teratoma likely secondary to auto-amputation of an ovarian teratoma with subsequent omental reimplantation and 2) an omental immature teratoma likely due to parthenogenetic activation of displaced primordial germ cells. We subsequently conduct a systematic review to characterise EGTs.
METHODS
We sourced for English, peer-reviewed case reports of extragonadal teratomas in women and female adolescents aged 11 and above published from inception of each database through 31st June 2020 following PRISMA guidelines. Two authors reviewed each case for appropriateness and each case was graded for methodological quality utilising a modified Newcastle Ottawa Scale. PROSPERO Registration Number: CRD42020190131 RESULTS: Upon literature review between 1920-2020, from an initial screen of 818 articles, 67 articles were selected featuring 70 cases. One case featured an immature teratoma while the remaining were mature. Omental EGTs were the most common (56.5 %) followed by Pouch of Douglas and uterosacral ligament (23.2 %) and upper abdomen (14.5 %). There were statistically significant differences in EGT mean sizes between each location with the largest being in the upper abdomen (10.9 cm) and the smallest being in the adnexa or hernia (6.2 cm). Auto-amputation was deemed the commonest cause amongst omental EGTs (55.3 %) and Pouch of Douglas and uterosacral ligament EGTs (37.5 %) while 70 % of upper abdominal EGTs were likely due to displaced primordial germ cells. We characterise clinical features associated with each pathogenic mechanism and imaging characteristics of EGTs. Characterisation of EGT tumour marker profiles was limited as only 42.9 % of cases reported them but 19.2-25.0 % had raised tumour markers. The main risks are torsion, rupture, immature components and potential malignant change of the cell lines. Treatment is largely surgical. The mean size of EGTs approached laparoscopically and via laparotomy was 5.23 cm and 9.16 cm respectively.
CONCLUSIONS
While rare, EGTs should be considered when evaluating pelviabdominal masses with imaging characteristics consistent with teratomas. Confirmation is usually intraoperative and a laparoscopic approach is reasonable if there is good surgeon comfort and the size is about 5 cm.
Topics: Abdominal Wall; Adolescent; Female; Humans; Omentum; Ovarian Neoplasms; Teratoma; Uterus
PubMed: 34022590
DOI: 10.1016/j.ejogrb.2021.05.005 -
Clinical Imaging May 2023Demonstration of a very dense or hyper-attenuated liver on the pre-contrast CT images of the abdomen can be an unexpected finding. It may present as a diagnostic... (Review)
Review
Demonstration of a very dense or hyper-attenuated liver on the pre-contrast CT images of the abdomen can be an unexpected finding. It may present as a diagnostic challenge if the underlying cause of it is not apparent from the provided clinical history. There are about 12 different pathologic conditions that are associated with deposition of radiopaque elements within the hepatic parenchyma, resulting in diffuse or multi-lobar hyperdense appearance of the liver on abdominal radiographs and CT. Most of them are drug-induced or iatrogenic in nature, while others are the sequelae of genetic disorders like thalassemia, Wilson's disease, and primary hemochromatosis. This pictorial essay will present the CT appearance and etiology of hyper-attenuated liver in various clinical entities.
Topics: Humans; Liver; Hepatolenticular Degeneration; Abdomen; Abdominal Cavity; Tomography, X-Ray Computed
PubMed: 36857928
DOI: 10.1016/j.clinimag.2023.02.012 -
The American Surgeon Nov 2021Carl Florian Toldt was an Austrian anatomist who made meaningful contributions worldwide and defined what is one of the most important surgical landmarks in abdominal...
Carl Florian Toldt was an Austrian anatomist who made meaningful contributions worldwide and defined what is one of the most important surgical landmarks in abdominal surgery. Through his research studies, the embryologic dissection plane known as the "White Line of Toldt" represents an important anatomical landmark that helps to mobilize either the ascending or descending colon. His career spanned over 45 years, beginning in Verona and continuing to Prague and Vienna. He was an author of several innovative books and scientific articles regarding micro- and macroscopic anatomy. In addition, he received numerous recognitions and prizes for his work, making him an essential figure in the medical scientific community. Even a street in Vienna, Karl-Toldt-Weg, is named in his honor. The purpose of this historical article is to celebrate and honor Toldt 100 years following his death, remembering his scientific contributions to the medical and surgical fields and giving thanks for his numerous accomplishments. This article brings light to the man behind the eponym.
Topics: Anatomy; Austria-Hungary; Colon; Dissection; Histology; History, 19th Century; History, 20th Century; Humans; Italy; Mesocolon; Peritoneum; Retroperitoneal Space
PubMed: 33720793
DOI: 10.1177/0003134821991979 -
Journal of Gastrointestinal Surgery :... Dec 2023The liver is one the largest organs in the abdomen and the most frequent site of metastases for gastrointestinal tumors. Surgery on this complex and highly vascularized...
The liver is one the largest organs in the abdomen and the most frequent site of metastases for gastrointestinal tumors. Surgery on this complex and highly vascularized organ can be associated with high morbidity even in experienced hands. A thorough understanding of liver anatomy is key to approaching liver surgery with confidence and preventing complications. The aim of this quiz is to provide an active learning tool for a comprehensive understanding of liver anatomy and its integration into clinical practice.
Topics: Humans; Portal Vein; Liver; Abdomen; Abdominal Cavity; Hepatic Artery
PubMed: 37803180
DOI: 10.1007/s11605-023-05778-7 -
Journal of Obstetrics and Gynaecology :... Oct 2021A total of 580 pregnant and 50 puerperal women were included in this cross-sectional study to assess the physiological changes that allow women to adapt to a chronic...
A total of 580 pregnant and 50 puerperal women were included in this cross-sectional study to assess the physiological changes that allow women to adapt to a chronic increase in intra-abdominal pressure during pregnancy. The volume of the uterus, intra-abdominal volume (IAV), visceral and subcutaneous fat was calculated. During pregnancy, the IAV increases up to 1.5 times. Changes in IAV until 24 weeks present a linear relationship (5.2%); thereafter, changes become exponential and, at 40 weeks, IAV increases by 61%. This fact is exclusively related to the progressive growth of the foetus and to the increase in uterine size. At term, the IAV reserve is exhausted, becoming equal the anteroposterior and transverse diameters of the abdomen.In conclusion, the adaptive capabilities of IAV related to the foetal growth are limited by the IAV reserve. The reserve capacity of the IAV and tensile properties of the abdominal wall can be estimated by the dynamics of the anteroposterior and transverse abdominal diameters.IMPACT STATEMENT A causal relationship between intra-abdominal hypertension and the development of adverse obstetric and perinatal outcomes has been suggested. Nevertheless, the role of this condition as a leading cause of systemic dysfunction during pregnancy remains unrecognised and underestimated. This study assesses the dynamics of IAV in uncomplicated singleton pregnancies. The study of abdominal pressure indicators such as intra-abdominal volume and compliance will help to a better understand the aetiology, pathophysiology, prognosis and treatment strategies for pregnant women with intra-abdominal hypertension.
Topics: Abdominal Cavity; Adaptation, Physiological; Adult; Anthropometry; Cross-Sectional Studies; Female; Humans; Intra-Abdominal Fat; Organ Size; Pregnancy; Pressure; Uterus
PubMed: 33251897
DOI: 10.1080/01443615.2020.1820470 -
Radiological features and clinical implications of persistent congenital mesocolon: Pictorial essay.Journal of Medical Imaging and... Apr 2022In human foetus, the mesenteries that carry vascular and neural supply to the alimentary tube play an important role in its development and anatomical location within... (Review)
Review
In human foetus, the mesenteries that carry vascular and neural supply to the alimentary tube play an important role in its development and anatomical location within the abdominal cavity. The mesenteric attachments of the small bowel, transverse colon and sigmoid allow them to be intraperitoneally mobile structures. In contrast, the ascending and descending colon lose their mesenteries by fusion with the parietal peritoneum and become fixed in retroperitoneal position along the posterolateral walls of the abdomen. In about 2%-4% of individuals, this process is disrupted, causing a complete or partial retention of their congenital mesocolon. The ascending or descending colon will then remain intraperitoneally mobile, affecting the normal visceral anatomy and causing potential complications. This article reviews the spectrum of radiological manifestations and clinical consequences of these anomalies.
Topics: Colon, Sigmoid; Humans; Laparoscopy; Mesocolon; Peritoneum; Radiography
PubMed: 34747133
DOI: 10.1111/1754-9485.13347 -
Surgical Infections Apr 2023Previously considered inert, the greater omentum is now thought to play a central role in intra-peritoneal immune defense. The intestinal microbiome has recently become... (Review)
Review
Previously considered inert, the greater omentum is now thought to play a central role in intra-peritoneal immune defense. The intestinal microbiome has recently become a target for potential therapeutic interventions. A narrative review of the immune functions of the omentum was generated using the Scale for the Assessment of Narrative Review Articles (SANRA) guideline. Articles were selected from domains including surgical history, immunology, microbiology, and abdominal sepsis. Evidence suggests the intestinal microbiome may be responsible for some maladaptive physiologic responses in disease states, particularly intra-peritoneal sepsis. Elaborate crosstalk exists between the gut microbiome and the omentum, given its innate and adaptive immune capabilities. We summarize current knowledge, provide examples of how normal and abnormal microbiomes interface with the omentum, and illustrate their impact on surgical disease and its management.
Topics: Humans; Omentum; Abdomen; Sepsis; Gastrointestinal Microbiome
PubMed: 37010963
DOI: 10.1089/sur.2022.421 -
Clinical Imaging Dec 2021Computed tomography (CT) can both locate and identify foreign bodies as well as pinpoint complications to help direct treatment. Retained foreign bodies in the abdomen... (Review)
Review
Computed tomography (CT) can both locate and identify foreign bodies as well as pinpoint complications to help direct treatment. Retained foreign bodies in the abdomen and pelvis can lead to perforation, obstruction, intussusception, fistula formation, and abdominal abscess formation. This article reviews the imaging appearance of incidentally found common foreign bodies and the role of CT in identifying unsuspected foreign bodies.
Topics: Abdomen; Abdominal Cavity; Foreign Bodies; Humans; Pelvis; Tomography, X-Ray Computed
PubMed: 34224951
DOI: 10.1016/j.clinimag.2021.06.029 -
The Lancet. Child & Adolescent Health Jun 2021This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and... (Comparative Study)
Comparative Study Review
This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging.
Topics: Abdominal Cavity; Clinical Decision-Making; Congenital Abnormalities; Female; Gestational Age; Head and Neck Neoplasms; Humans; Imaging, Three-Dimensional; Infant; Infant, Newborn; Magnetic Resonance Imaging; Pregnancy; Prenatal Care; Prenatal Diagnosis; Prognosis; Radiology; Spinal Diseases; Thoracic Diseases; Ultrasonography, Prenatal; Urologic Diseases; Video Recording
PubMed: 33721554
DOI: 10.1016/S2352-4642(20)30313-8