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International Journal of Surgery Case... Jun 2024Omental torsion is a rare cause of acute abdominal pain caused by twisting of the omentum along its long axis, thus compromising its vascularity. Its presentation is...
INTRODUCTION
Omental torsion is a rare cause of acute abdominal pain caused by twisting of the omentum along its long axis, thus compromising its vascularity. Its presentation is non-specific and can mimic other common pathologies, making its pre-operative diagnosis challenging.
PRESENTATION OF CASE
A 44-year-old female presented for periumbilical abdominal pain. Her laboratory results showed no leukocytosis and CRP was within normal range. CT scan of the abdomen and pelvis with oral and IV contrast showed a well demarcated pericecal mass at the right side, mostly suggestive of transmesenteric internal herniation with strangulation. The patient eventually required laparoscopic surgical intervention.
DISCUSSION
The acute abdominal manifestations in patients with omental torsion are due to the development of edema and necrotic tissue distal of the torsion after the arterial supply and venous drainage have been obstructed. Rotation around the right gastroepiploic artery is considered to be the most common cause of omental torsion. Primary torsion is considered to be idiopathic, while secondary torsion occurs due to an identifiable predisposing pathology such as omental cysts, hernias, adhesions, or intra-abdominal tumors. Since symptoms of omental torsion are non-specific, it is crucial to consider the differential diagnosis and rule out other causes of acute abdomen. Surgical intervention is the mainstay treatment when there is uncertainty in the diagnosis, or when the patient's clinical, radiological, and laboratory findings worsen with conservative treatment.
CONCLUSION
Early surgical intervention in cases of omental torsion reduces the incidence of formation of abscesses, adhesions, and omental necrosis. In cases of non-operative candidates, conservative treatment is the best option; therefore, the choice of treatment of omental torsion should be considered on a case-by-case basis.
PubMed: 38906039
DOI: 10.1016/j.ijscr.2024.109917 -
The Tokai Journal of Experimental and... Jul 2024To assese of potential benefint of photon-counting detector CT (PCD-CT) over conventional single-energy CT (CSE-CT) on accurate diagnosis of incidental findings with...
PURPOSE
To assese of potential benefint of photon-counting detector CT (PCD-CT) over conventional single-energy CT (CSE-CT) on accurate diagnosis of incidental findings with high clinical significance (IFHCS).
MATERIALS AND METHODS
This retrospective study included 365 patients who initially underwent abdominopelvic contrast-enhanced CT (AP-CECT) without non-enhancement (PCD-CT: 187 and CSE-CT: 178). We selected IFHCS and evaluated their diagnosability using CE-CT alone. IFHCSs that could not be diagnosed with only CE-CT were evaluated using additional PCD-CT postprocessing techniques, including virtual non-contrast image, low keV image, and iodine map. A PCD-CT scanner (NAEOTOM Alpha, Siemens Healthineer, Erlangen, Germany) was used.
RESULTS
Thirty-nine IFHCSs (PCD-CT: 22 and CSE-CT: 17) were determined in this study. Seven IFHCSs in each group were able to diagnose with only CE-CT. Fifteen IFHCSs were able to diagnose using the additional PCD-CT postprocessing technique, which was useful for detecting and accurately diagnosing 68.2% (15/22) of lesions and 65% (13/20) of patients. All IFHCSs were accurately diagonosed with PCD-CT.
CONCLUSION
PCD-CT was useful for characterizing IFHCSs that are indeterminate at CSE-CT. PCD-CT offered potential benefit of PCD-CT over conventional single-energy CT on evaluation of IFHCS on only abdominopelvic CT.
Topics: Humans; Incidental Findings; Female; Male; Tomography, X-Ray Computed; Retrospective Studies; Middle Aged; Aged; Photons; Adult; Aged, 80 and over; Radiography, Abdominal; Contrast Media; Pelvis; Abdomen
PubMed: 38904238
DOI: No ID Found -
The Tokai Journal of Experimental and... Jul 2024Panniculitis is an inflammation that occurs in subcutaneous adipose tissue. Panniculitis includes physical panniculitis (e.g., traumatic) and infectious panniculitis...
Panniculitis is an inflammation that occurs in subcutaneous adipose tissue. Panniculitis includes physical panniculitis (e.g., traumatic) and infectious panniculitis (e.g., bacterial, fungal, subcutaneous panniculitis-like T cell lymphoma [SPCTL], etc.). Accurate diagnosis is crucial due to similar clinical presentation of all types of panniculitis. Here, we report a case of SPCTL which was initially diagnosed with traumatic panniculitis. A 15-year-old male patient was admitted to a previous hospital due to a progressively enlarged right flank and inguinal mass after an abdominal bruise. He was initially diagnosed with traumatic panniculitis, but the mass expanded throughout the chest and abdomen accompanied by a fever of over 11 months. Computed tomography (CT) revealed a subcutaneous mass in the anterior chest and abdominal wall. Fludeoxyglucose F18 (FDG) uptake was observed at those lesions using FDG-positron emission tomography (PET). A biopsy of the mass lesion was performed, during which SPCTL was diagnosed based on pathological examination. He was initially treated with prednisolone and cyclosporine A for two weeks. His fever went down, but subcutaneous mass in the chest and abdominal wall persisted. Therefore, he received a cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen. After 6 courses of CHOP, CT revealed no disease evidence. He remained in complete remission at 30 months of therapy.
Topics: Humans; Male; Panniculitis; Adolescent; Lymphoma, T-Cell; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Doxorubicin; Vincristine; Disease Progression; Prednisone; Tomography, X-Ray Computed; Positron-Emission Tomography; Fluorodeoxyglucose F18; Treatment Outcome; Biopsy; Diagnosis, Differential
PubMed: 38904233
DOI: No ID Found -
Cureus Jun 2024Accessory liver lobes are indeed morphological variations of the liver, representing additional lobes or smaller structures connected to the main liver mass. Beaver tail...
Accessory liver lobes are indeed morphological variations of the liver, representing additional lobes or smaller structures connected to the main liver mass. Beaver tail liver is a rare anatomic variation where the left lobe of the liver encroaches to enclose the spleen. These variants, often found by chance in patients, can create challenges in accurately distinguishing between the liver and spleen in imaging, potentially leading to misdiagnosis as splenic trauma or a subcapsular hematoma. While conducting routine dissections of the abdomen region, a variation in the size, position, and anatomical connections of the liver was noticed in a female cadaver of age 45 years. The left lobe of the liver was elongated more towards the left lateral side with some angulated narrowing after extending across the midline, encroaching the left upper quadrant of the abdomen, reaching in between the stomach and the visceral surface of the spleen, above the hilum of the spleen. The narrow end of the left lobe of the liver, placed in between the stomach and spleen, is named the hiding beaver tail liver. This variation differs from the typical beaver tail liver as well as the "kissing sign" of the liver and spleen. Unfamiliarity with such an anomaly of the liver may lead radiologists and clinicians to identify a normal anatomical variant as a pathological condition mistakenly or could confuse radiologists with fluid collections that often suggest trauma, potentially leading to fatal outcomes during invasive abdominal procedures.
PubMed: 38903980
DOI: 10.7759/cureus.62665 -
Frontiers in Medicine 2024Acute abdominal pain (AAP) is a common symptom presented in the emergency department (ED), and it is crucial to have objective and accurate triage. This study aims to...
BACKGROUND
Acute abdominal pain (AAP) is a common symptom presented in the emergency department (ED), and it is crucial to have objective and accurate triage. This study aims to develop a machine learning-based prediction model for AAP triage. The goal is to identify triage indicators for critically ill patients and ensure the prompt availability of diagnostic and treatment resources.
METHODS
In this study, we conducted a retrospective analysis of the medical records of patients admitted to the ED of Wuhan Puren Hospital with acute abdominal pain in 2019. To identify high-risk factors, univariate and multivariate logistic regression analyses were used with thirty-one predictor variables. Evaluation of eight machine learning triage prediction models was conducted using both test and validation cohorts to optimize the AAP triage prediction model.
RESULTS
Eleven clinical indicators with statistical significance ( < 0.05) were identified, and they were found to be associated with the severity of acute abdominal pain. Among the eight machine learning models constructed from the training and test cohorts, the model based on the artificial neural network (ANN) demonstrated the best performance, achieving an accuracy of 0.9792 and an area under the curve (AUC) of 0.9972. Further optimization results indicate that the AUC value of the ANN model could reach 0.9832 by incorporating only seven variables: history of diabetes, history of stroke, pulse, blood pressure, pale appearance, bowel sounds, and location of the pain.
CONCLUSION
The ANN model is the most effective in predicting the triage of AAP. Furthermore, when only seven variables are considered, including history of diabetes, etc., the model still shows good predictive performance. This is helpful for the rapid clinical triage of AAP patients and the allocation of medical resources.
PubMed: 38903814
DOI: 10.3389/fmed.2024.1354925 -
ArXiv May 2024Segmentation of organs and structures in abdominal MRI is useful for many clinical applications, such as disease diagnosis and radiotherapy. Current approaches have...
BACKGROUND
Segmentation of organs and structures in abdominal MRI is useful for many clinical applications, such as disease diagnosis and radiotherapy. Current approaches have focused on delineating a limited set of abdominal structures (13 types). To date, there is no publicly available abdominal MRI dataset with voxel-level annotations of multiple organs and structures. Consequently, a segmentation tool for multi-structure segmentation is also unavailable.
METHODS
We curated a T1-weighted abdominal MRI dataset consisting of 195 patients who underwent imaging at National Institutes of Health (NIH) Clinical Center. The dataset comprises of axial pre-contrast T1, arterial, venous, and delayed phases for each patient, thereby amounting to a total of 780 series (69,248 2D slices). Each series contains voxel-level annotations of 62 abdominal organs and structures. A 3D nnUNet model, dubbed as MRISegmentator-Abdomen (MRISegmentator in short), was trained on this dataset, and evaluation was conducted on an internal test set and two large external datasets: AMOS22 and Duke Liver. The predicted segmentations were compared against the ground-truth using the Dice Similarity Coefficient (DSC) and Normalized Surface Distance (NSD).
FINDINGS
MRISegmentator achieved an average DSC of 0.861$\pm$0.170 and a NSD of 0.924$\pm$0.163 in the internal test set. On the AMOS22 dataset, MRISegmentator attained an average DSC of 0.829$\pm$0.133 and a NSD of 0.908$\pm$0.067. For the Duke Liver dataset, an average DSC of 0.933$\pm$0.015 and a NSD of 0.929$\pm$0.021 was obtained.
INTERPRETATION
The proposed MRISegmentator provides automatic, accurate, and robust segmentations of 62 organs and structures in T1-weighted abdominal MRI sequences. The tool has the potential to accelerate research on various clinical topics, such as abnormality detection, radiotherapy, disease classification among others.
PubMed: 38903743
DOI: No ID Found -
ArXiv May 2024Multi-parametric MRI (mpMRI) studies are widely available in clinical practice for the diagnosis of various diseases. As the volume of mpMRI exams increases yearly,...
Multi-parametric MRI (mpMRI) studies are widely available in clinical practice for the diagnosis of various diseases. As the volume of mpMRI exams increases yearly, there are concomitant inaccuracies that exist within the DICOM header fields of these exams. This precludes the use of the header information for the arrangement of the different series as part of the radiologist's hanging protocol, and clinician oversight is needed for correction. In this pilot work, we propose an automated framework to classify the type of 8 different series in mpMRI studies. We used 1,363 studies acquired by three Siemens scanners to train a DenseNet-121 model with 5-fold cross-validation. Then, we evaluated the performance of the DenseNet-121 ensemble on a held-out test set of 313 mpMRI studies. Our method achieved an average precision of 96.6%, sensitivity of 96.6%, specificity of 99.6%, and F1 score of 96.6% for the MRI series classification task. To the best of our knowledge, we are the first to develop a method to classify the series type in mpMRI studies acquired at the level of the chest, abdomen, and pelvis. Our method has the capability for robust automation of hanging protocols in modern radiology practice.
PubMed: 38903740
DOI: No ID Found -
Respiratory Medicine Case Reports 2024We analyzed the issue of a young woman who wanted our opinion regarding uncontrolled hypertension. Her hypertension was discovered to have a highly unusual origin, but...
We analyzed the issue of a young woman who wanted our opinion regarding uncontrolled hypertension. Her hypertension was discovered to have a highly unusual origin, but it is fairly prevalent in nations like India. A 19-year-old woman who complained of blurred vision was presented to an ophthalmologist, who diagnosed her with grade IV hypertensive retinopathy. Her 2D ECHO was normal, hence a thorough screening for secondary hypertension was carried out. A left paravertebral tumor that may have squeezed the left renal artery and contributed to her hypertension was discovered during the workup by a CECT chest and abdomen scan. She also exhibited widespread lymphadenopathy; a condition known as granulomatous pathology. She was started on anti-TB medication, and after six months of treatment, her radiological and clinical conditions improved. This case highlights a rare instance of TB causing excessively elevated blood pressure.
PubMed: 38903655
DOI: 10.1016/j.rmcr.2024.102063 -
Cureus May 2024Background Intestinal perforation is a life-threatening condition requiring immediate surgical intervention. Surgical-site infections (SSIs) and wound dehiscence are...
Background Intestinal perforation is a life-threatening condition requiring immediate surgical intervention. Surgical-site infections (SSIs) and wound dehiscence are common complications associated with emergency laparotomy for intestinal perforation. Finding optimal wound management and postoperative strategies can significantly impact patient outcomes and reduce the risk of complications. Negative-pressure wound therapy (NPWT) is a relatively recent tool employed in the care of wounds to control SSIs and foster healing. Methodology A prospective, observational, cohort study was conducted among 150 patients who underwent emergency exploratory laparotomy due to intestinal perforation at the general surgery department of a tertiary care hospital in New Delhi between July 2022 and December 2023. Preoperatively, all patients underwent initial resuscitation. Intraoperatively, the extent of peritonitis was determined and was categorized according to the Centers for Disease Control and Prevention (CDC) classification. Postoperatively, NPWT dressing was applied to the patient's midline laparotomy wound on postoperative day (POD) two. Negative pressure was set at 75-125 mmHg with suction. The number of NPWT dressing changes required was documented. The wound was closed with vertical mattress sutures under local anesthesia, delayed primary closure (DPC). The incidence of SSIs, the duration for DPC, the incidence of fascial dehiscence, the number of NPWT dressing changes, and the length of hospital stay were documented according to CDC groups. Results The mean age in CDC categories 2, 3, and 4 were 31.789, 28.733, and 42.676 years, respectively. The most common cause of perforation was enteric fever (n = 42, 28%), followed by tuberculosis (n = 36, 24%). Most patients had no known comorbidities (n = 80, 53.3%). Overall, 16% of patients (n = 24) were both alcoholics and smokers. The most frequent bacteria in all CDC categories was . Fourteen patients developed burst abdomen in the postoperative period and were excluded from the study. The mean duration of DPC increased with higher CDC categories, with CDC category 4 displaying the most extended mean duration at 10.70 days. The number of NPWT dressing changes increases with higher CDC categories, with CDC category 4 exhibiting the highest mean at 2.00 changes. The mean hospital stay increased with higher CDC categories, with CDC category 4 showing the most extended mean stay at 17.324 days. Statistical analysis revealed no significant association between SSI occurrence and CDC categories. Conclusions NPWT followed by DPC is a promising approach to managing gastrointestinal perforations, reducing SSIs, and potentially improving patient outcomes. However, further research is needed to explore the specific benefits of NPWT in conjunction with DPC and its efficacy in various clinical scenarios.
PubMed: 38903365
DOI: 10.7759/cureus.60738 -
Cureus May 2024Introduction Dengue fever, caused by the dengue virus transmitted by Aedes aegypti mosquitoes, is a significant public health concern globally. Its resurgence in recent...
Introduction Dengue fever, caused by the dengue virus transmitted by Aedes aegypti mosquitoes, is a significant public health concern globally. Its resurgence in recent years, particularly in low- and middle-income countries, has led to increased morbidity and mortality rates. Atypical manifestations, involving the cardiac, liver, gut, renal, blood, bone, nervous, and respiratory systems, in dengue, can complicate both diagnosis and management. This study aimed to investigate the incidence of lung manifestations in dengue-infected individuals and their correlation with patient outcomes. Background The prevalence of dengue fever has risen dramatically over the past two decades, with Asia bearing the brunt of the burden, particularly India. The pathophysiology of lung complications in dengue remains unclear but is thought to be related to capillary leak syndrome and thrombocytopenia. Studies suggest that respiratory symptoms may be associated with severe cases and increased mortality rates. Despite limited research in India, understanding lung manifestations in dengue is crucial for improving diagnostic accuracy and patient care. Methods A retrospective study was conducted at K.S. Hegde Hospital, a tertiary care facility located in Mangalore, India, involving patients aged 18 years and above diagnosed with dengue fever between January and December 2019. Data gathered comprised patient demographics, clinical symptoms, laboratory findings, imaging results including radiographs, computed tomography (CT) scans of the chest (if accessible), ultrasound examinations of the chest and abdomen, and 2D echocardiograms, as well as patient outcomes. Diagnosis of lung manifestation was established through clinical assessment, chest X-ray interpretation, and ultrasound of the chest. Statistical analysis was conducted using SPSS Statistics (version 20), with a significance set at p<0.05. Results Out of 255 dengue cases, 10.19% (n=26) exhibited pulmonary manifestations, with pleural effusion being the most common. Older age (>50 years) and comorbidities were associated with a higher incidence of lung involvement. Respiratory symptoms, such as breathlessness, were more prevalent in patients with pulmonary complications. Laboratory parameters indicated distinct profiles in patients with lung manifestations, including elevated total count, urea, bilirubin, and liver enzymes, and reduced platelet counts. Mortality rates were higher in patients with lung involvement, older age, and comorbidities. Discussion The study findings highlight the importance of recognizing respiratory symptoms in dengue fever, particularly in older patients and those with underlying health conditions. The association between pulmonary involvement and adverse outcomes underscores the need for early detection and appropriate management strategies. Future research should focus on elucidating the pathophysiology of lung complications in dengue and developing targeted interventions to improve patient outcomes. Conclusion Lung manifestations in dengue fever represent a significant clinical challenge and are associated with increased morbidity and mortality. Early recognition of respiratory symptoms, along with prompt diagnostic evaluation and appropriate management, is essential for improving patient prognosis. Further studies are warranted to deepen our understanding of lung involvement in dengue and optimize therapeutic approaches to mitigate its impact on patient outcomes.
PubMed: 38903312
DOI: 10.7759/cureus.60655