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This study investigates the prognostic value of early CT in acute pancreatitis, the role of pancreatic necrosis as a indicator of prognosis, and the need for the routine use of IV iodinated contrast material in early CT to assess prognosis in these patients.We conducted a retrospective review of 148 patients who underwent unenhanced and contrast-enhanced helical CT within 72 hr after onset of symptoms of a first episode of acute pancreatitis. Patients were classified by CT grade and grouped into two categories (mild: grades A, B, C; and severe: grades D and E) that were correlated with complications and death. In the grades including patients with pancreatic necrosis, it was also correlated with complications and death.All complications (n = 15) and deaths (n = 4) occurred in patients with a CT grade of severe disease; differences as compared with mild grade were significant (p0.001 and p0.03, respectively). CT grade had a sensitivity and specificity of 100% and 61.6%, respectively, for predicting morbidity and 100% and 56.9% for predicting mortality. The 13 patients with necrosis were all in the severe group (p0.001). Necrosis detection on early CT had a sensitivity and specificity of 53.3% and 90.2%, respectively, for predicting morbidity and 75% and 83.8% for mortality.Early unenhanced CT alone was a good indicator of severity of acute pancreatitis in our selected population. CT grade was sensitive for predicting outcome in acute pancreatitis. Pancreatic necrosis, estimated on early, contrast-enhanced CT and seen only in patients having severe disease, was a specific predictor of morbidity and mortality. These findings lead us to suggest that the use of iodinated contrast material to assess necrosis can be reserved for only those patients classified as having severe disease on unenhanced CT.

A case of unilateral renal cystic disease of the kidney is reported, in which the cysts were located to the lower pole of the right kidney. The radiologic and pathologic findings are described and their differential diagnosis is discussed. Conservative treatment and imaging follow-up is proposed for this condition.

Replacement lipomatosis of the kidney in a case of long-standing renal tuberculosis is reported. The radiologic and pathologic findings are described and the differential diagnosis is discussed. A hypothesis is given to explain the association of renal tuberculosis and replacement lipomatosis of the kidney.

Massive inguinoscrotal herniation of the bladder (i.e. scrotal cystocele) is very uncommon. We describe the ultrasonography and computed tomography features of scrotal cystocele in two patients, and review the radiologic findings of this rare entity reported in the literature.

Objectives To study the incidence of band erosion in patients who have undergone vertical banded gastroplasty and to describe the reparative techniques used. Design A retrospective review case series. Setting A university hospital–based tertiary referral center. Patients Two hundred fifty consecutive morbidly obese patients who underwent vertical banded gastroplasty between 1987 and 1995. Main Outcome Measures The development of band erosion into the stomach, reparative surgical techniques, and long-term weight loss control. Results Band erosion developed in 7 (2.8%) of the patients. Two patients had symptoms 1 month after undergoing forced endoscopy. Six patients required reoperation. The operative findings included 2 cases of "external" band erosion through the lesser curvature into the stomach and 4 cases of "internal" band erosion through the circular staple line. The surgical techniques used for repair depended on the radiological and endoscopic data and on the operative findings; the techniques included conversion into a gastric bypass, band replacement after the creation of a new stoma, and gastroplasty plus distal gastric bypass. There were no complications, and adequate long-term weight loss was achieved in all but 1 of the patients who underwent reoperation. Conclusion Band erosion may be corrected using appropiate surgical techniques to allow for adequate long-term weight loss in patients who have undergone vertical banded gastroplasty.

Primary linitis plastica of the colon is a rare entity, and its radiographic and CT findings have been described in previously published literature. We present the CT demonstration of the pelvic wall spread in this unusual disease, and briefly review its radiologic and pathologic features.

We report a case of midgut malrotation with volvulus in an adult diagnosed by ultrasonography, and we present the sonographic appearance of a specific sign of this uncommon anomaly: whirl-like encircling loops of bowel around the abnormal disposed mesenteric vessels.