Search

Symptomatic isolated celiac artery (CA) dissection (SICAD) is an extremely rare form of visceral artery dissection. It is diagnosed by a contrast abdominal computed tomography (CT) scan showing a CA dissection (CAD). There are 4 types of CAD: Type I-IV. Type I has entry and re-entry and no true luminal narrowing. All types other than type I have entry and re-entry. They have true lumen compression and true lumen constriction due to false lumen. We report a case with the longest follow-up, 120 months after symptom onset, without evidence of CAD exacerbation. A 56-year-old man presented with a sudden onset of abdominal and back pain. He had a past medical history of left pneumothorax, pulmonary tuberculosis at the age of 23, and hypertension on medication since the age of 46. On physical examination, he had mild muscle rebound tenderness in the epigastric region. The curved multiplanar reconstruction (MPR) of the urgent 3-dimensional contrast-enhanced abdominal computed tomography angiography (CTA) showed an isolated celiac artery dissection type I. Given the risk of emergency surgery for total occlusion of the CA, conservative management with analgesics during hospitalization resolved the abdominal pain, and the patient was discharged 3 days later. Subsequently, a total of 5 CTAs were performed over 120 months, but no worsening of CA arterial dissection and CA occlusion findings were observed. In type I SICAD cases, arterial dissection, and CA occlusion may progress, in which case emergency stenting or endovascular treatment may be indicated, and close follow-up such as CTA is required.

The prevalence of hepatic cyst (HC) ranges from 2.5 to 4.7%. Among them, HCs with with symptoms occur in 15%. Extrahepatic rupture of HCs with hemorrhagic shock and death may occur. Early detection of intracystic hemorrhage is necessary to prevent lifethreatening complications. In this case, a 77-year-old woman underwent regular checkups. Her ultrasound (US) showed multiple hepatic cysts (HCs). The largest HC was 80 mm in diameter and located in segment 8 of the right lobe. Her prognostic nutritional index (PNI) was 41.7, indicating high surgical morbidity and mortality after surgery. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) were added to identify intra- and extra-cystic anatomy. Compared to MDCT, MRI was able to identify intra-cystic heterogeneous low and high intensity. These findings were interpreted to indicate acute to chronic intra-cystic hemorrhage. As a complication of the rupture and death, an anterior segmentectomy with segmentectomy with cholecystectomy was planned and performed. Her postoperative course was uneventful and she was discharged on day 16. The life-threatening complex HCs include intra-cystic hemorrhage, rupture, hemorrhagic shock and death. To prevent these, we would like to emphasize that MRI appears to be superior to US or CT in providing accurate information on the time course of intra-cystic hemorrhage from hemoglobin to hemosiderin changes to guide urgent surgical intervention of hepatectomy to prevent HC rupture and prevent HC rupture and death.

A 67-year old male with intussusception due to sigmoid colonic caner was treated. For making correct classification of antegrade or retrograde type, multidetector-computed tomography in longitudinal views seemed optimal to demonstrate anatomical type. This radiological modality made to identify this instead of ultrasound sonography (US) could reveal details of surrounding information. Under intestinal obstruction due to intussusception, cancer-related information such as lymph nodal involvement could be visible using not US but MDCT because of air collection around lesions. His preoperative MDCT revealed antegrade type intussusception with cancerous mass at the leading point and no nodal involvements. Under general anesthesia, he has undertaken laparotomy to resect intussuscepted sigmoid colonic lesion successfully without delaying of surgical procedure. For correct preoperative identification of antero-retrograde type of intussusception using MDCT, safer surgical procedure could be provided. For these purposes, the authors classified these into 2 types, type M and W from longitudinal views of intussuscepted lesions using 3D-MDCT. This classification might be helpful for clinicians to diagnose type of intussusception and provide preoperative information of cancerous involvements with vessels and lymph nodal involvements to consider surgical option

A 72-year-old female diagnosed with rectal cancer treated with a surgical procedure was reported. As 3 liver metastases (LMs) appeared in multidetector CT, adjuvant chemotherapy using Bevacizumab combined with modified FOLFOX-6 was completed. LMs were changed to cystic lesions during the follow-up period, consistent with liquefactive necrosis. These cystic lesions that appeared in the course of disappearing LMs (DLMs) were identified by CT as homogeneous low signal intensity in hepatocyte specific Gd-enhanced MRI. This might be pathognomonic radiological footprint equivalent to liquefactive necrosis observed in the process of DLM and must be carefully followed in the course of radiological complete response. The radiological changing findings of LMs to cystic changes, high sensitivity of detecting DLM, and limitations of Gd-MRI might be meaningful to clinicians.

An invasive aspergillosis (IA) primarily occurs among immunocompromised patients. Recently with an influenzae infection prevalently spreading, influenzae-associated invasive aspergillosis (IAIA) has been reported occasionally. By contrast, neuroleptic malignant syndrome (NMS) occurs rarely in psychiatric patients who are treated with Olanzapine. We report a 43 years old male with psychiatric disorder who had developed IAIA followed by NMS and cerebral hemorrhage as the result of aspergillus invasion to cerebral vessels. He had also super-infection of COVID-19, 13 months later to be saved completely after invasive mechanical respiratory supports. From clinical aspects, we would emphasize that it is of importance to find earlier co-occurrence of IAIA patients with cerebral hemorrhage due to secondary infectious vasculopathy of IA.

An emphysematous cystitis s a rare urinary tract infectious disease and fatal unless any treatments. The case was a 97-year-old female presented with knee pain after falling with co-existence of macroscopic hematuria and pyuria. The ultrasonography examined on the same day showed a hyperechoic bladder-ring appearance bordering bladder wall which was re-was re-confirmed by computed tomography by air bubble collection on the circumferential bladder wall. We conclude and emphasize as the leaning point that emphysematous cystitis is raised as a differential diagnosis when ultrasonography showed the pathognomonic as hyperechoic bladder-ring appearance bordering bladder wall.

Although large bowel obstruction is a common surgical emergency, its occurrence due to bladder distension is rarely reported in the literature. We report a case of large bowel obstruction caused by bladder distention secondary to benign prostate hyperplasia in a 67-year-old man. This case demonstrates a grossly distended urinary bladder compressing the rectosigmoid colon against the sacrum, presenting as a complete large bowel obstruction. Management consisted of transurethral urinary catheter insertion, which resulted in complete resolution of the bowel obstruction with drainage of a large amount of urine. Early recognition of the underlying etiology resulted in the expeditious treatment of large bowel obstruction. Keywords: Large bowel obstruction, Urinary retention, Bladder distention, Benign prostate hyperplasia

A 79 years male with fishbone-induced acute appendicitis was treated surgically with laparoscopic procedure. In preoperative diagnostic study, 3-dimensional multidetector-computed tomography (3D-MDCT) demonstrated the foreign body in the appendix and 3D-reconstructed images seemed fishbone with sharp-pointed dorsal fin directing to the tip of the appendix. With these findings, surgical indication of appendectomy was confirmed and laparoscopic appendectomy was performed. He made a full recovery and was discharged in a satisfactory condition following 7 days of post-operative treatment. From this case experience, 3D-MDCT seems helpful to visualize details of foreign bodies in the appendix, and valuable to confirm surgical indication of complicated acute appendicitis.