Abdominal Abscess ; diagnosis ; diagnostic imaging ; pathology ; Aged ; Groin ; diagnostic imaging ; pathology ; Humans ; Male ; Radiography

PURPOSE: To evaluate the plain radiographic and CT findings of the necrotizing fasciitis. MATERIALS AND METHODS: We retrospectively reviewed the radiologic findings of 4 cases with necrotizing fasciitis. Three cases were proven pathologically. We evaluated pattern and extent of the gas shadows in plain films. CT findings were analysed, with emphasis on : (a) gas pattern, (b) extent, (c) location and involved site, (d) associated focal abscess, and (e) swelling of the adjacent muscles. RESULTS: On plain radiographs, four cases showed streaky or mottled gas densities in the pelvis, three cases in the perineum, one case in the abdomen, and two cases in the thigh. On CT images, gas pattern was mottled and streaky appearance with swelling of the adjacent muscles. Gasshadows located in the extraperitoneal space in four cases, fascial layer in four cases, and subcutaneous layer infour cases. There were gas shadows in pelvic wall, perineum, abdominal wall, buttock, thigh, and scrotum. Focallow density lesion suggestive of focal abscess was not visualized. CONCLUSION: Plain radiography is useful forearly diagnosis of the necrotizing fasciitis and CT is very useful for detection of precise location and extent of the disease. CT is also useful for differentiation of necrotizing fasciitis from focal abscess and cellulitis.
Abdomen ; Abdominal Wall ; Abscess ; Buttocks ; Cellulitis ; Diagnosis ; Fasciitis, Necrotizing* ; Muscles ; Pelvis ; Perineum ; Radiography ; Retrospective Studies ; Scrotum ; Thigh

Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of massive gastrointestinal bleeding. Diagnosis of PAEF is difficult to make and is frequently delayed without strong clinical suspicion. Timely surgical intervention is essential for patient's survival. We report on a case of an 86-year-old woman with no history of abdominal surgery, who presented with abdominal pain. Initially, computed tomography scan showed an intra-abdominal abscess, located anterior to the aortic bifurcation. However, she was discharged without treatment because of spontaneous improvement on a follow-up computed tomography scan, which showed a newly developed right common iliac artery aneurysm. One week later, she was readmitted due to recurrent abdominal pain. On the second day of admission, sudden onset of gastrointestinal bleeding occurred for the first time. After several endoscopic examinations, an aortoenteric fistula bleeding site was found in the sigmoid colon, and aortography showed progression of a right common iliac artery aneurysm. We finally concluded that intra-abdominal abscess induced an infected aortic aneurysm and enteric fistula to the sigmoid colon. This case demonstrated an extremely rare type of PAEF to the sigmoid colon caused by an infected abdominal aortic aneurysm, which has rarely been reported.
Abdominal Abscess/*diagnosis/microbiology ; Aged, 80 and over ; Aorta, Abdominal/radiography ; Aortic Aneurysm, Abdominal/*diagnosis/etiology ; Bacteroides/isolation & purification ; Bacteroides fragilis/isolation & purification ; Colon, Sigmoid/radiography ; Colonoscopy ; Enterococcus/isolation & purification ; Female ; Fistula/*diagnosis ; Humans ; Tomography, X-Ray Computed

A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely occur, familiarity with the various manifestations of colon cancer complications will facilitate making an accurate diagnosis and administering prompt management in these situations. The purpose of this pictorial essay is to review the CT appearance of the colonic complications associated with colon cancer.
Abdominal Abscess/complications/radiography ; Adult ; Aged ; Aged, 80 and over ; Appendicitis/complications/radiography ; Colitis, Ischemic/complications/radiography ; Colon/*radiography ; Colonic Diseases/complications/radiography ; Colonic Neoplasms/*complications/*radiography ; Female ; Humans ; Intestinal Diseases/*complications/*radiography ; Intestinal Obstruction/complications/radiography ; Intussusception/complications/radiography ; Male ; Middle Aged ; Tomography, X-Ray Computed/*methods

Pneumoperitoneum is usually the result of a perforated gastrointestinal (GI) tract associated with peritonitis. However, on rare occasions, spontaneous pneumoperitoneum not associated with a perforated GI tract has been described in the literature. A ruptured liver abscess is one of these occasions, and herein a case that resulted in pneumoperitoneum is reported. A 61-year-old woman was referred to the ER with acute onset of abdominal pain. The patient had been diagnosed as having diabetes mellitus and hypertension. The abdominal examination was not remarkable for tenderness, but her vital signs were unstable. Laboratory investigations revealed a WBC count of 4, 000/mm3, Na+ of 129 mEq/L, and K+ of 3.2 mEq/L. A plain radiography disclosed a minute amount of free air in the left subphrenic space, and a computed tomography (CT) scan visualized a low-density cystic mass suspected to be a gas forming pyogenic liver abscess. A laparoscopic exploration was performed for diagnosis and peritoneal drainage. Under the laparoscopy, a ruptured liver abscess and large amount purulent plaque were observed scattered in the entire peritoneal cavity. Evacuation of the abscess, cholecystectomy, liver biopsies, and peritoneal lavage were carried out after conversion to an open laparotomy. An abscess culture was obtained from the liver, with Klebsiella pneumoniae revealed as the pathogen. The administration of appropriate antibiotics followed the surgery, and she recovered without complications. A ruptured pyogenic liver abscess is an extremely rare and threatening condition despite the advances in diagnostic technology and new strategies for their treatment. However, the appropriate surgical management, followed by effective antibiotic therapy, will recover the patient without serious complications.
Abdominal Pain ; Abscess ; Anti-Bacterial Agents ; Biopsy ; Cholecystectomy ; Diabetes Mellitus ; Diagnosis ; Drainage ; Female ; Gastrointestinal Tract ; Humans ; Hypertension ; Klebsiella pneumoniae ; Laparoscopy ; Laparotomy ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic* ; Middle Aged ; Peritoneal Cavity ; Peritoneal Lavage ; Peritonitis ; Pneumoperitoneum ; Radiography ; Rupture, Spontaneous* ; Vital Signs

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treat-ment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was success-fully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.
Adult ; Aneurysm, Infected/drug therapy/radiography/*surgery ; Antitubercular Agents/therapeutic use ; Aortic Aneurysm, Abdominal/drug therapy/radiography/*surgery ; *Blood Vessel Prosthesis Implantation ; Case Report ; Female ; Human ; Male ; Psoas Abscess/surgery ; *Stents ; Tuberculosis, Cardiovascular/drug therapy/radiography/*surgery

Herein, a rare case of a spontaneous rupture of a liver abscess, resulting in pneumoperitoneum, is reported. A 71-year old female with uncontrolled diabetes mellitus, developed an acute abdomen. The chest x-ray and plain abdominal radiography findings revealed bilateral subphrenic free air, and the computed tomography suggested the rupture of a gas-containing pyogenic liver abscess in the left hepatic lobe, extending to the lesser omentum. An emergency laparotomy was performed, there was a ruptured pyogenic liver abscess in the left lobe, but no perforation of the hallow viscus organ. A left lobectomy of the liver, with surgical drainage, was performed. The occurrence of pneumoperitoneum secondary to the intraperitoneal rupture of a pyogenic liver abscess, is extremely rare. The condition is associated with high mortality as they are often misdiagnosis at a late stage as a hollow viscus perforation. Recently advances in computed tomography and ultrasound have resulted in liver abscesses being detect earlier. It must be borne in mind that a rupture of a gas-containing liver abscess can also mimic a perforation of the gastrointestinal tract.
Abdomen, Acute ; Aged ; Diabetes Mellitus ; Diagnostic Errors ; Drainage ; Emergencies ; Female ; Gastrointestinal Tract ; Humans ; Laparotomy ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic* ; Mortality ; Omentum ; Pneumoperitoneum* ; Radiography, Abdominal ; Rupture* ; Rupture, Spontaneous ; Thorax ; Ultrasonography

BACKGROUND/AIMS: p53 is known to play a central role in sensing and signaling for the growth arrest and apoptosis in cells with DNA damage. Mutation of p53 is a frequent event in esophageal squamous cell carcinoma (ESCC). p16 protein binds to cyclin dependent kinase 4 (CDK4) inhibiting the ability of CDK4 to interact with cyclin D1, and stimulates the passage through the G1 phase of cell cycle. We observed the expression patterns and frequencies of p53, p16, and cyclin D1 in esophageal dysplasia and in esophageal squamous cell carcinomas. METHODS: In 15 patients of ESCC, 5 patients of esophageal dysplasia and 5 volunteers with normal esophagus, tissue specimens were taken from esophageal lesions during the operation or endoscopic examination. We used specific monoclonal antibodies for p53 protein, p16INK4 protein and cyclin D1. Immunoreactivity was scored. RESULTS: Mean age of all groups was 66 years old (range 47-93) and men to women ratio was 19:1. p53 mutation was observed in 87% (13/15) of ESCC, in 80% (4/5) of esophageal dysplasia, in 0% (0/5) of normal mucosa (p=0.001). p16 expression was seen in 40% (2/5) of esophageal dysplasia, 27% (4/15) of ESCC and 100% (5/5) of normal mucosa (p=0.016). Cyclin D1 expression was not significantly different among 20% (1/5) of esophageal dysplasia, 53% (8/15) of ESCC and 20% (1/5) of normal mucosa. Either the expression of p53 mutation or the loss of p16 occurred in 80% (4/5) of esophageal dysplasia and in 93% (14/15) of ESCC. CONCLUSIONS: The expression of p53 mutation and the loss of p16 might play a central role in the pathogenesis of esophageal squamous cell carcinoma (ESCC), and contribute to the development of precancerous lesion such as dysplasia. In addition, there is a possibility that the mutations of p53 and p16 silencing would be the early events in ESCC development.
Aged ; Carcinoma, Neuroendocrine/*diagnosis/pathology ; Chromogranin A/analysis/immunology ; Drainage ; Female ; Humans ; Immunohistochemistry ; Liver Abscess/*radiography/surgery ; Liver Neoplasms/*diagnosis/pathology ; Radiography, Abdominal ; Synaptophysin/analysis/immunology ; Tomography, X-Ray Computed

Aneurysm, Infected ; etiology ; microbiology ; physiopathology ; Aorta, Abdominal ; diagnostic imaging ; physiopathology ; Comorbidity ; Female ; Humans ; Psoas Abscess ; etiology ; microbiology ; physiopathology ; Psoas Muscles ; diagnostic imaging ; physiopathology ; Radiography ; Salmonella ; isolation & purification ; Salmonella Infections ; complications

Iliopsoas abscess (IPA) is rare in neonates. We present a case of neonatal IPA that was initially believed to bean inguinal hernia. A 20-day-old male infant was referred to our hospital for herniorrhaphy after a 2-day history of swelling and bluish discoloration of the left inguinal area and leg without limitation of motion. Abdominal and pelvic ultrasonography suggested a femoral hernia, but the anatomy was unclear. Abdominal computed tomography revealed a multi-septated cystic mass extending into the psoas muscle from the lower pole of the left kidney to the femur neck. Broad spectrum antibiotics were initiated, and prompt surgical exploration was planned. After opening the retroperitoneal cavity via an inguinal incision, an IPA was diagnosed and surgically drained. Culture of the abscess fluid detected Staphylococcus aureus, sensitive to methicillin. The patient was discharged without complication on the 17th postoperative day.
Diagnosis, Differential ; Drainage ; Hernia, Inguinal/*diagnosis ; Humans ; Infant, Newborn ; Male ; Psoas Abscess/*diagnosis/*therapy ; Radiography, Abdominal/methods ; Rare Diseases ; Republic of Korea ; Staphylococcal Infections/*diagnosis/*therapy ; Tomography, X-Ray Computed/methods ; Treatment Outcome