The definition of volvulus is an axial twist of a portion of the gastrointestinal tract along its mesentery. The involved bowel is obstructed partially or completely with a variable degree of arterial and venous occlusion. The colon is the most common site for volvulus. The splenic flexure is the least common site of colonic volvulus. We experienced a case of the volvulus of the splenic flexure. It will be the 30th case of the volvulus involving the splenic flexure in the English literature, to our knowledge. A 30-year-old woman was admitted due to abdominal pain and distention with vomiting. An emergency barium study revealed characteristic "bird beak" sign. Surgery was performed resecting the involved colon of splenic flexure. The result was excellent.
Adult ; Barium Sulfate/diagnostic use ; Case Report ; Colonic Diseases/*radiography ; Female ; Human ; Intestinal Obstruction/*radiography

The pharyngoesophageal diverticulum in the lower part of the neck can be detected using neck ultrasonography. We present a case of pharyngoesophageal diverticulum mimicking a thyroid nodule, which was found incidentally by ultrasonography, and discuss its peculiar findings, which might be useful to diagnose pharyngoesophageal diverticulum and to prevent invasive procedures such as needle aspiration biopsy.
Aged ; Barium/diagnostic use ; Case Report ; Diagnosis, Differential ; Esophagus/radiography ; Human ; Male ; Thyroid Nodule/diagnosis/ultrasonography ; Zenker Diverticulum/diagnosis/*ultrasonography

Recently, the availability of multidetector-row CT (MDCT) and continuous refinement in three-dimensional (3D) imaging process have greatly expanded the role of CT in evaluating patients with gastrointestinal diseases. MDCT is the latest advancement in CT technology and is now more readily available. This imaging modality can offer full examination of the entire intestinal tract as well as powerful information about the bowel itself and its surrounding structures, which are inherent advantages of CT over conventional barium or optical endoscopic studies. In most cases, MDCT with various 3D technologies can make an easy, rapid, and accurate diagnosis by one-stop imaging, and enables to avoid other examinations. Therefore, knowledge and awareness of valuable clinical applications and proper scan technique of MDCT imaging is essential to achieve the diagnostic goal of one-step imaging.
Barium Sulfate/diagnostic use ; Colonic Neoplasms/diagnosis/radiography ; Colonic Polyps/diagnosis/radiography ; Colonography, Computed Tomographic/instrumentation/*methods ; *Enema ; Humans ; Imaging, Three-Dimensional ; Tomography, Spiral Computed/instrumentation/*methods

Clinical manifestations and imaging findings of mantle cell lymphoma involving gastrointestinal tract were evaluated. The subjects were 7 cases of mantle cell lymphoma involving the gastrointestinal tract. All cases were pathologically confirmed in our hospital during the period from April 1994 to July 2000. Five patients were male and 2 were female, and their age ranged from 49 to 63 years (average 57.4). The objectives were: 1) characteristics and distribution of multiple polyposis, 2) presence, location and enhancement pattern of bowel wall thickening or mass formation, 3) presence of splenomegaly, 4) presence and location of abdominal lymph node enlargement, 5) involved extra-abdominal organs, 6) combined cancer and location, and 7) other findings. All mantle cell lymphomas occurred in elderly persons, over 40 years, and most showed multiple polyposis (6/7), bowel wall thickening or mass formation (6/7), lymph node enlargements (6/7) and extra- abdominal involvement (5/7). All cases of polyposis involved the small bowel and colon, and the size of the polyps ranged from 0.1-4.0cm. Four of 6 patients showed combined sessile and polypoid polyps, while the other 2 showed only sessile polyps. Most of or some of the polyps in 3 patients showed small central ulcerations. Most of the patients (5/6) showed an uncountable number of polyps. Polyposis was predominant in the rectum, ascending colon, rather than other sections in the colon, and the ileum were almost always involved by polyposis. Bowel wall thickening or mass formation developed exclusively in the ascending colon, rectum or ileum. Extra- abdominal involvement developed either simultaneously or nonconcurrently with gastrointestinal involvement. Some of patients showed splenomegaly (3/7), appendiceal enlargement (2/7), and intussusception (1/7), and some had associated adenocarcinomas (3/7).
Barium Sulfate/diagnostic use ; Enema ; Female ; Gastrointestinal Neoplasms/*pathology/*radiography ; Human ; Lymphoma, Mantle-Cell/*pathology/*radiography ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVE: To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency. MATERIALS AND METHODS: Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean +/- SD in age, 51 +/- 6.4 years) and CTC (n = 176; 50 +/- 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of > or = 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups. RESULTS: Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p = 0.046). Electrolyte changes were similar in the two groups. CONCLUSION: In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.
Analysis of Variance ; Barium Sulfate/diagnostic use ; Colonic Polyps/diagnosis/radiography ; *Colonography, Computed Tomographic ; Colorectal Neoplasms/*diagnosis/radiography ; Contrast Media/diagnostic use ; *Enema ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Renal Insufficiency/*complications ; Risk Factors ; Sensitivity and Specificity

OBJECTIVE: To describe our initial experience with CT-guided percutaneous barium marking for the localization of small pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS). MATERIALS AND METHODS: From October 2010 to April 2011, 10 consecutive patients (4 men and 6 women; mean age, 60 years) underwent CT-guided percutaneous barium marking for the localization of 10 small pulmonary nodules (mean size, 7.6 mm; range, 3-14 mm): 6 pure ground-glass nodules, 3 part-solid nodules, and 1 solid nodule. A 140% barium sulfate suspension (mean amount, 0.2 mL; range, 0.15-0.25 mL) was injected around the nodules with a 21-gauge needle. The technical details, surgical findings and pathologic features associated with barium localizations were evaluated. RESULTS: All nodules were marked within 3 mm (mean distance, 1.1 mm; range, 0-3 mm) from the barium ball (mean diameter, 9.6 mm; range, 8-16 mm) formed by the injected barium suspension. Pneumothorax occurred in two cases, for which one needed aspiration. However, there were no other complications. All barium balls were palpable during VATS and visible on intraoperative fluoroscopy, and were completely resected. Both the whitish barium balls and target nodules were identifiable in the frozen specimens. Pathology revealed one invasive adenocarcinoma, five adenocarcinoma-in-situ, two atypical adenomatous hyperplasias, and two benign lesions. In all cases, there were acute inflammations around the barium balls which did not hamper the histological diagnosis of the nodules. CONCLUSION: CT-guided percutaneous barium marking can be an effective, convenient and safe pre-operative localization procedure prior to VATS, enabling accurate resection and diagnosis of small or faint pulmonary nodules.
Adult ; Aged ; Barium Sulfate/*diagnostic use ; *Contrast Media ; Female ; Humans ; Lung Neoplasms/radiography/*surgery ; Male ; Middle Aged ; *Radiography, Interventional ; Solitary Pulmonary Nodule/radiography/*surgery ; *Thoracic Surgery, Video-Assisted ; *Tomography, X-Ray Computed

OBJECTIVE: This preliminarily study was designed to determine and to compare the efficacy of two commercially available barium-based fecal tagging agents for CT colonography (CTC) (high-density [40% w/v] and low-density [4.6% w/v] barium suspensions) in a population in Korea. MATERIALS AND METHODS: In a population with an identified with an average-risk for colorectal cancer, 15 adults were administered three doses of 20 ml 40% w/v barium for fecal tagging (group I) and 15 adults were administered three doses of 200 ml 4.6% w/v barium (group II) for fecal tagging. Excluding five patients in group I and one patient in group II that left the study, ten patients in group I and 14 patients in group II were finally included in the analysis. Two experienced readers evaluated the CTC images in consensus regarding the degree of tagging of stool pieces 6 mm or larger. Stool pieces were confirmed with the use of standardized CTC criteria or the absence of matched lesions as seen on colonoscopy. The rates of complete fecal tagging were analyzed on a per-lesion and a per-segment basis and were compared between the patients in the two groups. RESULTS: Per-lesion rates of complete fecal tagging were 52% (22 of 42; 95% CI, 37.7-66.6%) in group I and 78% (28 of 36; 95% CI, 61.7-88.5%) in group II. The difference between the two groups did not reach statistical significance (p = 0.285). The per-segment rates of complete tagging were 33% (6 of 18; 95% CI, 16.1%-56.4%) in group I and 60% (9 of 15; 95% CI, 35.7%-80.3%) in group II; again, the difference between the two groups did not reach statistical significance (p = 0.171). CONCLUSION: Barium-based fecal tagging using both the 40% w/v and the 4.6% w/v barium suspensions showed moderate tagging efficacy. The preliminary comparison did not demonstrate a statistically significant difference in the tagging efficacy between the use of the two tagging agents, despite the tendency toward better tagging with the use of the 4.6% w/v barium suspension.
Administration, Oral ; Adult ; Barium/administration & dosage/*diagnostic use ; Colon/radiography ; *Colonography, Computed Tomographic/methods ; Colonoscopy ; Colorectal Neoplasms/diagnosis/radiography ; Contrast Media/*administration & dosage ; *Feces ; Female ; Humans ; Male ; Middle Aged ; Suspensions

The eventration of diaphragm is usually found incidentally on chest X-ray or sometimes presented as acute gastric volvulus. However, colonic volvulus on splenic flexure area complicated by diaphragmatic eventration is extremely rare. A 25 year old man complained of upper abdominal pain for three days. He had a history of brain injury during infant period, and had epilepsy and mental retardation. Plain chest X-ray showed left diaphragmatic eventration and marked dilatation of colon on splenic flexure area which had not been changed for last three years. Barium enema showed bird beak appearance on distal colon near the splenic flexure. Colonoscopic reduction failed. After decompression with rectal and nasogastric tubes, colonic volvulus was relieved. To prevent the recurrence of volvulus, we performed segmental resection of left colon including splenic flexure area and repaired the left diaphragmatic eventration. After the operation, the patient had no further recurrent episode of volvulus although ileus persisted.
Adult ; Barium Sulfate/diagnostic use ; Chronic Disease ; *Colon, Transverse ; Colonic Diseases/*radiography/surgery ; Diaphragmatic Eventration/*complications/radiography/surgery ; Humans ; Intestinal Volvulus/etiology/*radiography/surgery ; Male ; Recurrence ; Tomography, X-Ray Computed

OBJECTIVETo discuss the value of multi-slice CT dynamic enhancement scan in the diagnosis and treatment of colonic lymphomas.

METHODS16 patients with colonic lymphomas underwent multi-slice CT dynamic enhancement scans, images of axial and reconstructive images of VR, MPR and CTVE were analyzed, patients were respectively diagnosed.

RESULTSAppearances of primary colorectal lymphomas were categorized into focal and diffuse lesions. Focal and diffuse lesions were 6 and 10 patients, respectively. The accuracy rate of diagnosis was 87.5%.

CONCLUSIONMSCT dynamic scan has distinctive superiority in diagnosis and treatment of colonic lymphomas.

Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Barium Sulfate ; Child ; Colon ; diagnostic imaging ; drug effects ; surgery ; Colonic Neoplasms ; diagnosis ; drug therapy ; surgery ; Colonoscopy ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Enema ; Female ; Humans ; Lymphoma, B-Cell ; diagnosis ; drug therapy ; surgery ; Male ; Middle Aged ; Prednisone ; therapeutic use ; Radiographic Image Enhancement ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, Spiral Computed ; methods ; Vincristine ; therapeutic use