Although most patients with jejunoileal diverticulum are asymptomatic, a large, small-bowel diverticulum can be associated with midgut volvulus in an adult. We present a rare case of midgut volvulus that was associated with a large, small-bowel diverticulum in a 77-year-old woman presenting with chronic recurrent abdominal pain. The CT showed the characteristic whirl sign of twisted mesentery, the small bowel loops along the superior mesenteric artery and a large sac-like small-bowel diverticulum. A small bowel series also demonstrated a corkscrew appearance of proximal jejunum, a finding suggestive of midgut volvulus, and a large jejunal diverticulum. During the laparotomy, the small bowel was seen twisted counterclockwise 270 degree. The mesenteric root was very shortened. A 4 cm sized diverticulum was seen on the mesenteric border of jejunum, on the portion about 40 cm distal from the Treitz ligament.
Abdominal Pain ; Adult* ; Aged ; Diverticulum* ; Female ; Humans ; Intestinal Volvulus* ; Jejunum ; Laparotomy ; Ligaments ; Mesenteric Artery, Superior ; Mesentery

PURPOSE: To investigate the value of the computed tomography (CT) in the study of diagnostic and post-treatment findings of pulmonary actinomycosis. MATERIALS AND METHODS: Clinical data and CT findings were retrospectively analyzed in 10 patients with histopathologically confirmed pulmonary actinomycosis. We analyzed the initial CT findings in search of patterns and distributions which suggest possible lung abnormalities and found the pleura, chest wall, and lymphadenopathy to be involved as part of the indicators of lung abnormalities. We analyzed follow-up CT findings for changes in the lungs after antibiotic therapy and recurrence after surgery. RESULTS: Of the 10 patients analyzed by CT for lung lesions, seven had been diagnosed with alcoholism and nine were male. The initial CTs (n=10) indicated that all the pulmonary lesions were solitary without chest wall involvement. However, a transfissural extension was observed in 20% of the study population (n=2). Furthermore, peripheral lung distribution and adjacent pleural thickening was observed in 70% of the study population (n=7). Within the consolidation (n=6) or mass (n=4), a central low density with peripheral enhancement was seen in 70% of the study population (n=7). A follow-up CT of the seven cases following antiobiotic therapy revealed that four cases showed minimal improvement or aggravation of their lung lesions, whereas three cases showed resolution or improvement. The improvement of the central low density was related to the improvement of consolidation or mass. Furthermore the presence of fibrosis was observed after the resolution of pulmonary lesions (n=2). No relationship was found between the duration and response of antibiotic therapy. A follow-up CT (n=4) subsequent to a lung resection revealed the onset of chest wall actinomycosis and a thickened pleura in one case. CONCLUSION: The results of this study highlight the value of the CT in pulmonary actinomycosis in order to diagnose and evaluate antibiotic responses, complications, or post-surgical recurrences of lung lesions.
Actinomycosis ; Alcoholism ; Fibrosis ; Follow-Up Studies ; Humans ; Lung ; Lung Diseases ; Lymphatic Diseases ; Male ; Pleura ; Recurrence ; Retrospective Studies ; Thoracic Diseases ; Thoracic Wall ; Tomography, X-Ray Computed

The development of MR imaging techniques during the past decade has enabled researchers to use MR imaging as a noninvasive tool for evaluating structural and physiologic states in biologic tissues by measuring the diffusion process of water molecules. More recently, diffusion tensor MR imaging (DTI) technique based on the dependency of molecular diffusion on the orientation of white matter fiber tracts has been used to analyze the trajectory, shape, fiber structure, location, topology and connectivity of neuronal fiber pathways in living humans. Numerous efforts have been made by MR physicists, brain scientists, and medical doctors to advance MR techniques and computer-based algorithms which result in more accurate quantification of diffusion tensor and the generation of white matter fiber tract maps and to determine the pathophysiology of brain disease by DTI and useful clinical applications of DTI. In this article, we describe the tensor theory used to characterize molecular diffusion in white matter and a process of measuring tensor elements using diffusion-sensitive MR images to fiber mapping. We then provide review of current literature and some clinical examples that have been published and are on-going.
Brain Diseases ; Brain* ; Diffusion* ; Humans ; Magnetic Resonance Imaging* ; Neurons