The Usefulness of the Computed Tomography for Diagnosing DeepVenous Thrombosis of the Lower Extremities

PURPOSE: This study aims to access the usefulness of indirect computed tomographic venography (CTV) after performing computed tomographic pulmonary angiography (CTPA) to detect deep venous thrombosis. METHODS: Eighty six patients who were diagnosed with deep venous thrombosis (DVT) were retrospectively enrolled in this study. All the patients had CTPA & CTV performed within 24 hours after Doppler ultrasound (US). The CTV was compared with Doppler US for their ability to diagnose DVT. Pulmonary embolism (PE) and other findings that were detected by CTPA & CTV were analyzed. RESULTS: Among 86 patients, 83 had thrombi detected by Doppler US. CTV did not detect DVT in 11 of the 83 patients. Among the 11 patients, 8 had below the knee thrombosis, which was not in the scan area of CTV. In 2 patients, their Doppler US results could not be guaranteed. One case was a false positive result on Doppler US. The results for determining the thrombi level between Doppler US and CTV were roughly concordant. In addition to DVT or PE, 32 new lesions in 27 patients were incidentally detected by CTPA & CTV. CONCLUSION: Compared with Doppler US, CTPA & CTV are not inferior to detect DVT of the lower extremities and these modalities can also provide information about incidental disease, as well as pulmonary embolism.

Combined Inferior Vena Cava Resection during Pancreatoduodenectomy

There is no consensus for the surgical indications, as well as the surgical technique, for the treatment of inferior vena cava (IVC) invasion by pancreas head cancer. The authors experienced a case of pancreas head cancer invading the anterior wall of the IVC. We performed en bloc excision of the anterior wall of the IVC combined with pancreatoduodenectomy in this case under the assumption that only a margin-negative surgical resection could offer a chance for cure. Technically, the sequence of dissection and addressing the IVC at the end of dissection are considered to be important to secure the operative field surrounding the IVC and to achieve a margin-negative resection. There has been no recurrence up to now, 8 months after the extensive radical operation.

Combined Inferior Vena Cava Resection during Pancreatoduodenectomy

There is no consensus for the surgical indications, as well as the surgical technique, for the treatment of inferior vena cava (IVC) invasion by pancreas head cancer. The authors experienced a case of pancreas head cancer invading the anterior wall of the IVC. We performed en bloc excision of the anterior wall of the IVC combined with pancreatoduodenectomy in this case under the assumption that only a margin-negative surgical resection could offer a chance for cure. Technically, the sequence of dissection and addressing the IVC at the end of dissection are considered to be important to secure the operative field surrounding the IVC and to achieve a margin-negative resection. There has been no recurrence up to now, 8 months after the extensive radical operation.

Abdominal Aortic Aneurysm Infection Caused by Citrobacter freundii

Citrobacter freundii is frequently isolated in antimicrobial-resistant nosocomial infections. Many strains of Citrobacter freundii are capable of producing an inducible broad-spectrum beta-lactamase. We report a case of an abdominal aortic aneurysm infected with Citrobacter freundii. A 55-year-old woman presented with acute lower back pain. Contrast enhanced computed tomography revealed a saccular aneurysm of the infrarenal abdominal aorta, with impending rupture. She underwent emergency surgery, during which a segment of aneurysmal aorta and infected tissue were completely removed and an in situ graft was placed for vascular reconstruction. The anastomotic site and inserted graft were wrapped with greater omentum. Citrobacter freundii was isolated by tissue culture from the resected aneurysmal wall.