Follicular Dendritic Cell Sarcoma of the Abdomen: the Imaging Findings

Follicular dendritic cell sarcoma is a rare neoplasm that originates from follicular dendritic cells in lymphoid follicles. This disease usually involves the lymph nodes, and especially the head and neck area. Rarely, extranodal sites may be affected, including tonsil, the oral cavity, liver, spleen and the gastrointestinal tract. We report here on the imaging findings of follicular dendritic cell sarcoma of the abdomen that involved the retroperitoneal lymph nodes and colon. It shows as a well-defined, enhancing homogenous mass with internal necrosis and regional lymphadenopathy.

Ultrasonography of the Acute Abdomen

The initial radiologic evaluation of a patient with acute abdominal symptoms begins with plain abdominal radiographs. Plain abdominal radiographs are helpful for the diagnosis of intestinal obstruction and pneumoperitoneum. However, cross-sectional imaging modalities, such as ultrasonography or computed tomography, are necessary for specific diagnosis of acute abdomen. Ultrasonography is a non-invasive and comfortable tool for patients visiting emergency room. This article describes the ultrasonographic findings of most common diseases presenting with acute abdominal symptoms.

Gossypiboma in the Abdomen: A Case Report

Gossypiboma is retained surgical sponge or swab. We experienced a case of gossypiboma resulting from a retained surgical sponge, which had been left in intraperitoneal cavity for 4 years after appendectomy. Abdominal CT scan revealed a non-calcified soft tissue mass with wall enhancement. We thought this lesion was an abscess or hematoma. So we tried to perform aspiration and drainage guided by ultrasonography. Ultrasonography showed illdefined hyperechoic stripe with strong posterior acoustic shadow within the mass, which has hypoechoic fibrous capsule. We could not puncture the lesion with aspiration needle due to its hardness, and the mass was removed by surgery. We report a case of gossypiboma confirmed by surgery, which was suspected by ultrasonographic feature and difficulty in puncture of mass.

Ultrasonography in the Diagnosis of Appendicitis: Evaluation by Meta-analysis

OBJECTIVE: We wanted to review the usefulness of ultrasonography (US) for the diagnosis of appendicitis and to evaluate the diagnostic accuracy of US according to patients' and researchers' characteristics. MATERIALS AND METHODS: The relevant Korean articles published between 1985 and 2003 were included in this study if the patients had clinical symptoms of acute appendicitis. The histopathologic findings were the reference standard and the data were presented for 2x2 tables. Articles were excluded if patients had no sonographic signs of appendicitis according to graded-compression US. Two reviewers independently extracted the data on study characteristics. The Hasselblad method was used to obtain the combined estimates of sensitivity and specificity for the performance of US. RESULTS: Twenty-two articles (2, 643 patients) fulfilled all inclusion criteria. The estimate of d calculated by combining the sensitivity and specificity was 2.0054 (95% confidence interval [CI]: 1.8553, 2.1554) by a random effects model. The overall sensitivity and specificity (95% CI) were 86.7% (85.4 to 88.0), and 90.0% (88.9 to 91.2), respectively. According to the subgroup meta-analysis by patients' characteristics, the d estimate (95% CI) of dominantly younger age, male, and highly clinical suggestive group for US was 2.2388 (1.8758 to 2.6019), 2.7131 (2.2493 to 3.1770), and 2.4582 (1.7387 to 3.1777), respectively. Also, according to subgroup meta-analysis by researchers' characteristics, the d value (95% CI) for US done by diagnostic radiologists and gray-scale was 2.0195 (1.7942 to 2.2447) and 2.2630 (1.8444 to 2.6815). CONCLUSION: This evidence suggests that US may be useful for the diagnosis of acute appendicitis, especially when patients are younger age, male, and highly clinical suggestive.

Extragastrointestinal Stromal Tumor Presenting a Large Multilocular Cystic Mass Arising from the Greater Omentum: A Case Report

Extragastrointestinal stromal tumor (EGIST) has been reported to occur only rarely, and the cases of this disease appearing as cystic masses are also known to be very infrequent. Along with a review of the related articles, we report here on a case of EGIST arising from the omentum that was seen as a multiloculated large cystic mass with multiple thick septa and a solid component.

The Diagnostic Role of US in Patients with Right Lower Quadrant Abdominal Pain

PURPOSE: To determine the frequency with which ultrasonography (US) provides a correct diagnosis and suggests appropriate guidance for the treatment of patients with right lower quadrant abdominal pain. MATERIALS AND METHODS: During an 11-month period, US was consecutively performed in 84 patients who were presented with right lower quadrant abdominal pain. In the 76 [M ; F=16 ; 60, age range 14 -87 (mean, 41) years] who formed the study population, final diagnoses were made surgically or clinically. For US, a 5 -7-MHz convex-array, 4-MHz vector-array, and/or 7-MHz linear-array transducer was used, according to the patient 's body habitus. To determine how often our US reports had provided a correct diagnosis and suggested appropriate guidance for surgical or medical treatment, and to calculate their diagnostic value, the reports were retrospectively compared with final diagnoses. RESULTS: US diagnoses were acute appendicitis in 40 patients (53%), diseases other than this in 25 patients (33%), and no abnormality in 11 (14%). In 38 of the 40 patients (95%), the diagnosis of acute appendicitis was surgically confirmed as correct, and for other diseases, diagnoses based on the findings of US proved to be correct in 21 of 25 patients (84%). Overall, diagnosis was correct in 67 (88%). As regards appropriate guidance for treatment, 46 (61%) and 30 (39%) patients were diagnosed by US to have surgical and medical diseases, respectively. In 44 of the 46 (96%), it was confirmed guidance was appropriate, and for the 30 with medical disease, this was so in all but one case (97%). Overall, the treatment plan was appropriate in 72 patients (95%). CONCLUSION: Our study revealed that US was able to provide a correct diagnosis in 88% of patients with right lower quadrant abdominal pain, and in 95% of these, the treatment plan suggested was appropriate. US is, therefore, a valuable screening tool in the diagnosis and therapeutic guidance of such patients.

Ultrasonography and CT Findings of Abdominal Wall Endometrioma

PURPOSE: To evaluate the US and CT findings of abdominal wall endometrioma. MATERIALS AND METHODS: We respectively reviewed nine patients with abdominal wall masses diagnosed as endometrioma during a recent three-year period. Both US and CT scans were performed in six cases, only ultrasound in one, and only CT scans in two. The location, size, shape, margin, internal echo or density, enhancement patterns, and relation to adjacent masses, as seen on US and CT images, were reviewed. RESULTS: All patients had a previous history of deliveries by caesarian section. All masses were 2-4.5cm in size ; five were located in subcutaneous layers and four in musclel ayers. In all cases, sonographic findings were low echoic masses with irregular margins(7/7). Internal echotextures were inhomogeneous in five cases and homogeneous in two. On CT, masses in subcutaneous layers(5/8)showed spiculated margins and linear enhancement of the rectus muscle fascia. In cases of lesion located in muscle(3/8), slight thickening of the rectus muscle was visible on precontrast CT scans, but on postcontrast CT scans, well-defined enhancing masses, separate from the rectus muscle were seen. CONCLUSION: When patients with a previous history of caesarian section present palpable abdominal wall masses, with cyclic pain, sonographic findings of a low echoic mass separated from the internal organs, and CT findings of a strongly enhanced mass are useful for the diagnosis of endometrioma.

Systemic Lupus Erythematosus: Abdominal Radiologic Findings

Systemic lupus erythematosus(SLE) is a systemic disease of unknown etiology. Its main pathology is vasculitis and serositis, due to deposition of the immune complex or antibodies. Most findings are nonspecific ; abdominal manifestations include enteritis, hepatomegaly, pancreatic enlargement, serositis, lymphadenopathy, splenomegaly,nephritis, interstitial cystitis, and thrombophlebitis. We described radiologic findings of various organinvolvement of SLE; digestive system, serosa, reticuloendothelial system, urinary system, and venous system.Diagnosis of SLE was done according to the criteria of American Rheumatism Association. Understanding of thevariable imaging findings in SLE may be helpful for the early detection of abdominal involvement andcomplications.

Intra-abdominal Desmoplastic Small Cell Tumor in a Girl: A Case Report

PURPOSE: To review MRI in order to compare Gd-DTPA enhanced images before and after preoperative intraarterialchemotherapy for osteosarcoma. MATERIALS AND METHODS: In sixteen patients with pathologically-proven osteosarcomawho underwent intra-arterial chemotherapy, MR images were obtained before and after this treatment. The degree[grade 0(low) to IV(high)] and pattern (homogenous, inhomogenous) of changes in contrast enhancement and tumorsize were evaluated. RESULTS: Enhancement changed from Grade III to I in eight patients and from Grade III to IIin five. In three, the enhancement pattern changed from homogenous to inhomogenous; in ten, the inhomogenouspattern did not change; and in three, there was a change from thick, irregular to thin, smooth-rimmed enhancement.In all patients except one, the intraosseous tumor component was not changed. The extraosseous component becamelarger in three patients, smaller in two, and showed no size change in eleven. CONCLUSION: In osteosarcoma, MRimaging after Gd-enhancement following intra-arterial chemotherapy showed decresased enhancement, and increasedinhomogeneity and smooth rim enhancement. Neither the intra-nor extraosseous tumor component showed size changewith time.

Radiological Findings of Primary Abdominal Malignant Fibrous Histiocytoma: Emphasis on CT Findings

PURPOSE: To evaluate the radiological findings of abdominal malignant fibrous histiocytomas. MATERIALS AND METHODS: We retrospectively reviewed the radiological findings of 13 masses in seven patients including two patients with multiple masses. The masses were located at the mesentery and omentum in three patients and at theretroperitoneum in four. Gastrointestinal examination using barium was performed in four patients, ultrasonographyin five and computed tomography in all. RESULTS: The average diameter of masses was 7.8cm(range : 1-20cm); plain abdominal films revealed soft tissue masses in all patients. Three of four barium studies demonstrated only displacement of bowel loops and the other showed findings of submucosal tumor. Eight of 11 masses were detected on ultrasonography and all were round or lobulated and had well defined margins. Four of these masses were greater than 8cm in diameter and showed homogeneous echogenicity with central hypo or anechoic area ; the remaining wereless than 8cm and showed relatively homogeneous echogenicity. On computed tomography, all 13 masses were seen as highly enhanced and well circumscribed. Seven were greater than 5cm in diameter and had internal low-densityareas. Peritumoral vessel-like structures were seen in eight masses and on plain abdominal radiograph and computed tomogram, calcification was seen in one patient. In no patient was combined retroperitoneal or intraperitoneal lymphadenopathy noted. CONCLUSION: Abdominal malignant fibrous histiocytomas are well-circumscribed, round orlobulated bulky masses with frequent necrosis and occasional calcification. Characteristically, there is nocombined lymphadenopathy and multiple masses are a rare manifestation. These findings may be helpful in the diagnosis of malignant fibrous histiocytoma.

Abdominal Ultrasonographic Findings of Yersiniosis in Children

PURPOSE: To review abdominal ultrasonography in Yersinia Pseudotuberculosis(YP) infection. MATERIALS AND METHODS: From June 1993 through June 1994, abdominal ultrasonograms were reviewed in 36 patients with YP infection. The age of patients was from 4 to 14 years. A diagnosis of YP infection was made on the basis ofisolation of YP from stool (n=15/36, 41.7%) and by documenting at least a minimum agglutination antibody titer of1:160 or greater (n=34/36, 94.4%). RESULTS: Abdominal US findings were identifed in 33/36 (91.7%) of patients with YP infection. US abnormalities included right lower quadrant abdominal lymphadenopathy in 28/36 (77.8%) of cases ;increased bilateral renal cortical echogenecity with renal enlargement, 11/36 (30/6%) of cases ;hepatosplenomegaly, 6/36 (16.7%) of cases ; bowel wall thickening in termnal ileum and cecum, 4/36 (11/1%) of cases ; and ascites, 2/36 (5.5%) of cases. Three patients revealed no abdominal sonographic finding. CONCLUSION: We conclude that abdominal US can help in the diagnosis of YP infection when US demonstrates multiple right lower quadrant abdominal lymphadenopathy, increased renal cortical echogenecity with renal enlargement, hepatosplenomegaly, intestinal wall thickening or ascites.

Multicystic Mesothelioma of the peritoneum: A case Report

We report a case of multicystic mesothelioma in the visceral peritoneum anterior of the ascending colon. A 39-year-old female patient visited hospital with a palpabel tender mass in the right flank. An ultrasonogram showed multiple cystic mass lesions in the right flank and CT scan showed a multicystic rative mass with enhancing wall and septum in front of the ascending colon. The patient underwent explolaparotomy and the mass. which inpathology turned out to be a benign multicystic masothelioma, was removed.