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.

Evaluation of the Biodurability of Polyurethane-Covered Stent Using a Flow Phantom

OBJECTIVE:To evaluate the biodurability of the covering material in retrievable metallic stents covered with polycarbonate polyurethane. MATERIALS AND METHODS: Using a peristaltic pump at a constant rate of 1ml/min, bile was recirculated from a reservoir through a long tube containing four stents. Each of these was removed from the system every two weeks and a radial tensile strength test and scanning electron microscopy (SEM) were performed. Each stent, removed at 2, 4, 6 and 8 weeks, was compared with a control stent not exposed to bile juice. RESULTS: Gross examination showed that stents were intact at 2 weeks, but at 4, 6 and 8 weeks cracks were observed. The size of these increased gradually in accordance with the duration of exposure, and at 8 weeks several large holes in the polyurethane membrane were evident. With regard to radial tensile strength, extension and peak load at break were 84.47% and 10.030 N/mm, 54.90% and 6.769 N/mm, 16.55% and 2.452 N/mm, 11.21% and 1.373 N/mm at 0, 2, 4 and 6 weeks, respectively. Scanning electron microscopy at 2 weeks revealed intermittent pitting and cracking, and examination at 4, 6 and 8 weeks showed that the size of these defects was gradually increasing. CONCLUSION: When the polyurethane membrane was exposed to bile, biodegradation was first observed at week two and increased gradually according to the duration of exposure.

The Usefulness of Three-Dimensional Gadolinium-Enhanced MR Venography for the Evaluation of Varices in Lower Extremities

PURPOSE: To assess the performance of contrast-enhanced three-dimensional(3-D) magnetic resonance venography (MRV) of the pelvis and lower extremities in patients with varicose veins. MATERIALS AND METHODS: Ascending and MR venography were performed in seven legs of seven patients, and duplex Doppler sonography and MR venography in 15 legs of 12 patients, all referred for evaluation of varicose veins. For analysis, the venous system as revealed by ascending and MR venographic images was divided into 13 segments. For detection of reflux to the great saphenous vein, duplex Doppler sonography and MRV were performed. RESULTS: In ascending venography and MRV, 91 venous segments were potentially visible; both modalities depicted 78 of these, but failed to detect four. Ascending venography and MRV detected 17 and 19 varices, respectively. When two tourniquets were placed around the ankle and knee using the Valsalva maneuver, MRV and duplex Doppler sonography detected reflux in 8 of 11 and 13 of 15 legs, respectively. CONCLUSION: Contrast-enhanced 3-D MRV comprehensively displays the venous system of the lower extremities and permits assessment of varicose veins. MRV using the Valsalva maneuver allows assessment of reflux to the great saphenous vein.

MR Imaging of Medial Collateral Ligament Injury and Associated Internal Knee Joint Injury

PURPOSE: To assess the value of MR imaging in the diagnosis of medial collateral ligament injury of the knee, we used MR imaging to evaluate the characteristic findings in MCL tears and the frequency of associated knee joint injury. MATERIALS AND METHODS: We retrospectively reviewed 26 patients within four weeks of MCL injury, analysed MR findings and correlated them with surgical findings. We evaluated discontinuity, heterogeneous signal intensityof MCL, thin band- like low signal intensity at MCL, facial edema, loss of clear demarcation of adjacent fat andalso combined bone injury, meniscus injury and other ligament injury. RESULTS: Complete MCL tears were present in 14 patients and partial tears in 12. Complete tears showed discontinuity of MCL, fascial edema and loss of clear demarcation from adjacent fat in 11 patients (79%) ; proximal MCL tears are more common than distal tears. Partial tears showed thin band-like low signal intensity within MCL, fascial edema and loss of clear demarcation fromadjacent fat in seven patients (58%) ; all patients with MCL injury showed fascial edema ; in 12 patients there was loss of clear demarcation from adjacent fat. We could not, however, distinguish between complete tears and partial tears when MCL showed heterogeneous high signal intensity. Combined bone injury in MCL tears was found in eight patients (62%) ; the most common sites of this were the lateral femoral condyle and lateral tibial plateau. There was associated injury involving other ligaments(ACL:50%; PCL: 27%). Combined meniscus injury in MCL tearswas present in 17 patients and the most common meniscus site (50%) is the posterior horn of the medial meniscus. CONCLUSION: Complete MCL tears showed discontinuity of MCL and partial tears showed a thin band-like low signal intensity within MCL. All patients with MCL injury showed fascial edema, and loss of clear demarcation fromadjacent fat. Various other injuries combine with MCL tears. MR imaging is therefore useful in the evaluation ofmedial collateral ligament injury and associated knee joint injury.