GASTROINTESTINAL COMPLICATIONS OF ACCIDENTAL INGESTION OF FOREIGN OBJECTS.

Ingestion of foreign objects is common and most of the time, they pass without major problems. However sometimes they could cause significant morbidity or even mortality. Most of the time they cause pain in the pharyngeal or oesophageal area. In these instants, diagnosing the problem is straightforward, limiting the use of radiographic diagnosis. However the intraperitoneal complications include stomach or bowel perforation, obstruction, abscedation, septicemia or even hemorrhage or thrombosis of the abdominal veins. Because of the considerable risks, accompanied by the accidental ingestion of a metallic object, the preferred technique for screening is still Computed Tomography. However not all of these objects are radio-opaque and therefore could not always be diagnosed radiographically. In this article we will describe several cases of complications, due to the accidental ingestion of foreign objects. Also we will describe certain patient related risk factors significantly increasing, not only the amount, but also the severity of those complications. Diverticulosis seems the most common risk factor amongst the patients described and so it could be one of the more common triggers causing (recidivating) diverticulitis attacks. But because not all of the ingested foreign objects are radiopaque or still in the gastrointestinal tract, such a theory is difficult to prove.

Mounier-Kuhn Syndrome.

BACKGROUND: A 38-year-old male with no medical history complains about hemoptysis, chest pain, dyspnea on exertion and a cough. He has a history of occasional smoking, but had quitted smoking 1 year previously. There is a normal saturation and normal spirometry. Clinical examination and auscultation are also normal. Because of these complaints CT scan of the thorax was performed. For further diagnostic workup bronchoscopy was performed afterwards.

Amyloidoma of the skull base.

We report a case of a primary amyloidoma of the skull base. Plain radiography and CT showed a lytic, highly destructive lesion with multiple scattered calcifications within. MR imaging revealed that the tumor was isoto hypointense to muscle on T1-weighted images and extremely hypointense on T2-weighted images. In contrast to two previous reports, marked enhancement after the administration of contrast material was absent. Bone amyloidomas are very rare and are frequently misinterpreted as chondrosarcomas.

The place of helical CT scanning in acute pulmonary embolism.

Pulmonary embolism is a relative common, potentially fatal disorder that clinicians have difficulty detecting and difficulty diagnosing. Deep venous thrombosis (DVT) is the most important source of thrombi. Early and accurate diagnosis is essential for efficient therapy. Therapy is based on long-term anticoagulation and has an important impact on the mortality and morbidity of pulmonary embolism. For the diagnosis of pulmonary embolism, the ventilation/perfusion (V/Q) scan is still the first examination in many instances. A normal V/Q scan or the combination of a low probability scan and a low clinical suspicion are associated with a prevalence of pulmonary embolism of 4%. The combination of a high-probability V/Q scan and a strong clinical suspicion has a prevalence of pulmonary embolism of 96%. All other results should be considered as non-diagnostic. However, the number of non-diagnostic V/Q examinations can be as high as 70%. Nevertheless, an additional pulmonary angiography will be performed in only in 15% of these cases. In the low pre-test probability group (poor clinical suspicion, absence of risk factors and no medical history) the V/Q scan is useful as a screening test ("rule-out" strategy). When the pre-test probability is higher or in other cases in which early diagnosis is necessary ("rule-in" strategy), a contrast-enhanced spiral CT of the pulmonary arteries (possibly in combination with ultrasonography of the lower limbs) is the most accurate examination.

Imaging findings in Langerhans' cell histiocytosis of the liver and the spleen in an adult.

We present a case of Langerhans' cell histiocytosis (LCH) of the liver and spleen in an adult. The imaging features are different from those in the few previously reported cases of individual organ involvement by LCH.

CT imaging of soft tissue pathology of the ankle. A pictorial essay.

Despite the increasing importance of MR imaging, CT investigation remains a very useful and frequently applied method in the study of ankle pathology. In a short pictorial essay, the contribution of this technique to the diagnosis of soft tissue pathology of the ankle is discussed and illustrated.

Correlation of computed arthrotomography with arthroscopy of the glenohumeral joint.

We report our experience with CT-arthrotomography, compared to the arthroscopic findings in a group of 54 non-selected patients with a shoulder problem. Thirty-one patients had a CAT-scan of the shoulder and subsequently underwent a videotaped arthroscopy of the shoulder. Five out of the 10 negative CAT-patients were positive on arthroscopy for impingement syndrome. Arthroscopy picked up 5 partial thickness rotator cuff tears, not seen on CAT. Arthroscopy was also very helpful in diagnosing synovitis. For biceps problems, loose bodies, labrum tears and adhesive capsulitis, the sensitivity and accuracy figures were very high, comparing CAT-scan and arthroscopy. A shoulder with a history of instability or a painful clicking shoulder seems to be the best indication for CAT-scanning.

Vascular ring in annular pancreas associated with rare variant of celiac trunk. Case report.

A 12-year-old patient with annular pancreas (AP) is presented. The AP was diagnosed preoperatively by angiography which not only clearly demonstrated a vascular ring around the duodenum, but also revealed an extremely rare upper abdominal vascular anatomy.

Computed tomography of the polysplenia syndrome in the adult.

The computed tomographic appearance of the polysplenia syndrome in 2 cases is presented. Both are associated with absence of the hepatic segment of the inferior vena cava. Computed tomography can determine the exact location of the malpositioned organs, the presence of multiple spleens, and the type of the associated venous anomalies, which are the major features of the polysplenia syndrome.