Subject(s)
Gastric Bypass/adverse effects , Hernia, Abdominal/diagnostic imaging , Hernia, Abdominal/etiology , Obesity, Morbid/diagnostic imaging , Obesity, Morbid/surgery , Radiography, Abdominal/methods , Tomography, X-Ray Computed/methods , Humans , Obesity, Morbid/complications , Reproducibility of Results , Sensitivity and Specificity , Treatment OutcomeSubject(s)
Carotid Artery, Common , Inflammation/diagnosis , Pain/diagnosis , Anti-Inflammatory Agents/therapeutic use , Carotid Artery, Common/diagnostic imaging , Carotid Artery, Common/pathology , Female , Humans , Inflammation/classification , Inflammation/drug therapy , Magnetic Resonance Imaging , Middle Aged , Multimodal Imaging , Pain/classification , Pain/drug therapy , Pain Measurement , Positron-Emission Tomography , Predictive Value of Tests , Prednisolone/therapeutic use , Terminology as Topic , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, DuplexABSTRACT
OBJECTIVES/HYPOTHESIS: Prevertebral tendinitis is an inflammatory process that affects the cervicothoracic prevertebral muscles. Because of its clinical presentation and imaging features in computed tomography scans, prevertebral tendinitis can easily be mistaken for deep cervical abscess formation. Totally different therapy regimens require clinical and diagnostic pathways for sufficient differentiation between those two pathologic entities. STUDY DESIGN: Case series with comparison. METHODS: In 10 patients with prevertebral tendinitis, we evaluated the symptoms, laboratory reports, and radiological imaging findings. We compared these data to 65 patients with a deep cervical abscess formation. The basic radiologic imaging procedure was contrast-enhanced computed tomography. For detection of prevertebral tendinitis, we performed magnetic resonance imaging with diffusion-weighted images and calculated the apparent diffusion coefficient map. RESULTS: Patients with prevertebral tendinitis complained of severe neck pain, globus sensation, and neck stiffness. Diffusion-weighted images showed a typical benign prevertebral effusion. Computed tomography scans showed amorphous calcifications in the tendon of the prevertebral muscles. The C-reactive protein values were slightly increased in patients with prevertebral tendinitis, and white blood cell count remained normal. In comparison to patients with deep cervical abscess formation, the C-reactive protein and white blood cell count was significantly lower (P < .05) in the prevertebral tendinitis cases. CONCLUSIONS: Prevertebral tendinitis should be considered when patients suffer from neck pain, neck stiffness, and globus sensations despite low signs of inflammation in the laboratory report. To confirm the diagnosis, the best imaging feature is magnetic resonance imaging with diffusion-weighted images and apparent diffusion coefficient map.
Subject(s)
Tendinopathy/diagnosis , Adult , Aged , Cervical Vertebrae , Female , Humans , Male , Middle Aged , Retrospective Studies , Tendinopathy/surgery , Thoracic Vertebrae , Unnecessary ProceduresABSTRACT
PURPOSE: The purpose of this study was to evaluate whether hepatic periportal tracking (PPT) in patients with acute pyelonephritis correlates with the severity of pyelonephritis. MATERIAL AND METHODS: A database search was conducted of patients with clinically suspected acute pyelonephritis who underwent abdominal computed tomography (CT) between January 2004 and June 2009 for disease evaluation. The final study group consisted of 274 patients (221 women, 53 men) with a mean age of 43 ± 20 years. The abdominal CT studies were retrospectively reviewed by two radiologists by consensus to assess PPT, renal wedge-shaped hypoperfusion areas, and renal abscesses. The laboratory reports obtained on the day of the CT examinations were reviewed for C-reactive protein (CRP), white blood cell count (WBCC), and leukocytes in urine. Presence of PPT was correlated with the presence of renal abscess, extension of renal hypoperfusion areas as well with levels of CRP, leukocytosis, and urine leukocytes using the Fisher's exact Test and the Wilcoxon Test. RESULTS: All patients showed renal hypoperfusion areas consistent with the clinical diagnosis of acute pyelonephritis. Twenty-nine patients (11%) showed PPT which was significantly associated with the extension of the wedge-shaped renal hypoperfusion areas (P < 0.001), the presence of a renal abscess (P < 0.01), as well as the level of CRP (P < 0.001) and urine leukocytes (P < 0.01). A renal abscess was observed in 36% of patients with PPT compared with 14% of patients without PPT. CONCLUSION: The PPT should be kept in mind as an extrarenal finding in acute pyelonephritis and may indicate a more serious clinical course of the disease.
