[Deep venous thrombosis as a complication of congenital absence of vena cava inferior]. / Diepe veneuze trombose als complicatie van congenitale afwezigheid van de V. cava inferior.

A 19-year-old man was admitted with fever, haematuria, general malaise, pain on the left side of the pelvis and a full feeling in the left lower abdominal quadrant of the abdomen. His history mentioned a varices operation. During admission he developed an acute abdomen and deep vein thrombosis in both legs. CT of the abdomen showed a pathologic mass and absence of the vena cava inferior. Laparotomy revealed extensive thrombosis in widened veins. Clinical improvement occurred following adequate thrombolysis. Congenital absence of the vena cava inferior results from aberrant development during organogenesis. Patients are typically asymptomatic, but may present with venous insufficiency at a young age and deep vein thrombosis. Absence of the vena cava inferior can be accompanied by other congenital abnormalities such as dextrocardia and congenital heart diseases. Diagnosis is made using CT or MRI. Treatment consists of lifelong anticoagulant therapy and, if necessary, surgery.

Clinical usefulness of abdominal CT-scanning in Henoch-Schönlein vasculitis.

The abdominal CT appearance is reported in a patient with Henoch-Schönlein vasculitis having symptoms of acute abdomen. Initial CT-scan showed segmented mural thickening of the small bowel loops, strongly suggesting the diagnosis of gastrointestinal involvement of vasculitis. Adequate treatment was started without the need for laparotomy. The CT appearance completely resolved after steroid therapy. Abdominal CT-scanning seems useful in the differential diagnosis of acute abdomen in patients with vasculitis.

Comparison of computed tomography and 57Co-bleomycin scintigraphy in staging the mediastinal lymph nodes of patients with non-small-cell lung cancer.

The value of computed tomography (CT) and of 57Co-bleomycin scintigraphy (57Co-BLM) in staging the mediastinal lymph nodes was compared in 28 patients suffering from non-small-cell lung cancer. The results were assessed against the pathological findings obtained during thoracotomy or mediastinoscopy. CT staging of the mediastinum had a sensitivity of 75%, a specificity of 80%, an accuracy of 79%, a positive predictive index of 60% and a negative predictive index of 89%. 57Co-BLM scintigraphic staging had a sensitivity of 43%, a specificity of 94%, an accuracy of 80%, a positive predictive index of 75% and a negative predictive index of 81%. In this small series these differences were not statistically significant; it thus appears that CT and 57Co-BLM are of equal value in staging the mediastinum. Mediastinoscopy is not contributory in case of a negative CT or 57Co-BLM. A positive CT or 57Co-BLM, however, indicates the need for histological verification of the mediastinal findings.

Ivory and dense epiphyses of the hand: Thiemann disease in three sisters.

Three sisters with ivory epiphyses as well as dense epiphyses of the phalanges of the hand are presented. The difference between ivory and dense epiphyses, the radiologic differential diagnosis, and recently proposed diagnostic criteria for Thiemann disease are discussed.