RESUMO
BACKGROUND: Solitary necrotic nodule of the liver (SNNL) is a rare benign lesion with a complete necrotic core and a clear fibrous capsule containing elastic fibers. We present the case of a patient with a radiographic computed tomography (CT) finding of "ring"-like annular calcification within the lesion and postoperative pathologic diagnosis of necrotic nodules wrapped by dense fibers in liver tissue, as well as the patient's subsequent management and outcome. CASE SUMMARY: A 38-year-old Chinese woman with a history of systemic lupus erythematosus treated with prednisone and hydroxychloroquine, without any symptoms, was found to have hepatic space-occupying lesions by imaging examination at a health examination. A subsequent CT scan suggested a space-occupying lesion of the liver with annular calcification, which was not defined to be benign or malignant. After that, a laparoscopic hepatic space-occupying resection was performed. The postoperative pathological diagnosis was necrotic nodules wrapped by dense fibers in the liver tissue, and the final diagnosis was SNNL. The patient had an uneventful postoperative recovery. CONCLUSION: There is a "ring"-like calcification in SNNL. This patient had a history of systemic lupus erythematosus, without a history of parasite infection, trauma, or tumor. Therefore, whether the etiology and pathological changes of SNNL are related to rheumatic immune diseases remains to be investigated.
RESUMO
<p><b>OBJECTIVE</b>To introduce a new kind of grade system for thoracic pedicle screws placement by performing postoperative computerized tomography (CT) scanning and discussion the clinical purpose.</p><p><b>METHODS</b>Four hundred and fifty thoracic pedicle screws were implanted in 64 patients with the assistance of fluoroscopy. Postoperative CT scanning was conducted to determine a grade for each screw: Part A, screw entirely contained within pedicle; Part B(1), violate lateral or upper pedicle but screw tip entirely contained within the vertebral body (VB); Part B(2), violate medial or inferior of pedicle; Part B(3), tip penetrated anterior or lateral VB; Part C, violate pedicle or VB and endangers spinal cord, nerve roots, or great vessels. Based on anatomical morphometry, thoracic vertebral were subdivided into upper (T(1 - 2)), middle (T(3 - 6)), and lower (T(7 - 12)) regions. The mean follow-up period was 25.8 months.</p><p><b>RESULTS</b>The postoperative CT scanning-documented grade were determined: Part A, 367 screws (81.6%); Part B, 78 (17.3%), B(1) 40 (8.1%); Part B(2), 23 (5.1%); Part B(3), 15 (3.4%); Part C, 5 (1.1%). There were not significant difference between upper and lower thoracic that the placement of pedicle screws in part B or C. In part C, 5 pedicle screws were all in the middle thoracic.</p><p><b>CONCLUSION</b>Postoperative CT scanning should be considered as a routine examination for evaluating thoracic pedicle screw placement.</p>
