Differentiation of femoral and inguinal hernias on the basis of anteroposterior relationship to the inguinal ligament on multidimensional computed tomography.

PURPOSE: The purpose of this study was to evaluate whether multidimensional computed tomography (MDCT) can be used to differentiate between types of groin hernias, specifically femoral and inguinal hernias, based on their anteroposterior relationship to the inguinal ligament. MATERIALS AND METHODS: We retrospectively analyzed 75 groin hernias of 71 patients, including 28 femoral and 47 inguinal hernias. We diagnosed hernias prolapsing anterior to the inguinal ligament as inguinal hernias and those passing posterior to the ligament as femoral hernias. RESULTS: In 74 of 75 cases, femoral and inguinal hernias were correctly differentiated from each other based on MDCT. In one case of a "sign of aggregation" of an inguinal hernia, the anteroposterior relationship to the inguinal ligament could not be evaluated because the hernia existed superior to the ligament. CONCLUSIONS: Femoral and inguinal hernias that extend caudal to the inguinal ligament can be differentiated based on their anteroposterior relationship to the inguinal ligament using MDCT.

Drug-induced isolated visceral angioneurotic edema.

A 44-year-old woman on maintenance hemodialysis was admitted to our hospital because of severe abdominal pain. The patient had been medicated with lisinopril and valsartan for hypertension for one month prior to admission. An abdominal computerized scan (CT) showed a dilated and thickened loop of the small bowel with massive ascites and a small nodule in the jejunum. The patient's abdominal pain was thought to be due to isolated visceral angioneurotic edema induced by lisinopril and/or valsartan, and medication of these two drugs was therefore stopped. Her symptoms resolved and an abdominal CT demonstrated almost complete resolution of ascites and of small bowel edema except for a small nodule in the jejunum. A laparoscopic operation was performed to excise the small nodule of the jejunum, and a histological diagnosis of accessory pancreas of the jejunum was made. This is the first report of isolated visceral angioneurotic edema induced by lisinopril and/or valsartan in a patient on maintenance hemodialysis and, moreover, with the association of accessory pancreas of the jejunum.

[Radiofrequency ablation of rabbit liver: correlation between dual CT findings and pathological findings].

PURPOSE: To present the time-related imaging findings and correlative pathologic findings of radiofrequency pulse-irradiated regions of the liver. MATERIALS AND METHODS: Radiofrequency (RF) ablation was performed in 22 rabbit livers with 15-gauge RF probes inserted percutaneously. Regions were imaged with dual-phase CT at 3 days (n = 6), 2 weeks (n = 6), 4 weeks (n = 6), and 12 weeks (n = 4) after RF ablation. RESULTS: At 3 days, the regions showed a two-zone structure on plain CT and peripheral enhancement. The regions presented a three-zone structure on pathological study. Hepatocytes appeared as acidophilic bodies, and nuclei were pyknotic at the inner necrotic zone. The middle whitish zone showed enlarged sinusoids. The marginal zone was a regenerative band. At 2 weeks, the two-zone structure was obscured on unenhanced CT. The region showed a two-zone structure on pathological study. At the inner zone, acidophilic degeneration had progressed, however, cell structure remained. The marginal zone showed fibrous tissue bundles. At 12 weeks, the region was obscured on plain CT. Nuclei and cell structures had disappeared almost completely at the inner zone. Collagen fiber had replaced the marginal zone. CONCLUSION: Zone structural CT findings reflect the pathological findings and time-related changes after RF ablation. Peripheral enhancement in the arterial phase reflects the granulation tissue layer, and its time-related decrease reflects replacement by fibrous tissue.