Splenic size as a marker for active inflammation in Crohn's disease.

PURPOSE: The spleen, one of the major organs of the reticuloendothelial system, frequently enlarges in a variety of inflammatory states. We propose measurement of splenic volume as an additional marker for inflammatory bowel disease activity. METHODS: This is a retrospective study of patients with Crohn's disease who had computed tomography (CT) exams. Demographic data of the patients was recorded. To determine activity of the disease we analyzed clinical records, lab results and findings on CT scan. Splenic size and volume was calculated on each exam. RESULTS: The study cohort includes 90 patients with Crohn's disease who underwent 188 [R1.4] CT exams over 6 years. Splenic volume was found to be significantly larger in patients with CD compared to published values for a healthy population. However, the mean splenic volume was 324 cm ± 130.3 did not show significant difference between the group of active 339.2 ± 118.4, and non-active disease 304.2 ± 144.2 (p 0.21 for splenic volume). Interestingly, when splenic volume/BMI index (SV/BMI) was calculated, it was found to be significantly larger in patients with active diseases, 15.26 ± 4.86 compared to non-active phase, 11.69 ± 5.19 (p 0.004). CONCLUSION: Splenic size is enlarged in patients with Crohn's disease compared to standard published literature of normal individuals. While there is no statistically significant difference in our study between splenic volume in Crohn's disease patients with active versus nonactive disease, indexed splenic volume, as an additional marker, may add value to the assessment of patient with CD and monitoring of the disease activity.

Therapeutic Computed Tomography-Guided Pericardiocentesis: Lessons Learned Based on a 7-Year Single-Center Experience.

OBJECTIVE: Pericardiocentesis is a well-known procedure commonly performed by either image-guided intervention or surgical approaches. Computed tomography (CT)-guided pericardiocentesis is not widely used, but provides certain advantages. In the article we will discuss our technique of CT-guided therapeutic pericardiocentesis, including advantages and disadvantages, patient selection, possible approaches, and complications. METHODS: The retrospective study included 121 therapeutic pericardial drainages performed under CT guidance. Demographic data of the patients, entry site, and needle orientation were recorded. Procedure complications and their significance were analyzed. RESULTS: One hundred and twenty-one pericardial drainages with catheter insertion were performed under CT guidance on 119 patients presenting with clinically significant pericardial effusion. The most common approach was at the left anterior chest wall. The rate of minor complications was 5.8%, no major complications occurred. CONCLUSIONS: Therapeutic pericardiocentesis can be obtained under CT guidance in a safe and effective manner. Recommendations for building a patient-centered protocol with an interdisciplinary team are discussed. Patient selection, procedural guidance, and lessons to avoid complications are reviewed.

A 9-Year-Old Boy With Recurrent Chest Pain and Nonresolving Pneumonia.

CASE PRESENTATION: A previously healthy, 9-year-old boy presented with five recurrent episodes of left-sided chest pain with low-grade fever over the last 18 months. The pain usually lasted for few hours, was severe and consistent, and resolved spontaneously. It worsened during inspiration, physical activity, and swallowing. He did not experience any cough, dyspnea, chills, cold sweats, or weight loss. His medical and family history was unremarkable.