Hungarian Radiology

[Isolated gallbladder rupture following blunt abdominal trauma]

PÉTER Lívia

DECEMBER 10, 2005

Hungarian Radiology - 2005;79(06)

[INTRODUCTION - Gallbladder injuries following blunt abdominal trauma occur rarely and are usually associated with damage to other abdominal organs. Isolated rupture of the gallbladder is extremely rare. CASE REPORT - A 42-year old intoxicated male patient suffered a blunt abdominal trauma 4 days before the admission. The physical examination was of normal and no specific laboratory values were found. Ultrasound examination demonstrated the gallbladder with hyperechoic thickened wall and inhomogenous content. Beside of the gallbladder fluid collection was detected with irregular margins. To prove the diagnosis of gallbladder injury computed tomography was carried out. Break of the gallbladder wall and hight density lumen content, corresponding to blood was detected. Around the gallbladder an irregular fluid collection was seen, which reached the level of the transverse section of the mesocolon. Computed tomography excluded traumatic lesion of other parenchimal abdominal organs. Surgery confirmed the radiological diagnosis. CONCLUSION - The patient with isolated gallbladder injury had a multiphasic clinical course. Sometimes the diagnosis has to be established at a relatively asymptomatic stage. The basic methods of the diagnostics are the ultrasound examination and computed tomography.]

COMMENTS

0 comments

Further articles in this publication

Hungarian Radiology

[Autumn thoughts in winter]

LOMBAY Béla

Hungarian Radiology

[Ultrasound of the acute pediatric scrotum]

COLEY D. Brian

[Proper evaluation of the acute scrotum, like any condition, starts with a history and physical examination by an experienced clinician. Often this is all that is needed to arrive at an accurate diagnosis, which then allows prompt and appropriate treatment. However, the true nature of the underlying disease producing scrotal pain is not always clear, and the consequences of error (testicular loss) are undesirable. Ultrasound is the single most useful imaging tool for imaging the scrotum. While nuclear medicine studies can help assess blood flow, the combination of anatomic detail provided by modern ultrasound equipment and the ability to assess blood flow and perfusion with color Doppler makes ultrasound invaluable. Properly performed and interpreted, ultrasound provides very high sensitivity and specificity for acute scrotal conditions. Understanding of the conditions that produce acute scrotal pain in children will improve one’s diagnostic abilities. The most important diagnosis to consider is testicular torsion, since untreated this will result in testicular death. While testicular torsion can occur at any age, it is most common in the perinatal and peripubertal age groups. Torsion of a testicular appendage is a frequent cause of scrotal pain in prepubertal males. The sonographic findings can mimic epididymitis, but diligent and focused sonographic examination can make the diagnosis. Epididymitis typically affects postpubertal males, but can be seen in younger patients with functional or anatomic urinary tract anomalies. Sonographic evaluation of the post-traumatic painful scrotum can help to differentiate injuries that can be managed conservatively and those that require surgery. Less common causes of scrotal pain include hernias and hydroceles, vasculitis, and idiopathic edema. Understanding the characteristic sonographic features of these conditions allows the examining physician to make more accurate and confident diagnoses. It is hoped that this review article will help to promote this understanding.]

Hungarian Radiology

[Male breast cancer]

GÖBLYÖS Péter

[Male breast cancer does not get a sufficient attention which would be appropriate due to its special features. Diagnostical and therapeutical protocols are not existing, a national center and international collaboration would be necessary. Incidence of male breast cancer is one percent of the female breast cancers, and 5 percent of all male cancers. The absolute number of the cases increased in the past years. The mutation of gene BRCA2 plays the main role in the male breast cancer. The breast cancer of the men is a "late disease", because often neither the doctor nor the patient considers this opportunity. The diagnosis is often established at an advanced stage. Cancer can occur on both sides, but the right breast is more often affected. Staging is the same as in female patients. Prognosis is poorer than in females, the tumor-receptor rate is better, HER2 in men does not plays any role. Basic principles of diagnostics and therapy are same as in females, mainly because there is no consensus about the treatment of the male breast cancer. The same proved protocols are used in men which are applied in women. The ground-method is surgery, reduced radicality and mastectomy is usually applied. Males react on hormone therapy better, than women, mainly chemotherapy is suggested. Follow up of the patients and the psychological support is extremely important. A multidisciplinary collaboration is necessary in the treatment of the male patient, and education is of great importance.]

Hungarian Radiology

[X-ray examination of paintings]

SZABÓ Éva, SZENTKIRÁLYI Miklós

[INTRODUCTION - After the discovery of X-ray it was not only used for medical purposes, but also to study the internal structure of various objects. The X-ray examination can be applied not only to examine paintings, but other works of art. METHODS AND RESULTS - The rontgenograms are made by industrial film without any screen in the museum. In case of paintings soft-beam examination technique was used. The basic principle of the X-ray examination of different paintings is based on the presence of different atomic number in different paints. Authors after the examination of four paintings achieved a significant finding. In these paintings the stylistic and structural features of the pictures, injuries, originality, changes in the composition during the work of the artist can be studied. CONCLUSIONS - Recordings made by an industrial radiological equipment in the Museum of Fine Arts (Budapest) are helpful in the restorer work.]

Hungarian Radiology

[Márton Lányi's memorial tablet]

GÖBLYÖS Péter

All articles in the issue

Related contents

Hungarian Radiology

[Xanthogranulomatous cholecystitis]

PALKÓ András, MORVAY Zita, BERÉNYI Zsolt

[INTRODUCTION - The xanthogranulomatous cholecystitis is a rare and benign form of lesions associated with diffuse thickening of the gall bladder wall. It is important to recognize it radiologically because it can be mistaken easily for gall bladder carcinoma. The characteristic US, CT and MR findings, however, may be helpful in the differential diagnosis. CASE REPORT - We present the cases of two middleaged female patients suffering from right upper quadrant, radiating abdominal pain for several weeks without occurrence of fever. In both patients, the ultrasound examination revealed marked thickening of the gall bladder wall containing hypoechoic nodules. Further, non-specific sign such as cholecystolithiasis and fine infiltration of the adipose tissue surrounding the gall bladder and dilatation of extrahepatic or intrahepatic bile ducts were visible. On the post contrast CT images, rim enhancement was detectable. MR/MRCP examination showed a sharp delineation of the gall bladder from the liver parenchyma. Both patients underwent cholecystectomy. The pathological examination excluded malignancy and confirmed the diagnosis of xanthogranulomatous cholecystitis. CONCLUSION - The characteristic features of xanthogranulomatous cholecystitis (hypoechoic xanthogranulomas in the markedly thickened gall bladder wall and the presence of calculi) can be detected by ultrasound examination. CT or MRI may play an important role in confirmation of the diagnosis of an inflammatory process and provide useful information in exclusion of gall bladder carcinoma.]

Hungarian Radiology

[Dual energy computed tomography - dual-source CT]

WENINGER Csaba, BATTYÁNY István, VÁRADY Edit, CSETE Mónika, SZUKITS Sándor, DÉRCZY Katalin

[The authors describe fundamentals of computed tomography (CT) examination performed by dual-source, dual energy CT scanner. The special applications of dual energy acquisition are demonstrated, e. g. examination of pulmonary perfusion in case of embolism, bone subtraction during CT angiography, differentiation of various stones and calcifications. The dual energy acquisition can improve the accuracy and sensitivity of the radiological diagnosis.]

Hungarian Radiology

[Digital volume tomography - The use of cone beam CT in dentistry, oral and maxillofacial surgery]

PLACHTOVICS Márk

[Oral and maxillofacial radiology is a subspecialty with its own field of indication. The goal is to achieve proper diagnostic image quality with the minimal amount of harmful radiation. The most common acquisition techniques are the intraoral radiograph and the panoramic radiograph which result in an overview picture of the whole dental status of the patient or the full mouth survey with the higher doses of radiation indicated for periodontological treatment. The next level is the supplementary radiograph such as occlusal radiograph, transversal tomography (some panoramic radiographs have this option), lateral cephalometric projection, submentovertex view or Waters projection, etc. More over cone beam CT acquisition or digital volume tomography as is called. In case of some described special indications CT, MRI or sometimes US acquisition can be made. In the field of three dimensional radio-diagnostics, the CT has a superior place with well-known advantages for everybody, and the usage has been limited only by the high radiation dose. The main point of the acquisition is the image quality. The load of radiation only makes the field of indication narrow. In every day practice - because of the higher radiation load of each high quality CT - the pictures passing to the doctor are preferred to take with lower resolution and wider slices although the diagnostic value of this never reaches the wanted level. This is why this new acquisition system also mentioned in the title would be better known. This system works with reasonable low radiation coupling with the possibilities of the high fidelity 3D imaging focusing on the bony structures of the head and neck region. The purpose of this article is to give a comprehensive introduction to this method in use for more than a decade. From 2006 in Hungary we also have the option to use the technology.]

Hungarian Radiology

[A case of gastrointestinal stromal tumor of the small intestine causing gastrointestinal bleeding]

KALMÁR Katalin, KIRÁLY Ágnes, WENINGER Csaba, TAMÁS Krisztina, TORNÓCZKY Tamás

[INTRODUCTION - The neoplastic disease of the small intestine - especially the gastrointestinal stromal tumor - is a rare disease, its diagnostics is not an easy task. CASE REPORT - The authors examined a 71-year-old female patient who presented hematemesis and melena. A small intestine tumor was detected by endoscopy and abdominal computed tomography as the source of gastrointestinal bleeding. Histology proved gastrointestinal stromal tumor. The characteristics of the tumor were reviewed based on the literature. CONCLUSION - Radiological imaging plays a significant role in the diagnosis of gastrointestinal stromal tumors.]

Hungarian Radiology

[The role of ultrasonography and X-ray examinations in the diagnosis of gallstone ileus in preoperative stage]

LUDVIG Zsuzsanna, FARKAS József, KÁNYA László, BENDE Sándor

[INTRODUCTION - Gallstone ileus develops in elderly patients as a result of complication of cholelithiasis and causes 1-3% of mechanical ileus. Due to its variable presentation and in many cases insidious and intermittent symptoms it is difficult to establish the diagnosis which is often delayed. The mortality rate is high and early diagnosis is essential. The role of X-ray, abdominal ultrasound and recently CT has been emphasized. The role of imaging studies was evaluated in the preoperative diagnosis of gallstone ileus based on their surgically proven cases. PATIENTS AND METHODS - From 1st January 1988 to 30th June 2004 nineteen operations were performed on seventeen patients suffering from gallstone ileus. The average age of the patients was 74.2 years, male/female ratio was 4/13. Ultrasound examination was performed in all cases before the operation. Plane X-ray examination also was carried out except in two cases. CT study was not performed preoperatively. The calculi were removed through an enterotomy whole. In four cases gall bladder were also removed and the biliary fistula was closed. The disease was diagnosed on the basis of symptoms described by Rigler. If two signs from the three was present the diagnosis was established. RESULTS - 17 cases out of 19 mechanical ileus were diagnosed, in one case acute cholecystitis and in one incarcerated abdominal wall hernia was suspected before surgery. Small bowel obstruction was found in all cases (jejunum in six cases, ileum in 13). In five cases multiple calculi were seen in the bowels. Two patients had to undergo surgery twice because of gallstone ileus. It is noted that in eight cases (42.1% of total operations) gallstone ileus was diagnosed before the operation. In seven cases ultrasound played a crucial role in establishing diagnosis. In one case gas was detected in the biliary tract and in six, gallstone was directly seen in the small bowel with ultrasound. CONCLUSIONS - In the preoperative diagnosis of gallstone ileus more and more is expected from appropriate radiological examinations. If diagnosis is primarily based on the physical examination, an illusion of clinical improvement can be created, and the delay of surgical treatment can lead to decompensation of elderly patients with increased mortality rate. A thorough radiological examination can show the stone in the bowel lumen, and observation of the indirect signs together with clinical state can considerably improve the results. The rate of correct diagnosis of gallstone ileus before sugery in our patients can be considered an average and similar to the published data in medical literature.]