Hungarian Radiology

[The bubble-sign of spontaneous pneumoperitoneum]

SZÁNTÓ Dezső

SEPTEMBER 20, 2008

Hungarian Radiology - 2008;82(05-06)

[INTRODUCTION - Pneumoperitoneum is a reliable indicator of serious underlying damage. There are four etiologic categories of extraluminal-intraperitoneal gas collections: spontaneous, iatrogenic, traumatic and criminal perforations. The erect posteroanterior chest radiograph is the most sensitive plain film projection for detecting pneumoperitoneum and it may show 0.5-1 ml free abdominal gas when meticulous radiographic techniques (lateral, oblique, air-gap, lordotic, inspiratory and expiratory exposures) are used. The appearances of extraluminal gas collections are specified by physical rules and individual preferences. The bubble-sign is an uncommon, pathognomonic phenomenon. CASE REPORT - A case of an 86 years old female patient with spontaneous pneumoperitoneum, diagnosed on the basis of the bubble-sign is presented. On erect, lordotic inspiratory chest film, right medial inversion of diaphragm, left pleural effusion, emphysema, cardiomegaly and aortectasia were observed. The bubble-sign and hydromediastinum became evident in the right phrenicocostal angle on expiratory view. Our patient expired before the surgical intervention.The postmortem demonstrated double peptic duodenal ulcers; the older ulcer had penetrated and encapsulated in the hepatoduodenal ligament, while the more recent one perforated through the intraperitoneal space. CONCLUSION - Routine upright chest films are valuable screening tools for uncommon signs of pneumoperitoneum, also.]

COMMENTS

0 comments

Further articles in this publication

Hungarian Radiology

[Results of the elections held to elect new members of the Society of Hungarian Radiologists]

Hungarian Radiology

[Sixty years, fourty years - milestones in ultrasound diagnostics]

HARKÁNYI Zoltán

Hungarian Radiology

[Honours]

Hungarian Radiology

[Rheumatoid arthritis: significance and methodology of cervical spine X-rays in everyday practice]

NÉMETH Ildikó, BUDAY Ilona, MOLNÁR Éva, NYITRAI Márta, SAÁRY Krisztina, TARKOVÁCS Andrea, VARSÁNYI Nóra, FARBAKY Zsófia

[Cervical spine joint destruction in rheumatoid arthritis may lead to progressive vertebral instability. It is a severe risk factor for cord compression, which may even lead to sudden death. Many patients with atlantoaxial subluxation may have no symptoms referable to the neck. True degree of subluxation may occur during anaesthesia when the neck muscles are relaxed and protective spasm is absent. The cervical deformities can be visualised on conventional, transoral and functional lateral view in the flexion and extension positions of the neck. The aim of our study is to demonstrate the usefulness of cervical dynamic X-ray for patients suffering from rheumatoid arthritis. This is the first classical radiological imaging method in the diagnosis and in radiographic follow-up. It is a very important method in the preoperative evaluation to prevent definitive neurologic injury. We describe the method for screening, measuring and grading cervical subluxations and instability in our everyday routine.]

Hungarian Radiology

[Miklós Barta (ed.): Atlas of ultrasound diagnostics]

BOGNER Péter

All articles in the issue

Related contents

Hungarian Radiology

[Esophageal perforation in pneumectomized patient]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - In 58 per cent of cases the fistulas and perforations are developing in middle third part of the esophagus. CASE REPORT - A 58 year old male patient's left lung was surgically removed due to drug-resistant actinomycosis. The pneumectomy has induced mediastinal dislocation and fibrothorax. Six years later the patient complained of odyno-dysphagia and of swallowing cough. On chest plain film we observed left-sided hydrothorax and barium swallows showed perforation of esophagus at the ipsilateral side. Esophageal adenocarcinoma and exudative pleuritis were confirmed by endoscopy and by histology following thoracocentesis. CONCLUSION - In case of pneumectomized patient with swallowing cough, dysphagy and recently development of pleural fluid collection the diagnosis of esophageal perforation is likely. The pleural pain is usually missing due to postoperative indurative pleurisy.]

Hungarian Radiology

[Geophagy]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - The causes of geophagism are psychotic sociopathies, popular customs, religious rites, natural disasters, crimes besides alcohol and drug abuses. CASE REPORT - A 50-year-old midly drunken man ate ten tablespoonful wet sands up. Barium swallows showed the dense material to pass slowly into the stomach and duodenum resulting a cast sign two hours later. The dirt was washed out from the stomach, the bowels became spontaneously empty. There was no complications. CONCLUSION - The geophagy can be easily diagnosed based on gastroduodenal cast phenomenon and lingering passage.]

Clinical Oncology

[Current treatment of gastrointestinal lymphomas]

PAKSI Melinda, ISTENES Ildikó, KÖRÖSMEZEY Gábor, DEMETER Judit

[The most common extranodal site involved by lymphoma is the gastrointestinal tract. The majority of extranodal lymphoma cases are of the non-Hodgkin subtype. Usually, the involvement of the gastrointestinal tract by nodal lymphomas is secondary, the primary gastrointestinal localisation is rather rare. The most common pathological types are diffuse large B-cell lymphomas and extranodal marginal zone lymphomas of the mucosa-associated tissue (MALT) subtype. Although the primary gastrointestinal lymphoma can involve any part of the gastrointestinal tract, the stomach is the most frequently involved site. The treatment and prognosis are determinated primarily by the histologic type of lymphoma, the stage of disease and the patient’s age and general condition. Helicobacter pylori (HP) infection is one of the major risk factors for gastric lymphomas, the presence or abscence of which radically infl uences the effectivity of treatment. In case of HP positivity, HP eradication itself can result in complete remission. In most cases the treatment is immuno- and/or combination chemotherapy, which is performed according to the internationally accepted protocols, specifi c to the type of lymphoma. Radiotherapy plays a lesser role in the treatment of GI lymphomas, while surgery is performed almost only in complicated cases, such as haemorrhage, occlusion or perforation.]

Hungarian Radiology

[The glove-finger phenomenon on postero-anterior chest radiograph]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - The glove-finger phenomenon observed on chest plain film is characterized by branching tubular or fingerlike opacities that originate from the hilum and are peripherally directed. This change brings about impaction and inspissation of the mucus and inflammatory debris besides the obstruction of bronchi and of its prestenotic dilatation about. CASE REPORT - A 51 year old male patient presented with coexisting bronchial asthma and microcellular carcinoma of left 2nd pulmonary segment, leading to a tubular type glovefinger phenomenon. The diagnosis was proved by decrease of Tiffeneau’s index, bronchoscopy, bronchocytology and bronchogenic biopsy. CONCLUSION - The glove-finger phenomenon is correctly visible on postero-anterior chest plain film. The dilated and mucus-filled bronchi are not visible on radiography if the sorrounding lung is atelectasic. Because obstructive and nonobstructive bronchogenic diseases can appear with similar presentation, therefore, definitive diagnosis is only possible on the basis of pneumodynamic examinations, bronchoscopy, bronchocytology and biopsy.]

Journal of Nursing Theory and Practice

[What does a triage nurse do? ]

BALOGH Khernné Mariann

[Emergency patient care department problems have recently come to the fore, especially in terms of waiting times and triage activity. It is still not entirely clear to society what is the triage system is, what is it good for, and who is the person, who applies the classification of patients. There is countless conflicts and tensions in the process of health services due to lack of knowledge. In Hungary, emergency departments play a prominent role in healthcare. Increased patient flow is a global problem, and therefore a distinction should be made between the „door to physician time” of the patients. The so-called grading system (triage) has been developed for this purpose, during which an experienced qualified nurse will measure and assess the patient’s condition as quickly as possible on the basis of different criteria. In my communication, I present the triage activity, the use of the classification system, what the triage nurse is doing, by comparing two cases. ]