MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'gastrointestinal'. Sat, 03 Sep 2011 01:59:25 +0100 http://www.medworm.com/index.php?rid=5159009&cid=t_100108_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2Fs7S_ZPgTeFY%2F A case-based Q&A on the assessment and management of patients presenting with suspected rectal foreign bodies. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=5159009 Tue, 23 Aug 2011 00:00:50 +0100 5159009 http://www.medworm.com/index.php?rid=5096651&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2011%2F08%2F04%2Fliver-haemangioma%2F This multiphase CT shows the typical imaging features of liver haemangioma. There is peripheral nodular enhancement in the arterial phase which gradually fills in in later phases (portal venous and delayed). Haemangiomas are the most common benign tumour of the liver (78%), and the second most common liver tumour after metastases. Reference: Dahnert W. Radiology Review Manual 5th ed. Lippincott Williams & Wilkins (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=5096651 Wed, 03 Aug 2011 23:55:24 +0100 5096651 http://www.medworm.com/index.php?rid=5028664&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2011%2F07%2F15%2Fcarcinoma-of-the-pancreatic-head%2F This abdominal ultrasound shows the characteristic appearance of a pancreatic head carcinoma – a hypoechoic mass with irregular margins. Deep to the mass a biliary stent can be seen within the common bile duct. (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=5028664 Fri, 15 Jul 2011 02:50:08 +0100 5028664 http://www.medworm.com/index.php?rid=4960069&cid=t_100108_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fvariations-in-retrieving-a-foreign-body-from-the-stomach%2F2011.06.22 I have observed extreme variation in how my colleagues manage GI foreign-body retrieval from the stomach. Some always use general anesthesia and endotracheal intubation; others (myself included) use conscious sedation. Some use an overtube to withdraw the object into if possible; others simply pull it up to the endoscope and use the endoscope to guide it through the esophagogastric junction and upper esophageal sphincter. The reasons for this variation are clearly related to the perceived risk of airway compromise or gastrointestinal wall injury during withdrawal of the object from the stomach. So my questions to you are: 1)      When do you ask for endotracheal intubation during foreign-body retrieval? 2)      Do you use an overtube when removing foreign bodies from the stomach... Better Health blogs http://www.medworm.com/rss/comments.php?id=4960069 Wed, 22 Jun 2011 14:00:52 +0100 4960069 http://www.medworm.com/index.php?rid=4872234&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2011%2F05%2F26%2Fcholedocholithiasis-2%2F This patient has had a cholecystectomy but presents with recurrence of biliary symptoms. A CT cholangiogram was performed after intravenous administration of meglumine iotroxate (Biliscopin). Biliscopin is preferentially excreted by hepatocytes, opacifying the biliary tree. In the case of severe liver impairment, Biliscopin is renally excreted. CT cholangiography provides high-resolution imaging of the biliary tree and is an alternative to MRCP or ERCP for biliary imaging. The study shows multiple calculi within a dilated biliary tree. (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=4872234 Thu, 26 May 2011 05:39:07 +0100 4872234 http://www.medworm.com/index.php?rid=4361316&cid=t_100108_155_f&fid=38412&url=http%3A%2F%2Fpathlabmed.typepad.com%2Fsurgical_pathology_and_la%2F2011%2F01%2Fcolonic-mucosal-schwannona.html I'm finally emerging from a hiatus from blogging after the holidays and discoursing second-year medical students on lung pathology for the last 2 weeks.  So I'd like to kick 2011 off with an interesting little case I recently saw.  The patient is a 62-year-old man undergoing screening colonoscopy and a small sessile polyp was found and removed from the rectum.  Here 'tis--   The low power view confirms a polypoid lesion but doesn't declare itself as a obvious adenomatous or hyperplastic polyp.  However, the lamina propria appears modestly cellular and mildly distorts the crypt architecture. Higher power views demonstrate an intercryptal spindle cell proliferation of uniform bland cells with fibrillar eosinophilic cytoplasm.  The way the... The Daily Sign-Out blogs http://www.medworm.com/rss/comments.php?id=4361316 Tue, 18 Jan 2011 21:16:20 +0100 4361316 http://www.medworm.com/index.php?rid=4266292&cid=t_100108_155_f&fid=38412&url=http%3A%2F%2Fpathlabmed.typepad.com%2Fsurgical_pathology_and_la%2F2010%2F12%2Fgastric-cardia-polyps.html Melton and Genta from Caris Research Institute and UT-Southwestern Medical Center in Dallas have published an excellent review of these uncommon lesions in the December 2010 American Journal of Surgical Pathology that is worthy of note for the practicing pathologist, in spite of their relative rarity.  First, I emphasize that these are rare but I think if you sign out a lot of GI biopsies, especially from outpatient endoscopy centers, you will (or have) come across these lesions in practice.  Caris Life Sciences is a GI pathology subspecialty referral lab that receives specimens from such endoscopy centers from across the U.S.  This is one of the strengths of the paper--the huge denominator of GEJ biopsies for comparison.  They diagnosed a cardiac polyp in 330 patie... The Daily Sign-Out blogs http://www.medworm.com/rss/comments.php?id=4266292 Wed, 15 Dec 2010 15:55:56 +0100 4266292 http://www.medworm.com/index.php?rid=4183238&cid=t_100108_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F11%2Fmetastatic-melanoma%2F Malignant melanoma is the most common tumor to have metastatic lesions to the gastrointestinal tract. Up to 60% of patients who die of melanoma have develop gastrointestinal mets. PET scan is the test of choice for detecting metastatic melanoma and these lesions often present with bleeding and obstruction. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=4183238 Fri, 19 Nov 2010 07:33:48 +0100 4183238 http://www.medworm.com/index.php?rid=3994362&cid=t_100108_155_f&fid=38412&url=http%3A%2F%2Fpathlabmed.typepad.com%2Fsurgical_pathology_and_la%2F2010%2F09%2Fgenomics-and-inflammatory-bowel-disease.html This study identified 75 independent susceptibility loci associated with UC, including all previously identified susceptibility loci and 20 new loci that appear to be UC-specfic.  Interestingly, about half of the 75 loci have previously been associated with CD and of the ~45 putative novel loci, 25 have previously been associated with other autoimmune chronic inflammatory diseases.  These results strongly support the hypothesis that certain biological pathways are common between inflammatory diseases.  Although the Consortium currently testing all novel loci in an independent group of UC patients, preliminary results provide convincing evidence of association to genes with likely biological significance to disease pathogenesis, including TNFRSF14, JAK2, and CARD9. T... The Daily Sign-Out blogs http://www.medworm.com/rss/comments.php?id=3994362 Thu, 23 Sep 2010 11:43:00 +0100 3994362 http://www.medworm.com/index.php?rid=3861954&cid=t_100108_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F08%2Fsenator-dick-durbin-stomach-tumor-removed%2F Senate Majority Whip Dick Durbin (D-Ill) had a gastrointestinal stromal tumor (GIST) in his stomach removed today at the University of Chicago Medical Center. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=3861954 Fri, 13 Aug 2010 02:43:38 +0100 3861954 http://www.medworm.com/index.php?rid=3805875&cid=t_100108_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F07%2F30%2Frecovering-from-chronic-fatigue-syndrome-cfs%2F Today I have the pleasure of interviewing Jody Smith, creator of the website www.ncubator.ca, who spent 15 years losing the battle against Chronic Fatigue Syndrome. Three years ago, she found treatment that worked for her and is making a comeback. In the process, she’s helping a lot of people. (You can check out her blog, “ncubator” by clicking here.) You tried many treatments and finally you got there. What worked? Jody: My naturopath believed that my liver needed relief from its toxic load, and my immune system needed building up. She put me on a tincture with natural antivirals and adaptogens and vitamins in it, and put me on omega3 oil. I’d gone low carb some years before which had made quite a difference. I did dry skin brushing with a loofah, to help lymph mov... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3805875 Fri, 30 Jul 2010 16:32:43 +0100 3805875 http://www.medworm.com/index.php?rid=3585832&cid=t_100108_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FsrwCU4QU9zQ%2F The combination sounds like a winner, yes? But Braintree Labs, which sells gastrointestinal lavages, was tagged by the FDA for violating good manufacturing practices. This usually involves a host of serious, but somewhat dry, technical problems, but Braintree was cited because assorted bugs - such as spiders, and unnamed insect parts - showed up in its meds, which are used to clear the bowels before undergoing a colonoscopy. To wit, there were 21 consumer complaints back in 2008 and 2009 about “foreign materials” in five finished products. In its warning letter, the FDA notes that Braintree insisted its manufacturing practices simply could not have been responsible for the bugs, yet the agency also noted Braintree failed to conduct a thorough investigation and retorts that the ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3585832 Fri, 21 May 2010 13:18:58 +0100 3585832 http://www.medworm.com/index.php?rid=3577656&cid=t_100108_155_f&fid=38412&url=http%3A%2F%2Fpathlabmed.typepad.com%2Fsurgical_pathology_and_la%2F2010%2F05%2Fdigital-case-challenge-pseudomelanosis-duodeni.html I saw this biopsy yesterday and thought it was a curious little finding--pseudomelanosis duodeni is the lovely and impressive name given to this rare but apparently harmless and incidental entity.The patient is a 73-year-old woman with a history of recent GI bleeding, chronic anemia, diabetes mellitus, hypertension, CAD/CHF, and chronic renal disease, and CML with hemoccult-positive stool and hemoglobin 6.2 gm/dL and symptomatic anemia requiring RBC transfusions.  She underwent upper and lower GI endoscopy.  Her endoscopic examination of the duodenum was described as unremarkable and biopsies were obtained to exclude villous atrophy.  The stomach was described as showing mild diffuse antral gastritis without erosions or ulcers.  Antral biopsies showed features... The Daily Sign-Out blogs http://www.medworm.com/rss/comments.php?id=3577656 Wed, 19 May 2010 14:00:00 +0100 3577656 http://www.medworm.com/index.php?rid=3311889&cid=t_100108_136_f&fid=37846&url=http%3A%2F%2Fhealthinfoispower.wordpress.com%2F2010%2F02%2F25%2Fgenentech-announces-positive-results-of-avastin-phase-iii-study-in-women-with-advanced-ovarian-cancer%2F Genentech announces positive results of Avastin Phase III study (GOG 218) in women with advanced ovarian cancer. The study showed that women who continued maintenance use of Avastin alone, after receiving Avastin in combination with chemotherapy, lived longer without the disease worsening compared to those who received chemotherapy alone. This is the first Phase [...] (Source: Libby's H*O*P*E*) Libby's H*O*P*E* blogs http://www.medworm.com/rss/comments.php?id=3311889 Thu, 25 Feb 2010 18:40:30 +0100 3311889 http://www.medworm.com/index.php?rid=3167477&cid=t_100108_155_f&fid=38412&url=http%3A%2F%2Fpathlabmed.typepad.com%2Fsurgical_pathology_and_la%2F2010%2F01%2Fnodal-staging-score-a-tool-to-assess-adequate-staging-of-node-negative-colon-cancer----g%25C3%25B6nen-et-al-27-36-6166----journa.html Gonen, Schrag and Weiser recently report a study of colorectal cancer patients from the 1994-2005 SEER database to quantify the likelihood that a node-negative patient is, in fact, node-negative.  This is an interesting alternative method of assessing adequate staging of CRC in contrast to the usual "one-size-fits-all" minimum lymph node criteria (namely, 12).  They have developed a "nodal staging score" (NSS) that expresses the probability of a patient being "true negative" and find that this score depends on the T stage.  Overall, the probability of missing a positive node that is actually present is 29.7% if only 5 nodes are examined; 20.0% if eight are examined; 13.6% if 12 nodes are examined.  However, for a NSS of 90% (that is, a ... The Daily Sign-Out blogs http://www.medworm.com/rss/comments.php?id=3167477 Tue, 12 Jan 2010 20:32:02 +0100 3167477 http://www.medworm.com/index.php?rid=2934786&cid=t_100108_109_f&fid=35671&url=http%3A%2F%2Fwww.anxietyinsights.info%2Fstudies_explore_high_stressgastrointestinal_disorders_conne.htm Jennifer Burke Labriola, Burke PR Anne-Louise Oliphant, American College of Gastroenterology In two new studies, presented at the American College of Gastroenterology's (ACG) 74th Annual Scientific meeting in San Diego, researchers explored the connection between high stress, high exposure occupations and long-term gastrointestinal disorders. The studies, performed by the United States Navy and the State University of New York (SUNY), Stonybrook examine the long term effects of infectious gastroenteritis (IGE) among active duty military and the interaction between gastroesophageal reflux (GERD) and mental health disorders among World Trade Center workers, respectively. Dr Mark Riddle, of the United States Navy, led the study that examined functional gastrointestinal disorders within the ac... Latest entries from www.anxietyinsights.info blogs http://www.medworm.com/rss/comments.php?id=2934786 Wed, 28 Oct 2009 06:47:00 +0100 2934786 http://www.medworm.com/index.php?rid=2828474&cid=t_100108_155_f&fid=38412&url=http%3A%2F%2Fpathlabmed.typepad.com%2Fsurgical_pathology_and_la%2F2009%2F09%2Fintestinal-metaplasia-in-barretts-esophagusrip.html This is a follow-up to my post from last month regarding columnar metaplasia of the esophagus.  Dr. David Agbamu provided a reference to an article by renowned GI pathologists, Drs. Riddell and Odze, "Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead?" published online on July 21, 2009 in the Am J Gastroenterol.I finally had a chance to read and digest this paper and heartily recommend practicing pathologist colleagues to do the same as I think it can inform (and reform?) our practices.  GEJ biopsies and esophagus biopsies "r/o Barrett's" are common specimens seen in both "community" and "academic" practice settings.Drs. Riddell and Odze make a compelling argument challenging the American College... The Daily Sign-Out blogs http://www.medworm.com/rss/comments.php?id=2828474 Wed, 23 Sep 2009 19:03:04 +0100 2828474 http://www.medworm.com/index.php?rid=2757710&cid=t_100108_87_f&fid=34935&url=http%3A%2F%2Fmedicine.com.my%2Fwp%2F%3Fp%3D7814 I have seen local community forums where lay persons are advising others to take aspirin like “multivitamins” to prevent strokes and heart attacks. We do not have sound evidence for doing so in the healthy population. In fact indiscriminately popping low dose aspirin would probably result in seeing more bleeding complications. Recent research from Britain shows that Aspirin does more harm than good in healthy people At a conference for leading doctors, British scientists said they have found that for healthy people taking aspirin does not significantly reduce the risk of a heart attack. At the same time they found it almost doubles the risk of being admitted to hospital due to internal bleeding. The findings show that for otherwise healthy people the risks of taking aspirin ou... Malaysian Medical Resources blogs http://www.medworm.com/rss/comments.php?id=2757710 Mon, 31 Aug 2009 23:00:00 +0100 2757710 http://www.medworm.com/index.php?rid=3416365&cid=t_100108_155_f&fid=38410&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FOncopathology%2F%7E3%2FJ_wfP17mbzQ%2Fimmunopheotype-of-gastrointestinal.html Histogenesis:It has been suggested that GISTs originate from the interstitial cell of Cajal (ICC), or from a primitive stem cell that differentiates towards both the ICC and smooth muscle phenotye.Sites:GISTs occur at every level of the GI tract. Most tumours arise in the stomach (60%) and about20–30% occur in the small intestine. Colorectal and oesophageal GISTs account for less than 10%. A small proportion of GISTs arise in extra-GI tract sites including the omentum, mesentery and retroperitoneum.Morphologic patterns:GISTs show a spectrum of histological features.Morphologically, the cells of GISTs are spindle, epithelioid, mixed pattern and occasionally pleomorphic.Spindle cell type is the predominant pattern, seen in 70% of GIST cases.Immunophenotype The overwhelming majority of GIST... Oncopathology blogs http://www.medworm.com/rss/comments.php?id=3416365 Thu, 02 Jul 2009 20:03:00 +0100 3416365 http://www.medworm.com/index.php?rid=1838137&cid=t_100108_105_f&fid=36987&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FIvorKovicMd%2F%7E3%2F406790067%2F Modality has just released their two new educational apps for the iPhone. They started with fantastic Netter’s anatomy flash cards and now they moved on to one of the most respected step-by-step guides to general surgery procedures, Zollinger’s Atlas of Surgical Operations. Zollinger’s Atlas of Surgical Operations consists of several parts devoted to gastrointestinal, miscellaneous abdominal, vascular, gynecologic and additional procedures. So far Modality has released upper and lower gastrointestinal procedures. Here is what they say…. The classic guide to general surgery procedures is now available for the iPhone and iPod touch. Based on the renowned Eighth Edition as available on AccessSurgery, Zollinger’s iPhone applications allow you to access step-by-st... Ivor Kovic, M.D. blogs http://www.medworm.com/rss/comments.php?id=1838137 Tue, 30 Sep 2008 01:29:33 +0100 1838137 http://www.medworm.com/index.php?rid=1717131&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F08%2F19%2Fduodenal-diverticulum-draining-ampulla-of-vater%2F This patient had biliary obstruction from a Klatskin tumour. On inserting a biliary drain from the left hepatic ductal system into the duodenum, the common bile duct was noted to drain into a duodenal diverticulum. On this image, it can be seen by following the course of the biliary catheter into the diverticulum. Duodenal diverticula are usually acquired pseudodiverticula and most arise along the concave border of the second or third parts of the duodenum. 75% arise within 2 cm of the ampulla of Vater and it is not uncommon for the ampulla to empty into the diverticulum. Insertion of the ampulla into a duodenal diverticulum is clinically important for several reasons. Firstly, it may cause difficulty with retrograde cannulation of ampulla during ERCP, or antegrade cannulation into the mai... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1717131 Tue, 19 Aug 2008 12:00:51 +0100 1717131 http://www.medworm.com/index.php?rid=1618029&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F07%2F14%2Fappendicitis-in-pregnancy%2F Appendicitis during pregnancy is a relatively rare condition, though it is thought that the incidence is similar to that of the non-gravid population at approximately 1 in 1500 pregnancies. The majority of appendicitis in pregnancy occurs during the second trimester when they are difficult to diagnose both clinically and by imaging. The clinical presentation of appendicitis is usually typical in early pregnancy (right lower quadrant pain, nausea/vomiting) but becomes more non-specific with advancing pregnancy. As pregnancy progresses the appendix migrates cephalad towards the right costal margin and may lead to pain referred to this location. Due to the lack of specificity of the preoperative evaluation, the pathologic diagnosis of appendicitis is confirmed in only 30% to 50% of cases. Add... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1618029 Sun, 13 Jul 2008 16:01:58 +0100 1618029 http://www.medworm.com/index.php?rid=1594001&cid=t_100108_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F329315688%2F The widely used pills may increase the chance of GI bleeding, but a new study also indicates the risk remains low. The research, which was published in The Archives of General Psychiatry, looked at selective serotonin reuptake inhibitors, or SSRIs, and found bleeding in the upper gastrointestinal tract is more common in people taking the drugs than those who don’t. The study examined 1,321 people treated for upper GI bleeding and about 10,000 people of the same age and sex who did not have such bleeding. The results - 5.3 percent of those with bleeding were taking SSRIs, while 3 percent who didn’t have GI bleeding were taking SSRIs. The risk was even higher in people taking SSRIs and other non-steroidal anti-inflammatory drugs, or NSAIDs. Risk factors include a peptic ulcer or... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1594001 Tue, 08 Jul 2008 01:52:44 +0100 1594001 http://www.medworm.com/index.php?rid=1508262&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F06%2F11%2Fdiverticulosis%2F This patient had a recent barium enema which resulted in barium impaction in numerous colonic diverticula. Barium impacted in diverticula often persist for weeks or months, and sometimes for years. This property has been exploited in at least one known case to treat refractory colonic diverticular bleeding using barium impaction therapy. Inspissated barium may also form a barolith which is a rare cause of bowel obstruction. References: 1. Matsuhashi N. et al, Barium Impaction Therapy for Refractory Colonic Diverticular Bleeding, American Journal of Roentgenology 2003; 180:490-492 2. Chapman A. & El-Hasani S., Colon ischaemia secondary to barolith obstruction, The British Journal of Radiology, 1998; 71:983-984 (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1508262 Wed, 11 Jun 2008 11:50:49 +0100 1508262 http://www.medworm.com/index.php?rid=1501280&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F06%2F09%2Fgallbladder-adenomyomatosis%2F Adenomyomatosis is a benign hyperplastic condition of the gallbladder consisting of hyperplasia of the gallbladder wall with hernation of mucosal epithelium into the wall. The latter results in intramural diverticula lined by epithelium, also known as Rokitansky-Aschoff sinuses. Cholesterol crystals, sludge or stones often precipitate within the bile trapped within these sinuses. Adenomyomatosis may involve the gallbladder diffusely but is usually focal, most commonly in the fundus. Ultrasound often demonstrates non-specific gallbladder wall thickening. Small echogenic foci within the wall with V-shaped comet tail artefact, as shown in this case, represents cholesterol crystals within the Rokitansky-Aschoff sinuses. This finding, when present, is highly specific for gallbladder adenomyomat... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1501280 Sun, 08 Jun 2008 16:01:20 +0100 1501280 http://www.medworm.com/index.php?rid=1446012&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F05%2F16%2Fretrocaecal-appendicitis-2%2F This 36 year-old male presented with right loin-to-groin pain, and was thought to have renal colic despite absence of blood in the urine. A CT KUB was performed, and the sagittal image above shows the typical features of acute appendicitis. There are two appendicoliths in this retrocaecal appendix, a markedly distended lumen (appendix diameter 17mm, normal (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1446012 Fri, 16 May 2008 09:56:37 +0100 1446012 http://www.medworm.com/index.php?rid=1428978&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F05%2F09%2Fsickle-cell-anaemia%2F Sickle cell anaemia is an autosomal recessive genetic disease leading to production of a defective form of haemoglobin, haemoglobin S (HbS) causing sickle shaped erythrocytes. The major consequence of these sickled erthrocytes is that they much less deformable causing obstruction in the microcirculation. Manifestations in the spleen include splenomegaly in childhood, with splenic infarction and autosplenectomy in adults. Skeletal manifestations include avascular necrosis of the femoral head and H -shaped vertebrae. This AXR shows massive splenomegaly and bilateral femoral head AVN. Reference: eMedicine (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1428978 Thu, 08 May 2008 16:01:29 +0100 1428978 http://www.medworm.com/index.php?rid=1423143&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F05%2F07%2Fretained-surgical-sponge%2F Gossypiboma is the name given to a retained surgical sponge, pad, or towel (gossypium (Latin), cotton; + plboma (Swahili), place of concealment). Retained foreign bodies can cause either an acute inflammatory response or a chronic fibrinous response and so there is a very wide variation in the time course in which they are discovered, as evidence in a diverse array of case reports in the surgical and radiologic literature. The sponge in the above picture was found over a decade after an exploratory laparotomy for trauma as an incidental finding on a study performed for an unrelated reason. Policies and procedures such as thorough surgical instrument counts and intraoperative x-rays are designed to prevent this complication, however retained surgical instruments continue to be occur at a ra... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1423143 Tue, 06 May 2008 16:01:16 +0100 1423143 http://www.medworm.com/index.php?rid=1393708&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F04%2F24%2Fcrohns-disease-3%2F Crohn’s disease is an idiopathic inflammatory bowel disease with discontinuous and asymmetric involvement of the entire gastrointestinal tract. It is characterised by transmural non-caseating granulomatous inflammation. The usual onset is between 15 and 30 years, with no sex predominance. Presentation is with abdominal pain, fever, weight-loss, anaemia, perianal abscess or fistula, or malabsorption. There is involvement of the small bowel in 80% of cases, which manifests as fold thickening, aphthous ulcers, or extensive mucosal ulceration. In this case there is cobblestoning which is due to serpiginous longitudinal and transverse ulcers separated by areas of oedema. There is also separation of small bowel loops due to bowel wall thickening. Deep mucosal ulcers are seen, sometimes ref... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1393708 Wed, 23 Apr 2008 16:01:40 +0100 1393708 http://www.medworm.com/index.php?rid=1370727&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F04%2F15%2Fmesenteric-panniculitis%2F Mesenteric panniculitis, also known as mesenteric lipodystrophy, is characterised by non-specific inflammation of the fat in the small bowel mesentery. The aetiology is unclear. It generally occurs in people over 50 years of age. CT classically demonstrates a well-defined halo of increased fat density surrounding the mesenteric vessels without displacing them, and small soft tissue nodules within the halo. It typically extends from the mesenteric root into the left side of the abdomen along the jejunal mesentery. This condition is often asymptomatic and discovered incidentally on abdominal CT, but may cause abdominal pain or fullness, nausea, bowel disturbances or a palpable mass. Mesenteric panniculitis may have a fibrotic component, believed to represent progression of the disease. In su... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1370727 Mon, 14 Apr 2008 16:01:39 +0100 1370727 http://www.medworm.com/index.php?rid=1363695&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F04%2F11%2Fnutmeg-liver%2F Nutmeg liver is a perfusion abnormality of the liver due to hepatic venous congestion. When the hepatic veins are congested, contrast is prevented from diffusing through the liver in a normal manner. This results in a mottled pattern of contrast enhancement in the arterial and early portal venous phase with decreased enhancement of the liver periphery. The areas of decreased enhancement are due to decreased portal flow, hepatic congestion and ischaemia. On delayed images enhancement of the liver becomes more uniform. Hepatic venous congestion may be caused by Budd-Chiari syndrome, right heart failure or constrictive pericarditis. In Budd-Chiari syndrome the caudate lobe enhances normally as it has a separate draining vein directly into the IVC. References: 1. Reuther WL et al. Gastrointest... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1363695 Thu, 10 Apr 2008 16:02:02 +0100 1363695 http://www.medworm.com/index.php?rid=1329050&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F03%2F27%2Fachalasia%2F This women in her 20’s presented with grave difficulties swallowing both food and liquids. Achalasia is a oesophageal motility disorder due to failure of relaxation of the lower oesophageal sphincter. This occurs due to an abnormality within the Auerbach’s plexus - be it primary or secondary. Baruim swallow demonstrates: 1. Beaked tapering of the oesophagus at the gastro-oesophgeal junction 2. A grossly dilated oesophagus 3. Tertiary contractions 4. Air-fluid level on the control/plain film Key Points: a. Achalasia is associated with an increased risk of oesophageal malignancy b. Beware of pseudoachalasia due to destruction of the plexus by tumour such as linitis plastica c. The radiologist has a role in treatment by ballon dilatation Reference: Primer in Diagnostic Imaging, We... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1329050 Wed, 26 Mar 2008 16:01:22 +0100 1329050 http://www.medworm.com/index.php?rid=1307747&cid=t_100108_133_f&fid=35096&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAutismVox%2F%7E3%2F253103150%2F A new study in the Archives of Disease in Childhood suggests that autistic children do not appear to have proteins leaking into their intestinal systems and causing damage, today’s BBC News reports. Researchers at Great Ormond Street Hospital, Guy’s and St Thomas’ Hospital and the University of Edinburgh found that autistic children did not have more peptides in their urine than did non-autistic children in a control group. The “leaky gut” theory of autism is based on the belief that vaccines such as the MMR damage the lining of the intestine and create digestive problems in children. It is thought that some children are not able to fully digest proteins called peptides that are found in some foods; the peptides “leak” into the gut and affect the b... Autism Vox blogs http://www.medworm.com/rss/comments.php?id=1307747 Mon, 17 Mar 2008 16:45:32 +0100 1307747 http://www.medworm.com/index.php?rid=1297735&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F03%2F13%2Fportal-venous-and-mesenteric-gas%2F This elderly patient presented with abdominal pain. CT demonstrated extensive mesenteric, mural and portal venous gas. The patient passed away shortly after admission to the emergency department. Portal venous gas is merely the accumulation of gas in the portal vein and its branches. It needs to be distinguished from pneumobilia, although this is usually not too problematic, when associated findings are taken into account along with the pattern of gas (peripheral in portal venous gas (see axial image here), central in pneumobilia). Although traditionally considered a harbinger of death, portal venous gas is increasingly recognised in a variety of conditions, many of which do not carry as high mortality or morbidity. Causes of portal venous gas are best divided according to the age of the ... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1297735 Wed, 12 Mar 2008 16:01:33 +0100 1297735 http://www.medworm.com/index.php?rid=1247852&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F02%2F22%2Fgangrenous-appendicitis-2%2F This 71 year-old male had an abdominal CT for investigation of septicaemia and right upper quadrant tenderness. The oblique coronal image shows fat stranding around a gas-filled and distended appendix (large arrow) and extraluminal gas adjacent to it (arrowheads). There was a faecolith at the appendix base (not shown). The findings are consistent with perforation of a gangrenous appendix. Gas within the appendix is usually a sign of normality. This case clearly shows that this is not always true. Extraluminal gas has been evaluated along with four other findings for the assessment of perforation: extraluminal appendicolith, abscess, phlegmon, and a defect in the enhancing appendiceal wall. Each of these findings have a high specificity but a low sensitivity. By looking for all findings rat... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1247852 Thu, 21 Feb 2008 16:01:44 +0100 1247852 http://www.medworm.com/index.php?rid=1241873&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F02%2F20%2Fhypoxic-brain-injury-following-drug-packet-rupture-2%2F This young adult male patient collapsed on an international flight. A cerebral CT was performed for ongoing reduced level of consciousness. An abdominal CT was performed. The radiological findings are: Bilateral globus pallidus hypodensity consistent with hypoxic brain injury. Rounded heterogeneous structures in stomach and bowel (drug packets). The “knot sign” - an eccentric low density nodule on the drug packet, representing the knot in the condom. These findings together suggest drug packet rupture followed by collapse, hypoxia and subsequent brain injury. (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1241873 Tue, 19 Feb 2008 16:01:30 +0100 1241873 http://www.medworm.com/index.php?rid=1216568&cid=t_100108_109_f&fid=35671&url=http%3A%2F%2Fwww.anxietyinsights.info%2Fpsychological_stress_may_upset_gastrointestinal_flora_balanc.htm Some people find stressful life experiences coincide with gastrointestinal problems. New research has shown that their stomachs may be churning for a reason. Psychology lecturer Dr Simon Knowles along with his colleague biotechnology researcher Dr Enzo Palombo and PhD student Elizabeth Nelson from Australia's Swinburne University have studied the effect of stress on gastrointestinal flora. "This is the first study to show that perceived stress affects the levels of good bacteria in the intestine," Knowles said. "A reduction in these good bacteria is associated with gastrointestinal infections." The group studied the effect of perceived stress on salivary cortisol concentrations and lactic acid bacteria activity on 23 healthy undergraduate students. Saliva and fecal samples were collected f... Latest entries from www.anxietyinsights.info blogs http://www.medworm.com/rss/comments.php?id=1216568 Fri, 08 Feb 2008 07:21:00 +0100 1216568 http://www.medworm.com/index.php?rid=1185730&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2008%2F01%2F30%2Fportal-system-thrombosis%2F Portal (and splenic) vein thrombosis may be primary or more commonly secondary. There are a multitude of causes some of which are listed. 1. Idiopathic 2. Secondary to tumour (including HCC, Pancreatic and Cholangiocarcinoma) 3. Trauma 4. Abdominal sepsis 5. Pancreatitis 6. Ascending cholangitis 7. Myeloproliferative disorders 8. Hypercoagulable syndromes 9. Severe dehydration 10. Cirrhosis with portal hypertension Primary imaging investigations of choice include ultrasound and contrast enhanced CT. The appearances on CT are similar to those found at CTPA for a pulmonary embolus with a filling defect within the portal vein. Consideration should be made to identify potential causes as well as complications on the same imaging study, such as pancreatitis, splenomegaly and varices. References... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1185730 Tue, 29 Jan 2008 16:01:20 +0100 1185730 http://www.medworm.com/index.php?rid=1119231&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F12%2F28%2Ffeline-oesophagus%2F These transient lines (they disappear with a subsequent swallow)represent contraction of the muscularis mucosa. It is most commonly seen in patients with gastroesophageal reflux. This patient has a large hiatus hernia and reflux on subsequent imaging. Reference: Gohel VK, Edell SL, Laufer I, Rhodes WH. Transverse folds in the human esophagus. Radiology 1978;128:303-308 (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1119231 Fri, 28 Dec 2007 00:51:16 +0100 1119231 http://www.medworm.com/index.php?rid=1117594&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F12%2F27%2Fincarcerated-inguinal-hernia%2F Three month-old boy presented with intestinal obstruction caused by irreducible left inguinal hernia. Incarcerated hernias (constricted but not necessarily strangulated) occur when the contents of a hernia sac cannot be reduced into the abdominal cavity. Incarcerated hernias can be inguinal, femoral, or umbilical. The vast majority of inguinal hernias in children are indirect. Incarceration represents the most common complication associated with inguinal hernias, the incidence could be as high as 30% for infants younger than 2 months. Femoral hernias, which tend to incarcerate, are extremely rare in children and are the only hernias that occur in females more often than males. Umbilical hernias are very common in children but rarely incarcerate and often close spontaneously by age 5 years.... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1117594 Wed, 26 Dec 2007 16:01:42 +0100 1117594 http://www.medworm.com/index.php?rid=1100085&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F12%2F18%2Foesophageal-web%2F 21 yo female with dysphagia. Barium swallow shows circumferential radiolucent ring in upper esophagus. Proximal dilatation and jet phenomenon (Barium spurting through the ring on fluoroscopy) indicate partial obstruction. Esophageal web: A thin ring-like mucosal constriction projecting into the lumen 10% incidence at autopsy Can be congenital or acquired Most in hypopharynx and proximal esophagus Majority protrude from anterior esophageal wall Symptoms if lumen > 50% compromised Sideropenic dysphagia (Plummer-Vinson syndrome) -Iron deficiency anemia -Esophageal web with dysphagia -Increased incidence of carcinoma If symptomatic, balloon dilatation; bougienage during esophagoscopy. References: 1. Demos et al 2007: Esophagus I www.radiologyassistant.nl 2. Federle et al 2004: Diagnostic Im... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1100085 Mon, 17 Dec 2007 16:01:19 +0100 1100085 http://www.medworm.com/index.php?rid=1081783&cid=t_100108_133_f&fid=35096&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAutismVox%2F%7E3%2F197489864%2F 14-year-old Jack Piper endured multiple organ failure, including kidney and liver problems, a a swollen brain and neurological problems, after a colonoscopy procedure at the Royal Free Hospital in 1998. He also developed epilepsy and suffered stomach ulcers. The December 9th Daily Mail reports that the procedure was not “”not clinically indicated or justified’”; his parents claim that the procedure was carried out to “establish links between his condition and bowel problems” rather than for Jack’s clinical needs. Jack’s family has won a £500,000 payout from the hospital, which “admitted the operation itself was negligent and gave Jack and his family a public apology.” The documents also claimed that Jack’s parents were n... Autism Vox blogs http://www.medworm.com/rss/comments.php?id=1081783 Sun, 09 Dec 2007 09:31:27 +0100 1081783 http://www.medworm.com/index.php?rid=1054794&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F11%2F28%2Fulcerated-gastric-lymphoma%2F This patient had a large ulcerated tumour on the lesser curvature of the stomach. Gastrectomy specimen showed gastric lymphoma. The differential diagnosis is gastric carcinoma and gastrointestinal stromal tumour (GIST). The stomach is the commonest site of extranodal lymphoma (25%), but gastric lymphoma represents only 5% of all gastric malignancies. Most are B cell non-Hodgkins lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) and are associated with Helicobacter pylori. Reference: 1. Dahnert W. Radiology Review Manual, 5th edition. Lippincott, Williams and Wilkins 2003 2. Kumar V. et al Robbins and Cotran Pathologic Basis of Disease, 7th edition, Elsevier Saunders 2005 (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1054794 Tue, 27 Nov 2007 16:01:21 +0100 1054794 http://www.medworm.com/index.php?rid=1009397&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F11%2F07%2Fmidgut-volvulus%2F A 60 year-old male presented with acute severe abdominal pain. CT shows twisting of small bowel and mesentery around superior mesenteric artery (whirl sign). Malrotation is incomplete rotation of the bowel during embryologic development. As a result, the mesenteric root, which extends from the duodenojejunal junction (ligament of Treitz) to ilioceacal junction is shortened. The resultant short mesenteric root predisposes to volvulus of midgut (the portion of bowel supplied by the superior mesenteric artery). Midgut volvulus is the subsequent twisting of bowel around the superior mesenteric artery leading to bowel obstruction and ischemia. Urgent surgical repair is often required to prevent ischemia or to resect infarcted bowel loops. Reference: WE Berdon: Midgut Volvulus with Whirlpool sig... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=1009397 Tue, 06 Nov 2007 16:01:59 +0100 1009397 http://www.medworm.com/index.php?rid=987114&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F10%2F29%2Faccessory-right-inferior-hepatic-vein%2F Variations in hepatic vascular anatomy are common. They may occur in the arterial, portal venous or hepatic venous systems. This is an important consideration in patients undergoing liver surgery, transplantation and radiological intervention. The most common variation in the hepatic venous system is an accessory right inferior hepatic vein. It drains the posterior part of the right lobe (mainly segments 6 and 7) directly into the IVC. This venous pattern is present in approximately 48% of the population. References: 1. Saylisoy S, et al. Multislice CT angiography in the evaluation of hepatic vascular anatomy in potential right lobe donors. Diagnostic & Interventional Radiology, 2005 Mar;11(1):51-9 2. Orguc S, et al. Variations of hepatic veins: Helical computerized tomography experie... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=987114 Mon, 29 Oct 2007 11:56:25 +0100 987114 http://www.medworm.com/index.php?rid=957412&cid=t_100108_109_f&fid=35671&url=http%3A%2F%2Fwww.anxietyinsights.info%2Facg_psychological_distress_increases_gerd_severity.htm By Charles Bankhead, Staff Writer, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. PHILADELPHIA, Oct. 16 — Apparent treatment-resistant gastroesophageal reflux disease may reflect comorbid psychological distress that results in more severe symptoms, results of a study reported here suggest. About 40% of patients with GERD have comorbid psychological distress, William Chey, M.D., of the University of Michigan at Ann Arbor said at the American College of Gastroenterology meeting. More... © 2004-7 MedPage Today, LLC. All Rights Reserved. (Source: Latest entries from www.anxietyinsights.info) Latest entries from www.anxietyinsights.info blogs http://www.medworm.com/rss/comments.php?id=957412 Wed, 17 Oct 2007 07:52:00 +0100 957412 http://www.medworm.com/index.php?rid=932597&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F10%2F07%2Felevated-hemidiaphragm%2F This patient had a large subdiaphragmatic hepatocellular carcinoma. Causes of an elevated hemidiaphragm are: 1) Above the diaphragm – decreased lung volume (atelectasis, collapse, lobectomy, pneumonectomy, pulmonary hypoplasia). 2) Diaphragm – phrenic nerve palsy, diaphragmatic eventration 3) Below the diaphragm – abdominal tumour, subphrenic abscess, distended stomach or colon. Differential diagnoses which may mimic an elevated hemidiaphragm are subpulmonic effusion, diaphragmatic hernia, diaphragmatic rupture and a tumour of the pleura or diaphragm. Reference: Dahnert W. Radiology Review Manual, 5th edition. Lippincott, Williams and Wilkins 2003 (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=932597 Sat, 06 Oct 2007 16:02:25 +0100 932597 http://www.medworm.com/index.php?rid=927844&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F10%2F05%2Fomphalocoele%2F An omphalocoele is a congenital midline abdominal wall defect at the base of the umbilical cord insertion. It is typically a large defect through which liver or bowel or both herniate. It is covered by a peritoneal membrane with the umbilical cord inserting at or near its apex. Associated anomalies are common, including chromosomal, CNS, cardiac, genitourinary and gastrointestinal anomalies, which confer a poor prognosis. Syndromes that include omphalocoeles are Beckwith-Wiedemann syndrome, bladder exstrophy and pentalogy of Cantrell. The differential diagnoses are gastroschisis (smaller para-umbilical defect usually to the right of midline, usually containing only bowel loops and not covered by a membrane) and limb-body wall complex (large defect usually to the left of midline). Reference... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=927844 Thu, 04 Oct 2007 16:01:24 +0100 927844 http://www.medworm.com/index.php?rid=914081&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F09%2F30%2Fbody-packer%2F Brought in by police officers under the suspicion of carrying drugs on their person… well in their person in this case. Body packing is an increasingly ‘popular’ method for tourists to bring in illegal substances. This is one of the more obvious cases, but small multi-layered swallowed packets can be very difficult to discern from faecal matter, even on CT. For other unfortunate foreign bodies please visit Radiopaedia.org here. (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=914081 Sat, 29 Sep 2007 16:01:16 +0100 914081 http://www.medworm.com/index.php?rid=863706&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F09%2F12%2Fmeconium-peritonitis%2F A sterile chemical peritonitis that occurs in utero from fetal bowel perforation and spillage of meconium into the peritoneal cavity. The bowel perforates as a result of bowel obstruction, such as atresias or meconium ileus. Usually the perforation seals off and the bowel is intact at birth. Intraperitoneal meconium usually calcifies, sometimes within 24 hours. If the processus vaginalis is patent at the time of perforation, calcification may also be seen in the scrotum. Complications are ascites, bowel obstruction from the formation of fibroadhesive bands, and meconium pseudocyst (a walled-off mass of meconium surrounded by a calcific rim). References: 1. Blickman H. Paediatric Radiology The Requisites, 2nd edition. Mosby 1998 2. Dahnert W. Radiology Review Manual, 5th edition. Lippincott... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=863706 Tue, 11 Sep 2007 16:01:54 +0100 863706 http://www.medworm.com/index.php?rid=849958&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F09%2F08%2Fabdominal-discomfort%2F A middle-aged male presented to the emergency department with abdominal discomfort. An abdominal radiograph was performed as shown. There is no evidence of perforation or obstruction. The patient was taken to operating room within 12 hours of presentation, with consent for colostomy. Under general anaesthesia in the lithotomy position, dilatation of anal sphincter was performed and per rectum retrieval successful. These patients typically have a delayed presentation to the emergency department because of embarrassment and after multiple attempts at self removal. Respect for their privacy is a key factor in the patient’s care plan. ED physicians need to decide if removal of foreign body can be performed in the emergency department or surgical team to be notified. Operating room proced... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=849958 Fri, 07 Sep 2007 16:01:55 +0100 849958 http://www.medworm.com/index.php?rid=793928&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F08%2F12%2Fcoffee-anyone%2F This patient was admitted… well for obvious reasons. The pins inserted in the inner part of the lid are of unknown significance. The jar was of a well-known brand of instant coffee. For other foreign bodies, please visit Radiopaedia.org here. References: 1. Moccona.com (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=793928 Sun, 12 Aug 2007 11:32:11 +0100 793928 http://www.medworm.com/index.php?rid=775359&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F08%2F03%2Findirect-inguinal-hernia%2F This patient had an incidental indirect hernia found at CT. Note the majority of small bowel has descended into the hernia dragging the mesentery with it. To see why inserting an indwelling catheter was difficult in this patient please visit Radiopaedia.org here. Indirect hernias are five times more common than direct hernias, and are seven times more frequent in males, due to persistence of the processus vaginalis during testicular descent. An indirect hernia enters the inguinal canal at the deep ring, passes inferomedially to emerge via the superficial ring and, if large enough, extend into the scrotum. Contents may include small bowel loops, mobile colon segments (sigmoid, caecum, appendix), mesenteric fat, or urinary bladder. Many are long standing and asymptomatic, although the sheer ... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=775359 Thu, 02 Aug 2007 16:02:12 +0100 775359 http://www.medworm.com/index.php?rid=773318&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F08%2F02%2Fintestinal-ascariasis%2F Individual worms are seen as longitudinal tubular structures. If the alimentary tract of the worm is empty, the worm may appear as a filling defect. If its alimentary tract is distended, the worm appears as parallel bands (arrow). On transverse sections, the worm appears as a target sign (arrowhead) with body wall and a central dot representing its gut. Reference: DiSantis DJ, Ralls PW, Balfe DM, et al: The patient with suspected small bowel obstruction: imaging strategies. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun; 215(suppl): 121-4 (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=773318 Wed, 01 Aug 2007 16:02:27 +0100 773318 http://www.medworm.com/index.php?rid=713986&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F07%2F05%2Ftoxic-megacolon%2F This 55 years old male patient with known ulcerative colitis presented with fever and malaise suggesting a flare up. There is gross dilatation of the transverse colon which measures approximately 10cm in maximum diameter. There is also evidence of pseudopolyp formation (black arrows). This is typical of toxic megacolon and is a surgical emergency. If toxic megacolon is clinically suspected, patients are usually followed up with plain abdominal radiography every 12-24 hours, depending on the patient’s clinical condition. A single abdominal radiograph may not be sufficient and should be combined with a horizontal-beam radiograph because it may better depict large, dilated bowel loops with fluid levels. Also, abdominal perforation is less likely to be missed. Pancolitis (including chang... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=713986 Wed, 04 Jul 2007 14:01:40 +0100 713986 http://www.medworm.com/index.php?rid=708777&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F07%2F03%2Fcaecal-volvulus-2%2F This 60yrs female patient presented with 3-day history of severe abdominal pain. On abdominal radiograph, there is a grossly dilated loop of bowel in the central abdomen with the ends of the loop pointing towards the right half of pelvis - “coffee-bean sign”. This indicates a closed loop obstruction and is characteristic of caecal volvulus. The plain abdominal radiograph is usually the key to the diagnosis. Two types of cecal volvulus are described: axial torsion type and the cecal bascule type. In practice, differentiation between the types is not clinically important because the clinical presentation and treatment is the same. However, the radiographic appearances are different. In axial torsion, the image may show a markedly distended loop of large bowel with its long axis e... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=708777 Mon, 02 Jul 2007 14:01:16 +0100 708777 http://www.medworm.com/index.php?rid=692997&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fwww.radpod.org%2F2007%2F06%2F25%2Ftrichobezoar%2F This is a 15 year old female patient complaining of chronic pain in epigastric region. Her mother gave a positive history of seeing hairs in her mouth during wake-up time. The behaviour and mental scoring was normal. CT shows a large mass of heterogenous material in stomach which is probably a combination of hairs and trapped food. Bezoars are known to cause small bowel obstruction and sometimes CT may demonstrate the bezoar as a mass in the obstructed segment of bowel. The bezoar may be outlined by fluid in the proximally dilated small bowel, and the mass may be mottled owing to air trapped within it. Types of bezoar - (1) Trichobezoar is a bezoar formed from hair. This has also been called Rapunzel syndrome. (2) Phytobezoars are composed of nondigestible food material (e.g. cellulose) an... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=692997 Sun, 24 Jun 2007 14:03:03 +0100 692997 http://www.medworm.com/index.php?rid=682725&cid=t_100108_87_f&fid=34865&url=http%3A%2F%2Fwww.thecancerblog.com%2F2007%2F06%2F20%2Fknow-the-signs-and-symptoms-of-myeloma%2F Filed under: Blood Cancer, Bone CancerThe American Cancer Society estimates that approximately 16,600 new cases of myeloma are diagnosed each year in the United States. Bone pain is the most common early symptom of myeloma. Most patients feel pain in their back or ribs, but it can occur in any bone. The pain is usually made worse by movement.Patients fatigue more easily and often feel weak. They may also have a pale complexion from anemia which is a common medical problem for patients with myeloma and may contribute to the fatigue. If the disease progresses, the concentration of normal cells in the blood may also decrease. Headaches, bruising, nose bleeding, gastrointestinal bleeding, and tingling or numbness in extremities are all symptoms of myeloma. Patients may have repeated infections... The Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=682725 Wed, 20 Jun 2007 04:00:00 +0100 682725 http://www.medworm.com/index.php?rid=655436&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F06%2F04%2Fintussusception%2F This 2-year old male child presented with classical signs and symptoms of bowel intussusception. The abdominal pain was mainly located in the epigastric region with several bouts of vomiting. The parents also reported bloody stools and associated screaming episodes. Intussusception occurs in all ethnic groups with a M:F ratio of 3:1 and mostly in age groups from 6months-2years. In older children, there is higher association with leading points. A loop of bowel infolds (and inverts) more distally into the lumen of the bowel, and then is carried distally by peristalsis. Approximately 90% of intussusceptions are ileocolic, in which the terminal ileum is carried through the ileocaecal valve into the colon, and may reach the rectum. Ultrasound Transverse: Ultrasound (US) shows a mass with a swi... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=655436 Sun, 03 Jun 2007 14:01:12 +0100 655436 http://www.medworm.com/index.php?rid=650758&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F06%2F01%2Fgallstone-ileus-2%2F Classical findings: small bowel obstruction; gas in biliary tree; large ectopic gallstone (Rigler triad). Other findings: collapsed gallbladder; gas in gallbladder. Terminology: mechanical intestinal obstuction caused by impaction of one or more gallstones. Pathology: occurs in setting of chronic cholecystitis or following multiple ERCPs. Risk increases with age. Reference: Federle M. Jeffrey R. Desser T. Diagnostic Imaging: Abdomen 2004. Amirsys. Canada. (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=650758 Thu, 31 May 2007 14:01:13 +0100 650758 http://www.medworm.com/index.php?rid=631518&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F05%2F24%2Freactive-gastrohepatic-lymphadenopathy%2F This 39 year-old male patient presented with epigastric pain. The contrast-enhanced CT above shows multiple rounded structures in the region of the gastrohepatic ligament (click image for arrows). The structures do not enhance to the same degree as the portal vein, making gastric varices unlikely. The structures most probably represent enlarged lymph nodes. The scan also demonstrated moderate thickening of the gastric wall (not shown). The differential diagnosis included: gastritis or gastric ulcer with reactive lymphadenopathy; gastric lymphoma; gastrointestinal stromal tumour; and gastric carcinoma. An endoscopy was performed and a gastric ulcer found. Biopsies of the ulcer showed no evidence of malignancy. The final diagnosis is gastric ulcer with reactive lymphadenopathy. Ninety-five p... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=631518 Wed, 23 May 2007 14:02:23 +0100 631518 http://www.medworm.com/index.php?rid=628983&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F05%2F22%2Fgas-bag%2F Presentation: Difficulty with micturition. Findings: Multiple small bowel loops in scrotum due to right inguinal hernia. Compression of penile urethra. Pathology: 75-80% hernias occur in inguinal region. Indirect five times commoner than direct. Contents may include small bowel loops, mobile colon segments (sigmoid, caecum, appendix), mesenteric fat. Complications: incarceration; strangulation; intestinal obstruction. Reference: Federle M. Jeffrey R. Desser T. et al. Diagnostic Imaging: Abdomen 2004. Amirsys. Canada. (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=628983 Mon, 21 May 2007 14:01:38 +0100 628983 http://www.medworm.com/index.php?rid=594327&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F05%2F08%2Fcolonic-lipoma%2F Gastrointestinal lipomas are not common, and are most frequently seen in the colon. Most of these are right sided (as in this case) and submucosal (90%) - and these can become polypoid. Malignancy is exceedingly rare, and usually these are asymptomatic. The leading complication is intussusception. For further images of this case see Radiopaedia.org here. Reference: Medcyclopaedia.org. (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=594327 Mon, 07 May 2007 14:02:03 +0100 594327 http://www.medworm.com/index.php?rid=592474&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F05%2F07%2Facute-appendicitis%2F This 12 year-old girl presented with right iliac fossa pain. An abdominal ultrasound shows a blind-ending tubular structure with a diameter of 10mm in the right iliac fossa, surrounded by hyperechoic fat. The findings are diagnostic of acute appendicitis (although the differential diagnosis of Meckel’s diverticulitis should not be forgotten). Ultrasound is the imaging test of choice for the diagnosis of acute appendicitis in children, as there is no radiation exposure, and they are usually thinner than adults. An exception is the overweight or obese child, where ultrasound visualisation is poor. In this case, CT may be more useful. As ultrasound has a lower reported sensitivity than CT, CT may be helpful in the setting of ongoing pain when the ultrasound is negative. One reason for a... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=592474 Sun, 06 May 2007 14:02:32 +0100 592474 http://www.medworm.com/index.php?rid=587617&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F05%2F04%2Ffat-halo-sign%2F The “halo” represents infiltration of the submucosa with fat, between the muscularis and the mucosa. It is nearly pathognomonic of inflammatory bowel disease ( Crohn disease and ulcerative colitis) although it has been reported in cytoreductive therapy and graft vs host disease. As long as the latter two conditions are excluded on history, presence of a fat halo of small bowel (as in this case - see the anterior loop of bowel) and be not only considered equivalent to a diagnosis of Crohn disease, but also indicates chronicity. Occasionally a very thin layer of intramural fat can be seen both within the colon and terminal ileum, as of course at the iliocaecal valve, as a variant of normal. For another image visit Radiopaedia.org here. References: 1. Mukesh G. Harisinghani &#8... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=587617 Thu, 03 May 2007 14:02:32 +0100 587617 http://www.medworm.com/index.php?rid=529626&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F04%2F09%2Fduodenal-diverticula%2F This film shows an incidental finding on small bowel series - 2 duodenal diverticula (click image for arrows). Duodenal diverticula typically arise in the periampullary medial 2nd part of the duodenum (70%). Twenty-six percent arise in the 3rd or 4th parts, as in this case. Ninety percent of duodenal diverticula are asymptomatic. Complications include infection, haemorrhage, stasis, perforation, and panreaticobiliary disease (if the diverticulum is periampullary). The papilla of Vater may be within a diverticulum, creating a problem for the endoscopist intent on finding and otomising it. Reference: Federle et al. Diagnostic Imaging: Abdomen Amirsys 2004 (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=529626 Sun, 08 Apr 2007 14:05:43 +0100 529626 http://www.medworm.com/index.php?rid=516287&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F04%2F03%2Fhepatic-pyogenic-abscess%2F This 74 year-old female presented with right upper quadrant pain and fever. CT demonstrates a large irregular fluid-density lesion within the right lobe of the liver with rim enhancement. There are multiple smaller peripheral lesions with similar characteristics. Some of these appear coalescent. This is the typical appearance for a pyogenic liver abscess. Percutaneous CT-guided drainage was performed. A heavy growth of Streptococcus milleri was grown. The most common organisms found in pyogenic liver abscess are Staphylococcus aureus in children and Escherichia coli in adults. Differential diagnoses include: amoebic abscess; hydatid cyst; cystic metastasis; and biliary cystadenocarcinoma. Reference: Federle MP, et al. Diagnostic Imaging: Abdomen Amirsys 2004 (Source: Radiology Picture of t... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=516287 Mon, 02 Apr 2007 14:02:33 +0100 516287 http://www.medworm.com/index.php?rid=513728&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F04%2F01%2Fporcelain-gallbladder%2F This coronal reformat of a CT scan performed on a 74 year-old woman shows porcelain gallbladder. The high density is due to calcium carbonate encrustation of the gallbladder wall. It is associated with gallstones in 90% (this patient had a gallstone). It is seen in around 1% of cholecystectomy specimens. Subsequent gallbladder carcinoma develops in 10-20% of patients. Reference: Dahnert W. Radiology Review Manual 5th edition. Lippincott, Williams & Wilkins 2003 (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=513728 Sat, 31 Mar 2007 14:01:20 +0100 513728 http://www.medworm.com/index.php?rid=492332&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F03%2F23%2Fenterocutaneous-fistula-2%2F This 45 year-old female patient presented with fevers and two weeks of obstipation. There was a past history of Crohn’s disease, multiple laparotomies, enterocutaneous and enterovaginal fistulas. The CT shows a fistula from a loop of small bowel to the skin. None of the administered oral contrast passed into bowel distal to the fistula. Crohn’s disease is an idiopathic inflammatory bowel disease with discontinuous and asymmetric involvement of the entire gastrointestinal tract. It is characterised by transmural non-caseating granulomatous inflammation. The usual onset is between 15 and 30 years, with no sex predominance. Presentation is with abdominal pain, fever, weight-loss, anaemia, perianal abscess or fistula, or malabsorption. There is involvement of the small bowel in 80%... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=492332 Thu, 22 Mar 2007 22:25:01 +0100 492332 http://www.medworm.com/index.php?rid=489468&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F03%2F22%2Ffocal-hepatic-fat-infiltration%2F These in- and out-of-phase T1-weighted gradient-echo sequences show focal fat infiltration to the right of the fissure for the ligamentum teres (click images for arrows). There is signal loss on out-of-phase images. Signal loss occurs when water and fat molecules occupy the same voxel, and the signals they return negatively interfere. This is due to the different precession speeds of fat and water in the same magnetic field. At 1.5 T, the water and fat signal are in phase when TE is an even multiple, and out of phase when TE is an odd multiple of 2.3 ms. Focal fat infiltration is common. It is frequently seen as increased echogenicity on ultrasound, decreased density on CT, and increased T1 signal on MR. There is typically a geographic border and no distortion or displacement of vessels. A... Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=489468 Wed, 21 Mar 2007 13:04:05 +0100 489468 http://www.medworm.com/index.php?rid=474759&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F03%2F15%2Fhamburger-sign%2F This 77 year-old female with known chronic lymphocytic leukaemia presented in extremis with abdominal pain, abdominal distention, acidosis and elevated lactate. A CT was performed for possible ischaemic colitis. There is caecal pneumatosis and dilatation consistent with ischaemia (green arrows, click image). There is also a mesenteric and paraaortic nodal mass with the “hamburger sign” (red arrows) suggesting lymphoma. Americans may try to tell you this is the sandwich sign. The sign is specific for mesenteric lymphoma (typically non-Hodgkin’s) unless the patient has had a transplant. In this case posttransplant lymphoproliferative disorder should be considered. Reference: Hardy SM. The Sandwich Sign. Radiology 2003; 226:651–652 (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=474759 Wed, 14 Mar 2007 13:01:57 +0100 474759 http://www.medworm.com/index.php?rid=464569&cid=t_100108_115_f&fid=34679&url=http%3A%2F%2Fradpod.org%2F2007%2F03%2F06%2Fpneumobilia%2F This patient had a CT scan of the abdomen where gas was noted in the intrahepatic bile ducts. Note the relatively central location of linear air density in the liver (contrast this with the peripheral linear air densities seen with portal venous gas). The causes of pneumobilia include an incompetent Sphincter of Oddi (e.g. post sphincterotomy, or following passage of a gallstone), gallstone ileus, trauma, a duodenal ulcer perforating into the common bile duct, and secondary to surgery (e.g. cholecystoenterostomy). Gas in the gallbladder is seen in emphysematous cholecystitis. In this case it was due to previous biliary surgery. Reference: Dahnert W. Radiology Review Manual 5th ed. 2003. Lippincottt Williams & Wilkins. (Source: Radiology Picture of the Day) Radiology Picture of the Day blogs http://www.medworm.com/rss/comments.php?id=464569 Mon, 05 Mar 2007 13:01:22 +0100 464569 http://www.medworm.com/index.php?rid=1097849&cid=t_100108_145_f&fid=36688&url=http%3A%2F%2Ffeeds.egmedicine.com%2F%7Er%2Fegmedicine%2Fusmle%2F%7E3%2F199107436%2F Gastrointestinal P.280, Abdominal layers Not necessary, but I’m just begging you to change this image. In contrast to a typical cross-section on CT, this image is flipped over its axis. This means that with left body on right page, we are looking from head-to-toe and not toe-to-head (as in a CT) and the anterior abdominal wall is [...] (Source: USMLE) USMLE blogs http://www.medworm.com/rss/comments.php?id=1097849 Tue, 30 Nov 1999 00:00:00 +0100 1097849