CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome.

We have performed CT-guided percutaneous needle aspiration in 104 patients with severe pancreatitis strongly suspected of harboring pancreatic infection on the basis of systemic toxicity and CT findings (Balthazar CT grade D or E). Of these 104 patients, 51 (49%) were documented with pancreatic infection. Gram stain was positive in 54 of 58 infected aspirates, and culture was positive in all 58.

Bacteriologic status of necrotic tissue in necrotizing pancreatitis.

To confirm the accuracy of guided percutaneous aspiration (GPA) in distinguishing sterile from infected pancreatic necrosis, we have performed Brown-Brenn tissue Gram stains on pancreatic and peripancreatic necrotic tissue removed operatively in 15 patients. In eight patients judged to have sterile necrosis on the basis of negative cultures of pancreatic exudate obtained first preoperatively (by GPA) and then intraoperatively, necrotic tissue debrided at surgery was also free of bacteria. In seven patients judged to have infected necrosis on the basis of positive cultures of pancreatic exudate obtained first preoperatively (by GPA) and then intraoperatively, necrotic tissue debrided at surgery harbored a considerable number of bacteria.

CT of appendicitis. Diagnosis and treatment.

CT may provide valuable information in patients with appendicitis whose clinical presentations are atypical. The abnormal appendix and inflammatory changes in the pericecal fat are shown directly rather than inferentially. CT can reliably distinguish phlegmonous inflammation from a liquified abscess and can accurately delineate the full extent of such inflammatory masses.

Delayed common bile duct obstruction in acute pancreatitis.

Common bile duct obstruction during acute pancreatitis usually occurs in the early symptomatic phase of the illness, involves only the distal portion of the common bile duct, and subsides with clinical improvement. We present two cases of persistent common bile duct obstruction that developed 2-3 months after complete clinical subsidence of the initial episode of severe acute pancreatitis and involved a long segment of the common bile duct. After surgical decompression, there was no recurrence of common bile duct obstruction or pancreatitis.

Imaging techniques for infections in the surgical patient.

Gallium-67 citrate is easy to use and readily available, but the need to delay imaging for 2 to 4 days after injection hinders rapid diagnosis. Moreover, normal gastrointestinal activity limits its usefulness in evaluating the abdomen. Labeling leukocytes with Indium-111 oxine is a time-consuming, technically involved process, yet the images obtained at 24 hours will usually reveal sites of inflammation or infection.

Central cavitary necrosis: differentiation from pancreatic pseudocyst on CT scan.

Central cavitary necrosis of the pancreas has a computed tomography CT appearance of a well-defined sausage-shaped mass with a low-density center and convex margins, usually conforming to the pancreatic contour. Several other entities, including pancreatic pseudocyst, may have a similar appearance. Since the treatment of central cavitary necrosis differs considerably from that of these other entities, it is important to differentiate them.

Early diagnosis of pancreatic infection by computed tomography-guided aspiration.

We performed 92 computed tomography-guided percutaneous needle aspirations of pancreatic inflammatory masses in 60 patients suspected of harboring pancreatic infection. Thirty-six patients (60%) were found by Gram stain and culture to have a total of 41 separate episodes of pancreatic infection. Among 42 aspirates judged to be infected by computed tomography-guided aspiration, all but one were confirmed by surgery or indwelling catheter drainage.

Oxygen reservoir rebreathing mask simulating pneumothorax.

A case in which the superimposition of an oxygen rebreathing mask reservoir bag simulated pneumothorax on radiographs of the chest is described. A double white line parallel to the lateral ribs produced by the double seam of the bag distinguishes this artifact from a true pneumothorax.

Foucher's sign of the Baker's cyst.

We investigated the mechanism of Foucher's sign, the change in pressure in the Baker's cyst with extension and flexion of the knee, by echography, arthrography, and computed tomography. With extension the gastrocnemius and the semimembranosus muscles approximate each other and the joint capsule compressing the cyst against the deep fascia. Opposite effects in flexion allow the cyst to relax.

Problems in CT diagnosis of ruptured abdominal aortic aneurysms.

In a review of 17 cases in which the CT diagnosis of abdominal aortic aneurysm rupture was prospectively made and for which surgical correlation was available the CT diagnosis was correct in 10 and incorrect in seven. Two of the false positives were retrospectively reinterpreted as negative for rupture. Characteristics of 10 surgically confirmed cases revealed a spectrum of appearances not always in agreement with prior published reports, probably due to the age and magnitude of the aortic leaks at the time of diagnosis.

Relationship of fat distribution to glucose tolerance. Results of computed tomography in male participants of the Normative Aging Study.

Computed tomography (CT) scanning was used to assess the relationship of glucose tolerance to fat distribution in men. Three cross sections [chest (including upper arms), abdomen, and thigh] were scanned in 41 men randomly selected from the Normative Aging Study, a longitudinal study of aging. Greater amounts of fat in the upper body and greater ratios of upper-body fat to lower-body fat were significantly correlated with higher 2-h serum glucose levels after adjustment for age and body mass index.

The role of computed tomography in symptomatic aortic aneurysms.

Forty-seven patients with an abdominal aortic aneurysm (AAA) and recent onset of abdominal or back pain were evaluated by emergency computed tomography (CT) to identify those patients with a confined rupture, and unstable aneurysm, nonaneurysmal cause of pain and a stable AAA. CT suggested that 25 per cent of these had a confined rupture and should undergo emergency surgical treatment. Rupture was confirmed at operation in one-half of these instances.

Intrahepatic pyogenic abscesses: treatment by percutaneous drainage.

During a 6 year period, 18 liver abscesses in 12 patients were identified by computerized tomography. Five patients had presumed hematogenous seeding. Five patients previously had bilioenteric anastomoses, stents, or both to relieve obstructive jaundice.

Comparison of body composition in middle-aged and elderly males using computed tomography.

Computed tomography (CT) scans were taken of 21 middle-aged men (mean age 46.3 years) and 20 older men (mean age 69.4 years) to measure differences in body composition with age.

Expanded criteria for percutaneous abscess drainage.

The original criteria for percutaneous abscess drainage were limited to simple abscesses (well-defined, unilocular) with safe drainage routes. We expanded these entry criteria to include complex abscesses (loculated, ill-defined, or extensively dissecting abscesses), multiple abscesses, abscesses with enteric fistulas or whose drainage routes traversed normal organs, as well as complicated abscesses (appendiceal, splenic, interloop, and pelvic). Using these expanded criteria, cure was achieved nonoperatively in 92 (73.

CT appearance of appendicitis and its local complications.

During evaluation for occult fever or nonspecific abdominal pain CT will occasionally identify inflammatory disease of the appendix as the underlying cause. In these cases CT may also provide useful information about the presence of associated mesenteric inflammation, abscess, or perforation. Five cases are presented in which CT provided clinically useful information supplementing that gained from barium studies and clinical presentation.

Percutaneous drainage of infected pancreatic pseudocysts.

After diagnostic needle aspiration guided by computed tomography and/or ultrasound, 11 infected pseudocysts in ten patients were treated nonoperatively by percutaneous catheter drainage and intravenously administered antibiotics. Nine infected pseudocysts resolved after 11 to 37 days (mean, 21 days) with no recurrences at follow-up 16 to 42 months (mean, 24.4 months) later.

Mediastinal pancreatic pseudocyst.

Among previous cases of mediastinal pseudocyst requiring surgical decompression, all but one had been found at surgery to occupy a position both in the mediastinum and in the upper abdomen. In the present case, although preoperative ultrasound and CT scans suggested that the pseudocyst was straddling the diaphragm, an abdominal portion could not be found at surgery, and the pseudocyst was drained successfully through the diaphragm by a Roux-en-Y loop of jejunum. Because ultrasound and CT scan may not be able to determine the precise relationship of a mediastinal pseudocyst to the diaphragm and the availability of the lower portion of the pseudocyst for surgical decompression, an endoscopic retrograde cholangiopancreatography is strongly recommended as part of the preoperative evaluation.

Treatment of chronic pancreatitic pleural effusion by percutaneous catheter drainage of abdominal pseudocyst.

A 53-year-old man entered the hospital with a large, right chronic pancreatitic pleural effusion. Computed tomographic examination of the abdomen and chest demonstrated a pancreatic pseudocyst that had extended into the mediastinum. After conventional closed-chest tube thoracotomy drainage failed to empty the pleural space, percutaneous abdominal pseudocyst drainage was instituted using computed tomographic guidance.

Radiologic aspects of diagnosis and treatment of abdominal abscesses.

The precise anatomic display by computed tomography and ultrasonography provides the guidance to make diagnostic needle aspiration a safe routine procedure. Percutaneous catheter drainage of abdominal abscesses now offers an alternative to surgery and has already become a well-established radiologic procedure in many centers.

Relationships between computed tomography tissue areas, thicknesses and total body composition.

Computed tomography (CT) scanning was evaluated for its potential application to body-composition research. Three cross-sections (upper leg, abdomen, chest including upper arms) were scanned in 41 healthy men (mean age 57.6 years).

Age changes in body composition revealed by computed tomography.

Computed tomography scans were taken of 21 middle-aged men (M age 46.3 years) and 20 older men (M age 69.4 years) to measure differences in body composition with age.