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Fluid accumulation in the flanks — why is it not dependent?
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EVALUATION OF BILE DUCT CALCULI WITH MAGNETIC RESONANCE (MR) IMAGING . Fintan Reean, M.D.J. Fradin MD., M. Bohlman MD., T, Magnessum MD. Johns Hopkins University Medical School, Baltimore, MD. Obiective: To evaluate a T2 weighted, turbo spin echo MR sequence using laalf Fourier acquisition, (HASTE) in the diagnosis of bile duct calculi. Methods: A prospective evaluation of 16 patients with biliary duct calculi was carried out using HASTE MR cholangiography compared to ultrasound and direct cholangiography. The {rbup consisted of 9 women and 7 men with ages ranging from 42 - 89 years. All patients were imaged in the axial, sagittal and coronal planes with a 1.5 Teala Siemens MR scanner, using a body coil. 13 seconds per acquisition ' allowed a single breath-hold technique. Images were interpreted in a double blind fashion. Assessment of number and size of common bile duct (CBD) stones, and diameter of CBD was made. Results: 23 CBD stones in total were seen in 16 patients by direct cholangiography. MRC demonstrated 20L23 (87%) of these stones while ultrasound detected 12/23 (52%). Calculus size ranged from 4mm to 3.Scms. Bile duct diameter measurements correlated well (r=.82) with conventional cholangiography. Conclusion: HASTE MRC can depict accurately and safely, the number and size of CBD stones and degree of biliary dilation.
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P27 THE MULTI-FACETED APPEARANCE OF HEMORRHAGE IN THE ABDOMEN. EVALUATION BY CT. Klmbedv Bloomfield. M.D., T.M. Cummings, MoD., J.M. Colby, M.D,, E.B. Helskowitz, M.D., S.A. Afonse, M.D., A. Davidoff, M.D., Univ. Mass Medical Center, Worcester, MA
FLUID ACCUMULATION IN THE FLANKS - W H Y IS IT NOT DEPENDENT? Abblifi Rovcbnwdhu~. M.D., J.M, Colby, M.D., S),, Aionse, M.D., R,J. wage, M.D., T.M. Cummidgs, M.D., A. Devidoff, M.D., Univ. Mass Medical Center, Worcester, MA
Hemonltoge is a common clinical event in the abdomen. There is a supdsing paucity in the literature addressing its appearance on CT. AIM.- The elm of this paper is to address the varied, yet often characteristic appearance of hemorrhage. M~THQO: We reviewed 10fl cases of patients with known hemorrhage id the emergency, subacote and chronic setting. Tabulation of the etiology, size, shape, position end cilarsnter was based on review of ciinicel histoPj and CT scans. RESULTS: There is a wide ranging, yet often r,flareotedsfic appearance of hemowhage in the abdomen. High density within the abnormal fluid is the most common pathngnomonie CT finding of hemotThage. Linear streaking is also characteristic. DISCUSSION: The vadotion in etiology, odgin, location, size, pothngeansis, and natural history all play a role in the muitifaceted manifestations of hemontlage. We will review the varied appearance ranging from contusion through hematoma to active bleeding. C.OHCLUSION: t) High density within a fluid collection remaias a charectedstic finding of hemorrhage. 2) Unner streaking within a fluid collection is a previously unreported yet chersctedsflc appearance. 3) Identifying the location of hemonltage remains the most important contribution of CT in dotem'lintog the clinical significance of hemorrhage and clinical follow-up remainS the most important method in determining management.
The subcutaneous ~ frequently accomulnte fluid. Flank fluid is restdctod in its course and does not become dependent in the most postedor portions of the supine patient. AIM." To determine the dlstdbnflon of subcutaneous fluid in an inpatient popolefion wPthparticular attention to flank fluid acoumulefico. ~ETHOD: We Identified 50 Inpatleots with varied pathologid slates In whom there was abnormal fluid accemulafico in the subcutaneous fat on abdominal CT. We divided the fluid aecumulntion into anterior, flank, and posterior compeltments and tabulated the distdbntion of fluid In these compartments. The dominant site of fluid accumulation was determined based on size. The shape and relationship of the abnormal fluid to muscle and fascist planes was investigated. RESULTS: The suboutaneous compartment appears to have at least two planes - deep and superficial. The deep plane in the flanks is a common dominant site of fluid accumulation, particularly in thint space fluid accumulation. The shape and relationship to fasclnt and muscle planes is oharactodstic. CLONCLUSION: (1) The anatomy of the subcutaneous comportment is complex, and ce~ of interconnecting connective tissue with well defined plains of fascia. (2) Fluid accumulation in the subcutaneous cempadment follows recognizable pettems. These patterns may be helpful in diagnosis. (3) CT remains the study of choice in the diagnosis of subcutaneous disease.
P29 CHRONIC ORGANOAXIAL GASTRIC VOLVULUS -- PRESENTATION OF EIGHT CASES AND IMAGING FINDINGS • " C. Keesling, M.D., G. LyonS, M.D., G. Sehweiger, M.D., Universi~ of Kansas Medical Center, Kansas City, KS Purpase: To present imaging findings of chronic organoaxial gas~trievolvulus in a serins of eight patients. Methods: Over a two-year period the authors collected a group of eight eases of chronic organomxial gastric volvulnS detected during barium studies in patients with mild, nonspecifie upper abdominal symptoms and reviewed the clinical histories of these patients. Results: Organoaxial gastric volvdius was detected in eight patients in whom the diagnosis was unsuspected prior to imaging. Conelusinns: Chronic organoaxial volvulus usually presents with nonspeeifie symptoms such as upper abdominal tidiness and early satiety rather than obstruction and is oflan unsuspected prior to imaging. However, chronic volvulus can progress unprediotobly to acute volvulus with obstruction and strangulation and a mortulity rate of up to 50%. Therefore, it is important to recognize chronic volvulnS when there is opportunity for surgical or endoscopic correction with low mortality. Since endoscopy can be insensitive in deteoting chronic volvulus, the prime means of early recegnltion is radiographic and thus it is important for the praoticing radiologist to recognize this entity. We have complied eight eases of chronic organoaxlal gastric volvulus and present the clinical histories and iraaglng findings.
P30 FREEHAND ULTRASOUND GUIDED INrERVENFIONAL TEC}{NIQUES USING A GELATIN PHANTCH, Karon A+ Hunt, M.D., G.A. $isney, M.D., University of Colorado Health Science Center, ~enver, CO Purpose: Freehand ultrasound is a versatile tool for guiding needle placement in ~terventional procedures. This technique requires accurate hand-eye coordination while working within a narrow ultrasotmd plane, l~e present a method for teaching residents ultrasound guided procedures using a gelatin phantom. Methods: Principles of patient positioning, transducer manipulation, and needle + l-r~-~nt a are described. An organized approach is presented for performing ultrasoun~ guided biopsy from skin entry to successful placement of the needle within the lesion, Specific techniques are suggested for localizing the needle, maximally visualizing the needle, and verifying the relation of the needle to the lesion. Solutions are provided to avoid co~mon pitfalls associated with ultrasound guidance. Conclusions: Practicing an organized method of ultrasound techniques on a gelatin p~antbm i~an effective means to improve resident interventional skills.
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EVALUATION OF BILE DUCT CALCULI WITH MAGNETIC RESONANCE (MR) IMAGING . Fintan Reean, M.D.J. Fradin MD., M. Bohlman MD., T, Magnessum MD. Johns Hopkins University Medical School, Baltimore, MD. Obiective: To evaluate a T2 weighted, turbo spin echo MR sequence using laalf Fourier acquisition, (HASTE) in the diagnosis of bile duct calculi. Methods: A prospective evaluation of 16 patients with biliary duct calculi was carried out using HASTE MR cholangiography compared to ultrasound and direct cholangiography. The {rbup consisted of 9 women and 7 men with ages ranging from 42 - 89 years. All patients were imaged in the axial, sagittal and coronal planes with a 1.5 Teala Siemens MR scanner, using a body coil. 13 seconds per acquisition ' allowed a single breath-hold technique. Images were interpreted in a double blind fashion. Assessment of number and size of common bile duct (CBD) stones, and diameter of CBD was made. Results: 23 CBD stones in total were seen in 16 patients by direct cholangiography. MRC demonstrated 20L23 (87%) of these stones while ultrasound detected 12/23 (52%). Calculus size ranged from 4mm to 3.Scms. Bile duct diameter measurements correlated well (r=.82) with conventional cholangiography. Conclusion: HASTE MRC can depict accurately and safely, the number and size of CBD stones and degree of biliary dilation.
P28
P27 THE MULTI-FACETED APPEARANCE OF HEMORRHAGE IN THE ABDOMEN. EVALUATION BY CT. Klmbedv Bloomfield. M.D., T.M. Cummings, MoD., J.M. Colby, M.D,, E.B. Helskowitz, M.D., S.A. Afonse, M.D., A. Davidoff, M.D., Univ. Mass Medical Center, Worcester, MA
FLUID ACCUMULATION IN THE FLANKS - W H Y IS IT NOT DEPENDENT? Abblifi Rovcbnwdhu~. M.D., J.M, Colby, M.D., S),, Aionse, M.D., R,J. wage, M.D., T.M. Cummidgs, M.D., A. Devidoff, M.D., Univ. Mass Medical Center, Worcester, MA
Hemonltoge is a common clinical event in the abdomen. There is a supdsing paucity in the literature addressing its appearance on CT. AIM.- The elm of this paper is to address the varied, yet often characteristic appearance of hemorrhage. M~THQO: We reviewed 10fl cases of patients with known hemorrhage id the emergency, subacote and chronic setting. Tabulation of the etiology, size, shape, position end cilarsnter was based on review of ciinicel histoPj and CT scans. RESULTS: There is a wide ranging, yet often r,flareotedsfic appearance of hemowhage in the abdomen. High density within the abnormal fluid is the most common pathngnomonie CT finding of hemotThage. Linear streaking is also characteristic. DISCUSSION: The vadotion in etiology, odgin, location, size, pothngeansis, and natural history all play a role in the muitifaceted manifestations of hemontlage. We will review the varied appearance ranging from contusion through hematoma to active bleeding. C.OHCLUSION: t) High density within a fluid collection remaias a charectedstic finding of hemorrhage. 2) Unner streaking within a fluid collection is a previously unreported yet chersctedsflc appearance. 3) Identifying the location of hemonltage remains the most important contribution of CT in dotem'lintog the clinical significance of hemorrhage and clinical follow-up remainS the most important method in determining management.
The subcutaneous ~ frequently accomulnte fluid. Flank fluid is restdctod in its course and does not become dependent in the most postedor portions of the supine patient. AIM." To determine the dlstdbnflon of subcutaneous fluid in an inpatient popolefion wPthparticular attention to flank fluid acoumulefico. ~ETHOD: We Identified 50 Inpatleots with varied pathologid slates In whom there was abnormal fluid accemulafico in the subcutaneous fat on abdominal CT. We divided the fluid aecumulntion into anterior, flank, and posterior compeltments and tabulated the distdbntion of fluid In these compartments. The dominant site of fluid accumulation was determined based on size. The shape and relationship of the abnormal fluid to muscle and fascist planes was investigated. RESULTS: The suboutaneous compartment appears to have at least two planes - deep and superficial. The deep plane in the flanks is a common dominant site of fluid accumulation, particularly in thint space fluid accumulation. The shape and relationship to fasclnt and muscle planes is oharactodstic. CLONCLUSION: (1) The anatomy of the subcutaneous comportment is complex, and ce~ of interconnecting connective tissue with well defined plains of fascia. (2) Fluid accumulation in the subcutaneous cempadment follows recognizable pettems. These patterns may be helpful in diagnosis. (3) CT remains the study of choice in the diagnosis of subcutaneous disease.
P29 CHRONIC ORGANOAXIAL GASTRIC VOLVULUS -- PRESENTATION OF EIGHT CASES AND IMAGING FINDINGS • " C. Keesling, M.D., G. LyonS, M.D., G. Sehweiger, M.D., Universi~ of Kansas Medical Center, Kansas City, KS Purpase: To present imaging findings of chronic organoaxial gas~trievolvulus in a serins of eight patients. Methods: Over a two-year period the authors collected a group of eight eases of chronic organomxial gastric volvulnS detected during barium studies in patients with mild, nonspecifie upper abdominal symptoms and reviewed the clinical histories of these patients. Results: Organoaxial gastric volvdius was detected in eight patients in whom the diagnosis was unsuspected prior to imaging. Conelusinns: Chronic organoaxial volvulus usually presents with nonspeeifie symptoms such as upper abdominal tidiness and early satiety rather than obstruction and is oflan unsuspected prior to imaging. However, chronic volvulus can progress unprediotobly to acute volvulus with obstruction and strangulation and a mortulity rate of up to 50%. Therefore, it is important to recognize chronic volvulnS when there is opportunity for surgical or endoscopic correction with low mortality. Since endoscopy can be insensitive in deteoting chronic volvulus, the prime means of early recegnltion is radiographic and thus it is important for the praoticing radiologist to recognize this entity. We have complied eight eases of chronic organoaxlal gastric volvulus and present the clinical histories and iraaglng findings.
P30 FREEHAND ULTRASOUND GUIDED INrERVENFIONAL TEC}{NIQUES USING A GELATIN PHANTCH, Karon A+ Hunt, M.D., G.A. $isney, M.D., University of Colorado Health Science Center, ~enver, CO Purpose: Freehand ultrasound is a versatile tool for guiding needle placement in ~terventional procedures. This technique requires accurate hand-eye coordination while working within a narrow ultrasotmd plane, l~e present a method for teaching residents ultrasound guided procedures using a gelatin phantom. Methods: Principles of patient positioning, transducer manipulation, and needle + l-r~-~nt a are described. An organized approach is presented for performing ultrasoun~ guided biopsy from skin entry to successful placement of the needle within the lesion, Specific techniques are suggested for localizing the needle, maximally visualizing the needle, and verifying the relation of the needle to the lesion. Solutions are provided to avoid co~mon pitfalls associated with ultrasound guidance. Conclusions: Practicing an organized method of ultrasound techniques on a gelatin p~antbm i~an effective means to improve resident interventional skills.