Celiac plexus block: a palliative tool underused by radiologists.
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Abdominal Pain↗
Biomedical subjects
Brian C Lucey
Publications and source records attributed to Brian C Lucey.
Percutaneous nonvascular splenic intervention: a 10-year review.
OBJECTIVE: We performed a retrospective review of our experiences with percutaneous splenic interventions to evaluate the safety and usefulness of these procedures. We examined both the success rate and the complication rate. MATERIALS AND METHODS: We used our electronic database to perform a retrospective analysis of patients treated from January 1990 to December 2000. Thirty-nine imaging-guided percutaneous splenic procedures were performed in 38 patients: 27 men and 11 women who ranged in age from 17 to 83 years (mean age, 56.5 years). For 28 procedures, sonographic guidance was used, and for 11, CT guidance was used. Procedures performed included splenic biopsy (n = 24), fluid aspiration (n = 8), and fluid drainage (n = 7). RESULTS: Splenic biopsy was successful in 91% of the procedures; fluid aspiration, in 100%; and fluid drainage, in 86%. The overall complication rate was 10.3%, with three patients requiring emergency splenectomy as a result of massive bleeding after the procedure. Two of these patients had previously unrecognized vascular tumors, and one had concomitant refractory thrombocytopenia. CONCLUSION: This study suggests that splenic biopsy can be performed safely and is of considerable value in diagnosis. Our findings also show that percutaneous catheter drainage of splenic abscesses is successful and that splenectomy should be reserved for failed percutaneous drainage. The complications that occur after procedures on vascular tumors emphasize the importance of requiring normal coagulation parameters before the procedure because the vascular nature of the lesion may be difficult to recognize on imaging before the procedure.
Adolescent↗
Spontaneous hemoperitoneum: causes and significance.
Spontaneous hemoperitoneum is an uncommon cause of acute abdominal pain. When it occurs, it may be catastrophic. There are a myriad of causes for spontaneous hemoperitoneum and an underlying cause should always be looked for if the patient survives the initial event. This article describes the imaging findings of spontaneous hemoperitoneum and discusses the relative merits of multiple imaging modalities used for the diagnosis of the hemoperitoneum and an underlying cause. In addition, we outline the etiology of spontaneous hemoperitoneum, which includes hepatic, splenic, gynecologic, and vascular causes, and bleeding disorders.
Diagnosis, Differential↗
Sixty-four multi-detector row computed tomography in multitrauma patient imaging: early experience.
Sixty-four multi-detector row computed tomography (64-MDCT) offers the possibility of increasing the application of CT in multitrauma imaging. 64-MDCT affords significant increases in imaging speed while allowing for subisotropic voxel slice thicknesses. We have recently installed two 64-MDCT scanners in our Level I trauma center. Our routine protocols using these new scanners are detailed. Additionally, this new technology has made possible several novel protocols. These include an increased use of CT angiography in trauma imaging. The acquisition speed and table lengths available with 64-MDCT allow for whole-body scout images. These scout images may be used to plan complex, multistep CT studies incorporating pelvic and extremity angiography, when indicated, into a single study. Imaging speeds afforded by 64-MDCT allow for imaging in any number of phases, over any area to be imaged, all with a single initial bolus of contrast. Image quality afforded by 64-MDCT allows for increasing roles of MPR and 3D reformations. These alternatives to axial images are currently used both for primary interpretation by our trauma radiologists as well as for communication and use by our clinical colleagues. Technical challenges presented by 64-MDCT include further increases in the number of images generated. Currently, datasets may exceed 4,000 images when angiography is included in routine trauma protocols. Radiation doses are also an ever present concern. With the opportunity to image from head to toe in seconds with submillimeter slice thicknesses, radiologists must be constantly vigilant in their efforts to limit radiation. Novel techniques such as automated dose modulation currently offer means of reducing radiation doses. Though several technical challenges are faced, 64-MDCT represents an evolution in multitrauma imaging.
Adult↗
Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis.
Injuries of the pancreas, gallbladder, and bile ducts due to blunt trauma are relatively uncommon and difficult to detect but are associated with high morbidity and mortality, especially if diagnosis is delayed. Accurate and early diagnosis is imperative, and imaging plays a key role in detection. Knowledge of the mechanisms of injury, the types of injuries, and the roles of various imaging modalities is essential for prompt and accurate diagnosis. Early recognition of disruption of the main pancreatic duct is important because such disruption is the principal cause of delayed complications. Computed tomography (CT) can demonstrate pancreatic parenchymal injuries and complications such as abscess, fistula, pancreatitis, and pseudocyst. CT findings can also suggest disruption of the pancreatic duct; however, the ability of CT to indicate this finding depends on the degree of parenchymal injury. Magnetic resonance (MR) cholangiopancreatography allows direct imaging of the pancreatic duct and sites of disruption. Gallbladder injuries can be detected with CT, ultrasonography, hepatobiliary scintigraphy, or MR cholangiopancreatography. CT findings include a collapsed gallbladder, wall thickening, inhomogeneous mural enhancement, and pericholecystic fluid. Bile duct injuries can be suggested with CT, which may show ascites and associated liver injuries, and can be confirmed with hepatobiliary scintigraphy.
Abdominal Injuries↗
Mesenteric lymph nodes seen at imaging: causes and significance.
With the advent of multidetector computed tomography, routine evaluation of mesenteric lymph nodes is now possible. For the first time, normal mesenteric nodes may be reliably identified noninvasively. Because of the increasing volume of cross-sectional imaging examinations being performed, lymph nodes in the mesentery are being detected with increasing frequency. This is often an unsuspected finding. Although the detected lymph nodes may be normal, there is a large number of disease processes that may lead to mesenteric lymphadenopathy. The most common causes of mesenteric lymphadenopathy are neoplastic, inflammatory, and infectious processes. Many of these causes may also result in lymphadenopathy elsewhere in the body. It is important to recognize mesenteric lymphadenopathy in patients with a history of a primary carcinoma because the lymphadenopathy affects the staging of the disease, which in turn will affect further management. In addition, mesenteric lymphadenopathy may be the only indicator of an underlying inflammatory or infectious process causing abdominal pain. The distribution of the lymph nodes may indicate the exact nature of the underlying disease process, and the correct treatment may then be instituted. Besides neoplastic, inflammatory, and infectious processes, many other disease processes may occasionally result in mesenteric lymphadenopathy.
Adolescent↗