Aim: One of the pitfalls in managing multiple liver tumors is the difficulty in identifying individual tumors on ultrasonography. Computed tomography (CT)-assisted virtual sonography has been shown to improve sonographic diagnosis, however it requires additional equipment and software. We have developed a simple reconstruction method of virtual sonography (SRVS). Methods: We reconstructed SRVS mimicking ultrasonographic images, utilizing a workstation software attached to a multi-detector row CT system without any additional program. Results: We have performed SRVS in 32 patients with 41 liver tumors that could hardly be identifiy on ultrasonography. SRVS assisted the identification of malignant form non-pathologic ones and thereby contributed to the appropriate clinical strategy including RFA (18 tumors), liver biopsy (2 tumors), other therapies (4 tumors) and follow-up (17 tumors). Conclusion: We have developed virtual sonography using conventional CT software. SRVS seems useful in the clinical practice in managing liver tumors.
Background and Aims: Gastroesophageal reflux disease (GERD) is a well-known important cause of non-cardiac chest pain (NCCP). It has been shown that in western countries this condition can be in 22-66% of the cases. However, this situation is unclear in Japanese hospitals. We performed this study to clarify the frequency of GERD in NCCP patients who attended the emergency room. Methods: We investigated the final diagnosis of the patients with chest pain who attended the emergency room of our hospital in March, June, September and December of 2005. Results: Forty patients with NCCP attended the emergency room in the study periods. In these patients, only one patient (2.5%) was diagnosed as GERD. Conclusions: The results of this study showed that the frequency of GERD in NCCP patients of emergency room of Japan is lower than that of western countries.
A 76-year-old man with liver cirrhosis, a chronic defecation disorder and a refractory hepatic encephalopathy was hospitalized for the hepatic encephalopathy. The encephalopathy quickly improved upon treatment, but a high level of serum ammonia persisted. We inserted a percutaneous endoscopic cecostomy at the cecum and an antegrade glycerin enema through it to treat the chronic defecation disorder, which was a deteriorative factor of the hepatic encephalopathy. After the aforementioned procedure, the chronic defecation disorder improved and the serum ammonia level dramatically decreased. The patient continued the antegrade glycerin enema at home, and serum ammonia values remained low in comparison to levels measured prior to the administration of treatment. The subject has not experienced a recurrence of hepatic encephalopathy.
We experienced a case of mucin-producing cholangiocarcinoma with inflammatory wall thickening for 5 months. A 46-year-old man who had a stomach punch ulcer, was found to have a cyst by chance on CT. After 5 months, the diameter of the cyst on CT had decreased, the wall thickness increased and the border was unclear. We diagnosed mucin-producing cholangiocarcinoma and found it invading the surrounding liver. So we conducted left hepatectomy and caudate lobectomy. Pathologically, mucin-producing cholangiocarcinoma was confirmed, but the wall thickening was due to inflammation not cancer invasion.
A 65-year-old man was referred for a gallbladder elevated lesion. Abdominal US showed a hypoechoic tumor with wide base at the gallbladder body. The maximum velocity of the gallbladder wall blood flow was 20 cm/s. The outermost hyperechoic layer was irregular, but not disrupted on EUS images. We diagnosed the lesion as gallbladder carcinoma with the deptht of subserosa. Cholecystectomy was performed and the tumor was diagnosed as tubular adenoma of the gallbladder. The p53 immumostaining was negative. A gallbladder adenoma with wide base is rare, here we report this case with the several considerations.
A 53-year old man with a history of heavy alcoholic drinking was admitted for progressive cough and dyspnea. Chest radiography revealed a left-sided massive pleural effusion, and CT showed a pancreatic pseudocyst occurred from the body of the pancreas to mediastinum. MRI images clearly delineated the internal pancreatic fistula that extended to the mediastinum. A distal pancreatectomy with splenectomy was performed and the postoperative course was uneventful without recurrent pancreatitis or pleural effusion. MRI is a useful noninvasive imaging method to assess mediastinal pancreatic pseudocysts.
A 57-year-old woman was admitted to the hospiital because of obstructive jaundice. Abdominal computed tomography and ultrasonography showed a homogeneous mass 7cm in diameter at the head of the pancreas. Gamma-scintigraphy showed uptake in the head of the pancreas. Histological diagnisis was obtained by endoscopic ultrasoundscopy-fine needle aspiration (EUS-FNA). The pathological and immunohistochemical studies showed diffuse lymphoma with large B-cells. We experienced a rare case of pancreatic malignant lympoma and EUS-FNA was usefull in the diagnosis.
A 59-year-old woman with a history of abdominal injury was admitted to our hospital for abdominal discomfort. CT revealed a cyst showing a fluid-calcium level in the pancreatic body. EUS-FNA was performed to aspirate the fluid in a cyst. Aspirated was milky-white odorless material. Chemical analysis showed high amylase level in the fluid. Spectroscopic analysis revealed that the fluid mainly consists of calcium phosphate. To the best of our knowledge, this is the first case of milk-of-calcium in a pancreatic pseudocyst with an analysis of cystic fluid obtained by EUS-FNA.