Published: 2014 Feb
Issue: 8(2) :: Pages: 54-62

   

Abstract: Sigmoid volvulus complicating pregnancy is a rare, non-obstetric cause of abdominal pain that requires prompt surgical intervention (decompression) to avoid intestinal ischemia and perforation. We report the case of a 31-week pregnant woman with abdominal pain and subsequent development of constipation. Preoperative diagnosis was achieved using magnetic resonance imaging and ultrasonography: the large bowel distension and a typical whirl sign - near a sigmoid colon transition point - suggested the diagnosis of sigmoid volvulus. The decision to refer the patient for emergency laparotomy was adopted without any ionizing radiation exposure, and the pre-operative diagnosis was confirmed after surgery. Imaging features of sigmoid volvulus and differential diagnosis from other non-obstetric abdominal emergencies in pregnancy are discussed in our report, with special emphasis on the diagnostic capabilities of ultrasonography and magnetic resonance imaging.

Published: 2014 Feb
Issue: 8(2) :: Pages: 37-45

   

Abstract: Pylephlebitis - suppurative thrombophlebitis of the portal and/or mesenteric veins - is a rare complication of abdominal infections, especially diverticulitis. It can lead to severe complications such as hepatic abscess, sepsis, peritonitis, bowel ischemia, etc., which increase the mortality rate. Here we present a case of suppurative thrombophlebitis of the inferior mesenteric vein, as a complication of sigmoid diverticulitis. The epidemiology, clinical and radiological features as well as treatment strategies are discussed. We also review the anatomy of the mesenteric vein given its anatomic variation in the present case and how this anatomic knowledge might influence the operative approach should surgery be necessary.

Published: 2014 Feb
Issue: 8(2) :: Pages: 63-69

   

Abstract: Vascular Ehlers-Danlos Syndrome (previously Ehlers-Danlos IV) is a rare autosomal dominant collagen vascular disorder caused by a 2q31 COL3A1 gene mutation encoding pro-alpha1 chain of type III collagen (in contrast to classic Ehlers-Danlos, caused by a COL5A1 mutation). The vascular type accounts for less than 4% of all Ehlers-Danlos cases and usually has a poor prognosis due to life threatening vascular ruptures and difficult, frequently unsuccessful surgical and vascular interventions. In 70% of cases, vascular rupture or dissection, gastrointestinal perforation, or organ rupture is a presenting sign. We present a case of genetically proven vascular Ehlers-Danlos with fatal recurrent retroperitoneal hemorrhages secondary to a ruptured right common iliac artery dissection in a 30-year-old male. This case highlights the need to suspect collagen vascular disorders when a young adult presents with unexplained retroperitoneal hemorrhage, even without family history of such diseases.

Published: 2014 Feb
Issue: 8(2) :: Pages: 1-29

   

Abstract: Orbital pathology often presents a diagnostic challenge to the reporting radiologist. The aetiology is protean, and clinical input is therefore often necessary to narrow the differential diagnosis. With this manuscript, we provide a pictorial review of adult ocular and orbital pathology.

Published: 2014 Feb
Issue: 8(2) :: Pages: 46-53

   

Abstract: Congenital adrenal hyperplasia refers to a group of autosomal recessive disorders caused by a deficiency of an enzyme involved in the synthesis of glucocorticoids. The enzyme deficiency generally leads to a deficiency of cortisol and/or aldosterone production within the adrenal cortex. The lack of glucocorticoids generally leads to elevated levels of plasma corticotropin (ACTH), which often results in adrenal hyperplasia. Testicular adrenal rest tumors may develop in males with congenital adrenal hyperplasia due to overstimulation of aberrant adrenal cells within the testes. Recognition of this disease entity is essential when evaluating young males with testicular masses.

Published: 2014 Feb
Issue: 8(2) :: Pages: 30-36

   

Abstract: Massive pulmonary embolism not amenable to systemic thrombolysis is a therapeutic challenge. Catheter directed clot fragmentation and thrombolysis have been efficacious in this setting. We describe successfully treating a massive pulmonary embolism with catheter-directed thrombolysis and clot fragmentation using local tPA, aspiration, and the Cleaner^TM device in a patient with an absolute contraindication to systemic thrombolysis.