Among patients with acute abdominal pain, those whose CT scans did not show inner-layer enhancement of a thickened small-bowel wall were more prone to undergo surgery and small-bowel resection and were more likely to have small-bowel necrosis than those with such enhancement. Poor inner-layer enhancement on CT might be consistent with sloughed or necrotic mucosa, as observed on pathology.

Objectives: To identify indicators and possible risk factors of haemothorax in patients with spontaneous pneumothorax. Methods: All patients presenting to the emergency department of Chi-Mei Foundation Medical Center, Tainan, Taiwan with primary spontaneous pneumothorax between 1 January 1997 and 31 December 2002 were screened for inclusion in the present study. Of the 211 patients who qualified, eight had spontaneous haemopneumothorax (SHP) (3.79%). The clinical data and demographic characteristics of these patients were similar to those of patients with spontaneous pneumothorax without haemothorax (SP). Results: All eight SHP patients were thin and young men (mean age 24 years and mean weight 56.1 kg). Seven were smokers. The patients with SHP were taller that the patients with SP (177.4 cm v 170.3 cm, respectively; p,0.01), and tended to have a lower body mass index (BMI) (17.9 kg/m 2 v 19.6 kg/m 2 , respectively; p = 0.06) and higher heart rate (101.0 v 88.0 beats/min, respectively; p = 0.09). Clinically, patients with SHP were more likely to have dyspnoea compared with SP patients (62.5% v 26.6%, respectively; p = 0.04) and lower levels of haemoglobin (12.8 v 14.7 g/dl, respectively; p = 0.01) and haematocrit (38.1% v 44.1%, respectively; p,0.01). Chest x rays revealed pleural effusion in all patients with SHP but in none with SP. Conclusions: Patients with SHP are taller, with lower levels of haemoglobin and haematocrit, and are more likely to have dyspnoea than patients without haemothorax. The chest x ray finding of pneumothorax with an ipsilateral air-fluid level is a strong indicator of SHP.

Even though a retrohepatic gallbladder and a severely distorted hepatic morphology due to compensatory hypertrophy of the left and caudate lobes may raise a suspicion of agenesis of the right lobe of the liver, absence of visualization of all of the right hepatic vein, right portal vein and its branches, and dilated right intrahepatic ducts is a prerequisite of the diagnosis of agenesis of the right hepatic lobe on CT. In severe lobar atrophy, at least one of these structures is recognizable.

Saccular aneurysms, adjacent soft tissue masses, rim enhancement, stranding, fluid, gas, and unusual adjacent bony destruction highly suggest infected aneurysm.

No abstract