Purpose. To demonstrate capabilities and features in spleen pathology diagnostics based on clinical experience of Botkin City Hospital.Materials and methods. The analysis of 89 patients with spleen abnormalities was performed in the term from 01/2014 till 08/2020. All the patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) with contrast enhancing. All cases verified surgically and/or clinically.Results. There were 37 cases of trauma (42%). Accuracy and precision of the method was 100%. In detection of active bleeding the highest diagnostic accuracy (100%) was shown with extravasation symptom – 7 cases. In non-traumatic group (n = 52, 58%) two biggest sub-groups were abscesses (n = 19, 36% in this group) and infarctions (n = 15, 29%). There were 8 cases of cysts (15%), 3 of them – hydatid, 5 cases of spleen hemangiomas. (9.6%), 3 cases of spleen metastases (6%). There was 1 case of angiosarcoma (2%) and 1 case cystic lymphangioma (2%).Conclusion. The most frequent condition in spleen pathology, diagnosed in radiology department is trauma. In non-traumatic cases two biggest groups are abscesses and infarctions. CT features of spleen infarction are pyramidal wedge of hypoperfused splenic tissue with the apex pointing towards the hilum, and the base on the splenic capsule. In all cases in our study cysts were incidental findings. Spleen metastases are rare due to organ hemodynamics. The most rare lesions of the spleen are primal tumors.
In this article we would like to discuss the issues of adrenal pathology and its diagnostics. This is a complex review according to modern sources, fundamental knowledge and author’s experience. All clinical cases are original and morphologically verified. There are different types of classifications with different features, showed in this article. The most useful diagnostic methods are computed tomography (CT) and magnetic resonance imaging (MRI) with special contrast enhancement protocols, described in article.
Relevance. Retroperitoneal lymphocele is one of the most common complications in renal transplant recipients.Objective. To improve the results of treatment of kidney transplant recipients with retroperitoneal lymphocele by using a modern diagnostic and treatment algorithmMaterials and methods. Materials and methods: From June 2018 to March 2021 at the State Clinical Hospital named after S.P. Botkin, Moscow performed 174 kidney transplants from a posthumous donor. The accumulation of lymph in the retroperitoneal space was recorded in 24 patients, which amounted to 13.7%. Indications for surgical correction were found in 16 patients, which amounted to 9.1%. Computed tomography in 10 patients (62.5%) showed a wide adherence of the lymphocele cavity to the parietal peritoneum; peritoneum, the complexity of the planned laparoscopic surgery was assessed as high. These patients underwent laparoscopic peritoneal fenestration with ultrasound navigation. In 2 patients (12.5%), lymphocele adherence to the peritoneum was not revealed; these patients underwent open surgery.Results. Results: No relapses of lymphocele were detected after surgery. Mortality was not recorded. In the group of patients who underwent laparoscopic peritoneal fenestration with predictable low complexity, one postoperative complication was diagnosed – migration of the loop of the small intestine into the lymphocele cavity with subsequent infringement. The duration of hospitalization with laparoscopic intervention was 2.1 ± 0.43 (2–3) days, with open one it was 8.45 ± 3.25 (7–12) (p = 0.001).Conclusion. The use of a modern diagnostic and treatment algorithm can improve the results of treatment of kidney transplant recipients with retroperitoneal lymphocele.
Pulmonary or intercostal hernia appears as a bulge lung tissue result in the subcutaneous fat through a natural orifice or pathologically caused defects of the chest wall. Difficulties of diagnosis of the true pulmonary hernia owing to extremely infrequent occurrence of this pathology are, as a rule, bound to poor knowledge of doctors and quite often lead to inaccurate medical tactics. In the diagnosis of lung hernia along with clinical and laboratory data are used such research methods as x-ray, ultrasound, CT, among which, CT is a highly informative investigation method that allows to evaluate the status of lung tissue in the hernia sac and in other parts of the lungs, just to visualize the structures of the mediastinum, as well as the condition of the pleural cavity and chest wall, determining its proper treatment.
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