Acute Presentation of Large Size Clear Cell Ovarian Carcinoma as Double Torsed Ovarian Tumor

We report a 46-year-old patient who presented to the emergency department with complaints of acute abdominal pain, nausea, and vomiting. An abdominal CT scan revealed a large (207 × 155 × 182 mm) thin-walled inhomogeneous tumor connected to the uterus and right ovary. Emergency surgery laparotomy was performed. Inside the abdominal cavity, a 30 × 30 cm heterogenous, dark blue tumor in the right adnexa area, torsed two times, weighing 3700 g was found. Histological examination revealed right ovary clear cell carcinoma. We emphasize the rare nature of the histology and presentation of this case report. Ovarian clear cell carcinomas are relatively rare malignancies, presenting in 5 to 10% of ovarian malignant tumors in the west.

Assessment of the Awareness of Radiology Residents About Ionizing Radiations and Their Risks of Educational Hospitals, Kermanshah, Iran

Background: Although many radiological examinations are requested daily to aid clinical diagnosis by the referring physician, it should be kept in mind that ionizing radiation has adverse biological effects on the life of living organisms, which may vary in individuals depending on the dose and duration of exposure. Therefore, radiologists and their assistants should have comprehensive information about ionizing radiation. Methods: In this descriptive cross-sectional study, all the radiology residents (41) were included in the study. The questionnaire consisted of two parts, the first part including of demographic information and part 2 includes 21 questions about the effective dose created by a chest X-ray, the approximate effective dose from various imaging examines, as well as the awareness of the risks of brain, abdominal CT scans. Results: The results showed that out of 41 residents, 56.1% were male. Based on these results, 19.5% were aware of the approximate effective dose received by a patient on PA chest X-ray. Also, knowledge of some X-ray absorptiometry parameters based on chest X-ray in PA position are: 12.2% abdominal CT scan, 17.1% and 2.4% brain and chest CT scan respectively. In this study the radiology resident’s awareness about dangers of ionizing radiation and the likelihood of cancer were evaluated in 31% and 48.8% of brain and abdominal CT scan, respectively. Conclusions: According to the findings, awareness of radiology residents in Kermanshah university of medical sciences is at an inappropriate level. Therefore, training is needed to raise the awareness of radiology residents by conducting several workshops.

A case of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) with thrombosis of the superior mesenteric artery after ChAdOx1 nCov-19 COVID-19 Vaccine

We describe the case of a 64 years-old woman admitted to the Emergency Department of the ASST-Spedali Civili of Brescia with fever and gastrointestinal symptoms 10 days after the first dose of ChAdOx1 nCov-19 vaccine. Laboratory investigations showed severe thrombocytopenia and high D-dimer, while an abdominal CT scan reported a partially occluding thrombosis of the superior mesenteric artery. Following treatment with fondaparinux, immunoglobulins and high dosage steroid therapy, we observed a rapid improvement of patient’s conditions. An ELISA assay showed the presence of antibodies against heparin PF4-complex. Subsequent abdominal CT-scan showed the superior mesenteric artery thrombosis resolution, and the patient was finally discharged after 12 days of hospitalization. Several reports pointed to the venous system as the main district affected by Vaccine-Induced Thrombotic Thrombocytopenia (VITT), while a peculiar feature of this report is the involvement of the mesenteric arterial system. Further investigation of VITT’s pathophysiological mechanisms is mandatory to develop preventive strategies and effective treatments.

Mesenteric cyst detection and segmentation by multiple K-means clustering and iterative Gaussian filtering

<span lang="EN-US">In this article a fully automated machine-vision technique for the detection and segmentation of mesenteric cysts in computed tomography (CT) images of the abdominal space is presented. The proposed technique involves clustering, filtering, morphological operations and evaluation processes to detect and segment mesenteric cysts in the abdomen regardless of their texture variation and location with respect to other surrounding abdominal organs. The technique is comprised of various processing phases, which include K-means clustering, iterative Gaussian filtering, and an evaluation of the segmented regions using area-normalized histograms and Euclidean distances. The technique was tested using 65 different abdominal CT scan images. The results showed that the technique was able to detect and segment mesenteric cysts and achieved 99.31%, 98.44%, 99.84%, 98.86% and 99.63% for precision, recall, specificity, dice score coefficient and accuracy respectively as quantitative performance measures which indicate very high segmentation accuracy.</span>

P078 SURGICAL PLANNING WITH 3D TECHNOLOGY UN PATIENT WITH MORGAGNI HERNIA AND INGUINAL HERNIA

Aim The use of 3D technology is increasingly used for surgical planning in cases of complex surgery. In the case of the abdominal wall, its use is not very widespread. In this video we present the case of a patient with inguinal hernia and Morgagni hernia in which 3D planning provided us with multiple benefits Material and Methods 71-year-old patient awaiting intervention for right inguinal hernia, presenting progressive dyspnea, abdominal pain and vomiting. A thoraco-abdominal CT scan was performed, which reported a Morgagni hernia containing the transverse colon and omentum. Due to 3D planning, we were able to obtain the abdominal and hernial sac volumes, evaluate the hernial orifice and its relationship with the adjacent structures. Results Laparoscopic repair of the Morgagni hernia was performed by reducing the hernial content, placement of visceral contact mesh fixed with resorbable tackers. In the same surgical act, an inguinal hernioplasty was performed via TAPP. The postoperative period was correct, without complications, and the patient was discharged after 3 days. Two years after the intervention, the patient remains asymptomatic. Conclusions The use of 3D technology for surgical planning facilitates the repair of complex hernias, helping us to assess the surgical indication, hernial volumes and hernial content. Good surgical planning facilitates the performance of the intervention through minimally invasive surgery, in this case two hernias were repaired in the same surgical procedure and with the same incisions, which facilitated the recovery of the patient.

The potential cancer risk on body organs as abdomen CT-scan exposure result

Research has been carried out on the Potential Risk of Cancer in Body Organs Due to Abdomen CT Scan Radiation. The use of a CT-Scan tool that emits radiation has the potential to have quite a serious impact. An abdominal CT-Scan is one part of the examination that is often done because in that section many organs are very vital. The organs found in the abdomen include the liver, spleen, stomach, intestines, kidneys, gonads, pancreas, bladder, and ureters. The study used data on abdominal CT-Scan patients at Sanglah Hospital Denpasar, in the age range from 41 years to 56 years without distinguishing gender. From the CT-Scan data, the CTDIVol and DLP values ??of each patient can be taken. Furthermore, it is analyzed to determine the patient's effective dose so that the percentage of cancer risk in each of these organs can be known. The results showed that the potential risk of cancer for critical organs such as the bladder, stomach, and gonads, was 0.218 %, 0.262 %, and 0.390 % respectively. The most at risk for potential cancer occurs in the gonads.

A case of hematuria and vomiting in the emergency room: Never forget the emphysematous pyelonephritis

We describe the case of a 68-year-old man with a known history of hypertension and diabetes mellitus presented to our Emergency Department, complaining of hematuria and vomiting in the last 12 hours, stypsis and urinary incontinence in the last week, and worsening hyporexia in the last 6 months. Bedside ultrasound documented a slight right pleural effusion with B lines in the middle and basal right field, gastrectasis, dilated fluid-filled bowel loops, potential signs of gas in the upper right quadrant, grade 3 bilateral hydronephrosis, and bladder globe. Abdominal CT scan confirmed the bilateral hydroureteronephrosis and showed the right kidney with Emphysematous Pyelonephritis (EPN) with extension into the perinephric and muscular planes for 24 cm, and initial EPN in the left kidney. A RT-PCR nasopharyngeal swab for SARS CoV-2 was negative. A diagnosis of ileum paretic, acute renal failure and urosepsis due to EPN was made.

Diagnostic value of abdominal CT scan in ovarian tumors in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from January 2017 to December 2018

HIGHLIGHTS1. Ovarian tumors diagnostic value has been determined using the tools on contrast-enhanced abdominal CT Scan2. The tools including primary finding like mass size, septation, solid component, and additional finding such as ascites, peritoneal implants, lymph node enlargement3. Most tumors were ovarian malignant tumors according to their histopathological results 4. Contrast-enhanced abdominal CT Scan of ovarian tumors evaluated by the tools gave better and more reliable diagnostic value than without using the toolsABSTRACTObjectives: The purpose of this study was to determine the diagnostic value of contrast-enhanced abdominal CT scan in ovarian tumors in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, to provide scientific and clinical benefits.Materials and Methods: Samples were taken retrospectively by contrast-enhanced abdominal CT scan raw data in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from January 2017 to December 2018. Using inclusion and exclusion criteria, a total of 88 samples were obtained and reviewed blindly by Female Organ Division of Radiology Department, Faculty of Medicine Universitas Airlangga, and by using "tools" (primary and additional findings of modified ovarian tumors malignancy). The data were correlated with histopathological findings and analyzed by statistical tests and the results with and without "tools" were compared.Results: Samples were grouped by age, distributed with a range of 20 years and the group of 41-60 years had the highest age of ovarian tumor samples (46.6%) with 84.1% being ovarian malignant tumors according to their histopathological results. It was dominated by serous, mucinous and endometroid types with sensitivity of 93.3%, specificity of 64.3%, positive predictive value of 93.3% negative predictive value of 69.2%, and accuracy value of 89.8%. More reliable results were obtained by using “tools”.Conclusion: Contrast-enhanced abdominal CT scan of ovarian tumors in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, evaluated by “tools” still had a better and more reliable diagnostic value than without tools in determining policy steps in handling ovarian tumors with a note that more in-depth research on pitfalls is needed so it may enrich the characteristic findings in imaging.