Multidetector computed tomography three-dimensional and multiplanar reconstruction diagnosis of a rare cause of gastrointestinal bleeding: A case report

BACKGROUND Anastomosis of the testicular vein with the superior mesenteric vein rarely causes severe gastrointestinal bleeding.To date,there have been few studies describing its appearance on medical imaging.Here,we present multidetector computed tomography three-dimensional and multiplanar reconstruction(MPR)images of a typical digital subtraction angiography showing proven ectopic bleeding and provide the first review of the image performance.CASE SUMMARY A 68-year-old man who had been rushed to the hospital with a four-day history of melena and fainting underwent multiple esophagogastroduodenoscopy procedures that failed to identify the source of bleeding.We used MPR combined with three-dimensional reconstruction images,and found that the testicular vein had anastomosed with the superior mesenteric vein,and they clustered together in the jejunal vessel wall,which caused severe gastrointestinal bleeding.Digital subtraction angiography confirmed the location of bleeding.After transfusion and embolization therapy,the patient’s condition improved.CONCLUSION Computed tomography-MPR combined with three-dimensional images offers significant value in the localization and qualitative assessment of rare gastrointestinal hemorrhage.The features of multiphase spiral scanning can improve the accuracy of the diagnosis.

Application of multi-planar reconstruction technique in endovascular repair of aortic dissection

BACKGROUND Endovascular repair of aortic dissection is an effective method commonly used in the treatment of Stanford type B aortic dissection.Stent placement during the operation was one-time and could not be repeatedly adjusted during the operation.Therefore,it is of great significance for cardiovascular physicians to fully understand the branch status,position,angle,and other information regarding aortic arch dissection before surgery.AIM To provide more references for clinical cardiovascular physicians to develop treatment plans.METHODS Data from 153 patients who underwent endovascular repair of aortic dissection at our hospital between January 2021 and December 2022 were retrospectively collected.All patients underwent multi-slice spiral computed tomography angiography.Based on distinct post-image processing techniques,the patients were categorized into three groups:Multiplanar reconstruction(MPR)(n=55),volume reconstruction(VR)(n=46),and maximum intensity projection(MIP)(n=52).The detection rate of aortic rupture,accuracy of the DeBakey classification,rotation,and tilt angles of the C-arm during the procedure,dispersion after stent release,and the incidence of late complications were recorded and compared.RESULTS The detection rates of interlayer rupture in the MPR and VR groups were significantly higher than that in the MIP group(P<0.05).The detection rates of De-Bakey subtypesⅠ,Ⅱ,andⅢin the MPR group were higher than those in the MIP group,and the detection rate of typeⅢin the MPR group was significantly higher than that in the VR group(P<0.05).There was no statistically significant difference in the detection rates of typesⅠandⅡcompared to the VR group(P>0.05).The scatter rate of markers and the incidence of complications in the MPR group were significantly lower than those in the VR and MIP groups(P<0.05).CONCLUSION The application of MPR in the endovascular repair of aortic dissection has improved the detection rate of dissection rupture,the accuracy of anatomical classification,and safety.

Intestinal anisakiasis can cause intussusception in adults:An extremely rare condition

We report an extremely rare case of adult intussusception caused by anisakiasis. A 41-year-old man was admitted into our hospital for right lower abdominal colicky pain. Ultrasonography and computed tomography revealed the presence of intussusception. As pneumodynamic resolution by colonoscopy failed, surgery was performed. The anisakis body was found in the submucosal layer of the resection specimen. The patient was discharged 9 d after the operation. Anisakiasis may cause intussusception in any country where sushi or sashimi now exists as a popular food. If suspicious, detailed clinical interview as to food intake prior to symptom development is crucial.

Computed Tomography Imaging of Intracerebral Hematoma Anatomy in Hypertensive Intracerebral Hemorrhage

Objective:The image data of intracerebral hematoma in hypertensive intracerebral hemorrhage(HICH)patients were obtained by three-dimensional(3D)spiral computed tomography(CT)scan in this study to provide a basis for clinical minimally invasive surgery and the development and research of related surgical instruments.Methods:From June 2020 to March 2022,33 patients with supratentorial HICH admitted to the Department of Neurosurgery,the First Affiliated Hospital,Zhejiang University,School of Medicine were selected.All patients underwent 3D spiral CT scanning.Multiplanar reconstruction(MPR)was used to reconstruct along any plane to obtain coronal,sagittal,cross-sectional,or arbitrary angle reconstructed images.Then,we observed and measured relevant data indicators on these three planes by measuring tools.Results:All hemorrhage sites of these 33 HICH patients were basal ganglia hemorrhage,including left basal ganglia hemorrhage in 13 cases and right basal ganglia hemorrhage in 20 cases.It was also found that basal ganglia hematomas were usually elliptical,and the anteroposterior diameter was significantly larger than the transverse diameter,almost twice the size of the transverse diameter[(62±10)mm vs.(35±9)mm,P<0.05].Although the depth of the hematoma on the transfrontal(sagittal)approach was significantly greater than that on the transtemporal(transverse)approach[(100±15)mm vs.(59±14)mm,P<0.05],the angle of the hematoma on the transfrontal approach was significantly smaller than that on the transtemporal approach[(37±11)°vs.(70±17)°,P<0.05],which was conducive to improving the clearance rate of the hematoma.Conclusion:During neuroendoscopic surgery for HICH patients,different lengths of the tubular port should be selected according to the transfrontal or transtemporal surgical approach to meet the needs of hematoma removal.