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ABSTRACT |
Monday, May 7, 1:30 PM–3:30 PM
Abstracts 056-067
Moderator(s): Katherine Klein and Stephen Hatem
1:30 PM
056. MDCT Characterization of Active Extravasation: Prognostic Value of Extravasation Morphology, Location, and Delayed Imaging
Enriquez M.*; Shin L. K.; Rosenberg J.; Jeffrey R. Stanford University Medical Center, Stanford, CA
Address correspondence to M. Enriquez (menriq{at}stanford.edu)
Objective: The purpose of this study was to identify the characteristics of abdominal and pelvic active extravasation (morphology, location, and expansion rates) on MDCT which could predict clinical treatment and outcomes.
Materials and Methods: A total of 82 patients who demonstrated active extravasation (AE) on MDCT of the abdomen and pelvis were identified from January 2000 through June 2006. Etiologies for active extravasation were trauma (69%), post intervention/surgery (20%), neoplasm (6%) and miscellaneous (6%). Exams were retrospectively reviewed for organ of involvement, presence of intraperitoneal or extraperitoneal hemorrhage, morphology of extravasation (linear, round, or both), and rate of change in area of AE if delayed imaging was performed. Multivariate regression analyses were used to investigate the relationships among patient characteristics (age, sex, bleed location, size of bleed, short-term change in bleed area), interventions (blood products, surgery, or embolization), and outcome (intensive care unit admission, death).
Results: All 21 patients who underwent delayed imaging that demonstrated an increase in bleed area over 200 mm2/sec, received some form of intervention; 67% of them had unstable hemodynamics. Of the remaining 35 patients, those with unstable hemodynamics (46%) had three times the odds of receiving intervention compared to those with stable hemodynamics (p < 0.008). Patients with unstable hemodynamics had twice the odds of dying compared to patients with stable hemodynamics (p < 0.002) and twice the odds of being admitted to ICU (p < 0.018).
Conclusion: Increased rate of change in area of active extravasation found on MDCT and unstable hemodynamics profiles increase the odds of intervention (transfusions, embolization, surgery) in this sample. Unstable hemodynamics was the best predictor of patient death and of ICU admission.
057. Utilization Patterns and Diagnostic Yield of 3421 Consecutive Multidetector Row CT Pulmonary Angiograms in a Busy Emergency Department
Donohoo J. H.*; Mayo-Smith W.; Pezzullo J.; Egglin T. Brown University, Rhode Island Hospital, Providence, RI
Address correspondence to J. Donohoo (donohoo33{at}yahoo.com)
Objective: To compare exam volume and diagnostic yield of CT pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scintigraphy for detection of suspected pulmonary embolism in emergency department patients over four consecutive years.
Materials and Methods: We reviewed the official results of every CTPA and V/Q scan performed on emergency department patients for the four-year period between October 2001 and September 2005. The reports from 3937 CTPA exams and 214 V/Q scans were reviewed. Patients with known prior pulmonary embolism were excluded. Only the first exam in patients with multiple exams was included. The number of exams performed and diagnostic yield for each study was examined. Alternative diagnoses from the reports of the CTPA exams were also tabulated.
Results: A total of 3421 CTPA exams and 198 V/Q scans were included in the study. The number of CTPA exams ordered per month by emergency department physicians gradually increased throughout the study period. On average 33.4 exams per month were completed during the first 24-month period and increased to 109.2 exams per month for the last 24-month period, a 227% increase. During the same time periods, overall CT utilization increased 43% (from 2303 to 3288 exams per month) while emergency department visits increased only 3% (from 6536 to 6722) and V/Q scintigraphy volume decreased 80% (from 6.9 to 1.4 per month). The total number of patients diagnosed with pulmonary embolism per month increased 89% from 4.0 to 7.5, while the percentage of positive CTPA exams dropped from 9.8% to 6.8%.
Conclusion: Availability of a multidetector row CT scanner in the emergency department and changing physician thresholds for test utilization have lead to greater use of CT pulmonary angiography and increased detection of pulmonary embolism, although the percentage of positive exams has decreased.
058. 64 MDCT: Clinical Implications of Active Extravasation of Contrast in Trauma
Anderson S. W.*; Lucey B. C.; Rhea J.; Soto J. A. Boston University Medical Center, Boston, MA
Address correspondence to S. Anderson (stephan.anderson{at}bmc.org)
Objective: To evaluate the clinical implications of active extravasation on CT in multi-trauma patients imaged using 64 MDCT.
Materials and Methods: We reviewed our electronic database to identify all patients over 18 years with active contrast extravasation identified on CT imaging performed following blunt or penetrating trauma from 4/27/2005 until 9/01/2006 after the installation of two 64-MDCT scanners at our Level 1 trauma center. CT scans of the chest, abdomen, and pelvis were routinely completed using 1.25 mm collimation. If indicated, patients with pelvic or lower extremity fractures noted on initial plain radiographs also underwent pelvic or lower extremity angiography using 0.625 mm collimation prior to the standard pan scan. A single bolus of 100 mL of iodinated contrast was used in all cases.
Results: A total of 1460 multi-trauma patients were imaged using 64 MDCT during the study period and 47 (3%) patients were noted to have evidence of active extravasation of contrast. Thirty-five (78%) were secondary to blunt trauma and 12 (22%) to penetrating trauma. Of the 35 patients having sustained blunt trauma with an area of active hemorrhage identified on CT, 19 patients (54%) underwent operative or angiographic intervention, two patients (6%) died, and the remaining 14 patients (40%) were managed conservatively. Of the 22 patients with solid visceral or pelvic sources of extravasation, 19 (86%) underwent operative or angiographic intervention, 1 patient (5%) died, and the remaining two were managed conservatively with injuries of the spleen and kidney. Of the 12 patients having sustained penetrating trauma with an area of active hemorrhage identified, 6 patients (50%) underwent operative management with the remaining 6 patients (50%) managed conservatively. Of the three patients with solid visceral organ injury, 100% underwent operative or angiographic intervention.
Conclusion: Though the overall need for immediate intervention in patients with active extravasation may be somewhat decreased compared to prior reports, the clinical implication of this finding is dependent on the area of injury. Even in the age of 64-MDCT technology, the findings of active extravasation often demand urgent intervention.
059. MDCT of Blunt Aortic Injuries: Initial Experience with 64-slice MDCT
Steenburg S. D.*; Ravenel J. G. Medical University of South Carolina, Charleston, SC
Address correspondence to S. Steenburg (steenbu{at}musc.edu)
Objective: With improvements in multidetector computed tomography (MDCT) there has been a trend away from direct catheter aortography for the confirmation of acute traumatic aortic injury (ATAI). However, some surgeons still request direct catheter angiography for the confirmation of aortic injuries seen on MDCT. To our knowledge, the efficacy of 64-slice MDCT in the evaluation of ATAI has not been objectively evaluated. Therefore, our purpose is to retrospectively evaluate the value of 64-slice MDCT in the evaluation of blunt ATAI.
Materials and Methods: The Trauma Registry at our Level 1 trauma center was reviewed beginning in March 2005, when a 64-slice MDCT scanner was installed in our trauma center, to the end of August 2006. MDCT images were correlated with angiographic images when performed. Surgical reports were reviewed for confirmation of injury in those patients without catheter angiography.
Results: During the study period, a total of 581 patients were imaged for suspicion of blunt aortic injury, yielding 16 patients (2.8%) diagnosed with ATAI (contour abnormality or intimal flap and peri-aortic hematoma) by contrast-enhanced 64-slice MDCT. Mean age was 39.5 years (16–68 years) with a strong male predominance (n = 13). The mechanism of injury was motor vehicle collision in 15 and fall from height in one. One patient had an injury to the abdominal aorta, one patient had a combined aortic root and isthmus injury and the remainder (14) had isolated injuries at the aortic isthmus. All 16 had direct signs of ATAI. During the study period 10 catheter aortograms were performed: 2 confirmed positive CT, 4 confirmed negative CT, 3 done for periaortic hematoma only were negative and 1 case was equivocal at CT and angiography. Of the cases that were not imaged with direct catheter angiography, all were confirmed to have ATAI at surgery.
Conclusion: A technically adequate contrast-enhanced 64-slice MDCT demonstrating ATAI does not necessitate catheter angiography confirmation. Although we still recommend catheter-based angiography for isolated peri-aortic hematoma and equivocal findings, the same difficulties in interpretation are present with both studies. With the utilization of 64-slice MDCT technology, the paradigm shift away from diagnostic catheter angiography confirmation to diagnostic MDCT appears complete.
060. Blunt Trauma: Utility of Pelvic CT Angiography Using 64 MDCT
Anderson S. W.*; Lucey B. C.; Rhea J.; Soto J. A. Boston University Medical Center, Boston, MA
Address correspondence to S. Anderson (stephan.anderson{at}bmc.org)
Objective: To evaluate the utility of pelvic CT angiography (CTA) in blunt trauma patients with pelvic fractures using 64 MDCT.
Materials and Methods: All blunt trauma patients with displaced pelvic fractures seen on radiographs in the trauma bay underwent pelvic CTA using 64-MDCT technology (LightSpeed VCT) and were included in this study. This study included 46 patients since the installation of two 64-MDCT scanners in our Level I trauma center from 5/01/2005 until 10/08/06. Pelvic CTA was integrated into the comprehensive pan-scan of polytrauma victims which includes portal venous phase imaging of the abdomen and pelvis. CTAs were completed using a single bolus of intravenous contrast and utilized a slice thickness of 0.625 mm. Pelvic CTAs were reviewed for evidence of arterial injury. Portal venous phase images were also reviewed, noting evidence of extravascular contrast accumulation. Size and attenuation of areas of active extravasation, when present, were measured both in arterial and portal venous phase images. Clinical course, including subsequent therapeutic procedures, was determined by chart review.
Results: Acute arterial injury was identified on pelvic CTA in 18 (39%) of 46 patients. Of these, four patients had occlusion of the superior gluteal arteries. Fifteen patients had evidence of active arterial extravasation (single patient with both superior gluteal occlusion and extravasation). When comparing arterial and portal venous phase images in these 15 cases, portal venous phase images demonstrated the areas to be larger in size in all cases. In two cases, extravasation was identified only on portal venous phase images suggesting a venous hemorrhage; this was confirmed at DSA in both cases. This suggests the possible utility of CTA in differentiating arterial from venous injury. Of the 15 patients with extravasation identified, 11 patients underwent DSA imaging with 5 of these demonstrating areas of active hemorrhage which were coil embolized. The remaining four patients with active extravasation, as well as those only demonstrating evidence of superior gluteal occlusion at CTA were managed conservatively.
Conclusion: Pelvic CTA, following a single injection of intravenous contrast and integrated into the blunt trauma protocol for polytrauma patients, aids in management of patients with pelvic fractures. CTA, in distinguishing arterial from venous hemorrhage, may be useful in predicting which patients should undergo conventional angiography and possible therapeutic intervention.
061. Correlation With Fluid Resuscitation for the Finding of Free Peritoneal Fluid in Men Without Underlying Injury on 64-MDCT Evaluation Following Blunt Trauma
Drasin T.*; Anderson S.; Asandra A.; Rhea J. T.; Soto J. A. Boston Medical Center–Boston University School of Medicine, Boston, MA
Address correspondence to T. Drasin (teric.drasin{at}bmc.org)
Objective: To determine the significance of the isolated finding of free peritoneal fluid in male trauma patients who had undergone evaluation of the abdomen and pelvis with 64 MDCT and to correlate this finding with the amount of pre-imaging resuscitative intravenous fluids administered.
Materials and Methods: The study was IRB approved and HIPAA compliant. A retrospective evaluation was performed of 556 male patients who were admitted to our Level I trauma center over a 16-month period following blunt trauma and who had undergone an abdomino-pelvic CT scan which was performed with a LightSpeed VCT scanner (GE Medical Systems, Milwaukee, WI), using 1.25-mm-thick images and after the administration of 100 mL of IV contrast. The axial CT images, as well as coronal and sagittal reformations, were reviewed by two radiologists for the presence of free peritoneal fluid. From this subset of patients, the patients' electronic records were reviewed for documentation of the amount of pre-imaging intravenous fluids (IVF) administered, as well as whether further imaging or exploratory surgery was performed in patients who did not have an identifiable intraperitoneal injury.
Results: Documentation of the amount of pre-imaging IVF was available for 286 patients who underwent abdomino-pelvic CT for blunt trauma. Nineteen patients (7%) demonstrated free peritoneal fluid without evidence of solid organ or bowel injury. Of these 19 patients, those that had unexplained free fluid were as follows: 9/195 (5%) of patients who received less than 2 liters (L) of IVF, 8/87 (9%) for those who received 2–4 L of IVF, and 2/4 (50%) for those who received greater than 4 L of IVF. All 19 of these patients were admitted to the hospital for observation, and all were discharged in satisfactory condition without undergoing further imaging or exploratory surgery.
Conclusion: With 64-MDCT technology, the finding of incidental free peritoneal fluid in male patients is not uncommon and may have no significant clinical implication. In addition, incidental free fluid in male trauma patients is more common with increasing pre-imaging IV fluid volume.
062. Lumbar Spine Plain Film in Blunt Trauma—Is It Necessary if an Abdomen and Pelvis CT are Obtained?
Kapur S.*; Kreeger M. C.; Wissman R.; Choe K. A. University of Cincinnati, Cincinnati, OH
Address correspondence to S. Kapur (kapur13{at}hotmail.com)
Objective: To retrospectively evaluate the utility of lumbar spine plain film in trauma patients undergoing abdomen and pelvis CT.
Materials and Methods: Institutional review board approval has been obtained for direct image review. Informed consent was waived. The study is HIPAA compliant. All trauma patients at our institution, who underwent lumbar spine plain film and abdomen and pelvis CT within 3 days of injury during a 2-year period were included. The reports of the lumbar spine plain films and abdomen and pelvis CTs were reviewed for the presence or absence of a fracture in the lumbar spine. The abdomen and pelvis CTs and lumbar spine plain films of all patients who were CT negative and lumbar spine plain film positive for fracture of lumbar spine will be reviewed by two independent observers.
Results: A total of 932 patients were reviewed. The results were divided into patients with and without lumbar spine fracture, based on either modality. Approximately, 180 (19.3%) of the patients had a fracture of the lumbar spine, diagnosed by either modality. CT was positive for fracture in 165/180 patients (91.7%) and plain films were positive in 101/180 patients (56.4%). CT and plain films were concordant in 86/180 (47.8%) patients. Therefore 8.3% of the fractures were missed by CT while 43.9% were missed by plain film. Out of the 15 (8.3%) that were missed by CT, 11 represented compression deformities of indeterminate age, 3 were possible transverse process fractures, while one was a superior end plate fracture. Review of abdomen and pelvis CT and lumbar spine plain film images for patients in the group CT negative, plain film positive is pending.
Conclusion: A great majority of the lumbar spine fractures in patients with trauma can be detected by routine trauma abdomen and pelvis CT. A small number of mainly compression fractures are however missed by CT and will likely be detected if the lateral scout view is carefully examined.
Clinical Relevance/Application: Since the majority of lumbar spine fractures can be detected by routine trauma abdomen and pelvis CT, the utility of additional plain radiographs of the lumbar spine is limited.
063. Physiologic Biometrics of the Finger by Ultrasound Imaging
Narayanasamy G.2*; Fowlkes J.2; Schmitt R.1,2; Kripfgans O.2; Jacobson J.2; de Maeseneer M.2; Carson P.2 1. Cross Match Technologies, North Palm Beach, FL; 2. University of Michigan, Ann Arbor, MI
Address correspondence to G. Narayanasamy (gnarayan{at}umich.edu)
Objective: Diagnostic ultrasound of the human finger to be used for unique identification and physiologic assessment.
Materials and Methods: Three-dimensional imaging in conventional grayscale, compound, and color flow modes performed using a commercial scanner shows many identifiable anatomic and physiologic features of the human finger. Images were collected on 20 volunteers using an automated motorized translation stage to move an M12 linear array probe (GE Logiq 9 US system). Spatial registration by affine transformation of the image volumes was carried out using a well-studied algorithm, MIAMI-Fuse® that maximizes the overall mutual information. For visual 1-to-1 matching of ultrasound image volumes acquired at different times, a group of four readers was selected including two musculoskeletal radiologists. 3D power Doppler images were collected before and after a mild exercise to study the variation.
Results: Evaluation of repeated scans on volunteers showed reproduction of identifiable structures in time-separated 3D volumes, both in B-mode and Doppler imaging. Compounded images (with and without further speckle reduction) showed more structures than the single-view gray scale images. Registration of 15 pairs of image volumes gave 100% successful match (no false positives or negatives) for a low tolerance level setting. Radiologist readers matching the image pairs were 100% successful and the average success of all four readers was 96%. Flow and vascular features are dependent on ones physiologic state, measured here as heart rate, body temperature, and blood pressure. Three-dimensional color flow imaging reveals presumably unique spatial vascular features as well as heart rate and peripheral flow. The average color pixel density (CPD) increased from a level of 0.03 to about 0.04 upon mild exercise (heart rate increase of 25%–75%).
Conclusion: 3D ultrasound scanning of fingers is a novel technique for biometric identification. The reader study identified a set of structures that could be used for identification based on matching of paired images, structures that would be difficult to simulate. Registration using maximization of mutual information may provide automated method for biometric identification. For individuals with sufficient detectable blood flow, CPD is seen to change along with the physiologic status. (This work is supported in part by NIST-ATP cooperative agreement 2001-00-4392 and P01 CA887634).
064. Gadolinium-associated Nephrogenic Systemic Fibrosis— Why Radiologists Should Be Concerned
Broome D. R.*; Girguis M.; Baron P.; Cottrell A.; Kjellin I.; Kirk G. Loma Linda University Medical Center, Loma Linda, CA
Address correspondence to D. Broome (dbroome{at}ahs.llumc.edu)
Objective: Nephrogenic systemic fibrosis (NSF) is a rare multi-systemic fibrosing disorder that affects renal insufficiency patients most commonly resulting in skin fibrosis but may also affect skeletal muscle and other organs. The purpose of our study was to identify any common risk factors and determine whether intravenous gadolinium is associated with the development of NSF.
Materials and Methods: A retrospective chart review was performed of all eleven patients with NSF between 2000 and 2006 at our institution to identify the onset of clinical manifestations, histologic diagnosis, timing and dose of gadolinium administration, dialysis records, concurrent medications, comorbid conditions and surgeries, laboratory findings, imaging findings, and clinical outcome.
Results: The diagnosis of NSF was established by clinical findings, absence of scleroderma serologic markers, and biopsy of skin or skeletal muscle. All eleven patients had renal insufficiency–seven with dialysis-dependent chronic renal insufficiency and four with acute hepatorenal syndrome. All eleven patients had received intravenous gadolinium for MRI examinations within 2 months prior to the development of skin fibrosis. The patients had no other common medications, medical conditions, or surgical history, although six had a vascular surgical procedure in the interval between gadolinium administration and development of NSF. Four patients had abnormal bone scans with skin and muscle uptake and lower extremity MRI finding of edema in the muscles, intermuscular fascia, and skin. Despite the fact that nine patients were dialyzed within 2 days of gadolinium administration, this did not prevent the development of NSF.
Conclusion: NSF was strongly associated with intravenous gadolinium administration in the setting of either acute hepatorenal syndrome or dialysis-dependent chronic renal insufficiency. Dialysis following gadolinium administration failed to prevent the development of NSF.
065. Characterization of Small Pancreatic Cyst (3 cm or smaller): A Comparison Between MDCT and MRI/MRCP for Assessing Cyst Morphology and Predicting Malignancy
Sainani N. I.*; Catalano O. A.; Fernandez-Del Castillo C.; Hahn P. F.; Sahani D. V. Massachusetts General Hospital, Boston, MA
Address correspondence to N. Sainani (nsainani{at}partners.org)
Objective: To characterize pancreatic cysts (<3 cm) on MDCT and MRI MRCP. To compare the performance of CT and MRI for assessing cyst morphology. To determine the incidence of malignancy in <3 cm cysts and features that may predict malignancy on imaging.
Materials and Methods: Between 1999 and 2006, patients with pancreatic cysts 3 cm or smaller in size who have had surgical or endoscopic ultrasound (EUS)-guided histologic confirmation of cysts were studied. Only those patients who had MDCT and MRI/MRCP were included for analysis. Our cohort included 27 patients (13 M: 15 F, age range 42–93 years) with 38 cysts. The following features of cyst morphology were evaluated: size, septations, mural nodules, cyst communication with the pancreatic duct, vascular invasion and metastasis. A 5-point scale of reader confidence was used for histopathological diagnosis and characterization into benign or malignant.
Results: The cyst pathology included, 21/38 side-branch IPMN, 8/38 mucinous cystic neoplasms, 7/38 benign cyst/pseudocyst, and 1 each of serous cystic neoplasm and solid pseudopapillary neoplasm. The cysts varied in size from 5 mm to 30 mm in maximum diameter (8 cysts < 10 mm, 17 cysts < 20 mm and 13 cysts < 30 mm). In 23 / 38 cysts (65.7 %), CT and MRI were concordant for cyst morphology. The overall accuracy of CT and MRI for cyst morphology was 51.4 % and 60 % respectively. On pathology, 17/38 cysts were benign, 20/38 had borderline changes without malignancy and 1/38 had malignant potential. Positive predictive value (PPV) of CT and MRI/MRCP for prediction of benignity, based on cyst morphology were 100% and 96.8%.
Conclusion: CT and MRI/MRCP were moderately accurate in characterizing small (< 3 cm), MRI being slightly better that CT, irrespective of the cyst size. The overall incidence of malignancy is low in small (< 3 cm) pancreatic cyst and cyst morphology on CT and MRI is accurate in predicting benignity.
066. Can MDCT Accurately Characterize Serous Cystadenomas of the Pancreas? Imaging-Pathologic Correlation
Sahani D. V.*; Shah Z. K.; Fernandez-Del Castillo C.; Hahn P. F. Massachusetts General Hospital, Boston, MA
Address correspondence to D. Sahani (dsahani{at}partners.org)
Objective: Identification of important CT features of serous cystadenomas (SCA) of the pancreas and their impact on diagnosis. Correlation of MDCT findings with pathology
Materials and Methods: From a database of 180 patients with pancreatic cystic neoplasms, 22 patients with pathology diagnosis of SCA were identified. Features assessed on MDCT were: size, location, lobulations, demarcation from pancreatic parenchyma, central scar, calcification, nodules, ductal obstruction, vascular encasement, lymphadenopathy, and metastasis. Diagnosis confidence of CT was graded on a 5-point scale. Correlation was made with pathology data.
Results: Lesion distribution included 14/22 lesions in the body and tail and 8/22 in the head and uncinate process. Lesions ranged from 8 mm–92 mm in maximum dimension.19/22 patients were sharply marginated and lobulated (86.3%) and a central scar was seen in 8/22 (36.4%). Accurate CT diagnosis was possible in 17/22 (77.2%); 15/17 were microcystic, 2/17 were macrocystic, 17/17 were lobulated and 8/17 had a central scar (included 2 macrocystic). Of the remaining 5 lesions, 3 were macrocystic and 2 were unilocular; none had a central scar, all were lobulated and sizes ranged from 8–54 mm. Segmental ductal obstruction was seen in 1/22 (4.5%) and this patient had an IPMN with the SCA. Solid nodules and vascular encasement were not seen in any patient in this group.
Conclusion: Both microcystic morphology and presence of lobulations are strong predictors of SCA. The presence of a central scar is highly suggestive of SCA even in the absence of the typical microcystic appearance. Size of the lesions does not have significant impact on diagnosis. Recognizing the features can avoid surgical intervention in these benign neoplasms.
067. Love Hurts: Fitz-Hugh-Curtis and Liver Capsular Enhancement
Bloomer C. W.*; Rivas L. Jackson Memorial Hospital/University of Miami, Miami, FL
Address correspondence to C. Bloomer (cbloomer{at}um-jmh.org)
Objective: Pelvic inflammatory disease (PID) is a common malady affecting over 1 million women a year (and occasionally sexually active men); PID accounts for up to 250,000 hospital admissions per year. If left untreated, PID may progress to tubo-ovarian abscesses, peritonitis, and right upper quadrant inflammatory changes, so called Fitz-Hugh-Curtis (FHC). Extrapelvic involvement, FHC, may present without pelvic pain; right upper quadrant pain and fever may be the initial and only symptoms. Subtle pelvic inflammatory changes in addition to liver capsular (Glisson's capsule) enhancement suggest the diagnosis of FHC. Enhancement of Glisson's capsule is not specific to FHC; other entities, particularly intrahepatic pathology such as neoplasm and abscess, may cause capsular enhancement.
Materials and Methods: An internal review of computed tomography (CT) studies was performed. 13 cases of capsular enhancement with pelvic inflammatory changes and clinical records were reviewed. CT studies of the abdomen and pelvis included 2 phases after the administration of iodinated contrast: early and delayed imaging.
Results: Enhancement of the liver capsule was best demonstrated on the delayed imaging phase. The anterior capsule enhancement was more evident than posterior. Endometrial fluid, hydrosalpinx was seen in addition to the capsular enhancement in the female patients.
Conclusion: FHC, liver capsular enhancement as a manifestation of pelvic inflammatory disease, may present as isolated right upper quadrant pain in sexually active female population. In the emergency radiology setting, CT is often performed as the initial screening exam for acute onset of abdominal pain. Liver capsular enhancement may often be subtle and overlooked as a source of right upper quadrant pain. When capsular enhancement is present, in addition to inflammatory changes in the pelvis which maybe subtle, FHC is a likely diagnosis. PID and FHC are both medically treated, and usually are managed on an outpatient basis. If the patient is immunocompromised or tubo-ovarian abscesses are present, hospital admission is usually necessary. To prevent unnecessary surgery, the radiologist must be versed in the radiologic findings of PID and the subtle imaging characteristics of liver capsular enhancement. Quick diagnosis and treatment of PID and FHC are imperative for preservation of reproduction in sexually active patients.
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