technetium-tc-99m-sulfur-colloid and Rupture--Spontaneous

Analysis of the diagnostic approach and management of 20 patients with hepatocellular adenoma, 1979-1996.. University Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.. Retrospective and follow-up analysis.. Medical records of patients with histologically proven hepatocellular adenoma were analysed with respect to complaints, diagnostic approach and therapeutical management. Follow-up took place at the outpatient department where history-taking, physical examination, ultrasonography and hepatitis B and C serology tests were performed.. In the period 1979-1996, 20 patients with hepatocellular adenoma were treated. Eight patients (mean tumour size 3.2 cm (1.5-5)) were treated conservatively, 12 (mean tumour size 8.1 cm (6-10)) underwent hepatic resection; four because of rupture of the tumour. Serum liver enzyme values did not contribute to the diagnosis. Of the lesions 78% were diagnosed correctly by ultrasonography and 71% by computer tomography. Median follow-up of the patients treated operatively was 73 months (1-204). One patient died three years after an incomplete resection of a hepatocellular adenoma, because of a hepatocellular carcinoma. Ultrasonography did not demonstrate any recurrent tumours in the other patients. In the group of patients conservatively treated (median follow-up 39 months (24-72)) two patients died because of a hepatocellular carcinoma. Ultrasonography demonstrated stable tumour diameters in three patients and regression in three others.. Based on the literature and the presented experience surgical treatment is the treatment of choice in patients with large (> or = 5 cm diameter) hepatocellular adenomas because of the risk of malignant transformation and rupture of the tumour. With smaller tumours (< 5 cm) a conservative treatment may suffice in hepatitis virus negative patients, including withdrawal of oral contraceptives followed by thorough ultrasound follow-up of tumour size. In case of tumour growth or complaints a resection of the tumour is indicated.

Topics: Adenoma, Liver Cell; Adult; Biopsy, Needle; Carcinoma, Hepatocellular; Cause of Death; Diagnosis, Differential; Disease-Free Survival; Female; Follow-Up Studies; Humans; Liver; Liver Neoplasms; Male; Retrospective Studies; Rupture, Spontaneous; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Treatment Outcome; Ultrasonography

The diagnosis of hepatic rupture in patients with pregnancy-induced hypertension (preeclampsia and eclampsia) is rarely made preoperatively. Diagnostic imaging can be utilized in some patients to confirm the preoperative diagnosis. Since hematoma formation precedes hepatic rupture, then, when diagnostic modalities such as sonography and computed tomography identify patients with hematomas, these patients are at risk of rupture, and should be hospitalized until the hematomas resolve.

Topics: Abdomen; Adolescent; Adult; Female; Hematoma; Humans; Liver Diseases; Pain; Pre-Eclampsia; Pregnancy; Rupture, Spontaneous; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Spontaneous splenic rupture is a rare but serious complication of infectious mononucleosis. Although radionuclide spleen imaging is a well accepted method for diagnosis of traumatic rupture, interpretation can be difficult in the setting of mononucleosis, as tears may be ill-defined and diagnosis hampered by inhomogeneous splenic uptake. Four proven cases of spontaneous rupture are presented, three of which illustrate these diagnostic problems.

Topics: Adult; Colloids; Humans; Infectious Mononucleosis; Male; Radionuclide Imaging; Rupture, Spontaneous; Splenic Rupture; Splenomegaly; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Arthritis, Infectious; Cysts; Diagnosis, Differential; Humans; Knee; Male; Radionuclide Imaging; Rupture, Spontaneous; Staphylococcal Infections; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Thrombophlebitis