EURORAD ESR

Case 14621

Spontaneous leakage of ascites from umbilical hernia in alcohol-related cirrhosis

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 65 year(s)
 
 
  • Figure 1
    Unenhanced and multiphase contrast-enhanced CT one year earlier
     

    Precontrast scans (a,b) showed cirrhotic liver, abundant homogeneously fluid-attenuating ascites (*), and umbilical hernia (arrow in b) contaning ascitic fluid.

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Precontrast scans (a,b) showed cirrhotic liver, abundant homogeneously fluid-attenuating ascites (*), and umbilical hernia (arrow in b) contaning ascitic fluid.

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Multiphase contrast-enhanced study including arterial (c,d), portal venous (e..h) and equilibrium (not shown) phases. No focal liver lesions suspicious for hepatocellular carcinoma were present. Note abundant ascites...

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Multiphase contrast-enhanced study including arterial (c,d), portal venous (e..h) and equilibrium (not shown) phases. No suspicious focal liver lesions were present. Additionally, a right-sided inguinal hernia...

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Portal venous phase images (e..h) confirmed abundant multicompartmental ascites (*), patent porto-mesenteric venous system, absence of suspicious focal liver lesions, and a right-sided inguinal hernia (arrowhead)...

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Dilation; Special Focus: Hernia;

    Detail multiplanar contrast-enhanced images (f...h) showed round-shaped, externally convex umbilical hernia (arrows) filled with ascitic fluid, with narrow neck and integrity of the uniform, enhancing hernial sac...

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Detail multiplanar contrast-enhanced images (f...h) showed round-shaped, externally convex umbilical hernia (arrows) filled with ascitic fluid, with narrow neck and integrity of the uniform, enhancing hernial sac...

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Detail multiplanar contrast-enhanced images (f...h) showed round-shaped, externally convex umbilical hernia (arrows) filled with ascitic fluid, with narrow neck and integrity of the uniform, enhancing hernial sac...

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;
     
     
  • Figure 2
    Current unenhanced and post-contrast CT
     

    Precontrast images showed mild decrease of ascites (*) compared to Fig.1, collapsed umbilical hernia (arrow in b) with concave outer border.

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Precontrast images showed mild decrease of ascites (*) compared to Fig.1, collapsed umbilical hernia (arrow in b) with concave outer border.

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Contrast-enhanced images confirmed decrease of ascites (*) compared to Fig.1, unchanged liver and portal venous system.

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Detail multiplanar images showed collapsed umbilical hernia (arrows) with concave outer border of hernial sac, thinned skin overlying the enhancing peritoneal serosa, some residual herniated ascitic fluid (*).

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;

    Detail multiplanar images showed collapsed umbilical hernia (arrows) with concave outer border of hernial sac, thinned skin overlying the enhancing peritoneal serosa, some residual herniated ascitic fluid (*).

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hernia;
     
     
Precontrast scans (a,b) showed cirrhotic liver, abundant homogeneously fluid-attenuating ascites (*), and umbilical hernia (arrow in b) contaning ascitic fluid.
 
Precontrast scans (a,b) showed cirrhotic liver, abundant homogeneously fluid-attenuating ascites (*), and umbilical hernia (arrow in b) contaning ascitic fluid.
 
Multiphase contrast-enhanced study including arterial (c,d), portal venous (e..h) and equilibrium (not shown) phases. No focal liver lesions suspicious for hepatocellular carcinoma were present. Note abundant ascites (*).
 
Multiphase contrast-enhanced study including arterial (c,d), portal venous (e..h) and equilibrium (not shown) phases. No suspicious focal liver lesions were present. Additionally, a right-sided inguinal hernia (arrowhead) filled with ascitic fluid (*) was present.
 
Portal venous phase images (e..h) confirmed abundant multicompartmental ascites (*), patent porto-mesenteric venous system, absence of suspicious focal liver lesions, and a right-sided inguinal hernia (arrowhead) filled with ascitic fluid.
 
Detail multiplanar contrast-enhanced images (f...h) showed round-shaped, externally convex umbilical hernia (arrows) filled with ascitic fluid, with narrow neck and integrity of the uniform, enhancing hernial sac including the peritoneal serosa. Note ascites (*).
 
Detail multiplanar contrast-enhanced images (f...h) showed round-shaped, externally convex umbilical hernia (arrows) filled with ascitic fluid, with narrow neck and integrity of the uniform, enhancing hernial sac including the peritoneal serosa. Note ascites (*).
 
Detail multiplanar contrast-enhanced images (f...h) showed round-shaped, externally convex umbilical hernia (arrows) filled with ascitic fluid, with narrow neck and integrity of the uniform, enhancing hernial sac including the peritoneal serosa. Note ascites (*).
 
Precontrast images showed mild decrease of ascites (*) compared to Fig.1, collapsed umbilical hernia (arrow in b) with concave outer border.
 
Precontrast images showed mild decrease of ascites (*) compared to Fig.1, collapsed umbilical hernia (arrow in b) with concave outer border.
 
Contrast-enhanced images confirmed decrease of ascites (*) compared to Fig.1, unchanged liver and portal venous system.
 
Detail multiplanar images showed collapsed umbilical hernia (arrows) with concave outer border of hernial sac, thinned skin overlying the enhancing peritoneal serosa, some residual herniated ascitic fluid (*).
 
Detail multiplanar images showed collapsed umbilical hernia (arrows) with concave outer border of hernial sac, thinned skin overlying the enhancing peritoneal serosa, some residual herniated ascitic fluid (*).
 
 
 
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