Traumatic Aortic Tear

CTA chest: Aortic tear at ligamentum arteriosum level with extensive RT hemothorax

Up to 15% of all deaths following motor vehicle collisions are due to injury to the thoracic aorta.  The proximal descending aorta, where the relatively mobile aortic arch can move against the fixed descending aorta at theligamentum arteriousm, is at greatest risk from the shearing forces of sudden deceleration.Chest X-ray is still used as the primary screening study, but has a low sensitivity. The sensitivity of modern CT scanners is reported at 97-100%, with a negative predictive value of 100% and specificity of 83-99%. Many surgeons  rely solely on the CT scan to plan operative or endovascular repair. Endovascular repair of thoracic aortic injury is available.

Reference: trauma.org 9:4, April 2004 Chest Trauma: Traumatic Aortic Injury

Ulcerative Colitis

Fig 1. coronal CT abdomen and pelvis. Mildly distended colon with loss of haustral markings.






Fig 2. Coronal 3d. featureless, lead pipe colon

Ulcerative colitis is a type of inflammatory bowel disease. It involves the large intestine with characteristic ulcers. Symptoms include bleeding and diarrhea. Like Crohns, Ulcerative colitis is an intermittent disease, with periods of active disease and periods that are asymptomatic.

Ulcerative colitis occurs in less than 0.1% of the population. The disease is more prevalent in northern countries. Ulcerative colitis has no definIte cause. These appears to be a genetic component. Treatment is with anti-inflammatory drugs, immunosuppression, and biological therapy targeting specific components of the immune response. Colectomy (partial or total removal of the large bowel through surgery) is occasionally necessary, and is considered to be a cure for the disease.

In patients with long standing disease, a lead-pipe colon can develop. There is hypertrophy of the muscularis mucosa. The thickened muscle layer gives the colon a narrowed ahaustral form. Strictures may also narrow the lumen.


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Caput Medusae

VR image of abdominal wall in a patient with cirrhosis and portal venous hypertension.  Inset is Head of Medusa from God of War II (Sony)

Distended and engorged paraumbilical veins, radiating from the umbilicus across the abdomen to join systemic veins. The name caput medusae (Latin for "head of Medusa") originates from the apparent similarity to Medusa's hair once Athena had turned it into snakes. It is a sign of severe portal hypertension that has decompressed by portal-systemic shunting through the paraumbilical veins. DDX would include IVC obstruction which can also produce abdominal wall collateral veins.

Sorry it has ben a while since last post .