Purpose

Superinfection of abdominal collections increases morbidity and mortality of hospitalized patients. A prompt diagnosis is fundamental for allowing timely and appropriate management. The purpose of this study is to evaluate CT findings that may suggest superinfection of abdominal fluid collections.

Material and methods

A retrospective review of our records between January 2017 and September 2019 identified 38 patients (25 males, 13 females; mean age 63.5 years) with intra-abdominal collections that were sampled and for wich microbiological culture results were available. Of these, 19 were post-operative and 19 were resulting from inflammatory conditions. Two readers evaluated the contrast-enhanced CT for presence of gas, density of the content and wall enhancement. T-test and Fisher’s test were used for analysis.

Results

24/38 (63.1%) collections were infected and 14/38 (36.9%) were not infected. Gas was present in 17/38 (44.7%) collections which were all infected. Of those that did not present with gas: 14/21 (66.6%) were not infected, while 7/21 (33.4%) were infected, all with anaerobes. Presence of gas in the collection had 70.8% sensitivity and 100% specificity for superinfection (p=0.0001).

No difference was observed in collection density and enhancement between infected and non-infected collections, respectively 16.7±7.3 vs 19.7±10.1 HU; p=ns and 31.1±19.1 vs 25.2±11.1 HU; p=ns.

Conclusion

In our experience the only factor predictive of superinfection was the presence of gas in the collection. No significant difference was observed for the other parameters.

Purpose

Superinfection of abdominal collections increases morbidity and mortality of hospitalized patients. A prompt diagnosis is fundamental for allowing timely and appropriate management. The purpose of this study is to evaluate CT findings that may suggest superinfection of abdominal fluid collections.

Material and methods

A retrospective review of our records between January 2017 and September 2019 identified 38 patients (25 males, 13 females; mean age 63.5 years) with intra-abdominal collections that were sampled and for wich microbiological culture results were available. Of these, 19 were post-operative and 19 were resulting from inflammatory conditions. Two readers evaluated the contrast-enhanced CT for presence of gas, density of the content and wall enhancement. T-test and Fisher’s test were used for analysis.

Results

24/38 (63.1%) collections were infected and 14/38 (36.9%) were not infected. Gas was present in 17/38 (44.7%) collections which were all infected. Of those that did not present with gas: 14/21 (66.6%) were not infected, while 7/21 (33.4%) were infected, all with anaerobes. Presence of gas in the collection had 70.8% sensitivity and 100% specificity for superinfection (p=0.0001).

No difference was observed in collection density and enhancement between infected and non-infected collections, respectively 16.7±7.3 vs 19.7±10.1 HU; p=ns and 31.1±19.1 vs 25.2±11.1 HU; p=ns.

Conclusion

In our experience the only factor predictive of superinfection was the presence of gas in the collection. No significant difference was observed for the other parameters.

Purpose

To assess the value of preoperative CT features for predicting clinically relevant postoperative pancreatic fistula (POPF).

Material and methods

This multicenter retrospective study included 88 patients who underwent pancreaticoduodenectomy in two centers. Patients were divided into 2 groups according to clinical data: 44 patients with POPF and 44 patients without POPF. In each center, one reader (≥10 years experience) reviewed the preoperative MDCTs of the patients, measuring at the planned resection plane the main pancreatic duct (MPD) diameter, the parenchymal density in the different phases and the parenchymal thickness. HUven-HUart was calculated, and progressive enhancement was interpreted as a sign of fibrosis. Body composition was analysed by calculating visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area at the L2 level (ImageJ software). Retrorenal fat thickness and psoas density were measured. Fisher’s test and Mann–Whitney test were used as appropriate.

Results

MPD diameter was 2.7±2.6mm in the fistula group and 6.3±3.1mm in the non-fistula group (P<0.0001). The mean attenuation difference between venous and arterial phases was 2.6HU in POPF group and -13.2HU in the non-POPF group (P=0.0010). VAT was 19164.2mm² in the POPF group and 13263.5mm² in the non-POPF group (P=0.002). SAT was 18018.6mm² in POPF group and 12269.7mm² in the non-POPF group (P=0.004). No difference was observed for other parameters.

Conclusion

Fibrosis, expressed by increasing enhancement of the normal pancreatic parenchyma, MPD diameter and increased VAT and SAT may express increased risk for pancreatic fistula after pancreaticoduodenectomy.