Should Small Sliding Hiatal Hernias Be Reported at CT Colonography?
Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA. American Journal of Roentgenology
(Impact Factor: 2.73).
04/2011; 196(4):W400-4. DOI: 10.2214/AJR.10.5392
The objective of our study was to determine whether colonic distention at CT colonography (CTC) induces small incidental sliding hiatal hernias.
This study evaluated for the presence and, if present, the size (small, moderate, or large) of sliding (type 1) hiatal hernias in 3126 consecutive asymptomatic adults (mean age ± SD, 57.0 ± 7.4 years) undergoing screening CTC. Colonic distention was achieved with automated continuous CO(2) delivery. As an internal control, standard CT studies (i.e., without colonography technique) were available for comparison in 123 individuals with a hernia present at CTC. In addition, the prevalence of hiatal hernia was assessed in an external control group of 488 adults (mean age, 60.8 years) undergoing abdominal CT without colonic distention. The Fisher exact test was used to test for statistical significance.
Hiatal hernias were present in 47.8% (1495/3126) of adults at screening CTC (86% small, 13% moderate, 1% large). Abdominal CT of the 123 internal control subjects showed resolution of the hernia in 64.2% (79/123) of cases and was smaller in an additional 12 cases. The prevalence of sliding hiatal hernias in the external control group was 23.8% (116/488), significantly lower than in the CTC screening cohort (p < 0.0001). After applying an empiric correction factor based on results from the internal control group to account for technique-induced hernias, the estimated prevalence for the CTC cohort more closely matched that for the external control subjects.
Our findings suggest that small sliding hiatal hernias are commonly induced by colonic distention at CTC and should probably not be reported to avoid inappropriate diagnosis, workup, or treatment.
Available from: Dileta (Rutkauskaite) Valanciene
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Key words: virtual colonoscopy, CT colonography, colon cancer, colon polyps.
Colorectal cancer is a common malignancy that results in significant morbidity and mortality. It is a curable disease if detected early and may be prevented if precursor adenomas are detected and removed. One of noninvasive examination methods of the colon is computed tomography colonography. Computed tomography colonography has been shown to be sufficiently accurate in detecting colorectal neoplasia. Recent data about examination was collected from MEDLINE and Pubmed databases. This article reviews current indications, contraindications and methodology of computed tomography
colonography. We describe computed tomography colonography Reporting and Data System and discuss the accuracy of computed tomography colonography based on recent reports and literature data. We conclude that computed tomography colonography is safe and effective colon examination method, especially when carried out properly. Probability of complications of this procedure is very low with minimal discomfort for the patient. The noninvasive nature of computed tomography colonography may be attractive to patients, and the use of this modality may improve screening compliance and diagnostic rates.
Reikšminiai žodžiai: virtuali kolonoskopija, KT kolonografija, storosios žarnos vėžys, storosios žarnos polipai.
Storosios žarnos vėžys yra dažnai pasitaikantis piktybinis navikas su aukštais sergamumo ir mirtingumo rodikliais. Anksti nustačius šį vėžį, jis yra pagydomas, taip pat jo galima išvengti pašalinus jo pirmtakus adenomas. Vienas iš neinvazinių storosios
žarnos tyrimo metodų yra kompiuterinės tomografijos kolonografija. Iš literatūros šaltinių žinoma, kad kompiuterinės tomografijos kolonografija yra gana tikslus diagnostikos metodas ir gali aptikti gaubtinės bei tiesiosios žarnos neoplazijas. Šiame straipsnyje pateikiami „Medline“ ir „PubMed“ duomenų bazėse surinkti naujausi duomenys apie kompiuterinės tomografijos kolonografiją. Taip pat straipsnyje apžvelgiamos dabartinės indikacijos, kontraindikacijos ir kompiuterinės tomografijos kolonografijos metodikos. Aprašoma kompiuterinės tomografijos kolonografijos ataskaitų teikimo ir duomenų sistema, naujausi literatūros šaltiniai apie tyrimo tikslumą. Tinkamai atliekama kompiuterinės tomografijos kolonografija yra saugus ir veiksmingas storosios žarnos tyrimo metodas. Šios procedūros komplikacijų tikimybė yra labai maža, diskomfortas pacientui būna minimalus. Neinvazinė kompiuterinės tomografijos kolonografija gali būti pacientams patraukli ir galėtų pagerinti storosios žarnos vėžio atranką bei diagnostikos rodiklius.
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ABSTRACT: Background: The link between organizing pneumonia (OP) and gastroesophageal reflux disease (GERD) is not well known. There is little evidence in the literature to establish a causal link between GERD and OP. Objectives: The aim of the study was to assess the hypothesis that OP is more severe when it is associated with GERD and that it leads to more frequent relapses. Methods: In a retrospective study on 44 patients suffering from OP, we compared the clinical, radiological and histological characteristics of 2 groups, 1 composed of patients with GERD (n = 20) and the other of patients without GERD (n = 24). Results: The GERD group was distinguished by a higher number of patients with migratory alveolar opacities on chest radiography and thoracic computerized tomography (14/20 vs. 9/24; p = 0.03 and 18/20 vs. 13/24; p = 0.01), greater hypoxemia [60 (42-80) vs. 70 (51-112) mm Hg; p = 0.03], greater bronchoalveolar lavage cellularity [0.255 (0.1-1.8) vs. 0.150 (0.05-0.4) g/l; p = 0.035] and more frequent relapses (14/20 vs. 9/24; p = 0.03). Conclusions: OP associated with GERD is more severe and results in more frequent relapses. Microinhalation of gastric secretions might induce lung inflammation leading to OP and relapse. We suggest that typical symptoms of GERD such as pyrosis should be investigated in OP. © 2015 S. Karger AG, Basel.
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ABSTRACT: Hiatal hernia is a well-known factor impacting on most mechanisms underlying gastroesophageal reflux, related with the risk of developing complications such as erosive esophagitis, Barrett's esophagus and ultimately, esophageal adenocarcinoma. It is our firm opinion that an erroneous reporting of hiatal hernia in CT exams performed with colonic distention may trigger a consecutive diagnostic process that is not only unnecessary, inducing a unmotivated anxiety in the patient, but also expensive and time-consuming for both the patient and the healthcare system. The purposes of our study were to determine whether colonic distention at CT with water enema and CT colonography can induce small sliding hiatal hernias and to detect whether hiatal hernias size modifications could be considered significant for both water and gas distention techniques.
We retrospectively evaluated 400 consecutive patients, 200 undergoing CT-WE and 200 undergoing CTC, including 59 subjects who also underwent a routine abdominal CT evaluation on a different time, used as internal control, while a separate group of 200 consecutive patients who underwent abdominal CT evaluation was used as external control. Two abdominal radiologists assessed the CT exams for the presence of a sliding hiatal hernia, grading the size as small, moderate, or large; the internal control groups were directly compared with the corresponding CT-WE or CTC study looking for a change in hernia size. We used the Student's t test applying a size-specific correction factor, in order to account for the effect of colonic distention: these "corrected" values were then individually compared with the external control group.
A sliding hiatal hernia was present in 51 % (102/200) of the CT-WE patients and in 48.5 % (97/200) of the CTC patients. Internal control CT of the 31 patients with a hernia at CT-WE showed resolution of the hernia in 58.1 % (18/31) of patients, including 76.5 % (13/17) and 45.5 % (5/11) of small and moderate hernias. Comparison CT of the 28 patients with a hiatal hernia at CTC showed the absence of the hernia in 57.1 % (16/28) patients, including 68.8 % (11/16) and 50 % (5/10) of small and moderate hernias. The prevalence of sliding hiatal hernias in the external control group was 22 % (44/200), significantly lower than the CT-WE and CTC cohorts' prevalence of 51 % (p < 0.0001) and 48.5 % (p < 0.0001). After applying the correction factors for the CT-WE and the CTC groups, the estimated residual prevalences (16 and 18.5 %, respectively) were much closer to that of the external control patients (p = 0.160 for CT-WE and p = 0.455 for CTC).
We believe that incidental findings at CT-WE and CTC should be considered according to the clinical background, and that small sliding hiatal hernias should not be reported in patients with symptoms not related to reflux disease undergoing CT-WE or CTC: When encountering these findings, accurate anamnesis and review of medical history looking for GERD-related symptoms are essential, in order to address these patients to a correct diagnostic iter, taking advantage from more appropriate techniques such as endoscopy or functional techniques.
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