Computed Tomography: A Valuable Aid to the Abdominal Surgeon Avram M. Cooperman, MD, Cleveland, Ohio John Haaga, MD, Cleveland, Ohio Ralph Alfidi, MD, Cleveland, Ohio Ezra Steiger, MD, Cleveland, Ohio Robert Hermann, MD, Cleveland, Ohio Computed tomography (CT) was developed by Hounsfield [I] and Ambrose [Z] for the study of intracranial disease. This computerized scanner has simplified the evaluation and diagnoses of intracra- nial pathology. Recently CT has been utilized to evaluate intrathoracic, intra-abdominal, and retro- peritoneal disease [3-51. This paper illustrates the value and potential applications of CT in the diag- nosis of intra-abdominal disease. Material and Methods At the Cleveland Clinic from November 19’74 to April 1976, more than 1,000 patients have had CT of the abdo- men. This procedure was performed to diagnose, to obtain a biopsy, and at times to treat intra-abdominal disease. The-patient is brought to the radiology suite and posi- tioned on the scanning table. The angle of the scanning gantry is adjusted for each examination. The instrument scans axially through an arc of 180°, obtaining two simul- taneous adjacent thicknesses in a period of 2.25 minutes. The scanner is equipped with a black and white and color display and Polaroid camera. A digital printout is available as well. Slice thickness is 1.3 cm and all scanning is done at 130 kv. On the newer machines a “cursor circle” allows computation of densities which range from 0 “water ref- erence” H to +l,OOO “bone” H and 1,000 “air” H. A normal CT scan of the upper abdomen is shown in Figure 1. The organs seen in cross section are labelled. From the Departments of General Surgery and Radiology, the Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio. Reprint requests should be addressed to Avram M. Cooperman. MD. Department of General Surgery, the Cleveland Clinic Foundation; 9500 Euclid Avenue, Cleveland, Ohio 44106. Presented at the Seventeenth Annual Meeting of the Society for Surgery of the Alimentary Tract, Miami Beach, Florida, May 25-26, 1976. Case Reports Case I. A fifty-six year old woman with epigastric pain and malaise and 50 pound (22.7 kg) weight loss had a large 15 X 20 cm right upper quadrant abdominal mass. A lap- arotomy was performed and a diagnosis of hepatoma made by biopsy. The lesion involved the entire right lobe and questionably a portion of the left lobe of the liver as well. She was transferred to the Cleveland Clinic Hospital in February 1976 where selective angiography revealed a large tumor arising in the right lobe of the liver. CT revealed the lesion in cross section to be confined to the right lobe and a right hepatic lobectomy was performed. (Figures 2A- c.1 Case II. A thirty-nine year old man was referred to the Cleveland Clinic in May 1975 because of crampy abdominal pain, flushing, diarrhea, and hepatomegaly. A diagnosis of Figure I, A normal CTscan of the upper abdomen. The liver (L), pancreas (P), aorta (A), and kidney (K) are dem- onstrated. Volume 133, January1977 121