How the Workload and Outcome of Imaging Examinations Changed During the COVID-19 Pandemic Lockdown.

BACKGROUND: On March 9th, 2020, the Italian government decided to go into lockdown due to the COVID-19 pandemic, which led to changes in the workflow of radiological examinations. AIMS: Aim of the study is to illustrate how the workload and outcome of radiological exams changed in a community hospital during the pandemic. METHODS AND MATERIAL: The exams performed in the radiology department from March 9th to March 29th, 2020 were retrospectively reviewed and compared to the exams conducted during the same time-period in 2019. Only exams coming from the emergency department (ED) were included. Two radiologists defined the cases as positive or negative findings, based on independent blind readings of the imaging studies. Categorical measurements are presented as frequency and percentages, and p-values are calculated using the Chi-squared test. RESULTS AND CONCLUSIONS: There was a significant reduction in the amount of exams performed in 2020: there were 143 (93|65% male, 60.7±21.5 years) patients who underwent radiological examinations from the ED vs. 485 (255|53% male, 51.2±24.8 years) in 2019. Furthermore, the total number of ED exams dropped from 699 (2019) to 215 (2020). However, the percentage of patients with a positive result was significantly higher in 2020 (69|48%) compared to 2019 (151|31%) (p<.001). The reduction of emergency radiological examinations might be a result of the movement restrictions enforced during the lockdown, and possible fear of the hospital as a contagious place. This translated to a relative increase of positive cases as only patients with very serious conditions were accessing the ED.

[Actual role of MR in the small bowel studies: dynamic sequences and bowel distension]. / Attuali possibilità della RM nello studio dell'intestino tenue: sequenze dinamiche e distensione digiuno-ileale.

Magnetic resonance (MR) is even more becoming important in the evaluation of the small bowel, thanks to the technologic advances of the machines and thanks to the improvement of specific diagnostic protocols of study. MR is a pivotal in identifying acute stenosis and alterations of the bowel wall and in differentiating between inflammatory and fibrotic alterations. Diffusion techniques and dynamic MRI allows the assessment of the degree of disease activity of IBD, although nuclear medicine represents the gold standard.

[Multidetector CT for the assessment of the groin region]. / La TC multidetettore nello studio del canale inguinale.

Assessment of the complex anatomy of the groin region using different imaging modalities is important to identify those pathological conditions that may present with atypical symptoms. In obese patients or in the presence of complications, physical examination may be unremarkable and instrumental studies based on non-invasive techniques (e.g., ultrasounds) do not allow accurate assessment of this region. Multidetector CT scanning and reconstruction can provide useful information on inguinal canal anatomy and its related diseases, contributing to timely therapeutic interventions.

[Lymphoscintigrams with anatomical landmarks obtained with vector graphics]. / Linfoscintigrafie distrettuali e whole body associate a profilo anatomico modificabile, prodotte con tecnica vettoriale.

Nuclear medicine images are difficult to interpret because they do not include anatomical details. The aim of this study was to obtain lymphoscintigrams with anatomical landmarks that could be easily interpreted by General Physicians. Traditional lymphoscintigrams were processed with Adobe© Photoshop® CS6 and converted into vector images created by Illustrator®. The combination with a silhouette vector improved image interpretation, without resulting in longer radiation exposure or acquisition times.

[Atypical appearance of pneumatosis intestinalis at multidetector CT]. / Aspetto atipico della pneumatosi intestinale in TC multidetettore.

Pneumatosis intestinalis may be caused by bowel ischemia and may display different patterns of appearance. We report a case of pneumatosis intestinalis with an atypical target pattern, detected by multidetector computed tomography (CT) in a 66-year-old male presenting with acute abdominal syndrome. Abdominal CT scan showed a double gas collection within the wall of a jejunal segment, with a characteristic target air distribution. The patient was surgically treated and successfully discharged from our hospital with the diagnosis of acute bowel ischemia. The target air sign can be an initial CT finding of the typical pneumatosis intestinalis and it can be useful in the early diagnosis of bowel ischemia.

[Relapse of primary testicular non-Hodgkin's lymphoma detected by 18F-FDG-PET/CT]. / Recidiva muscolo-cutanea di linfoma non-Hodgkin primitivo del testicolo riconosciuta con 18F-FDG-PET/TC.

We report the case of a 62-year-old male with a history of primary testicular non-Hodgkin's lymphoma, treated with orchidectomy. After 14 months, the patient developed left leg swelling and pain, and was diagnosed and treated as having leg vein thrombosis. 18F-FDG-PET/CT showed a relapse of testicular lymphoma in the cutaneous muscle tissue of the left leg.

Postpartum hemorrhage: what every radiologist needs to know.

Postpartum hemorrhage is among the most common causes of maternal morbidity and mortality. Postpartum hemorrhage is defined as a blood loss of greater than 500 mL or any amount that, if not replaced, could cause shock or death in the mother. The most common cause of postpartum hemorrhage is uterine atony. This occurs when the normal myometrium fails to contract after delivery of the placenta. The initial treatment involves the administration of intravenous oxytocin and uterine massage. If the initial maneuvers fail to stop the postpartum hemorrhage, other techniques, such as uterine packing, suture techniques, uterine or hypogastric artery ligation, can be considered. In the last 30 years, a new angiographic approach for treatment of postpartum hemorrhage has emerged. Pelvic arterial embolization, after emerging as a treatment option to control and prevent pregnancy-related hemorrhage, has been established to be safe and effective. The goal of treatment for all causes of postpartum hemorrhage is cessation of bleeding in a timely fashion, before the onset of consumptive coagulopathy and end organ damage.