Left side jejunal diverticulitis: US and CT imaging findings.

Small bowel jejunoileal diverticulosis is an uncommon and usually asymptomatic condition. Complications may occur such as acute diverticulitis including infection or perforation, bleeding, small bowel obstruction and volvulus. Herein we report a case of a 76 years-old woman with acute left side abdominal pain and tenderness. A clinical suspected diagnosis of colonic diverticulitis was formulated. She underwent Ultrasound that revealed a collapsed small bowel loop with a large sac-like out-pouching lesion with mixed content (fluid and pockets of air) associated to hyperechogenicity of perilesional fat. Because of the atypical US findings, the patient underwent abdominopelvic CT that confirmed that the large sac-like out-pouching was a jejunal inflamed diverticulum. The patient underwent emergency surgery. Radiologist should be aware of imaging findings of jejunoileal diverticulitis in order to achieve a prompt diagnosis.

Gross hematuria: Renal cell carcinoma mimicking a renal arteriovenous malformation.

The differential diagnosis between renal arteriovenous malformations (AVM) and cancer may be a challenge, due to the similar clinical and imaging findings. Herein, we report the case of an 80-year-old male patient presenting gross hematuria, initially diagnosed and treated with embolization for a renal AVM. Due to the recurrence of hematuria and rapid progression and changes of the vascular lesion with detection also of an intralesional solid nodule, a radical nephrectomy was performed revealing the presence of a renal cell carcinoma (RCC). Renal cell carcinoma and renal AVM can be difficult to differentiate from one another, for this reason a short-term follow-up should be carried out in patients diagnosed and treated for renal AVM to confirm the resolution of AVM or to assess any changes, such as atypical neovascularization or intralesional renal masses, which may increase the suspect of a hidden renal tumor.

Gastric outlet obstruction in uncomplicated mesentero-axial gastric volvulus associated to hiatal hernia.

Gastric volvulus is a rare condition determined by the rotation of one part of stomach around another. Stomach can rotate around its longitudinal or short axis or both. The presentation can be acute, subacute and chronic due to twisting and untwisting andimaging should be performed in the acute phase. MDCT shows high accuracy in thediagnosis and definition of gastric volvulus being the preferred diagnostic test in emergency settings. Gastric volvulus may be associated or determined by pre-existing hiatal hernia and accurate analysis of CT signs may be evaluated on order to differentiate between a stomach in an abnormal position and a volvulus.At CT, a displaced antrum at the same level or cranial to the fundus and a transition point at the pylorus is diagnostic for mesenteroaxial volvulus. We present a case of a 70 years old woman with mesenteroaxial volvulus in hiatal hernia.

CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer.

PURPOSE: To identify CT prognostic signs of poor outcomes in acute obstructive colonic cancer (AOCC). METHODS: Demographic, clinical, laboratory, radiological and surgical data of 65 consecutive patients with AOCC who underwent emergency surgery were analyzed. CT exams were reviewed to assess diameters of cecum, ascending, transverse, descending, and sigmoid proximal to the tumor; colon segments' CD/L1-VD ratios, continence of the ileocecal valve, small bowel overdistension, presence of small bowel feces sign and cecal pneumatosis. Post Operative complications (PO), according to the Clavien-Dindo classification, were analyzed. RESULTS: Gender, age and location of the tumor were not predictive factors of complications. Among laboratory exams, CRP was the most important predictive value of PO (OR 8.23). A cecum distension ≥ 9 cm represented the critical diameter beyond which perforation and cecal necrosis were found at surgery. Cecal pneumatosis at CT was correlated with cecal necrosis at surgery in < 50% of patients. Pre-operative transverse colon CD/L1-VD ratio ≥ 1.43 and descending colon CD/L1-VD ratio ≥ 1.31 were associated with the development of PO (grade ≥ III-V). PO (grade ≥ III-V) occurred in 18/65 patients. CONCLUSION: Postoperative complications in emergency surgery of AOCC were not related to the age, sex and tumor's location. Preoperative PCR values (≥ 2.17) predict the development of postoperative complications. CT resulted a valid diagnostic tool to identify patients at higher risk of complications: a CD/L1-VD ratios with cut-off values of 1.43 (transverse) and 1.31 (descending) predicted major complications (grade ≥ III-V) and a cecum distension ≥ 9 cm represented the critical diameter beyond which perforation occurred in > 84% of patients.

MRI Assessment of Cesarean Scar Pregnancies: A Case Series.

Cesarean scar pregnancies (CSPs) are a type of ectopic pregnancy that occur when an embryo implants within the fibrous scar tissue of a previous cesarean surgery. If not promptly detected and treated, CSPs can result in serious maternal complications, such as uterine rupture and hemorrhage. TVUS (transvaginal ultrasonography) represents the imaging of choice for the diagnosis of CSPs; however, recent studies proposed a complementary role of MRI due to its capability in soft tissue characterization that may impact the therapeutical decision-making process. The purpose of our study was to explore the role of MRI in the diagnosis and its impact on therapeutical options in CSPs. Our experience showed that MRI has a complementary role to TVSU in correctly diagnosing CSPs, identifying the type, and guiding the therapeutical approach.

Gunshot vaginal trauma.

Nonobstetric vaginal or vulva trauma is an extremely rare occurrence, with an incidence of < 0.2% of traumas. CT represents the gold standard in the diagnosis of gunshot lesions due to its ability to detect and stage injuries with very high sensitivity and specificity. A standardized protocol for penetrating trauma is still under debate for the use of intravenous contrast only or also rectal and oral contrast. Herein, we report a case of gunshot vaginal trauma in a 43-year-old patient presenting with vaginal bleeding. In our case, the protocol was "patient's tailored," the intravaginal selective use of air was administered due to symptoms (vaginal bleeding) and CT findings, this 2-step protocol increased diagnostic confidence and allow a correct and challenging diagnosis.

Traumatic segmental renal infarction due to renal apical artery thrombosis by minor blunt abdominal trauma: the role of CEUS.

Post-traumatic segmental renal infarction is an extremely rare event, especially in case of minor blunt abdominal trauma. While major trauma guidelines are well established, several problems account for the adequate management of minor trauma. Herein, we report a case of minor blunt abdominal trauma determining traumatic thrombosis of the apical renal artery and segmental renal infarction, firstly diagnosed by CEUS in emergency care setting.

Advanced Cardiac Imaging and Women's Chest Pain: A Question of Gender.

Awareness of gender differences in cardiovascular disease (CVD) has increased: both the different impact of traditional cardiovascular risk factors on women and the existence of sex-specific risk factors have been demonstrated. Therefore, it is essential to recognize typical aspects of ischemic heart disease (IHD) in women, who usually show a lower prevalence of obstructive coronary artery disease (CAD) as a cause of acute coronary syndrome (ACS). It is also important to know how to recognize pathologies that can cause acute chest pain with a higher incidence in women, such as spontaneous coronary artery dissection (SCAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) gained a pivotal role in the context of cardiac emergencies. Thus, the aim of our review is to investigate the most frequent scenarios in women with acute chest pain and how advanced cardiac imaging can help in the management and diagnosis of ACS.

Case Series of MRI and CT Assessment of Acquired Hepato-Biliary and Pancreatic Transdiaphragmatic Fistulae.

Transdiaphragmatic fistulae are rare conditions characterized by pathological communication between two epithelium-lined surfaces. Hepato-thoracic fistula consists of abnormal communication between the liver and/or the biliary system and the thorax; while the pancreaticopleural fistula consists of abnormal communication between the pancreas and the thorax, the pleuro-biliary fistula represents the more common type. Clinical symptoms and laboratory findings are generally non-specific (e.g., thoracic and abdominal pain, dyspnea, cough, neutrophilia, elevated CPR, and bilirubin values) and initially, first-level investigations, such as chest RX and abdominal ultrasound, are generally inconclusive for the diagnosis. Contrast-enhanced CT represents the first two-level radiological imaging technique, usually performed to identify and evaluate the underlying pathology sustained by transdiaphragmatic fistulae, their complications, and the evaluation of the fistulous tract. When the CT remains inconclusive, other techniques such as MRI and MRCP can be performed. A prompt and accurate diagnosis is crucial because the recognition of fistulae and the precise definition of the fistulous tract have a major impact on the management acquisition process.

Bimekizumab treatment in patients with moderate to severe plaque psoriasis: a drug safety evaluation.

INTRODUCTION: Biological treatments deeply changed the management of moderate-to-severe forms of psoriasis. Among the available biological therapies, interleukin (IL)-17 inhibitors, secukinumab, ixekizumab, brodalumab, and bimekizumab represent one of the most rapid and effective biologic classes available for psoriasis. Bimekizumab, the latest available IL-17 inhibitor, is a humanized monoclonal immunoglobulin (Ig)G1 antibody that acts by neutralizing both IL-17A and IL-17F, showing a unique mechanism of action differing from ixekizumab and secukinumab (selective IL17A inhibitor), as well as brodalumab (antagonist of IL17 receptor). AREAS COVERED: This review aims to evaluate the safety profile of bimekizumab in the treatment of moderate-to-severe plaque psoriasis. EXPERT OPINION: The efficacy and safety of bimekizumab have been reported by several phase II and III clinical trials, even in a longer-term period. Moreover, clinical trials also showed bimekizumab to have significantly higher efficacy compared to other biological classes, including anti-TNF, anti-IL-12/23, and even to another IL-17 inhibitor, secukinumab. Although numerous biologics are currently available for psoriasis, some patients may result resistant to other treatments and/or experience psoriatic flares during or after treatment withdrawal. In this scenario, bimekizumab may represent an additional valuable alternative for patients with moderate-to-severe forms of psoriasis.

MDCT Diagnosis and Staging of Xanthogranulomatous Pyelonephritis.

Background: Benign nephrectomy to treat patients with renal inflammatory disease in cases of severe urinary infection represents a diagnostic and management challenge because of significant inflammatory, fibrotic, and infectious components. Among renal inflammatory diseases, fistulization and invasiveness to adjacent structures are some of the hallmarks of xanthogranulomatous pyelonephritis (XGP). The aims of this study were as follows 1. to retrospectively determine key demographic and clinical features of XGP among benign nephrectomies; 2. to assess the CT preoperative diagnostic accuracy; and 3. to define the imaging characteristics of the CT stage. Material and Methods: A retrospective review of clinical, laboratory, and radiological features and operative methods of patients who underwent benign nephrectomy with histologically proven XGP was performed. Results: XPG was diagnosed in 18 patients over a 4-year (2018-2022) period. XGP represented 43.90% among benign nephrectomies. The mean age of the patients was 63 years, and the sex prevalence was higher in women (72.22%). Symptoms were vague and not specifically referrable to urinary tract disorders and unilateral (100%), with the left kidney affected in 61.11% of cases. Staghorn calculi and stone disease were the most common underlying cause (72.22%). All patients underwent CT. The preoperative CT imaging accuracy for renal inflammatory disease was 94.44% and indeterminate in 5.56%. A suspected diagnosis of XGP was formulated in 66.67% (12/18; 2 stage II/10 stage III), meanwhile, in 33.33% (6 patients with stage I), a non-specific diagnosis of renal inflammatory disease was formulated. CT was reported according to the Malek and Elder classification and staged in the stage I nephric form (33.33%), stage II perinephric form (11.11%), stage III paranephric form (55.56%). Conclusions: The CT diagnostic accuracy for kidney inflammatory disease was extremely high, whereas the suspected diagnosis of XGP was formulated preoperatively in only 66.67% of high-stage disease, where the hallmarks of invasiveness and fistulization of the pathology increased the diagnostic confidence.

Preaxial polydactyly of the foot in an adult patient diagnosed by X-ray after a trauma.

Polydactyly, or hyperdactyly, is a frequent malformation, with a reported incidence between 0.37 and 1.2 per 1000 live births. Most cases encountered in medical practice are sporadic cases, usually presenting one-sided manifestations. More frequently, polydactyly can be detected prenatally through an ultrasound examination, if not, it is usually diagnosed at birth, during the first physical examination. Although the clinical diagnosis is relatively easy in patients with manifest cases, it can sometimes be present with mild or partial forms that are not clinically evident on physical examination, resulting in later diagnosis and treatment. We reported a particular case of polydactyly of the foot not clinically manifest, diagnosed in a 39-year-old Caucasian Male patient with a history of recurrent localized pain in the big toe often associated with subungual bleeding, since he was a child who came to our emergency room following a car accident. Polydactyly is a frequently reported congenital malformation which may present in many different varieties of deformities. In this case, the X-ray, which was required after a car accident, leads to the incidental diagnosis of polydactyly in an adult patient. As described, because of the functional limitations related to this malformation, as well as to limit recurrent pain, and subungual anomalies, the patient underwent to a surgical correction to improve its quality of life.

The Role of Teledermatology During the COVID-19 Pandemic: A Narrative Review.

Teledermatology represented one of the most important and useful tools during the COVID-19 pandemic era. Indeed, due to the severe restriction, and to reduce the spread of the infection, different measures were applied among different countries and hospitals to ensure a continuity of care for patients. In this scenario, teledermatology played a central role, especially in the management of patients suffering from chronic inflammatory skin diseases. The aim of this narrative review is to describe the role of teledermatology during the COVID-19 pandemic to analyze main strengths and limitations of this tool, as well as to provide future perspectives in clinical applications.

Strategies to Improve Outcomes of Bullous Pemphigoid: A Comprehensive Review of Clinical Presentations, Diagnosis, and Patients' Assessment.

Bullous pemphigoid (BP) is the most frequent autoimmune bullous disease mainly affecting elderlies. Diagnosis usually results from clinical features, histological examination, and the quantification of circulating typical autoantibodies, due to its higher incidence in elderly patients, bullous pemphigoid treatment and management still represents a challenge due to the higher frequency of several comorbidities in this group of patients, which may also be linked to a reduced tolerance to BP treatments. Hence, an early diagnosis and a prompt correct treatment are mandatory to reach better clinical outcomes and improve as much as possible BP outcomes. Herein, we carried out a comprehensive literature review about the known clinical presentations, diagnosis, assessment and monitoring procedures used in daily clinical practice in patients with BP, to better define strategies to improve as much as possible BP clinical outcomes.

MRI in Pregnancy and Precision Medicine: A Review from Literature.

Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy.