Preoperative evaluation of living kidney donors with multidetector computed tomography angiography.

OBJECTIVE: The purpose of this study was to determinate the accuracy of multidetector computed tomography (MDCT) angiography for imaging evaluation of renal anatomic variants among potential living renal donors for surgical planning. MATERIALS AND METHODS: Two hundred twenty-three living kidney donors underwent MDCT angiography (MDCTA) in our institution over the last 2 years. The examination was performed with a 4-detector scanner, including scanning before and after power injection of nonionic contrast material during the arterial, nephrographic, and excretory phases. Scans were reconstructed for three-dimensional (3D) images using MIP, MPR, VRT, and CPR techniques. RESULTS: Arterial variants, including supernumerary renal arteries, were present in 140 subjects: 11 presented luminal stenosis; 10 had calcifications within the vessel wall; 3 had renal artery aneurysms; 2 had obstructions; and 1 had angulation of the renal artery. Calcifications were associated with luminal stenosis (4 subjects) or no pathology (6 subjects). Venous variants were present in 4 subjects, including 3 retroaortic renal veins and 1 left renal vein draining into the retrohepatic portion of the IVC. Incidental findings were 3 renal infarcts. CONCLUSION: MDCTA and urography are a minimally invasive, fast method to detect and classify a variety of anatomic anomalies among potential living renal donors relevant to surgical planning.

The effect of environmental pollution on the respiratory system of lignite miners: a diachronic study.

BACKGROUND: It is not known whether working in surface lignite mines can cause x-ray lesions or disorders of respiratory function. OBJECTIVES: The aim of the study was to investigate the diachronic impact of environmental pollution on the respiratory system of lignite miners at mines in Eordea, Greece. METHODS: Cases of 199 workers (Group A) residing permanently in the Eordea valley and 151 (Group B) living outside the Eordea valley were studied during Phase I and then re-examined after three years (Phase II). These cases were compared to those of 71 office workers living in Eordea valley (Group C) and to 96 living in Grevena, a region without pollution (Group D). The study included the completion of the MRC questionnaire for the detection of respiratory diseases, pulmonary function tests, measurement of diffusion capacity, otorhinolaryngologic examination, rhinomanonetry as well as chest and paranasal cavity X-rays. RESULTS: Chronic bronchitis was reported by 26.8%, 24.8%, 17.9% and 10.6% respectively of the subjects of groups A, B, C and D according to the answers of the questionnaire (p<0.001). The spirometry and diffusion capacity findings presented no considerable differences either in the 4 groups or between phases I and II of the study. The main problems were detected in the upper airways. A very high prevalence of severe nasal obstruction (73%, 71.2%, 55.7% and 19.3% in Groups A, B, C and D respectively) was detected. Furthermore, a high percentage of atrophic rhinitis (14%) was detected both among workers (Groups A and B) and subjects living in the Eordea valley who participated as controls (Group C). From the X-rays, hypertrophy of nasal turbinates-cartilage and polyposis was observed as follows: Group A: 53.9%, Group B: 48.1%, Group C: 46.5% and Group D: 20.3% (p<0.001). The findings related to the upper respiratory system may be due to excessive pollution by airborne particles (fly ash) pollution in the region and particularly to chromium, nickel, cobalt and lead found at high concentration levels in airborne dust. A marked association between the total air-flow in the nose and the mid-expiratory flow (p<0.01) was detected. CONCLUSIONS: We conclude that subjects working in lignite mines under conditions of excessive pollution by airborne contaminants have a high prevalence of atrophic rhinitis and, in addition to other standard examinations, should undergo rhinomanometry testing and X-ray imaging of the paranasal cavities.

Imaging of an unusually located aggressive osteoblastoma of the pelvis: a case report.

INTRODUCTION: We present a case of an aggressive osteoblastoma involving the posterior acetabular column and the ischium, which is very rare location for the tumor. CASE PRESENTATION: A 21-year-old man presented with a persistent pain on the left buttock which extended on the rear surface of the thigh and the front surface of the left hip. A plain radiograph, a CT and MRI examinations were performed. The tumor was radically excised and histologically it proved to be an aggressive osteoblastoma. CONCLUSIONS: Although aggressive osteoblastoma is a rare entity it should be considered in the differential diagnosis of bone tumors. Our purpose is to reveal the radiographic presentation of this rare tumor.

The value of magnetic resonance arthrography of the temporomandibular joint in imaging disc adhesions and perforations.

OBJECTIVES: This study attempted to validate MR arthrography (MRAr) of the temporomandibular joint (TMJ) in detecting the position, integrity and relations of the articular disc and retrodiscal tissue. METHODS: A total of 20 TMJs from 10 patients with severe TMJ dysfunction underwent MRI and MRAr. A paramagnetic contrast medium was injected into the upper joint compartment to observe possible adhesions and/or leakage into the lower compartment. 15 TMJs were surgically or arthroscopically explored and restored. RESULTS: MRAr was approximately in the same diagnostic value as MRI when locating position, but superior in detecting disc perforations (eight TMJs) and adhesions (seven TMJs) appearing together in four cases. Surgery confirmed radiological findings in all but one case, where arthroscopy and surgery failed to confirm a disc perforation indicated by MRAr. CONCLUSIONS: TMJ MRAr may simultaneously reveal adhesions and perforations. Sensitivity and the probability of false-positive results require further study.

Mediastinal germ cell tumors: a radiologic-pathologic review.

Germ cell tumors of the mediastinum are histologically identical to those found in the testes and ovaries. Early diagnosis and treatment improve the survival rate. Imaging studies of teratoma demonstrate a rounded, often lobulated heterogeneous mass containing soft tissue elements with fluid and fat attenuation. Calcification is present in 20-43% of cases. Seminomas are large masses of homogeneous soft tissue attenuation. Malignant nonseminomatous germ cell tumors are heterogeneous tumors with irregular borders due to invasion of adjacent structures. CT shows the location and extent of the tumors as well as intrinsic elements including soft tissue, fat, fluid, and calcification. CT is the modality of choice for the diagnostic evaluation of these tumors. MRI reveals masses of heterogeneous signal intensity, is more sensitive in depicting infiltration of the adjacent structures by fat plane obliteration, and is performed as an ancillary study.

Albendazole treatment of cerebral hydatid disease: evaluation of results with CT and MRI.

We report a case of cerebral hydatid disease demonstrated by CT and MRI, treated with albendazole. Follow-up showed complete disappearance of the cysts with residual focal calcification on CT and presumed gliosis on MRI.

MRI appearance of pulmonary Wegener's granulomatosis with concomitant splenic infarction.

The MRI appearance of pulmonary lesions in a patient with Wegener's granulomatosis is presented. Pulmonary involvement was characterized by multiple solid and cavitated nodules connected to vessels. Transbronchial biopsy demonstrated typical findings of granuloma. The spleen presented diffuse low signal intensity and an enhancing capsule on T1-weighted images, and inhomogeneously high signal intensity on T2-weighted images. This appearance of diffuse infarction could result from the vasculitis caused by Wegener's disease.

CT of hemodynamically unstable abdominal trauma.

This article is an appraisal of the use of CT in the management of patients with unstable abdominal trauma. We examined 41 patients with abdominal trauma using noncontrast dynamic CT. In 17 patients a postcontrast dynamic CT was also carried out. On CT, 25 patients had hemoperitoneum. Thirteen patients had splenic, 12 hepatic, 6 pancreatic, 8 bowel and mesenteric, 12 renal and 2 vascular injuries. Seven patients had retroperitoneal and 2 patients adrenal hematomas. All but five lesions (three renal, one pancreatic, and one splenic) were hypodense when CT was performed earlier than 8 h following the injury. Postcontrast studies (n = 17), revealed 4 splenic, 3 hepatic, 1 pancreatic, 3 renal, and 2 bowel and mesenteric injuries beyond what was found on noncontrast CT. Surgical confirmation (n = 21) was obtained in 81.81% of splenic, 66.66% of hepatic, 83.33% of pancreatic, 100% of renal, 100% of retroperitoneal, and 85.71% of bowel and mesenteric injuries. The majority of false diagnoses was obtained with noncontrast studies. Computed tomography is a remarkable method for evaluation and management of patients with hemodynamically unstable abdominal trauma, but only if it is revealed in the emergency room. Contrast injection, when it could be done, revealed lesions that were not suspected on initial plain scans.