MR imaging evaluation of the postoperative meniscus.

MR imaging has been widely evaluated in the assessment of patients with recurrent or residual symptoms following meniscal surgery. Importantly, the causes of such symptoms may relate to failure or complication of the surgical procedure, a possible recurrent or residual meniscal tear, or may be related to other causes of joint symptoms, including tears of the contralateral meniscus, or local hyaline cartilage, or marrow abnormalities subjacent to or distant to the meniscal surgical site. The complex diagnostic issues involved in the MR imaging evaluation of the postoperative meniscus were identified in early MR imaging studies. The knowledge of the normal MR imaging appearance of the knee after the more common repair procedures will allow radiologists to recognize complications associated with such procedures. In this article, we discuss the MR imaging evaluation of the knee after meniscal surgery.

Retrospective study of 23 cases of hepatic infarction: CT findings and pathological correlations.

PURPOSE: The aim of this study was to retrospectively review the cases of hepatic infarction diagnosed at our institute using conventional, spiral and multislice computed tomography (CT) over the last decade in order to describe its morphological and density characteristics and define its possible etiopathogenesis. MATERIALS AND METHODS: Twenty-three consecutive patients aged 27-65 years with hepatic infarction were studied by CT at our institute over a period of about 10 years. A conventional CT unit was used in seven patients, a helical CT scanner in ten and a multislice CT in six. CT was performed before and after the administration of 130-150 cc of contrast material infused at a rate of 3-3.5 ml/s. RESULTS: CT showed hepatic infarction due to arterial causes in 19 cases, 11 of which were in liver transplant patients. The infarction was related to right hepatic artery embolisation to control haemorrhage (one case), chemoembolisation of a multifocal hepatocarcinoma in a cirrhotic liver (one case), arterial mesenteric infarction due to thromboembolism (two cases), necrotising pancreatitis (one case), surgery in pancreatic cancer invading the hepatic artery (one case), pancreaticoduodenectomy (two cases), portal thrombosis in a young woman with pregnancy-related clotting disorder (one case), haemolytic anaemia, elevated liver enzymes, low platelet count (HELLP) syndrome (one case); eclampsia and disseminated intravascular coagulation (DIC) (one case) and acute exacerbation of Budd-Chiari syndrome (one case). At CT scans, hepatic infarction was depicted as a hypodense parenchymal area, at times triangular in shape, with sharp peripheral contours (12 cases) or as a rounded central or marginal area (four cases) with irregular appearance (three cases), with lobar extension (two cases) and ill-defined shape (two cases). Moreover, CT showed intralesional gas not correlated to bacterial infection (two cases). In all surgical cases, the results were confirmed by pathology. CONCLUSIONS: CT is the method of choice in the diagnosis of hepatic infarction, providing useful information regarding site, morphology, and extent of the lesion. Furthermore, in most cases, CT is able to suggest the possible aetiology and guide appropriate management.

[Upper gastrointestinal hemorrhage of unusual etiology: clinical case and technical note]. / Emorragia digestiva alta da causa rara: caso clinico e note di tecnica.

The Authors report a case of upper digestive tract haemorrhage at atypical side, the diagnosis being often difficult as well as therapeutical options, particularly referent to the surgical solutions adopted.

[The role of spiral computed tomography in sigmoid diverticulitis and the diagnostic-therapeutic implications]. / Ruolo della Tomorafia Computerizzata spirale nella diverticolite del sigma e implicazioni diagnostico-terapeutiche.

PURPOSE: Colonic diverticula are saccules made of colonic mucosa and submucosa that herniate from the colonic lumen through the muscular layer of the wall where straight vessels penetrate. Diverticula are localized in the sigmoid colon in 95% of cases. Bacteria pooling in the lumen may cause lumen erosion and eventually perforation. CT is a useful technique in this condition because it can demonstrate intra- and/or extramural inflammation. Aim of this retrospective study was to assess the capabilities of contrast-enhanced helical Computed Tomography (CT) in sigmoid diverticulitis, especially relative to selection of the appropriate treatment. MATERIAL AND METHODS: We retrospectively reviewed the findings of 41 patients referred to our emergency department for diverticulitis. CT scans were performed 65 seconds after i.v. injection of nonionic contrast material (3 mL/s, 120 mL in all) administered by a CT-power injector. The following 7 CT findings were considered at least suggestive of acute diverticulitis: focal wall thickening, intramural abscess, inflammatory changes in the sigmoid mesentery root, pericolic fat inflammation or pericolic abscess formation, fistula, peritonitis. CT results were compared with surgical and physical findings. RESULTS: Based on CT findings, diverticulitis was classified as mild (25 patients) or severe (15 patients). In mild diverticulitis we found: focal sigmoid wall thickening (6 patients), intramural abscess (3 patients), sigmoid mesentery root thickening (5 patients), edema fluid (8 patients) and phlegmon (3 patients). In severe diverticulitis we found: sigmoid mesentery abscess (6 patients), fistula (5 patients) and peritonitis (4 patients). CT findings were questionable in 1 case and thus we could not exclude a perforated carcinoma. CONCLUSION: Contrast-enhanced helical CT is the imaging modality of choice in assessing mild or severe acute diverticulitis because it provides useful information for appropriate treatment planning in the emergency setting. This technique is most useful in questionable cases and in patients with suspected severe diverticulitis where a choice must be made between different treatment options.

[Traumatic liver injuries: advances in diagnostic and therapeutic methods]. / Lesioni traumatiche del fegato: evoluzione delle strategie diagnostico-terapeutiche.

One hundred five patients affected by traumatic rupture of the liver were admitted in the Emergency Surgical Unit at Ospedale "A. Cardarelli" in Napoli over a period of five years. In 40 patients a conservative treatment was applied, monitoring red blood count, and haemoglobin values as well as abdominal ultrasound and CT scans. The remaining 65 patients underwent surgery for liver trauma. Twelve out of 65 patients presented with an hepatic injury alone whereas in 53 liver injury was associated with other lesions, as splenic rupture, kidney hematoma, bone fracture, chest trauma, diaphragmatic or cranial injury. Eleven out of 65 patients underwent postoperative complications such as bile collection (nine) and biliary fistula (two); however, none of these complicated patients died or underwent further surgery. On the basis of their data the Authors conclude that a careful preoperative assessment and the monitoring of haemodynamic pattern are advisable in patients with liver trauma, allowing the choice of a conservative treatment whenever possible. In the patients undergoing surgical treatment, a more conservative approach should be advocated, with a wider use of intraparenchymal haemostasis and packing, both to improve the haemodynamic status and to refer the patient to specialized units.

Spontaneous splenic rupture in a patient with acute lymphoblastic leukemia of Burkitt type.

We describe a case of spontaneous splenic rupture occurred in a patient with acute lymphoblastic leukemia of Burkitt type before starting cytotoxic chemotherapy. Left hypochondrial pain radiating to the homolateral shoulder was the only clinical symptom. Emergency computed tomography showed splenic laceration and hemoperitoneum. The patient underwent immediate laparatomy with splenectomy and experienced an uneventful postoperative recovery. Eight days after surgery, chemotherapy could be administered and complete remission was achieved. Although spontaneous rupture of the spleen is rare in leukemia and related disorders, this diagnosis should be taken in account also when clinical symptoms are mild. Following immediate operative management, patients may completely recover and receive cytotoxic chemotherapy with substantial possibilities of achieving complete remission.

[Gallbladder blunt trauma: comparison between radiologic and anatomo-surgical findings]. / Traumi chiusi della colecisti: confronto tra reperti radiologici e anatomo-chirurgici.

PURPOSE: To assess the diagnostic accuracy and the possible role of ultrasonography (US) and Computed Tomography (CT) in a small group of patients who had a blunt abdominal trauma involving the gallbladder. MATERIAL AND METHODS: We retrospectively reviewed the US and CT findings of five patients with surgically confirmed post-traumatic gallbladder injury. The whole series consisted of 196 consecutive patients submitted to laparotomy for blunt abdominal trauma in the past 7 years. The following US and CT findings were considered at least suggestive of a possible post-traumatic gallbladder injury: pericholecystic fluid collection, ill-defined wall margin, collapsed lumen, high intraluminal density. RESULTS: At surgery, the following findings were observed: gallbladder hematoma (1 case), acute colecystitis (1 cases), gallbladder tear (3 cases), gallbladder tear associated with post-traumatic hepatic injuries (2 cases), duodenal tear (2 cases), hemoperitoneum alone (2 cases), hemoperitoneum associated with choleperitoneum (1 case), choleperitoneum alone (1 case). The US and CT findings were pericholecystic fluid collections (4 cases), ill-defined gallbladder wall margins (3 cases), collapsed lumen with intraluminal high density (1 case) and free intraperitoneal fluid collections (4 cases). They were suggestive of a possible post-traumatic gallbladder injury in all the five patients. CONCLUSIONS: The radiologic findings of our five patients were suggestive of a gallbladder damage but did not permit to distinguish minor from major injuries, the latter requiring surgical treatment. US proves to be a useful screening tool which can also help timing surgery in these patients. CT confirmed the US suspicions and also permitted accurate assessment of associated post-traumatic injuries to the liver and duodenum. Nevertheless, the clinical presentation was the most important factor as to the therapeutic management of these blunt abdominal trauma patients.

[Computerized tomography of osteochondral diseases of the talus dome]. / La Tomografia Computerizzata nella valutazione delle malattie osteocondrali della cupola astragalica.

The definition "osteochondritis dissecans" of the talus improperly includes a variety of diseases involving the chondral surface of the talus dome and the relative subchondral bone. To investigate the CT diagnostic potentials in the study of these conditions, 35 patients complaining of a "painful ankle" were examined with plain radiography and axial and direct paracoronal CT over a 2-year period. Twelve patients were then examined with double contrast CT arthrography with air and iodated contrast agents. CT diagnostic accuracy was assessed evaluating the following parameters: the presence and extent of the subchondral bone fragment, the presence of residual bone fragment attachment at the lesion base or its intraarticular dislocation, the presence of subchondral bone cysts, of chondral surface lesions and, finally, of capsular and ligamentous damage. All the patients with CT findings of osteochondral conditions of the talus dome were submitted to arthroscopic examination/treatment and/or surgical arthrotomy. Baseline CT exams accurately depicted all the lesions, except for early (grade I) lesions. Moreover, the administration of intraarticular contrast agent (CT arthrography) increased the diagnostic accuracy in articular cartilage studies. Therefore, the authors believe baseline CT on the orthogonal planes to represent an effective tool for the staging of osteochondral talar lesions and for accurate treatment planning.

[Blunt trauma of the larynx: comparative assessment of computerized tomography, conventional radiology, and laryngoscopy]. / Traumi chiusi della laringe: valutazione comparativa tra Tomografia Computerizzata, radiologia tradizionale e laringoscopia.

We report on the retrospective analysis of a series of 11 patients with blunt laryngeal injuries examined with Computed Tomography (CT), conventional radiology and laryngoscopy, to compare the diagnostic yield of each technique. Conventional frontal and lateral radiographs showed subcutaneous emphysema in 5 patients, with soft tissue swelling in 4, and thus failed to assess the degree of damage adequately. Cross-section CT showed cartilaginous injuries in 5 patients and adjacent soft tissue changes in 9, thus allowing rapid and accurate assessment of airway damage even in emergency. Laryngoscopy showed laryngeal mucosal tears in 3 patients, with decreased motion of the left true vocal cord in one patient and of both true vocal cords in another, associated with the upward dislocation of arytenoid cartilage. Moreover, laryngoscopy showed a mucosal tear in the hypopharynx in one patient. Comparative CT and laryngoscopy assessment showed, in two cases, that CT can demonstrate even minimal peripharyngeal and perilaryngeal air images which are suggestive of posttraumatic mucosal tears. Thus, CT appears the most valuable diagnostic tool to study the injured larynx.

[Magnetic resonance in the diagnosis and follow-up of soft-tissue sarcomas]. / La Risonanza Magnetica nella diagnosi e nel follow-up dei sarcomi dei tessuti molli.

The authors analyze the advantages of MR imaging in the detection, staging and follow-up of malignant soft-tissue sarcomas. The role of MR imaging is retrospectively evaluated in 34 patients (16 men and 18 women) ranging in age from 3 to 82 years (mean: 38); 19 of them had a primary neoplasm, while the extant 15 patients were examined after surgery, and residual or recurrent tumors were present. Ten examinations were performed on an 0.5 T imager (CGR Magniscan 5000), and 27 were obtained with a 1.5 T system (Magnetom 42 SP Siemens). In all cases T1 and T2 sequences were acquired; in 3 patients T1-weighted sequences were performed after Gd-DTPA administration. In the 19 patients with primary tumors pathologic specimens were obtained. The value of MR imaging in the evaluation and characterization of soft-tissue sarcomas and its capabilities in detecting neurovascular encasement and bone involvement are discussed. Post-Gd-DTPA scans may help in the differentiation of necrotic areas from active tumors. MR diagnostic criteria of malignancy, including tissue heterogeneity and irregular margins, were not fulfilled in 3 of the studied cases.