Role of CT in diagnosis of major arterial injury after blunt thoracic trauma.

The role of computed tomography (CT) in the diagnosis of blunt thoracic vascular injury is controversial. Several recent reports have advocated the use of CT to exclude aortic and major branch injuries in hemodynamically stable patients with blunt trauma. This approach potentially avoids invasive angiography and unnecessary treatment delays in multiply injured patients but risks missed aortic transections if the CT or its interpretation is not accurate. We prospectively evaluated 153 consecutive trauma patients in whom we suspected blunt aortic injury between September 1985 and August 1988. All hemodynamically stable patients underwent contrast-enhanced chest CT followed by immediate aortic arch angiography. Forty-nine unstable patients underwent immediate angiography without chest CT, and 11 (22%) had major thoracic arterial injuries. Data from the remaining 104 stable patients indicate that the sensitivity of chest CT for diagnosis of major thoracic injury is 55%; specificity, 65%. If the chest CT had been used as a screening modality to perform aortic angiography, two transected aortas and three major aortic branch injuries would have been missed. We conclude that chest CT has no screening role in the evaluation of blunt trauma patients with possible major vascular injury.

Internal carotid artery occlusion due to idiopathic cranial pachymeningitis.

A 35-year-old black woman had a 6-month history of headaches and a 1-month history of abducens nerve palsy. MR showed a mass in the sella and cavernous sinuses with encasement of the carotid artery. The mass enhanced intensely and homogeneously with Gd-DTPA. Arteriography revealed complete occlusion of the left internal carotid artery and severe stenosis of the C5 and C6 segments of the right internal carotid artery. Transsphenoidal biopsy of the mass led to the diagnosis of idiopathic cranial pachymeningitis.

Radiologic-pathologic correlation. Capillary hemangioma of the meninges.

Hemangiomas are the most common tumor of the head and neck in children, including intracranial neoplasms. Capillary hemangioma in turn is the commonest type of hemangioma. Our case establishes that its anatomic distribution may include the intracranial compartment. We were unable to distinguish capillary hemangioma from meningioma based on imaging findings alone.

Angiographic embolization for epistaxis: a review of 114 cases.

Angiography with selective embolization has become an accepted method of treating posterior epistaxis that is not controlled with conservative measures. The authors reviewed 112 cases of patients who had received selective angiographic embolization for refractory epistaxis from January 1990 to December 1995. There were 114 embolizations over this 5-year period. The immediate success rate was 93%, with long-term success achieved in 88% of patients. The overall complication rate was 17%, with the long-term morbidity rate less than 1%. Selective angiographic embolization is a safe and effective method that should be considered in the treatment of refractory epistaxis.

Usefulness of color Doppler ultrasound in the management of a spinal arteriovenous fistula.

BACKGROUND: While color Doppler ultrasonography and microvascular Doppler recordings have been used intraoperatively for spinal cord vascular malformations, they have not been employed for similar spinal cord lesions preoperatively. CASE DESCRIPTION: We report the usefulness of color Doppler ultrasonography through a lumbar laminectomy defect in the management of a spinal arteriovenous fistula. CONCLUSION: Color Doppler ultrasonography should be considered for spinal lesions in which a laminectomy defect is present.

CT appearance of mesenteric saponification.

Although saponification of the pancreas is a frequent finding on computed tomography, saponification of extrapancreatic mesenteric sites has not been previously recognized. A case is presented of acute pancreatitis in which serial scans over a four-year period documented calcifications in old extrapancreatic phlegmons. Saponification from pancreatitis should be considered in the differential diagnosis of mesenteric calcifications.

A radiology department intranet: development and applications.

An intranet is a "private Internet" that uses the protocols of the World Wide Web to share information resources within a company or with the company's business partners and clients. The hardware requirements for an intranet begin with a dedicated Web server permanently connected to the departmental network. The heart of a Web server is the hypertext transfer protocol (HTTP) service, which receives a page request from a client's browser and transmits the page back to the client. Although knowledge of hypertext markup language (HTML) is not essential for authoring a Web page, a working familiarity with HTML is useful, as is knowledge of programming and database management. Security can be ensured by using scripts to write information in hidden fields or by means of "cookies." Interfacing databases and database management systems with the Web server and conforming the user interface to HTML syntax can be achieved by means of the common gateway interface (CGI), Active Server Pages (ASP), or other methods. An intranet in a radiology department could include the following types of content: on-call schedules, work schedules and a calendar, a personnel directory, resident resources, memorandums and discussion groups, software for a radiology information system, and databases.

Small bowel obstruction due to enterolith: CT appearance.

A case of small bowel obstruction due to an enterolith presented on CT with a laminated appearance mimicking intussusception.

Vaginal reconstruction with rectus abdominis myocutaneous flap: CT findings.

The distally based rectus abdominis myocutaneous flap is used in a new technique for vaginal reconstruction after pelvic exenteration for malignant disease. We identified 27 patients who underwent this procedure, of whom eight had a total of 14 postoperative CT scans and two CT-directed biopsies. The myocutaneous flap appeared as a unilateral arcuate band of soft tissue extending from the linea alba to the rectal fascia or sacrum. Additional CT findings included asymmetric thinning of the ventral abdominal wall (7/8), fluid collections (2/8), vaginal breakdown (1/8), presacral soft-tissue thickening (6/8), and tumor recurrence (3/8). The postoperative CT scan reflects the altered anatomy produced by the surgery. Complications and recurrent disease can be recognized as deviations from the normal postoperative appearance.

Evaluation of splenic injury by computed tomography and its impact on treatment.

We reviewed 37 consecutive, hemodynamically stable patients (16 adults, 21 children) who had splenic injuries diagnosed by computed tomography (CT) scan to compare the CT evaluation with operative assessment of injury and eventual treatment. Computed tomographic scans and operative findings were graded by a splenic injury scoring system. Two patients were classified as having grade 1, 21 as grade 2, 11 as grade 3, and 3 as grade 4 splenic injuries. Computed tomography underestimated the degree of injury in 9 of 17 (53%) operated patients (mean CT score, 2.6; mean operative score, 3.3; p less than 0.01). Six of sixteen adults and 19 of 21 children were intentionally treated by observation. There were 5 treatments failures (20%), 3 due to bleeding and 1 each due to pancreatic injury and splenic abscess. The failure rate of observation was lower in children (16%) than in adults (33%), even though children had a higher Splenic Injury Score (2.4 versus 1.8). Patients who underwent an operation received twice as much blood as the observed group. There was no significant difference in Injury Severity Score or total fluid requirements between operated and observed patients. Operations increased in frequency in both adults and children as the injury score increased. This experience suggests that CT scan accurately determines the presence of splenic injury but commonly underestimates its severity. While children with grades 1 through 3 injuries are likely to be treated successfully with observation, adults who have more minor splenic injuries often fail observation and may be treated better by prompt operation.