Real-life experience with liver iron concentration R2 MRI measurement in patients with hemoglobinopathies: baseline data from LICNET.

BACKGROUND: Real-life data on the use of R2 MRI for the assessment of liver iron concentration (LIC) remain limited. METHODS: We conducted a cross-sectional analysis on 363 patients (mean age 35.6 yr, 44.1% men) with hemoglobinopathies (204 ß-thalassemia major [TM], 102 ß-thalassemia intermedia [TI], and 57 sickle cell disease [SCD]) that were evaluated with R2 MRI as part of LICNET, an MRI network of 13 Italian treatment centers. RESULTS: The mean LIC was 7.8 mg/g (median: 4.0), with high LIC (>7 mg/g) noted in both transfused (TM, TI 37%; SCD 38%) and non-transfused (TI 20%) patients. Ferritin levels correlated with LIC in both transfused (TM, TI, SCD) and non-transfused (TI) patients (P < 0.001), although lower values predicted high LIC in non-transfused patients (1900 vs. 650 ng/mL in TM vs. non-transfused TI). A correlation between LIC and ALT levels was only noted in HCV-negative patients (rs = 0.316, P < 0.001). The proportion of patients with high LIC was significantly different between iron chelators used (P = 0.023), with the lowest proportion in deferasirox (30%) and highest in deferiprone (53%)-treated patients. CONCLUSIONS: High LIC values persist in subgroups of patients with hemoglobinopathy, warranting closer monitoring and management optimization, even for non-transfused patients with relatively low ferritin levels.

Congenital Ventricular Diverticulum.

Herein, we describe a 54-year-old patient with a congenital ventricular diverticulum (CVD), referred to our emergency department for presyncope episodes and multiple re-entrant ventricular tachycardias (VT). Significantly, echocardiographic findings were not clear, and the diagnosis was made by cardiac magnetic resonance imaging (CMRI), which showed the presence of an apical accessory cavity connected to the ventricle and contracting synchronously. CMRI allowed the differential diagnosis with other outpouching cardiac defects. The patient underwent a subcutaneous implantable cardioverter defibrillator (S-ICD) implant and was referred for heart transplantation (HT). The diagnosis, treatment, and main findings of the CVD are discussed in this case report.

Acute aortic dissection in a young man with bilateral Covid-19 pneumonia: A suggestive case report at Computed Tomography Angiography.

Acute Aortic Dissection (AAD) is one of the most common lifethreatening diseases that affects the aortic vessel. An its immediate and accurate diagnosis is crucial to initiate the appropriate treatment. The Covid-19 Coronavirus infectious pandemic started since December 2019 and was declared a pandemic by the World Health Organization in March 2020. It caused mainly bilateral interstitial pneumonia, up to causing a severe respiratory failure for the patients, and other complications. Now, we describe the case of a young man that was admitted to our hospital and was found positive for the Coronavirus disease 2019 (Covid-19). While we were performing Computed Tomography (CT) scan of the chest, we had suspected the concomitant presence of an aortic dissection, which was then immediately confirmed by Computed Tomography Angiography (CTA) study, that we had performed to complete the baseline CT scan.

A simultaneous superior mesenteric arterial and venous thrombosis in an elderly woman with a previous COVID-19 pneumonia: A suggestive case report diagnosed at computed tomography angiography.

Superior mesenteric artery (SMA) and superior mesenteric vein (SMV) thrombotic occlusion is a rare but potentially fatal condition. Though isolated mesenteric arterial occlusion associated with COVID-19 has been reported in literature, combined superior mesenteric arterial and venous thrombosis is very rare. We report the case of an 88-years-old woman with a combined superior mesenteric arterial and venous thrombotic occlusion with a previous COVID-19 pneumonia of about 15 days before, diagnosed at computed tomography angiography (CTA) scan. CTA had an important key-role for the diagnosis and evaluation of the severity of the mesenteric venous and arterious thrombosis.

A suggestive case report of acute mesenteric venous thrombosis diagnosed at Computed Tomography Angiography.

Acute mesenteric venous thrombosis (MVT) is a rare but potentially fatal condition with superior mesenteric vein being the most common site of thrombosis development. It is more common in patients with underlying disorders which cause disruptions to Virchow's Triad of hypercoagulability, stasis and endothelial injury. The disease is often associated with intestinal ischemia in its acute form, further complicating its management. We present a case of acute superior mesenteric venous thrombosis, in a 65 years old man with initial features of intestinal infarction, diagnosed at Computed Tomography Angiography (CTA) scan. However, the patient was stable, with a nonperitonitic abdomen, and was subsequently managed with conservative measures.

Bilateral acute pulmonary embolism and Covid-19 pneumonia: CT findings.

Since the widespread of acute respiratory syndrome infection caused by coronavirus-19, unenhanced computed tomography (CT) was considered a useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated Covid-19 pneumonia. If there is clinical or laboratory suspicion of pulmonary embolism complicating Covid-19 pneumonia, CT angiogram of the pulmonary arteries may be necessary. Here we describe the case of a 52 years old man, affected by a high-risk myelodysplastic syndrome patient, with Covid-19 pneumonia, complicated by a bilateral massive acute pulmonary embolism. An unenhanced CT and then a CT pulmonary angiography were made, and the patient was immediately hospitalized and treated.

Retroperitoneal hematoma by different causes: Presentation of two emergency cases at computed tomography.

Retroperitoneal hematoma is a rare clinical entity with variable aetiology, which is increasing in incidence mainly due to complications related to interventional procedures. The causes of RE are different. We present 2 suggestive cases of RE, one for renal cause and another of adrenal origin. Both came to our attention as a matter of urgency. Retroperitoneal hematoma, therefore, originated from different causes, with consequent different treatments. Both cases were diagnosed, as a matter of urgency, thanks to the use of contrast Computed Tomography, which allowed a rapid diagnosis, careful specialist evaluation, a monitoring of their clinical conditions, and a consequent adequate outcome for the patients.

Pericardial and pleural effusion in an elderly woman with Covid-19 pneumonia: CT findings.

Coronavirus-19 disease is an acute respiratory syndrome infection that primarily infects the lungs, and may extend to other organs such as the cardiovascular system. Here we describe the case of a 90-year-old woman, affected by heart failure (NYHA, class III), with bilateral Covid-19 pneumonia, complicated by pleural and pericardial effusion. An unenhanced Computed Tomography, urgently made, allowed to hospitalize and treat the patient, monitoring her clinical situations.

A pulmonary hamartoma in Covid-19 pneumonia: an interesting case studied with computed tomography.

Since the widespread of acute respiratory syndrome infection caused by Coronavirus-19, chest computed tomography (CT) was considered a useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated Covid-19 pneumonia. Many typical imaging features of this disease were carefully described with chest CT, as well as the collateral CT findings in the lungs and mediastinum. Here we describe the case of a patient with Covid-19 pneumonia, that collaterally had a pulmonary hamartoma in the left lung, documented at CT.

The spider web sign in Covid-19 pneumonia: An interesting case studied to resolution with computed tomography.

Since the widespread of acute respiratory syndrome infection caused by Coronavirus-19, unenhanced computed tomography (CT) was considered a useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated Covid-19 pneumonia. Many typical imaging features of this disease were described such as bilateral multilobar ground-glass opacity (GGO) with a prevalent peripheral or posterior distribution, mainly in the lower lobes, and sometimes consolidative opacities superimposed on GGO. As less common findings were mentioned septal thickening, bronchiectasis, pleural thickening, and subpleural involvement. Here we describe the case of a patient, with Covid-19 pneumonia, that had the spider web sign, a triangular or angular GGO in the subpleural lung, documented at CT.

Gallstone obstruction at the proximal ileum in an elderly woman: CT findings.

We present the case of a 73 years old woman with intestinal obstruction caused by a rare cause of biliary ileus, who arrived at our emergency department with lower abdominal quadrants pain (since about 2 months), recently associated with nausea, vomiting and abdominal distension. After clinical and laboratory evaluations, a computed tomography (CT) scan without intravenous contrast medium administration was urgently requested. CT had shown the presence of a large gallstone (diameter of about 6 cms) at the proximal ileum (stopped in this tract after the passage through a biliary-enteric fistula), and another gallstone (diameter of about 2 cms) in the gallbladder, associated with concentric thickening of gallbladder's walls, gas in the biliary tree, obliteration of peri-gallbladder's fat density and fluid in the peri-subhepatic area. The patient had urgently a surgical treatment (videolaparoscopy). CT had a crucial role for the diagnosis of intestinal obstruction, for its high sensitivity and specificity. It is well able to provide the causes and the level of the obstruction, its extension and complications, thus orienting toward the best clinical management/outcome for the patient.