Congenital bronchial abnormalities revisited.

Bronchial anatomy is adequately demonstrated with the appropriate spiral computed tomographic technique on cross-sectional images, multiplanar reconstruction images, and three-dimensional reconstruction images. Contrary to the numerous variations of lobar or segmental bronchial subdivisions, abnormal bronchi originating from the trachea or main bronchi are rare. Major bronchial abnormalities include accessory cardiac bronchus (ACB) and "tracheal" bronchus. An ACB is a supernumerary bronchus from the inner wall of the right main bronchus or intermediate bronchus that progresses toward the pericardium. Fourteen ACBs were found in 17,500 consecutive patients (frequency, 0.08%). The term tracheal bronchus encompasses a variety of bronchial anomalies originating from the trachea or main bronchus and directed to the upper lobe. In a series of 35 tracheal bronchi, only eight originated from the trachea, three originated from the carina, and 24 originated from the bronchi. Displaced tracheal bronchi (27 of 35) are more frequent than supernumerary tracheal bronchi (eight of 35). Minor bronchial abnormalities include variants of tracheal bronchus, displaced segmental bronchi, and bronchial agenesis. The main embryogenic hypotheses for congenital bronchial abnormalities are the reduction, migration, and selection theories. Knowledge and understanding of congenital bronchial abnormalities may have important implications for diagnosis, bronchoscopy, surgery, brachytherapy, and intubation.

MRI guided percutaneous abdominal biopsy in a closed magnet: assessment in an animal study.

MRI guided percutaneous abdominal biopsy was evaluated in an animal model, using a closed magnet and different types of needles. Thirty-six single pass biopsies were performed in 6 piglets with 6 types of MR compatible needles. Virtual targets of a diameter of 2 cm were drawn on the images of the right and left lobe of the liver and the upper and lower poles of both kidneys. FMPSPGR sequences were applied during an apnea of 19 to 23 seconds in axial, sagittal, coronal or axial oblique planes using a closed 1.0 T magnet and the body coil. Piglets were autopsied 1 hour after the procedure. Mean duration of the procedure was 16.9 (11-37) minutes; mean number of acquisitions per procedure was 5.9 (3-12); mean number of redirections of the needle was 0.6 (0-4). Pathological samples from the liver and kidneys of good quality were obtained in 22/36 (72.2%) cases. A subcapsular hematoma was observed in 18/24 (75.0%) cases of renal biopsies and in 1/12 (8.3%) of hepatic biopsies. No statistically significant correlation could be established between duration of the procedure and site of biopsy and between the type of biopsy needle and complication (p = 0.18 to 0.85). In conclusion, MRI guided percutaneous needle biopsy in the abdomen is a reliable technique in piglets using a closed magnet.

Radiologic damage control: evaluation of a combined CT and angiography suite with a pivoting table.

PURPOSE: To evaluate retrospectively the integrated diagnostic and therapeutic management of severely polytraumatized patients using a combined computed tomography (CT) and angiography suite with a single pivoting table. METHODS: Eleven patients, aged 16-74 years (median 30 years), were managed with spiral CT and angiography without patient transfer. Four patients were unstable, seven had received blood transfusions (2-18 units) and six were intubated. In 10 patients in whom active bleeding was demonstrated (splenic 5, hepatic 2, renal 2, left inferior epigastric artery 1), hemostatic embolization was obtained. RESULTS: Total procedure time did not exceed 80 min. Immediate hemostasis was achieved in all patients. Recurrent bleeding from the liver required additional embolization in one patient. Median length of stay in the intensive care unit was 4 days and median hospital stay was 27 days. All patients survived without significant sequelae. CONCLUSION: The use of a combined CT-angiography suite enables rapid diagnostic investigation and hemostatic embolization in actively bleeding trauma patients.