RESUMEN
Hand and wrist infections can present with a spectrum of manifestations ranging from cellulitis to deep-space collections. The various infectious processes can be categorised as superficial or deep infections based on their respective locations relative to the tendons. Superficial hand infections are located superficial to the tendons and are comprised of cellulitis, lymphangitis, paronychia, pulp-space infections, herpetic whitlow, and include volar as well as dorsal subcutaneous abscesses. Deep hand infections are located deep to the tendon sheaths and include synovial space infections, such as infectious tenosynovitis, deep fascial space infections, septic arthritis, necrotising fasciitis, and osteomyelitis. Knowledge of hand and wrist compartmental anatomy is essential for the accurate diagnosis and management of hand infections. Although early and superficial infections of the hand may respond to non-surgical management, most hand infections are surgical emergencies. Multidetector computed tomography (MDCT), with its muliplanar reformation (MPR) and three-dimensional (3D) capabilities, is a powerful tool in the emergency setting for the evaluation of acute hand and wrist pathology. The clinical and imaging features of hand and wrist infections as evident on MDCT will be reviewed with emphasis on contiguous and closed synovial and deep fascial spaces. Knowledge of hand compartmental anatomy enables accurate characterisation of the infectious process and localise the extent of disease in the acute setting.
Asunto(s)
Infecciones Bacterianas/diagnóstico por imagen , Mano/diagnóstico por imagen , Mano/microbiología , Tomografía Computarizada Multidetector/métodos , Muñeca/diagnóstico por imagen , Muñeca/microbiología , Humanos , Imagenología Tridimensional/métodosRESUMEN
Computed tomography plays an important role for the evaluation of most patients with suspected renal injury after trauma. Intravenous urography is used for gross assessment of renal function in hemodynamically unstable patients. Renal injuries can be classified into four large groups: (1) minor renal contusion, lacerations, subcapsular hematoma, and small cortical infarcts; (2) major renal lacerations extending to the medulla with or without involvement of the collecting system; (3) catastrophic renal injuries including fragmentation of the kidney and renal pedicle vascular injuries; and (4) ureteropelvic junction injuries. Integration of the imaging findings of renal injury with clinical information is important to developing a treatment plan.
Asunto(s)
Riñón/diagnóstico por imagen , Riñón/lesiones , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Cintigrafía , Ultrasonografía , Heridas y Lesiones/complicaciones , Heridas y Lesiones/diagnóstico por imagenAsunto(s)
Derrame Pericárdico/diagnóstico por imagen , Pericardio/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/secundario , Hemangiosarcoma/diagnóstico por imagen , Humanos , Neoplasias Pulmonares/patología , Linfoma/patología , Melanoma/patología , Pericarditis/diagnóstico por imagen , Pericardio/anomalías , Pericardio/anatomía & histología , Neumopericardio/diagnóstico por imagenRESUMEN
Helical CT evaluation of the abdomen and pelvis can be challenging in the cancer patient. This pictorial essay illustrates the important sites of neoplastic dissemination in the abdomen and pelvis. We will emphasize the classic CT appearance of several selected sites and indicate, where appropriate, the primary lesions usually associated with each.
Asunto(s)
Neoplasias Abdominales/diagnóstico por imagen , Neoplasias del Sistema Digestivo/diagnóstico por imagen , Neoplasias de las Glándulas Endocrinas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Humanos , Invasividad Neoplásica/diagnóstico por imagen , Metástasis de la Neoplasia/diagnóstico por imagen , Pelvis/diagnóstico por imagenRESUMEN
Renal cell carcinoma is the most common primary tumor of the kidney, with more than 30,000 new cases diagnosed in the United States each year. With the widespread use of cross-sectional imaging, many tumors are detected incidentally. Single- and multidetector computed tomography (CT) have helped refine the diagnostic work-up of renal masses by allowing image acquisition in various phases of renal enhancement after intravenous administration of a single bolus of contrast material. The scanning protocol should include unenhanced CT followed by imaging during the corticomedullary and nephrographic phases of enhancement. The nephrographic phase is the most sensitive for tumoral detection, while the corticomedullary phase is essential for imaging the renal veins for possible tumoral extension and the parenchymal organs for potential metastases. Knowledge of the tumoral stage at the time of diagnosis is essential for prognosis and surgical planning. The accuracy of CT for staging has been reported to reach 91%, with most staging errors related to the diagnosis of perinephric extension of tumor. Three-dimensional CT provides the urologist with an interactive road map of the relationships among the tumor, the major vessels, and the collecting system. This information is particularly critical if the tumor extends into the inferior vena cava and if nephron-sparing surgery is being planned.
Asunto(s)
Carcinoma de Células Renales/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Carcinoma de Células Renales/irrigación sanguínea , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Medios de Contraste , Humanos , Imagenología Tridimensional , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Metástasis Linfática , Invasividad Neoplásica , Estadificación de Neoplasias , Nefrectomía/métodos , Radiografía IntervencionalRESUMEN
Invasive cervical cancer is the third most common gynecologic malignancy. The prognosis is based on the stage, size, and histologic grade of the primary tumor and the status of the lymph nodes. Assessment of the stage of disease is important in determining whether the patient may benefit from surgery or will receive radiation therapy. The official clinical staging system of the International Federation of Gynecology and Obstetrics has led to errors of 65%-90% in stage III and IV disease; the result has been unofficial extended staging with cross-sectional imaging modalities such as computed tomography (CT). CT is useful in staging advanced disease and in monitoring patients for recurrence. The primary tumor is heterogeneous and hypoattenuating relative to normal stroma on contrast material-enhanced scans. Obliteration of the periureteral fat plane and a soft-tissue mass are the most reliable signs of parametrial extension. Less than 3 mm separation of the tumor from the pelvic muscles and vascular encasement are signs of pelvic side wall invasion. Lymphatic spread is along the external and internal iliac nodal chains and the presacral route to the paraaortic nodes. Distant metastases are seen with primary or recurrent disease and can involve the liver, lung, and bone.
Asunto(s)
Tomografía Computarizada por Rayos X , Neoplasias del Cuello Uterino/diagnóstico por imagen , Femenino , Humanos , Metástasis Linfática , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias Pélvicas/diagnóstico por imagen , Neoplasias Pélvicas/secundarioAsunto(s)
Carcinoma de Células Renales/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Carcinoma de Células Renales/cirugía , Femenino , Humanos , Neoplasias Renales/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Nefrectomía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , ReoperaciónRESUMEN
Important sites of metastasis from intrathoracic and extrathoracic primary neoplasms are depicted on helical CT of the neck and thorax. This pictorial essay reviews several of these key sites of dissemination. For each, we illustrate the typical or classic appearance on helical CT and note the commonly associated primary malignancies.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/secundario , Neoplasias Torácicas/diagnóstico por imagen , Neoplasias Torácicas/secundario , Tomografía Computarizada por Rayos X , Humanos , Metástasis Linfática , Tomografía Computarizada por Rayos X/métodosRESUMEN
Computed tomography (CT) is the modality of choice in the evaluation of blunt renal injury. Intravenous urography is used primarily for gross assessment of renal function in hemodynamically unstable patients. Selective renal arteriography or venography can provide detailed information regarding vascular injury. Retrograde pyelography is valuable in assessing ureteral and renal pelvic integrity in suspected ureteropelvic junction injury. Ultrasonography is useful in detecting hemoperitoneum in patients with suspected intraperitoneal injury but has limited value in evaluating those with suspected extraperitoneal injury. Occasionally, radionuclide renal scintigraphy or magnetic resonance imaging may prove helpful. Renal injuries can be classified into four large categories based on imaging findings. Category I renal injuries include minor cortical contusion, subcapsular hematoma, minor laceration with limited perinephric hematoma, and small cortical infarct. Category II lesions include major renal lacerations extending to the medulla with or without involvement of the collecting system and segmental renal infarct. Category III lesions are catastrophic renal injuries and include multiple renal lacerations and vascular injury involving the renal pedicle. Category IV injuries are ureteropelvic junction injuries. CT is particularly useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help assess the extent of penetrating injuries in selected patients with limited posterior stab wounds. Integration of the imaging findings in renal injury with clinical information is critical in developing a treatment plan.
Asunto(s)
Riñón/diagnóstico por imagen , Riñón/lesiones , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Angiografía , Humanos , Imagen por Resonancia Magnética , Urografía , Heridas no Penetrantes/diagnósticoRESUMEN
OBJECTIVE: Recent improvements of computer technology have resulted in a new approach to medical illustration and the scientific research process. The purpose of this manuscript is to define the current state of the art and to review paths of progress. CONCLUSION: Using examples, we compared the process of time-intensive hand-rendered art with current art created using new computer technology. Specific emphasis was made on the newest technologies and how high-quality lower cost medical art can now be created. These newly available tools and illustration methods have resulted in a new approach to research, creation, and reproduction of medical art.
Asunto(s)
Gráficos por Computador , Ilustración Médica , Humanos , Factores de TiempoRESUMEN
Computed tomography (CT) is valuable for detection and characterization of many inflammatory conditions of the colon. At CT, a dilated, thickened appendix is suggestive of appendicitis. A 1-4-cm, oval, fatty pericolic lesion with surrounding mesenteric inflammation is diagnostic of epiploic appendagitis. The key to distinguishing diverticulitis from other inflammatory conditions of the colon is the presence of diverticula in the involved segment. In typhlitis, CT demonstrates cecal distention and circumferential thickening of the cecal wall, which may have low attenuation secondary to edema. In radiation colitis, the clinical history is the key to suggesting the diagnosis because the CT findings can be nonspecific. The location of the involved segment and the extent and appearance of wall thickening may help distinguish Crohn disease and ulcerative colitis. In ischemic colitis, CT typically demonstrates circumferential, symmetric wall thickening with fold enlargement. CT findings of graft-versus-host disease include small bowel and colonic wall thickening, which may result in luminal narrowing and separation of bowel loops. In infectious colitis, the site and thickness of colon affected may suggest a specific organism. The amount of wall thickening in pseudomembranous colitis is typically greater than in any other inflammatory disease of the colon except Crohn disease.
Asunto(s)
Colitis/diagnóstico por imagen , Colon/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apendicitis/diagnóstico por imagen , Enfermedades del Ciego/diagnóstico por imagen , Colitis/microbiología , Colitis Isquémica/diagnóstico por imagen , Colitis Ulcerosa/diagnóstico por imagen , Colon/efectos de la radiación , Enfermedad de Crohn/diagnóstico por imagen , Diverticulitis del Colon/diagnóstico por imagen , Divertículo del Colon/diagnóstico por imagen , Edema/diagnóstico por imagen , Enterocolitis Seudomembranosa/diagnóstico por imagen , Femenino , Enfermedad Injerto contra Huésped/diagnóstico por imagen , Humanos , Inflamación , Intestino Delgado/diagnóstico por imagen , Masculino , Mesenterio/diagnóstico por imagen , Persona de Mediana Edad , Peritonitis/diagnóstico por imagen , Traumatismos por Radiación/diagnóstico por imagenAsunto(s)
Nefrectomía/métodos , Nefronas/diagnóstico por imagen , Planificación de Atención al Paciente , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Angiografía/métodos , Femenino , Humanos , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Nefronas/irrigación sanguínea , Nefronas/cirugía , Cuidados PreoperatoriosRESUMEN
This article reviews the CT imaging features of a variety of nonneoplastic conditions that affect the small bowel and stresses important distinctive patterns that may help distinguish specific entities. Various inflammatory conditions (Crohn disease, radiation enteritis, graft versus host disease, celiac disease, Whipple disease, eosinophilic gastroenteritis, Behçet disease) as well as infiltrative disorders (amyloidosis, lymphangiectasia) and infectious diseases (Mycobacterium avium intracellulare, cytomegalovirus, cryptosporidiosis) are reviewed, with key differential points emphasized. In addition, miscellaneous conditions such as ischemia, small bowel diverticulitis, and small bowel hemorrhage are discussed.
Asunto(s)
Colon/patología , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/patología , Humanos , Tomografía Computarizada por Rayos XRESUMEN
Laparoscopic nephrectomy (LN) was recently introduced as a minimally invasive alternative to open nephrectomy in living related renal donation. Because of the limited field of view available with laparoscopic techniques, the role of preoperative radiologic evaluation in LN has expanded to include anatomic definition of the renal arteries, collecting system, renal parenchyma, and renal venous anatomy. Computed tomographic (CT) angiography has proved to be a minimally invasive alternative to conventional angiography in the preoperative evaluation of living related renal donors. CT angiography has been shown to have an accuracy comparable to that of conventional angiography in predicting renal arterial anatomy. In addition, CT angiography provides comprehensive definition of the renal vascular anatomy including the location, size, and length of the renal, adrenal, gonadal, and lumbar veins. Dual-phase spiral CT combined with three-dimensional CT angiography constitute a single, minimally invasive procedure that can provide a complete preoperative evaluation of potential living related renal donors prior to LN. Comprehensive anatomic depiction of the renal arterial and venous supplies aids in surgical planning and helps avoid potential complications.