COVID-19 follow-up: Chest X-ray findings with clinical and radiological relationship three months after recovery.

INTRODUCTION: To evaluate the radiological sequelae of coronavirus disease (COVID-19) in a mid-term follow-up and investigate their relationship with clinical-radiological findings. METHODS: This prospective study included COVID-19 patients who underwent a CXR three months after discharge. The relationship between CXR score at three months after discharge and clinical findings and previous CXR scores, at admission and before the discharge, were evaluated. Then, based on mid-term follow-up CXR score, patients were divided in Group A (score = 0) and Group B (score≥1), and clinical-radiological findings were compared between two Groups. Finally, we calculated the CXR scores at admission and before the discharge with the highest sensitivity and specificity to predict normal and abnormal CXR score at mid-term follow-up. RESULTS: The study included 119 patients, mean age 65.9 ± 14.6 years. The oxygen saturation (SaO2) (p = 0.0006), the days of hospitalization (p < 0.0001) and the CXR score before the discharge (p = 0.0091) were independent factors to predict the mid-term follow-up CXR score. The Group A, 59 (49.6%) patients, had CXR scores at admission and before the discharge lower than Group B. The CXR scores at admission and before the discharge with the highest sensitivity and specificity to predict normal and abnormal CXR score at mid-term follow-up were, respectively, 3 and 2 (p < 0.0001). CONCLUSIONS: The radiological abnormalities were present in about half patients three months after discharge, which had higher age, previous CXR scores and longer hospitalization. The SO2, days of hospitalization and previous CXR scores were independent factors for predicting the CXR at three months. IMPLICATIONS FOR PRACTICE: The radiologist with CXR could play a central role in mid to long-term follow-up of COVID-19, assessing the radiological sequelae of patients and identifying those who might require a closer follow-up.

Multichannel computed tomography (MCCT) analysis of glenoid erosion in shoulder hemiarthroplasty: preliminary clinical applications.

Glenoid wear following shoulder hemiarthroplasty (HA) has been reported around 80% in long-term follow-up studies. Radiographic analysis is useful to depict glenoid erosion but does not evaluate accurately glenoid bone loss. Multichannel computed tomography (MCCT) allows scanning with submillimeter section thickness through dense areas of glenoid bone, despite the presence of metallic prostheses. In this preliminary study, we performed a MCCT analysis of glenoid erosion, in 15 patients with painful shoulder HA, at an average follow-up of 5.5 years. Clinical scores were retrospectively assessed at an early (1 year), medium (2.5 years), and late (5.5 years) follow-up. We analyzed the following glenoid features: articular line space (ALS), glenoid length (bone stock), glenoid version, morphology of erosion (concentric, superior ed inferior tilt), and gross bone defects. Glenoid was retroversed in 13 patients (minimum 0 degrees maximum 8 degrees), antiversed in 2 patients (2 degrees and 6 degrees). Erosion was described as concentric in 13 patients, eccentric ("superior tilt") in 1 patient, biconcave in another patient. The mean glenoid length was 19.7 mm (min 16.4 max 22.7). Gross bone defects were described in six patients. The scores registered at latest follow-up showed a significant decrease compared with the values at 1 year (P < 0.001) and at 2.5 years (P < 0.001). The patients with glenoid erosion associated with gross defects and ALS

Saturday night brachial plexus palsy.

An unusual case of brachial plexopathy following an alcohol binge is presented. The patient developed numbness and weakness of his right hand and neurophysiological tests demonstrated that the lesion level was at the brachial plexus. MRI of the brachial plexus, cerebrospinal fluid examination and DNA analysis for hereditary neuropathy with liability to pressure palsies were normal. Repeated neurological examination and neurophysiological studies 60 days later were normal. A diagnosis of brachial plexus neuropathy consequent to non-traumatic stretching of the middle and the lower trunks was made.

[Gadolinium for DSA in two patients with azotemia: Images of suitable quality and risk of acute renal failure]. / Angiografia con Gadolinio in due pazienti azotemici: la qualita' diagnostica ed il rischio d'insufficienza renale acuta.

BACKGROUND: Gadolinium is an alternative angiographic contrast agent in patients with impaired renal function and high risk for iodinated contrast adverse reaction. We report two cases of acute renal failure caused by gadolinium (0.6 and 0.9 mmol/kg of body weight) after the execution of digital subtraction angiography (DSA) to produce diagnostic-quality images in two elderly diabetic patients with pre-existing renal insufficiency. Both patients needed dialysis treatments for as long as a few weeks until their renal function improved. In our opinion, and according to the guidelines of European Society of Urogenital Radiology, gadolinium has not been assessed as less nephrotoxic than iodinated contrast agents. In fact, 1.8 to 4.8 g of iodine, equally attenuated with a relatively high dose (0.2 to 0.4 mmol) of a gadolinium chelate, is a low iodine dose and could hardly have any important nephrotoxic effects. CONCLUSIONS: The maximum dose of gadolinium-based contrast agents should never exceed 0.2 to 0.4 mmol/kg in azotemic patients who are undergoing DSA, even though these doses of gadolinium may not provide images of suitable quality for diagnosis and intervention.

In vivo evaluation of intravascular stents at three-dimensional MR angiography.

The aim of this study was to assess in vivo patency of seven commonly used non-ferromagnetic plain stents as regards demonstration of the contained lumen at 3D gadolinium-enhanced MRA in a 0.5-T MR environment. Twenty-one patients with 22 stents (1 aortic, 18 iliac, 3 popliteal) were imaged with MRA. Stent-related artefacts were evaluated. Images were assessed for the presence and size of stent artefacts, luminal patency, and were correlated with stent metal mass, composition, configuration and angulation with respect to the magnetic field. Four different types of stent (Symphony, Wallstent, Memotherm, SMART) showed major artefacts preventing assessment of intradevice luminal patency or restenosis, in two stents (ZAV stent, Intracoil) minor artefacts allowed assessment of high-degree stenosis, and only one type of stent (Strecker) was perfectly imaged. Based on our limited experience, Gd-MRA appears well suited for the evaluation of only a minority of MR-compatible stents.

Failing hemodialysis arteriovenous fistula and percutaneous treatment: imaging with CT, MRI and digital subtraction angiography.

PURPOSE: To evaluate failing hemodialysis arteriovenous fistulas with helical CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA), and to compare the efficacy of the three techniques in detecting the number, location, grade, and extent of stenoses and in assessing the technical results of percutaneous transluminal angioplasty (PTA) and stenting. METHODS: Thirteen patients with Brescia-Cimino arteriovenous fistula malfunction underwent MRA and CTA of the fistula and, within 1 week, DSA. A total of 11 PTAs were performed; in three cases an MR-compatible stent was placed. DSA served as the gold standard for comparison in all patients. The presence, site, and number of stenoses or occlusions and the technical results of percutaneous procedures were assessed with DSA, CTA, and MRA. RESULTS: MRA underestimated a single stenosis in one patient; CTA and MRA did not overestimate any stenosis. Significant artifacts related to stent geometry and/or underlying metal were seen in MRA sequences in two cases. CONCLUSIONS: CT and MRI can provide information regarding the degree of vascular impairment, helping to stratify patients into those who can have PTA (single or multiple stenoses) versus those who require an operative procedure (occlusion). Conventional angiography can be reserved for candidates for percutaneous intervention.

[Anatomo-radiologic correlations in spontaneous hematoma of the rectus abdominis muscles]. / Correlazioni anatomo-radiologiche negli ematomi spontanei dei muscoli retti dell'addome.

PURPOSE: Rectus sheath hematomas are a frequent but sometimes misdiagnosed disease in patients under anti-coagulative drugs, hemodialysis, or simply in the elderly. The most frequent localization is in the lower part of the abdomen: the explanation lies in the anatomy of the abdominal wall, especially in the arcuate line of the rectus sheath. Aim of this work is to explain the reason of the almost constant location correlating the anatomy with the CT features. ANATOMIC CONSIDERATIONS: The rectus abdominis muscle lies between the aponeuroses of the transverse and oblique muscles which form the so called rectus sheath. This arrangement is found from the costal arch to a level approximately between the umbilicus and the pubic symphisis, where the rear layer of the rectus sheath ends with a curved edge, called the arcuate or semicircular line of Douglas. Beneath this line the aponeuroses of the three muscles pass in front of the rectus which is separated from the peritoneum only by the fascia trasversalis, a thin connective layer between the rectus and the preperitoneal fat. In this lower aspect of the muscle the perforating branches of the inferior epigastric artery running in the preperitoneal fat may rupture causing a large hematoma widely spreading in this loose space. MATERIAL AND METHODS: 11 cases of rectus sheath hematoma diagnosed over 5 years were reviewed. They were referred to US because of a rapidly growing palpable mass or painful swelling of the abdominal wall with acute anemia. Sonography was performed in 11 patients and CT in 7. RESULTS: 10 hematomas were located in the lower third of the rectus muscle below the arcuate line in the pelvis, 1 was in the upper third of the muscle: the vast majority of pelvic hematomas is easily accounted for by the peculiar anatomy of the region. DISCUSSION: The diagnosis of hematoma of the rectus abdominis, sometimes misleading, should be included as a differential in all the patients who present with acute abdominal pain and blood loss. The anatomy of abdominal wall correlates well with CT findings and explains the reason why most hematomas are found in the lower third of the muscle. CONCLUSIONS: The diagnosis, whether clinical or based on imaging findings, needs accurate pathoanatomic knowledge of the anterior abdominal wall. Once the diagnosis has been confirmed (by US or CT) patients should be treated conservatively as those that are operated are at risk of developing complications, mainly hemorrhagic.

[Follow-up after radical prostatectomy in prostatic cancer. CT: normal findings]. / Follow-up dopo prostatectomia radicale per neoplasia. TC: aspetti normali.

We retrospectively reviewed the CT findings of 18 patients submitted to radical prostatectomy for prostate cancer. CT follow-up studies showed the bladder base in retropubic location in all 18 patients. Two patients had local recurrences, while no evidence of local recurrence was found in 16 patients. The following CT findings were observed in the latter group: a) bladder to rectum adhesion in 2 cases (13%); b) a complete transverse bar of soft tissue density between bladder and rectum in 9 cases (57%); c) an incomplete rectovesical bar in 6 cases (40%). The transverse bar was already apparent on the first pelvic CT scan performed within two weeks in 3 cases for surgical complications. In two local recurrences some dense tissue was demonstrated distorting rectovesical lateral triangle fat. To conclude, since a complete or incomplete horizontal bar of soft tissue structures is usually depicted in the rectovesical space, these structures should not be misdiagnosed as local tumor recurrences.

[Aneurysm of the abdominal aorta and stenosis caused by compression of the celiac tripod in a young woman with tuberous sclerosis and previous mesoblastic nephroma]. / Aneurisma dell'aorta addominale e stenosi da compressione del tripode celiaco in giovane donna con sclerosi tuberosa già trovata affetta da nefroma mesoblastico.

Tuberous sclerosis, first described by Bourneville in 1880, is a syndrome characterized essentially by mental deterioration, seizures and cutaneous sebaceous adenoma; an association with malformative lesions of the kidney and cardiovascular apparatus has been documented. Recently a case of a young woman with tuberous sclerosis has come to our observation; she was also affected by abdominal aortal aneurysm and stenosis due to compression of the truncus coeliacus; previously she operative elsewhere for right nephrectomy for breakage of nephric right arterial aneurysm: the histological examination of the removed kidney manifested the presence of a mesoblastic nephroma and afterward tuberous sclerosis was diagnosed. The angiomyolipomatosis evidence confirmed the suspicion of a notable inclination to polydistrict malformations in tuberous sclerosis.

[Subrenal coarctation of the aorta. Presentation of a clinical case]. / Coartazione sottorenale dell'aorta. Presentazione di un caso clinico.

Coarctation of abdominal aorta constitutes a rare group of vascular abnormalities, including segmental stenoses and extended hypoplasia below the restriction. Usually hypertension is the only clinical evidence. The natural history of the surgically untreated disease foresees a decline of life expectancy; while surgical operation permit an almost complete "restitutio ad integrum". The Authors report a case of coarctation of the abdominal aorta come to their observation whose particularly was determined by the absence of high blood pressure, the aortic stenoses being located under the renal arteries.