[Pulmonary sequestration in the adult. Diagnostic contribution of angiography]. / Il sequestro polmonare nell'adulto. Contributo diagnostico dell'angiografia.

PURPOSE: The diagnosis of pulmonary sequestration is based on demonstration of mal-developed lung tissue, feeding on abnormal systemic level. We investigate the role of angiography in the diagnosis of pulmonary sequestration in adult patients. MATERIAL AND METHODS: 1987 to 1998 we examined 9 patients with suspected pulmonary sequestration who were subsequently submitted to surgery. The patients were 3 women and men; 6 of them were symptomatic and 3 asymptomatic. Six patients were examined with CT of chest and upper abdomen, thoracoabdominal aortography and selective arteriography of the abnormal vessel; one patient also submitted to left angiopneumography. One patient underwent bronchography and another one MRI. RESULTS: An unquestionable diagnosis was made in 8 cases, namely 6 of intralobar and 2 of extralobar sequestration, and confirmed surgically. The only questionable case was diagnosed at histology as extralobar pulmonary sequestration atypically fed by thin branches from the left diaphragmatic artery. CONCLUSIONS: Angiography demonstrated the abnormal arterial feeding typical of pulmonary sequestration in all cases but one. The evidence of venous drainage was the key sign to diagnose extra-versus intralobar sequestration. Therefore we conclude that angiography remains an essential tool in the diagnosis of pulmonary sequestration, notwithstanding the great potentials of Helical CT of MR angiography.

Helical CT angiography in gastrointestinal bleeding of obscure origin.

OBJECTIVE: The aim of the study was to verify the usefulness of helical CT angiography for diagnosis of gastrointestinal hemorrhage of obscure origin. SUBJECTS AND METHODS: Eighteen consecutive patients underwent catheterization of the abdominal aorta followed by helical CT angiography before and after intraarterial injections of a contrast medium. Helical CT angiography revealed the site of hemorrhage as an extravasation of contrast medium resulting in a hyperdense area in the intestinal lumen. All patients then underwent conventional angiography that was selective for the 13 patients in whom helical CT angiography was positive and standard for the remaining five patients with negative helical CT angiograms. RESULTS: Helical CT angiography revealed the site of hemorrhage in 13 (72%) of 18 patients. Diagnosis of bleeding site was confirmed, and the cause was established at surgery in 11 of these 13 patients. The site of bleeding for the remaining two patients was confirmed by angiography as angiodysplasia of the jejunum (n = 1) and of the colon (n = 1). Of the five patients with negative helical CT angiograms, location of bleeding was revealed by conventional angiography in two patients; one of the remaining three patients underwent exploratory laparotomy; and bleeding ceased in the remaining two patients, who were treated without surgery. Conventional angiography was negative for two of the 13 patients in whom helical CT angiography was positive. CONCLUSION: Despite our limited experience, helical CT angiography proved to be an easier and faster technique than conventional angiography for localizing gastrointestinal bleeding of obscure origin and useful as a guide for subsequent selective conventional angiography.

[Spiral computed tomography with arteriography in the diagnosis of digestive system hemorrhages of obscure origin]. / La Tomografia Computerizzata spirale con arteriografia nella diagnosi delle emorragie dell'apparato digerente con origine oscura.

Some 5-20% of gastrointestinal (GI) bleeding cases are of obscure origin because bleeding is difficult to diagnose or locate with conventional imaging methods. The authors suggest arterial spiral CT (ASCT) of the abdomen as an original tool to study GI bleeding of obscure origin. This diagnostic method consists of two subsequent phases: first, after abdominal aorta catheterization, the catheter is positioned in the celiac artery; then, CT of the abdomen is performed before and after intra-arterial contrast agent injection. In 6 of 10 patients with GI bleeding of obscure origin, ASCT depicted small high-intensity areas in the intestinal lumen, which indicate a source of bleeding. The site of bleeding was studied only with topographic criteria according to scanning planes, and the morphological features of the intestinal segments were investigated. All patients were submitted to surgery: when ASCT identified a bleeding site, angiography was limited to the involved arterial district. Angiography alone could locate the source of bleeding in 5 patients; angiography and ASCT were in agreement in 4 patients. The combined techniques located the source of bleeding in 7/10 patients and the nature of bleeding was diagnosed in 3/10 patients (angiodysplasia). Even though their experience is limited, the authors believe that ASCT can be useful in locating GI bleeding of obscure origin, as well as in guiding subsequent selective angiography.

[The sulcus angle of the femoral trochlea: ultrasonographic evaluation]. / Angolo del solco della troclea femorale. Valutazione ecografica.

The sulcus angle of femoral trochlea is particularly important to evaluate the femoro-patellar joint. Our study was aimed at studying the normal trochlea, and especially the sulcus angle, with US. The right knees of 11 normal subjects were examined with US and Computed Tomography (CT) on the same section planes. The US measurements of the sulcus angle were correlated with CT results, which were considered the gold standard. The US and CT data were compared and a direct correlation was found (r = 0.832). The intraobserver difference in US measurements was r = 0.943. The mean sulcus angle value was 132 degrees, in agreement with literature data. We conclude that the US measurements of the sulcus angle are reproducible and as sensitive as CT.

[Radiologic evaluation and prognosis of lymphoid nodular hyperplasia of the mesenteric intestine]. / Valutazione radiologica e prognosi nell'iperplasia nodulare linfoide dell'intestino mesenteriale.

Nodular lymphoid hyperplasia (NLH) is a reaction of the intestinal lymphatic tissue to specific inflammatory stimuli. Radiologically, it presents with multiple nodular filling defects of various sizes (2-4 mm) and with segmental, focal or diffuse distribution. The condition may be benign but, under particular circumstances (chronic stimuli), it may evolve to neoplastic forms. Seven hundred and sixty-eight patients underwent small bowel X-rays from January 1990 to April 1992. Twenty-two patients with NLH with or without associated mucosal or wall lesions were selected. The radiologic and histologic features of the lesions, together with the clinical data, were helpful to make the diagnosis. In 8 patients the hyperplastic nodules were benign, while 10 patients were affected with Crohn's disease and 4 with Herman's syndrome or common variable immunodeficiency. This work was aimed at defining NLH from a diagnostic point of view relative to both morphology and extent of lesions and at stressing the role of radiology of the small bowel in the follow-up of the cases at risk of evolving to cancer.