Diagnostic imaging of traumatic pseudoaneurysm of the thoracic aorta.

BACKGROUND: The purpose of the study was the presentation of findings and diagnostic imaging in patients with traumatic pseudoaneurysms of the thoracic aorta, as a rare consequence of road traffic accidents. PATIENTS AND METHODS: In 22 years we have found 8 traumatic pseudoaneurysms of the thoracic aorta, out of which 7 (87.5%) in male and 1 (12.5%) in female patients. At the time of accidents the youngest patient was 21 and the oldest was 55 (mean age 33.8 years), and at the moment of diagnosing a pseudoaneurysm they were 26 and 55 years old, respectively (mean age 38.7 years). In all patients chest radiography was performed as well as CT scan, in 6 (75%) patients intra-venous digital subtraction angiography was performed (i.v. DSA) and in 1 (12.5%) MRI. CT was performed with the application of 120 ml, and i.v. DSA with 60 ml of contrast medium, respectively. RESULTS: In 8 (100%) patients, who suffered a road traffic accident, and whose chest radiograph showed the enlargement of the aortic knob and widening of the mediastinum, CT, i.v. DSA and MRI revealed a traumatic pseudoaneurysm of the thoracic aorta. Periods of time between the accidents and the initial diagnosis of the pseudoaneurysm varied from 7 days to 18 years (median 2.0 years). The diameter of the pseudoaneurysm was from 4.5 to 9.2 cm (median 5.5 cm). In 7 (87.5%) isthmus was involved, and in 1 (12.5%) descending thoracic aorta, respectively. The chest radiograph revealed marginal calcifications in 4 (50%), and on the CT in 5 (62.5%) patients. Intraluminal thrombosis was found by CT in 2(25%) traumatized patients. CONCLUSIONS: Traumatic pseudoaneurysm should be taken into consideration in blunt chest trauma, where a chest radiograph shows suspicious regions. A multislice CT is a diagnostic method of choice.

Possibilities of computer assisted tomography (CT) in evaluation of lung cancer operability.

As is well known, surgical treatment is the most effective therapy for non-small cell lung cancer, although only a small number of patients are suitable for this type of treatment (25%-30%). The outcome of operative treatment and prognosis greatly depends on accurate preoperative diagnostic process using the TNM classification. Until now, different diagnostic methods are used in the preoperative staging of this severe illness, including computer assisted tomography which acquired a leading role. Despite its high value as a method of assessing the operability of lung cancer, there is a smaller percentage of diagnostic oversights where the stage was under or over-estimated and where discrepancy between CT and operative findings was present. Prospective study was conducted on 60 patients with lung cancer in the period from December 2000 to December 2007. Among our respondents there were more males (6.5:1), average age was 56; the youngest patient was 32 and the oldest 70 years old. All patients underwent complete pulmonary and bronchial CT examination and then were subjected to one of the surgeries (28 lobectomies, 15 pneumectomy and 17 exploration thoracotomy) with pathohistological verification of findings. CT and postoperative lung cancer results were compared and statistically processed using the usual statistical methods. The results show that CT as a method in the preoperative clinical evaluation of patients with lung cancer is very useful because of its high diagnostic accuracy in determination of TNM stages of disease (83.33% accuracy, sensitivity 76.40%, specificity 93.00%, PPV 90.90% and 81.25% NPV). CT of thoracic organs still remains irreplaceable method in everyday clinical treatment of patients with lung cancer.

Color Doppler pseudolymphomatous manifestations of the cat scratch disease.

Cat Scratch Disease (CSD) is an infectious illness, caused by the Bartonella henselae bacterium. Besides the common infective symptoms, swelling in the axillary and cervical region is very common and is usually evaluated by Color Doppler US (CDUS) (among other diagnostic methods). The aim of this work is to present ultrasound findings of the Cat Scratch Disease. During 2002 and 2003, we followed four patients (three male and one female) by CDUS, with different manifestations of the disease. The average age of the patients was 12. In all four cases, the local and generalized lymphadenopathy was found, and in two cases we found multiple focal hepatolienal lesions as well. The enlarged lymph nodes were found, with heterogeneous echogenicity of the cortex, and increased number of the hiluses, disturbed vascular structure and non specific hemodynamic. Hepatolienal lesions were hypoechogenic, round, unclear outline, and poorly vascularised. CDUS has proved to be a very sensitive imaging method in detection of pathomorphologic and hemodynamic changes of superficial lymph nodes and focal lesions of visceral organs in CSD. Opposite to the high sensitivity, its specificity is much lower, because of similar findings in lymphoma, TB lymphadenopathy and multiple visceral abscesses. Detailed anamnesis, clinical findings, with laboratory and specific serological tests (IgG, IgM), US characteristics, sometimes percutaneous aspiration biopsy as well, are crucial in determination of etiology of the disease.

[Takayasu arteritis: radiological characteristics]. / Takayasu arteritis: radioloske karakteristike.

Takayasu arteritis is a granulomatous vasculitis of unknown etiology that commonly affects the thoracic and abdominal aorta, great vessels, results in segmental stenosis, occlusion, dilatation and aneurysm formation in these vessels. We described case 19-year-old girl with and clinical and radiology manifestation disease. Patient had absent upper-extremity pulses, hypotension, (RP: 90/50 mmHg), easy fatigability and ischemic symptoms. Radiology findings were present Type I - classic pulse less type that involves the brachiocephalic trunk, carotid arteries and subclavian arteries.