Urinary ascites due to retroperitoneal fibrosis: a case report.

Urinary ascites in adults is usually secondary to iatrogenic or traumatic injuries. A case of a 69-year-old male with abdominal pain and decreased renal function is described. Ultrasound showed bilateral hydronephrosis and ascites. Computed tomography revealed retroperitoneal fibrosis complicated by a rupture at the right ureteropelvic junction and urine extravasation in the perirenal and intraperitoneal spaces. Delayed scans showed leaking of contrast media from the anterior perirenal space to the peritoneal cavity. The urinary ascites resolved using a double-J stent.

[Computerized tomography false positives in knee medial meniscus injuries. Retrospective study of 400 cases]. / Falsa immagine con Tomografia Computerizzata di lesione del menisco mediale del ginocchio. Studio retrospettivo in 400 casi.

PURPOSE: We retrospectively evaluated the diagnostic reliability of high resolution CT (HRCT) in the study of knee joint conditions. MATERIAL AND METHODS: We reviewed the results of 400 HRCT examinations of the knee performed in 1993 and compared them with arthroscopic findings. The patients were affected with knee pain and the physical findings were insufficient for diagnosis but a sufficient indication for further instrumental tests. CT slices were 1 mm, with .5 mm feed; the images were reconstructed on the coronal and sagittal planes (2 mm thickness and 2 mm gap) with a CT Sytec 3000 unit (GE Systems, Milwaukee, WI, USA). RESULTS: The patients positive for meniscal fracture were submitted to arthroscopy and operated on if positive arthroscopically. We had 164 surgical cases even though the meniscus was damaged in 236 cases. CT was negative in 16 of 164 surgical cases. The meniscal injury was demonstrated with both CT and arthroscopy in 236 cases; there were 8 false positives and 32 questionable cases. In the latter, arthroscopy showed 24 cases of meniscal degeneration and 8 horizontal fractures. Diagnostic accuracy was 96%. CT showed the 8 false positives as radial injuries of the free margin, but in fact they were false images caused by a normal fold which increases in knee valgus. DISCUSSION AND CONCLUSIONS: HRCT is more reliable than conventional CT (diagnostic accuracy: 96% vs 85-90%) and MRI (90% reliable). The use of thin slices also permitted to show that a meniscal tissue interruption on the radial margin is not referrable to fracture, as indicated also in the recent literature, but to a normal fold.

Diagnostic accuracy of CT scan in intra-articular lesions of the knee (arthroscopic confirmation of 100 cases).

The results obtained for 100 CT scans of the knee confirmed by arthroscopy are analyzed in order to determine the probability of error in the various lesions and thus establish indications for the use of CT scan. This test was particularly reliable in traumatic lesions of the meniscus and in chronic breakage of the anterior cruciate ligament. It was more difficult to make an evaluation of degenerative meniscus tear or so-called "menisci at risk for tear". First and second degree chondropathies cannot be evaluated, while third and fourth degree ones may easily be evaluated on plane surfaces (tibial plate and patella), but not so easily on spherical surfaces (femoral condyles).

[Radiologic and clinical aspects of osteoarticular amyloidosis caused by dialysis]. / Aspetti radiologici e clinici dell'amiloidosi osteoarticolare da dialisi.

Many long-term (greater than 60 months) hemodialysis patients develop a severe osteoarticular disease, called "dialysis arthropathy", which is characterized by the deposition in bone and synovia of a new type of amyloid made mainly of beta 2-microglobulin. In the present study, 31 patients (17 males, 14 females; age 54.1 +/- 13 years), undergoing chronic hemodialysis for 60-125 months, were examined for dialysis arthropathy by means of clinics and of radiological investigations (conventional radiography and computed tomography). Sixteen patients (51.6%) had radiographic evidence of dialysis arthropathy: geodes (shoulders, 12 cases; wrists, 11; hips, 2; knees, 2) and/or destructive arthropathies (cervical spine, 13 cases, dorsolumbar spine, 2; hands, 2; hips, 1). Within 24 months, these lesions were found to progress slowly in the majority of cases. In the diagnostic process, CT should be employed in the study of spine, shoulders and hips when the lesions have not been sufficiently demonstrated by conventional radiography in the presence of evident clinical signs. Patients with dialysis arthropathy had undergone dialysis for longer periods than those without it (p less than 0.005) and showed a significantly higher incidence of both carpal tunnel syndrome (p less than 0.0005) and shoulder pain (p less than 0.005). Our findings confirm the high incidence and clinical importance of dialysis arthropathy in long-term hemodialysis patients and the value of diagnostic imaging in screening such patients for those lesions.

[Diagnostic imaging for the study of popliteal masses in dialyzed patients]. / La diagnostica per immagini nella valutazione delle masse poplitee dei pazienti in dialisi.

A new type of amyloidosis, secondary to the massive deposition of beta 2-microglobulin, has been identified which is peculiar to long-term (greater than or equal to 5 years) hemodialysis. Popliteal masses have recently been described as a possible manifestation of this type of amyloidosis. We report the results of a clinical-radiologic study of the popliteal region in 28 patients (14 males, 14 females; age 52.9 +/- 12.6 years) undergoing chronic hemodialysis for 60-212 months (mean 127 +/- 40). We aimed at determining the role of diagnostic imaging (conventional radiography, ultrasonography, Computed Tomography) in this pathologic condition. Clinics detected popliteal masses in 4 patients (bilateral in 1). US allowed 2 more cases to be detected and demonstrated the cystic nature of the lesion. Ultimately, popliteal masses could be demonstrated in 6 (bilateral in 5) of 28 patients (incidence 21.4%). In the 3 patients who were investigated by CT, cysts were seen to communicate with the joint cavity (Baker's cysts). In 1 case, immunocytochemical analysis showed diffuse beta 2-microglobulin positive amyloid deposition within the synovial wall of the surgically removed cyst. All the 6 patients experienced some of the major features of dialysis-related amyloidosis: carpal tunnel syndrome (6 cases), destructive arthropathy (5 cases), carpal and shoulder bone radiolucencies (5 and 4 cases, respectively). These findings, while documenting the high prevalence of popliteal cysts among long-term hemodialysis patients and the strong correlation with dialysis-related amyloidosis, stress the importance of diagnostic imaging in the detection and follow-up of such lesions.

[Destructive cervical amyloidotic spondyloarthropathy in patients undergoing periodic dialysis. Personal experience]. / La spondiloartropatia cervicale destruente amiloidotica nei pazienti in dialisi periodica. Esperienza personale.

The accumulation of amyloid (beta 2-microglobulin) in several organs and tissues of patients in chronic dialysis is a recent pathologic condition. A wide range of cases, supported by specific tests for amyloid on bioptic and autoptic samples, showed a radiographic semiology of osteostructural alterations in various areas which allows amyloidotic condition of bone to be diagnosed with high reliability. In 11 of 62 patients (17.74%) we observed destructive cervical amyloidotic spondyloarthropathy (DCAS). The radiological patterns common to all patients were subchondral sclerosis, erosions of vertebral body plates, widening/narrowing of intervertebral spaces, no/poor osteophytosis. Over-hanging was present in 54.5% of cases, and deformation of vertebral bodies in 45.4%. CT was useful in improving the definition of the various alterations, and in locating others, such as cavitations in vertebral bodies and involvement of apophyseal joints. Constant factors were the association with extravertebral osseous amyloidosis, dyalitic age over 60 months, and the use of Cuprophan membranes for dialysis. The frequent (72.72%) association with alterations involving the lumbar rachis (subchondral sclerosis, erosions and geodes) was suggestive of amyloidotic condition.