Pancreatic trauma: The role of computed tomography for guiding therapeutic approach.

AIM: To evaluate the role of computed tomography (CT) for diagnosing traumatic injuries of the pancreas and guiding the therapeutic approach. METHODS: CT exams of 6740 patients admitted to our Emergency Department between May 2005 and January 2013 for abdominal trauma were retrospectively evaluated. Patients were identified through a search of our electronic archive system by using such terms as "pancreatic injury", "pancreatic contusion", "pancreatic laceration", "peri-pancreatic fluid", "pancreatic active bleeding". All CT examinations were performed before and after the intravenous injection of contrast material using a 16-slice multidetector row computed tomography scanner. The data sets were retrospectively analyzed by two radiologists in consensus searching for specific signs of pancreatic injury (parenchymal fracture and laceration, focal or diffuse pancreatic enlargement/edema, pancreatic hematoma, active bleeding, fluid between splenic vein and pancreas) and non-specific signs (inflammatory changes in peri-pancreatic fat and mesentery, fluid surrounding the superior mesenteric artery, thickening of the left anterior renal fascia, pancreatic ductal dilatation, acute pseudocyst formation/peri-pancreatic fluid collection, fluid in the anterior and posterior pararenal spaces, fluid in transverse mesocolon and lesser sac, hemorrhage into peri-pancreatic fat, mesocolon and mesentery, extraperitoneal fluid, intra-peritoneal fluid). RESULTS: One hundred and thirty-six/Six thousand seven hundred and forty (2%) patients showed CT signs of pancreatic trauma. Eight/one hundred and thirty-six (6%) patients underwent surgical treatment and the pancreatic injures were confirmed in all cases. Only in 6/8 patients treated with surgical approach, pancreatic duct damage was suggested in the radiological reports and surgically confirmed in all cases. In 128/136 (94%) patients who underwent non-operative treatment CT images showed pancreatic edema in 97 patients, hematoma in 31 patients, fluid between splenic vein and pancreas in 113 patients. Non-specific CT signs of pancreatic injuries were represented by peri-pancreatic fat stranding and mesentery fluid in 89% of cases, thickening of the left anterior renal fascia in 65%, pancreatic ductal dilatation in 18%, acute pseudocyst/peri-pancreatic fluid collection in 57%, fluid in the pararenal spaces in 45%, fluid in transverse mesocolon and lesser sac in 29%, hemorrhage into peri-pancreatic fat, mesocolon and mesentery in 66%, extraperitoneal fluid in 66%, intra-peritoneal fluid in 41% cases. CONCLUSION: CT represents an accurate tool for diagnosing pancreatic trauma, provides useful information to plan therapeutic approach with a detection rate of 75% for recognizing ductal lesions.

Multidetector computed tomography in the preoperative evaluation of retrosternal goiters: a useful procedure for patients for whom magnetic resonance imaging is contraindicated.

BACKGROUND: Diagnostic imaging provides useful anatomical and morphological information of cervico-mediastinal goiters. The aim of this study was to assess the usefulness of multidetector computed tomography (MDCT) with multiplanar reformatting and volume rendering reconstructions for the preoperative evaluation of retrosternal goiters in patients for whom magnetic resonance imaging is contraindicated. METHODS: From March 2006 to January 2009, 34 patients (20 women and 14 men; mean age, 48 years; range, 42-74 years) with suspected cervico-mediastinal goiter were assessed by MDCT after intravenous injection of contrast material. The following parameters were evaluated: morphology, size, and enhancement of thyroid lobes; presence, location, and mediastinal extension of thyroid tissue; and relations with mediastinal vessels and organs. All patients underwent thyroidectomy. A reference group of 34 patients evaluated by single-detector computed tomography was created. The two groups of patients were compared searching for operative time (OT, in hours), hospital stay (HS, in days), and morbidity rate observed after thyroid surgery in all cases. RESULTS: In 29/34 patients, thyroid was enlarged with left mediastinal extension in 12 cases, right extension in 10 cases, and posterior extension in 7 cases. In 3/34 patients, a normal cervical thyroid connected to the mediastinal goiter through a thin parenchymal stripe was observed. In 2/34 patients, thyroid lobes were enlarged, without mediastinal extension. By comparing the two groups of patients for OT and HS values, a significant reduction to 3.7 +/- 0.1 hours and 4.3 +/- 0.1 days, respectively, was found in the group of MDCT patients, and also a trend to the reduction for morbidity rate (21%) could be recognized. CONCLUSIONS: MDCT represents a noninvasive tool in the evaluation of retrosternal goiters. High-quality multiplanar reformatting and volume rendering reconstructions allow an optimal analysis of the plunged gland and could reduce OT, HS, and probably the morbidity rate.

Contrast-enhanced multislice pneumo-CT-cystography in the evaluation of urinary bladder neoplasms.

PURPOSE: To evaluate the accuracy of contrast-enhanced multislice CT (MSCT) in the study of urothelial tumors after distension of the bladder with air. MATERIALS AND METHODS: We evaluated 43 consecutive patients with endoscopically proven bladder lesions. After air distension of the bladder, unenhanced pelvic and enhanced abdomino-pelvic scans were obtained with the following protocol: thickness 2.5mm x 4mm, increment 1mm, scan delay 40'' and 7-10 min. For each patient we considered the number, size, aspect (papillary or sessile) and contrast enhancement of lesions. Ureteral involvement and the presence of synchronous lesions in the excretory scan were also evaluated. MPR and virtual endoscopy images were reviewed in all cases. RESULTS: Bladder lesions were visualized in 39/43 cases. Compared to conventional cystoscopy, MSCT recognized single lesions in 31/33 patients, two lesions in 4/6, three in 2/2 and more than five foci in 2/2 patients. A papillary aspect was described in 44 cases while 11 lesions were sessile. Conventional Cystoscopy recognized six more lesions as compared with MSCT (four flat and two small papillary lesions). The detection rate for protruding lesions was 100% (52/52) for lesions>5mm and 60% (3/5%) for lesions<5mm. In four patients hydronephrosis was present, while in one case a synchronous lesion was evident in the renal pelvis. CONCLUSION: Contrast-enhanced MSCT with air distension of the urinary bladder is a safe and complete investigation to evaluate the local stage of bladder cancer and to evaluate the ureteral extension of the tumor, as well as the presence of synchronous lesions.