[The biopsy of pulmonary masses guided by computed tomography after iatrogenic pneumothorax]. / Biopsia delle masse polmonari con la guida della Tomografia Computerizzata dopo pneumotorace iatrogeno.

INTRODUCTION: Biopsy of lung nodules under CT guidance is frequently complicated (in 20-60% of cases) by sudden pneumothorax; when a pneumothorax occurs, the radiologist usually stops the procedure and the histologic specimen is often inadequate for diagnosis. We report our personal experience in eight patients with early pneumothorax in whom we repeated biopsy inserting the needle through the pneumothorax to try to obtain adequate material for histologic diagnosis. MATERIAL AND METHODS: 1990 to 1996, we performed 352 CT-guided biopsies to diagnose chest nodules. Early pneumothorax occurred in eight patients, in one of them when local anesthesia was being given, and was in the left-hand side in five cases and in the right-hand side in three. Biopsy was always performed with 21, 19 and 18 G needles. RESULTS: Pneumothorax occurred during posterior bioptic approach in all patients; the nodule was localized in lung parenchyma in three cases and in subpleural site in the others. Post-pneumothorax biopsy was performed with a single 18 or 19 G needle puncture in six cases and with two punctures in the other cases. An inflammatory mass was diagnosed in three patients and a hamartochondroma in two, which avoided surgery in all cases. Three adenocarcinomas were treated with surgical lobectomy and pathology confirmed the diagnosis. Moderate hemoptysis occurred in two patients and the pneumothorax worsened in two patients, requiring transpleural drainage. CONCLUSION: CT-guided biopsy of lung nodules is a safe procedure which can be performed also in the patients with sudden and early pneumothorax when the first biopsy yielded inadequate material for histologic diagnosis. In our experience, five patients avoided surgery because a benign lesion was diagnosed. The complications of post-pneumothorax biopsy were always negligible.

The US,CT and MR findings of cubital bursitis: a report of five cases.

OBJECTIVE: The purpose of the study was to evaluate the appearance of "cubital bursitis" on ultrasonography and CT and MR imaging. "Cubital bursitis" is a rare pathological condition involving a large swelling of the bicipito-radial or interosseous bursae located at the insertion of the distal biceps tendon on the radial tuberosity. DESIGN AND PATIENTS: We report on five patients with "cubital bursitis" resulting from their work or sporting activities. All patients underwent an ultrasound and MR examination. CT scans were performed on two patients before and after contrast enhancement. RESULTS: Ultrasound studies showed a fusiform anechoic or hypoechoic lesion. CT images showed the lesions but there were some difficulties in determining the exact extent of the bursae. MR imaging showed the enlarged bursae and their fluid content. Four patients each underwent a surgical procedure. CONCLUSION: Ultrasound and CT were effective in the evaluation of "cubital bursitis", but with some diagnostic difficulties. MR imaging is probably the method of choice for determining both the development of the bursae and their fluid content.

Large lipomas of the colon: CT and MR findings in three symptomatic cases.

We report on three patients with large lipomas in the wall of the cecum, causing intussusception. Endoscopy is the preferred modality for small lipomas, whereas CT and MR imaging are more useful in their ability in detecting fatty masses and assessing the location of lesions. Barium enema study may contribute to the preoperative planning in selected cases.

[Cholangiopancreatography with magnetic resonance. Clinical use of a new "inversion-recovery" sequence]. / Colangiopancreatografia con Risonanza Magnetica. Impiego clinico di una nuova sequenza "inversion-recovery".

This study was aimed at correlating the yield of a three-dimensional (3D) inversion-recovery (IR) turbo spin-echo MR cholangiopancreatography (MRCP) sequence with that of ERCP and PTC in the imaging of the normal and abnormal biliopancreatic tract. Thirty patients with suspected biliary and pancreatic diseases were examined with MRCP first and then with ERCP or PTC; they were also submitted to US, CT and conventional MR studies and in 5 of them CT cholangiography was also performed. Five patients were normal and 25 had various obstructive abnormalities: 5 patients had gallbladder stones, 8 common bile duct stones, 5 a cholangiocarcinoma and 7 an adenocarcinoma of the pancreatic head or papilla. MRCP was performed with a superconductive magnet at 0.5 T, with volumetric images on coronal planes acquired using an IR turbo SE sequence (TR 2500, TE 1000, TF 89, 4 NEX) with respiratory triggering and vascular presaturation. Segmental intrahepatic bile ducts were correctly depicted in all the patients with benign or malignant obstruction of the common bile duct, but with some respiratory artifacts. Common bile duct stones were correctly depicted in 7 of 8 patients, but studying also the single coronal slices. With this method, the stones were clearly demonstrated in 22 examined gallbladders. Neoplastic obstruction and the obstruction level were correctly identified in all patients. Pancreatic ducts were shown in normal patients and in 8 of 13 patients with neoplastic or lithiasic obstruction of the common bile duct mainly on the pancreatic head. ERCP was carried out successfully in 5 patients with common bile duct stones and in 7 patients with neoplastic obstruction; in the other cancer patients, PTC was necessary. To conclude, respiratory-triggered 3D IR turbo spin-echo MRCP is a noninvasive technique to study mostly biliary conditions which yields similar information to ERCP and PTC in a large number of patients. Moreover, this sequence can be used with midfield MR units to study the obstruction of the biliary and pancreatic ducts not only when invasive techniques fail, but also routinely.

[Medial luxation of the long head of the brachial biceps. Magnetic resonance imaging]. / La lussazione mediale del capo lungo del muscolo bicipite del braccio. Quadri con risonanza magnetica.

The medial intraarticular dislocation of the biceps tendon of the shoulder is a rare pathologic condition and its diagnosis before surgery is very important to properly repair the tears of rotator cuff tendons, the rotator cuff being nearly always involved. We report our experience in 8 patients (1.8%) with biceps tendon dislocation observed in a series of 432 patients submitted to MR studies to address several diagnostic issues. The MR patterns of biceps tendon dislocation and the related physiopathologic mechanisms are discussed. The MR images were retrospectively reviewed by two of the authors and dislocations were diagnosed in a subgroup of 34 patients (7.8%), associated with full-thickness tears of the tendon of supraspinatus muscle; all patients also presented a full-thickness tear of the subscapularis tendon. A dislocated biceps tendon can follow a variety of courses depending on the pattern of subscapularis tendon tear. We always found a complete dislocation of the biceps tendon; other dislocation patterns reported in the literature, and particularly oblique and superficial dislocations, were never observed in our series. Dislocation is visible on axial images, where the tendon appears completely displaced from the bicipital groove, but also sagittal and coronal images can depict the more medial position of the tendon. In our patients this abnormality was correctly identified in 4 patients during the first observation and in the extant patients during the retrospective review. The dislocation of the biceps tendon of the shoulder was frequently associated with a complete tear of the supraspinatus tendon (23.5%). All patients exhibited severe joint effusion and in two patients the dislodged tendon was also inflamed.