Retained surgical gauzes: acute and chronic CT and US findings.

Surgical sponges retained after laparotomy represent a diagnostic problem if they cannot be identified by radiopaque markers on standard radiographs. We report on 9 patients from different hospitals with an abdominal gossypiboma 7 days to 21 years after the surgical procedure. Plain radiographs may suggest the diagnosis if a textile foreign body is calcified, that is, is equipped with radiopaque marker, or when a characteristic "whirl-like" pattern is present. CT and US are necessary procedures in chronic cases, since the lesion may mimic a mass; US shows specific echogenic areas with acoustic shadow; CT usually reveals a hypodense mass with a thick peripheral rim.

[Cystic lymphangiomas of the abdomen. CT and US findings]. / Linfangiomi cistici dell'addome. Rilievi TC e US.

Cystic lymphangiomas of the abdomen are an uncommon kind of hamartoma. Their diagnosis is often difficult and calls for an accurate differential diagnosis of this disease and such lesions as cystic pancreatic neoplasms, pseudocysts, hematomas, abscesses and urinomas. Eight cases of abdominal lymphangioma are reported, in patients ranging 35 to 68 years; all lesions were uni/multilocular containing serous fluid. Lymphangiomas were located in the retroperitoneal space (3 cases), in the mesenteric bed (3 cases), close to the left lumbar ureter (1 case), and on the left colon wall (1 case); the symptoms were little characteristic, mostly due to pressure on the adjacent organs. Both CT and US were able to detect and evaluate the lesions; in particular, CT provided also with exact topography. A small lymphangioma in the left colon was revealed only by barium enema. In 2 huge retroperitoneal lymphangiomas the diagnostic evaluation was improved by the use of CT-guided fine-needle biopsy; in patients with mesenteric lesions angiography was employed, also for surgical planning. Lymphography was never performed because CT and US proved the best diagnostic procedures. All patients underwent surgery, whose results confirmed the previous diagnosis, but for the patient with para-ureteral location the surgeon thought nephrectomy necessary.

[Traumatic hematomas of the adrenal glands: CT and US findings in 3 cases]. / Gli ematomi traumatici del surrene. Rilievi TC e US in tre casi.

Traumatic hematomas of the adrenal gland are but little known; they are but seldom discussed in literature, and can be demonstrated only by US and CT due to their small size. These lesions are mostly located on the right side, probably following a direct trauma of the adrenal parenchyma against vertebral bodies, or as a result of the rupture of medullary sinusoids for a sharp rise in pressure into the inferior vena cava, during trauma. Bilateral traumatic hematomas can cause severe adrenal failure, and the healing is slow, without calcifications, and takes several months. Three new cases are reported, unilateral on the right adrenal bed. In 2 patients CT demonstrated a slight parenchymal enlargement after thoraco-abdominal traumas; the patients were young and healthy, and the lesions completely disappeared in some years. US detected a third hematoma in a young woman with suspected metastasis from ovarian carcinoma: CT confirmed the parenchymal swelling, and a percutaneous transhepatic biopsy clarified the diagnosis. Adrenal hematomas are to be reported in order to avoid confusing them with neoplastic lesions, even though only percutaneous biopsy allows a quick and reliable diagnosis.

[Pleural fibroma: radiographic and CT findings]. / Il fibroma pleurico. Rilievi radiografici e TC.

Pleural fibroma is a rare and benign primary tumor, mainly asymptomatic and of big size due to its slow growth from visceral pleura. Six patients (5 males and 1 female) with this pathologic condition were studied; the tumors had diameters ranging 2.5-18 cm. The diagnosis was occasional in 4 patients, while the extant presented with dyspnea, cough, and thoracic pain. Two large fibromas originating from the left basal visceral pleura failed to be correctly diagnosed on plain films, while 2 small pedunculated lesions exhibited blurred outlines at the pleural origin. On chest films, neither rib erosions nor pleural effusions or calcifications were detected. CT scans showed 2 small lesions to have both shape and localization typical of pleural origin, while a third pedunculated fibroma mimicked an intrapulmonary mass. Three huge fibromas, especially 2 of them originating from left basal pleura, were misdiagnosed by CT and topographic criteria. CT images after intravenous injection of contrast medium showed mainly a mottled and irregular densitometric pattern. A correct diagnosis was very difficult to make also with the help of CT-guided biopsy (performed on 5 patients), because the specimens had a fibrous content and were very small due the elasticity of the mass against the needle. All patients underwent surgery and were cured when discharged. Histology was always necessary for a conclusive diagnosis to be made.

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.

[CT-guided percutaneous biopsy of adrenal masses. Experience of the technic in 54 neoplasm patients]. / La biopsia percutanea con guida TC delle masse surrenali. Esperienza di tecnica in 54 pazienti neoplastici.

Cross-sectional CT and US imaging have allowed the visualization of adrenal glands anatomy and abnormalities. In cancer patients a unilateral or bilateral adrenal enlargement may result from metastasis because the adrenal gland is one of the most common locations for metastasis in thoracic and abdominal tumors. We report our experience in 54 patients who underwent adrenal biopsy for unilateral (44 cases) or bilateral (10 cases) masses during CT examination mostly for lung cancer studies. Twenty-nine of 54 patients (53.7%) had metastatic deposits in the enlarged parenchyma. Other lesions included various pathologic conditions such as primary malignant tumors (2 carcinomas, 2 lymphomas, and 1 pheochromoblastoma) (5.5%), pheochromocytomas (3.7%), nonfunctioning adenomas (14.8%), and simple hyperplasias (12.4%). Eight of 10 patients with bilateral enlargement were metastatic; the extant 2 had simple hyperplasia. Biopsy was useless in 5 cases (9.2%), especially in the beginning and due to poor technique. All procedures were carried out with 18 and 19 G needles and under CT guidance, after standard scanning. The posterior approach was initially used, for both right (15%) and left (7.4%) lesions, but 3 pneumothoraces occurred. At present, we prefer transhepatic approach for the right adrenal gland: this access route is, in our experience, the safest and quickest. Left adrenal masses were approached anteriorly through the left hepatic lobe; when possible, in other patients, we used an oblique posterior transrenal approach, even though macroscopic hematuria occurred in 2 patients, without sequelae. We never used trans-splenic approach, even though this access has been described in literature for pancreatic masses. Transhepatic and transrenal CT-guided biopsy for adrenal masses in cancer patients provides, in our opinion, a correct and unquestionable diagnosis of possible metastasis, also for lesions smaller than 3 cm.

[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.

[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.