Magnetic Resonance Signal Abnormalities Within the Pericruciate Fat Pad: A Possible Secondary Sign for Acute Anterior Cruciate Ligament Tears.

PURPOSE: The study sought to investigate the presence of magnetic resonance (MR) signal alterations within the pericruciate fat pad in patients with an acute anterior cruciate ligament (ACL) tear as well as evaluate its diagnostic value in comparison with the main secondary signs of ACL tears. METHODS: Two musculoskeletal radiologists retrospectively reviewed knee MR examinations performed from May to October 2015. The ACL was considered as torn or intact based on either previous arthroscopic findings or unequivocal MR imaging interpretation if arthroscopic correlation was unavailable. Abnormalities of the pericruciate fat pad were evaluated as increased signal on the fluid-sensitive sequences; the main secondary signs of ACL tears were identified. Sensitivity and specificity were calculated for each sign. RESULTS: A total of 182 patients entered this study: 22 with an acute ACL tear, 160 with intact ACL. Signal hyperintensity of the pericruciate fat pad was demonstrated in all patients with an acutely torn ACL, resulting significantly different between individuals with intact ACL and those with ligament tear (P < .0001). This sign was much more sensitive (100%) but less specific (72.5%-75%) than other secondary signs. CONCLUSIONS: Signal hyperintensity of the pericruciate fat pad on the fluid-sensitive sequences is associated with acute ACL tears and could be considered as a possible indicator of these injuries.

A late presentation of a left paraduodenal hernia in an elderly patient admitted in emergency: A case report.

Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect elderly patients and pose a significant diagnostic challenge due to their nonspecific symptoms. In most cases, laparotomy was used to diagnose IHs. However, multidetector computed tomography (MDCT) is usually the best imaging tool to use in the emergency setting for the diagnosis of IHs. An 83-year-old man was admitted to emergency with acute abdominal pain and a coffee-ground vomitus. The abdominal MDCT showed a clustered-like appearance of proximal jejunal loops at the level of the Treitz ligament with the absence of transit of the medium water-soluble iodine oral contrast agent (Gastrografin). Mesenteric edema was also present with initial suffering of the intestinal wall. A left paraduodenal hernia (LPDH) with strangulation was suspected following the radiological report. The emergency laparotomy revealed about 20 cm of proximal jejunal loops herniated through a 3 cm wide hernia orifice (HO) along the Treitz ligament, at the level of Landzert fossa, located in the confluence of the descending mesocolon, posterior to the inferior mesenteric vein (IMV) and confirming the LPDH. The patient was discharged in good condition some days later. IHs do not have sufficient coverage in literature, especially in cases regarding elderly patients, however, they can be a cause of SBO in people older than 80 years of age. Radiologists and surgeons should be aware of the anatomical aspects of the IHs.

Intestinal and Extraintestinal Findings of Graft-versus-Host Disease on CT: A Case Series with Radiological and Histopathological Correlations.

Graft-versus-host disease (GVHD) is an expected and relatively common complication after allogeneic hematopoietic stem cell transplantation. It may affect different organs and typically involves the skin, liver, and gastrointestinal tract (GI-GVHD). GI-GVHD may show heterogeneous presentations with peculiar diagnostic implications. Although an endoscopic biopsy is considered the "gold standard" for the diagnosis of GI-GVHD, its broad application is limited due to the poor clinical conditions usually present in these patients, including thrombocytopenia. In the emergency department, enhanced computed tomography (CECT) has emerged as the best imaging modality for the evaluation of GI damage in frail patients. However, the role of CT in the context of either acute or chronic GI-GVHD has not been systematically investigated. Herein, we focus on the radiological features found on CECT in five patients with GI-GVHD confirmed on histology. CECT was performed for the persistence of GI symptoms in three cases (case 1, case 3, and case 4), for small bowel occlusion in one case (case 5), and for acute GI symptoms in one case (case 2). Serpiginous intestinal wall appearance with multisegmental parietal thickness and homogeneous, mucosal, or stratified small bowel enhancement were common features. Colic involvement with segmental or diffuse parietal thickness was also present. One patient (case 5) presented with inflammatory jejunal multisegmental stenosis with sub-occlusion as a chronic presentation of GI-GVHD. Regarding mesenterial findings, all five patients presented comb signs in the absence of lymphadenopathy. Extraintestinal findings included biliary tract dilatation in two cases (case 2 and case 4). These data support the utility of appropriate radiological investigation in GI-GVHD, paving the way for further serial and systematic investigations to track the appearance and evolution of GI damage in GVHD patients.

Dynamic MRI defecography vs. entero-colpo-cysto-defecography in the evaluation of midline pelvic floor hernias in female pelvic floor disorders.

PURPOSE: The aim of this study was to compare the diagnostic efficacy of dynamic MR defecography (MR-D) with entero-colpo-cysto-defecography (ECCD) in the assessment of midline pelvic floor hernias (MPH) in female pelvic floor disorders. METHODS: From August 2004 to August 2010, 3,006 female patients who required ECCD for the evaluation of pelvic floor disorders were enrolled in this study. All the 1,160 patients with ECCD findings of MPH were asked to undergo MR-D; 1,142 accepted to undergo MR-D and constituted the object of analysis. This study was approved by the Institutional Ethical Committee. All the patients gave their written informed consent to take part in the study. RESULTS: Overall, the prevalence of MPH at ECCD was higher if compared with that at MR-D. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on ECCD than on MR-D, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at ECCD was significantly higher than that at MR-D. In spite of a 100% specificity, the sensibility of MR-D in the detection of an omentocele, sigmoidocele, and enterocele was, respectively, 95%, 82%, and 65%, showing an inferior diagnostic capacity if compared with that of ECCD. CONCLUSION: MR-D shows lower sensitivity than ECCD in the detection of MPH development. The less-invasive MR-D may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery.

Acute Ischemic Hemorrhagic Stroke in Two COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First identified in December 2019, in Wuhan, China, it has since become a global pandemic. Complications of COVID-19 are not limited to the pulmonary system, but also include neurologic manifestations such as stroke. We report two cases of coincidental presentation of COVID-19 and cerebrovascular accident. Further studies are needed for a comprehensive understanding of the neurological pathology of COVID-19 and its effects on the nervous system, but stroke teams should be wary of the fact that COVID-19 patients may present with cerebrovascular accidents.

Chest CT Findings after 4 Months from the Onset of COVID-19 Pneumonia: A Case Series.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the reference standard for SARS-CoV-2 diagnosis is real-time reverse transcription polymerase chain reaction (RT-PCR), computed tomography (CT) is recommended for both initial evaluation and follow-up. There is a growing body of published evidence about CT evolution during the course of COVID-19 pneumonia. Here, we report six confirmed cases of COVID-19 patients who underwent unenhanced chest CT on admission and after 4 months from the onset of symptoms. Chest-CT at first admission showed the typical CT features of COVID-19. Interestingly, the follow-up CT revealed the persistence of lung abnormalities in five cases even if all the patients were completely asymptomatic. Further studies are needed for a comprehensive understanding of the disease progression and the resulting late imaging modifications.

Involvement of the Mediastinal Subpleural Pulmonary Parenchyma on Chest CT in COVID-19 patients: A Case Series.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First identified in December 2019 in Wuhan, China, it has since become a global pandemic. Although the reference standard for SARS-CoV-2 diagnosis is real-time reverse transcription polymerase chain reaction (RT-PCR), computed tomography (CT) is recommended for both initial evaluation and follow-up. The CT findings in COVID-19 are varied, but typical ground-glass opacities are usually reported to occupy a peripheral costal subpleural distribution. Here we report eight confirmed COVID-19 cases who underwent clinical evaluation, laboratory testing, and unenhanced chest CT. In all patients, chest CT showed the presence of ground-glass opacities in the mediastinal subpleural parenchyma. While these cases also showed the typical CT features of COVID-19, involvement of the mediastinal subpleural parenchyma should not lower the index of suspicion for COVID-19.

Knee bursitis: a sonographic evaluation.

OBJECTIVE: To evaluate the use of ultrasound for the diagnosis of knee bursitis. MATERIALS AND METHODS: One-hundred and fifty-eight patients who, from May 2013 to May 2014, had an ultrasound examination of the knee and magnetic resonance imaging (MRI) of the knee during the following month were eligible for the study. The exams were reviewed by two musculoskeletal radiologists with 20 years of experience. RESULTS: Of these patients, 15 (7 men, 8 women) had bursitis, while 143 (76 men, 67 women) had no bursitis. In evaluating knee bursitis, US, when compared to MRI, correctly identified 13 out of 15 cases of bursitis, showing a sensitivity of 86.67 %, specificity 100 %, and K index of 0.92. Particularly in the suprapatellar bursa, ultrasound showed bursitis in 5 cases versus 7 by MRI (sensitivity of 71.4 %, specificity of 100 %, and K index of 0.82). CONCLUSION: Ultrasound can be used as a valuable tool for the evaluation of bursitis of the superficial bursae in patients who cannot undergo MRI.

Joint effusion of the knee: potentialities and limitations of ultrasonography.

PURPOSE: This study aimed at comparing the diagnostic accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) for the detection of joint effusion of the knee. METHODS: For this retrospective study, approbation by the institutional review board was not required, and written informed consent from the patients was waived. One hundred and fifty-eight patients (83 men and 75 women; median age 41.2 years; age range 13-81 years) who underwent US and MRI of the knee were included in the study. The sensitivity and specificity of US with respect to MRI in the evaluation of the effusion of the knee and in each recess were compared. RESULTS: In evaluating joint effusion of the knee, compared with MRI, US correctly identified 78 of 96 patients with joint effusion, showing a sensitivity of 81.3 % and a specificity of 100 %, with a positive predictive value (PPV) of 100 % and a negative predictive value (NPV) of 77.5 % (p value = 0.001). Various results were obtained comparing ultrasound with MRI, regarding the various recesses. CONCLUSION: US showed high specificity and sensitivity in diagnosing knee joint effusion and could be used in patients who cannot undergo MRI.