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Luigia Romano

Publications and source records attributed to Luigia Romano.

32 records · Page 2Linked to original sources
PubMed2004

Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging.

Abdominal blunt trauma represents the main cause of death in people of age less than 40 years; the liver injury occurs frequently, with an incidence varying from 3 to 10%. Isolated hepatic lesions are rare and in 77-90% of cases, lesions of other organs and viscera are involved. Right hepatic lobe is a frequent site of injury, because it is the more voluminous portion of liver parenchyma; posterior superior hepatic segments are proximal to fixed anatomical structures such as ribs and spine that may have an important role in determining of the lesion. The coronal ligaments' insertion in this parenchymal region augments the effect of acceleration-deceleration mechanism. Associated lesions usually are homolateral costal fractures, laceration or contusion of the inferior right pulmonary lobe, haemothorax, pneumothorax, renal and/or adrenal lesions. Traumatic lesions of left hepatic lobe are rare and usually associated with direct impact on the superior abdomen, such as in car-crash when the wheel causes a compressive effect on thorax and abdomen. Associated lesions to left hepatic lobe injuries correlated to this mechanism are: sternal fractures, pancreatic, myocardial, gastrointestinal tract injuries. Lesions of the caudal lobe are extremely rare, usually not isolated and noted with other large parenchymal lesions. The Institution of Specialized Trauma Centers and the technical progress in imaging methodology developed in the last years a great reduction of mortality. New diagnostic methodologies allow a reduction of negatives laparotomies and allow the possibility of conservative treatment of numerous traumatic lesions; however, therapy depends from imaging findings and clinical conditions of the patient. Computed tomography (CT) certainly presents a large impact on diagnosis and management of patients with lesions from blunt abdominal traumas. It is important to establish a prognostic criteria allowing decisions for conservative or surgical treatment; CT findings and peritoneal fluid evaluation may be used to make a first differentiation of severity of lesions, but haemodynamic parameters may help the clinician to prefer a conservative treatment. In emergency based hospitals and also in our experience, positive benefits spring from diagnostic accuracy and consequent correct therapeutic management.

Emergency Medical Services↗
PubMed2004

Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process?

The CT diagnosis of bowel and mesenteric injuries is difficult and warrants optimal technique and skilled interpretation. We retrospectively reviewed 36 consecutive patients with blunt traumatic injuries to the bowel and mesentery at our regional level I trauma center during the past 3 years. Physical examination, laboratory, Computed tomographic (CT), and intraoperative findings were compared. Surgically proven bowel injuries (13 cases) occurred in the duodenum (three cases), ileum (two cases), jejunum (two cases), colon (three cases), and stomach (three cases). CT findings considered specific of bowel rupture were observed in 5/13 patients including: extraluminal oral contrast or luminal content extravasation (four cases) and discontinuity of hollow viscus wall (one case). In the remaining 8/13 CT findings considered suggestive of bowel injury consisted of: pneumoperitoneum (six), gas bubbles close to the injured hollow viscus (three), thickened (>4-5mm) bowel wall (five), bowel wall hematoma (three), intraperitoneal fluid of unknown source (three). Mesenteric injury (23 cases) were surgically observed at the level of the mesenteric vessels (17 cases), legament of Treitz (two cases), gastro-duodenal artery (one case), transverse (one case) and sigmoid mesocolon (one case). CT finding considered specific of mesenteric laceration was active extravasation of contrast material from the mesenteric vessels (10 cases). CT findings suggestive of mesenteric injury (13 cases) consisted of: mesenteric hematoma (five) and/or high attenuation fluid collections, within the mesenteric root (eight) and folds (four). Helical CT is sensitive in the identification of bowel and mesenteric injury after blunt trauma providing a wide spectrum of findings. However, CT cannot be used as the sole indicator in cases with isolated thichened bowel wall, mesenteric hematoma, bowel hematoma, pneumoperitoneum or gas bubbles. Persistent, active extravasation of intravenous constrast medium from the mesenteric vessels, in isolation or associated with further injuries, requires immediate exploration and repair; disruption of bowel wall and extravasation of oral contrast are definite signs of bowel rupture. Close clinical observation, monitoring, and surgical expertise are mandatory for appropriate management.

Contrast Media↗
PubMed2004

[Pictorial essay: foreign body of the gastrointestinal tract in emergency radiology].

The ingestion of a foreign body is a relatively common gastrointestinal emergency that causes significant morbidity. Radiological procedures play a very important role in revealing the presence, the location and the nature of an ingested foreign body, thus enabling the best therapeutic approach. We present the radiological features of common and uncommon foreign bodies ingested or with transanal insertion, differentiated on the basis of the location in the gastrointestinal tract. Diagnostic pitfalls are also considered.

Diagnosis, Differential↗
PubMed2004

Comparison between the site of multislice CT signs of gastrointestinal perforation and the site of perforation detected at surgery in forty perforated patients.

PURPOSE: To compare the site of multislice spiral computed tomography (MSCT) signs of gastrointestinal perforation and the site of perforation at surgery in forty perforated patients. MATERIALS AND METHODS: Between January 1 and July 31, 2003, a total of 40 patients (23 men and 17 women) underwent surgery for gastrointestinal perforation. In all cases, plain radiography of the abdomen was integrated by MSCT with the following parameters: 0.5 seconds gantry rotation time, 2.5-5.0 mm slice thickness, 3.75 reconstruction interval, 120 kV, 250-300 mAs, pitch 1.5, after intravenous administration of 140 ml of contrast agent at 3 ml/s with an automatic injector and a delay time of 70 seconds from the injection of the contrast agent. The MSCT findings were: free air and free fluid observed in supramesocolic compartments and/or in inframesocolic compartments and bowel wall discontinuity. The sites of the MSCT findings were compared with the site of perforation observed at surgery. RESULTS: Free air was detected in 60%, free intraperitoneal fluid in 92.5%, and a combination of both findings in 57.5% of the 40 cases examined. There were no cases of bowel wall discontinuity. In nine patients with gastroduodenal perforation, free air and free fluid were detected in combination and free air was localised in supramesocolic compartments in all cases; in two patients with jejunal perforation, free intraperitoneal fluid was observed both in supramesocolic and inframesocolic compartments; in six patients with acute perforated appendicitis, free air was never detected, while free fluid was observed in all cases in inframesocolic compartments; in six patients with isolated sigmoid perforation free air was observed in four cases in supramesocolic compartments while free fluid was seen in both supramesocolic and inframesocolic compartments. CONCLUSIONS: MSTC is the most reliable diagnostic method with which to assess gastrointestinal perforation as it allows detection of even small amounts of free air in the abdomen, which are a sign of perforation. In our study, the comparison of the sites of MSCT signs of perforation with those observed at surgery showed that in gastroduodenal perforations free air and free fluid are present in combination and free air is localised in supramesocolic compartments; in acute perforated appendicitis free air is absent, while free fluid is present in inframesocolic compartments; in isolated sigmoid perforations free air, if present, is localised in supramesocolic compartments, while free fluid is seen in both compartments.

Adolescent↗
PubMed2003

Adrenal injuries: spectrum of CT findings.

Injury to the adrenal gland is often incidentally diagnosed with Computed Tomography (CT) following blunt abdominal trauma. In a high percentage of cases, it is accompanied by other intra-abdominal, retroperitoneal or intrathoracic injuries. Although not usually clinically significant, adrenal traumatic lesions can be a source of infection, as well as a cause of acute adrenal insufficiency. We discuss and illustrate typical and less common CT findings of adrenal injuries.

Journal Article↗
PubMed2002

Portomesenteric vein gas: diagnostic and prognostic value.

Portomesenteric pneumatosis has been traditionally associated with intestinal infarction and poor outcome; however, recent studies have questioned its clinical value. To assess its diagnostic and prognostic significance we have retrospectively evaluated 47 patients correlating the CT finding of portomesenteric vein gas with clinical data and outcome. Thirty-nine patients (83%) had surgical evidence of intestinal infarction, four had necrotic small bowel volvulus (8.5%), two had blunt trauma, one had necrotic gastric volvulus, and one a gastric mucosal lesion induced by a nasogastric tube. Fifteen patients survived (31.9%); only 8/39 patients with intestinal infarction survived. Portomesenteric pneumatosis is a reliable marker of intestinal infarction and poor outcome; however, in trauma patients this sign is associated with a better prognosis.

Journal Article↗
PubMed2002

Value of contrast-enhanced CT for managing mesenteric injuries after blunt trauma: review of five-year experience.

OBJECTIVE: The purpose of this retrospective study was to determine the value of contrast-enhanced computed tomography (CT) in the detection and management of mesenteric injuries after blunt trauma. MATERIALS AND METHODS: Between June 1995 and December 2000, 1,619 consecutive abdominal CT examinations were performed in the setting of major blunt trauma. Findings at CT were evaluated before patients were classified as having grade 1 or grade 2 lesions or none. Grade 1 represented the presence of minor injuries: mesenteric haziness, confined fluid, and/or small hematomas (<30 mm) within the mesenteric folds and abdominal injuries; grade 2 was appropriate to evidence of major injuries: moderate to large hematomas (>30 mm), active bleeding, hemoperitoneum, and further abdominal injuries. RESULTS: On the basis of the CT findings, 161 (9.9%) of 1,619 patients were classified as having grade 1 and 25 (1.5%) of 1,619 patients as having grade 2 injuries. Of the 161 (77.6%) patients with grade 1 injuries, 125 were managed conservatively, while 36 (22.4%) underwent surgery. Of the 25 (84%) patients with grade 2 injuries, 21 were treated surgically and 1 (4%) patient was followed medically. Three (12%) of the 25 patients underwent laparotomy after 24 h close clinical observation and monitoring. Initial CT findings in 1,433 (88%) of the 1,619 patients were negative for mesenteric injuries, and in 1,430 of these cases no delayed mesenteric hemorrhage was observed. CONCLUSION: Contrast-enhanced CT has a critical role in the identification and exclusion of mesenteric injuries. Persistent, active extravasation of contrast material, in isolation or associated with further abdominal lesions, is a sign of a high likelihood of injury requiring urgent laparotomy. Haziness, isolated confined clotted mesenteric hemorrhage, and small hematomas within the mesentery are nonspecific findings and should be considered in the appropriate clinical context. Close clinical observation, monitoring, and surgical expertise are mandatory for appropriate management.

Journal Article↗
PubMedDate not supplied

[Positive predictive value and negative predictive value of spiral CT in the diagnosis of closed loop obstruction complicated by intestinal ischemia].

PURPOSE: To assess the positive predictive value and the negative predictive value of spiral CT in the diagnosis of "closed-loop" obstruction complicated by intestinal ischaemia. MATERIALS AND METHODS: Between January 1999 and January 2002, 120 patients with small intestine closed-loop obstruction who had undergone surgical laparotomy within 2-6 hours from abdominal and pelvic spiral CT were retrospectively reviewed. The CT scans were performed using 5-mm slice thickness, 1 s scan delay, 5 x 5-mm collimation and 1.5 pitch after administering i.v. iodinated contrast material (120 ml volume, 60 s scan delay, 2.5-3 ml/s rate) with an automatic injector. For the diagnosis of closed-loop obstruction the following CT findings were examined: identification of the transitional area, 'C', 'U' or 'beak' shape of the obstructed loops, radial distribution of the involved mesenteric vessels. For the diagnosis of loop ischaemia, the following findings were evaluated in addition to the CT signs described above: submucosal oedema, increased, reduced, or no enhancement of the loop walls, oedema of the mesenteric vessels, fluid within the loops or in the intraperitoneal spaces. RESULTS: 'U', 'C', 'beak' loop configuration with poor or no contrast enhancement of the obstructed loop walls, ascites, rotation and engorgement of mesenteric vessels enabled the diagnosis of 26 cases of closed-loop obstruction complicated by ischaemia, infarction. U- or C-shaped loops with radial distribution and/or rotation of mesenteric vessels towards the obstruction site suggested the correct diagnosis in 94 cases, but did not allow identification of ischaemia in 25 cases. The positive predictive value of spiral CT related to ischaemic loop complications was 100%; the negative predictive value was 73%. CONCLUSIONS: Spiral CT is a reliable imaging technique enabling the diagnosis of closed-loop obstruction with or without intestinal ischaemic complications. Any alterations detected in the trophic status of the loops or mesentery imply ischaemic complications requiring emergency surgery. On the contrary, if only CT signs of closed-loop obstruction are detected, the existence and/or development of ischaemia cannot be ruled out.

Adult↗
PubMedDate not supplied

Pictorial essay: common and uncommon CT features of acute pelvic pain in the woman.

Acute pelvic pain in women is a frequent cause of emergency hospital admission. Because the source may be either gynaecological or non-gynaecologic and because of the complex anatomy of the pelvic area, the differential diagnosis of the underlying disease is extensive. In such cases ultrasonography is the procedure of choice, as it leads to a diagnosis in most cases. Sometimes, however, when the sonographic findings are non-diagnostic or disagree with the clinical picture, especially in acutely ill patients, a Computed Tomography (CT) scan of the abdomen and pelvis can assist in the diagnosis. We present the CT features of different gynaecological and non-gynaecological conditions in women presenting to the Emergency Room with acute pelvic pain.

Acute Disease↗
PubMedDate not supplied

Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus.

In recent years the increasing use of ultrasonography and computed tomography in the assessment of diseases causing acute abdomen and the diagnostic possibilities of magnetic resonance have decreased the role of conventional radiology techniques, especially of plain abdominal film in the diagnosis of acute abdomen. However, serial plain abdominal film is still the first diagnostic procedure used in the assessment of patients with acute abdominal pain, providing important diagnostic information if correctly performed and carefully observed. In this paper serial plain abdominal film findings related to the different types of ileus (spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus) are presented.

Abdomen, Acute↗