Conventional X-ray and CT findings in a case of intraluminal choledochocele.
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Biomedical subjects
Publications and source records attributed to O Catalano.
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PURPOSE: To describe and discuss the thoracic CT features of hypovolemic shock. MATERIAL AND METHODS: From a group of 18 patients with signs of hypovolemia on contrast-enhanced abdominal CT, 11 were selected for our study as having also undergone a complete chest examination. Pulse rate, blood pressure, trauma score value, Glasgow coma scale value, surgical result, and final outcome were retrospectively evaluated. The CT features analyzed were: decreased cardiac volume, reduced caliber of the thoracic aorta, aortic branches and caval venous system, increased enhancement of the aorta, and increased enhancement of the pulmonary collapses/contusions. RESULTS: All 11 subjects presented severe injuries and hemodynamic instability; 7 were stable enough to undergo surgery; only 1 of the 11 survived. Two patients showed none of the features of thoracic hypovolemia. All the other patients presented at least two signs: reduced caliber of the thoracic aorta in 7 cases; decreased volume of the cardiac chambers and increased aortic enhancement in 6; decreased caliber of the aortic vessels in 4; decreased caliber of the caval veins in 3; and increased enhancement of the pulmonary collapses/contusions in 3. CONCLUSIONS: In patients with hypovolemia, CT may show several thoracic findings in addition to abdominal ones. Knowledge of these features is important for distinguishing them from traumatic injuries.
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PURPOSE: We report on our personal experience with the radiologic and CT demonstration of the traspyloric duodenal spread of gastric carcinoma, whose relative frequency and prognostic value are recent literature data. MATERIAL AND METHODS: In the last 4 years we submitted to double contrast studies of the upper gastrointestinal (GI) tract 49 gastric carcinoma patients with antrum involvement. Twenty-one cases were staged with CT performed with gastric water distension, pharmacological hypotonia and dynamic contrast agent perfusion. Finally, 41 patients underwent surgical treatment. RESULTS: Radiologic evidence of transpyloric gastric carcinoma spread was found in 6 cases; CT, performed in 5 of them, was always in agreement. Five of 6 positive cases had surgical confirmation while one lesion was unresectable. No radiologic or CT false negatives were found among the remaining 36 surgical patients. Barium studies showed irregular antral lumen narrowing, rigid, open and eccentric pyloric channel, duodenal bulb deformity and irregular thickening. CT demonstrated antrum infiltration along the two gastric curvatures and the tumor spread to the duodenal cap. CONCLUSION: Antral cancer transpyloric spread is more frequent than previously reported and its presence should not exclude a carcinomatous process. Double contrast barium studies are a valuable tool in the demonstration of this spread, showing good correlation with CT staging findings.
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PURPOSE: We report our preliminary experience concerning Doppler studies with the intravenous injection of a galactose-based echo contrast agent (SHU 508 A) in hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization. We correlated US findings with those of iodized-oil helical CT. MATERIAL AND METHODS: In 1997 we examined 18 patients with cirrhosis and HCC (31 nodules in all) submitted to hepatic oily chemoembolization 15-30 days earlier. The lesions were studied with color and power Doppler US before and after echo contrast agent infusion (300 mg/mL, injection/nodule, constant rate in 60-90 s) and with Lipiodol CT (0-7 days after US). In the retrospective analysis, special care was paid to Doppler signals from pulsatile intra- and perinodular flow and to the detection of new small vessels on enhanced images. The signal was graded as absent (0), weak (1), medium (2) and strong (3). The oily agent uptake on CT images was graded as absent (0), grade I (< 10%), II (< 50%), III (> 50%) and homogeneous (IV). All scores were given on a blind basis. RESULTS: Liver enhancement was found in all cases and always lasted long enough to allow the accurate depiction of parenchymal lesions (at least 8 minutes). Signal intensity could be evaluated in 27 of 31 HCCs (2 were too deeply seated and two were too affected by cardiac activity). We had the following scores: basal color Doppler: grade 0 = 15 lesions, grade 1 = 8 lesions, grade 2 = 4 lesions; contrast-enhanced color Doppler: grade 0 = 11 lesions, grade 1 = 7 lesions, grade 2 = 8 lesions, grade 3 = 1 lesion; basal power Doppler: grade 0 = 12 lesions, grade 1 = 8 lesions, grade 2 = 6 lesions, grade 3 = 1 lesion; contrast-enhanced power Doppler: grade 0 = 10 lesions, grade 1 = 7 lesions, grade 2 = 8 lesions, grade 3 = 2 lesions; Lipiodol-CT: grade 0 = 1 lesion, grade I = 1 lesion, grade II = 7 lesions, grade III = 8 lesions, grade IV = 10 lesions. The difference between color and power Doppler scores, both compared to each other and between basal and enhanced images, never exceeded one. CONCLUSIONS: Contrast-enhanced Doppler US is a simple and fast technique allowing strong, constant and long-lasting enhancement. Doppler US techniques permit the effective and realistic study of HCC nodules treated with chemoembolization and show a better correlation with Lipiodol CT than basal studies. Power Doppler is slightly more sensitive and accurate than color Doppler and shows a better correlation with Lipiodol CT.
PURPOSE: To report our personal experience with color Doppler ultrasound (US) in the study of the ureterovesical jet in patients with recent renal colic. MATERIAL AND METHODS: First, the jet was studied in 10 healthy subjects and then 42 consecutive patients with urinary colic were submitted to plain radiography, which was sometimes integrated with conventional renal tomography, and real time US to detect the stone and to study the urinary tract above. Then, color Doppler function studies were carried out with transverse scans at the trigone and with the scan plane rotated on the ureterovesical junction. Retrospectively, the jet frequency, velocity, duration, volume, direction and interval were analyzed. Finally, all patients were examined with excretory urography. RESULTS: The jet had an anteromedial direction and exceeded the midline in the controls, with a peak velocity of 20-30 cm/s, mean duration of 15 s, mean frequency of 4-5 min and interjet interval 2-150 s. The jet was abnormal in the obstruction side in all renal colic patients; it was slow, continuous, decreased in volume and intensity, and prolonged in 26 patients--20 of them had incomplete lumbo-iliac ureteral obstruction and 6 pyeloureteral junction stones. The jet was diverted from its orientation in 7 subjects with intramural stones. There was no jet in 9 patients and urography demonstrated complete urinary obstruction--4 at the pyeloureteral junction and 5 at the lumbo-iliac ureter. CONCLUSIONS: Color Doppler US of the ureteral jet is a valuable tool in urinary colics because it yields in real time more pieces of functional information than radiography and B-mode US and also demonstrates the grade of urinary obstruction.
Acute mesenteric insufficiency is a surgical emergency with a difficult methodological approach. Its high mortality is mainly due to delay in the correct diagnosis. In turn, this is due to the lack of specificity, specially in the early-middle phase, of the clinical presentation, laboratory data, and plain abdominal radiographic findings. In front of this uncertainty, some authors advocated an "aggressive" approach with early use of angiography (nevertheless at risk of a high rate of negative examinations), other remained on more wait-and-see or fatalist positions, and other evaluated the possible diagnostic impact of noninvasive methods alternative to angiography. With the purpose of a correct employment from the surgeon of the various diagnostic tools actually available, we illustrated in this review the possibilities and limitations of the methods proposed in the evaluation of bowel infarction: plain abdominal radiography, gastrointestinal tract contrast studies, angiography, sonography, computed tomography (CT), magnetic resonance imaging (MRI).
BACKGROUND: The diagnostic procedures proposed in the evaluation of sigmoidovesical fistulas complicating diverticulitis are various and their effectiveness is still not well established. METHODS: Personal experience is based on 14 cases of colovesical fistulas secondary to sigmoid diverticulitis. Several diagnostic tools were employed: plain abdominal film (10 cases), large bowel enema (12), urography (3), cystography (2), sonography (4), and CT (5). The semeiotics of these fistulas were distinguished in direct, indirect, secondary, and related to the underlying disease. RESULTS: The fistulous tract itself was recognized in 100% of the cases with sonography, in 75% with enema, in 60% with CT, in 33% with urography, and in none with cystography. Vesical gas was visible in 100% of the cases with sonography and CT, and in 40% with plain radiographs. Diffusion of contrast medium was present in 91% of the cases with enema, in 60% with CT, and in 33% with urography. Focal thickening and/or irregularity of the bladder wall was evident with cystography and urography in 67% of the cases, with CT in 60%, with sonography in 50%, with enema in 8%. Diverticulosis/diverticulitis was recognizable in 100% of the cases with CT, in 91% with enema, in 25% with sonography. A paravesical abscess was recognizable in 40% of the cases with CT, in 25% with sonography, in 8% with enema. CONCLUSIONS: The radiourological procedures, though of limited use in our series, have a poor effectiveness. Large bowel enema and, specially, CT confirm as the method with greatest accuracy in the evaluation of these fistulas. The sonographic examination, according to personal preliminary experiences, is a valuable diagnostic alternative. Sonography and CT allow analysis of the perivisceral structures and, if compared with barium enema, provide a larger number of information on diverticulitis, which is essentially an extraluminal disease, and its complications.
A case of acquired volvulus as a cause of late small bowel obstruction, in a patient who had undergone a colectomy with ileal pouch-anal anastomosis two years previously, is described. Computed Tomography (CT) accurately demonstrated signs of adhesive strangulating obstruction, detecting also a radial disposition of the loops around the mesenteric root and an abnormal position of the superior mesenteric artery and vein on the right side of the aorta. From a literature survey, there are no previous studies reporting the CT appearance of a small intestine volvulus developed as a complication of an ileal pouch-anal anastomosis.
The faeces sign is a recently described computed tomography (CT) feature of small-bowel obstruction and is seen as a mottled, faeces-like content within the lumen of the dilated loops above the level of the obstacle. To evaluate its prevalence, significance, and diagnostic value we retrospectively reviewed 94 consecutive cases of small-intestine obstruction studied with CT in the last 6 years. The faeces sign was recognizable in 7 cases (7.4%) and was localized within ileal loops in all these subjects. In 6 of the 7 cases there was a simple and progressive obstruction, while there was a sudden onset with intestinal strangulation in only 1. The faeces sign is due to the intraluminal stagnation of enteric material and is generally recognizable in subjects with subacute obstruction. In our experience it is relatively uncommon. Nevertheless, it seems to be rather specific and may be a valuable accessory feature in the CT study of small-bowel obstruction.
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Angiomyolipoma is an uncommon lipomatous neoplasm of the liver, usually asymptomatic and identified incidentally. We describe the CT findings of a surgically confirmed case of spontaneously ruptured angiomyolipoma with evidence of internal hemorrhage and hemoperitoneum. The CT features were that of an exophitic, oval, well-defined mass with inhomogeneous attenuation values due to the presence of fat- and soft-tissue densities. A review of the literature identified 49 cases of hepatic angiomyolipoma. Few of these occurred in symptomatic patients and showed intratumoral hemorrhagic foci, but none had a clear rupture with external bleeding. To our knowledge, this is the first reported case with this complication.
Intraosseous pneumatocyst of the ilium is a rare lesion of uncertain origin. It predilects male subjects and may be associated or not with sacroiliac joint degenerative disease, intra-articular gas, sacral pneumatocyst, and communication with the articular space. To our knowledge, only 16 observations have been reported in the literature. We have evaluated with plain radiographs and CT two additional cases. Plain films frequently identify these lesions, but CT is the method of choice in demonstrating their air density and assessing the possible abnormalities of the surrounding bone and sacroiliac joints.