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Biomedical subjects

Roberto Grassi

Publications and source records attributed to Roberto Grassi.

At least 37 records · Page 2Linked to original sources
PubMed2004

The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults.

INTRODUCTION: The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation of the intestinal loops, however recently some Authors attested the increasing important role of sonography in the acute abdominal disease. Aim of our report is to demonstrate the value of free fluid detected by US in differentiating between low and high-grade small bowel obstruction. MATERIALS AND METHODS: The study is based on 742 consecutive patients who presented symptoms of the acute abdomen; all patients had undergone initial serial abdominal plain film and US examinations prior to any medical intervention. We reviewed the imaging findings of 150 cases in whom small bowel obstruction was clinically suspected and confirmed at surgery. We consider the following radiographic and US findings: dilatation of small bowel loops; bowel wall thickness; presence of air-fluid levels; thickness of valvulae conniventes; evidence of peristalsis; presence and echogenicity of extraluminal fluid. We looked at the value of extraluminal peritoneal fluid at US examination in differentiating low and high-grade small bowel obstruction based on the surgical outcome. RESULTS: In 46 patients altered peristaltic activity, thin bowel walls, fluid filled loops with hyperechoic spots in the bowel segment proximal to obstruction were noted at US, whereas radiographic features were: moderate dilatation of small bowel loops, with thin bowel wall and evidence of numerous and subtle valvulae conniventes; presence of air-fluid levels was also noted. In 70 other patients, US examination revealed all the findings described in the precedent cases and also the presence of free extraluminal fluid; abdominal plain film showed an increased dilatation of small bowel loops with moderate thickened wall and air-fluid levels. In 34 other patients US examination revealed the presence of thick-walled loops, hypoperistalsis and a larger amount of free extraluminal fluid. Radiographic findings in these patients were: horizontal featured and markedly dilated small bowel loops presenting parietal thickness, presence of intraluminal fluid stasis and evidence of thickened, sparse and incomplete valvulae conniventes. At surgery etiology of small bowel obstructions was various, but most of cases related to adhesions (70 cases). The presence of extraluminal fluid were confirmed at surgery in 104 patients. CONCLUSIONS: Our experience using sonography in suspicion of SBO (small bowel obstruction) suggests the usefulness of this imaging modality to differentiate a functional or obstructive ileus, demonstrating the evidence of intestinal peristalsis. Furthermore, the presence of a large amount of fluid between dilated small bowel loops suggests worsening mechanical small bowel obstruction, that requires not a medical therapy but immediate surgery.

Abdomen, Acute↗
PubMed2004

Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients.

INTRODUCTION: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. MATERIAL AND METHODS: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the "A.Cardarelli" Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. RESULTS: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24 (16,4%) of them showed indirect findings of perforation. In other 12 patients no direct or indirect finding of free peritoneal air was detected. CONCLUSIONS: Our experience documents that in 146 gastroduodenal perforations the free peritoneal air was not evident in 12 cases and in 66% of these patients the presence of intraperitoneal fluid could be the only sign of perforation. If free peritoneal air was detected with conventional radiography, other investigations were not indicated. In the absence of direct or indirect findings of pneumoperitoneum, US examination could help to confirm intestinal paresis and the evidence of intraperitoneal free fluid. Helical CT examination was useless before at least 6h from the onset of symptomatology, because in the absence of direct or indirect findings of penumoperitoneum at abdominal plain film and sonograpy, CT could not demonstrate any additional diagnostic information.

Abdomen, Acute↗
PubMed2004

Association of splenic and renal infarctions in acute abdominal emergencies.

INTRODUCTION: Splenic and renal infarctions are usually related to vascular disease or haematologic abnormalities. Their association is infrequent and rarely observed in trauma. In this study, we analyze our data to look at the occurrence of renal and splenic infarctions based on CT findings in a period of 4 years. MATERIALS AND METHODS: We retrospectively reviewed the imaging findings of 84 patients admitted to our Department of Diagnostic Imaging from June 1998 to December 2002, who underwent emergency abdominal spiral CT examination and in whom there was evidence of splenic and/or renal infarction. RESULTS: We found 40 cases of splenic infarction and 54 cases of renal infarction, associated in 10 patients. In 26 patients, there was also evidence of intestinal infarction. A traumatic origin was found in 19 cases; non-traumatic causes were found in 65 patients. Association between renal and splenic infarction in the same patient was related to trauma in two cases. CONCLUSIONS: Although renal and splenic infarctions are a common manifestation of cardiac thromboembolism, other systemic pathologies, infections or trauma may lead to this occurrence. Renal infarction may be clinically and/or surgically managed with success in most cases. There are potential complications in splenic infarction, such as development of pseudocysts, abscesses, hemorrhage, subcapsular haematoma or splenic rupture; splenectomy in these cases may be necessary. Some patients with splenic and/or renal infarction may be clinically asymptomatic. The high accuracy of CT examination is needed to allow a correct evaluation of infarcted organs.

Abdomen, Acute↗
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

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

Regarding three cases of descending necrotizing mediastinitis: spiral CT assessment.

Descending necrotizing mediastinitis (DNM) is a rare and life-threatening complication of deep neck space infection which occurs when infection spreads from the deep spaces of the neck, propagating within the soft tissue into the mediastinal spaces. The disease has a high mortality rate due to frequent delay in diagnosis and treatment. Computed Tomography (CT) is important in determining the level of infection, showing the presence and extension of fluid collections (with or without gas bubbles) and diffuse soft-tissue infiltration of the mediastinal fat, and indicating the best surgical approach and progress of treatment. Three cases of DNM evaluated with spiral CT from June 1999 to June 2001 are presented.

Adult↗
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

Unusual feature of jejunal leiomyosarcoma studied with US and CT-enteroclysis: a case report.

Leiomyosarcoma is a mesodermal malignant neoplasm affecting the small intestine. Usually, the clinical signs are not specific and most commonly related to intestinal bleeding or obstruction. We report the case of a 71-year-old woman presenting anemia and melena: there was no evidence of abdominal palpable mass and endoscopic examinations were negative for pathologic findings. We performed sonography and CT-enterclysis. We detected a small jejunal mass presenting a heterogeneous density and echogenicity pattern, with some large peripheral calcifications. Histologic examination after surgery revealed the lesion to be a small bowel leiomyosarcoma.

Aged↗
PubMedDate not supplied

Small bowel metastases of lung cancer as unique metastatic lesions: CT, MRI and small bowel enema findings. a case report.

Small bowel metastases of lung cancer as unique secondary lesions are a very rare occurrence and may be clinically missed due to the aspecificity of the symptoms. Diagnosis is usually made at acute abdominal symptomatology that requires emergency surgical treatment. We report a case of 69-year-old woman, previously treated for epidermoid lung carcinoma, complaining only of aspecific asthenia; blood cell count and chemistry showed a moderate but progressive anemia; no signs of small bowel occlusion were present. The follow-up CT scan showed two large masses at the small bowel level, without any evidence of hepatic, lung, adrenal or brain metastases. MRI and small bowel enema confirmed the presence of the masses, and the diagnosis of small bowel metastases was hypothesized. Surgical specimens of the masses confirmed the radiological suspicion.

Aged↗
PubMedDate not supplied

Recrudescence of pulmonary tuberculosis: radiological and CT features in an asymptomatic Southern Italian young population.

AIM: The authors report the results observed in apparently healthy young adults undergoing chest radiography for pre-employment screening. MATERIALS AND METHODS: Between July 1996 and December 1997, 2292 young adults underwent conventional chest radiography for pre-employment screening purposes. Of these, 378 subjects (16.4%) in whom the chest X-ray showed alterations indicative for pulmonary parenchymal lesions were selected for the study. The lesions were divided into four groups: 1) single nodular opacity (n=98/378=25.9%); 2) multiple nodular opacities (n=25/378=6.6%); 3) single or multiple parenchymal consolidation(s) (n=203/378= 53.7%); 4) interstitial disease ( %). All subjects received a tuberculin skin test. The subjects in groups 1, 2 and 3 underwent the diagnostic protocol, which consisted of tuberculin skin test (TST) and CT scan for groups 1 and 2, and a repeat chest radiograph at 30 days for group 3. The subjects in group 4 were studied by high-resolution CT (HRCT). RESULTS: In group 1, CT showed nodular opacities with psammomatous calcifications in 13 cases, vascular dilatations in 3, calcified nodule in 7 subjects with positive TST, and uncalcified nodular lesions in 75 subjects (53/75 with positive TST). In group 2, FNAB confirmed the preliminary diagnosis of metastases in 2 cases; CT demonstrated the pleural origin of opacities in 1 patient, and multiple nodular lesions in 12 subjects; it invalidated the radiographic findings in 3 subjects, and demonstrated multiple nodules associated to increased interstitial thickening in 3 subjects. In group 3, the lung alterations had completely disappeared in 106 subjects, whereas in 97 subjects there was reduced extension of the previously observed lesions, but appearance of new sites of parenchymal consolidation. In group 4 CT confirmed the radiographic suspicion in 14 cases. CONCLUSIONS: Tubercular infection is currently increasing in industrialised countries. In our study it showed a relatively high prevalence of about 4.5% in a young asymptomatic population.

Adolescent↗
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↗