Acute intestinal ischemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. The causes can be occlusive or non occlusive. Early diagnosis is important to improve survival rate...Acute intestinal ischemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. The causes can be occlusive or non occlusive. Early diagnosis is important to improve survival rates. In most cases of late or missed diagnosis, the mortality rate from intestinal infarction is very high, with a reported value ranging from 60% to 90%. Multidetector computed tomography(MDCT) is a fundamental imaging technique that must be promptly performed in all patients with suspected bowel ischemia. Thanks to the new dedicated reconstruction program, its diagnostic potential is much improved compared to the past and currently it is superior to that of any other noninvasive technique. The increased spatial and temporal resolution, high-quality multi-planar reconstructions, maximum intensity projections, vessel probe, surface-shaded volume rending and tissue transition projections make MDCT the gold standard for the diagnosis of intestinal ischemia, with reported sensitivity, specificity, positive and negative predictive values of 64%-93%, 92%-100%, 90%-100% and 94%-98%, respectively. MDCT contributes to appropriate treatment planning and provides important prognostic informationthanks to its ability to define the nature and extent of the disease. The purpose of this review is to examine the diagnostic and prognostic role of MDCT in bowel ischemia with special regard to the state of art new reconstruction software.展开更多
AIM: To evaluate the role of computed tomography(CT) for diagnosing traumatic injuries of the pancreas and guiding the therapeutic approach.METHODS: CT exams of 6740 patients admitted to our Emergency Department betwe...AIM: To evaluate the role of computed tomography(CT) for diagnosing traumatic injuries of the pancreas and guiding the therapeutic approach.METHODS: CT exams of 6740 patients admitted to our Emergency Department between May 2005 and January 2013 for abdominal trauma were retrospectively evaluated. Patients were identified through a search of our electronic archive system by using such terms as "pancreatic injury", "pancreatic contusion", "pancreatic laceration", "peri-pancreatic fluid", "pancreatic active bleeding". All CT examinations were performed before and after the intravenous injection of contrast material using a 16-slice multidetector row computed tomography scanner. The data sets were retrospectively analyzed by two radiologists in consensus searching for specific signs of pancreatic injury(parenchymal fracture and laceration, focal or diffuse pancreatic enlargement/edema, pancreatic hematoma, active bleeding, fluid between splenic vein and pancreas) and non-specific signs(inflammatory changes in peri-pancreatic fat and mesentery, fluid surrounding the superior mesentericartery, thickening of the left anterior renal fascia, pancreatic ductal dilatation, acute pseudocyst formation/peri-pancreatic fluid collection, fluid in the anterior and posterior pararenal spaces, fluid in transverse mesocolon and lesser sac, hemorrhage into peri-pancreatic fat, mesocolon and mesentery, extraperitoneal fluid, intraperitoneal fluid).RESULTS: One hundred and thirty-six/Six thousand seven hundred and forty(2%) patients showed CT signs of pancreatic trauma. Eight/one hundred and thirty-six(6%) patients underwent surgical treatment and the pancreatic injures were confirmed in all cases. Only in 6/8 patients treated with surgical approach, pancreatic duct damage was suggested in the radiological reports and surgically confirmed in all cases. In 128/136(94%) patients who underwent non-operative treatment CT images showed pancreatic edema in 97 patients, hematoma in 31 patients, fluid between splenic vein and pancreas in 113 patients. Non-specific CT signs of pancreatic injuries were represented by peri-pancreatic fat stranding and mesentery fluid in 89% of cases, thickening of the left anterior renal fascia in 65%, pancreatic ductal dilatation in 18%, acute pseudocyst/peri-pancreatic fluid collection in 57%, fluid in the pararenal spaces in 45%, fluid in transverse mesocolon and lesser sac in 29%, hemorrhage into peri-pancreatic fat, mesocolon and mesentery in 66%, extraperitoneal fluid in 66%, intra-peritoneal fluid in 41% cases.CONCLUSION: CT represents an accurate tool for diagnosing pancreatic trauma, provides useful information to plan therapeutic approach with a detection rate of 75% for recognizing ductal lesions.展开更多
Objectives: To evaluate the primary lesions, the complications and the evolution of disease in patients affected by H1N1 viral infection. Materials and Methods: 24 Patients affected by H1N1 infection, diagnosed by pol...Objectives: To evaluate the primary lesions, the complications and the evolution of disease in patients affected by H1N1 viral infection. Materials and Methods: 24 Patients affected by H1N1 infection, diagnosed by polymerase chain reaction (PCR) on throat swabs, underwent CT examination. Seven patients were hospitalized in intensive care unit (ICU). In five patients the evolution of disease was monitored. The following features were evaluated: primary lesions significant for viral infection, their possible complications and the evolution of disease in controlled patients. Results: Primary lesions variously associated with each other were found in 22 out of 24 patients: ground glass opacities (19/24, 79.2%), interstitial thickening (13/24, 54.2%), centrilobular nodules (3/24, 12.5%) and consolidation (8/24, 33.3%). The following complications were observed: 3 consolidations with air bronchogram, 9 pleural effusions, 7 ARDS and 1 barotrauma. In the 5 patients who underwent follow-up (including 3 admitted to ICU), complete resolution was demonstrated in 4 cases and focal fibrotic evolution in one case. 3 ICU patients affected by ARDS died. Conclusions: In case of H1N1 virus infection. CT is an important tool for staging the disease, recognize complications and to study disease展开更多
文摘Acute intestinal ischemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. The causes can be occlusive or non occlusive. Early diagnosis is important to improve survival rates. In most cases of late or missed diagnosis, the mortality rate from intestinal infarction is very high, with a reported value ranging from 60% to 90%. Multidetector computed tomography(MDCT) is a fundamental imaging technique that must be promptly performed in all patients with suspected bowel ischemia. Thanks to the new dedicated reconstruction program, its diagnostic potential is much improved compared to the past and currently it is superior to that of any other noninvasive technique. The increased spatial and temporal resolution, high-quality multi-planar reconstructions, maximum intensity projections, vessel probe, surface-shaded volume rending and tissue transition projections make MDCT the gold standard for the diagnosis of intestinal ischemia, with reported sensitivity, specificity, positive and negative predictive values of 64%-93%, 92%-100%, 90%-100% and 94%-98%, respectively. MDCT contributes to appropriate treatment planning and provides important prognostic informationthanks to its ability to define the nature and extent of the disease. The purpose of this review is to examine the diagnostic and prognostic role of MDCT in bowel ischemia with special regard to the state of art new reconstruction software.
文摘AIM: To evaluate the role of computed tomography(CT) for diagnosing traumatic injuries of the pancreas and guiding the therapeutic approach.METHODS: CT exams of 6740 patients admitted to our Emergency Department between May 2005 and January 2013 for abdominal trauma were retrospectively evaluated. Patients were identified through a search of our electronic archive system by using such terms as "pancreatic injury", "pancreatic contusion", "pancreatic laceration", "peri-pancreatic fluid", "pancreatic active bleeding". All CT examinations were performed before and after the intravenous injection of contrast material using a 16-slice multidetector row computed tomography scanner. The data sets were retrospectively analyzed by two radiologists in consensus searching for specific signs of pancreatic injury(parenchymal fracture and laceration, focal or diffuse pancreatic enlargement/edema, pancreatic hematoma, active bleeding, fluid between splenic vein and pancreas) and non-specific signs(inflammatory changes in peri-pancreatic fat and mesentery, fluid surrounding the superior mesentericartery, thickening of the left anterior renal fascia, pancreatic ductal dilatation, acute pseudocyst formation/peri-pancreatic fluid collection, fluid in the anterior and posterior pararenal spaces, fluid in transverse mesocolon and lesser sac, hemorrhage into peri-pancreatic fat, mesocolon and mesentery, extraperitoneal fluid, intraperitoneal fluid).RESULTS: One hundred and thirty-six/Six thousand seven hundred and forty(2%) patients showed CT signs of pancreatic trauma. Eight/one hundred and thirty-six(6%) patients underwent surgical treatment and the pancreatic injures were confirmed in all cases. Only in 6/8 patients treated with surgical approach, pancreatic duct damage was suggested in the radiological reports and surgically confirmed in all cases. In 128/136(94%) patients who underwent non-operative treatment CT images showed pancreatic edema in 97 patients, hematoma in 31 patients, fluid between splenic vein and pancreas in 113 patients. Non-specific CT signs of pancreatic injuries were represented by peri-pancreatic fat stranding and mesentery fluid in 89% of cases, thickening of the left anterior renal fascia in 65%, pancreatic ductal dilatation in 18%, acute pseudocyst/peri-pancreatic fluid collection in 57%, fluid in the pararenal spaces in 45%, fluid in transverse mesocolon and lesser sac in 29%, hemorrhage into peri-pancreatic fat, mesocolon and mesentery in 66%, extraperitoneal fluid in 66%, intra-peritoneal fluid in 41% cases.CONCLUSION: CT represents an accurate tool for diagnosing pancreatic trauma, provides useful information to plan therapeutic approach with a detection rate of 75% for recognizing ductal lesions.
文摘Objectives: To evaluate the primary lesions, the complications and the evolution of disease in patients affected by H1N1 viral infection. Materials and Methods: 24 Patients affected by H1N1 infection, diagnosed by polymerase chain reaction (PCR) on throat swabs, underwent CT examination. Seven patients were hospitalized in intensive care unit (ICU). In five patients the evolution of disease was monitored. The following features were evaluated: primary lesions significant for viral infection, their possible complications and the evolution of disease in controlled patients. Results: Primary lesions variously associated with each other were found in 22 out of 24 patients: ground glass opacities (19/24, 79.2%), interstitial thickening (13/24, 54.2%), centrilobular nodules (3/24, 12.5%) and consolidation (8/24, 33.3%). The following complications were observed: 3 consolidations with air bronchogram, 9 pleural effusions, 7 ARDS and 1 barotrauma. In the 5 patients who underwent follow-up (including 3 admitted to ICU), complete resolution was demonstrated in 4 cases and focal fibrotic evolution in one case. 3 ICU patients affected by ARDS died. Conclusions: In case of H1N1 virus infection. CT is an important tool for staging the disease, recognize complications and to study disease
