A. La Fianza

Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms.

Abstract. We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 ± 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3–0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 ± 0.12 cm vs 1.09 ± 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients.

Spiral CT findings in a case of pulmonary sequestration

Pulmonary sequestration has always been diagnosed by direct demonstration of the vessels tributary to the lesion, usually by angiography. Conventional CT can identify the arterial supply in only two thirds of cases. We report a case of pulmonary sequestration diagnosed using Spiral CT, based on the demonstration of both arterial supply and venous drainage. The capabilities of Spiral CT to detect subtle vessel abnormalities and to yield reliable multiplanar imaging enabled us to show the whole course of both the artery and the vein tributary to the lesion. Axial images were the most useful ones to diagnose pulmonary sequestration; 2D and 3D reconstructions were useful for a detailed and immediate spatial depiction of the parenchymal abnormality and of its vascular pedicle.

Communicating bicornuate uterus with double cervix and septate vagina: an uncommon malformation diagnosed with MR imaging

Abstract We report a case of communicating uterus diagnosed with MRI. These uterine malformations are characterized by a communicating tract between two separate uterocervical cavities, which is usually detected with hysterosalpingography performed for a suspected uterine malformation. In our patient MRI was performed after the clinical finding of a double cervix and a vaginal septum and demonstrated two separate uterine cavities, each of them with its own junctional area, and an isthmian transverse communicating tract with endometrial tissue inside, which helped make the diagnosis of a type-4 a communicating uterus according to Toaff.

Infiltrative subcutaneous metastases from ovarian carcinoma after paracentesis: CT findings

Abstract. Implantation subcutaneous metastases from ovarian cancer are an uncommon event in surgery, and diagnostic procedures such as laparoscopy, fine-needle biopsy, and intraperitoneal catheter access are usually used. Findings of tumor implantations are rarely reported with diagnostic imaging techniques. In this case, an infiltrative subcutaneous metastasis appeared on computed tomography 4 months after paracentesis in a patient with untreated ovarian cancer. Differential diagnostic problems are discussed.

Peliosis hepatis associated with hereditary haemorrhagic telangiectasia

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal, predominantly inherited disease characterized by diffuse telangiectases involving the skin, mucous membranes, lung, brain, gastrointestinal tract and liver. Peliosis hepatis is a rare, benign disorder causing sinusoidal dilatation and the presence of multiple blood-filled lacunar spaces within the liver. We report a case of an HHT patient with incidental magnetic resonance findings of focal hepatic peliosis.

Intralesional hemorrhage in Krukenberg tumor: a case report and review of the literature

Acute abdomen due to female genital apparatus disease is very rare. Most are due to intralesional effusion of benign tumors. The authors present a 40-year-old woman with acute abdomen pain due to haemorrhagic ovarian metastasis of colorectal cancer, focusing on the role of imaging to get the management of the patient.RiassuntoIl dolore addominale acuto dovuto a patologie di pertinenza ginecologica è una condizione rara. La maggior parte dei casi sono dovuti ad emorragie endolesionali di formazioni benigne. Presentiamo il caso di una Donna di 40 anni con dolore addominale acuto dovuto a sanguinamento di metastasi ovariche originate da un tumore del colon-retto, concentrando l’attenzione sul ruolo dell’imaging nella gestione del paziente.

CT diagnosis of extraperitoneal rupture of aortic aneurysm into the anterior abdominal wall

Abstract With CT we studied the case of a 98-year-old patient who exhibited a large chronic infrarenal aneurysm with a thin leakage resulting in collection of blood directly within the muscles of the anterior abdominal wall. There was no massive intra- or extraperitoneal hemorrhage. The only imaging differential diagnosis we considered was a spontaneous hemorrhage in the anterior abdominal wall.