Ivan Turkalj

Blunt chest trauma--an audit of injuries diagnosed by the MDCT examination.

BACKGROUND/AIM Multidetector computed tomography (MDCT) characterised by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. METHODS This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT) of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. RESULTS Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. CONCLUSION Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.

Recurrent longitudinally extensive transversal myelitis in a patient with Sjögren's syndrome.

INTRODUCTION Longitudinally extensive transverse myelitis (LETM) is a transversal myelitis that extends through three or more vertebral segments in length. CASE REPORT A 52-year-old woman was hospitalized due to pain in the lumbar region, difficulty in walking, hypoesthesia of the anogenital area and urinary retention. In the past medical history, two years earlier, the patient had been diagnosed with transversal myelitis confirmed by MRI of the cervical spine and six months earlier, the patient was diagnosed with primary Sjögrens syndrome (SS). During the current hospitalization MRM of the spinal cord revealed extensive inflammatory lesions of almost the whole spinal cord. Lumbar puncture (LP) revealed mild pleocytosis and slightly increased protein level. Isoelectric focusing of cerebrospinal fluid (CSF) and serum proteins was normal. Visual evoked potentials were normal. Serological testing excluded acute viral infections. Corticosteroid therapy was applied with good therapeutic response. Control MRI revealed regression of pathological changes in the spinal cord. CONCLUSION A wide range of disorders can cause LETM, but usually the first line diagnosis is neuromyelitis optica (NMO). Based on the detection of NMO immunoglobulin G in the serum of affected patients, a variety of allied disorders were grouped under the name of NMO spectrum disorders, including recurrent myelitis associated with LETM and myelitis associated with autoimmune disorders such as SS. There have been only a few cases reported in the literature with recurrent LETM associated with non-organ specific autoimmune disorder.

Post-traumatic Focal Adhesive Arachnoiditis

referred for magnetic resonance imaging (MRI) of the thoracic spine due to longstanding walking difficulties. His complaints started shortly after he was beaten with a baseball bat in the region of his back. On admission, the patient suffered from disturbed walking scheme with bilateral spastic hypertonia and reduced muscle strength of the lower limbs. Further neurological examination was unremarkable, while laboratory findings were within the range of normal limits. MRI examination showed widespread intradural bands of low T2-signal (Figure 1A–C, arrows) showing vivid enhancement (Figure 1D and E, arrows). There was distortion of the thoracic spinal cord, especially at Th7/8 level where the cord was displaced posteriorly (Figure 2A and B, arrows). At this level, the spinal cord showed marked T2-hyperintense signal in keeping with myelomalacia (Figure 2A–C, arrowheads). There was cord atrophy below the level of Th8 extending to the conus medullaris (Figure 2A, asterisk). Based on imaging and clinical findings, the diagnosis of post-traumatic focal adhesive arachnoiditis was made.