Salvatore Lamberto

Dual-energy CT for detection of endoleaks after endovascular abdominal aneurysm repair: usefulness of colored iodine overlay.

OBJECTIVE The purpose of our study was to evaluate the value of dual-source dual-energy CT with colored iodine overlay for detection of endoleaks after endovascular abdominal aortic aneurysm repair. We also calculated the potential dose reduction by using a dual-energy CT single-phase protocol. SUBJECTS AND METHODS From November 2007 to November 2009, 74 patients underwent CT angiography 2-7 days after endovascular repair during single-energy unenhanced and dual-energy venous phases. By using dual-energy software, the iodine overlay was superimposed on venous phase images with different percentages ranging between 0 (virtual unenhanced images) and 50-75% to show the iodine in an orange color. Two blinded readers evaluated the data for diagnosis of endoleaks during standard unenhanced and venous phase images (session 1, standard of reference) and virtual unenhanced and venous phase images with colored iodine overlay images (session 2). We compared the effective dose radiation of a single-energy biphasic protocol with that of a single-phase dual-energy protocol. The diagnostic accuracy of session 2 was calculated. RESULTS The mean dual-energy effective dose was 7.27 mSv. By using a dual-energy single-phase protocol, we obtained a mean dose reduction of 28% with respect to a single-energy biphasic protocol. The diagnostic accuracy of session 2 was: 100% sensitivity, 100% specificity, 100% negative predictive value, and 100% positive predictive value. Statistically significant differences in the level of confidence for endoleak detection between the two sessions were found by reviewers for scores 3-5. CONCLUSION Dual-energy CT with colored iodine overlay is a useful diagnostic tool in endoleak detection. The use of a dual-energy single-phase study protocol will lower radiation exposure to patients.

Embryologic and acquired anomalies of the inferior vena cava with recurrent deep vein thrombosis.

AbstractAnomalies of the inferior vena cava theoretically favor venous stasis and development of deep vein thrombosis. We report two cases of repeated deep vein thrombosis in patients with embryologic and acquired anomalies of the inferior vena cava, in which hypercoagulability syndrome was ruled out.

Hepatic artery aneurysm, an unusual cause of obstructive jaundice: MR cholangiography findings.

Hepatic artery aneurysms are rare vascular lesions, often with a nonspecific clinical presentation, and difficult to diagnose before rupture. We report the case of a patient with obstructive jaundice caused by a compression on the right biliary duct by a right hepatic artery aneurysm in which the diagnosis was suggested by magnetic resonance cholangiography and confirmed by Doppler sonography and preoperative digital subtraction angiography.

Intrahepatic portal vein aneurysm: three-dimensional power Doppler demonstration in four cases.

Wedescribe four cases of portal vein aneurysm that were studied with ultrasonography, color Doppler, computed tomography, and magnetic resonance imaging as well as three-dimensional power Doppler. Three-dimensional ultrasonography showed the portal aneurysm and its relationship to its portal branches in all patients and showed the portosystemic communication in three. In all cases, computed tomography or magnetic resonance imaging confirmed the three-dimensional ultrasonographic findings.

Unusual pleural involvement after exposure to amorphous silicates (Liparitosis): report of two cases

Abstract. Liparitosis is a rare pneumoconiosis determined by inhalation of pumice, an amorphous complex silicate extracted in the quarries of Lipari (Aeolian Archipelago, Italy). We describe two cases of subjects occupationally exposed to pumice dust in which high-resolution computed tomography (HRCT) revealed the presence of pleural lesions without parenchymal involvement.

Tunneled dialysis catheter and pacemaker leads determining superior vena cava syndrome

Superior vena cava (SVC) syndrome results from an obstacle to the usual blood flow from vena cava to right heart by total or partial obstruction of the lumen of the vessel. The obstruction can be either extrinsic from compression by intrathoracic pathological developments (right lung, lymph nodes, or mediastum) or internal for thrombosis of the vessel secondary to placement of central venous catheters or pacemakers (PMs). The external reasons, especially neoplastic disease (bronchogenic carcinoma or lymphoma), are the most common etiology (95%) (1). Benign cases are increasing, due in large part to iatrogenic injuries from central venous catheters and transvenous PMs (2). Since chronic kidney disease (CKD) patients have several risk factors for cardiovascular disease, it is not uncommon for them to undergo implantation of PMs or defibrillators, which may increase the prevalence of central vein stenosis (CVS) and SVC syndrome (3). We report the case of a 65-year-old man who presented at our institution with dyspnea, acrocyanosis, facial swelling, and distended neck veins. He started hemodialysis in September 2007 for end-stage renal disease (ESRD). For the absence of an adequate vascular heritage for the creation of arteriovenous fistula (AVF) in his upper limbs, the patient underwent placement, several times, of central venous catheters (CVCs) from the right subclavian and jugular vein.