La Radiologia medica
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La Radiologia medica · Jul 2000
[Spiral computed tomography in the assessment of vascular lesions of the pelvis due to blunt trauma].
We investigated the role of Helical Computed Tomography (CT) in the evaluation of low or high flow vascular injuries in patients with blunt pelvic trauma. ⋯ Fractures of the pelvic ring generally result from severe trauma. Management of these injuries must include not only treatment of the skeletal trauma but also of the associated shock and complications. Major blood loss usually occurs as a result of bleeding from the branches of the internal iliac artery. With respect to pelvic plain radiography, CT provides superior detailing of fractures, position of fracture fragments and extent of diastasis of the sacroiliac joints and pubic symphysis. Moreover CT provides diagnostic information regarding the presence or absence of pelvic bleeding and can identify the site of bleeding. In our experience, Helical CT allows us to distinguish high flow hemorrhage, where vascular injuries must be treated first, from low flow hemorrhage which can be managed differently.
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La Radiologia medica · Jul 2000
[The radiological diagnostic and clinical approach to the patient with stab and cut wounds of the chest. The authors' personal experience].
To report our personal experience with the clinical and radiological diagnostic approach to stab and cut wounds of the thoracic cage and its content, a type of injury whose diagnosis and treatment, as well as the surgical approach, vary case by case. CT of deep penetrating wounds permits correct assessment of severe changes such as pneumothorax, hemothorax and pneumomediastinum. ⋯ CT was an accurate tool and had higher sensitivity than chest radiography in detecting and detailing pneumothorax, pneumomediastinum and lacero-hemorrhagic foci, as well as in quantifying hemothorax. Chest radiography had 12% false negatives and therefore we decided to perform CT in all the patients with penetrating wounds to prevent radiographic underestimation. Given the low rate of false negatives (7/57 cases) CT might appear superfluous but since in 2 of these 7 cases we had massive pneumothorax and pneumomediastinum associated with neck emphysema we suggest its use to prevent complications, clinical failures and medicolegal problems. CT permits correct assessment of penetrating stab and cut wounds of the chest and efficient and targeted treatment, which can be conservative, with thoracostomy with pleural drainage, or surgical.
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La Radiologia medica · Jul 2000
[The treatment of iatrogenic pneumothorax with small-gauge catheters. The author's personal experience in 30 cases].
Pneumothorax (PNX) is the most frequent complication in patients who have undergone lung biopsy. If PNX is asymptomatic and < 30%, it does not require treatment, while if it is > 30% and the patient is symptomatic treatment is needed. As a rule surgery is required and patients are hospitalized and undergo intrathoracic drainage with positioning of a large gauge catheter--i.e. over 15 French (F). In the last 10 years radiologists have begun treating PNX with much smaller catheters (7-10 F). We report the execution technique using 6.3 F catheters and the results obtained in 30 patients with symptomatic iatrogenic PNX and/or iatrogenic PNX > 30%. ⋯ Small gauge catheters provide the following advantages: the procedure presents a low risk of complications, is easy to carry out and much better tolerated by the patient; also in some cases the cost is lower because no hospitalization is required. The close correlation of oximetric values with the presence/absence of PNX < 30% could be considered to decrease follow-up radiographic examinations. Finally the possibility of treating iatrogenic PNX using radiological techniques further promotes the acceptability of lung biopsy by colleagues from other branches of medicine.