La Radiologia medica
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Missing cervical spine fractures during the initial plain film study may lead to severe neurological complications for patients and to medicolegal responsibilities for the physician. The upper cervical spine tract (C1-C2) is considered to be at high risk for misdiagnoses. We decided to investigate the possible causes of mistake in the cases of missed fractures on the initial plain film, performed in the emergency room. ⋯ Among the causes of false-negative interpretation, osteoporosis, suboptimal film quality due to associated fractures and overlapping bone structures must be considered unavoidable. On the other hand these possibilities should be indicated on the X-ray report because, if painful symptoms persist, a CT exam is strongly advised. Subtle alterations like dens tilting, double cortex sign, lateral subluxation of C1 and prevertebral soft tissue swelling should be regarded as highly suspicious for fracture. Missing these lesions might be considered a true diagnostic mistake with possible legal consequences, which may also expose the patient to the risk of neurological complications. The satisfaction of search phenomenon can be avoided only by trying to use a search pattern for every film, which includes checking all the visible anatomical structures even in the presence of a particularly evident lesion. In all questionable cases or high-risk fracture patients, even with an apparently negative plain film, it is advisable to perform CT instead of additional plain films. Finally, in all the patients treated in the intensive care unit for head trauma, an upper cervical CT scan should be routinely carried out at the same time as the brain scan.
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La Radiologia medica · Sep 1999
[Gunshot wounds of the abdomen studied by computed tomography. The authors' personal experience in 30 cases].
CT plays an important role in depicting gunshot wounds in parenchymal and hollow organs in the abdomen. Relative to other techniques and to emergency laparotomy, CT permits good assessment of abdominal content, major injuries and changes in other districts, such as chest, pelvis and skull. We investigated the yield and role of CT in diagnosing abdominal gunshot wounds, with their rich and varied radiological signs and associated injuries. ⋯ Tissue damage extent depends on the speed and kinetic energy the bullet carries into the abdomen. Abdominal radiography shows the bullet and its site, pneumoperitoneum from gastrointestinal perforation, crash bone injuries, vertebral trauma and subcutaneous emphysema. Instead, CT depicts early parenchymal damage and vascular injury and thus becomes a complete and necessary tool for imaging gunshot wounds. CT provides early diagnostic information which help plan emergency treatment and thus decrease mortality. As for angiography and US, we suggest they be used subsequently because in emergency they may delay the diagnosis. Moreover, vessel rupture and active intraabdominal bleeding are easily detected with spiral CT, which appears the best tool for prompt assessment of the injuries associated with gunshot wounds in other districts such as, the skull. To conclude, CT permits adequate planning of emergency surgery and helps select the cases for follow-up, intensive care and conservative treatment.
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La Radiologia medica · Sep 1999
[Vascular complications in intestinal obstructions. The role of computed tomography].
We investigated CT capabilities in showing vascular complications (ischemia, infarction) secondary to intestinal obstruction. ⋯ CT is a sensitive tool for diagnosing small bowel obstruction and for assessing the site and cause of obstruction. CT plays a pivotal diagnostic role in vascular complications, giving very important indications for a correct treatment.
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La Radiologia medica · Sep 1999
Comparative Study[Brain magnetic resonance with magnetization transfer in multiple sclerosis. Lesion hyperintensity before and after intravenous gadolinium administration].
To evaluate lesion contrast enhancement in brain magnetic resonance (MR) images with and without magnetization transfer pulse (MT) in patients affected with multiple sclerosis (MS). ⋯ The postcontrast sequence obtained with the MT pulse detects more active lesions than the postcontrast sequence without MT. However, the comparison with the plain images with the MT pulse is mandatory to exclude pseudoenhancement foci, i.e. hyperintense areas already present in the precontrast images with the MT pulse, without disruption of the blood-brain barrier. The post-Gd without MT sequence needs not be compared with the precontrast images without MT. Differences in evaluation time are practically negligible.
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La Radiologia medica · Sep 1999
Comparative Study[Color Doppler-echo in rheumatoid arthritis with extra-articular location. Preliminary experience].
Chronic inflammation in rheumatoid arthritis usually involves articular synovia and extends to other joint components such as bursae, tendons and sheaths. Conventional US with high frequency transducers is an accurate tool for assessing abnormal changes in evolutive rheumatoid arthritis. We investigated the role of color and power Doppler imaging in staging extra-articular involvement, monitoring local inflammatory changes and drug treatment response. ⋯ Color and power Doppler can be a necessary and useful integration to high resolution US for flow mapping in rheumatoid arthritis patients with tendon and extra-articular involvement. These modes depict local circulation changes related to disease stage and treatment response.