Disc-like herniation in association with gas collection in the spinal canal: CT evaluation

Gas production as a part of disk degeneration can occur but rarely causes nerve compression syndromes. Few cases have been reported in which lumbar intraspinal epidural gas cause nerve root compression symptoms. We present 12 cases of gas collection in the spinal canal that were presented to the orthopaedic out-patient department with symptoms of low back pain and sciatica. CT showed the presence of free epidural gas collections adjacent to or over the affected nerve roots. Relief of symptoms was noted with the change of positions, lying down or sleeping. In this study, we conclude that the presence of lumbar intraspinal epidural gas that causes radicular compressing phenomena, can be easily detected with the use of CT.     

Spinal chordoma: radiologic features in 14 cases

The radiologic appearance of chordoma of the cervical (three patients), thoracic (four patients), and lumbar spine (seven patients) was studied. Eleven patients were over 50 years old and presented with long-standing back pain. All were examined with conventional radiographs; three cases also had CT examinations. In thirteen patients, the tumor originated in the vertebral body and, in one patient, in the posterior element of a vertebra. In nine (64%) of the 14 cases, osteosclerosis was a prominent feature. In the remaining five cases (36%), the bone lesion was purely osteolytic. Involvement of the intervertebral disk was found in three patients; in two of these the tumor extended to an adjacent vertebra. In nine patients, a soft-tissue mass was a distinctive additional feature. A sclerotic and/or osteolytic lesion in a vertebral body with a large, paraspinal soft-tissue mass in an older patient with long-standing back pain should raise the possibility of a chordoma.     

Vacuum phenomenon in non-open fracture of the mandibular condyle: report of three cases

Gas in the joint space was observed in three patients with condylar fracture who were referred for CT examinations of the mandible. CT showed that the condylar fractures were non-open fractures. The gas was only observed in the intrajoint capsule of the temporomandibular joint (TMJ). Follow-up CT, 4 days after the initial CT, showed that the gas in the joint space was absorbed in one of three cases. In the non-open condylar fractures, the gas collection in the TMJ was considered to be a vacuum phenomenon due to the intact joint capsule of the TMJ on CT.     

Recognition of lumbar disk herniation with NMR

Fifteen nuclear magnetic resonance (NMR) studies of 14 patients with herniated lumbar intervertebral disks were performed on the UCSF NMR imager. Computed tomographic (CT) scans done on a GE CT/T 8800 or comparable scanner were available at the time of NMR scan interpretation. Of the 16 posterior disk ruptures seen at CT, 12 were recognized on NMR. Diminished nucleus pulposus signal intensity was present in all ruptured disks. In one patient, NMR scans before and after chymopapain injection showed retraction of the protruding part of the disk and loss of signal intensity after chemonucleolysis. Postoperative fibrosis demonstrated by CT in one patient and at surgery in another showed intermediate to high signal intensity on NMR, easily distinguishing it from nearby thecal sac and disk. While CT remains the method of choice for evaluation of the patient with suspected lumbar disk rupture, the results of this study suggest that NMR may play a role in evaluating this common clinical problem.     

Computerized tomography follow-up after percutaneous renal lithotripsy]

Even though extracorporeal shock wave lithotripsy (ESWL) is nowadays considered the treatment of choice for the majority of upper urinary tract calculi, percutaneous stone removal will continue to be an alternative treatment method in selected cases. Therefore, percutaneous techniques must not be forgotten by the interventional radiologist. In order to assess the effects and the potential damage caused by this interventional procedure to kidney and perirenal tissues, CT was performed on 20 patients before and after percutaneous nephrolithotripsy. In the cases where no complications occurred during the maneuver, post-nephrolithotripsy scans demonstrated low incidence of significant renal abnormalities. Thickening of pararenal fascia (8 patients) and irregular renal outline (10 patients) were our most frequent findings. In 5 patients we found edema of the pyelo-ureteral junction, in 3 thickening of the bridging perinephric septa and retained stone fragments, in 2 perirenal hematomas, in one a subcapsular fluid collection. Urinoma with pelvic laceration was demonstrated in the only patient in whom the maneuver presented marked technical problems. On the basis of this series of pre- and post-nephrolithotripsy CT scans of treated kidneys, the authors conclude that this percutaneous technique is quite atraumatic.     

Findings in myelographic block. Correlations with computerized tomography image

Fifteen cases with complete myelographic stop were examined by CT. CT showed stenosis of the spinal canal in 11/12 cases with extradural lesion (92%). The stenosis was or was not associated to disk pathology; one case was due to a large herniated disk. Three cases were due to a neurinoma and were not visualized at CT without intrathecal contrast medium. This situation represents a limitation of CT and therefore an indication for myelography.     

Magnetic resonance imaging of the lumbar spine with CT correlation

The results of magnetic resonance (MR) imaging and computed tomography (CT) in 18 patients with known degenerative disk disease of the lumbar spine were compared. In 60 intervertebral disk levels studied, there were 17 disks with degeneration and disk bulge, and 15 herniated disks. Final diagnoses were based on several factors, with surgical confirmation in five patients. There was good correlation between the two methods at 51 of the 60 levels studied. However, there were major discrepancies in interpretation at nine intervertebral disk levels. These included three false-positive MR imaging interpretations of a herniated disk and one false-negative herniated disk on MR imaging. MR imaging detected one case of disk herniation that was missed prospectively on CT. There were also four presumed degenerated disks seen on MR scans that appeared normal on CT. The conus medullaris was imaged in 16 of 18 patients. The sagittal view proved best for demonstrating both disk abnormality and the conus medullaris. The transaxial view was sometimes helpful in localizing a disk herniation, but partial-volume averaging in the 7-mm slice thickness limited its usefulness. There were five disk herniations that could not be accurately localized on the MR scan. MR imaging proved more sensitive than CT in detecting early disk disease, which appeared as decreased signal intensity within the disk. In three postoperative cases, MR imaging was better able to distinguish between recurrent disk herniation and postoperative scar formation. CT, on the other hand, was more specific in distinguishing herniated disk from disk bulge and proved far superior to MR imaging in localizing disk herniation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Computed tomography of bronchial adenomas

Computed tomography (CT) was used to evaluate nine patients with bronchial adenomas: five carcinoid tumors and four adenoid-cystic carcinomas. Seven patients with lesions of the trachea or proximal bronchi presented with wheezing, hemoptysis, or obstructive pneumonitis. In such cases CT was effective in displaying the total extent of infiltrating lesions including the extraluminal component. The cases of adenoid-cystic carcinoma of the bronchi demonstrated extraluminal spread in a pattern indistinguishable from bronchogenic carcinoma. In one patient, CT demonstrated an exclusively endobronchial carcinoid tumor, and conservative resection was planned and accomplished. In two cases of carcinoid tumors that presented as solitary pulmonary nodules adjacent to bronchi in the midlung zone, CT served as a road map for the bronchoscopist. Computed tomography has been employed in the post-operative patient to evaluate for possible recurrence.     

Esophageal injuries: spectrum of multidetector row CT findings

BACKGROUND: Aim of this study is to illustrate the multidetector row computed tomographic findings related to oesophageal injuries and their significance for therapeutic decisions. METHOD: From April 2002 to April 2005 we studied 16 patients with suspected oesophageal injury. Ten patients underwent standard chest radiograph, while five patients with suspected foreign body ingestion were submitted to cervical plain film and gastrografin swallow study. All 16 patients underwent multidetector row CT examination. RESULTS: In six patients with cervical, thoracic and abdominal trauma, CT showed the presence of thoracic traumatic lesions and findings suggestive of perforation of the oesophagus. In five patients with foreign body ingestion cervical radiography was positive in only one case, while CT showed the presence of a foreign body in all cases. In three patients with post-intubation complications, CT showed the presence of perioesophageal fluid collection containing small gas bubbles in two cases and an oesophageal-aortic fistula in one case. In the remaining two patients with suspected spontaneous oesophageal perforation, CT demonstrated an oesophageal wall oedema and thickening in one case, and oesophageal fluid distension with perioesophageal small bubbles gas and fluid in the second case. CONCLUSION: Oesophageal injuries, when complicated with perforation, constitute a life-threatening condition. Knowledge of the CT signs of oesophageal injuries has important implications for the role of imaging at the time of initial diagnosis.     

Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization

AIM: To present the imaging findings of five patients with renal artery pseudoaneurysm (RAP) after partial nephrectomy. METHODS: Five patients (four men and one woman) with RAP as a complication of partial nephrectomy were studied. The diagnosis of RAP was established using contrast-enhanced computed tomography (CT) in three patients and renal angiography in two patients. In two cases, the diagnosis was evident on ultrasound with colour Doppler. RESULTS: The indication for partial nephrectomy (open approach in four patients and laparoscopic in one patient) was a space-occupying lesion, which proved to be a renal cell carcinoma. All patients presented with macroscopic haematuria, 1-21 days (mean 12.2 days) after surgery. In three of patients the definitive diagnostic imaging method was contrast-enhanced CT. The arterial phase of CT showed a well-circumscribed dense collection of contrast material located within the renal parenchyma. In two other patients the initial and conclusive diagnostic imaging method was renal angiography. All patients underwent selective renal angiography with therapeutic coil embolization. The procedure failed in one patient, which necessitated nephrectomy. CONCLUSIONS: Pseudoaneurysm of the renal artery should be considered in patients presenting with macrohaematuria after nephron-sparing surgery. The diagnosis can be established using contrast-enhanced CT, ultrasound with colour Doppler, or angiography. Renal angiography with selective embolization is a safe and efficacious technique for managing the condition.     

Primitive neuroectodermal tumor of the kidney manifested as a spontaneous hematoma

Ultrasound and CT in a young man, admitted for violent left flank pain, revelead a large heterogeneous left renal mass, with hypodense collection along the psoas. The diagnosis was spontaneous renal hematoma. A check CT 3 weeks later found a large tumor of the inferior pole. After radical nephrectomy, histopathology diagnosed a primitive neuroectodermal tumor. The patient died one year later despite neoadjuvant chemotherapy. This article reports the clinical, radiological and histopathological aspect of a primitive neuroectodermal tumor of the kidney, compared with the other cases in literature.     

Role of computed tomography in the diagnosis of rib and lung involvement in tuberculous retromammary abscesses

OBJECTIVE: To assess the role of computed tomography (CT) in the diagnosis of rib and lung involvement in tuberculous abscess in the retromammary region. DESIGN AND PATIENTS: Eight patients with tuberculous retromammary abscess were examined by CT and the findings were evaluated. A cold abscess (purulent collection with absence of acute inflammation) was aspirated in all cases. Diagnosis was confirmed by acid-fast bacillus culture, or histologic examination. RESULTS: CT showed a relatively well marginated, inhomogeneous, hypodense lesions in all eight cases. Following administration of intravenous contrast medium, these lesions showed enhancing walls, suggestive of an infective collection. Lung involvement was seen in one patient. A direct communication from the retromammary lesion through the thoracic wall into the pleura was seen in five cases. In four cases destroyed rib fragments within the abscess were noted. CONCLUSION: A tuberculous abscess in the retromammary region is usually shown on CT as a focal, well-marginated, inhomogeneous, hypodense lesion with a surrounding enhancing rim. A direct communication with the pleura, a destroyed rib fragment in the abscess, and associated lung involvement may be revealed by CT.     

CT findings of non-traumatic colorectal perforation]

We retrospectively analyzed CT scans from 23 patients with non-traumatic colorectal perforation. We compared the sensitivity of CT and plain film radiography in the detection of free gas. Free gas was observed in 7 of the 23 cases (30.4%) on plain film radiography and 16 of the 23 cases (69.6%) on CT. Retroperitoneal abscess was demonstrated in 6 of the 7 patients without free gas on CT. Extraluminal air and abscess covered by the omentum and mesenterium were demonstrated in the remaining one patient. The site of perforation was identified in 19 of the 23 patients (82.6%) on CT. CT was useful for demonstrating retroperitoneal free gas, changes in mesenteric fat, extraluminal feces, and tumors. We conclude that CT is indicated in cases of suspected colorectal perforation.     

Computed tomography in sciatica

Lumber facet arthropathy and a herniated disk are two major causes of low back pain and sciatica. The authors evaluated the importance of computed tomography (CT) in 243 patients with low back pain and/or sciatica. Lumbar facet abnormalities were found in 139 patients (57%), and a herniated disk was found in 48 patients (20%). CT findings correlated precisely with surgical observations in cases involving a herniated disk and correlated well with the results of an intra-articular facet block in a small series of patients. CT can effectively diagnose and differentiate between lumbar facet arthropathy and a herniated disk.     

High-dose i.v. contrast in CT scanning of the postoperative lumbar spine

Evaluation of the postoperative lumbar spine is sometimes difficult because of obliteration of epidural fat by hypertrophic scarring. We examined 70 patients using a high-dose intravenous contrast technique in an attempt to distinguish hypertrophic scarring from herniated disk. The CT interpretation was confirmed in all 17 patients who had follow-up operations. Thirteen had herniated disk material associated with scar and four had hypertrophic scarring only. The latter four patients underwent reoperation because of concomitant foraminal or spinal canal stenosis seen on CT. Twelve of the herniated disks had the expected appearance of a nonenhancing mass surrounded by a rim of enhancing scar tissue. In the 13th patient, homogeneous enhancement of the herniated disk was seen. It is thought that chronically herniated disks, such as this one, may incite enough surrounding scar to give the CT appearance of an enhancing disk. Finally, marginal enhancement in the anulus fibrosus region was seen in over 90% of disk spaces examined. Although an anatomical explanation cannot be given at present, this phenomenon is thought to represent a normal finding.     

Diagnosis of lumbar intervertebral disk prolapse by computed tomography. A comparative clinical study between myelographic, computed tomographic and the surgical research results with 158 patients

The diagnostic accuracy of CT in cases of lumbar disk prolapse was investigated on the basis of a group of 158 of our own patients who were divided into three separate groups. CT findings were compared on the one hand with myelograms and on the other with results of surgery. Simultaneously performed myelographic and CT examinations produced different diagnostic findings in 7 out of 80 lumbar disks (approx. 9%). These deviating findings ranged from gradual differences (in 3 cases) to completely contradictory findings (in 4 cases). In 31 patients who underwent surgery, approximately the same amount of false-positive and false-negative findings were obtained in preoperative diagnosis using CT as with myelography. The overall accuracy calculated for non-invasive computerized tomography was 93.7%, while for myelography it was 90.7%. Out of a further 91 patients in whom myelography was not performed and whose condition was checked surgically, the diagnosis had been established correctly by CT in 88. This represents a degree of accuracy of 96%. The vertical and lateral location of the disk prolapses as determined by CT corresponded with findings at surgery in every case. It is concluded from the results of these investigations that CT should be given absolute priority over myelography in the diagnosis of lumbar disk prolapse and that if there is a correlation between clinical history, neurological deficiency symptoms, and CT findings, myelography is unnecessary, even for surgery. Only if there are discrepancies between the findings myelography is indicated as a supplementary examination. CT and myelography are examination methods which complement, rather than complete with one another.     

Late contrast enhancement in the CT diagnosis of herniated lumbar disk

Summary Twenty-five patients clinically suspected of herniated lumbar disk have undergone a CT examination before and 40 min after contrast enhancement. In every case, 13 of which were surgically verified, significant contrast enhancement of herniated disks was seen; there was only one false positive case. The authors conclude that late contrast enhancement really improves the CT diagnosis of herniated lumbar disk, particularly in cases with a doubtful or negative precontrast scan. The mechanism of the late contrast enhancement is discussed.     

Thoracic trauma in fatal falls from height — Traumatic pneumopericardium correlates with height of fall and severe injury

Pneumopericardium (PPC) describes the collection of gas in the pericardial sac. In tension Pneumopericardium (tPPC), this collection of gas may lead to cardiac tamponade. PPC following blunt trauma is considered a rare finding, as reflected by the low number of case reports on the topic. We analyzed the prevalence and pathophysiology of PPC and the associated trauma in 44 cases of falls from height. We retrospectively analyzed postmortem CT data and autopsy reports of fatal falls in the period March 2014–2017. A valid estimation of the height of the fall and a documented impact on an even and hard surface were inclusion criteria. A total of 44 cases were included in the study. We identified PPC in 18 of the 44 cases, and it was associated with an increased height of the fall, alongside aortic, pericardial, and myocardial ruptures. All cases with PPC also presented with bilateral pneumothorax. Five cases presented with a “ballooning” pericardium, indicating tPPC. PPC is a common finding in cases of falls from great heights. Due to a significant correlation with height and thus impact severity, PPC may be used as a reconstructive element in medico-legal investigations. Association with trauma makes PPC a sign of severe thoracic injury in postmortem and clinical radiology.     

Loose bodies of the temporomandibular joint: arthrographic and CT findings in five patients

We report a series of five patients with symptoms of internal derangements of the temporomandibular joint (TMJ), in whom intraarticular loose bodies were found. Three patients with a single loose body had osteochondrosis dissecans of the temporal part of the joint; one trauma patient had two loose bodies (including a bony and a meniscal fragment). The fifth patient presented with a loose meniscal fragment and a complete meniscal rupture, complicating a long-lasting TMJ dysfunction due to non-reducible anterior meniscus displacement. The diagnosis was made by arthrotomography (3 cases), CT (one case) and by CT and arthrotomography (one case). Surgical confirmation was obtained in all patients. Arthrography and CT are accurate in diagnosing TMJ loose bodies; characteristic findings disclosed in both examinations are described.     

X线及CT联合应用对胆石性肠梗阻的诊断价值

目的：探讨X线及CT联合应用对胆石性肠梗的阻诊断价值。方法：回顾性分析10例胆石性肠梗阻患者的X线及CT表现。结果：10例患者中2例胆结石位于十二指肠,4例胆结石位于空肠,3例胆结石位于回肠,1例胆结石位于横结肠,结石直径2．5～6．5cn2,平均3．5cm;4例出现胆囊一十二指肠瘘,1例出现胆囊一结肠瘘,1例出现胆囊一十二指肠一结肠复合瘘,瘘口平均直径约1．5cm,其影像学表现包括肠管扩张积气积液、梗阻段肠腔内环形高密度结石影、胆囊积气及消化道造影剂外漏。结论：X线及CT联合应用可明确诊断胆石性肠梗阻,为临床治疗提供重要信息。