[The cardiovascular system].
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Cardiomyopathies↗
Biomedical subjects
R Dore
Publications and source records attributed to R Dore.
[Computerized tomography in the differential diagnosis of non-gynecologic abdomino-pelvic masses].
The female pelvis is an anatomical region where masses can be found originating from pelvic organs, mostly from the genital system or else from abdominal organs and systems, by continuity, by contact or by metastatic spread. The clinician needs to define and characterize a pelvic mass since treatment options can vary greatly. If a malignant pelvic lesion is clinically suspected, ultrasonography is the investigation technique of choice, whose differential diagnosis accuracy is good especially in gynecologic conditions. However, in nongynecologic masses, US diagnostic yield is poorer, which led us to retrospectively review 31 such cases. CT was used to assess the mass origin and tissue characterization to define the clinical role of this method. On the whole, CT yielded good results (80.6% overall diagnostic accuracy, 25/31 cases) which however differed according to the different pathologic conditions. Gastrointestinal system conditions, tumors and inflammations were easy to diagnose with CT (11/15 cases, 73.3%), except for the patients with intestinal cancer spreading to the ovaries, that is, a Krukenberg's lesion, or the cases with an abscess hiding the annexa and thus preventing CT from detecting the mass origin, be it intestinal or annexial. CT diagnostic accuracy was high in extraperitoneal (retro- and properitoneal) masses (8/8 cases, 100%), but much lower (75%, 6/8 cases) in the diagnosis of primary intraperitoneal organs conditions. To conclude, CT is confirmed as an accurate imaging technique in the differential diagnosis of nongynecologic abdominopelvic masses. The mass origin is usually correctly detected and tissue characterization is accurate, which provides the clinician with enough pieces of information for best treatment planning.
Abdominal Neoplasms↗
[Combined diagnostic assessment of a case of giant pseudoaneurysm of the gastroduodenal artery].
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Aneurysm↗
[Secondary solid neoplasms in young patients treated for lymphoproliferative diseases: computed tomography findings].
Diagnostic imaging still plays a key role in the follow-up of oncologic patients. In particular, in hemolymphoproliferative disorders, diagnostic imaging is used to differentiate the complications of integrated treatment from possible relapses. Integrated treatments have lengthened the survival of these patients and therefore such long-term complications as secondary--especially solid--tumors are now more frequently observed. We report on two such cases whose onset followed by 6 and 5 1/2 years the end of the initial treatment: the patients had been cured for acute lymphatic leukemia and Hodgkin's lymphoma. In the leukemia patient, CT and MRI demonstrated a large mediastinal mass, which had been an occasional finding at chest film. CT correctly diagnosed the mass and suggested extrapulmonary and extramediastinal localization, since fat cleavages were normal. MRI allowed better characterization of the mass which was isointense to muscle independent of TR. Disease relapse was excluded and surgery allowed the complete ablation of the ganglioneuroma. In the lymphoma patient, a left hypochondrium mass was supposed as an abdominal relapse from Hodgkin's lymphoma. CT allowed the correct diagnosis of gastric adenocarcinoma to be made on the basis of the mass multifocality and marked enhancement, of the infiltration of liver and hepatogastric ligament lymph nodes and finally of peritoneal involvement. Secondary solid tumors are no remote finding in the follow-up of the patients treated for lymphoproliferative disorders. Diagnostic imaging must allow the differential diagnosis especially from relapses and must use the techniques which are most capable of doing so.
Adenocarcinoma↗
[Abdominal manifestations in immunocompromised patients].
Abdominal infections or tumors in the immunocompromised host are both common in AIDS but uncommon in transplant recipients. The role of diagnostic imaging modalities differs in the patients with specific symptoms such as dysphagia, diarrhea, malabsorption and jaundice and in the patients with aspecific clinical findings such as fever, weight loss, superficial lymphadenopathies and abdominal pain. In the former patients, the symptoms suggest a disease of one or more alimentary tracts, in which case radiology is ancillary to clinics and endoscopy plays the leading role to make the diagnosis. However, X-ray barium studies yield valuable information on different types of infections--e.g., Candida, Cytomegalovirus, mycobacterium avium intracellulare and Cryptococcus infections--in Kaposi's sarcoma and in gastrointestinal lymphoma. In these cases CT findings may suggest the diagnosis. In the patients with aspecific findings, US, as an easy immediate examination, and CT, as a panoramic means, can demonstrate deep lymphadenopathies and focal parenchymal lesions which are sometimes suspected to be abscesses or tumors. Moreover, both methods can provide indications and guide to percutaneous needle biopsies. Especially CT findings can distinguish mycobacterial infections from neoplastic lesions on the basis of the involved anatomical sites and of densitometric features. US and CT are useful means to monitor HIV+ subjects, to manage AIDS patients and to follow-up transplant recipients.
Acquired Immunodeficiency Syndrome↗
[Interventional modalities in immunosuppressed patients].
In immunocompromised patients interventional modalities have diagnostic and/or therapeutic purposes--in both cases they are justified on the basis of the frequently aspecific clinical and instrumental findings and because of the clinical need to carry out the most specific treatment as soon as possible. The authors stress the particular weakness of immunocompromised patients to invasive approaches and discuss the indications, contraindications and precautions which must be taken when performing interventional radiologic modalities. Diagnostic imaging uses radioscopy, US and CT for guidance, each of them allowing a rapid percutaneous confirmation of lesion nature, the assessment of infection in a collection, of a neoplastic lesion type, or of the microbiology of an infectious lesion. Interventional modalities are frequently indicated in chest diseases--e.g., for punctures and percutaneous drainage of empyematous pleural collections or of pulmonary abscesses, percutaneous needle biopsies of lung lesions, or endoscopic dilatation of tracheobronchial stenoses. The percutaneous drainage of lung abscesses in immunocompromised patients makes recovery easier. The diagnostic accuracy of the results of needle biopsy is lower in lung infections than in neoplastic lesions. Indications to abdominal interventional procedures are less frequent--i.e., percutaneous drainage of rare abscesses, percutaneous needle biopsy of nodal mesenteric or lumboaortic masses. Some clinical conditions are diagnosed only with invasive radiologic procedures--e.g., ERCP diagnoses sclerosing cholangitis in AIDS. CT is the basic and the best modality to guide percutaneous drainage in both the abdomen and the chest, to assess contraindications or to indicate some specific modes; in some cases even plurifocal abscesses can be treated with a percutaneous imaging approach.
Abdomen↗
The clinical value of computed tomography and lymphography in detecting lymph node metastases from epithelial ovarian cancer.
We investigated the accuracy of both lymphography and computed tomography (CT) in detecting lymph node metastases in 58 patients with primary epithelial ovarian cancer (group a) and subsequently submitted to surgery including pelvic and/or lumbo-aortic lymphadenectomy. CT accuracy was also investigated in 41 patients with clinically suspected relapse of ovarian cancer (group b). In the first group (a) overall results in the pelvis were, respectively, for lymphography and CT: 94.8 vs 89.6% accuracy, 85.7 vs 57.1% sensitivity, 97.7 vs 100% specificity, 97.7 vs 100% positive predictive value and 95.5 vs 88% negative predictive value. In the lumbo-aortic region, we had: 88.8 vs 86.1% accuracy, 71.4 vs 64.2% sensitivity, 100% specificity and positive predictive value for both techniques, and 84.6 vs 81.6% negative predictive value. In the second group (b) CT accuracy, sensitivity and specificity were 90.2, 80 and 100%, respectively. CT, thanks to its high specificity and positive predictive value, can represent the method of choice for the evaluation of pelvic and lumbo-aortic lymph node metastases in untreated and relapsing ovarian cancer. CT demonstration of lymph node metastases can affect not only lesion staging, but also chemotherapy; different indications for lymphadenectomy may also depend on CT.
Adult↗
[Computed tomography and tumor markers as diagnostic alternatives to second-look surgery in the treatment of malignant ovarian tumors].
Advanced malignant ovarian cancers are treated, after initial surgery, with first-choice mono/polychemotherapy, the response to which is evaluated by means of second-look laparotomy. The poor prognostic value of second-look results, the incidence of false negatives, the lack of valuable second-choice therapies, and the high incidence of complications after repeated interventions, lead to the testing of diagnostic imaging modalities--especially CT and tumor markers (Ca 125 and Ca 15-3). To define their actual clinical value, CT and serum assays of Ca 125 and Ca 15-3 have been performed on 32 treated patients affected with ovarian cancers (stages II-IV), who were clinically free of disease. The results have been compared with second-look pathology, but especially with patient follow-up (min. 24 months). Second-look laparotomy yielded a high number of false negatives (9/22 = 41%); moreover, many important/severe complications were observed. Thus, its value appears to be questionable. CT exhibited high positive predictive value (76.9% over the 24-month follow-up); high for both Ca 125 and Ca 15-3 (100% respectively, at 24-month follow-up) thus, few false positives were observed. Moreover CT, having higher sensitivity (55.5%) than Ca 125 (11.5%) and Ca 15-3 (27.7%), has greater diagnostic capabilities, especially when the lesion is in extraperitoneal location.
Aged↗
[Computed tomography of intraperitoneal retained gauzes].
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Adult↗
[Computerized tomography versus lymphography in the assessment of lymph node metastasis in epithelial carcinoma of the ovary].
We investigated the accuracy of both lymphangiography and CT in detecting lymph node metastases in 59 patients evaluated preoperatively and subsequently submitted to surgery with selective/systemic pelvic and paraaortic lymphadenectomy. CT accuracy was also investigated in 46 patients with a clinically suspected relapse of ovarian cancer (verified by means of clinical and/or CT follow-up in 36 patients, by laparotomy in 7, by fine-needle biopsy in 1 and by necroscopy in the last 2). In the first group (previously untreated patients) the overall results in the pelvis were, respectively, for lymphangiography and CT: 94.9% vs 89.8% accuracy, 86.6% vs 60% sensitivity, 97.7% vs 100% specificity, and 92.8% vs 100%, 95.5% vs 88% positive and negative predictive values. In the paraaortic region the results were: 89.1% vs 86.5% accuracy, 73.3% vs 66.6% sensitivity, 100% specificity for both techniques, 100% positive predictive value, and 84.6% vs 81.5% negative predictive value. In the second group (clinically suspected relapse), CT accuracy, sensitivity, and specificity were, respectively: 91.3%, 81.8%, and 100%. Our experience demonstrated a high incidence of lymph node metastases in ovarian cancer, both in pelvic (15/49; 25.5%) and especially in aortic (15/37; 40.5%) locations in untreated patients, and an even higher incidence in relapses (22/42; 52.5%). The high specificity and positive predictive value of CT depended on the fact that there were no false positives. We arbitrarily considered as metastatic a lymph node with phi greater than 2 cm, and this threshold seemed to be of clinical value since it made a good predictor of metastases.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Peritoneal hemorrhage caused by hepatic metastasis. Description of a case and diagnostic considerations].
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Female↗
Serous carcinoma of the ovary: value of computed tomography in detection of calcified pleural and pulmonary metastatic implants.
Reported are three cases of serous papillary cystoadenocarcinoma of the ovary with pleural and pulmonary calcified metastatic implants detected by computed tomography (CT), but not by chest X-ray. CT patterns of metastatic calcifications were considered because of the unexpected frequency of this finding (15.7%) and in view of a possible clinical use of CT in monitoring extraabdominal disease.
Adult↗
[Pseudoaneurysm of the left ventricle. Description of a clinical case].
The paper describes a case of pseudoaneurysm of the left ventricle following an earlier operation to close a post-infarction interventricular defect. The nosological entity is described paying particular attention to preoperative functional tests and intraoperative anesthesiological procedures. The careful monitoring of refilling pressure and cardiac load represents an essential for the correct infusion of drugs and optimal volemic refilling.
Heart Aneurysm↗
[Lymph node metastasis of carcinoma of the cervix uteri. Role of lymphography and computerized tomography].
The presence of lymph nodal metastases in the patients affected with carcinoma of the uterine cervix is of the utmost clinical relevance. In the Radiology, Obstetrics and Gynecology Departments of Pavia University we have evaluated the accuracy of lymphangiography and CT in recognizing lymph nodal metastases in 95 patients, 58 of them evaluated preoperatively (49 subsequently submitted to radical hysterectomy). CT accuracy was also evaluated in 37 patients with a clinically suspected relapse of cervical cancer. In the first group the overall results were: 91% accuracy, 88% sensitivity, 92.5% specificity for lymphangiography and 87.9% accuracy, 72.2% sensitivity, and 95% specificity for CT (in 49 patients, stage I-II, submitted to lymphadenectomy, lymphangiographic accuracy was 91%, sensitivity was 88%, specificity 92% versus CT accuracy 85.7%, 44.4% sensitivity, and 95% specificity). In the second group (relapse) CT accuracy, sensitivity and specificity were 94%, 100%, and 91%, respectively. In conclusion, lymphangiography gives better results than CT in the patients with early stages (I-II) of the disease. In advanced stages and relapses CT was found to have high accuracy in demonstrating lymph node status. This information is useful for treatment planning and for avoiding unnecessary surgical exploration.
Adult↗
Computed tomography of cystic lymphangioma in a wandering spleen.
A large cystic lymphangioma in a wandering spleen was discovered by chance in a young woman, 2 months after she delivered her first child. The clinical finding was that of a pelvic mass, which at CT was found to be a wandering spleen, containing multiple cystic lesions. The diagnosis of cystic lymphangioma was made at the pathological examination of the specimen after splenectomy. The association of cystic lymphangioma in a wandering spleen has not been reported previously.
Adult↗
Clinical value of computerized tomography (CT) in assessment of recurrent uterine cancers.
Fifty-one patients with a clinically suspected relapse of uterine cancer were evaluated with computerized tomography (CT) in the Departments of Obstetrics/Gynecology and Radiology of the University of Pavia. The accuracy of these scans was always compared with biopsy results (31 cases) or clinical outcome (20 cases). To evaluate the role CT played in the treatment of each patient we divided the results of these examinations into "Confirmative" (when there was clinical evidence of a tumor) and "Diagnostic" (when physical examination and conventional radiologic techniques were inconclusive). Overall diagnostic accuracy was 92%, specificity 80%, and sensitivity 92%. The authors found that CT provides information that is useful for planning treatment and for avoiding unnecessary surgical exploration when a tumor is clinically evident; furthermore, CT was found to be better than conventional diagnostic means in doubtful cases, especially those in which post-therapeutic pelvic fibrosis was not extensive (correct diagnosis is 15 of 19 cases).
Adult↗
Unusual CT features in ruptures of abdominal aortic aneurysms.
The authors present two cases of impending rupture of abdominal aortic aneurysms correctly diagnosed by means of some unusual CT findings. The clinical signs were not clear. On CT examination, despite the absence of haematomas, minor, but precise, changes allowed the correct diagnosis: loss of definite contours of the aneurysm, non-homogeneous peri-aortic and peri- and para-renal adipose tissue, thickening of the renal fascia and a thin fluid collection over the psoas muscles.
Acute Disease↗
[Ovarian dermoid cysts. Radiographic fat floating sign and CT diagnosis of chronic rupture].
Unsuspected chronic rupture was discovered during surgical removal of a very large ovarian dermoid cyst. Abdomen X-ray, US and CT examinations were preoperatively performed. Standing X-ray projection of the abdomen allowed the appearing of a new radiographic finding of dermoid cyst, the "fat floating" as the equivalent of the "gravity dependent layering" in US and CT features. This radiographic sign appears as an horizontal line between two soft tissues of different opacity; it is caused by oily and sebaceous fluid floating over serous fluid and over intracystic debris. Literature was reviewed and radiographic findings in dermoid cysts were reconsidered; the sign of "fat floating" could enhance the diagnostic accuracy of abdomen X-ray. So when a pelvic or an abdominal-pelvic mass is discovered in a young woman, standing projection is required for abdomen X-ray. Rupture of a dermoid cyst may happen without notice and chronically; CT has been more accurate than US in evaluating rupture, in particular the peritoneal spread of oily pseudocyst.
Adult↗