Biomedical subjects
Publications and source records attributed to R Dore.
Two cases of lung tumor in the left upper with neoplastic thrombus in the pulmonary veins and extension into the left atrium are reported. The diagnosis was made preoperatively with CT.
A comparison was made of the densitometric values of the lumbar vertebrae obtained using quantitative Computed Tomography, and those measured with dual energy X-ray absorptiometry. A selected group of patients at increased risk of developing postmenopausal osteoporosis was chosen: women who had undergone bilateral oophorectomy in child-bearing years. The densitometric data recorded revealed a considerable decrease in bone mass, in particular in the cancellous portion of the vertebrae (a 17% change in the quantitative Computed Tomography value and a 13% decrease in that of dual energy X-ray absorptiometry a one year after oophorectomy). Although quantitative Computed Tomography and dual energy X-ray absorptiometry demonstrated a similar trend in bone mass reduction, given the marked and unexplained variability of both absolute values and percent variations, it was impossible to establish a clinically useful mathematical correlation between the two sets of data. Quantitative Computed Tomography is the densitometric procedure of choice to study metabolic bone disorders that involve mainly tha cancellous portion, such as postmenopausal osteoporosis. Nevertheless, given its accuracy, short execution time, lower radiation dose required, as well as good sensitivity in the measurement of bone mass variations, it would seem that dual energy X-ray absorptiometry could also find a place in clinical studies on postmenopausal osteoporosis.
We report a case of acute promyelocytic leukemia who suffered spontaneous splenic rupture with massive hemoperitoneum while receiving intensive induction chemotherapy. Emergency computed tomography of the abdomen helped in the diagnosis of intra-abdominal bleeding. The patient was successfully treated with immediate splenectomy and made an uneventful postoperative recovery. Ten days after surgery chemotherapy could be resumed and complete remission was achieved. Although spontaneous splenic rupture is a rare complication of hematologic malignancies, this diagnosis should be considered in all patients with leukemia who develop acute abdominal pain with hypotension, even in the absence of splenomegaly.
Explore the source record for details and available documents.
A total number of 117 cervical herniated disks was observed in 103 patients. Among these, 30 underwent surgical treatment. A comparison is made between CT findings and myelographic and surgical data. Purpose of the investigation is to define the reliability of CT in the diagnosis of cervical herniated disk. The morphology, level and tomographic localization into the vertebral canal are described. Moreover the possible association with spondylosis and "narrow canal" is stressed. The diagnosis was correct in all operated cases (100%). The topographic description too was correct in all cases. In 3 patients the level-diagnosis was mistaken. CT shows a higher degree of sensibility and specificity than myelography in the diagnosis of herniated disk in the cervical spine.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Percutaneous fine-needle aspiration biopsy (FNAB) is widely used in adult but not in pediatric patients, probably because young patients cooperate little. Twenty-six CT-guided FNABs were performed in children aged 40 days to 15 years (mean: 11.6 years) from January through December, 1993. The lesions were found in anterior mediastinum (17 cases), posterior mediastinum (5 cases) and lung (4 cases). Some specimens were fixed for cytology and some were cultured. Twenty-five of 26 biopsies (96.1%) provided adequate material for the cytologic assay, while in one case the result was poor because of much necrotic material. Cytologic findings were compared with postoperative biopsy results in 9 cases and confirmed by follow-up in 17 non-surgical lesions.
Explore the source record for details and available documents.
The staging of gynecologic cancers requires the knowledge of lymph node status and thus pelvic and/or lumbo-aortic lymphadenectomy remains, to date, a widely used procedure. Lymphoceles are a frequent complication of surgical lymph node dissection. They are lymph collections in the retroperitoneum following the continuous drainage of afferent lymph vessels. To assess the incidence of this complication, its CT features and the role of diagnostic imaging to treat lymphoceles, 140 patients were retrospectively evaluated. Forty of them had undergone pelvic and/or lumbo-aortic lymphadenectomy for proved endometrial carcinoma, 51/140 for proved carcinoma of the cervix uteri, and 49/140 for proved malignant epithelial cancer in the ovary. CT exams were performed during the follow-up, not on a systematic basis but only when a recurrence was clinically suspected (117 cases), or in the presence of surgery and/or irradiation complications (11 cases), or to assess the extent of residual lesion during chemo/radiotherapy (12 cases). Fifty-three lymphoceles were observed in 36 patients: they were monolateral in 18 cases and bilateral in 16; in 34 cases the lymphoceles were found in the iliac space and in 3 cases only in the median perivascular lumbo-aortic space. In the patients with clinically suspected recurrence (117 patients, 27 lymphoceles), lymphoceles were associated with the recurrence in 25 cases, while they were the only CT evidence of a mass in 2 patients. In the cases with clinically suspected complications of former irradiation and surgery (11 patients, 3 lymphoceles), lymphoceles were correctly differentiated from abscesses (2 cases), seroceles (1 case), and hematomas (2 cases). In the group of asymptomatic patients monitored for residual disease (12 patients, 5 lymphoceles), lymphoceles were an occasional finding and, since they caused no complications to the urinary and GI tracts, they were never treated. Four asymptomatic patients only, with no evidence of disease, were submitted to transcutaneous aspiration and drainage under CT-US guidance (1.7 procedures per patient), and lymphoceles resolved in 3/4 cases. The only lymphocele recurring more than once required another laparotomy. In our experience, lymphoceles appear as a common sequela of pelvic lymphadenectomy for gynecologic cancer. CT has proved to be a useful diagnostic tool to assess and characterize the lesions, which must be differentiated from other postoperative complications and from recurring tumors. Lymphoceles needed to treatment in most cases and thus only symptomatic patients, with no cancer, were submitted to aspiration and drainage under CT-US guidance; the maneuver was successful on 75% of cases.
Insulinomas are usually benign tumors originating in the pancreatic islets: since they are biologically active tumors, insulinomas present at clinics with hypoglycemia caused by increased insulin production. We examined 7 patients with clinically suspected insulinomas with spiral CT to investigate its capabilities in identifying and characterizing this type of lesion. Four patients had abnormal spiral CT findings (true positives); the diagnosis was confirmed at surgery in 3 patients and at instrumental follow-up in the other. The tumors were 12.2 mm in average diameter. CT showed no tumor mass in 3 cases, which was confirmed at angiography and MRI (true negatives). We observed a typical contrast pattern in 50% of cases, namely a ring-like enhancement changing into homogeneous enhancement. Multiplanar and 3D reconstructions were not necessary for lesion identification, but we used them for regional vascular mapping. In our experience, which is limited to few cases and dose not allow any statistically significant conclusion, spiral CT exhibited high sensitivity in the detection and characterization of pancreatic insulinomas which permits to reduce the resort to more invasive angiographic techniques.
Spontaneous esophageal perforation, or Boerhaave syndrome, is an uncommon finding requiring prompt diagnosis and immediate surgery because of its high mortality rate. The clinical diagnosis in typical cases is based on the symptom triad of Macler: vomiting, strong sudden chest pain and subcutaneous emphysema. We report 4 cases of Boerhaave syndrome with atypical presentation studied with Computed Tomography (CT) to make the correct diagnosis with atypical clinical findings. In each patient, we assessed the clinical symptoms, classifying them as typical and atypical, the diagnostic course leading to diagnosis and CT patterns. The classic symptoms were absent in one patient, while one patient had vomiting only, one had vomiting and chest pain and one had chest pain and cough. Chest radiography was performed in three patients and permitted the diagnosis in one of them only. CT permitted the definitive diagnosis in all cases. When spontaneous esophageal rupture presents with aspecific clinical findings. CT permits its accurate and specific diagnosis. We found atypical CT signs of esophageal rupture, namely pneumopericardium, uncommunicating mediastinal and pleural effusions, and focal pleural effusion in a contralateral cavity. Finally, our finding of a periesophageal mediastinal collection moving to the parietal subpleural space is not reported in the radiological literature. The severity of these findings varies and it is probably related to the increase in intraesophageal pressure affecting the progression of abscessual and hydroaerial collections in different anatomical structures; the time when CT is performed is also important. To conclude, the CT diagnosis of spontaneous esophageal rupture is specific and CT shows lesion site correctly.