[High-resolution echography and angiography in the study of vascular accesses for hemodialysis]

In 23 hemodialytic patients with clinically presumed complications of the vascular access the arteriovenous shunt was studied by high resolution ultrasonography (US) and by angiography. In 21/23 cases US identified the shape of the shunt correctly; in these patients US always showed the alterations of vascular size (stenosis, aneurysm) and complete occlusion, also detecting the intravascular extension of thrombosis. In 3 patients US identified partial venous thrombosis missed on angiography; furthermore, unlike angiography, US gave precise information on the vascular wall and perivascular tissue changes. These findings suggest that US may represent the first imaging procedure in the study of the vascular access in hemodialytic patients; angiography might be performed when US findings are uncertain or when a vascular map is needed for surgery.

[A simple method of studying cruciate ligaments in arthrography]

After a review of the methods employed for arthrographic visualization of cruciate ligaments (CL), the authors present a new technique to separately study the anterior and posterior CL during traction. This technique enables to obtain a good visualization of CL and a good diagnostic accuracy; it can radiographically demonstrate a pathologic sagittal instability of the knee; it is easy to perform and is easily repeatable in different patients.

Knee arthrography: effects of various contrast media and epinephrine on synovial fluid

Changes in synovial fluid leukocytes, total protein, and total complement were studied in 58 patients after they underwent single contrast material-enhanced knee arthrography with ionic (sodium iothalamate, sodium meglumine diatrizoate, meglumine iothalamate) and nonionic (iopamidol, iohexol) contrast media. In 30 of 58 cases, 0.3 mg epinephrine was also injected. In patients examined without epinephrine, a significant increase in the number of leukocytes was observed when sodium iothalamate and sodium meglumine diatrizoate were used. When administered with epinephrine all ionic compounds produced significant leukocytosis; articular reactions were most evident in patients examined with sodium salts. No inflammatory changes in the synovial fluid were observed when nonionic compounds were used. These data suggest that sodium-containing compounds produce a greater reaction in the joint compared with other contrast media, nonionic compounds are better tolerated by the joint, and epinephrine increases the articular reaction to ionic contrast media.

[Case of hemorrhagic pericarditis as the initial manifestation of pulmonary adenocarcinoma]

The Authors describe a case of pericardial involvement as the first sign of lung adenocarcinoma. Several evacuatory pericardiocentesis were required to treat recurrent hemorrhagic effusion. Pericardiectomy was finally carried out. The course of pericarditis was rapid: three and half months elapsed from the first symptoms of dyspnea to the death of patient.

[Magnetic resonance (MR) imaging of the normal mediastinum]

Magnetic Resonance (MR) cross sectional images of the normal mediastinum are presented and discussed. In normal subjects most mediastinal structures visible on Computed Tomography (CT) are also visible using MR. The primary advantages of MR over CT in the evaluation of mediastinum are the greater soft tissues contrast resolution, the multiplanar (axial, coronal and sagittal) display of the mediastinal anatomy and its ability to distinguish vascular from nonvascular structures without injection of contrast media.

[Echography in the diagnosis of spontaneous hematoma of the rectus muscle]

After a brief explanation of the pathogenesis and of the clinical picture of spontaneous rectus muscle hematoma, the Authors describe 9 diagnosed cases by ultrasonography. The various echographic appearances of this disease are described and the importance of ultrasonography for a correct diagnosis and to avoid unnecessary laparotomy is emphasized.

CT appearance of generalized von Recklinghausen neurofibromatosis

Two cases of von Recklinghausen neurofibromatosis (VRN) with thoracic and abdominal involvement are described. Computed tomography demonstrated the typical lesions of this disease: meningoceles, neurofibromas, and skeletal alterations. In both cases lesion morphology and location were similar and characteristic, in particular in the pelvic region. Computed tomography findings in generalized VRN are sufficiently characteristic to be considered diagnostic for this disease.

CT demonstration of portal and superior mesenteric vein thrombosis in hepatocellular carcinoma

Three cases of hepatocellular carcinoma in which computed tomography (CT) demonstrated thrombosis of the portal vein are reported. In one patient, extension of the thrombus into the superior mesenteric vein was identified as well. The outstanding CT features of portal vein thrombosis were: (a) enlargement of the vein, (b) intraluminal low density area, and (c) hyperdense peripheral ring due to the enhancement of the venous wall. These findings may be useful in differentiating hepatocellular carcinoma from hepatic metastases.