Comparison study of combined CT pulmonary angiography and venography with bilateral leg sonography in thromboembolic disease

The purpose of this study was to compare combined CT pulmonary angiography and venography with leg sonography for accuracy and relative efficacy in diagnosis of deep venous thrombosis from the popliteal vein to the common femoral vein. Seventy consecutive patients with clinically suspected pulmonary embolism underwent both combined CT pulmonary angiography and venography and bilateral leg sonography within 24 hr. CT venograms were analyzed independently in a blinded fashion for quality of venous opacification and patency by two observers. CT venography was compared with sonography for femoropopliteal vein thrombosis, and the final assessment based on multiple subjective and objective clinical and imaging criteria was recorded in three categories: 1, CT venography better than sonography; 2, CT venography equivalent to sonography; and 3, sonography better than CT venography. Sixty-eight patients [97%] had a satisfactory or good quality CT venography examination. Two CT venography studies had false-positive findings due to flow artifacts. Both CT venography and sonography had positive findings for deep venous thrombosis in five patients, and both had negative findings in 63 patients [100% sensitivity, 97% specificity, 100% negative predictive value, and 71% positive predictive value]. CT venography was better and more efficacious than sonography [category I] in 25 patients [36%]. CT venography was equivalent to sonography [category 2] in 26 patients [3 7%], and sonography was better than CT venography [category 3] in 19 patients [27%]. Compared with sonography, CT venography in addition to CT pulmonary angiography is a relatively accurate method for evaluation of femoropopliteal venous thrombosis. Combined CT pulmonary angiography and CT venography may be more efficacious than sonography or two separate examinations in selected patients

Rare testicular cystic mass "epidermoid cyst"

We describe the case of a 13-year-old boy with testicular epidermoid cyst who presented with a painless testicular mass. Epidermoid cyst of the testis is a benign, non-teratomatous tumor, It is often possible to make the diagnosis preoperatively, combining typical sonographic features with normal biochemical tumor markers. Preoperative diagnosis will allow for testis-sparing surgery and prevent unnecessary orchiectomy

Migrating pelvic "wandering" spleen

We present a case of migrating "wandering" spleen, in a 55-year-old Man who presented with constipation and lower abdominal pain, migrating spleen is a rare clinical condition characterized by ectopic positioning of the spleen due to abnormal peritoneal attachments including the lienorenal and gastrosplenic ligaments. The spleen can "wander" or migrate into various positions within the abdomen or pelvis due to this ligamentous laxity. The clinical presentation of patients with this entity is variable and can range from an incidental finding to an acute abdomen associated with torsion. Various imaging modalities can be utilized for the diagnosis of this condition

Role of spiral CT in the diagnosis of intestinal ischemia in small-bowel obstruction

The purpose of our study was to determine prospectively the value of spiral CT and of various signs of ischemia in the context of acute bowel obstruction. All patients seen over a 3-year period with a CT diagnosis of small-bowel obstruction were included. There were 144 examinations in 142 patients. Images were interpreted prospectively with attention focused on the presence of the following signs of strangulation and ischemia: reduced enhancement of the small-bowel wall mural thickening, mesenteric fluid, congestion of small mesenteric veins, and ascites. A diagnosis of ischemia was made if enhancement of the bowel wall was reduced or if at least two of the other signs were found. A diagnosis of ischemia was made at surgery in 24 patients. CT diagnosis was correct in 23 patients [96% sensitivity]. There were nine false-positive diagnoses [93% specificity]. The negative predictive value of CF was 99%. Reduced enhancement of the bowel wall had a sensitivity of 48% and specificity of 100%, mural thickening had a sensitivity of 38% and specificity of 78%, mesenteric fluid had a sensitivity of 88% and specificity of 90%, congestion of mesenteric veins had a sensitivity of 58% and specificity of 79%, and ascites had a sensitivity of 75% and specificity of 76%. Spiral CF is a highly sensitive method to diagnose or rule out intestinal ischemia in the context of acute small-bowel obstruction