Usefulness of computed tomography performed immediately after excretory urography in patients with delayed opacification or dilated upper urinary tract of unknown cause.

PURPOSE: To evaluate the diagnostic value of computed tomography (CT) performed immediately after excretory urography (EU) in patients with delayed renal opacification or dilated upper urinary system with nonconclusive diagnosis after EU. MATERIALS AND METHODS: CT was performed immediately after EU in 39 patients with delayed opacification or dilated upper urinary system of unknown cause, without additional intravenous contrast administration for the CT study. We classified EU + CT findings as benign or malignant causes and we compared our results with the final diagnosis. RESULTS: The combination of EU + CT correctly diagnosed 38 out of the 39 cases with a sensitivity of 97%. Correct diagnosis was established in all malignant cases (n = 17) but one benign case consistent with blood clots in the upper urinary tract was incorrectly diagnosed as a multicentric urothelial carcinoma. Sensitivity, specificity, and accuracy for the diagnosis of the underlying cause with EU + CT was 100%, 95%, and 97%, respectively. The final diagnoses were: urothelial carcinoma (n = 10), stone disease (n = 10), bladder tumor (n = 4), benign post-treatment ureteral stenosis (n = 4), ureteral invasion (n = 3), benign bladder disease (n = 2), urinary tract infections (n = 2), crossing vessels (n = 1), ureteropelvic junction obstruction (n = 1), retrocaval ureter (n = 1), and blood clots in the upper urinary tract due to bleeding renal metastasis from lung cancer (n = 1). CONCLUSION: Combined EU and CT study allowed correct diagnosis of the underlying cause of delayed excretion or upper urinary tract dilatation in 97% of cases. The combination of EU and CT provides diagnosis reducing time and radiation.

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Rotura de teratoma quístico maduro de ovario: hallazgos por tomografía computarizada / Rupture of ovarian mature cystic teratoma: computerized tomography findings

Presentamos los hallazgos por tomografia computarizada (TC) de tres casos de rotura intraperitoneal de teratomas maduros quísticos de ovario. Los hallazgos radiológicos en la fase aguda incluyen la presencia de líquido intraabdominal, infiltración de la grasa mesentérica y masa pélvica con contenido cálcico y graso en su interior. Los hallazgos en la fase crónica incluyen infiltración de la grasa peritoneal con aumento de tamaño de los ganglios adyacentes, debido a una reacción inflamatoria crónica por cuerpo extraño demostrable histológicamente. Se han revisado los diagnósticos diferenciales de la rotura intraperitoneal del teratoma maduro agudo y crónico (AU)

Aortic stenosis: spectrum of diseases depicted at multisection CT.

Aortic stenosis, or narrowing of the aortic lumen, has many causes. It may originate in coarctation or pseudocoarctation of the aorta, midaortic dysplastic syndrome, atherosclerosis, Takayasu arteritis, aortic dissection, or various intraaortic and periaortic diseases or as a result of aortic surgical repair. The impedance of blood flow through the stenotic segment may lead to the development of various collateral arterial pathways, according to the location of stenosis. Aortography is the standard technique for evaluating aortic stenosis; however, helical computed tomography (CT), particularly multisection CT, may provide additional information or in some cases may be used instead of arteriography. Multisection CT can depict the aorta and thoracoabdominal collateral pathways in less than 1 minute and provide high-quality arterial-phase imaging data suitable for multiple two-dimensional and three-dimensional reformations. To produce a useful differential diagnosis, the imaging specialist must be able to recognize the type of stenosis and the configuration of collateral circulatory pathways.