ABSTRACT
The case of a patient with intermittent dysphagia and suspected GERD is discussed. Pharyngoesophageal scintigraphy was performed. Reflux test was negative. To better define the lesion and establish the diagnosis the study was completed with an X-ray of the upper digestive tract. The finding of a barium collection and a tear in the posterior wall of the pharyngoesophageal tract was suggestive of the diagnosis of Zenker's pseudodiverticulum.
Subject(s)
Deglutition Disorders/etiology , Upper Gastrointestinal Tract/diagnostic imaging , Zenker Diverticulum/diagnosis , Diagnosis, Differential , Esophagus/diagnostic imaging , Gastroesophageal Reflux/diagnosis , Humans , Male , Middle Aged , Pharynx/diagnostic imaging , Radiography , Radionuclide Imaging , Radiopharmaceuticals , Technetium Tc 99m Sulfur ColloidABSTRACT
A case of a female patient admitted to the emergency department for the onset of acute abdominal pain and increased amylasemia, is discussed. In the suspicion of acute pancreatitis, abdominal spiral CT was performed. CT findings of acute pancreatitis were evaluated to confirm the diagnosis based on clinicolaboratory results, on staging to establish the prognosis and rule out complications.
Subject(s)
Pancreatitis/diagnostic imaging , Tomography, Spiral Computed , Acute Disease , Adult , Female , HumansABSTRACT
Zenker's diverticulum (ZD) is a rare pathology, with a prevalence of between 0.01% and 0.11%. Definitive diagnosis of ZD can be accomplished by contrast radiographic examination (barium oesophagogram, BE); oesophageal manometry (ME) is recommended mainly for those patients suffering from dysphagia and/or gastro-oesophageal reflux. The aims of the present study were to assess whether oropharyngo-oesophageal scintigraphy (OPES) is able (a) to visualise ZD and (2) to demonstrate the corresponding alteration in the swallowing phases. We studied 16 patients (nine male, seven female, mean age 67.4 years), and 17 healthy volunteers (ten male, seven female, mean age 53 years) as a control group. All the patients underwent ME, BE and OPES. Nine patients underwent surgery and six of them were re-evaluated after 6 months. We administered 10 ml of water with 37 MBq of technetium-99m colloid through a straw, acquiring 480 sequential images (0.125 s/frame for a total of 60 s) with the patient standing in front of the gamma camera in the 80 degrees right anterior oblique position. Two static images were performed at the end of the dynamic phase, before and after ingestion of 100 ml of unlabelled water to evaluate the presence of inflammation (persistence of radioactivity in the diverticulum or oesophagus). Study of the sequential scintigraphic images and time-activity curves permitted both qualitative (diverticulum visualisation, multiple deglutitions, reflux, presence of inflammation) and quantitative analyses [oral, pharyngeal and oesophageal transit times and retention indexes, tracheal aspiration percentage] of swallowing disorders. OPES showed a good correlation with the results of other diagnostic techniques usually performed in patients with this pathology, and especially with ME in the evaluation of oropharyngeal phase disorders. Furthermore, OPES is a sensitive and simple technique that is well tolerated and entails a low irradiation dose for patients.
Subject(s)
Deglutition Disorders/diagnostic imaging , Esophagus/diagnostic imaging , Pharynx/diagnostic imaging , Zenker Diverticulum/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Esophagus/abnormalities , Female , Humans , Male , Middle Aged , Pharynx/abnormalities , Radionuclide Imaging , Reproducibility of Results , Sensitivity and Specificity , Zenker Diverticulum/complications , Zenker Diverticulum/diagnosisABSTRACT
Crohn's disease is an inflammatory disease of the mucosa and bowel wall layers involving peritoneal, mesenteric structures and lymph nodes. The combination of the various imaging procedures plays a major role in the evaluation of Crohn's disease patients, based on which an optimal definition of the disease stage is achieved. This is required for a correct therapeutic strategy that can be exclusively medical, surgical or elective in complications. In the combined approach, the follow-through study of the small bowel and enteroclysis in particular, represents the examination of choice to document the early disease, early signs of recurrence with the demonstration of all mucosal alterations, including fistulous tracts. Sonography, CT and MRI allow the evaluation of Crohn's location in the wall and adjacent region. Preliminary results of CT-enteroclysis and MR-enteroclysis seem able to document mucosal alterations and morphofunctional characteristics In the near future these new examinations could become a real one-stop-shop coupled with wireless endoscopy in the study of Crohn's disease.
Subject(s)
Crohn Disease/diagnosis , Diagnostic Imaging/methods , HumansABSTRACT
Small bowel tumors represent less than 25% of all gastrointestinal tumors and 1-2% of malignant tumors in general. However for their nonspecific clinical presentation, diagnosis is often late, because of the patient delay to contact the doctor and especially the doctor difficulty to advance the clinical suspicion and request the suitable clinicoinstrumental diagnostic tests. The radiologist plays a major role in early diagnosis, treatment and prognosis. In the last decade diagnostic imaging (US, CT, MRI) has supported conventional barium studies: the diagnostic accuracy has been enhanced in terms of identification, characterization and evaluation of the degree of severity of these diseases. The choice of the most suitable technique should be based on the diagnostic skills acquired in the field and on the awareness of the limits and indications of each method. In this article, the contribution of imaging to the diagnosis of small bowel tumors, is analyzed.
