Resection of a solitary bone metastasis using preoperative computed tomography (CT)-guided hook wire localization: a case report.

Secondary bone metastasis are a common evolution of many types of cancer. In some instance, it is needed to remove those metastases to improve the prognosis of the patient. Bone metastasis that are invisible and non-palpable during the intervention are difficult to remove while being sure to respect safe resection margins. We present the case of a woman suffering from breast cancer. Despite the treatment of the primitive lesion, she presented a solitary bone metastasis on her iliac crest. The lesion was removed surgically but could not be seen or touched during the procedure due to its location. To be certain to remove this lesion during surgery, while respecting safe resection margins, we performed a pre-operative computed tomography (CT)-guided hook wire localization. Using this method, the anatomopathological examination confirmed the tumoral nature of the lesion and that the resection margins were in a safe zone. This technique frequently used to target soft lesion in cases of breast or lung cancers could therefore be used the same way with solid bone lesion.

Assessment of normal left atrial appendage anatomy and function over gender and ages by dynamic cardiac CT.

OBJECTIVES: The aim of this study was to evaluate variations in anatomy and function according to age and gender using cardiac computed tomography (CT) in a large prospective cohort of healthy patients. BACKGROUND: The left atrial appendage (LAA) is considered the most frequent site of intracardiac thrombus formation. However, variations in normal in vivo anatomy and function according to age and gender remain largely unknown. METHODS: Three-dimensional (3D) cardiac reconstructions of the LAA were performed from CT scans of 193 consecutive patients. Parameters measured included LAA number of lobes, anatomical position of the LAA tip, angulation measured between the proximal and distal portions, minimum (iVolmin) and maximum (iVolmax) volumes indexed to body surface area (BSA), and ejection fraction (LAAEF). Relationship with age was assessed for each parameter. RESULTS: We found that men had longer and wider LAAs. The iVolmin and iVolmax increased by 0.23 and 0.19 ml per decade, respectively, while LAAEF decreased by 2% per decade in both sexes. CONCLUSIONS: Although LAA volumes increase, LAAEF decreases with age in both sexes. KEY POINTS: • Variations in normal left atrial appendage in vivo anatomy and function remain largely unknown. • Cardiac CT is reliable for left atrial appendage volume measurements. • Although LAA volumes increase, LAAEF decreases with age in both sexes.

MDCT in the assessment of laryngeal trauma: value of 2D multiplanar and 3D reconstructions.

OBJECTIVE: The purpose of this study was to analyze fracture patterns and related effects of laryngeal trauma and to assess the value of 2D multiplanar reformation (MPR) and 3D reconstruction. MATERIALS AND METHODS: Among 4222 consecutively registered trauma patients who underwent emergency MDCT, 38 patients had presented with laryngeal trauma. Axial, 2D MPR, 3D volume-rendered, and virtual endoscopic images were analyzed retrospectively by two blinded observers according to predefined criteria. Laryngeal fractures, soft-tissue injuries, and airway compromise were evaluated and correlated with clinical, endoscopic, surgical, and follow-up findings. RESULTS: Fifty-nine fractures (37 thyroid, 13 cricoid, nine arytenoid) were present in 38 patients. They were isolated in 21 (55%) patients. The other 17 (45%) patients had additional injuries to the neck, face, brain, chest, or abdomen. Laryngeal fractures were bilateral in 31 (82%) patients and were associated with hyoid bone fractures in nine (24%) patients. Arytenoid luxation was present in eight cartilages. Axial imaging missed 7 of 59 (12%) laryngeal fractures, six of eight (75%) arytenoid luxations, and four of nine (44%) hyoid bone fractures. Additional 2D MPR imaging missed 5 of 59 (8%) laryngeal fractures, five of eight (62.5%) arytenoid luxations, and two of nine (22%) hyoid bone fractures, whereas 3D volume-rendered images depicted them all. Virtual endoscopy and 3D volume rendering added diagnostic accuracy with respect to the length, width, shape, and spatial orientation of fractures in 22 of 38 (58%) patients; arytenoid luxation in six of eight (75%) luxations; and the evaluation of airway narrowing in 19 of 38 (50%) patients. Three-dimensional volume rendering was not of additional value in evaluation of the cricoid cartilage. CONCLUSION: The use of 2D MPR and 3D volume rendering with or without virtual endoscopy improved assessment of thyroid and hyoid bone fractures, arytenoid luxations, and laryngotracheal narrowing, providing helpful data for optimal management.