A suggestive case report of acute mesenteric venous thrombosis diagnosed at Computed Tomography Angiography.

Acute mesenteric venous thrombosis (MVT) is a rare but potentially fatal condition with superior mesenteric vein being the most common site of thrombosis development. It is more common in patients with underlying disorders which cause disruptions to Virchow's Triad of hypercoagulability, stasis and endothelial injury. The disease is often associated with intestinal ischemia in its acute form, further complicating its management. We present a case of acute superior mesenteric venous thrombosis, in a 65 years old man with initial features of intestinal infarction, diagnosed at Computed Tomography Angiography (CTA) scan. However, the patient was stable, with a nonperitonitic abdomen, and was subsequently managed with conservative measures.

A simultaneous superior mesenteric arterial and venous thrombosis in an elderly woman with a previous COVID-19 pneumonia: A suggestive case report diagnosed at computed tomography angiography.

Superior mesenteric artery (SMA) and superior mesenteric vein (SMV) thrombotic occlusion is a rare but potentially fatal condition. Though isolated mesenteric arterial occlusion associated with COVID-19 has been reported in literature, combined superior mesenteric arterial and venous thrombosis is very rare. We report the case of an 88-years-old woman with a combined superior mesenteric arterial and venous thrombotic occlusion with a previous COVID-19 pneumonia of about 15 days before, diagnosed at computed tomography angiography (CTA) scan. CTA had an important key-role for the diagnosis and evaluation of the severity of the mesenteric venous and arterious thrombosis.

Acute aortic dissection in a young man with bilateral Covid-19 pneumonia: A suggestive case report at Computed Tomography Angiography.

Acute Aortic Dissection (AAD) is one of the most common lifethreatening diseases that affects the aortic vessel. An its immediate and accurate diagnosis is crucial to initiate the appropriate treatment. The Covid-19 Coronavirus infectious pandemic started since December 2019 and was declared a pandemic by the World Health Organization in March 2020. It caused mainly bilateral interstitial pneumonia, up to causing a severe respiratory failure for the patients, and other complications. Now, we describe the case of a young man that was admitted to our hospital and was found positive for the Coronavirus disease 2019 (Covid-19). While we were performing Computed Tomography (CT) scan of the chest, we had suspected the concomitant presence of an aortic dissection, which was then immediately confirmed by Computed Tomography Angiography (CTA) study, that we had performed to complete the baseline CT scan.

A fuzzy-enhanced deep learning approach for early detection of Covid-19 pneumonia from portable chest X-ray images.

The Covid-19 pandemic is the defining global health crisis of our time. Chest X-Rays (CXR) have been an important imaging modality for assisting in the diagnosis and management of hospitalised Covid-19 patients. However, their interpretation is time intensive for radiologists. Accurate computer aided systems can facilitate early diagnosis of Covid-19 and effective triaging. In this paper, we propose a fuzzy logic based deep learning (DL) approach to differentiate between CXR images of patients with Covid-19 pneumonia and with interstitial pneumonias not related to Covid-19. The developed model here, referred to as CovNNet, is used to extract some relevant features from CXR images, combined with fuzzy images generated by a fuzzy edge detection algorithm. Experimental results show that using a combination of CXR and fuzzy features, within a deep learning approach by developing a deep network inputed to a Multilayer Perceptron (MLP), results in a higher classification performance (accuracy rate up to 81%), compared to benchmark deep learning approaches. The approach has been validated through additional datasets which are continously generated due to the spread of the virus and would help triage patients in acute settings. A permutation analysis is carried out, and a simple occlusion methodology for explaining decisions is also proposed. The proposed pipeline can be easily embedded into present clinical decision support systems.

Retroperitoneal hematoma by different causes: Presentation of two emergency cases at computed tomography.

Retroperitoneal hematoma is a rare clinical entity with variable aetiology, which is increasing in incidence mainly due to complications related to interventional procedures. The causes of RE are different. We present 2 suggestive cases of RE, one for renal cause and another of adrenal origin. Both came to our attention as a matter of urgency. Retroperitoneal hematoma, therefore, originated from different causes, with consequent different treatments. Both cases were diagnosed, as a matter of urgency, thanks to the use of contrast Computed Tomography, which allowed a rapid diagnosis, careful specialist evaluation, a monitoring of their clinical conditions, and a consequent adequate outcome for the patients.

Pericardial and pleural effusion in an elderly woman with Covid-19 pneumonia: CT findings.

Coronavirus-19 disease is an acute respiratory syndrome infection that primarily infects the lungs, and may extend to other organs such as the cardiovascular system. Here we describe the case of a 90-year-old woman, affected by heart failure (NYHA, class III), with bilateral Covid-19 pneumonia, complicated by pleural and pericardial effusion. An unenhanced Computed Tomography, urgently made, allowed to hospitalize and treat the patient, monitoring her clinical situations.

A pulmonary hamartoma in Covid-19 pneumonia: an interesting case studied with computed tomography.

Since the widespread of acute respiratory syndrome infection caused by Coronavirus-19, chest computed tomography (CT) was considered a useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated Covid-19 pneumonia. Many typical imaging features of this disease were carefully described with chest CT, as well as the collateral CT findings in the lungs and mediastinum. Here we describe the case of a patient with Covid-19 pneumonia, that collaterally had a pulmonary hamartoma in the left lung, documented at CT.

Bilateral acute pulmonary embolism and Covid-19 pneumonia: CT findings.

Since the widespread of acute respiratory syndrome infection caused by coronavirus-19, unenhanced computed tomography (CT) was considered a useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated Covid-19 pneumonia. If there is clinical or laboratory suspicion of pulmonary embolism complicating Covid-19 pneumonia, CT angiogram of the pulmonary arteries may be necessary. Here we describe the case of a 52 years old man, affected by a high-risk myelodysplastic syndrome patient, with Covid-19 pneumonia, complicated by a bilateral massive acute pulmonary embolism. An unenhanced CT and then a CT pulmonary angiography were made, and the patient was immediately hospitalized and treated.

The spider web sign in Covid-19 pneumonia: An interesting case studied to resolution with computed tomography.

Since the widespread of acute respiratory syndrome infection caused by Coronavirus-19, unenhanced computed tomography (CT) was considered a useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated Covid-19 pneumonia. Many typical imaging features of this disease were described such as bilateral multilobar ground-glass opacity (GGO) with a prevalent peripheral or posterior distribution, mainly in the lower lobes, and sometimes consolidative opacities superimposed on GGO. As less common findings were mentioned septal thickening, bronchiectasis, pleural thickening, and subpleural involvement. Here we describe the case of a patient, with Covid-19 pneumonia, that had the spider web sign, a triangular or angular GGO in the subpleural lung, documented at CT.

Gallstone obstruction at the proximal ileum in an elderly woman: CT findings.

We present the case of a 73 years old woman with intestinal obstruction caused by a rare cause of biliary ileus, who arrived at our emergency department with lower abdominal quadrants pain (since about 2 months), recently associated with nausea, vomiting and abdominal distension. After clinical and laboratory evaluations, a computed tomography (CT) scan without intravenous contrast medium administration was urgently requested. CT had shown the presence of a large gallstone (diameter of about 6 cms) at the proximal ileum (stopped in this tract after the passage through a biliary-enteric fistula), and another gallstone (diameter of about 2 cms) in the gallbladder, associated with concentric thickening of gallbladder's walls, gas in the biliary tree, obliteration of peri-gallbladder's fat density and fluid in the peri-subhepatic area. The patient had urgently a surgical treatment (videolaparoscopy). CT had a crucial role for the diagnosis of intestinal obstruction, for its high sensitivity and specificity. It is well able to provide the causes and the level of the obstruction, its extension and complications, thus orienting toward the best clinical management/outcome for the patient.

Radiomics predicts survival of patients with advanced non-small cell lung cancer undergoing PD-1 blockade using Nivolumab.

Immune checkpoint blockade is an emerging anticancer strategy, and Nivolumab is a human mAb to PD-1 that is used in the treatment of a number of different malignancies, including non-small cell lung cancer (NSCLC), kidney cancer, urothelial carcinoma and melanoma. Although the use of Nivolumab prolongs survival in a number of patients, this treatment is hampered by high cost. Therefore, the identification of predictive markers of response to treatment in patients is required. In this context, PD-1/PDL1 blockade antitumor effects occur through the reactivation of a pre-existing immune response, and the efficacy of these effects is strictly associated with the presence of necrosis, hypoxia and inflammation at the tumour sites. It has been indicated that these events can be evaluated by specific assessments using a computed tomography (CT) texture analysis (TA) or radiomics. Therefore, a retrospective study was performed, which aimed to evaluate the potential use of this analysis in the identification of patients with NSCLC who may benefit from Nivolumab treatment. A retrospective analysis was performed of 59 patients with metastatic NSCLC who received Nivolumab treatment between January 2015 and July 2017 at Siena University Hospital (35 patients, training dataset), Catanzaro University Hospital and Reggio Calabria Grand Metropolitan Hospital, Italy (24 patients, validation dataset). Pre- and post-contrast CT sequences were used to contour the gross tumour volume (GTV) of the target lesions prior to Nivolumab treatment. The impact of variations on contouring was analysed using two delineations, which were performed on each patient, and the TA parameters were tested for reliability using the Intraclass Coefficient Correlation method (ICC). All analyses for the current study were performed using LifeX Software©. Imaging, clinical and pathological parameters were correlated with progression free survival and overall survival (OS) using Kaplan Meier analysis. An external validation testing was performed for the TA Score using the validation dataset. A total of 59 patients were included in the analysis of the present study. The reliability ICC analysis of 14 TA parameters indicated a highly reproducibility (ICC >0.70, single measure) in 12 (85%) pre- contrast and 13 (93%) post-contrast exams. A specific cut-off was detected for each of the following parameters: volume (score 1 >36 ml), histogram entropy (score 1 > 1.30), compacity (score 1 <3), gray level co-occurrence matrix (GLCM)-entropy (score 1 >1.80), GLCM-Dissimilarity (score 1 >5) and GLCM-Correlation (score 1<0.54). The global texture score allowed the classification of two subgroups of Low (Score 0-1; 36 patients; 61%) and High Risk patients (Score >1; 23 patients; 39%) that respectively, showed a median OS of 26 (mean +/- SD: 18 +/- 1.98 months; 95% CI 14-21 months) and 5 months (mean +/- SD: 6 +/- 0.99 months; 95% CI: 4-8 months; P=0.002). The current study indicated that TA parameters can identify patients that will benefit from PD-1 blockage by defining the radiological settings that are potentially suggestive of an active immune response. These results require further confirmation in prospective trials.