[AIDS-related pulmonary Kaposi's sarcoma: role of high-resolution computerized tomography]. / Sarcoma di Kaposi polmonare nell'AIDS: ruolo della Tomografia Computerizzata con alta risoluzione.

INTRODUCTION: HIV-related Kaposi sarcoma (KS) is characterized by lesion multifocality, stronger progression and recurrent involvement of some internal organs. Pulmonary lesions are found in 18-47% of cases and not necessarily associated with skin involvement. Lung infections are potentially life-threatening and their early and prompt demonstration is a crucial step for both treatment planning and the prognosis of this severe disease. As a rapid recognition of a pulmonary condition leads to a complete or partial regression in at least 50% of cases, we investigated the role and the diagnostic yield of HRCT in depicting HIV-related KS. MATERIAL AND METHODS: The findings of thirty-nine patients with HIV-related pulmonary KS were retrospectively reviewed. We excluded the patients with associated diseases and incomplete radiologic findings and included 12 patients who had a chest radiograph and a HRCT scanning at least. HRCT showed parenchymal and subpleural micronodules (< 10 mm) and macronodules (> 10 mm), with the halo sign in some cases; perivascular and peribronchial infiltrates, linear or irregular opacities, pleural effusions and enlarged lymph nodes were also seen. Chemotherapy response was also evaluated. RESULTS: All 12 patients had advanced AIDS. The chest films showed abnormal patterns, such as peribronchial and perivascular infiltrates which were most often in midlower pulmonary lobes (88.9%) and often symmetric. Nodules were depicted in 50% of cases and were often associated with peribronchial and perivascular infiltrates; they were always bilateral and characterized by the presence of macronodules in most cases. Eleven of 12 HRCT examinations were considered sufficiently accurate for evaluation, while a pleural effusion prevented lung assessment in one case. Peribronchial and perivascular infiltrates were the most frequent abnormal findings (83.3%), with bilateral involvement in 80% and mostly in the midlower lobes (90%). Parenchymal and subpleural nodules were depicted in 58.3% of cases and always had irregular borders; the halo sign was seen around the nodules in 2 cases and macronodules were found in 2 cases. Pleural effusions were seen in 3 cases and enlarged lymph nodes in 4. Lung KS diagnosis was always confirmed at pathology. The response to chemotherapy (ABV protocol) was evaluated in 5 patients: transient and definitive regressions were observed in 1 and 2 cases, respectively, and disease progression was seen in 2 cases. CONCLUSIONS: HRCT allows the accurate assessment of pulmonary KS in its different stages detailing the disease and its spread, which makes biopsy easier. It also permits to avoid more invasive diagnostic procedures and it is useful in the follow-up after chemotherapy.

[High-resolution computerized tomography in diffuse forms of bronchiolo-alveolar carcinoma]. / Tomografia Computerizzata con alta risoluzione nelle forme diffuse del carcinoma bronchiolo-alveolare.

Bronchioloalveolar carcinoma (BAC) is a relatively uncommon tumor of the lung accounting for 1 to 9% of all pulmonary neoplasms. Its radiologic appearance is characterized by solitary nodular opacity or diffuse air-space consolidation. The aim of this work is to report the different patterns of this neoplasm, particularly in the diffuse form, and to demonstrate the sensitivity and specificity of HRCT in its early identification. We examined 11 patients affected with multifocal bronchioloalveolar carcinoma to identify HRCT signs which could lead to improved diagnostic criteria. These signs are represented by ground-glass opacity (8/11) and alveolar consolidation (6/11), with a plurilobular, segmentary or lobar distribution. The lesions were bilateral in 8/11 cases and abnormal mediastinal lymph nodes were found in 5/11 cases. Air bronchogram was seen in all cases of ground-glass opacity and in 5/11 cases of air-space consolidation. In conclusion, in our experience, HRCT is a useful tool in the study of BAC, which has a long and slow evolution and is underestimated at chest radiograph in its early stage. Moreover, HRCT can help distinguish this condition from other lung diseases characterized by diffuse air-space consolidations, whose clinical history is useless to make an unquestionable diagnosis.

CT demonstration of liquid intratumoral fat layering in a necrotic renal cell carcinoma.

We describe a case of clear-cell adenocarcinoma of the kidney with CT evidence of fat that contradicts the rule that radiologically demonstrable fat is absent in renal carcinoma. The cyst-like appearance, egg-shell parietal calcifications, and extrarenal development of the mass suggested a preoperatively incorrect diagnosis of teratoma.

[The evolution of the liver metastases from colorectal carcinoma treated with hepatic intra-arterial chemotherapy. The echographic and CT aspects]. / Evoluzione delle metastasi epatiche da carcinoma del colon-retto trattate con chemioterapia intra-arteriosa epatica. Aspetti ecografici e tomodensitometrici.

The response of liver metastases to chemotherapy relies mainly on quantitative US and CT investigations, the two techniques being indifferently used. The morphologic changes of metastatic lesions during treatment have received little attention and their significance is still questionable. Based on the review of 53 US and 41 CT examinations of 15 patients treated with hepatic arterial chemotherapy for colorectal liver metastasis, our study was aimed at assessing: 1) the relationship between US and CT measurements of metastasis response to chemotherapy and 2) changes in the US and CT patterns of liver metastases during treatment and the existence of specific patterns of favorable response to chemotherapy or of disease progression. We concluded that: 1) as to quantitative response to chemotherapy, US and CT, performed on 13 patients within 1 month, were in agreement in all but 1 case, 2) US and CT patterns of treated liver metastases were different in case of favorable response and of disease progression; lesion outline, homogeneity and calcifications are useful diagnostic criteria to this purpose, 3) liver perfusion abnormalities may occur at various times during and after chemotherapy; these ischemic lesions must be differentiated from new metastases.

[Pulmonary involvement in scleroderma assessed with high-resolution computerized tomography and functional tests]. / Danno polmonare nella sclerodermia valutato con Tomografia Computerizzata con alta risoluzione e prove funzionali.

This study was aimed at investigating and analyzing lung involvement in scleroderma patients with different imaging methods, toward a rational diagnostic approach. Twenty-four patients with systemic sclerosis were examined with pulmonary function tests (PFT), spirometry and diffusing capacity for carbon monoxide (DLCO), chest radiography and high-resolution Computed Tomography (HRCT). Abnormal findings were present in 42% of cases on X-ray films and in 71% of cases on HRCT images. PFT was abnormal in the spirometries of 42% of cases and in DLCO tests in 50% of cases. The most common findings at HRCT were the small reticular and the ground-glass patterns. HRCT emerged as the most effective method to evaluate lung involvement in systemic sclerosis. In our series, HRCT allowed possibly curable lung lesions to be differentiated from incurable ones. However, HRCT is suggested in the patients with impaired pulmonary function to allow treatment choice; on the contrary, in the patients with no functional impairment, HRCT adds little information to clinical findings, showing only limited focal lesions.

[Dynamic computed tomography in the prognostic assessment of acute pancreatitis]. / Tomografia Computerizzata dinamica nella valutazione prognostica delle pancreatiti acute.

Pancreatic necrosis is a well-known risk factor for infectious complications in the patients affected with acute pancreatitis. Dynamic CT with i.v. administration of a large bolus of contrast medium can establish the diagnosis of necrotizing pancreatitis. A series of 49 cases of severe acute pancreatitis was reviewed, and early CT investigations were seen to fail to detect pancreatic necrosis in 22 instances, versus 27 positive cases. In the group of patients with no necrosis, the clinical course was uneventful or characterized by mild complications which regressed spontaneously or by means of adjuvant medical treatment. On the contrary, 17 patients with necrotizing pancreatitis developed severe complications requiring intensive treatment. These complications occurred in 50% of the patients with < 50% of pancreatic necrosis, while the figure rose to 77% whenever more extensive involvement was observed. Our results show that the presence and extent of pancreatic necrosis must be diagnosed as early as possible for prognostic and therapeutic purposes; this can be done by the routinary use of dynamic CT with the administration of large amounts of contrast media at high flow rates.

Pulmonary lymphangiomyomatosis. Report of a case with immunohistochemical and ultrastructural findings.

Pulmonary lymphangiomyomatosis is a rare disease characterized by wide-spread proliferation of smooth muscle cells around lymphatic and blood vessels, smaller airways and in the interstitium. Young women in the fertile status are almost exclusively affected. Spontaneous recurrent pneumothorax is the most important symptom. Chylous effusions are reported in 37.5% of cases. Our observation deals with a woman aged 43. Light- and electron-microscopic findings are described. Estrogen receptors have been detected on smooth muscle cells. Bilateral oophorectomy and treatment with progesterone were successful.

[Angiographic diagnosis in intestinal angiodysplasia. Series of 13 cases]. / Diagnosi angiografica dell'angiodisplasia intestinale. Osservazione di 13 casi.

The authors report 13 cases of intestinal bleeding; while serials endoscopic and radiological examinations had been negative, arteriography allowed intestinal angiodysplasia to be diagnosed, and detected 18 lesions (12 of the right colon, 6 of the small bowel), confirming the fundamental role of arteriography in the diagnosis the localization and extension of these lesions. The importance of accuracy is emphasized both in the performance and in the evaluation of angiographic findings, in order to avoid missing multiple localizations (colon and small bowel). The authors illustrate and evaluate the different angiographic findings. Among these, the collection of contrast medium into parietal vascular lacunae and the early and dense opacification of the draining veins appear to be the most specific and frequent findings of angiodysplasia. In their series of patients the authors have also observed how the dilatation of the feeding artery, up to the antimesenteric side (a sign which is hardly ever reported in literature), was often present in the cecal localizations but could never be observed in the small bowel. Finally the surgical results and follow-up are considered.

[Intestinal angiodysplasias. Diagnostic and therapeutic problems]. / Le angiodisplasie intestinali. Problemi diagnostici e terapeutici.

The cases are presented of 9 patients with intestinal angiodysplasia observed in 1979-85 in the surgery departments of San Carlo Borromeo Hospital, Milan. Diagnostic problems are discussed with particular reference to angiographic and endoscopic methods. Surgical treatment gave good results. Recurrent bleeding may depend on the inadequate assessment of the extension of the lesion or on the existence of other unrecognised intestinal sites.

Tubular nephrotoxicity after intravenous urography with ionic high-osmolal and nonionic low-osmolal contrast media in patients with chronic renal insufficiency.

Nephrotoxicity of intravenous contrast media is more frequent and striking in patients with risk factors, the major one being preexisting chronic renal insufficiency. New nonionic low-osmolal contrast media allegedly have less nephrotoxicity than the traditional ionic high-osmolal ones. This was tested for two contrast media in a group of 18 patients with stable chronic renal insufficiency. The urinary excretion of two brush-border enzymes (alanine aminopeptidase, AAP, and gamma-glutamyl transpeptidase, gamma-GT) and of a lysosomal enzyme (N-acetyl-beta glucosaminidase, NAG), functional markers of tubular injury, were measured before and after intravenous urography with an ionic high-osmolal radiocontrast medium, meglumine sodium diatrizoate, or with a non ionic low-osmolal one, iopamidol. Urinary NAG excretion did not change significantly after administration of either contrast media. Urinary AAP and gamma-GT excretion increased significantly (p less than 0.01) after diatrizoate. After iopamidol, only gamma-GT excretion increased significantly (p less than 0.05). Our data suggest that the nonionic low-osmolal radiocontrast medium iopamidol is less toxic to tubules than the ionic high-osmolal medium diatrizoate and that the brush-border enzymes AAP and gamma-GT are sensitive markers for this toxicity.

[The value of xeroradiographic patterns in the diagnosis of breast diseases (author's transl)]. / Il valore diagnostico della semeiotica xeroradiografica nello studio delle affezioni mammarie.

The purpose of this study was to establish the value of xeroradiographic patterns and their applicability in the automatic diagnosis of breast diseases. Such an evaluation is based on the comparison with the histologic examination, irrespective of the overall diagnostic judgement previously formulated. From an analysis of the material examined it was possible to ascertain the distribution frequency, the sensitivity, the specificity, the discriminating capacity, and finally the weight of each radiologic sign considered. There are xeroradiographic signs that are apparent almost exclusively in the malignant pathology and therefore can be considered as positive indices of the malignancy of the alteration. The specificity of the radiologic signs considered is very high, whereas the same cannot be said for the sensitivity. Moreover, a linear discriminating analysis made it possible to identify those semiologic elements which, with a minor probability of error, would attribute the pathologic process to the class verified histologically, for malignant neoplasms as well as benign tumors and dysplastic processes.

Diagnostic accuracy of xeromammography.

The analytical study of the case material has allowed a precise evaluation of the distribution by age groups of the different pathologic processes of the breast, of the localization and dimensions of malignant tumors, as well as the diagnostic accuracy for those cases histologically ascertained and those with a follow-up. The diagnostic accuracy and the consequent reliability of the xeroradiographic method for the diagnosis of breast cancer is distinctly superior to that reported in the literature for traditional mammography, whereas for the differential diagnosis between circumscribed dysplastic manifestations and benign tumors xeromammography is not sufficiently reliable. The authors critically discuss the results and in particular the problem of false positives, which also include diagnostic errors that cannot be avoided in that they directly derive from the pathologic morphology of the disease process (plasma cell mastitis and sclerosing adenosis). As regards the problem of false negatives, they can be reduced within certain limits by resorting to other instrumental investigations. However, there are cases (1% of the malignant neoplasias histologically ascertained) that present a completely negative xeroradiographic finding. There are the limits of the radiologic investigation which cannot in any way be surmounted.