CT-guided ozone mixture injection in treatment of symptomatic lumbar facet synovial cysts.

BACKGROUND AND AIM: To evaluate the clinical and radiological outcomes, in terms of safety and efficacy, of a new treatment method for symptomatic lumbar facet synovial cysts (LFSC), based on ozone injection inside the cyst. METHODS: We retrospectively reviewed clinical records and imaging studies of 77 patients who underwent CT-guided ozone treatment of symptomatic facet joint synovial cysts in our department over a 5-year span. Clinical outcome was assessed with Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) evaluations, obtained prior to the intervention and at 1-, 3-, 6- and 12-months follow-up. Follow-up MRI imaging at 6 and 12 months were obtained and confronted with the pre-procedural MRI to analyse cyst modification after the intervention. RESULTS: Ozone administration was technically successful in 100% of procedures; no immediate complications occurred. At 1 month evaluation, 92% of the patients referred partial or complete symptomatic response; 86% of patients at 3 months and 84% at 6 months confirmed symptoms improvement; final assessment, at 12 months after intervention, outlined overall significant clinical improvement in 81% of patients. During the 12 months of follow-up only 3 patients had a relapse of the cyst (at 6 months) that were retreated with a 100% success. CONCLUSIONS: CT-guided ozone therapy for symptomatic LFSC is a safe and innovative treatment option, with good clinical results at 12 months follow-up in a significative percentage of patients, thus reducing the need for invasive surgical interventions.

Overview on Percutaneous Therapies of Disc Diseases.

Low back pain is an extremely common pathology affecting a great share of the population, in particular, young adults. Many structures can be responsible for pain such as intervertebral discs, facet joints, nerve roots, and sacroiliac joints. This review paper focuses on disc pathology and the percutaneous procedures available to date for its treatment. For each option, we will assess the indications, technical aspects, advantages, and complications, as well as outcomes reported in the literature and new emerging trends in the field.

Congenital kidney malformation: Computed tomography and scintigraphy findings of renal reversed rotation.

Renal reversed rotation is a congenital abnormality due to anomalous kidney rotation around its long axis, resulting in faced laterally renal hilum; this condition is associated with several vascular variants. The aim of this report is to describe the case of a 47-year-old male with renal reversed rotation who came to our attention after ultrasound exam. The association of renal rotation and vascular anomalies increases long-term complications as kidney lithiasis, hydronephrosis, colic pain, hematuria, and renal failure. We decided to study the anatomy and renal function of the reversed rotated kidney by multiphasic computed tomography and renal dimercaptosuccinic acid-scintigraphy. It is critical for urologists and radiologists to recognize this abnormality in order to plan the best treatment and follow-up.

Paucisymptomatic pulmonary and right ear tuberculosis in young woman suffering from anorexia and bulimia nervosa.

Nowadays tuberculosis has become a reemerging infectious disease due to the many forms of immunodeficiency. Patients with eating disorders like anorexia nervosa and bulimia are a susceptible group due to the immune impairment correlated with severe malnutrition and their prevalence and incidence is growing. We describe the case of a 31-year-old woman, with long-standing history of anorexia nervosa and bulimia, diagnosed with advanced pulmonary tuberculosis. This case underlines the importance on never neglecting even the slightest symptoms in patients with malnutrition and never excluding this pathology without a proper investigation.

Post-traumatic superior mesenteric venous thrombosis with subsequent extension to the portal vein.

Acute superior mesenteric vein thrombosis was first described in 1935 by Warren and Eberhardt. It is a potentially life-threatening condition, as it can lead to bowel ischemia and, ultimately, infarction. Its etiology may be primary or secondary to acquired prothrombotic conditions. Early recognition of mesenteric venous thrombosis is important, but can be challenging due to its nonspecific clinical presentation. Contrast-enhanced computed tomography is currently the gold standard for diagnosis. Systemic anticoagulation and surgical resection of the necrotic segment are the two main treatments. Here, we describe a case of acute post-traumatic superior mesenteric vein thrombosis, which was treated with systemic anticoagulation and resection of the ischemic bowel segment, with subsequent extension of the thrombosis to the portal vein.

Evaluation of a cardiac sarcoma with CT multislice contrast-enhanced and 18FDG-PET/TC.

We present the case of an adult male who arrived to our emergency room with progressive dyspnea that had been ongoing for 2 months. During the radiological investigation, we found a large intracardiac mass, which invaded the pericardium, pulmonary trunk, pulmonary arteries, and left ventricle. Studies done with the 18FDG-PET/CT scan helped us to determine the malignant nature of the mass and to suspect the diagnosis of rhabdomyosarcoma.

Anomalous development of the inferior vena cava: Case reports of agenesis and hypoplasia.

We reported the cases of two adult male patients who were admitted to our emergency room with abdominal pain and dyspnea caused by gallstones and pulmonary embolism respectively. During the radiological investigations, as collateral findings, we found two anomalous development of the inferior vena cava. These conditions affect about 4% of population and, although asymptomatic or mildly symptomatic, are associated with thrombotic manifestations as deep vein thrombosis and pulmonary embolism. The prompt recognition of these anomalies is necessary in order to prevent the complications associated with these conditions and to set the best therapy for patients.

Chronic expanding hematoma of the left flank mimicking a soft-tissue neoplasm.

Soft-tissue hematomas are a common clinical entity often associated with trauma, surgery, and bleeding disorders. In the majority of cases, soft-tissue hematomas acutely appear and spontaneously resolve, but sometimes, they present as swellings that slowly expand and progressively increase with time. We present a case of a 70-year-old man with chronic expanding hematoma of the left flank without any history of recent trauma or other medical disease. The diagnosis could not be confirmed on imaging features alone, so the patient was taken to surgery for open biopsy and excision. In patients with slowly growing extremity masses without recent trauma or chronic medical disorders, the differential diagnosis becomes challenging, and chronic expanding hematoma should be considered in addition to soft-tissue sarcomas and other malignancies.