Inadvertent left ventricular placement of ICD lead through the left subclavian artery right positioned in a patient with situs viscerum inversus and Kartagener syndrome.

Inadvertent placement of pacemaker and implantable cardioverter-defibrillator (ICD) leads in the left ventricle is a rare but well-recognized complication of device implantation. We report a case of an unicameral ICD lead inadvertently placed through the left subclavian artery right positioned, across the aortic valve into the left ventricle, in a patient with situs viscerum inversus. A transthoracic echocardiogram about a month after the procedure showed an unusual course of the lead. The lead was successfully removed without complications or sequelae. .

Streak artefacts in Computed Tomography Urography: Comparative evaluation between two different iodinated contrast media.

INTRODUCTION: The objective of this study was to compare the frequency and entity, in computed tomography (CT) urography, of streak artefacts on the urinary tract generated by two contrast agents with a different iodine concentration and osmolarity. METHODS: Computed tomography scans including an excretory renal phase, performed on adult subjects in the period May-July 2020, were retrospectively evaluated in consensus by three expert radiologists, to detect any streak artefacts located in the urinary tract. Patients were administered either 1.6 mL/kg of Iodixanol 320 mgI/mL or 1.3 mL/kg of Iomeprol 400 mgI/mL. RESULTS: In total, 144 CT scans were analysed, subdivided into two groups administered either Iodixanol (71/144 (49.3%) patients) or Iomeprol (73/144 (50.7%) patients). In 41% cases, no beam hardening artefacts were found; among these, 12/59 (20.3%) patients had received Iodixanol and 47/59 (79.7%) Iomeprol. In the Iodixanol group, the mean contrast density on the renal pelvis was 2565.6 HU and streak artefacts occurred in 59/71 cases (83.1%); in 33/59 (55.9%) cases, the artefacts were marked, and in 26/59 (44.1%) minimal. In the Iomeprol group, the mean contrast density on the renal pelvis was 1666 HU and streak artefacts occurred in 26/73 cases (35.6%); in 7/26 (27%) cases, the artefacts were marked and in 19/26 (73%) minimal. CONCLUSION: The study data demonstrate a significant difference in the attenuation values of iodine urine in the excretory system between the Iodixanol and Iomeprol group. Iodixanol induced a higher frequency and burden of artefacts, compared to Iomeprol.

The Multifaceted COVID-19: CT Aspects of Its Atypical Pulmonary and Abdominal Manifestations and Complications in Adults and Children. A Pictorial Review.

Our daily experience in a COVID hospital has allowed us to learn about this disease in many of its changing and unusual aspects. Some of these uncommon manifestations, however, appeared more frequently than others, giving shape to a multifaceted COVID-19 disease. This pictorial review has the aim to describe the radiological aspects of atypical presentations and of some complications of COVID-19 disease in adults and children and provide a simple guide for radiologists to become familiar with the multiform aspects of this disease.

Influenza Vaccination and Health Outcomes in COVID-19 Patients: A Retrospective Cohort Study.

COVID-19 is an infectious disease caused by the novel coronavirus SARS-CoV-2. Several measures aimed at containing the spread of this virus have been recommended by international and nation public health institutions, but whether the influenza vaccine, while not protective against COVID-19, nonetheless reduces disease severity is unclear. This study evaluated the potential role of influenza vaccine in reducing the rate of hospitalization and death in COVID-19 patients. COVID-19 cases recorded in the province of Brindisi (Apulia, Southern Italy) during the first pandemic wave (February-May 2020) and occurring in patients vaccinated with the influenza vaccine during the 2019-2020 influenza season were considered. From February 2020 to May 2020, 3872 inhabitants of the province of Brindisi underwent SARS-CoV-2 PCR testing and 664 (8.7%) tested positive. A multivariate analysis showed that among COVID-19 patients neither hospitalization nor death was significantly associated with influenza vaccination (p > 0.05), whereas within this group male sex, older age, and chronic diseases were identified as risk factors for morbidity and mortality. Our study did not show an association between the influenza vaccine and complications of COVID-19. Nonetheless, influenza vaccination must be promoted as a central public health measure, because by reducing the burden on hospitals it can greatly benefit the management of COVID-19 patients.

Sex determination through the evaluation of sella turcica measurements using head CT scan.

The estimation of age and sex is mandatory in forensic identification of unknown skeletal remains and it could be reached analyzing different bones' features. The morphometric evaluation of Sella turcica is less described in literature. Many studies have been published in this field for age estimation but none of them based on head CT scan measurement. Previous studies were carried out for age estimation on different populations, but any study has been carried out on the Italian population. Furthermore, no studies were carried out with CT scan technology for the correlation between sex and Sella turcica. Thanks to CT scan technology it has been possible to measure sella turcica's dimensions in an easier way than previous methods, to detect more accurate parameters and even introduce a new one. In this study, the sample was composed of 115 adults, 53 males, and 62 females. Five different measurements of the sellae turcicae were taken. The purpose of this study was to find new elements for sex assessment with the evaluation of sella turcica measurements, improving previous studies, analyzing an Italian European sample. In this study, results of the statistical analysis showed correlation between sex and sella turcica's parameter "Length of Sella Turcica" for which grater values are related to male gender. In conclusion, the Authors consider this unexpected result useful for sex determination in association with other parameters.

Prevalence and clinical significance of incidental extra-intestinal findings in MR enterography: experience of a single University Centre.

PURPOSE: To determine the incidence and clinical relevance of extra-intestinal incidental findings (IF) in a cohort of patients with proven or suspected Crohn disease (CD) examined with magnetic resonance enterography (MR-E) in a single University Centre. METHODS: Between January 2018 and June 2019, 182 patients with proven or suspected CD with a planned first MR-E examination, were retrospectively included in this study. Incidental findings were considered as any abnormality identified in the absence of previous clinically suspected or known disease. IF were categorized as unremarkable, benign or potentially relevant findings requiring further imaging or specific treatment. RESULTS: Of the 182 revised MR-E, extra-intestinal IF were recorded in 70 cases (38.5%); 35 (50%) incidental lesions were recognized as non-significant, 24 (34%) as benign and 11 (16%) as clinically relevant. Moreover, there was a positive correlation between IF and patients' age (p < 0.0001). CONCLUSIONS: In our experience, a high number of IF (38.5%) was found, with a prevalence that increases with patients' age. Clinically relevant findings were found in 16% of MR-E. This means that MR-E is a useful tool to detect IF, therefore, the presence of a radiologist during the image acquisition is crucial in adding sequences to the examination.

Bone Involvement in Hodgkin's Lymphoma: Clinical Features and Outcome.

Hodgkin's lymphoma (HL) is now a highly curable disease, with an improving 5-year survival rate that has now reached 86%. At the time of presentation, HL is usually almost entirely confined to the lymph nodes. We performed a retrospective single-institution study of 384 cases with a median follow-up of 44 months, with the aim of identifying clinical and radiological characteristics and outcomes of patients with bone HL; 32 patients (8%) had primary bone involvement, always with concurrent nodal disease. These included 22 men (69%) and 10 women (31%) with the median age as 41 years. Advanced stages and nodular sclerosis histology prevailed among the subgroup. Radiographic features of bone HL are not specific but indicate a destructive malignant process with osteosclerosis and/or osteolysis. With current chemotherapeutic regimens, the long-term prognosis of patients with osseous HL appears good. The presence of bone lesions in HL should not be interpreted as implying a worse prognosis than without bone involvement.

Extralymphatic Disease Is an Independent Prognostic Factor in Hodgkin Lymphoma.

PURPOSE: To identify the characteristics and outcomes of patients with extralymphatic Hodgkin lymphoma. PATIENTS AND METHODS: We performed a retrospective single-institution study of 341 cases comprising 207 male (61%) and 134 female (39%) subjects with a median follow-up of 44 months. RESULTS: Fifty-five patients (16%) had extralymphatic disease. The sites were lung in 29 patients (44%), bone in 22 (33%), liver in 12 (18%), and kidney in 3 (5%). In 46 patients (86%) only one organ was involved, while in 7 patients (13%) extralymphatic disease was present in 2 sites and in 2 patients (3%) in 3 sites. The extralymphatic disease group had a poorer prognosis than the lymphatic disease group. Complete remission rates in the extralymphatic and lymphatic patient subsets were 65% and 82% (P = .043), respectively. CONCLUSION: Extralymphatic disease in patients with Hodgkin lymphoma is a rare occurrence (16%) associated with poor clinical outcome.

CT-guided needle biopsy performed with modified coaxial technique in patients with refractory or recurrent lymphomas.

The aim of this study was to evaluate the role of computed tomography (CT)-guided core needle biopsy (CNB) performed by modified coaxial technique as an alternative tool to surgical biopsy in patients with refractory or recurrent lymphomas. Between May 2005 and May 2012, 57 CT-guided CNB of deep lesions were performed in patients with a previous diagnosis of lymphoma and suspected for refractory or recurrent disease. A modified coaxial technique was used in all cases and multiple samples were obtained for histological and immunohistochemical studies. A diagnosis of lymphoma with specification of subtype according to the World Health Organization (WHO) classification was established in 30/57 cases (52.6 %). The previous diagnosis of lymphoma was confirmed in 27/57 patients (47.4 %), whereas histological progression in 3/57 (5.3 %) and other malignant neoplasms in 17/57 (29.8 %) were found. Lymphoma without subtype specification was diagnosed in 6/57 (10.5 %), and no conclusive diagnosis could be established in 4/57 cases (7 %). Overall diagnostic accuracy was 82.5 %. In patients with a final diagnosis of malignant lymphoma, accuracy was 75 %. No complications occurred. Percutaneous CT-guided CNB is a safe, effective and reliable tool in the management of patients with refractory or recurrent lymphomas without superficial lymphadenopathy and can be considered as alternative to surgical sampling.

MDCT in the differentiation of adrenal masses: comparison between different scan delays for the evaluation of intralesional washout.

PURPOSE: To evaluate the accuracy of the washout in the differential diagnosis between adenomas and nonadenomas and to compare the obtained results in delayed CT scans at 5, 10 and 15 minutes. METHODS: Fifty patients with adrenal masses were prospectively evaluated. CT scans were performed by using a 320-row MDCT device, before and after injection of contrast material. In 25 cases, delayed scans were performed at 5' and 10' (group 1), while in the remaining 25, at 5' and 15' (group 2). Absolute and relative wash-out percentage values (APW and RPW) were calculated. RESULTS: Differential diagnosis between adenomas and nonadenomas was obtained in 48/50 (96%) cases, with sensitivity, specificity, and accuracy values of 96%, 95%, and 96%, respectively. In group 1, APW and RPW values were, respectively, 69.8% and 67.2% at 5' and 75.9% and 73.5% at 10' for adenomas and 25.1% and 15.8% at 5' and 33.5% and 20.5% at 10' for nonadenomas. In group 2, APW and RPW values were 63% and 54.6% at 5' and 73.8% and 65.5% at 15' for adenomas and 22% and 12.5% at 5' and 35.5% and 19.9% at 15' for nonadenomas. CONCLUSIONS: The evaluation of the wash-out values in CT scans performed at 5', 10', and 15' provides comparable diagnostic results. CT scans performed at 5' are, therefore, to be preferred, since they reduce the examination time and patient discomfort.

An Uncommon Pericardial Cyst in the Central Mediastinum: Incremental Diagnosis with Contrast-Enhanced Three-Dimensional Transesophageal Echocardiography.

We report a case of a 76-year-old man, with the occasional finding of a mediastinal cyst because of subtle chronic dysphagia associated to sore throat, belching, and dysphonia. The paraesophageal cyst in the central mediastinum was studied with computed tomography (CT) scan and transesophageal three-dimensional (3D) echocardiography with contrast echo. In order to clarify doubts about localization (intra- versus extrapericardial) of the mediastinal cystic lesion the 3D transesophageal echocardiography (TEE) confirmed the presence of a large round cystic mass located contiguous to the esophagus, the left atrium and the aortic root/pulmonary trunk (located at the front of the lesion), as well as located intrapericardial. The cystic mass showed no blood flow at color Doppler mode and at ultrasound contrast echo with SonoVue agent. Due to the paucity of symptoms and to the definite imaging information of this intrapericardial cyst of nonvascular nature, due to pericardial cyst in an extremely unusual location, surgery was not performed. At follow-up of 1 month echocardiogram and 3 month CT scan the cyst appeared unchanged in dimensions.

Multiple pancreaticoduodenal penetrating gunshot trauma evolving into acute necrotizing pancreatitis. A combined surgical and minimally invasive approach.

CONTEXT: Shotgun injuries are the cause of increasing surgical problems related to the proliferation of firearms. Gunshot pancreaticoduodenal traumas are unusual in urban trauma units. Their management remains complex because of the absence of standardized, universal guidelines for treatment and the high incidence of associated lesions of major vessels as well as of other gastrointestinal structures. Surgical treatment is still controversial, and the possibilities offered by the safe and effective mini-invasive techniques seem to open new, articulated perspectives for the treatment of pancreaticoduodenal injury complications. CASE REPORT: We present the case of a 27-year-old man with multiple penetrating gunshot trauma evolving into acute necrotizing pancreatitis, treated by combining a surgical with a mini-invasive approach. At admission, he presented a Glasgow Coma Score of 4 due to severe hemorrhagic shock. First, surgical hemostasis, duodenogastric resection, multiple intestinal resections, peripancreatic and thoracic drainage were carried out as emergency procedures. On the 12th postoperative day, the patient underwent re-surgery with toilette, external duodenal drainage with Foley tube and peripancreatic drainage repositioning as a result of a duodenal perforation due to acute necrotizing pancreatitis. Eight days later, following the accidental removal of the peripancreatic drains, a CT scan was done showing a considerable collection of fluid in the epiploon retrocavity. Percutaneous CT-guided drainage was performed by inserting an 8.5 Fr pigtail catheter, thus avoiding further re-operation. The patient was successfully discharged on the 80th postoperative day. CONCLUSIONS: The treatment of multiple pancreaticoduodenal penetrating gunshot traumas should focus on multidisciplinary surgical and minimally invasive treatment to optimize organ recovery.

Reliability of diagnostic fluid hysteroscopy in the assessment of cervical invasion by endometrial carcinoma: a comparative study with transvaginal sonography and MRI.

OBJECTIVE: This study aimed at comparing the reliability of diagnostic fluid hysteroscopy, transvaginal sonography (TVS), and magnetic resonance imaging (MRI) to assess pre-operatively the presence of cervical involvement by endometrial carcinoma. METHODS: Cervical involvement was assessed by diagnostic fluid mini-hysteroscopy, TVS and MRI before surgery in 100 patients with histological diagnosis of endometrial carcinoma. Results were compared with pathological examination on surgical specimen. The sensitivity, the specificity, the positive and negative predictive values, the accuracy, the positive and negative likelihood ratios (LR) of the three techniques for recognizing the cervical involvement by the carcinoma were calculated. RESULTS: At histology cervical involvement was found in 15 cases. Compared to TVS and MRI, hysteroscopy showed the highest sensitivity (0.53, 0.67 and 0.93, respectively). The specificity of MRI was significantly higher than both hysteroscopy and TVS (0.95, 0.88 and 0.82, respectively). The diagnostic accuracy of hysteroscopy (0.89) and MRI (0.91) was similar and significantly higher than TVS (0.78). The LR for a positive result of MRI was 14.16, that was 2.08 and 4.68 times higher than that of hysteroscopy and TVS, respectively. CONCLUSIONS: In conclusion, this study demonstrates that in women with endometrial carcinoma the exclusion of cervical canal involvement at hysteroscopy is more reliable than at MRI and TVS while MRI is the most reliable technique for predicting cervical involvement. In the pre-surgical work-up of patients affected by endometrial carcinoma hysteroscopy and MRI are both useful for staging and planning the correct surgical strategy.

Preoperative staging of gastric carcinoma with multidetector spiral CT.

PURPOSE: To assess the accuracy of Multidetector computed tomography (MDCT) in the preoperative staging of gastric cancer. MATERIALS AND METHODS: Between March 2002 and October 2002, 27 patents with histologically proven gastric adenocarcinoma underwent MDCT. Unenhanced and contrast-enhanced CT scans were obtained after the oral administration of 400-600 ml of water for gastric wall distension. Biphasic enhanced scans were performed after the automatic injection of 2ml/kg of contrast agent at a flow rate of 3.5 ml/sec with a scan delay of 35 and 70 sec. The images were evaluated for: lesion morphology, degree of wall infiltration, presence of locoregional lymphadenopathies and distant metastases. Based on the findings, a TCMD staging system was established according to the criteria reported in the literature. All the patients underwent surgery, and the preoperative MDCT staging was evaluated against the pathology findings. RESULTS: MDCT staging was correct in 17/27 patients (62.9%). The T parameter was correctly assessed in 24/27 cases (88.9%), whereas it was understaged in 1 case (3.7%) (T1 stage at CT vs T2 at surgery) and overstaged in 2 cases (7.4%) (T3 vs T2). The N parameter was correctly evaluated in 19/27 patients (70.4%), understaged in 6/27 (22.2%) and overstaged in 2/27 (7.4%). CONCLUSIONS: MDCT may be proposed for the staging of gastric carcinomas and, although accuracy in N staging remains low in comparison to single-detector spiral CT, it provides a larger amount of diagnostic information.