Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings.

BACKGROUND: Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition, especially in cases of delayed treatment. Computed tomography angiography (CTA) plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage. AIM: To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings. METHODS: In this retrospective single-centre study, 35 patients (22 men; median age 69 years; range 16-92 years) admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled. Twenty-three (65.7%) patients underwent endoscopy before CTA. Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software. Bleeding rate was obtained from volume change between the two phases and standardised for unit time. Patients were divided into two groups, according to the angiographic signs and their concordance with CTA. RESULTS: Upper bleeding accounted for 42.9% and lower GIB for 57.1%. Mean haemoglobin value at the admission was 7.7 g/dL. A concordance between positive CTA and direct angiographic bleeding signs was found in 19 (54.3%) cases. Despite no significant differences in terms of bleeding volume in the arterial phase (0.55 mL vs 0.33 mL, P = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL vs 0.9 mL, P = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min vs 0.19 mL/min, P = 0.02). CONCLUSION: In GIB of any origin, extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.

Magnetic Resonance Signal Abnormalities Within the Pericruciate Fat Pad: A Possible Secondary Sign for Acute Anterior Cruciate Ligament Tears.

PURPOSE: The study sought to investigate the presence of magnetic resonance (MR) signal alterations within the pericruciate fat pad in patients with an acute anterior cruciate ligament (ACL) tear as well as evaluate its diagnostic value in comparison with the main secondary signs of ACL tears. METHODS: Two musculoskeletal radiologists retrospectively reviewed knee MR examinations performed from May to October 2015. The ACL was considered as torn or intact based on either previous arthroscopic findings or unequivocal MR imaging interpretation if arthroscopic correlation was unavailable. Abnormalities of the pericruciate fat pad were evaluated as increased signal on the fluid-sensitive sequences; the main secondary signs of ACL tears were identified. Sensitivity and specificity were calculated for each sign. RESULTS: A total of 182 patients entered this study: 22 with an acute ACL tear, 160 with intact ACL. Signal hyperintensity of the pericruciate fat pad was demonstrated in all patients with an acutely torn ACL, resulting significantly different between individuals with intact ACL and those with ligament tear (P < .0001). This sign was much more sensitive (100%) but less specific (72.5%-75%) than other secondary signs. CONCLUSIONS: Signal hyperintensity of the pericruciate fat pad on the fluid-sensitive sequences is associated with acute ACL tears and could be considered as a possible indicator of these injuries.

Premenstrual inguinal swelling and pain caused by endometriosis in the Bartholin gland: a case report.

Endometriosis is a pathological condition characterized by the presence of endometrial tissue outside the endometrium. The authors describe a case of endometriosis in the Bartholin gland, which was initially diagnosed as a Bartholin gland cyst. The correct diagnosis was later made on the basis of the patient history and the results of the ultrasound examination. Endometriosis in the Bartholin gland should be considered in the presence of dyspareunia, cyclic swelling and pain at the vulvar level, and characteristic ultrasound findings.

A refinement of Hong's technique for the removal of stuck dialysis catheters: an easy solution to a complex problem.

AIM: A long-term tunneled hemodialysis catheter can be difficult or impossible to pull out if a fibrin sleeve has attached it to the venous wall. We report the outcome of a refinement of Hong's technique for removing incarcerated catheters aimed at improving its feasibility and safety. METHODS: We applied a modification of Hong's technique in four patients (two males, age ranging from 51 to 68 years) with jugular twin hemodialysis catheters (five of eight lines incarcerated). Hong pioneered the technique of endoballooning to expand a stuck central venous catheter, thus freeing it from adhesions. In our technical refinement, we cut the catheter close to its venous entry point in order to facilitate pullout and inserted a valved introducer as access for guide wires as well as for inflations of the catheter balloon. A stiff guide wire was placed in the inferior vena cava to avoid potential damage to heart cavities. Dilation was monitored under fluoroscopy with constrictions showing points where the catheter was incarcerated. If adhesions persisted through the same introducer, endoluminal dilations were repeated with a larger diameter balloon until the catheter was released. New catheters can be positioned using the stiff guide wire already in place. All removals were carried out under local anesthesia in an angiographic room by interventional radiologists. RESULTS: All catheters were successfully removed without complications. Average fluoroscopy time for removal was 12 minutes. In the case of a Tesio catheter removed after 12 years because of infection, a computed tomography scan 2 months later revealed persistence of a calcified fibrin sleeve in the vessel. CONCLUSIONS: Hong's technique was confirmed to be a simple, safe and highly effective way to remove incarcerated long-term central venous catheters. The refinements we adopted made the procedure more flexible and possibly less prone to complications. By properly using ordinary tools available anywhere, Hong's technique could be considered Columbus' egg in this previously risky field.