Traumatic pseudoaneurysm following ankle trauma.

False aneurysms following inversion trauma of the ankle are very uncommon. We present a case of a 40-year-old male referred to our radiology department with persisting and painful swelling of the ankle following an inversion trauma. An MRI scan was performed that showed a false aneurysm originating from a distal anterior tibial artery side branch; the lateral malleolar artery. The false aneurysm was confirmed with ultrasound and successfully treated with ultrasoundguided thrombin injection. The patient made an uneventful recovery.

Radiological evaluation of colorectal anastomoses.

BACKGROUND AND AIMS: The purpose of this study was to determine the accuracy, interobserver variability, timing and discordance with relaparotomy of postoperative radiological examination of colorectal anastomoses. PATIENT/METHODS: From 2000 to 2005, 429 patients underwent an ileocolonic, colo-colonic, or colorectal anastomosis. Radiological examination of the anastomosis was not performed routinely, but only when there were clinically signs of leakage. Radiological imaging was reviewed by an independent radiologist and medical records were retrospectively analyzed. Clinical anastomotic leakage was the standard of reference and defined as leakage confirmed during relaparotomy, drainage of pus per anum or as an anastomotic defect identified at digital examination. RESULTS: Radiological evaluation of the anastomosis was performed in 91 patients (21%): CT in 27 patients, contrast radiography in 40, and both imaging modalities in 24 patients. The interobserver variability of CT and contrast radiography was 10% and 14%, respectively. The sensitivity and negative predictive value of imaging of the anastomosis was 65% and 73%, respectively. Anastomotic leakage was found in 11 of 21 patients (52%) who underwent relaparotomy despite negative imaging. Three of 36 patients (8%) with a diagnosis of anastomotic leakage based on radiological examination had an intact anastomosis at relaparotomy. CONCLUSION: Radiological imaging of the anastomosis after colorectal surgery should be restrictively applied and interpreted with caution because of the high false-negative rate and the substantial interobserver variability.