[Diagnosis of synovial sarcoma of the knee accidentally revealed by trauma. Role of ultrasound. Differential diagnosis by scar-hematoma]. / Diagnosi di sarcoma sinoviale del ginocchio fortuitamente favorita da evento traumatico. Il contributo dell'ecografia in urgenza al sospetto clinico e la diagnosi differenziale con l'ematoma in fase di cicatrizzazione.

Synovial sarcoma accounts for 8-10% of all of the soft tissue sarcomas; it's characterized by high risk of local relapse, even after surgical complete excision, deceiving onset ed slowly growth. Generally arising in the contest of joint or from immediately surrounding anatomical sites, first of all affecting inferior limbs (2/3), a sarcoma of the knee, elective anatomical site, is described, accidentally diagnosed after traumatic event. Exhibiting a very poor 5 year survey, (55%), related to dimension, distal or proximal arising, necrosis rate and grading, it's the most fequently soft tissue malignancy misdiagnosed with benign neoplasms, such as Baker cyst or villonodular pigmented synovitis, considering its deceiving macroscopic and chronological features; the differential diagnosis seems to be very hard, relying on histhological biopsy. Though the normal conventional x-ray finding, clinical examination and anamnesis have suggested in our patient the ultrasonographic investigation in urgency, which revealed the suspected nature of the lesion, which must be distinguished by hematoma, much more frequent thraumatic pathology, inducing severe prognosis in false negative cases.

[Very early diagnosis of tubal unruptured pregnancy: the role of echography in urgency for early surgical resolution]. / Diagnosi precocissima di gravidanza tubarica non perforata: ruolo dell'ecografia in urgenza per la tempestiva risoluzione chirurgica.

AIM: To emphasize the role of clinical suspect and echographic approach to heterotopic pregnancy in young women complaining of acute abdominal pain. MATERIAL OF STUDY: Tubal pregnancy in a young woman has been reported. Diagnostic clinical suspect, also supported by serum hormonal substances (beta HCG), has been confirmed by US in urgency; transabdominal investigation requires skilled operator, preferably surgically trained, to identify early study of heterotopic pregnancy (fifth week of gestation), which has undergone left salpingectomy in our experience. RESULTS: The early diagnosis of unruptured tubal pregnancy in our experience prevented hemorragic shock and other potential fatal complications, usually occurring in this condition. DISCUSSION: Ectopic pregnancy is a life threatening condition, rarely occurring during natural cycle; however its incidence is increasing, considering the wider and wider use of assisted reproductive techniques and of gynecological surgical diagnostic and therapeutic procedures. The rupture of ectopic part causes acute abdomen and potentially fatal hemorrhage, whose only solution relies on surgical operation in urgency. CONCLUSIONS: Clinical and anamnestic evaluation, ultrasonography and serum gonadotropin concentration are the first choice approach to fertile women suffering from abdominal recurrent pain, when no other causes are suspected. The heterotopic tubal pregnancy described is a very rare condition; in spite of early diagnosis, radical surgery consisting in left salpingectomy has been the only surgical feasible option, patient's life-sparing.

Giant splenic artery aneurysm, incidentally diagnosed.

Splenic artery aneurysm is a rare pathology, asymptomatic for a long time. It's in fact often revealed by its complications, such as the rupture and potentially fatal acute haemorrhage. It's incidentally discovered during instrumental exams, performed for other reasons, like the case of our woman, affected by ulcerating rectocolitis and suffering from renal colic pain, demonstrated. While surgical treatment is recommended for aneurysms larger than 2 cm in diameter or for symptomatic patients, or in pregnancy (condition known to lead to a rupture), or in case of growing dilatation, the size rarely exceeds 3 cm. The unsuspected echographic identification of giant splenic aneurysm (> 11 cm) is reported, eligible for elective surgery.