Contribution of us and ct for diagnosis of intra peritoneal focal fat infarction (iffi): a pictorial review

The term IFFI – for Intraperitoneal Focal Fat Infarction – includes various acute abdominal clinical conditions in which focal fatty tissue necrosis represents the common pathologic denominator. Only differing by their various anatomical locations and dimensions, all cases nevertheless present rather similar clinical signs, aetiology, radiological features and prognosis. In clinical practise, most cases of IFFI concern torsion and/or infarction of the greater omentum or epiploic appendages. Rarer types of torsion and/or infarction of lipomatous appendages of the hepatic falciform ligament and of the lesser omentum have also been reported. Cases are finally described in the paediatric population. US and merely CT have been shown having a high sensitivity and specificity for the diagnosis of IFFI and in most cases the clinical evolution is spontaneously favourable. For these two reasons, the option of conservative treatment after specific imaging diagnosis now represents the other common denominator of IFFI. Such a safe and unambiguous imaging diagnosis of IFFI represents thus an important challenge for each abdominal radiologist with the intention of persuading the referent clinician to avoid unnecessary surgery for their patients. The aim of this pictorial review is to extensively explore not only the classical imaging findings of various types of IFFI but also to review the normal US and MDCT anatomy of the fatty abdominal structures being usually implicated in IFFI. More rare or atypical presentations are also illustrated as well as subacute findings and sequels. All reported patients were collected in our department during a 7-year-period and most were successfully treated conservatively

Mesenteric panniculitis part 1: mdct - pictorial review

Mesenteric panniculitis is an uncommon benign inflammatory condition of unknown etiology that involves the adipose tissue of the mesentery and for which an extremely varied terminology has been used, causing considerable confusion. It can be evaluated as a single disease with two pathological subgroups: Mesenteric Panniculitis (MP), representing the very large major subgroup where inflammation and fat necrosis predominate and Retractile Mesenteritis (RM), much rarely found, where fibrosis and retraction predominate. In histo-pathological terms the preferred terminology is sclerosing mesenteritis. We hereby extensively illustrate the characteristic MDCT findings of MP through pictures selected among a collection of cases constituted over a 5-year period. All patients were scanned with 64-row MDCT equipment. We also review the literature and discuss the differential diagnosis. The radiological diagnosis of MP was based on classical CT signs described in the literature and comprising: the presence of a well-defined “mass effect” on neighbouring structures (sign 1) constituted by mesenteric fat tissue of inhomogeneous higher attenuation than adjacent retroperitoneal or mesocolonic fat (sign 2) and containing small soft tissue nodes (sign 3). It may typically be surrounded by a hypoattenuated fatty “halo sign” (sign 4) and an hyperattenuating pseudocapsule may also surround the all entity (sign 5). The last two signs are considered inconstant but very specific. The absence of histological verification constitutes the weakness of our study. The differential diagnosis of MP is extensive and includes all disorders that can affect the mesentery. The most common ones are lymphoma, well-differentiated liposarcoma, peritoneal carcinomatosis, carcinoid tumor, retroperitoneal fibrosis, lipoma, mesenteric desmoid tumor, mesenteric inflammatory pseudotumor, mesenteric fibromatosis and mesenteric edema. PET/CT is proved useful to correctly exclude mesenteric tumoral involvement in patients presenting with typical MP. The course of MP is favorable in most cases and progression of MP to retractile mesenteritis not only appears very being rare but finally remains doubtful

Tympanic plate fracture following mandibular trauma with emphasis on 3D imaging

A 73-year-old patient was addressed to our department of medical imaging for combined CT imaging of the head and petrous bone. The patient had fallen from his height on his mandibula and reported pain in the area of the left temporo mandibular joint. The pain was associated by external otorrhagia. At physical otoscopic exam there was some narrowing of the external auditory canal in which blood was visible. Neurootologic symptoms were absent

Diffuse “vertebra-within-vertebra” appearance at the adult age due to biphosphonate (pamidronate) administration during early adolescence

We report a rare case of diffuse alteration of the vertebral bony structure fortuitously found in a 20-year-old patient and essentially characterized by an impressive “vertebra-within-vertebra” appearance. This aspect was found being the result of an unusual use of intravenous perfusions of biphosphonate (Pamidronate) during early adolescence for reflex sympathetic dystrophy after tibial fracture. The clinical applications of biphosphonates are briefly reminded and the physiopathology of the induced bone changes is explained

Mesenteric panniculitis part 2: prevalence and natural course: mdct prospective study

Background: Mesenteric panniculitis (MP) is an uncommon benign inflammatory condition of unknown etiology that involves the adipose tissue of the mesentery. I can be evaluated as a single disease with two pathological subgroups: MP, representing the very large majoritary subgroup where inflammation and fat necrosis predominate and Retractile Mesenteritis, rarely found, where fibrosis and retraction predominate. Objective: To re-estimate the prevalence of MP in general population through a large prospective study, to compare the results with those of the literature and to evaluate the natural course of the condition. Methods: A continuous series of 613 consecutive unselected patients (280 females and 333 males) imaged with abdominal MDCT for various neoplastic (27%) or non neoplastic conditions (73%) constitutes the prospective material. A positive CT diagnosis of MP was based on the observation of at least three of five typical CT signs comprising: the presence of a well-defined “mass effect” on neighbouring structures (sign 1) constituted by mesenteric fat tissue of inhomogeneous higher attenuation than adjacent retroperitoneal or mesocolonic fat (sign 2), containing small soft tissue nodes (sign 3) typically surrounded by a hypoattenuated fatty “halo sign” (sign 4). Finally a hyperattenuating pseudocapsule may surround the all entity (sign 5). Results: A positive diagnosis of MP was made in 48 patients (prevalence of 7,83%) on the basis of the presence of at least 3 CT signs. After reconsidering the presence of the “halo sign” (sign 4) and of the “pseudocapsule” (sign 5) as “sine qua non” conditions for a positive diagnosis, a more restricted positive group of 21 cases was constituted (prevalence of 3,42%) comprising 10 males (3%) and 11 females (3,93%). There were 14 “non-neoplastic” patients – 6 males (2,27 %) and 8 females (3,6%) – and 7 “neoplastic” patients – 4 males (3,73%) and 3 females (5,17%) –. Conclusions: The prevalence of MP appears much higher than previously reported and the reason probably resides in the major technological evolution experienced in CT imaging during the last decade. This high prevalence probably explains the spontaneous association with the numerous and probably unrelated clinical situations found in the literature. Finally the vast majority of cases are considered as idiopathic, benign an asymptomatic. Except a discrete higher prevalence found in patients presenting with bladder and/or prostatic neoplasms and with lymphoma in group 1 the general prevalence of MP in our study doesn’t significantly differs in the “neoplastic” and “non neoplasic” groups of patients. We conclude that the value of MP in term of predictivity of an associated neoplasm is probably non relevant. Finally PET/CT is proved useful to correctly exclude mesenteric tumoral involvement in patients presenting with typical MP and follow-up studies show a great stability of the CT findings of MP in about 85% of cases

Extravertebral gas and fluid effusions associated with vertebral collapse containing a vacuum cleft possibly result from a pumping phenomenon: a new evidence of the dynamic hydro-pneumatical nature of the so-called vacuum phenomenon

We report two very unusual observations in which gas and fluid effusions were transiently and unexpectedly found in the extravertebral spaces of patients presenting with painful necrotic vertebral collapse containing a vacuum cleft. We hypothesize that gas and/or fluid which progressively may replace vacuum in vertebral compression fractures could be secondarily pumped through extravertebral and retroperitoneal spaces. Although being rare, these observations may represent a potential missing link in the imaging snapshots of the cyclic and dynamic vacuum phenomenon

Unusual vacuum phenomenon suggesting occult vertebral instability

A 70-year-old female was referred to our department with complaints of bilateral lumbar sciatalgia. Lumbar CT was performed. Bilateral spondylolysis of L5 with secondary olisthesis had been previously surgically stabilised by anterior arthodesis. Ankylosis appeared effective at this level

Closed loop small bowel occlusion through a congenital defect of the greater omentum

An 80-year-old male was admitted with a 15-h history of persistent epigastric and peri umbilical pain. Pain had spontaneously appeared during night and awakened the patient. There was neither nausea nor vomiting. Physical examination revealed moderate epigastric and supraumbilical abdominal tenderness. The patient was without surgical antecedent

Mesenteroaxial volvulus in an adult: time is of the essence in acute presentation

Acute gastric volvulus is an uncommon condition with severe repercussions if untreated in the acute presentation. We describe such a case. We assert that computed tomography (CT) should be the first line of investigatio