Synchronous tumours detected during cancer patient staging : prevalence and patterns of occurrence in multidetector computed tomography

Purpose: The incidental detection of one or more additional primary tumours during computed tomography (CT) staging of a patient with known malignancy is rare but possible. This occurrence should be considered by the radiologist when a new lesion is detected, especially if the lesion location is atypical for metastases. The purpose of this report was to document the usefulness of total body CT scan to detect synchronous primary malignancies in cancer patients undergoing a staging workup. Material and methods: This was done by reviewing the staging CT studies of the adult patients with a newly diagnosed cancer evaluated during a five-year period in a single cancer institute in order to identify any possible correlation, establishing which tumours are more frequently combined with a second tumour and which second tumours are more commonly present. Results: Among the patients with a second tumour, the most frequent first primary tumours were melanoma (eight patients, 17.8%), lymphoma (seven patients, 15.6%), and prostate carcinoma (seven patients, 15.6%). The most frequent incidentally detected second tumours were hepatocellular carcinoma (nine patients, 20% of 45 incidental tumours), renal carcinoma (eight patients, 17.8%), lung carcinoma (seven patients, 15.6%), and bladder carcinoma (four patients, 8.9%). One patient had three primary tumours synchronously. Conclusions: We believe that the radiologist's knowledge of the prevalence and pattern of occurrence of these multiple primary malignancies represents added diagnostic value

Shoulder impingement in overhead athletes: An uncommon complication of distal clavicle fracture

Impingement syndrome is one of the most common pain disorders of the shoulder. The causes are numerous and most frequently it is due to structural alterations of coracoacromial arch; however, in in rare cases it may be caused by malunion of distal clavicle fractures. We report our experience in the case of a young tennis player with shoulder impingement after a conservative management of distal clavicle fracture

Calcific tendinopathy of supraspinatus tendon in elite volleyball players: A point-of-care ultrasound diagnosis

In overhead sports like volleyball, the onset of a rotator cuff tendinopathy due to functional overload is a not uncommon observation. Herein, we present the case of a symptomatic calcific tendinopathy involving the supraspinatus tendon with a subacromial impingement syndrome in a young elite volleyball player. Shoulder and supraspinatus tendon evaluation with static and dynamic ultrasonography (US) can assist in the rapid diagnosis of tendinopathy. Thus, sports physicians must be aware of this in order to expedite rapid referral to a musculoskeletal specialist who can perform a point-of-care US examination of the shoulder. This approach to sports pathology potentially improves patient outcomes

The role of interventional radiology in the treatment of lower limb vascular injuries after orthopaedic surgery

Purpose: This paper focuses on the role of interventional radiology embolisations in a series of patients presenting with iatrogenic vascular injuries of the lower limbs following orthopaedic interventions. Material and methods: Fourteen patients (mean age: 64 years, range 23-90 years) were retrospectively analysed. Clinical presentation consisted of palpable pulsatile mass, pain, reduced lower limb motion, or visible haematoma; 11 patients had also anaemia (haemoglobin < 7 g/dl). Results: The time between orthopaedic surgery and embolisation ranged between 0 and 67 days (mean: 15 days). Injured arterial vessels were as follows: inferior gluteal artery (2), superficial external pudendal artery (2), deep femoral artery (1), lateral circumflex femoral artery (3), medial circumflex femoral artery (2), articular branch of descending genicular artery (1), perforating femoral arteries (3), posterior tibial recurrent artery (1), and anterior tibial artery (1). The typologies of vascular lesion were: pseudoaneurysm 57%, bleeding with extraluminal contrast agent blush of the terminal arterial segment 36%, and laceration and bleeding with extraluminal contrast agent blush of the arterial main trunk 7%. Embolising agents adopted were microcoils 57%, glue 14%, microplug 7%, particles 14%, and covered stent 7%. In all cases clinical and procedural technical successes were obtained (100%). Conclusions: For the management of vascular injuries occurring after different orthopaedic interventions of the lower limbs, endovascular embolisations have proven to be safe and effective; orthopaedic surgeons should be aware of the support that interventional radiology could provide in the case of iatrogenic vascular complications

Left-sided omental infarction without torsion: report of a case with radiologic-pathologic correlation

Abstract Background Omental infarction is a rare disease that affects the entire omentum or a segment of the greater omentum. It presents as acute abdominal pain mainly in the right lower quadrant or right flank. Left-sided omental torsion is infrequent and it is rarely preoperatively diagnosed. Omental infarction is a differential diagnosis in the acute abdomen. As most cases of omental infarction can be adequately diagnosed via computed tomography, a conservative treatment strategy for patients without complications should be considered in order to avoid any unnecessary surgical intervention. Case presentation We herein report a case of a surgically proved left-sided infarction of the greater omentum presenting with abdominal pain, tenderness of the left flank. Specifically, we describe the ultrasound (US) and computed tomography (CT) findings of this rare disease providing a radiological-pathological correlation of them. To date, there are few similar correlation reports in literature. Conclusions Although the classical treatment of omental infarction is surgery, more recently the conservative management has been suggested. Thus, we believe that the knowledge of the characteristic imaging findings is essential for establish a correct preoperative diagnosis, which can avoid unnecessary surgical intervention

Riconoscersi. Cosa dicono le migrazioni delle comunità occidentali

In recent years, in the wake of the coincidence of economic, social and environmental crises, the unceasing inflow of the Other has catalyzed distress and fears. It is a meeting from which arise questions and doubts about crucial issues: personal and collective identity, the balance of society and the capacity of a culture of generating a shared sense. Taking these into account, a new perspective on the matter becomes possible, that does not interpret it as the fault of marauders who come “inexplicably” to plunder the already scarce resources, but rather as the shared responsibility of those who fail to properly receive migrants or to foster better conditions in the countries of origin. Migrations thus reveal themselves as indicators of a deeper problem. To treat such processes as a permanent emergency to be managed in bureaucratic and procedural terms highlights the loss of ethical and moral bearings and the disintegration of the social bond. This essay addresses two dimensions of this issue: first of all the tight connection between recognition and generation of a shared sense and the consequences of the failed perception of this link; secondly the paradigmatic and imaginal root of the Western tendency to discrimination and more and more emphasized opposition. The “hidden king “ of the age turns out to be the tension toward a qualitative relationality, put back together in spite of modern separations and elisions, that can sustain a complex dynamic balance from which spring forth the answers to the great questions of the XXI century

Diastasis of rectus abdominis muscles : patterns of anatomical variation as demonstrated by ultrasound

Purpose: The aim of our study was to categorise the anatomical variations of rectus abdominis muscle diastasis (diastasis recti) by using ultrasound (US). Material and methods: In a one-year period 92 women were evaluated with US because of suspected diastasis of rectus muscles. Patients were examined in a supine position, with head extended, upper limbs aligned to the trunk, and knees flexed. US was performed with high-frequency, broad-band transducers. Trapezoid field-of-view and extended field-of-view were employed to measure diastasis exceeding 5 cm. Diastasis was defined as a margin-to-margin distance > 20 mm at rest and classified according to the following anatomical patterns: open only above the navel, open only below the navel, open at the navel level, open completely but wider above the navel, and open completely but wider below the navel. Results: Diastasis was found in 82 patients (30-61 years old, mean age 35 years). The width was 21-97 mm, mean 39 mm. The prevalence and severity of the anatomical patterns was as follows: open only above the navel in 48 patients (21-88 mm, mean 40 mm), open only below the navel in one patient (33 mm), open at the navel level in seven patients (23-39 mm, mean 34 mm), open completely but wider above the navel in 24 patients (21-97 mm, mean 41 mm), open completely but wider below the navel in two patients (21-29 mm, mean 25 mm). Conclusions: The above-navel patterns of recti muscle diastasis are the most common. Even when open completely, diastasis is usually wider above the navel. Knowledge of the anatomical type of rectus muscle diastasis could be of value to the patient (exercises to do and to avoid) and to the surgeon (abdominoplasty planning)

Acute epiploic appendagitis : ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques

Purpose: Acute epiploic appendagitis (EA) is a relatively rare, benign and local inflammatory disease involving the epiploic appendices. Unlike its mimics, EA is generally a self-limiting inflammatory disease and can be treated conservatively. Case presentation: A 33-year-old Caucasian man presented to our emergency department with a sever and sharp left iliac fossa pain. He underwent abdominal X-ray, ultrasound (US) and computed tomography (CT) evaluations. Conclusion: We illustrate US and CT findings to increase the radiologists’ awareness of this condition and to avoid diagnostic delay and unnecessary use of antibiotics, hospitalization and surgery

Essere umani nel XXI secolo

This essay is about the image of the Human in the XXI century. A Human that aims, in the dreams/projects of contemporary elites, at transcending itself, thus becoming purer and being absolved from some flaws/sins with which it could never come to terms. It would then be free of any limit, thanks only to its mechanical-mathematical intelligence. If this should come to pass, however, something must be left behind. Until a few years ago, it seemed that renouncing the flesh and its tangle of passions, weaknesses and emotions would be enough. Now, just as Baudrillard had foreseen, it seems that there will be no need even of the limpid intellectual talents that have been carefully selected throughout recent centuries. They abandoned their carriers to move to more fitting environments: the long chain of separations and reductions led to the predominance of only one component of the human intelligence, which got objectified in the information technologies and needs now neither parents nor servants

A singular case of massive urethrorrhagia solved by transarterial embolization

Abstract Background Urethrorrhagia is frequent in pelvic trauma, rarely due to traumatic injuries of internal pudendal artery branches. Case presentation Our aim is to underline the role of transarterial embolization in selected patients, as in this case in which a young man manifested urethral hemorrhage after high-energy motorcycle crash not associated with injuries of the inferior urinary tract. Multi-detector computed tomography (MDCT) showed pubic symphysis diastasis and perineal hematoma with pseudoaneurysm into the penis bulb. The first approach was conservative with perineal external compression and intravenous injection of tranexamic acid. Afterward, due to the decline of clinical conditions, we decided to perform a selective angiography, confirming the vascular injury of distal branches of both internal pudendal arteries with contrast agent extravasation into urethral bulb; endovascular embolization was performed with detachable micro-coils. The principal results were seen quickly, indeed urethrorrhagia arrested and hemoglobin values normalized. Erectile function was preserved at 6-months follow-up. Conclusions Endovascular embolization proved to be a minimally invasive therapeutic approach, clinically effective, with a low rate of complications and high probability to preserve erectile function