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

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

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

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