CT of blunt diaphragmatic rupture

The diagnosis of blunt diaphragmatic rupture (BDR) is difficult and often missed, leaving many patients with this traumatic injury at risk for life-threatening complications. The potential diagnostic pitfalls are numerous and include anatomic variants and congenital and acquired abnormalities. Chest radiography, despite its known limitations, may still be helpful in the early assessment of severe thoracoabdominal trauma and for detecting initially overlooked BDR or late complications of BDR. However, since the development of helical and multidetector scanners, computed tomography (CT) has become the reference standard; thus, knowledge of the CT signs suggestive of BDR is important for recognition of this injury pattern. A large number of CT signs of BDR have been described elsewhere, many of them individually, but the use of various appellations for the same sign can make previously published reports confusing. The systematic description and classification of CT signs provided in this article may help clarify matters and provide clues for diagnosing BDR. The authors describe 19 distinct CT signs grouped in three categories: direct signs of rupture, indirect signs that are consequences of rupture, and signs that are of uncertain origin. Since no single CT sign can be considered a marker leading to a correct diagnosis in every case of BDR, accurate diagnosis depends on the analysis of all signs present

Multiple-detector CT venography in: MDCT of the chest

peer reviewe

Ground-glass opacity and mixed pulmonary nodules: a new computed tomography semiology of the pulmonary adenocarcinoma

peer reviewedRecently a new computed tomography semiology of the pulmonary adenocarcinoma was highlighted. Studies on ground-glass nodule and on mixed nodule showed the relation between these radiological images and the different anatomopathological forms of lung adenocarcinoma. Ground-glass opacity can correspond to precancerous lesions and morphological characteristics of nodules are correlated with the prognosis. The presence of spiculation, pleural retraction and air bronchogram is significantly more important in neoplasic lesions. The presence or the apparition of a solid component inside the nodule or the presence of indentation is highly suggestive of adenocarcinoma. A lesion smaller than 20 mm and persistant after 1 month must be, either followed up, or removed by a limited surgical resection. Lesions larger than 20 mm or associated with a solid component must be treated by conventional surgery

Does multi-detector row CT pulmonary angiography reduce the incremental value of indirect CT venography compared with single-detector row CT pulmonary angiography?

peer reviewedPURPOSE: To compare retrospectively the incremental value of indirect computed tomographic (CT) venography performed after multi-detector row CT pulmonary angiography and single-detector row CT pulmonary angiography for the diagnosis of venous thromboembolism (VTE). MATERIALS AND METHODS: The institutional ethics committee approved this study; informed consent was not required. The authors retrospectively reviewed results of 1100 combined single-detector row CT pulmonary angiographic and indirect CT venographic examinations (542 men, 558 women; mean age, 61 years +/- 17 [standard deviation]) (group 1) and 308 combined multi-detector row CT pulmonary angiographic and indirect CT venographic examinations (150 men, 158 women; mean age, 62 years +/- 18) (group 2), performed in 1408 patients suspected of having pulmonary embolism (PE). Frequency of deep venous thrombosis (DVT), PE, and VTE, and the incremental value of indirect CT venography were recorded in both groups. Data were compared by means of the Student t test for continuous data and z statistics for independent proportions. RESULTS: VTE, PE, and DVT were found in 23.3% (n = 256), 19.9% (n = 219), and 18.3% (n = 201) of the 1100 patients in group 1, respectively, and in 23.7% (n = 73), 17.2% (n = 53), and 18.8% (n = 58) of the 308 patients in group 2, respectively (P values ranging from .273 to .876). The incremental value of indirect CT venography was 14.4% (37 of 256 patients) in group 1 and 27.4% (20 of 73 patients) in group 2. CONCLUSION: Despite potential improved accuracy of multi-detector row CT pulmonary angiography for the diagnosis of PE, the addition of indirect CT venography increased the diagnosis of VTE in 27.4% of patients

Surgical Treatment of Chest Wall Tumors

peer reviewedThe observation of a primary chest wall desmoid tumor discovered incidentally in a young patient is an opportunity to review the nosology, diagnosis and treatment of this uncommon pathology. Surgical intervention should aim at resecting completely the lesion with sufficient margins. Subsequent reconstruction of the bony thorax uses synthetic materials and muscle or myocutaneous flaps