Inflammatory Pseudotumor Presenting as a Facial Swelling

We present a case of inflammatory pseudotumor (IPT) presenting as a facial swelling after an accidental hit on a right side of a face. As swelling did not resolve, dental examination and teeth extraction were done by a dentist presuming the swelling was misdiagnosed with infection of dental origin. Swelling grew even bigger and patient was referred to Department of Maxillofacial Surgery. CT scan of the face and FNA of the lesion was ordered. A homogenous tumor mass in the right infraorbital region in front of anterior wall of the maxillary sinus was seen on CT. The result of the FNA was reactive hyperplasia of the lymph node. Since the lesion was easily accessible surgical exploration and complete extirpation was done. Pathohistological analysis indicated a low grade B-cell Non Hodgkin lymphoma. PCR showed policlonality of B cells discarding the diagnosis of lymphoma. Pathohistological review showed diffuse intramuscular, perineural and perivascular infiltration with small lymphocytes without formation of germinative centers. Imunohistochemistry was positive for CD20 and CD3. Taking into account all features the diagnosis of IPT was established. Diagnosis of IPT is a diagnosis by exclusion, combining clinical, radiological and pathohistological characteristics. Lack of clear histologic criteria makes differential diagnosis extremely difficult. Our case is unique regarding localisation of head & neck IPT, no case presenting on the face in infraorbital region has been described in the literature. Although IPT is very rare in general and especially on the face, one should be aware of it when considering differential diagnosis of facial swelling

Macroscopic and CT Diagnostic Approach in Interpreting a Non-traumatic Calvarial Lesion in a Medieval Man from Northern Croatia

Na kaloti mlađe odrasle muške osobe koja potječe iz ranosrednjovjekovnoga grobnog kompleksa Zvonimirovo (sjeverna Hrvatska) prikazala se remodelirana lezija koja zahvaća liniju sagitalnog šava u blizini bregme. Mali udubljeni anteroposteriorno (AP) izduženi − ovalni defekt u središnjoj liniji vanjskog svoda kalote, s rubnim odlaganjem kortikalne kosti, upućivao je na razvitak nekadašnje mekotkivne (cistične) tvorbe. Nisu se prikazali pokazatelji – traumatski ili patološki, koji bi upućivali na drukčiju vrstu lezije, ili varijaciju. Pored makroskopskog pristupa u tumačenju netraumatske koštane lezije, imali smo za cilj koristiti podršku pomoću računalne tomografije (CT). Na CT presjecima prikazala se dobro razgraničena nepravilna i u AP smjeru izdužena litička lezija (u obliku erozije) vanjske table s osteosklerotičnim rubovima koja se protezala do diploë, tj. s izostankom zahvaćenosti površine unutarnjeg svoda lubanje (unutarnje table). Diferencijalna dijagnoza u ovom radu uključuje procjenu prisutnosti dermalne nasuprot epidermalnoj inkluzijskoj cisti, varijante sinus pericranii povezanog s defektom na kaloti i ateroma popraćenog upalnim procesom. Najizglednija dijagnoza koštane lezije koja se, po svemu sudeći, temelji na kožnoj leziji jest varijanta površinske kongenitalne dermalne inkluzijske ciste s lokalizacijom u (nekadašnjem) skalpu. Na to upućuju sveukupan izgled, smještaj u središnjoj liniji, pojavljivanje u mlađoj dobi i tendencija manje invazivnosti u usporedbi s epidermoidom. Na pojavljivanje nekadašnje mekotkivne tvorbe u skalpu, umjesto dublje u kaloti, upućuju erozija vanjskog svoda kalote (koja završava u diploë), te izostanak zahvaćenosti površine unutarnjeg svoda kalote. Popratno odlaganje kortikalne kosti uokrug koštane litičke lezije moglo bi upućivati na nekadašnji rubni upalni proces povezan s mekotkivnom tvorbom. Moguću prisutnost varijante sinus pericranii isključili smo na osnovi iznjedrenih CT presjeka, dok smo prisutnost ateroma isključili na temelju smještaja lezije i dobi osobe.The calvaria of a young adult male from the early medieval burial complex Zvonimirovo (northern Croatia) exhibited the presence of a remodelled solitary lesion embracing the course of the sagittal suture line near the bregma. The small concave antero-posteriorly (AP) elongated – ovoid defect in the midline of the calvarial vault, with marginal cortical bone deposition, was indicative of a once soft-tissue lesion (cystic) development. There were no indicators – neither traumatic nor pathological, which would suggest a different type of lesion or variation. Beside the macroscopic approach, we aimed to use computed tomography (CT) support in interpreting the present non-traumatic dry bone lesion. The CT scans generated well-demarcated irregular and AP elongated lythic lesion (erosion) of the outer table, with osteosclerotic borders, ending up in the diploë, i.e. lacking the involvement of the inner calvarial vault surface (inner table). In this study, the differential diagnosis involved dermal versus epidermal inclusion cyst, sinus pericranii variant in association with the calvarial defect and inflamed atheroma evaluation. The most probable diagnosis of the present, apparently, skin-based dry bone lesion was a variant of a superficial congenital dermal inclusion cyst which was located in the (onetime) scalp. This was suggested by its gross morphology, midline localization, the appearance in early age and the tendency of minor invasiveness when compared to epidermoid. The once soft-tissue feature occurrence in the scalp instead of deeper in the calvaria was suggested by the erosion of the external calvarial vault (ending up slightly in the diploë), i.e. the absence of the inner calvarial vault surface involvement. The accompanying cortical bone deposition surrounding dry bone lythic lesion was suggestive of the past marginal inflammation associated with once soft-tissue feature. The possible presence of a sinus pericranii variant was excluded by the generated CT scans, while atheroma was ruled out due to the lesion localization and the age of the individual

Employment of Computed Tomography in the Study of Traumata Scored from Two Adults from Croatian Bioarchaeology

Računalnu smo tomografiju (CT) rabili u proučavanju trauma dviju odraslih osoba iz hrvatske bioarheologije – žene iz sekundarnog arheološkog konteksta (Zagajci) i muškarca iz srednjovjekovnog grobnog kompleksa (Zvonimirovo). Ozljede smo razmotrili u odnosu na moguća nasilna djelovanja nasuprot slučajnim nezgodama. Imali smo ukupno dva cilja: izolirani nalaz lubanje iz Zagajaca sa zacijeljenom depresijskom frakturom čeone kosti (slučaj 1) ispitali smo kako bismo dobili uvid u mogući utjecaj ozljede na unutarnju lubanjsku tablu. Izolirani slučaj osobe iz starije zbirke Zvonimirova koja je pokazivala zacijeljene prijelome lijeve lakatne i ključne kosti, te relikt mandibularnog zuba (slučaj 2), ispitali smo kako bismo dobili detaljne radiološke podatke o drugim mogućim traumama (korijena zubā). CT presjeci koje smo dobili u slučaju ženske osobe pokazali su depresijsku frakturu s prodorom u unutarnju tablu upućujući na agresivni udarac u čelo tupo-tvrdim predmetom. CT presjeci koje smo dobili u slučaju muške osobe iznjedrili su nazočnost nezacijeljenih (perimortalnih) prijeloma korijena gornjočeljusnih zubā. Vremenski različite implikacije na koje upućuju zaživotne i perimortalne traume ukazuju na različite scenarije traumatskih događaja u slučaju muškarca: ozljede je mogao zadobiti prilikom (vremenski različitih) nezgoda, budući da nema nazočnih zaživotnih/perimortalnih ozljeda kostiju lubanje; ipak, s obzirom na srednjovjekovni kontekst ne može se isključiti scenario u dvije etape prema kojem ponovljene ozljede na lijevoj strani mogu upućivati na nekoliko epizoda nasilnog djelovanja na sljedeći način: muškarac je prvotno mogao zadobiti udarac u lijevu podlakticu podignutu u samoobrani; prijelom ključne kosti, nastao po svemu sudeći za vrijeme istog događaja, mogao se zbiti prilikom pada koji je uslijedio. Vremenski različit udarac u bradu, pri čemu bi zubi donje čeljusti vrlo snažno udarili o gornjočeljusne zube s učinkom neizravnih (perimortalnih) prijeloma korijena zubā, mogao bi upućivati na posttraumatske implikacije koje su mogle pridonijeti smrti osobe.Computed tomography (CT) was employed in the study of two adults’ traumata from Croatian bioarchaeology – a female from a secondary archaeological context (Zagajci) and male from a medieval burial complex (Zvonimirovo). Injuries were considered in reference to possible violent acts versus accidents. Our aim went two ways: an isolated Zagajci cranium with healed depressed fracture to the frontal bone (case 1), was investigated as to assess insight into a possible impact effect of the injury on the inner table. An isolated case from the early Zvonimirovo collection with healed left ulna/clavicle fractures and the mandibular tooth relic (case 2), was investigated as to obtain detailed radiological data on other possible (root) traumata. The female CT scans showed a depressed fracture penetrating the inner table – suggestive of aggressive blow to the forehead with hard-blunt object. The male CT scans generated unhealed (perimortal) left maxillary root fractures. Different time implications suggested by antemortal/perimortal traumata offer alternative traumatic scenarios for the male: traumata could be sustained in (different time) accidents due to the absence of (antemortal/perimortal) cranial bone traumata; however in terms of the medieval context one cannot exclude the two-step scenario whereby repeated injuries to the left body side could be suggestive of several episodes of violence as follows: firstly a man could sustain a blow to the left forearm raised in defense; possibly co-occurring fractured clavicle might be suggestive of the fall that followed. Different time blow to the chin, whereby the lower teeth could violently hit the upper causing indirect (perimortal) root fractures, might be suggestive of posttraumatic implications accounting for the death of individual

Macroscopic and CT Diagnostic Approach in Interpreting a Non-traumatic Calvarial Lesion in a Medieval Man from Northern Croatia

Na kaloti mlađe odrasle muške osobe koja potječe iz ranosrednjovjekovnoga grobnog kompleksa Zvonimirovo (sjeverna Hrvatska) prikazala se remodelirana lezija koja zahvaća liniju sagitalnog šava u blizini bregme. Mali udubljeni anteroposteriorno (AP) izduženi − ovalni defekt u središnjoj liniji vanjskog svoda kalote, s rubnim odlaganjem kortikalne kosti, upućivao je na razvitak nekadašnje mekotkivne (cistične) tvorbe. Nisu se prikazali pokazatelji – traumatski ili patološki, koji bi upućivali na drukčiju vrstu lezije, ili varijaciju. Pored makroskopskog pristupa u tumačenju netraumatske koštane lezije, imali smo za cilj koristiti podršku pomoću računalne tomografije (CT). Na CT presjecima prikazala se dobro razgraničena nepravilna i u AP smjeru izdužena litička lezija (u obliku erozije) vanjske table s osteosklerotičnim rubovima koja se protezala do diploë, tj. s izostankom zahvaćenosti površine unutarnjeg svoda lubanje (unutarnje table). Diferencijalna dijagnoza u ovom radu uključuje procjenu prisutnosti dermalne nasuprot epidermalnoj inkluzijskoj cisti, varijante sinus pericranii povezanog s defektom na kaloti i ateroma popraćenog upalnim procesom. Najizglednija dijagnoza koštane lezije koja se, po svemu sudeći, temelji na kožnoj leziji jest varijanta površinske kongenitalne dermalne inkluzijske ciste s lokalizacijom u (nekadašnjem) skalpu. Na to upućuju sveukupan izgled, smještaj u središnjoj liniji, pojavljivanje u mlađoj dobi i tendencija manje invazivnosti u usporedbi s epidermoidom. Na pojavljivanje nekadašnje mekotkivne tvorbe u skalpu, umjesto dublje u kaloti, upućuju erozija vanjskog svoda kalote (koja završava u diploë), te izostanak zahvaćenosti površine unutarnjeg svoda kalote. Popratno odlaganje kortikalne kosti uokrug koštane litičke lezije moglo bi upućivati na nekadašnji rubni upalni proces povezan s mekotkivnom tvorbom. Moguću prisutnost varijante sinus pericranii isključili smo na osnovi iznjedrenih CT presjeka, dok smo prisutnost ateroma isključili na temelju smještaja lezije i dobi osobe.The calvaria of a young adult male from the early medieval burial complex Zvonimirovo (northern Croatia) exhibited the presence of a remodelled solitary lesion embracing the course of the sagittal suture line near the bregma. The small concave antero-posteriorly (AP) elongated – ovoid defect in the midline of the calvarial vault, with marginal cortical bone deposition, was indicative of a once soft-tissue lesion (cystic) development. There were no indicators – neither traumatic nor pathological, which would suggest a different type of lesion or variation. Beside the macroscopic approach, we aimed to use computed tomography (CT) support in interpreting the present non-traumatic dry bone lesion. The CT scans generated well-demarcated irregular and AP elongated lythic lesion (erosion) of the outer table, with osteosclerotic borders, ending up in the diploë, i.e. lacking the involvement of the inner calvarial vault surface (inner table). In this study, the differential diagnosis involved dermal versus epidermal inclusion cyst, sinus pericranii variant in association with the calvarial defect and inflamed atheroma evaluation. The most probable diagnosis of the present, apparently, skin-based dry bone lesion was a variant of a superficial congenital dermal inclusion cyst which was located in the (onetime) scalp. This was suggested by its gross morphology, midline localization, the appearance in early age and the tendency of minor invasiveness when compared to epidermoid. The once soft-tissue feature occurrence in the scalp instead of deeper in the calvaria was suggested by the erosion of the external calvarial vault (ending up slightly in the diploë), i.e. the absence of the inner calvarial vault surface involvement. The accompanying cortical bone deposition surrounding dry bone lythic lesion was suggestive of the past marginal inflammation associated with once soft-tissue feature. The possible presence of a sinus pericranii variant was excluded by the generated CT scans, while atheroma was ruled out due to the lesion localization and the age of the individual

Mastoid Trepanation in a Deceased from Medieval Croatia: A Case Report

We present a rare case of infratentorial mastoid trepanation, by drilling, from medieval Croatia. An artifi cial antemortal opening was found in a male skeleton from the 11th century cemetery Zvonimirovo. It was placed roughly at the intersection of the Frankfurt’s plane and the midline of the right mastoid. The right posterior parietal of the deceased also exhibited a callus-like formation consistent with the linear cranial fracture. Our aim was to investigate by computed tomography (CT) a possible presence of otopathology – a chronic middle ear infection – MEI/mastoiditis or cholesteatoma. On the other hand, both standard radiography and CT were employed in a cranial fracture diagnostic agreement. The generated CT scans confi rmed the presence of an artifi cial hole running into a well defi ned trepanne canal connected with the antrum. The presence of otopathology was not established. The radiography and CT substantiated the presence of a linear posterior parietal discontinuity – without displacement, in front of the right lambdoid suture. From the medical point of view, it would be unusual to perform infratentorial – mastoid trepanation for reasons of treating supratentorial trauma, i.e. possible posttraumatic acute subdural hematoma (PTASDH). However, since there was a lack of CT evidence of osteolysis in ME, there is a possibility of medieval trepanation procedure performed for reasons of posttraumatic treatment. To our best knowledge, usually, ancient trepanations described in Croatian bioarchaeology and all over the world are supratentorial and do not always reveal such sophisticated surgical techniques

Magnetska rezonanca mozga i magnetska angiografija u zbrinjavanju bolesnika s ishemijskim moždanim udarom u vertebrobazilarnoj cirkulaciji

Vertebrobasilar occlusion is a life-threatening event that requires prompt diagnostic evaluation and subsequent therapy. Advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging and magnetic resonance angiography (MRA), are highly sensitive for the detection of ischemic tissue injury, and for the detection and localization of intracranial arterial occlusion and stenosis. In the era of thrombolytic therapy, MRI and MRA provide useful information for therapeutic decision making in the early stage of stroke evaluation. This retrospective review included patients with posterior circulation symptomatology examined at our Department between July 2002 and January 2005, 8 female and 11 male, mean age 54.9 years. The aim was to present the possibilities of MRI and MRA in the management of patients with ischemic stroke in posterior circulation. In 19 patients with an ischemia in the vertebrobasilar circulation detected by MRI of the brain, MRA identified 8 cases of basilar artery occlusion, 4 cases of basilar artery stenosis, 3 cases of multiple atherosclerotic stenoses of the vertebral arteries with 2 cases of concurrent vertebral artery occlusion, 2 cases of vasculitis in the posterior circulation, 1 case of proximal posterior cerebral artery occlusion, and 1 case of posterior cerebral artery stenosis. In 8 patients with basilar artery occlusion, the site of occlusion was proximal in 3 cases, proximal and middle in 2 cases, middle and distal in 2 cases, and distal in 1 case. MRI is a powerful tool to detect ischemic changes in stroke immediately upon stroke onset, while MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries as well as in posterior circulation. In the acute stroke setting, MRI and MRA are useful for: 1) early and reliable identification of ischemic stroke; 2) improved choice of treatment modality by helping exclude from thrombolysis patients at high risk of hemorrhage and by identifying those patients most likely to benefit from it; 3) pinpoint the vascular origin of ischemic stroke; 4) determination of neurologic consequences of stroke, including final infarct size, clinical outcome and hemorrhagic risk.Vertebrobazilarna okluzija je za život opasno stanje koje zahtijeva brzu dijagnostičku obradu i terapiju. Suvremene metode magnetske rezonance (MR) mozga, uključujući difuzijski mjerenu sliku i magnetsku angiografiju (MRA), imaju visoku osjetljivost u otkrivanju ishemijske lezije moždanog parenhima, te u otkrivanju i lokalizaciji okluzije i stenoze intrakranijskih arterija. U doba trombolitične terapije MR mozga i MRA daju korisne podatke bitne za donošenje odluke o izboru terapije u procjeni ranog stadija ishemijskog moždanog udara. Proveden je retrospektivni pregled bolesnika sa simptomatologijom stražnje cirkulacije koji su na našem Zavodu pregledani u razdoblju od srpnja 2002. do siječnja 2005. godine, 8 žena i 11 muškaraca srednje životne dobi od 54,9 godina. Cilj je bio pokazati mogućnosti MR mozga i MRA u zbrinjavanju bolesnika s ishemijskim moždanim udarom stražnje cirkulacije. U 19 bolesnika s ishemijskim moždanim udarom vertebrobazilarnog sliva, koji je dokazan pomoću MR mozga, MRA je otkrila 8 okluzija bazilarne arterije, 4 stenoze bazilarne arterije, 3 slučaja višestrukih aterosklerotskih stenoza vertebralnih arterija s 2 slučaja istodobne okluzije vertebralne arterije, 2 vaskulitisa u stražnjoj cirkulaciji, 1 okluziju proksimalnog dijela i 1 stenozu stražnje moždane arterije. Među 8 bolesnika s okluzijom bazilarne arterije mjesto okluzije bilo je proksimalni dio arterije u 3, proksimalni i srednji dio u 2, srednji i distalni dio u 2 slučaja i distalni dio bazilarne arterije u 1 slučaju. MR mozga je moćno sredstvo u otkrivanju ishemijskih promjena neposredno nakon nastupa moždanog udara, dok MRA ima visoku osjetljivost za otkrivanje okluzivne bolesti velikih intrakranijskih arterija. Kod zbrinjavanja akutnog moždanog udara MR mozga i MRA su korisne zbog: 1) brzog i sigurnog otkrivanja ishemije; 2) sigurnijeg izbora oblika terapije pomažući da se tromboliza ne primijeni kod bolesnika s visokim rizikom za razvoj krvarenja te da se otkriju bolesnici koji će imati najviše koristi od iste; 3) mogućnosti točnog određivanja vaskularnog podrijetla ishemijskog moždanog udara; 4) određivanja neuroloških posljedica moždanog udara uključujući konačnu veličinu ishemijske lezije, klinički ishod i rizik od krvarenja

Procjena cerebrovaskularne bolesti magnetskom rezonancijom mozga i magnetskom angiografijom

Magnetic resonance imaging (MRI) is an important imaging technique for evaluation of cerebral ischemic changes. Using magnetic resonance angiography (MRA), both large and medium sized intracranial arteries and veins can be visualized by selecting appropriate imaging parameters. The aim of this retrospective study was to evaluate our own results in the diagnosis of cerebrovascular diseases with MRI and MRA, and to compare them with literature data. Data on 278 patients with cerebrovascular symptomatology (158 female and 120 male, mean age 45-54 years), examined between April 2001 and November 2002, were analyzed. MRA was performed in all 278 and both MRA and MRI in 231 patients. On MRA, 90 pathologic alterations of intracranial arteries (69 aneurysms and 21 vascular malformations), 13Rintracranial arterial occlusions, 19 intracranial arterial stenoses, and 14 cases of intracranial arteriosclerotic changes were identified. On MRI, 114 strokes (73 brain infarctions, 22 cerebral hemorrhages and 19 sub-arachnoid hemorrhages), 14 vascular malformations and 14 cases of small vessel disease were detected. MRI was found to be a powerful tool to detect ischemic lesions immediately upon stroke onset. MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries. For cerebral venous and sinus thrombosis, MRI and MRA are first line studies. MRA of extracranial and intracranial vessels alone or in combination with transcranial color-coded duplex sonography (TCCD) as well as computed tomography angiography (CTA) may eliminate the need of intra-arterial digital subtraction angiography (DSA) in most patients studied for occlusive cerebrovascular disease. DSA may be reserved for those patients in whom there is a disagreement among the results obtained by use of noninvasive techniques, and for the diagnosis of arteriovenous malformations, whereas MRA can prove useful on follow-up examinations.Magnetska rezonancija (MR) mozga je važna tehnika prikazivanja u procjeni ishemijskih promjena moždanoga parenhima. Magnetskom angiografijom (MRA) se birajući odgovarajuće parametre prikaza mogu pokazati i velike i male intrakranijske arterije i vene. Cilj ove retrospektivne studije bila je procjena vlastitih rezultata u dijagnostici cerebrovaskularnih bolesti pomoću MR mozga i MRA, te njihova usporedba s literaturnim podacima. Analizirani su podaci 278 bolesnika (158 žena i 120 muškaraca srednje životne dobi od 45,54 godine), koji su bili pregledani u razdoblju od travnja 2001. do studenoga 2002. Učinjeno je 278 postupaka MRA, a u 231 bolesnika učinjena je i MR mozga. MRA je otkrila 88 patološki promijenjenih intrakranijskih krvnih žila (69 aneurizma i 21 vaskularnu malformaciju), 13 okluzija intrakranijskih arterija, 19 stenoza intrakranijskih arterija, te 14 slučajeva arteriosklerotskih promjena intrakranijskih arterija. MR mozga otkrila je 114 cerebrovaskularnih inzulta (73 cerebralne ishemije, 22 intracerebralne hemoragije i 19 subarahnoidnih hemoragija), 14 vaskularnih malformacija, te 14 slučajeva "patologije malih krvnih žila". MR mozga je moćno sredstvo u otkrivanju ishemijskih promjena neposredno nakon nastupa moždanog inzulta. RMRA ima visoku osjetljivost za otkrivanje okluzivne bolesti velikih intrakranijskih arterija. MR mozga i MRA su osnovne pretrage za dijagnozu tromboze moždanih vena i sinusa. Samo se pomoću MRA ekstrakranijskih i intrakranijskih krvnih žila ili u kombinaciji s obojenom dupleks sonografijom krvnih žila glave i vrata (TCCD) te kompjutoriziranom tomografijskom angiografijom (CTA) može isključiti potreba za intraarterijskom digitalnom subtrakcijskom angiografijom (DSA) u većine bolesnika pregledanih zbog okluzivne cerebrovaskularne bolesti. DSA može biti rezervirana za one bolesnike kod kojih postoji neslaganje između nalaza neinvazivnih metoda pregleda, te za dijagnozu arteriovenskih malformacija, dok se MRA može rabiti za daljnje praćenje

Etiology of Deafness in Children Cochlear Implant Candidates in Croatia

The aim of this study was to provide more information on the causes of sensorineural hearing loss (SNHL) in children cochlear implant candidates in Croatia. The retrospective study included 270 children candidates for cochlear implantation between January 1997 and January 2005 at our institution. The medical assessment of the candidates included the history, physical examination, radiologic evaluation of the temporal bone and audiologic assessment. A family history of SNHL had 82 (30.4 %) candidates. The prematurity and/or complicated perinatal course was found in 35 (12.9%) of candidates. Computerized tomography (CT) scan analysis identified 44 (16.3%) candidates presenting with an inner ear malformation. Overall, a definite or probable cause of SNHL was identified in 58.9% of candidates and 41.1% had no obvious cause. The results of the study might give us better insight into the potential causes of SNHL and allow more timely intervention, allowing children with SNHL to reach their potential

Vrijednost CT-a mozga u hitnoj službi: retrospektivna analiza

The objective of the study was evaluation and radiologic - clinical correlation of brain computed tomography (CT) scans performed at emergency service. The relation between the number of urgent and total CT scans performed during a 2-year period (January 1, 2001 - December 31, 2002) was analyzed. Emergency brain CT scans were especially investigated according to clinical indications, requests from particular clinical specialties, and need of anesthesiologist\u27s assistance. CT scans were correlated with clinical examinations and diagnoses as well as with literature data. During the study period, 15,933 CT scans were performed at our department, 3132 (19.66%) of them at emergency service (1757 male and 1375 female, mean age 56.97 years), and 2576 (82.25%) of the latter emergency brain CT scans (1398 male and 1178 female, mean age 57.80 years). Data analysis showed the following distribution of emergency brain CT scans according to hospital departments: neurology 1441 (55.94%), neurosurgery 632 (24.53%), internal medicine 186 (7.22%), surgery 138 (5.36%), other departments 150 (5.82%), and other institutions 29 (1.13%). Clinical diagnoses for emergency brain CT scanning were as follows: stroke 905 (35.13%), subarachnoid hemorrhage 128 (4.97%), head injury 617 (23.95%), consciousness disorders and convulsions 389 (15.10%), intracranial expansive lesions 234 (9.08%), headache and/or vertigo 141 (5.47%), cerebrovascular insufficiency 50 (1.94%), infectious disease 46 (1.79%), hydrocephalus 12 (0.47%), metabolic disorders 2 (0.08%), and lost or unavailable data at the time of the study 52 (2.02%). Anesthesiologist\u27s assistance during emergency brain CT scanning was needed in 234 (9.08%) cases. Correlation of CT findings with clinical diagnosis yielded the following results: 96 (3.73%) lost or unavailable data at the time of the study, 639 (25.77%) normal findings, and 1841 (74.23%) pathologic findings. Study results showed the number of emergency brain CT scans to be quite high with a tendency of continuous growth (cerebrovascular disorders, new therapeutic approaches, head injury). Difficulties encountered on brain CT scanning because of the patient\u27s state, and delicacy of the emergency interpretation of CT scans impose the need of higher availability of a neuroradiologist within the frame of the emergency state algorithm.Cilj ove studije bila je evaluacija i radiološko-klinička korelacija CT pretraga mozga u hitnoj službi. Tijekom dvogodišnjeg razdoblja (1. siječnja 2001. - 31. prosinca 2002.) analiziran je odnos hitnih i sveukupnih CT pretraga. Posebno su obrađeni hitni CT pregledi mozga prema kliničkim indikacijama, zastupljenosti pojedinih kliničkih struka i potrebi anesteziološke asistencije. CT nalazi su korelirani s kliničkim upitima i dijagnozama, te uspoređeni s literaturnim podacima. Tijekom 24 mjeseca na Kliničkom zavodu su izvedene 15.933 CT pretrage, od čega 3132 (19,66%) u hitnoj službi (1757 muškaraca i 1375 žena srednje dobi od 56,97 godina). Čak 2576 (82,25%) svih hitnih CT pretraga bile su hitne CT pretrage mozga (1398 muškaraca i 1178 žena srednje dobi od 57,80 godina). Raspoređenost hitnih CT pretraga mozga prema klinikama bila je slijedeća: neurologija 1441 (55,94%), neurokirurgija 632 (24,53%), interna medicina 186 (7,22%), kirurgija 138 (5,36%), ostale klinike 150 (5,82%) i vanjske ustanove 29 (1,13%). Kliničke indikacije za hitnu CT pretragu mozga bile su slijedeće: moždani udar 905 (35,13%), subarahnoidno krvarenje 128 (4,97%), trauma glave 617 (23,95%), poremećaj svijesti i konvulzije 389 (15,10%), intrakranijska ekspanzija 234 (9,08%), glavobolja i/ili vrtoglavica 141 (5,47%), cerebrovaskularna insuficijencija 50 (1,94%), infekcija 46 (1,79%), hidrocefalus 12 (0,47%), metabolične promjene 2 (0,08%) i nedostupni podaci u vrijeme studije 52 (2,02%). Anesteziološka asistencija pri hitnom CT pregledu mozga bila je potrebna u 234 (9,08%) slučaja. Korelacija CT nalaza s kliničkom dijagnozom (kliničkim upitom) pokazala je kako je 96 (3,73%) podataka bilo nedostupno u vrijeme studije, dok je od 2480 preostalih nalaza hitnih CT pregleda mozga bilo 639 (25,77%) normalnih i 1841 (74,23%) patoloških. Provedena je i usporedba s podacima iz literature. Zaključeno je kako je velik broj hitnih CT pretraga mozga s tendencijom stalnog porasta (cerebrovaskularne bolesti, novi terapijski pristupi, trauma glave). Otežano izvođenje pretrage zbog teškog stanja bolesnika i osjetljivost hitne interpretacije nalaza nameću potrebu veće dostupnosti neuroradiologa uz pridržavanje algoritma pretraga u hitnim stanjima