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Intestinal pneumatosis (IP) is an infrequent radiological sign defined as pathological gas infiltration into the bowel wall. It may be associated to different underlying clinical conditions—inflammatory bowel diseases, malignancies, chemotherapy, infections, immune deficiency status, trauma, intestinal ischemia, and necrosis—that are often related to emergency state and require a prompt diagnosis. All the imaging techniques, especially abdominal radiography and Computed Tomography, could detect the presence of IP and discern the forms related to emergency conditions. The differential diagnosis is essential to start an immediate clinical or surgical management and treatment. The aim of this article is to review the radiological features of IP in different illnesses, with particular attention to differential diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: Increasing evidence suggests that SARS-CoV-2 infection may lead to severe and multi-site vascular involvement. Our study aimed at assessing the frequency of vascular and extravascular events' distribution in a retrospective cohort of 42 COVID-19 patients. Methods: Patients were evaluated by whole-body CT angiography between March 16 and April 30, 2020. Twenty-three out of the 42 patients evaluated were admitted to the intensive care unit (ICU). Vascular and extravascular findings were categorized into "relevant" or "other/incidental," first referring to the need for immediate patient care and management. Student T-test, Mann-Whitney U test, or Fisher exact test was used to compare study groups, where appropriate. Results: Relevant vascular events were recorded in 71.4% of cases (n = 30). Pulmonary embolism was the most frequent in both ICU and non-ICU cases (56.5% vs. 10.5%, p = 0.002). Ischemic infarctions at several sites such as the gut, spleen, liver, brain, and kidney were detected (n = 20), with multi-site involvement in some cases. Systemic venous thrombosis occurred in 30.9% of cases compared to 7.1% of systemic arterial events, the first being significantly higher in ICU patients (p = 0.002). Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the study population, with no significant differences in ICU and non-ICU patients. Conclusions: Vascular involvement is not negligible in COVID-19 and should be carefully investigated as it may significantly affect disease behavior and prognosis. Key Points: • Relevant vascular events were recorded in 71.4% of the study population, with pulmonary embolism being the most frequent event in ICU and non-ICU cases. • Apart from the lung, other organs such as the gut, spleen, liver, brain, and kidneys were involved with episodes of ischemic infarction. Systemic venous and arterial thrombosis occurred in 30.9% and 7.1% of cases, respectively, with venous events being significantly higher in ICU patients (p = 0.002). • Among incidental findings, small-sized splanchnic arterial aneurysms were reported in 21.4% of the whole population. [ABSTRACT FROM AUTHOR]

The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical presentation of acute chest pain/hypotension. Echocardiography is the first-line test for diagnosis of pericardial effusion and its etiology, but sometimes there are different drawbacks to the correct cardiovascular ultrasound diagnosis. Radiologists are reporting an increasing amount of thoracic Multidetector CT examinations at the emergency department. Multidetector CT has now become an established and complementary method for cardiac imaging, and diseases of the pericardium can now be quickly identified with increasing certainty. The aim of this review is to discuss the hemopericardium key Multidetector CT features in acute clinical setting which indicate the need to proceed with predominantly medical or surgical treatment, however, being able to identify forms of bleeding pericardial effusion for which only "a watch and wait strategy" and/or deferred treatment is indicated. In the emergency care setting, radiologists must be aware of different findings of hemopericardium in order to address a tailored and timely management approach. [ABSTRACT FROM AUTHOR]

Background: Acquired peripheral or intraparenchymal pulmonary artery aneurysms (PPAA) are rare entities but are important to recognize because of the associated morbidity. Hemoptysis is their principal complication and is a potentially fatal condition.Purpose: To illustrate the causes, multidetector CT angiography (MDCTA) findings and differential diagnosis of acquired PPAA.Materials and methods: The institutional review boards approved this study. We conducted a retrospective review of the demographic data and the results of clinical and laboratory examinations, and imaging studies of patients managed between January 2012 and January 2017 in two institutions.Results: A total of 19 patients had acquired PPAA that were detected at MDCTA, 9 patients with normal pulmonary artery pressures and 10 with pulmonary hypertension. Nine patients developed PPAA-related acute symptoms. MDCTA features of PPAA include: a lobulated vascular mass, an indistinct irregular arterial wall, aneurysmal thrombosis or wall calcification, findings of impending rupture including perianeurysmal edema, gas or a soft tissue mass.Conclusion: PPAA are rare. In our series, endocarditis and pulmonary hypertension are the PPAA leading causes. The treatment modality preferred is embolization, especially as surgery poses a very high risk for patients with severe pulmonary hypertension. Further clarification of the natural history of these rare arterial aneurysms is needed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to review the normal anatomy of the extrapleural space, its soft tissue-containing lesions, and to illustrate the extrapleural fat sign with Multidetector Computed Tomography (MDCT) and Ultrasound (US), which was never described so far. Materials and methods: The study includes 28 patients. 24 with histologically or surgically proven extrapleural soft tissue-containing lesions and 4 pleural lesions. Six patients underwent unenhanced MDCT of the chest, while 22 patients had a contrast-enhanced chest MDCT. Furthermore, 9/28 patients underwent Thoracic Ultrasound after MDCT. The lesions included 12 extrapleural hematomas (8 post-traumatic and 4 from other causes), 3 extrapleural lesions from pleural infection extension, 9 extrapleural lesions from metastases. MDCT multiplanar Minimum Intensity Projection (MinIP) reconstructions were always obtained; T-US and MDCT findings were correlated. Results: Among 9 patients who underwent T-US 4/9 showed the 'UltraSonography fat extrapleural sign'. Among 24 patients who underwent chest MDCT all show the well-known computed tomography (CT) extrapleural fat sign and new auxiliary (MDCT) findings that serve to 'strengthen' the diagnosis of correct intrathoracic extrapleural space attribution of lesion. Conclusions: MDCT with its multiplanar capabilities and post-processing MinIP reconstructions and Thoracic US play a prominent role in the identification and characterization of abnormalities of the frequently overlooked extrapleural space. In conjunction with main CT thoracic findings they provides relevant information in the diagnostic process and correct management. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this multicentric study is to assess the usefulness of multiphasic Computed tomography in the identification of spontaneous non-traumatic retroperitoneal hematoma (SRH) and its management, with references to the role of interventional radiology. Materials and methods: From January 2011 to June 2014, 27 patients with SRH were selected. Patients with aortic, traumatic, or iatrogenic source of bleeding were excluded. All the patients were studied with multiphasic MDCT after injection of intravenous contrast. Digital Subtraction angiography and percutaneous embolization treatment were performed. Results: CT identified SRH in all cases (100 %), showing the source of bleeding in 11 cases (40 %) and pointing out the source of bleeding in 15 cases (55 %). In one case (5 %), the bleeding origin was recognized only at surgery as adrenal source. CT has identified a contrast medium extravasation in the arterial phase in 17 patients (63 %), treated successfully by percutaneous embolization in 13 and by open-surgery in two cases. Two patients died before undergoing intervention and surgery, respectively. Ten patients (37 %) were non-operatively treated successfully with clinical, laboratory, and imaging follow-up. Conclusions: Multiphasic CT is the gold standard for the identification of a SRH. Recognition of CT signs of active bleeding is the crucial feature influencing the timing of therapeutic treatment. Urgent embolization should be performed in cases of arterial bleeding or contained vascular injuries supplying the retroperitoneal hematoma. Surgery is to be addressed in cases of actively bleeding hematomas associated with complication. Finally, an initial more conservative approach can be adopted in patients without signs of contrast extravasation or low-flow active bleeding. Technical skill, expertise, and recognition of CT signs of arterial active bleeding are critical features influencing patients management. [ABSTRACT FROM AUTHOR]

Traumatic diaphragmatic rupture is a life-threatening injury that may occur in patients with blunt trauma. At present, supine chest radiographs is the initial, most commonly performed imaging test to evaluate a traumatic injury of the thorax. However, computed tomography (CT) is the imaging tool of choice, as it is the 'gold standard' for the detection of diaphragmatic injury after trauma. In particular, recent literature indicates that multidetector CT with multiplanar reformations has significantly improved in accuracy. Radiologists working in the emergency room should keep in mind the possibility of diaphragmatic injuries and should routinely integrate the axial images CT with multiplanar reformations in order to detect any potential, subtle or doubtful sign of incomplete diaphragmatic injury. [ABSTRACT FROM AUTHOR]