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To define the accuracy of Magnetic Resonance (MR) in the diagnosis of inferomedial displacement of the meniscal fragment.The MR examinations of the knee performed between December 2002 and April 2004 on 676 patients (mean age 32 years) with knee trauma and subsequently subjected to arthroscopy were retrospectively reviewed to assess the presence of bucket-handle meniscal tear and inferomedial displacement of the meniscal free fragment. The MR examinations were performed using a superconductive 0.5 T MR unit with a transmitting/receiving coil dedicated for the extremities. The MR images were acquired with SE T1 and GE T2* sequences in the sagittal, coronal and axial planes with 3 mm thickness and 1 mm gap. The images were independently reviewed by two authors blinded to the arthroscopic findings. In case of disagreement, a third author, unaware of the arthroscopic findings, gave his judgment.On MR images a bucket-handle meniscal tear was identified in 54/676 patients. In 6 out of 54 patients, an inferomedial meniscal fragment displacement of the medial meniscus with associated inflammatory synovial reaction around the fragment was detected. In one case an associated inflammatory bursal reaction with effusion around the distal insertion of the medial homolateral collateral ligament was detected. All cases were confirmed by arthroscopy and no statistical differences between the two authors were observed.MR allows the detection of the inferomedial meniscal fragment displacement and a more correct planning of arthroscopy with a strong reduction of repeat interventions.

To describe an original protocol for single slice spiral Computed Tomography (CT) virtual bronchoscopy in the evaluation of patients with central airway stenoses and compare the results with fibreoptic bronchoscopy.Ten patients (4 female and 6 male; age range 22-60 years; mean age 44 years) with endobronchial disease diagnosed by fibreoptic bronchoscopy (8 malignant tumours, 1 benign tumour and 1 fibroid stenosis) underwent virtual bronchoscopy with single slice spiral CT. A panoramic spiral CT scan of the whole chest was first obtained. Once the area of interest had been identified, a new contrast enhanced scan was performed, from bottom to top, with the following parameters: 2 mm slice thickness, 1 mm reconstruction index, 1.3 pitch, 120 Kvp, 80 mAs. Virtual bronchoscopy was generated with an upper threshold of -500 HU from the cross-sectional images of the second scan on a dedicated workstation. Axial, multiplanar reformations (MPR), and virtual endoscopy simulation were simultaneously visualised. Virtual CT bronchoscopy findings were compared with those of fibreoptic bronchoscopy.The protocol we used to perform single slice spiral CT virtual bronchoscopy enabled us to obtain virtual bronchoscopy images that correlated well with fibreoptic bronchoscopy findings in all cases, as well as allowing the visualization of the airways beyond the stenoses. Information about tissues surrounding the tracheobronchial tree was also available from axial and MPR images. Only in 1 case were motion artefacts observed.The set of the most appropriate parameters for performing virtual bronchoscopy by single slice spiral CT has not yet been standardized. In our opinion the appropriate selection of the protocol to adequately realize virtual bronchoscopic images is crucial when using CT devices such as the above, so as to achieve the correct balance between the quality of image definition and exposure dose.

To assess the diagnostic potential of ultrasound as compared to conventional radiography in quantifying the anatomic and structural damage and determining the grade of acute traumatic lesions of the acromioclavicular (AC) joint.From September 2001 to September 2002, 18 patients (16 men, 2 women; age range: 17-78 years) who came to our Emergency Service with clinically suspected acute traumatic AC joint lesion were examined by ultrasonography with a variable frequency linear-array transducer (7.5-12 Mhz). The morphology of the AC joint peri-articular ligaments and soft tissues, distance between the edge of the acromion and the lateral margin of the clavicle, distance between the superior edge of the coracoid and the inferior margin of the clavicle were evaluated. Conventional radiography was performed prior to ultrasound using routine antero-posterior (A-P), single-film stress and "outlet" projections. All patients subsequently underwent clinical follow-up for a mean period of six months.On US examination, all patients presented AC ligament lesion associated with consistent intra- and extra-articular sero-haemorrhagic effusion. Six of the 18 patients had suffered indirect trauma. Diastasis of the AC joint with ligament lesion not associated with involvement of coracoclavicular (CC) joint and with ligament integrity was observed. Twelve of the 18 patients had direct trauma. Changes to AC and CC ligaments with consequent diastasis of both joints were observed. Measurements of AC and CC distance obtained on US examination corresponded to those obtained at conventional radiography in the A-P projection. At clinical follow-up, no variation in the previously established diagnosis was recorded in any patient.If appropriate methodology and adequate transducers are used, ultrasound is an accurate and reliable technique for the evaluation of acute AC joint injuries, complementing and correlating well with conventional radiography.

To describe our experience in three cases of abdominal haemorrhage caused by bleeding renal angiomyolipomas, which were studied with Computed Tomography (CT).A retrospective study carried out at our archives identified 3 patients (aged 58.6 on average) with renal angiomyolipomas clinically manifested with acute abdomen and haemorrhage. The patients underwent an emergency CT scan of the abdomen. One patient also under-went a subsequent renal angiography. All patients had surgery and histological characterizations of the renal lesions.The CT study on all three patients allowed detection of a lesion in the kidneys with inhomogeneous density due to haemorrhage. Areas with fat-density values (-60 -80 UH) were always observable within the lesions. The lesions, measuring 5-9 cm, were located in the right kidney in two patients and in the left kidney in one.In 40% of patients, renal angiomyolipoma may account for a picture of hypovolemic shock, so a correct diagnostic approach is important to guide the surgical approach. CT allows detection of the angiomyolipoma as the cause of the haemorrhage in most cases. The diagnosis is relatively simple when the lesion has typical features such as adipose content, whereas it may be difficult with non-typical aspects. Furthermore the fat content may also be detected in varying quantities in other renal lesions responsible for bleeding.