Search

Abdominal emergencies in cancer patients encompass a wide spectrum of oncologic conditions caused directly by malignancies, paraneoplastic syndromes, reactions to the chemotherapy or often represent the first clinical manifestation of an unknown malignancy. Not rarely, clinical symptoms are the tip of an iceberg. In this scenario, the radiologist is asked to exclude the cause responsible for the patient's symptoms, to suggest the best way to manage and to rule out the underlying malignancy. In this article, we discuss some of the most common abdominal oncological emergencies that may be encountered in an emergency department. [ABSTRACT FROM AUTHOR]

Transdiaphragmatic fistulae are rare conditions characterized by pathological communication between two epithelium-lined surfaces. Hepato-thoracic fistula consists of abnormal communication between the liver and/or the biliary system and the thorax; while the pancreaticopleural fistula consists of abnormal communication between the pancreas and the thorax, the pleuro-biliary fistula represents the more common type. Clinical symptoms and laboratory findings are generally non-specific (e.g., thoracic and abdominal pain, dyspnea, cough, neutrophilia, elevated CPR, and bilirubin values) and initially, first-level investigations, such as chest RX and abdominal ultrasound, are generally inconclusive for the diagnosis. Contrast-enhanced CT represents the first two-level radiological imaging technique, usually performed to identify and evaluate the underlying pathology sustained by transdiaphragmatic fistulae, their complications, and the evaluation of the fistulous tract. When the CT remains inconclusive, other techniques such as MRI and MRCP can be performed. A prompt and accurate diagnosis is crucial because the recognition of fistulae and the precise definition of the fistulous tract have a major impact on the management acquisition process.

Aim: To investigate the effectiveness of head compensatory postures to ensure safe oropharyngeal transit., Methods: A total of 321 dysphagia patients were enrolled and assessed with videofluoromanometry (VFM). The dysphagia patients were classified as follows: safe transit; penetration without aspiration; aspiration before, during or after swallowing; multiple aspirations and no transit. The patients with aspiration or no transit were tested with VFM to determine whether compensatory postures could correct their swallowing disorder., Results: VFM revealed penetration without aspiration in 71 patients (22.1%); aspiration before swallowing in 17 patients (5.3%); aspiration during swallowing in 32 patients (10%); aspiration after swallowing in 21 patients (6.5%); multiple aspirations in six patients (1.9%); no transit in five patients (1.6%); and safe transit in 169 patients (52.6%). Compensatory postures guaranteed a safe transit in 66/75 (88%) patients with aspiration or no transit. A chin-down posture achieved a safe swallow in 42/75 (56%) patients, a head-turned posture in 19/75 (25.3%) and a hyperextended head posture in 5/75 (6.7%). The compensatory postures were not effective in 9/75 (12%) cases., Conclusion: VFM allows the speech-language the-rapist to choose the most effective compensatory posture without a trial-and-error process and check the effectiveness of the posture.

To study the potential impact of iodine-124-beta-carbomethoxy-3beta(4-iodophenyl)tropane (I-124 betaCIT) in Parkinson disease, a I-124 betaCIT-PET scan was performed in 30-year-old man with suspected early Parkinson disease. The scan showed normal striatum uptake together with a focal spot in the left parietal cortex. The subsequent magnetic resonance imaging of the brain revealed a corresponding nodular lesion, presumably representing a metastasis. After clinical and diagnostic evaluation, a malignant metastatic melanoma was discovered. betaCIT is a cocaine derivative with a high affinity for dopamine and serotonin transporters mainly used to image the density of the dopamine reuptake transporter. In fact the role of I-123 betaCIT is typically represented by Parkinsonian syndromes of uncertain classification. The iodine-124 betaCIT uptake is a marker of dopamine transporters density, and the presence of focal uptake corresponding to a lesion on magnetic resonance images suggests a specific binding in this case of melanoma brain metastasis.

Background: Multidetector computed tomography (CT) improves scan length and spatial resolution. The availability of a single test that allows a comprehensive evaluation of the chest and pulmonary arteries, of the deep venous system of the abdomen and legs and the hemodynamic impact of pulmonary emboli on the right heart could be a new and effective strategy for patients with venous thromboembolic disease. We assess a combined study protocol on venous thromboembolic disease by multidetector CT., Methods: Twenty-four patients with confirmed acute pulmonary embolism, in stable clinical conditions, underwent multidetector CT. After antecubital intravenous infusion of 120 ml of contrast medium at a rate of 4 ml/s followed by 30 ml of saline solution a CT of the chest was performed using 4 x 1 mm collimation, pitch 1.5 and 500 ms rotation time of the X-ray tube; the start delay was checked for each single patient. Indirect CT venography study was acquired 150s after starting the infusion using a 5 mm section width from the diaphragm to the popliteal zone. We evaluated: 1) the presence of intraluminal filling defects in the pulmonary arteries and in the deep venous system from the inferior vena cava to the popliteal veins, and 2) the presence of right ventricular dilation with a right ventricle/left ventricle (RV/LV) ratio > 1. The patients with CT diagnosis of deep vein thrombosis (DVT) and and RV/LV ratio > 1 underwent venous compressive ultrasound and/or echocardiography., Results: Pulmonary embolism was detected in 12% in the main arteries and in 66, 87 and 20% in the lobar, segmental and subsegmental arteries respectively. DVT was found in 14/24 (58%) patients with pulmonary embolism involving the ileo-femoral district in 14% of the whole group. Thirteen patients (54%) showed a volumetric prevalence of the right ventricle on the left ventricle. CT data in the presence of DVT and an RV/LV ratio > 1 was confirmed at ultrasonography., Conclusions: Multidetector CT allows to obtain rapidly and in one examination useful information about the source and pulmonary involvement of venous thromboembolic disease and about the hemodynamic impact on the right heart.