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Purpose: Dysphagia is a common symptom in patients with Parkinson's disease (PD), though it may go undiagnosed until severe complications arise. Dysphagia can be suspected on a clinical basis, but an instrumental assessment is mandatory to confirm its presence and evaluate pathophysiological aspects and severity of the swallowing impairment. Aim of this review is to inform the clinician and the radiologist on the importance and the main radiological findings of the Video-Fluoroscopic-Swallow-Study (VFSS) in patients with PD starting from the most recent literature data on the topic., Materials and Methods: Databases analysis identified 98 papers (January 2000/October 2022) of which 55 were excluded after reading title, abstract and full-text. After evaluation of the selected articles and their references 7 additional papers were added., Results: Fifty papers were reviewed to answer the following four main questions: Should VFSS be routinely used to screen dysphagia? Compared to other diagnostic tools, what is the role of VFSS in PD patients with suspected dysphagia? What are the main VFSS findings and technical expedients ? What is the role of VFSS in the choice of the best treatment strategy ?, Conclusions: VFSS represents a gold standard technique in the diagnostic evaluation of dysphagia in PD, having a fundamental role in the identification of patients with high risk of aspiration pneumonia and also being extremely helpful to guide to the choice of treatment strategies for dysphagia., (© 2022. Italian Society of Medical Radiology.)

Acquired double pylorus (DP) is an uncommon condition consisting of two communicating channels between the gastric antrum and the first part of duodedum. Little is known about the origin of DP. As there is no specific gastrointestinal symptom due to DP, most often it is diagnosed by gastroscopy while performing for other indicationsFew data are also known about the clinical course of DP. In the patients with peptic ulcer symptoms, the pyloroplasty-like drainage effect, improving gastric emptying after the estabilishment of the fistula, could relieve these symptoms. This represents an unresolved issues about the necessity of repeating endoscopy to document in the patients with DP its final outcome, as the risk of ulcer recurrence. We describe a case of a 76-years-old woman admitted to our department for hyposideremic anemia associated to a recent history of melena.

Background: Small intestine contrast ultrasonography (SICUS), when performed after distention of the small bowel lumen with an iso-osmolar polyethylene glycol electrolyte-balanced solution, shows high sensitivity (100%) and specificity (97%) in detecting small bowel abnormalities in patients who have not received a diagnosis but in whom there is a suspicion of intestinal diseases. The diagnostic yield of SICUS remains to be established in detecting small bowel lesions in patients with proven Crohn's disease (CD) in comparison with transabdominal ultrasonography (TUS), and in relationship to the experience of the operator, using small bowel enema (SBE) as the "gold standard.", Aim: The aim of this study was to evaluate the diagnostic value of SICUS, when performed by a sonologist with 1 year of experience, and TUS, when performed by a sonologist with 10 years of experience, compared to SBE in the assessment of the site, extension, and stenosis of small intestinal lesions in CD patients., Patients and Methods: A total of 28 consecutive patients (men, 16; women, 12; age range, 21 to 60 yr) with a diagnosis of CD underwent TUS and SICUS, which were performed by 2 sonologists who were unaware of the radiologic findings, on the same day. SICUS was performed after the ingestion of 375 mL of a polyethylene glycol contrast solution. A standard SBE was performed on a different day by an expert radiologist who was unaware of the sonographic findings., Results: Sensitivities in the detection of small bowel lesions were 96% for TUS and 100% for SICUS. Compared with SBE, SICUS detected the presence of 4 lesions in the jejunum that had been missed by TUS. The mean (+/-SD) extent of the ileal disease was 22 +/- 12.5 cm when measured during SBE, 14.5 +/- 8.6 cm when measured during TUS, and 19.5 +/- 12.5 cm when measured during SICUS [P = 0.05 (SICUS versus SBE)]. The correlation of the extension of the lesions between SICUS and SBE (r = 0.88) was better than that between TUS and SBE (r = 0.64). The sensitivities of TUS and SICUS in the detection of at least 1 stricture were 76% and 94%, respectively. Sensitivity and specificity in assessing prestenotic dilatation were 50% and 100%, respectively, at TUS, and 100% and 90%, respectively, at SICUS., Conclusion: In inexperienced hands, SICUS is a more accurate technique for assessing CD lesions, and the accuracy is better than that of TUS performed by an expert sonologist. The use of SICUS, instead of SBE, could be indicated for the follow-up of patients with CD.

Purpose: To evaluate the current role of small bowel (SB) radiologic barium examinations in adult celiac disease (ACD)., Materials and Methods: Retrospective review of 61 SB barium examinations in 280 ACD patients. Sixty-one examinations in 61 patients were performed: 7/61 with small bowel ''follow-through'' (SBFT) method, and 54/61 with small bowel double-contrast enteroclysis (SBE). Radiological criteria for ACD diagnosis were divided in four groups: 1) definite ACD (reversal of jejuno-ileal fold pattern); 2) possible ACD (malabsorption pattern and ileal jejunization); 3) malabsorption (fluid, dilatation, ''moulage'', flocculation); 4) complicated ACD (irregular, thickened, nodular folds; wall thickening; masses)., Results: In 49/61 patients RX examinations were performed before ACD diagnosis. In this group, clinical presentations included one or more of the following: diarrhea, weight loss, malabsorption, anemia, abdominal pain; 7/49 had a SBFT, and 42/49 a SBE. All 7 SBFTs showed pattern 3, and 8/42 SBEs showed pattern 2 (suspected ACD). In 34/42 patients SBE allowed a definite ACD diagnosis (pattern 1); however, 6/34 were also false-positive for complicated ACD (pattern 4). Ten out of sixty-one patients were clinically suspected of having complicated ACD, correctly excluded (8/8) or confirmed (2/2) by SBE. None of these 59/61 patients had a radiologic diagnosis of normal' SB. The last 2/61 patients with ACD, examined for persisting chronic anemia, had a normal SBE., Conclusions: This study confirm that SB radiology may be of value either in ACD diagnosis or in excluding complications: SBE is currently the most accurate examination. SBE alone is however less accurate in confirming complicated ACD; further imaging techniques are always needed in this clinical context.

The number of folds and lumen diameter of the proximal jejunum and distal ileum were retrospectively measured in 40 double-contrast small bowel enteroclysis studies of patients with a biopsy-proven diagnosis of adult celiac disease (ACD) and in 46 healthy control subjects. For both parameters an inverse radiographic pattern was found in celiacs compared to control subjects, in whom the number of folds and lumen calibers are physiologically greater in proximal jejunum than in the distal ileum. Mean differences in the jejuno-ileal number of folds (-7.1) and lumen calibers (-1.3 cm.) were in fact negative in ACD patients, in whom the values of both the parameters are less in the proximal jejunum than in the distal ileum. Particularly, the sign of "reversal of jejuno-ileal caliber" was both sensitive and specific for diagnosis of ACD in this retrospective series. Double-contrast small bowel enteroclysis can play an important role in excluding or confirming the presence of ACD, provided that an assessment of reproducibility and a prospective re-evaluation of operative characteristics of such radiographic signs are performed.

The authors retrospectively reviewed the radiographic (double-contrast small-bowel enema) examinations of 20 patients with primitive small intestinal lymphomas. The diagnosis was histologically confirmed in all cases. The technique was very sensitive (100%) in detecting small-bowel abnormalities. On the contrary, a definite differential diagnosis was difficult to make (65%), except for 4 cases of lymphoma complicating celiac disease in which the presence of a nodular pattern and of thickened and irregular mucosal folds seemed to be highly specific. The most difficult differential diagnosis was with Crohn's disease. In all the cases with surgical confirmation (17), disease extent exactly corresponded to that suggested by small-bowel enema. Primitive small intestinal lymphoma is not radiologically distinguishable from secondary involvement during systemic lymphoma. From the analysis of radiological abnormalities, the authors observed that, different from previous reports, severe luminal narrowing was frequent, whereas "aneurysmal" dilatations of intestinal loops were never observed. CT was confirmed as the best technique for staging. Clinical implications of double-contrast enema in the diagnosis of primitive small intestinal lymphomas are discussed; radiographic patterns are reviewed.

The authors retrospectively reviewed the radiographic findings (obtained with double-contrast small bowel enema) of 27 patients with adult celiac disease and of 27 healthy control subjects. Two parameters were measured in two different locations; lumen diameter and number of folds both in the proximal jejunum and in the distal ileum. Statistical differences in mean values between cases and controls were calculated, and correlations between the four variables were assessed. Sensitivity, specificity and their 95% confidence limits were calculated for all the variables. The best parameter in discriminating cases from controls seems to be the caliber of distal ileum (greater than 3 cm), with 93% sensitivity and 100% specificity. The value of the obtained results is discussed.

Cancer of the pancreas is the fourth cause of death for tumor in USA; ultrasound has been shown a sensitive and specific technique in detection of this condition. We have prospectively studied with ultrasound 76 patients with clinical suspicion of cancer of the pancreas. Forty of these patients had carcinoma of the pancreas (histologically proved) and in the other 36 patients the cancer was clinically and/or surgically excluded. Sensitivity of ultrasound was 100%; specificity was 73%. The great part of our false-positive results were patients in which ultrasound detected a modification in the head of the pancreas and in which we couldn't have a biopsy from surgeons. The role of ultrasound scanning as first procedure to use in patients with clinical suspicion of carcinoma of the pancreas is confermed.

This report describes the case of a 70-year-old female suffering from diabetes mellitus and dilatative cardiomyopathy with congestive heart failure. It is likely that alveolar-capillary membrane damage occurred apart from cardiac involvement. Diffuse interstitial pulmonary fibrosis subsequently occurred with consequent acute progressive respiratory failure and death. The cause of the damage to the alveolar-capillary membranes is still unknown and we thought that long-term administration of captopril might have contributed to the damage itself, since like all ACE-inhibitors, captopril is able to bring about tissular storage of both bradykinin and prostaglandins and therefore alter the pulmonary reactivity to phlogistic stimuli.

The accuracy of ultrasound (US) and alpha-fetoprotein (AFP) in the diagnosis of hepatocellular carcinoma (HCC) in 363 patients with cirrhosis (C) and a clinical suspicion of HCC was assessed. The ultrasonographic patterns of HCC and their relationship with AFP values were analyzed. Echographic patterns were distributed as follows: 47 patients had sonodense lesions; 30 patients had hypoechoic lesions; 47 had mixed-pattern lesions, and in four patients focal dilated intrahepatic bile ducts were demonstrated. The sensitivity of US was 90%; specificity was 93.3%. Serum AFP level greater than or equal to 500 ng/ml (RIA) was the first clue to the diagnosis in 71 patients (48.6%); specificity was 100%. In 28 patients AFP levels became significantly elevated during follow-up after US detection of HCC. No relationship between echo pattern and serum AFP levels was demonstrated. An algorithm for diagnosis of HCC is proposed.

The ultrasound diagnosis of appendicular mucocele may sometimes present problems in relation to its differentiation from other space-occupying intra or extra-peritoneal lesions. An observed case is described in which the echographic pattern of the mass suggested other diagnostic possibilities.