Hungarian Radiology

[The value of multislice computed tomography in the diagnosis of pulmonary embolism and in differential diagnostics]


OCTOBER 20, 2006

Hungarian Radiology - 2006;80(05-06)

[INTRODUCTION - The multislice CT (MSCT) pulmonary angiography has been used increasingly in the diagnosis of pulmonary embolism with worldwide application and nowadays it can be considered as a gold standard technique. At the author's department a single slice CT has been used from 1993 and a 10 slice CT system with 24 detector-lines was installed in 2004. The authors summarize the advantages of MSCT in the diagnosis and differential diagnosis of pulmonary embolism and its role in the follow-up of cases and the significant increase of the diagnostic safety. PATIENTS AND METHODS - 2576 chest MSCT examinations were performed between 16 February 2004 and 20 June 2005. In 261 cases pulmonary MSCT angiography was made due to suspected pulmonary embolism. In 7 cases the indication of the CT was different, but due to the findings (pulmonary embolism) this group of patients is discussed in this paper. 268 cases were evaluated retrospectively. In 12 patients, CT could not be performed due to contrast agent allergy or because of seriously impaired renal function. In 2 cases it was not possible to establish a venous access. The therapeutical result was monitored upon the request of the clinicians. The pulmonary MSCT angiography was performed in accordance with a detailed acquisition and reconstruction protocol. In the reprocessing stage the 2D (MPR) reconstruction in different directions was an important step. In addition, three-dimensional MIP was used and VRT reconstruction was also made, if needed. Bolus tracking was applied in order to achieve a good contrast phase. RESULTS - In 116 out of 268 cases pulmonary embolism was detected by pulmonary MSCT angiography. In 7 patients pulmonary embolism was not the primary diagnosis. Pathological changes could not be detected in 55 cases (20.5%) and embolism was not proven later in these patients. No false negative study was recognized. In one case, after the death of the patient the autopsy failed to prove the presence of pulmonary embolism, this represents one false positive diagnosis. In 97 patients pulmonary embolism was not detected, however other findings were found relating to the complains of the patients and thus proper therapy could be introduced. CONCLUSION - Pulmonary MSCT angiography proved to be a highly accurate method for the diagnosis and for exclusion of pulmonary embolism and also in the evaluation of its extent. MSCT can be used in monitoring the result of the therapy. In addition, MSCT gives an opportunity to detect other acute pathological conditions of the chest, thus value of the study is significant in the differential diagnosis.]



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[Successful radiological diagnostics in Bouveret’s syndrome]

KISS Katalin, FARKAS Szabolcs, LUKOVICH Péter, MAGYAR Péter, MESTER Ádám, MAKÓ Ernő†

[INTRODUCTION - Bouveret’s syndrome I is a rare clinical entity, a special form of gallstone ileus. Based on a case study the authors describe the clinical presentation, the complications and diagnostic work up of the Bouveret’s syndrome I. CASE REPORT - A 75-year-old female patient with repeated vomiting and haematemesis was examined. Known gallstones and obstructive jaundice was noted in the case history. Urgent gastroscopy was performed at admission, which proved haemorrhagic esophagitis as the cause of the haematemesis. A gallstone was found by endoscopy distal to the pyloric region obstructing the bowel lumen. Radiological examinations proved the presence of the stone exactly at the localization that was given. Surgery confirmed the diagnosis. CONCLUSION - Bouveret’s syndrome I should be considered in patients with repeated and long lasting vomiting and bile stone in the case history. Conventional X-ray may be sufficient to establish the diagnosis, however further imaging studies are needed to clarify exact anatomical situation and potential complications of the disease.]

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