The aim of this study was to assess a newly developed computerized tomography (CT)‐based splenic injury index in predicting the outcome of splenic injury. Twelve patients with isolated splenic injuries were studied. Splenic parenchymal injury was graded from 1 to 4 based on CT. The splenic injury index was obtained by multiplying the parenchymal score by the volume of haemoperitoneum, which was measured on the CT scanner. The 12 patients with CT‐proven splenic injuries had a mean injury index of 193.5 ± 191 (mean ± s.d.). The 3 patients who failed conservative management had a mean index of 475 ± 50, compared with an index of 99.5 ± 100 in the nine managed non‐operatively (P < 0.001).
This new CT‐based splenic injury index allows morphological assessment of splenic injury and may predict the outcome of splenic trauma.
A case of jejunojejunal intussusception is presented, in which a malignant melanoma deposit acted as the lead point. The diagnosis was made on CT and the appearances are described.
Over a 42 month period 133 patients underwent 148 CT guided biopsies of 104 pulmonary lesions (78%), 21 mediastinal/hilar masses (16%) and 8 pleural lesions (6%). There were 48 cases (32%) complicated by a pneumothorax, of which 13 (9%) required a chest drain. Two cases each of minor haemopneumothorax (1.4%) and haematoma (1.4%) were found, and haemoptysis occurred in a single patient (0.7%). This low complication rate reflects the use of the 22 gauge Chiba needle, the small number of passes undertaken at each sitting and the wide range of lesion size. In four cases no diagnosis was established either at the time of biopsy or subsequently. There were 100 cases proven to be malignant, of which 81 were diagnosed at the first biopsy. Three further cases were regarded as suspicious of malignancy. Of the 29 patients with benign disease, a specific diagnosis was made in 10 (34%) and nonspecific inflammation was seen in 17 (59%) further patients. Fine needle aspiration under CT control is a useful and accurate diagnostic technique. It has widened the scope of lesions which can be biopsied, enabling small, deep or necrotic parenchymal lesions to be targeted accurately. A precise placement of the needle tip into pleural or mediastinal lesions is a further advantage. However, if an inadequate sample is obtained, the biopsy may need to be repeated.
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