Abstract:Multidetector computed tomography (MDCT) cystography currently represents the modality of choice to image the urinary bladder in traumatized patients. In this review we present our experience with MDCT cystography applications outside the trauma setting, particularly for diagnosing bladder fistulas and leaks. A detailed explanation is provided concerning exam preparation, acquisition technique, image reconstruction and interpretation. Colovesical fistulas most commonly occur as a complication of sigmoid divert… Show more
“…The protocol for cystography‐CT includes scan of the pelvis before and after adequate bladder distention and introduction, through a Foley catheter insertion, of diluted mixture of contrast material (50 mL of Gastrografin in 450 mL normal saline solution) . Image processing using multiplanar thick‐slab sliding MIP or volume rendering techniques is highly recommended because it helps visualization of thin fistulas or leaks . If urinary tract injuries are suspected, Urographic‐CT can be useful.…”
SummaryUterine malignancies account for the majority of gynaecologic cancers. Different treatment options are available depending on histology, disease grade and stage. Hysterectomy is the most frequent surgical procedure. Chemotherapy and radiation therapy (CRT) represents the preferred therapeutic choice for locally advanced uterine and cervical malignancies. Imaging of the female pelvis following these treatments is particularly challenging due to alteration of the normal anatomy. Radiologists should be familiar with both the expected post-treatment imaging findings and the imaging features of possible complications to make the correct interpretation and avoid possible pitfalls. The purpose of this review is to show the expected computed tomography (CT) and Magnetic Resonance Imaging (MRI) appearances of the female pelvis following surgery and CRT for uterine and cervical cancer, to illustrate the imaging findings of early and delayed most common complications after surgery and CRT, describing the suitable imaging modalities and protocols for evaluation of patients treated for gynaecologic malignancies.
“…The protocol for cystography‐CT includes scan of the pelvis before and after adequate bladder distention and introduction, through a Foley catheter insertion, of diluted mixture of contrast material (50 mL of Gastrografin in 450 mL normal saline solution) . Image processing using multiplanar thick‐slab sliding MIP or volume rendering techniques is highly recommended because it helps visualization of thin fistulas or leaks . If urinary tract injuries are suspected, Urographic‐CT can be useful.…”
SummaryUterine malignancies account for the majority of gynaecologic cancers. Different treatment options are available depending on histology, disease grade and stage. Hysterectomy is the most frequent surgical procedure. Chemotherapy and radiation therapy (CRT) represents the preferred therapeutic choice for locally advanced uterine and cervical malignancies. Imaging of the female pelvis following these treatments is particularly challenging due to alteration of the normal anatomy. Radiologists should be familiar with both the expected post-treatment imaging findings and the imaging features of possible complications to make the correct interpretation and avoid possible pitfalls. The purpose of this review is to show the expected computed tomography (CT) and Magnetic Resonance Imaging (MRI) appearances of the female pelvis following surgery and CRT for uterine and cervical cancer, to illustrate the imaging findings of early and delayed most common complications after surgery and CRT, describing the suitable imaging modalities and protocols for evaluation of patients treated for gynaecologic malignancies.
“…Radiographic or better CT-cystography allows confident identification or exclusion (Fig. 10) of extraluminal contrast leakage indicating perforation (18). While large bladder defects need repair, small mural defects can be managed conservatively with catheter bladder decompression (4,5,11).…”
A rguably the most frequent general surgery procedure, inguinal hernia repair (IHR) reaches an annual rate of approximately 200 operations per 100.000 people/years. Since the introduction of the open-mesh IHR by Lichtenstein in 1989, tension-free hernioplasty with prosthetic mesh (PM) implantation became the standard of care and decreased the likelihood of recurrence by approximately 50%. Furthermore, the increasing use of laparoscopy in IHR allows faster recovery, decreased postoperative pain, lower risk of postoperative seroma, wound infection and hemorrhage, lower incidence of chronic pain and long-term hernia recurrence-at the price of longer operative time and higher risk of rare yet serious visceral injuries (1-5).Since most general hospitals perform hundreds of IHR procedures each year, radiologists are increasingly requested to investigate suspected iatrogenic complications (6, 7).Some authors recommend ultrasonography (US) as a helpful first-line modality to assess the operated groin, which allows rapid and confident detection of anechoic fluid seromas abutting the PM. However, US is often hampered by obesity, thickened subcutaneous fat, medications, and local tenderness at the surgical wound. Furthermore, hypo-anechoic or septated collections corresponding to hematomas or abscesses are sonographically challenging to interpret (7,8).During the last decade, some focused radiologic reports described the expected postsurgical computed tomography (CT) appearances after PM-IHR, particularly the characteristic pseudolesions which are discussed in-depth in a dedicated section of this paper (6, 9). Conversely, very limited literature exists on cross-sectional imaging of iatrogenic complications, mostly including a 2004 review based on axial CT (10) and a recent paper generally devoted to imaging complications related to laparoscopic access (11).This paper provides an overview of contemporary IHR, reviews and illustrates the expected postoperative imaging appearances and iatrogenic injuries with emphasis on multidetector CT findings.
Overview of surgical techniquesAs recent studies estimated a very low (<1%) risk of incarceration, a reducible inguinal hernia is not an indication for surgery unless the patient complains of pain or discomfort.
E M E R G E N C Y R A D I O LO G Y P I C TO R I A L E S S AY
ABSTRACTInguinal hernia repair (IHR) with prosthetic mesh implantation is the most common procedure in general surgery, and may be performed using either an open or laparoscopic approach. This paper provides an overview of contemporary tension-free IHR techniques and materials, and illustrates the expected postoperative imaging findings and iatrogenic injuries. Emphasis is placed on multidetector CT, which represents the ideal modality to comprehensively visualize the operated groin region and deeper intra-abdominal structures. CT consistently depicts seroma, mesh infections, hemorrhages, bowel complications and urinary bladder injuries, and thus generally provides a consistent basis for therapeutic choice. Since ...
“…The volumetric MDCT acquisition at sufficient bladder distension is visualised with multiplanar image reformations at CT angiography window settings (width 600–900 level 150–300 Hounsfield Units, HU) and by maximum intensity projection (MIP) or 3D-VR techniques. The only potential pitfall of this technique is the possible occlusion of a limited anastomotic dehiscence by the Foley catheter balloon [8, 15, 16]. …”
Section: Imaging Techniquesmentioning
confidence: 99%
“…8, 9) or MDCT cystography. Urinary VUA leaks invariably dictate prolonged bladder catheterisation, and imaging-guided drainage is needed in exceptional (less than 1 %) cases [8, 11, 15, 23]. Fig.…”
BackgroundRobot-assisted laparoscopic radical prostatectomy (RALRP) is currently accepted as the preferred minimally invasive surgical treatment for localised prostate cancer, with optimal oncologic and functional results. Despite growing surgical experience, reduced postoperative morbidity and hospital stays, RALRP-related complications may occur, which are severe in 5–7 % of patients and sometimes require reoperation. Therefore, in hospitals with an active urologic surgery, urgent diagnostic imaging is increasingly requested to assess suspected early complications following RALRP surgery.MethodsBased upon our experience, this pictorial review discusses basic principles of the surgical technique, the optimal multidetector CT (MDCT) techniques to be used in the postoperative urologic setting, the normal postoperative anatomy and imaging appearances.ResultsAfterwards, we review and illustrate the varied spectrum of RALRP-related complications including haemorrhage, urinary leaks, anorectal injuries, peritoneal changes, surgical site infections, abscess collections and lymphoceles, venous thrombosis and port site hernias.ConclusionKnowledge of surgical procedure details, appropriate MDCT acquisition techniques, and familiarity with normal postoperative imaging appearances and possible complications are needed to correctly perform and interpret early post-surgical imaging studies, particularly to identify those occurrences that require prolonged in-hospital treatment or surgical reintervention.Teaching points• Robot-assisted laparoscopic radical prostatectomy allows minimally invasive surgery of localised cancer• Urologic surgeons may request urgent imaging to assess suspected postoperative complications• Main complications include haemorrhage, urine leaks, anorectal injuries, infections and lymphoceles• Correct multidetector CT techniques allow identifying haematomas, active bleeding and extravasated urine• Imaging postoperative complications is crucial to assess the need for surgical reoperation
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