Abstract: The objective of the study was to evaluate the ability of hemorrhage site and location as demonstrated on pelvic CT to predict the source of arterial hemorrhage in patients with traumatic pelvic fractures CT scans of 104 consecutive patients who had sustained traumatic pelvic fracture and undergone emergent pelvic angiography were digitized, and fracture-related hemorrhage area and volume were measured at multiple locations within the pelvis Clots that measured greater than 10 cm2 were compared to angiographic results The χ2 test was used to find locations on CT that were significantly associated with specific arterial injuries found on angiography Sixty-one (58%) of the patients had arterial bleeding at angiography The most commonly injured arteries were the internal pudendal and the superior gluteal Specific locations on CT were statistically significant indicators of injury to the superior gluteal artery (relative risk=29, 95% CI 12–73, P=0013), the anterior division of the internal iliac artery (relative risk=32, 95% CI 14–41, P=0006), and the internal pudendal arteries (relative risk=20, 95% CI 11–40, P=0037) More blood was visible on CT when an artery was injured (mean volume with negative angiogram=318 ml, mean volume with positive angiogram=554 ml, (P=0007)) The rectus sheath region at the top of the iliac crest (P=0004), pelvic sidewalls at the L5–S1 disk space level (P=0001), and gluteal regions also at the L5–S1 disk space level (P=0012) were significant indicators of a positive arteriogram CT can help predict the specific bleeding artery to potentially guide angiographic intervention

Abstract: The aim of the study was to evaluate clinical and laboratory variables in patients undergoing spleen autotransplantation. We studied 29 patients with severe trauma of the spleen and its pedicle. Of these, 20 underwent autotransplantation (group I) and 9 underwent total splenectomy without preservation of splenic tissue (group II). Twenty-two additional subjects with an intact spleen were used as controls (group III). Immediate and late postoperative complications were investigated. Laboratory counts were performed during the late postoperative period (red blood cells, hemoglobin, white blood cells, platelets, and Howell–Jolly bodies). To investigate the immunological profiles of patients we performed B- and T-lymphocyte counts and determined IgA, IgG, and IgM levels. All patients underwent splenic scintigraphy with technetium 99m sulfur colloid. Groups I and III did not present abnormal blood bodies, and their hematological and immunological patterns were normal. Group II showed increased numbers of Howell–Jolly bodies and low IgM levels. Splenic scintigraphy indicated the viability and filtering function of the splenic remnant in group I. Autotransplantation is a good option to maintain splenic function when total splenectomy is necessary.

Abstract: The aim of the study was retrospectively to evaluate the spectrum of chest diseases in patients presenting with clinical suspicion of thoracic aortic dissection in the emergency department We performed a retrospective medical records review of 86 men and 44 women (ages ranging between 23 and 106 years) with clinically suspected aortic dissection, for CT scan findings and final clinical diagnoses dating between January 1996 and September 2001 All images were obtained by using a standard protocol for aortic dissection We found aortic dissection in 32 patients (246%), 22 of which were Stanford classification type A and 10 Stanford type B In 70 patients (539%), chest pain could not be explained by the CT scan findings However, in 28 patients (215%), CT scanning did reveal an alternate diagnosis that, along with the clinical impression, probably explained the patients' presenting symptoms, including: hiatal hernia (7), pneumonia (5), intrathoracic mass (4), pericardial effusion/hemopericardium (3), esophageal mass/rupture (2), aortic aneurysm without dissection (2), pulmonary embolism (2), pleural effusion (1), aortic rupture (1), and pancreatitis (1) In cases where there is clinical suspicion of aortic dissection, CT scan findings of an alternate diagnosis for the presenting symptoms are only slightly less common than the finding of aortic dissection itself Although the spectrum of findings will vary depending upon your patient population, beware the alternate diagnosis

Abstract: Acute epiploic appendagitis (AEA) is a benign self-limiting process presenting with acute abdominal pain often misdiagnosed clinically as either diverticulitis or appendicitis, but which has a pathognomonic CT appearance. The CT findings in 33 adult patients diagnosed by CT over a 33-month period as having AEA were retrospectively reviewed. The study group included 24 men and 9 women, with a mean age of 44.6 years. The mean age of the male patients was lower than that of the female patients, 40.9 vs 54.7 years. All patients presented with acute abdominal pain, mainly in the left (n=21) and right (n=9) lower quadrants, with localized tenderness in all patients and peritoneal irritation in 15 of them. Low-grade fever was found in 8 patients and mild leukocytosis in 16. Characteristic CT findings of an oval fatty mass with central streaky densities and surrounded by mesenteric stranding adjacent to the serosal surface of the colon were seen in all cases. Additional findings included mural thickening of the juxtaposed colon in 16 patients and peritoneal fluid in 7. One patient underwent surgery on the basis of an erroneous diagnosis of acute appendicitis. As CT is often used nowadays to evaluate various acute abdominal complaints, it may be the first imaging modality by which AEA is diagnosed. AEA should be included in the differential diagnosis in young male patients with localized left lower abdominal pain and tenderness.

Abstract: Injuries to the sternoclavicular joint are an uncommon problem, but can be life-threatening if not diagnosed and treated properly. Both anterior and posterior sternoclavicular dislocations or subluxations can occur, the latter being a rare injury. In this case report we report the imaging findings of both conventional radiography and multidetector CT on a 16-year-old man who developed a posterior sternoclavicular dislocation while participating in a football match. The current literature regarding this subject is also reviewed.

Abstract: Portomesenteric pneumatosis has been traditionally associated with intestinal infarction and poor outcome; however, recent studies have questioned its clinical value. To assess its diagnostic and prognostic significance we have retrospectively evaluated 47 patients correlating the CT finding of portomesenteric vein gas with clinical data and outcome. Thirty-nine patients (83%) had surgical evidence of intestinal infarction, four had necrotic small bowel volvulus (8.5%), two had blunt trauma, one had necrotic gastric volvulus, and one a gastric mucosal lesion induced by a nasogastric tube. Fifteen patients survived (31.9%); only 8/39 patients with intestinal infarction survived. Portomesenteric pneumatosis is a reliable marker of intestinal infarction and poor outcome; however, in trauma patients this sign is associated with a better prognosis.

Abstract: Several conditions can clinically mimic renal colic. We assessed the accuracy of non-contrast-enhanced helical CT and of ultrasonography (US) in offering an alternative explanation for flank pain. In a 3-year period, 181 patients with acute flank pain underwent US and non-contrast-enhanced helical CT in a blinded sequence. Their efficacy in detecting both alternative causes of pain and additional findings unrelated to the pain was assessed in 160 cases with a confirmed diagnosis. An alternative cause was found in 23 cases (14%). US gave 4 false-negative results (1 acute appendicitis, 1 ovarian cyst torsion, 1 diverticulitis, and 1 papillary necrosis) and 2 false-positive results (1 acute pyelonephritis and 1 diverticulitis), with a 78% sensitivity and a 98% specificity for nonlithiasic causes. CT gave 5 false-negative results (1 complicated ovarian cyst, 1 pleuritis, 1 epididymitis, 1 acute pyelonephritis, and 1 papillary necrosis) and 1 false-positive (1 simple ovarian cyst described as a complicated lesion), resulting in a 74% sensitivity and a 99% specificity for diagnosing alternative causes. There were 130 additional US findings in 68 patients and 151 additional CT findings in 77 patients. A wide spectrum of findings can be identified in subjects imaged for flank pain. Non-contrast-enhanced helical CT and US have comparable accuracy in diagnosing causes other than stone disease.

Abstract: The aim of this study was to determine the sensitivity, specificity, and diagnostic accuracy of helical computed tomography (CT) without oral, intravenous, or rectal administration of contrast material in confirming the diagnosis of acute appendicitis in patients with suggestive clinical and laboratory findings. One hundred and thirty patients with suspected acute appendicitis underwent an unenhanced helical CT scan. Scans were obtained in a single breath-hold from the level of umbilicus to the pubic symphysis using a 5-mm collimation. Oral, intravenous, or rectal contrast materials were not used. The criteria for diagnosis of acute appendicitis included an enlarged diameter of appendix more than 6 mm with associated periappendiceal inflammation. The results yielded a sensitivity of 94.7%, a specificity of 91.7%, an accuracy of 93.8%, a positive predictive value of 96.7%, and a negative predictive value of 86.8%. Unenhanced helical CT accurately diagnoses acute appendicitis, and it protects the patients from unnecessary further time-consuming diagnostic procedures, the risks associated with contrast material administration, and unnecessary surgical interventions.

Abstract: Following initial clinical evaluation and stabilization of a patient who has sustained blunt chest trauma, imaging has an important role in the evaluation of thoracic injuries. The initial study is the chest radiograph. However, chest CT is being used with increased frequency in the evaluation of blunt chest trauma. Although CT is used primarily to assess for traumatic aortic injuries, it is also useful in the evaluation of pulmonary and bronchial, airway, skeletal and diaphragmatic injury. The aim of this article is to review the characteristic imaging findings of pulmonary and bronchial, esophageal, thoracic, skeletal and diaphragmatic injuries.

Abstract: Traumatic aortic injury (TAI) is a major cause of fatality in high speed deceleration injuries. It accounts for 10–20% of fatalities in blunt chest trauma. These injuries are usually related to high-speed motor vehicle and motorcycle collisions, pedestrian–motor vehicle collisions, and falls. Only 10–20% of patients who suffer TAI survive the initial injury and reach the emergency department. If left untreated, 30% die within 6 h, 40–50% die within 24 h, and 90% die within 4 months. A chronic pseudoaneurysm will develop in 2–5% of patients whose injury is not diagnosed. It is imperative, therefore, that these injuries are detected promptly and accurately. Symptoms and physical examination findings are nonspecific. External evidence of chest wall injury is present in 7–90% of cases, so that in up to 30% of the cases no apparent chest injury is identified on physical examination. Chest radiographs are very sensitive in detecting mediastinal hemorrhage, but have a low positive predictive value for aortic injury. The positive predictive value for chest radiography ranges between 5% and 20% for TAI. Aortography has been considered the gold standard for many years in the evaluation of TAI, but is time-consuming, labor- and resource-intensive, and invasive. Because of the shortcomings of physical examination and these more traditional imaging examinations, computed tomography (CT) has become increasingly utilized as a screening and diagnostic tool. Recent investigations have documented its high sensitivity and specificity in the detection of TAI. This article reviews the recent investigations of imaging evaluation of TAI, with a focus on helical CT.

Abstract: Any irritation or disruption to the underlying bone will cause a periosteal reaction and result in new periosteal bone deposition. Periosteal bone formation may be due to either physiologic or pathologic causes. Pathologic bone formation generally results from an adjacent inflammatory process or a hypoxic or toxic stimulus. Common causes of pathologic periosteal reaction in children include trauma to the underlying bone. However, other causes such as hypervitaminosis A, prostaglandin therapy, cortical hyperostosis (Caffey's disease), hypertrophic osteoarthropathy (primary and secondary), osteomyelitis, leukemia, trauma, and syphilis must also be considered. The last four are usually associated with some degree of bone destruction, while in the first four diseases the underlying bone is left radiologically intact. This paper will concentrate on those diseases that appear to leave the underlying bone intact. The clinical and radiological features that help to differentiate some of these entities are presented.

Abstract: The multiple trauma patient is usually initially imaged with a portable "trauma series" consisting of a lateral cervical spine film, a portable chest film, and a portable pelvis film (PPF). An investigation was performed to determine whether the screening PPF could be eliminated for multiple trauma patients being examined by abdominopelvic CT scan (APCT). A retrospective investigation analyzed all patients evaluated in our level I trauma center from 1 January to 31 December 2000 who were examined with a "trauma series" followed by an APCT scan within 8 h. The numbers and types of fractures diagnosed by PPF and by APCT were compared and correlated with clinical follow-up. Of 397 patients imaged by both PPF and APCT, 43 patients were diagnosed with 109 individual fractures by CT scan. The PPF did not detect 51 of the 109 individual fractures (47%) and failed to diagnose 9 of the 43 patients (21%) with a pelvic fracture. The PPF most often failed to detect sacral and iliac fractures. The four cases in which the PPF reported a fracture not listed in the APCT report were due to reporting errors or film artifacts. No soft tissue injuries were seen by PPF that were not also seen by APCT. We conclude that the screening PPF appears to be an unnecessary exam in multiple trauma patients about to be imaged by APCT scan.

Abstract: Objective: To define patterns of diagnostic error in the interpretation of trauma abdominal CT. Materials and methods: Two hundred fifty-four out of 1751 abdominal CT scans performed for evaluation of trauma had a definite or equivocal diagnosis of an abdominal injury. Cases were re-read initially without reference to the original reports, in which 44 potential diagnostic errors were identified. A panel of two or three expert readers reviewed each of the 44 cases along with the original report to evaluate the diagnostic error and to search for patterns among the errors. Results: Thirty-one of the 254 CT scans (12%) that were re-read contained non-trivial mistakes that could affect patient outcome. Seventeen were false negative and 14 were false positive. Diagnostic errors were found in the liver, spleen, kidney, retroperitoneum, and peritoneal cavity. Patterns of false-negative diagnosis included missed vascular contrast extravasation, missed hemoperitoneum, and missed right retroperitoneal hematoma. Patterns of false-positive diagnosis included: periportal edema or blood tracking, called a liver laceration; respiratory motion, called a splenic or renal injury; and linear or round lucencies in the spleen or liver, called a laceration. Conclusion: Diagnostic errors in interpreting trauma abdominal CT cluster in several recurring patterns. Awareness of these patterns may assist readers in avoiding future errors.

Abstract: We report on a 58-year-old man with known diabetes, congestive heart failure, and need for chronic hemodialysis presenting with right lower abdominal quadrant pain, fever, and leukocytosis. Although initial clinical findings were highly suggestive of acute appendicitis, CT revealed marked circumferential wall thickening of the cecum, which was interpreted as cecal infarction by the radiologist. Intraoperatively, cecal necrosis was confirmed, but the ileocecal valve and, especially, the appendix showed no ischemia. No vascular occlusions were found. Histopathologic analysis of the resected cecum demonstrated isolated transmural cecal necrosis with marked infiltration of the cecal wall by numerous bacteria and neutrophils. We present the CT features and histopathologic findings of isolated cecal gangrene, review the pathogenesis of occlusive and nonocclusive cecal ischemia or infarction, and discuss the role of bacterial superinfection as a potential cofactor in the pathogenesis of isolated cecal necrosis which should be included in the differential diagnosis of right-sided inferior abdominal quadrant pain.

Abstract: The aim of this study is to describe the effects of a new night float system on the circadian rhythm and clinical judgment of our residents. In addition, the study looks at the residents' opinions of how to optimize the night float system in the future. All 20 of the radiology residents at our institution completed a questionnaire about the night float system after completing their night float coverage. The results of the questionnaire were then compiled and tabulated. It took our residents an average of 2.0 days to become acclimated to the night float and an average of 2.3 days to return to a normal daily routine after completing the night float. No residents perceived impairment in their clinical judgment while on the night float. However, 9 of the 20 residents (45%) stated that their clinical judgment was improved on the night float compared to that of a 24-hour call. Eighteen of 20 residents (90%) preferred the night float system to a 24-hour call system. On average, our residents believe that the optimal number of hours for a night float shift is 10.5 hours and the optimal numbers of days to do the night float consecutively is 6.8 days. In conclusion, a night float system can be a preferable means of evening coverage as it has a minimal effect on the circadian rhythm by allowing residents to become acclimated to working the night shift over the course of several days. The night float system also demonstrates no appreciable adverse effects on clinical judgment and may allow better clinical judgment than a 24-hour call system.

Abstract: The CT diagnosis of bowel injury is difficult and warrants an organized approach. Careful scrutiny of CT images for extraluminal gas or fluid and bowel wall thickening is required. Review of images of the entire abdomen and pelvis using lung window settings is recommended, followed by the analysis using soft tissue window settings. Specific search for extraluminal fluid collections with a triangular or matted appearance will help detect bowel injury.

Abstract: Objectives: To determine whether the Ottawa ankle rules (OAR) can be applied in children and what the potential reduction in the use of X-ray studies might be. Methods: Prospective, observational study of children attending emergency department with blunt ankle and midfoot injuries. X-ray studies were obtained after recording of the physical assessment. A single investigator who was blinded to the emergency physician's interpretations and to the radiologist's interpretations of the studies then applied the OAR to each patient. Sensitivity, specificity, and positive and negative predictive values of the OAR were calculated with 95% confidence intervals. Results: The OAR were 100% sensitive (95% CI=81–100%) and 30% specific (95%CI=19–43%). Positive and negative predictive values were 28% (95%CI=17–41%) and 100% (95% CI=82–100%) respectively. The number of X-ray studies ordered would have been reduced by 24% if the OAR had been applied. Conclusions: The Ottawa ankle rules are very sensitive and can be applied in children, resulting in a reduction in the use of X-rays studies.

Abstract: Objective: To determine whether a vacuum phenomenon in the sacroiliac joint is a reliable sign of pelvic injury in trauma patients. Materials and methods: Prospective data were collected over a 1-year period for 107 patients with pelvic trauma and 104 nontrauma patients. Age ranges were 13–93 years in the trauma group and 19–83 years in the nontrauma group. All the patients had pelvic CT scans. The cases were assessed with regard to gas in the sacroiliac joint, osseous pelvic injuries, and mechanism of injury, and demographic data were analyzed. Injuries were caused by motor vehicle accidents in 67 cases, pedestrians being struck by a motor vehicle in 20, falling from a height in 18, gunshot wound in 1, and crush injury in 1. The indications for CT scan in the nontrauma patients were pain in 33 cases, infection in 31, cancer in 29, transplant in 5, bleeding in 4, and abnormal liver function tests in 2. Results: Gas in the sacroiliac joint was present in 11 out of 107 trauma patients (10%) and 12 out of 104 nontrauma patients (12%). There was no statistical difference in the incidence of the vacuum phenomenon between the two patient populations according to the Χ2 test. Degenerative sacroiliac changes were evident in 18 out of 107 trauma patients (17%) and 32 out of 104 nontrauma patients (41%). Conclusion: Gas in the sacroiliac joint is not a reliable indicator of sacroiliac joint injury.

Abstract: The purpose of this study was to determine the value of flexion and extension MR in traumatized cervical spines following rear low-impact acceleration-deceleration injury. The cervical spines of 100 consecutive uninjured normal asymptomatic adults and 100 adult accident victims following rear low-impact motor vehicle accidents were evaluated using rapid T2-weighted MRI. Subjects were matched for age but not gender. The age range was 18 to 53 years, with a mean of 35 years. Injured subjects were evaluated during the subacute period, at 12 to 14 weeks after injury, following clinically resolved muscle spasm. Imaging findings were compared between normal and injured subjects. The normal subjects showed a stepwise segmental motion pattern that started at C1-C2 and transmitted to the lower cervical segments. Loss of normal cervical lordosis (hypolordosis) was observed in 4% (4 of 100) patients. Normal range of motion (rounded to the nearest 5 masculine ) was quantified as 50 masculine flexion (range, 45-65 masculine; standard deviation, 6.5 masculine ) and 60 masculine extension (range, 50-70 masculine; standard deviation, 6.5 masculine ). Asymptomatic disk herniations were observed in 2% (2 of 100) patients. In the subacute post-traumatic subjects, there was a loss of the normal segmental motion pattern, with hypolordosis in 98% (98 of 100) patients. Range of motion (rounded to the nearest 5 masculine ) was restricted, quantified as 25 masculine flexion (range, 5-40 masculine; standard deviation, 15 masculine ) and 35 masculine extension (range, 20-50 masculine; standard deviation, 10 masculine ). Disk herniations were observed in 28% (28 of 100) patients. Biomechanical changes in the herniated disk were noted, with mildly increased spinal stenosis following flexion. The authors conclude that flexion and extension MR can be a valuable adjunct examination in the evaluation of patients in the clinical setting of subacute cervical spine trauma.

Abstract: Rupture of a silicone Port-a-Cath catheter may occur, especially with costoclavicular pinch-off syndrome (POS), which is a typical consequence of fatigue when the catheter is introduced in the subclavian vein too medially. This case report describes the percutaneous retrieval of a fractured silicone port catheter fragment, which had migrated into the internal jugular vein. Extraction was complicated by the presence of an internal jugular vein stenosis and the fact that the catheter fragment was looped upon itself. Several retrieval devices failed before an Amplatz gooseneck snare finally allowed retrieval of the fragment. We recommend this device for extraction of silicone port catheter fragments. Rerupture of the port catheter occurred 7 months after surgical reinsertion at the same infraclavicular site, as a consequence of constant compression by POS. Alternative approaches should be used after catheter failure due to POS.

Abstract: Imaging plays an important role in the evaluation of the pediatric thorax following blunt and penetrating trauma. This essay reviews important differences between children and adults with respect to the pattern of thoracic injury. Additionally, the role of various imaging modalities in the assessment is discussed. Finally, the spectrum of pediatric thoracic injury is provided.

Abstract: The purpose of this study was to describe isolated injury of the cuboid bone as a potentially radiographically occult cause of foot pain The imaging studies of 17 patients, 13 women and 4 men aged 17–79 years (average 45 years), who presented with pain over the lateral aspect of the midfoot were retrospectively reviewed Frontal, lateral, and inversion-oblique radiographs were available for all patients In addition, MR imaging was performed in eight patients, CT in two, conventional tomography in two, and bone scan in one Conventional radiographs revealed cuboid fracture in seven patients Of the remaining ten, eight underwent MR imaging which demonstrated four fractures, three bone bruises, and one stress reaction, and two had tomography, CT, and/or bone scan, all of which documented an isolated cuboid fracture Isolated fracture of the cuboid may be radiographically occult Other imaging modalities, particularly MR imaging, can document this injury as the source of pain

Abstract: Mesenteric vascular ischemia is a known complication of cocaine use. Although the majority of cases of cocaine-induced mesenteric ischemia present with ischemic colitis and rectal bleeding, several cases have been described presenting only with abdominal pain. We present a case of mesenteric vasoconstriction with angiographic documentation and treatment.

Abstract: Purpose: The purpose of this study is to evaluate the MR findings in patients with long-term ankylosing spondylitis (AS) and acute cervical spine fractures. Materials and methods: The magnetic resonance imaging (MRI) studies of five patients with AS and acute cervical spine fractures were retrospectively reviewed for the presence of cervical spine instability, spinal cord compression, and epidural hematoma. Results: Spinal fractures were unstable in all five patients. Three patients had neurological symptoms and abnormal signal within the spinal cord. All patients with neurological deficits had epidural hematomas posterior to the dural sac. Conclusion: MRI is useful for assessment of the integrity of intervertebral disks and spinal ligaments and, therefore, of the instability of the spinal fracture. MRI is mandatory in patients with neurological symptoms, especially in those with a symptom-free interval and those with neurological deterioration after established spinal cord injury, when suspicion for epidural hematoma is high.

Abstract: Purpose: To assess acute phase multi-slice CT findings in horse-riding accidents in patients referred to a level one trauma center. Methods: Using PACS, we retrieved all CT requests during a time period of 19 months. Patients who had a horse-riding accident and were examined with multi-slice CT were included. The imaging findings of multi-slice CT were retrospectively evaluated by location and injury mechanism. Results: Forty-six patients (3 male, 43 female, age 16–55 years, mean age 30) were assessed. The injuries we found were five head, three facial, 13 spine, five body, two pelvic, and three lower extremity trauma. Multiple injuries were seen in five (11%) patients. In 21 patients (46%) the initial multi-slice CT examination(s) was normal. Three main injury mechanisms were established; falling off a horse (72%), a horse kick (11%), and crushing injury caused by a falling horse (13%). Fifteen (33%) patients had serious injuries, one lethal and they were associated more frequently with falling off a horse. Conclusion: Serious injuries with horse riding accidents are not uncommon. In two thirds of patients, the injury mechanism was falling off a horse. Multiple injuries were seen in 11% of cases. In the acute phase, multi-slice CT provided fast and valuable information in assessing these injuries.

Abstract: Rigid or fiberoptic endoscopy is performed to evaluate the trachea in a patient with suspected tracheal injury. We present a case in which CT virtual endoscopy identified a tracheal laceration not seen on axial or sagittal reformations. This case highlights the usefulness of this modality in the diagnosis and preoperative planning of tracheal injury.

Abstract: Objective: The purpose of this retrospective study was to determine the value of contrast-enhanced computed tomography (CT) in the detection and management of mesenteric injuries after blunt trauma. Materials and methods: Between June 1995 and December 2000, 1,619 consecutive abdominal CT examinations were performed in the setting of major blunt trauma. Findings at CT were evaluated before patients were classified as having grade 1 or grade 2 lesions or none. Grade 1 represented the presence of minor injuries: mesenteric haziness, confined fluid, and/or small hematomas ( 30 mm), active bleeding, hemoperitoneum, and further abdominal injuries. Results: On the basis of the CT findings, 161 (9.9%) of 1,619 patients were classified as having grade 1 and 25 (1.5%) of 1,619 patients as having grade 2 injuries. Of the 161 (77.6%) patients with grade 1 injuries, 125 were managed conservatively, while 36 (22.4%) underwent surgery. Of the 25 (84%) patients with grade 2 injuries, 21 were treated surgically and 1 (4%) patient was followed medically. Three (12%) of the 25 patients underwent laparotomy after 24 h close clinical observation and monitoring. Initial CT findings in 1,433 (88%) of the 1,619 patients were negative for mesenteric injuries, and in 1,430 of these cases no delayed mesenteric hemorrhage was observed. Conclusion: Contrast-enhanced CT has a critical role in the identification and exclusion of mesenteric injuries. Persistent, active extravasation of contrast material, in isolation or associated with further abdominal lesions, is a sign of a high likelihood of injury requiring urgent laparotomy. Haziness, isolated confined clotted mesenteric hemorrhage, and small hematomas within the mesentery are nonspecific findings and should be considered in the appropriate clinical context. Close clinical observation, monitoring, and surgical expertise are mandatory for appropriate management.

Abstract: Ultrasound is a rapid, widely available and inexpensive imaging modality for the evaluation of the ankle and hindfoot. Ultrasonography can be performed in acute, semiacute and chronic conditions. Ankle injuries can be evaluated with ultrasound combined with X-rays. In the emergency room, acute trauma of ankle and hindfoot is an important indication for ultrasound.

Abstract: We report here a case of sigmoid diverticulitis complicated by a colovenous fistula, as a rare but also a nonfatal cause of hepatic portal venous gas. The different radiological examinations and their features will be discussed.