Giovanni Tortora

Cardarelli Hospital, Napoli, Campania, Italy

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Publications (15)20.64 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Nontraumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. In this context, multidetector computed tomography (MDCT) is the gold standard due to its intrinsic diagnostic value; its performance approaches 100% sensitivity and specificity, and it is accepted as a first-line modality for suspected acute aortic disease. MDCT allows early recognition and characterisation of acute aortic syndromes as well as the presence of any associated complications - findings that are essential for optimising treatment and improving clinical outcomes. Although classic CT findings have long been known, other unusual signs are continually reported in the medical literature. We reviewed the classic and less common CT findings, correlating them with pathophysiology, timing and management options, to achieve a definite and timely diagnostic and therapeutic definition.
    La radiologia medica 11/2011; 117(3):393-409. · 1.46 Impact Factor
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    ABSTRACT: We investigated the role of multidetector-row computed tomography (MDCT) in identifying active bleeding and its source in polytrauma patients with pelvic vascular injuries with or without associated fractures of the pelvis. From January 2003 to December 2007, 28 patients (19 men and nine women, age range 16-80 years) with acute symptoms from blunt pelvic trauma and a drop in haematocrit underwent MDCT and angiography. Conventional radiography of the pelvis was performed in all patients at the time of admission to the emergency department. MDCT was performed with a four-row unit in 15 patients and a 16-row unit in the remaining 13 patients. The study included whole-body CT to identify craniocerebral, vertebral, thoracic, abdominal and pelvic injuries. CT was performed before and after rapid infusion (4-5 ml/s) of intravenous contrast material (120 ml) using a power injector. A triphasic contrast-enhanced study was performed in all patients. MDCT images were transferred to a workstation to assess pelvic fracture, site of haematoma and active extravasation of contrast material, visibility of possible vascular injuries and associated traumatic lesions. At angiography, an abdominal and pelvic aortogram was obtained in all cases before selective catheterisation of the internal iliac arteries and superselective catheterisation of their branches for embolisation purposes. Results related to identifying the source of bleeding at MDCT were compared with sites of bleeding or vascular injury identified by selective pelvic angiography. The sensitivity and positive predictive value (PPV) of MDCT were determined. MDCT allowed us to identify pelvic bleeding in 21/28 patients (75%), with most cases being detected in the delayed contrast-enhanced phase (13/21 cases, 61.9%). Injured arteries were identified on MDCT in 12/21 cases (57%): the obturator artery (n=9), internal iliac artery (n=6), internal pudendal artery (n=6) and superior gluteal artery (n=5) were most frequently injured. In 8/21 patients (28.6%), more than one artery was injured. Among the 12 patients in whom MDCT showed the presence of pelvic haemorrhage, there was agreement between MDCT and angiography in ten cases. Angiography confirmed the site of bleeding detected on MDCT and identified a second arterial haemorrhage in one patient. There was no agreement between MDCT and angiography in the last patient. MDCT showed a sensitivity of 42.85% and a PPV of 100% in identifying the injured arteries. Arterial haemorrhage is one of the most serious problems associated with pelvic fracture, and it remains the leading cause of death attributable to such fractures. MDCT provides diagnostic information regarding the presence of small pelvic fractures and, thanks to the contrast-enhanced angiographic technique, it is capable of identifying pelvic bleeding, with the demonstration in some cases of it source. The presence of contrast material extravasation is an indicator of injury to a specific artery passing through the region of the pelvis where the extravasation is noted on MDCT. Urgent angiography and subsequent transcatheter embolisation are the most effective methods for controlling ongoing arterial bleeding in pelvic injuries.
    La radiologia medica 06/2010; 115(4):648-67. · 1.46 Impact Factor
  • Radiologia Medica - RADIOL MED. 01/2010; 115(4):648-667.
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    ABSTRACT: Inflammatory changes of the intestine leading to acute abdomen could represent a frequent diagnostic challenge for radiologists actively involved in the emergency area. MDCT imaging findings needs to be evaluated considering the clinical history and symptoms and other abdominal findings that could be of help in differential diagnosis. Several protocols have been suggested and indicated in the imaging of patient with acute intestine. However, a CT protocol in which the precontrast scanning of the abdomen is followed by i.v. administration of contrast medium using the 45-55 s delay could be effective for an optimal visualization of the bowel wall. It is important to learn to recognize how the intestine reacts to the injury and how it "talks", in order to become aware of the different patterns of disease manifestation related to an acute intestinal condition, for an effective diagnosis of active and acute inflammatory bowel disease.
    European journal of radiology 02/2009; 69(3):381-7. · 2.65 Impact Factor
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    ABSTRACT: Descending necrotizing mediastinitis is an acute, polymicrobial infection of the mediastinum, originating from odontogenic, oropharyngeal and cervical infections. Anatomical continuity of the fascial spaces between the neck and the mediastinum leads to an occasional mediastinal extension of deep neck infection as a serious sequela. An understanding of the anatomy of the deep spaces of the neck and familiarity with the imaging findings in descending necrotizing mediastinitis may allow rapid diagnosis and treatment of this rare and life-threatening complication of deep neck space infection. In this article, we discuss the current role of radiology in diagnosing descending necrotizing mediastinitis, in determining the level of infection and the pathways of spread of infections from the neck to the mediastinum and in planning a successful treatment.
    European Journal of Radiology 04/2008; 65(3):389-94. · 2.51 Impact Factor
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    ABSTRACT: Nosocomial pneumonia is the most frequent hospital-acquired infection. In mechanically ventilated patients admitted to an intensive-care unit as many as 7-41% may develop pneumonia. The role of imaging is to identify the presence, location and extent of pulmonary infection and the presence of complications. However, the poor resolution of bedside plain film frequently limits the value of radiography as an accurate diagnostic tool. To date, multi-detector row computed tomography with its excellent contrast resolution is the most sensitive modality for evaluating lung parenchyma infections.
    European Journal of Radiology 04/2008; 65(3):333-9. · 2.51 Impact Factor
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    ABSTRACT: The diseases affecting the large intestine represent a diagnostic problem in adult patients with acute abdomen, especially when clinical symptoms are not specific. The role of the diagnostic imaging is to help clinicians and surgeons in differential diagnosis for an efficient early and prompt therapy to perform. This review article summarizes the imaging spectrum of findings of colonic acute disease, from mechanical obstruction to inflammatory diseases and perforation, offering keys to problem solving in doubtful cases as well as discussing regarding the more indicated imaging method to use in emergency, particularly MDCT.
    European Journal of Radiology 04/2007; 61(3):424-32. · 2.51 Impact Factor
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    ABSTRACT: Injuries to the small and large intestine from blunt trauma represent a defined clinical entity, often not easy to correctly diagnose in emergency but extremely important for the therapeutic assessment of patients. This article summarizes the MDCT spectrum of findings in intestinal blunt lesions, from functional disorders to hemorrhage and perforation.
    European Journal of Radiology 10/2006; 59(3):359-66. · 2.51 Impact Factor
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    ABSTRACT: Intestinal ischemia in the pediatric age group is a rare occurrence. We describe a case of MDCT findings of ischemia due to midgut torsion without intestinal obstruction in a 12-year-old boy, successfully submitted to surgery without any intestinal resection required.
    Emergency Radiology 07/2005; 11(4):236-8.
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    ABSTRACT: In this pictorial essay, we consider the post operative MDCT findings after liver resection, transplantation, surgical managed major trauma and radiofrequency ablation of focal lesions. Common complications such as fluid collections, hemorrhage, biloma, vascular disease, hematoma, abscesses will be also considered.
    European Journal of Radiology 04/2005; 53(3):425-32. · 2.51 Impact Factor
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    ABSTRACT: Abdominal blunt trauma represents the main cause of death in people of age less than 40 years; the liver injury occurs frequently, with an incidence varying from 3 to 10%. Isolated hepatic lesions are rare and in 77-90% of cases, lesions of other organs and viscera are involved. Right hepatic lobe is a frequent site of injury, because it is the more voluminous portion of liver parenchyma; posterior superior hepatic segments are proximal to fixed anatomical structures such as ribs and spine that may have an important role in determining of the lesion. The coronal ligaments' insertion in this parenchymal region augments the effect of acceleration-deceleration mechanism. Associated lesions usually are homolateral costal fractures, laceration or contusion of the inferior right pulmonary lobe, haemothorax, pneumothorax, renal and/or adrenal lesions. Traumatic lesions of left hepatic lobe are rare and usually associated with direct impact on the superior abdomen, such as in car-crash when the wheel causes a compressive effect on thorax and abdomen. Associated lesions to left hepatic lobe injuries correlated to this mechanism are: sternal fractures, pancreatic, myocardial, gastrointestinal tract injuries. Lesions of the caudal lobe are extremely rare, usually not isolated and noted with other large parenchymal lesions. The Institution of Specialized Trauma Centers and the technical progress in imaging methodology developed in the last years a great reduction of mortality. New diagnostic methodologies allow a reduction of negatives laparotomies and allow the possibility of conservative treatment of numerous traumatic lesions; however, therapy depends from imaging findings and clinical conditions of the patient. Computed tomography (CT) certainly presents a large impact on diagnosis and management of patients with lesions from blunt abdominal traumas. It is important to establish a prognostic criteria allowing decisions for conservative or surgical treatment; CT findings and peritoneal fluid evaluation may be used to make a first differentiation of severity of lesions, but haemodynamic parameters may help the clinician to prefer a conservative treatment. In emergency based hospitals and also in our experience, positive benefits spring from diagnostic accuracy and consequent correct therapeutic management.
    European Journal of Radiology 05/2004; 50(1):59-66. · 2.51 Impact Factor
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    ABSTRACT: 1. Un trombo venoso recente della vena gonadica destra. 2. Direttamente nella vena cava inferiore, a differenza della vena ovarica sinistra che affluisce alla vena renale dello stesso lato. 3. Sub-totale, per la presenza di sottile lume vasale opacizzato dal mdc disposto tra il trombo e la parete del vaso, da non confondere con il ring contrastografico dovuto all’enhancement dei vasa vasorum delle occlusioni complete.
  • Giovanni Tortora, Luigia Romano
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    ABSTRACT: 1. Il cianoacrilato che occlude l’AMS e sottili rami della pancreatico-duodenale. 2. Si: in tale fase sembra che l’AMS sia normo-opacizzata dal mdc, in realtà il reperto risulta erroneo. 3. Segni ischemico-infartuali con vasi afferenti occlusi dal cianoacrilato.
  • Giovanni Tortora, Teresa Cinque, Raffaele Mazzeo
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    ABSTRACT: 1. Sì, sono secondarie alla trombosi della vena renale. 2. Disseminazione ematogena di emboli settici. 3. Aree di colliquazione ad evoluzione ascessuale. 4. Lesioni cavitate polmonari, lesioni infartuali polmonari, lesioni primitive e/o secondarie polmonari, infiltrati fungini, lesioni renali primitive.
  • Luigia Romano, Ciro Stavolo, Giovanni Tortora
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    ABSTRACT: 1. Ascesso pluriconcamerato dei muscoli iliaco, piriforme e piccolo gluteo di destra con falda di versamento fluido corpuscolato nel cavo di Douglas. 2. Il protocollo prevede uno studio di base e monofasico con mdc e.v. per rilevare eventuali focolai ascessuali o segni di flogosi appendicolare. Parametri di iniezione del mdc: concentrazione 400 mg/mL; flusso: 2,5-3 mL/sec; volume 100 mL; soluzione fisiologica: flusso 2 mL/sec; volume 40 mL; fase portale ottenuta con ritardo di 75 secondi. 3. È opportuno associare un esame colturale del fluido ascessuale previa aspirazione con ago sottile sotto guida TC. 4. Lo studio MDCT di base ha evidenziato un coagulo nell’ambito della raccolta perivasale di destra. A circa 7 giorni dal primo esame TC, nell’ottica di una valutazione dell’efficacia della terapia antibiotica si è ritenuto opportuno effettuare un studio con protocollo bifasico in fase arteriosa e portale per chiarire il significato del coagulo identificato nel precedente controllo.