Assessment of suspected cervical spine injuries remains a major debate in trauma care. It is generally accepted that many fractures are missed or incompletely shown at radiography, mainly because of suboptimal studies obtained in obtunded, uncooperative trauma victims. In a series of 88 severely traumatized patients, the authors retrospectively determined the type, distribution, and significance of such missed lesions. This assessment was made by comparing radiographs and helical computed tomographic (CT) scans of the cervical spine and reviewing medical records in these cases. Of the 88 patients, 32 patients had cervical spine fractures (n = 50) that were not revealed or were incompletely demonstrated at radiography. Most missed fractures occurred at the C-1 to C-2 and C-6 to C-7 levels, and most involved the transverse processes and the posterolateral elements of the vertebrae. One-third of the patients with missed fractures had either clinically significant or unstable injuries, as determined on the basis of mechanistic or imaging criteria. Helical CT can depict significant fractures not shown by plain radiography and should be added routinely to the initial screening for cervical spine fractures in polytrauma victims.

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Ten patients with subhepatic fluid collections complicating laparoscopic cholecystectomy were successfully treated by interventional radiological procedures. The series included five abscesses, three hematomas, one biloma, and one serous collection. Abdominal pain or fever developed from 3 to 21 days after the laparoscopic intervention. All patients were asymptomatic 72 h after percutaneous drainage and there were no complications related to the procedure. Subhepatic fluid accumulations are common findings after laparoscopic cholecystectomies and have been considered an unreliable indicator of infection or other postoperative complications. However, the significance of these collections should not be underestimated in symptomatic patients. In such cases we propose diagnostic aspiration and drainage, when necessary, to safely and promptly establish the precise diagnosis and treatment. More serious complications can be avoided by early percutaneous intervention.