Computed tomography (CT)-guided biopsy of the spine is considered a safe, accurate, and relatively inexpensive examination technique. Our purpose was to determine the diagnostic accuracy of CT-guided biopsies exclusively for vertebral osteomyelitis. A retrospective study was performed from a consecutive series of 72 patients with confirmed vertebral osteomyelitis with 46 CT-guided biopsies performed in 40 patients. Biopsy specimens were sent for bacteriologic and cytologic analysis. An adequate specimen for microbiologic examination was not obtained in one case and not enough sample for additional pathologic examination in 17 cases. The mean age of patients was 58 years, with a range of 1-88 years, including 24 men and 16 women. The level of spinal biopsy was thoracic in 18 (40%) and lumbar in 28 (60%). The analysis revealed the infection agent in 20 cases (43% sensitivity). Diagnostic rates obtained in patients with previous antibiotic treatment were significantly lower (23% vs. 60%, p = 0.013). Computed tomography-guided fine-needle aspiration biopsy is an important tool in the diagnostic evaluation of vertebral osteomyelitis. However, this technique yields a lower diagnostic rate than previously reported biopsy of neoplastic vertebral lesions, especially if performed in patients with previous antibiotic treatment.

Necrotizing fasciitis is a rare, rapidly progressive infectious process primarily involving the fascia and the subcutaneous tissue, with thrombosis of the cutaneous microcirculation. We present a case of necrotizing fasciitis secondary to diverticulitis in an immunosuppressed patient with rheumatoid arthritis.

We present the case of a 76-year-old man referred to our hospital with a round stone in central mediastinum and pneumomediastinum in chest radiography and computed tomography. He had a previous history of attempt of endoscopic retrievement of a gallstone that had caused a gastric outlet obstruction (Bouveret syndrome). To our knowledge, this is the first imaging description of mediastinal gallstone caused by esophagus perforation during complicated endoscopic lithotomy.

Metastasic cardiac disease from the breast is rarely diagnosed in the lifetime. It has a poor prognosis and limited management. Both echocardiography and computerized tomography (CT) should be the first imaging studies in suspicion of this entity. Other diagnostic methods should be based on the possibilities of treatment although a histopathological analysis of the metastasic mass is needed to confirm the diagnosis. Magnetic resonance imaging (MRI) could be useful to complete a morphological and functional evaluation in case of surgical removal.

Introduction: Presacral tumours are extremely rare entities as the asymptomatic retrorectal mass, although its clinical presentation includes infectious complications and signs of malignant degeneration. Magnetic resonance imaging is the most efficient imaging study for its diagnosis. The treatment of choice is complete surgical excision and traditional approaches are mainly through abdominal, posterior and perineal approach, depending on anatomical characteristics of the lesion. Laparoscopic excision of these retrorectal lesions has been reported in a few cases. Patients and methods: We report two cases of 38 and 24-year-old women who complained of anorectal symptoms and were diagnosed as retrorectal tumour by imaging studies. One of them was infected. Both cases were resected by means of laparoscopic techniques. There was no surgical complication and they were discharged on the 3 rd and 4 th postoperative day, respectively. Histopathologic findings revealed benign cystic teratoma in both cases. A follow-up after 36 months showed no recurrence. Our surgical endoscopic technique and a brief review of perioperative cares are presented and discussed. Discussion: Laparoscopic excision could be indicated in selected retrorectal tumours and a great surgeon's resolve is always required. A meticulous dissection must be performed in order to identify and preserve vital structures. It's only absolute contraindications seemed to be the suspicion of malignancy and operative inexperience. Conclusions: The complete laparoscopic removal of presacral lesions is a responsible surgical procedure which offers advantages from the sanitary and aesthetic point of view. This new endoscopic indication could be considered probably as a better technique than open approach in selected patients.