Purpose: We aim to compare the diagnostic ability and interpretation times of two dimensional (2D) and three dimensional (3D) images for skull fracture diagnosis in head injury computed tomography (CT) examination and to verify the usefulness of each image.

Methods: We identified 104 cases of traumatic intracranial hemorrhage caused by head trauma and diagnosed by CT. Axial and coronal images with a thickness of 2 mm were created as 2D images, and volume rendering, surface maximum intensity projection, and ray-summation images were created as 3D images. Interpretation was performed by three radiation technologists and one radiologist, and the sensitivity, specificity, time spent on interpretation, and displacement of fractures were calculated for 2D and 3D images.

Results: Compared with 2D images, 3D images showed improved sensitivity and individual differences in specificity, but there were no significant differences in diagnostic performance. Fractures missed by 2D and 3D images tended to have less displacement, but fractures were not missed if 2D and 3D images were used in the same case. 3D images significantly reduced the time spent on visual evaluation as compared to 2D images.

Conclusion: Because 2D and 3D images show different fractures, both images should be used for high diagnostic performance.

Cardio-cerebral infarction (CCI) is defined as the simultaneous incidence of acute cerebral infarction and acute myocardial infarction. We present a case of a female patient in her early 50s presented with splenic infarction accompanied by CCI that was affected by thrombus embolization. An acute cerebral infarction was discovered via magnetic resonance imaging (MRI). However, bradycardia developed after MRI and electrocardiogram revealed elevated ST segments in leads II, III, and aVF. Coronary angiography was performed, and revealed a proximal right coronary artery constriction with a thrombus. But ventricular fibrillation occurred during angiography, and the heartbeat resumed after defibrillation. Immediately after that, angiography was performed again, but there was no evidence of a constriction of the proximal right coronary artery. A splenic infarction was discovered using contrast computed tomography (CT). Blood clots scattered across the body are thought to be the source of these embolism. If an acute cerebral infarction and an acute myocardial infarction arise simultaneously, a CCI should be considered as differential diagnosis, and a contrast CT must be performed to rule out aortic dissection and multi-organ embolism.

Idiopathic omental infarction is rare and clinically manifests as acute abdomen. Patients usually present to the outpatient emergency department; however, no guidelines are available for acute management of this condition. Computed tomography(CT)-based preoperative diagnosis facilitates prompt initiation of conservative treatment, although omentectomy is required in some patients. This condition usually occurs in young patients with good prognosis; however, outpatient treatment has not been reported in Japan. A 44-year-old man with a 2-day history of laxative use presented with sudden abdominal pain, 4 hours prior to his visit. Physical examination at the time of admission showed tenderness localized to the umbilical region and a right inguinal mass. CT revealed a right inguinal hernia and localized elevation of fat tissue density in the greater omentum, which coincided with the site of abdominal pain. The inguinal hernia was not incarcerated, and we observed no findings suggestive of omental torsion. Therefore, the patient was diagnosed with idiopathic segmental omental infarction and was successfully treated with outpatient conservative therapy using orally administered analgesics and discontinuation of oral laxatives. We conclude that outpatient conservative treatment following diagnostic confirmation within 24-48 hours is a useful option for patients with controllable pain. Patients should be instructed to seek immediate medical attention for any exacerbation of symptoms.