Encephalocele presenting with bacteremia and meningitis.

An encephalocele is a cranial defect that allows brain matter to present in other portions of the skull. We present a case of a 57-year-old female who presented to the ICU with fever and unresponsiveness and was diagnosed with meningitis, bacteremia, and pneumonia. After diagnostic imaging was performed, a nasofrontal encephalocele was found and corrected via surgical intervention. The patient's nasofrontal encephalocele caused a predisposition for opportunistic infections due to the exposed and unprotected brain matter, which caused a simple case of sinusitis to turn into a life-threatening case of meningitis and bacteremia.

Prolonged Emesis Causing Esophageal Perforation: A Case Report.

Transmural esophageal rupture or Boerhaave syndrome carries a high mortality rate due to delayed diagnosis and treatment. The heterogeneity of symptoms, age, comorbidities, and the severity of illness in this group of patients add to the difficulty of the management of Boerhaave syndrome. It generally occurs in the distal part of the esophagus and may result in the leakage of gastric contents into the thoracic cavity leading to mediastinal necrosis and bacterial infection. The management relies on prompt detection and intervention with conservative care and/or surgical repair. Early recognition within 24 hours followed by primary repair of the esophagus with mediastinal and chest drainage is associated with a 90% survival rate.

Accessory Spleen Masquerading as an Intrapancreatic Tumor: A Case Report.

The finding of splenic tissue within the pancreas, also known as splenosis or intrapancreatic accessory spleen (IPAS), is a relatively uncommon condition that presents as an intrapancreatic mass. The discovery of an intrapancreatic mass often prompts a thorough diagnostic workup for a primary pancreatic malignancy, often exposing patients to unnecessary risks associated with invasive testing and even surgery. The benign, asymptomatic nature of this finding places emphasis on utilizing non-invasive techniques for confirmation of the diagnosis, reducing risks of morbidity and mortality in this patient population. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) will display near-identical signal intensities (SI) between the spleen and the intrapancreatic mass, as well as identical contrast-enhancement patterns. Nuclear medicine evaluation with Tc-99m heat-damaged red blood cells (HDRBCs) is often used as a confirmatory test and allows for differentiation from malignancies.

Severe Post-prandial Pain: A Case Report.

Median arcuate ligament syndrome (MALS) is a rare cause of post-prandial abdominal pain due to compression of the celiac artery and celiac plexus. Associated symptoms include nausea, vomiting, diarrhea, and weight loss. The incidence of radiologic compression of the celiac axis is reported to be between 10% and 24%; however, symptomatic compression is noted to be found in about half of the population. MALS is considered a diagnosis of exclusion due to its tendency to present with nonspecific symptoms that mimic other common causes of abdominal pain. Radiologic evidence from angiography with breathing maneuvers is the gold standard for diagnosis. Surgical division of the median arcuate ligament to decompress the celiac artery is an effective treatment proving to provide up to 60-70% of symptomatic relief.

Comparison of percutaneous and laparoscopic cryoablation for the treatment of solid renal masses.

OBJECTIVE: The goal of this study was to compare the outcome, complications, and charges of percutaneous renal cryoablation and laparoscopic cryoablation of solid renal masses. MATERIALS AND METHODS: A total of 30 percutaneous renal cryoablations (mean tumor size, 2.1 cm) in 30 patients (mean age, 67.0 years) and 60 laparoscopic renal cryoablations (mean tumor size, 2.5 cm) in 46 patients (mean age, 67.4 years) were compared. The size of the tumor, procedural complications, hospital charges, length of hospital stay, and tumor follow-up parameters were recorded. Monitoring after ablation was performed every 3 months using contrast-enhanced MRI or CT. RESULTS: Both percutaneous cryoablation and laparoscopic cryoablation of solid renal masses had a high technical success rate (30/30 [100%] and 59/60 [98.3%]). There was no significant difference in the rate of residual disease (3/30 [10%] and 4/60 [6.7%], p = 0.68), and the secondary effectiveness rate is 100% for both groups to date. One renal mass treated using laparoscopic cryoablation had a local recurrence, but none of the masses treated using percutaneous cryoablation had a recurrence. The disease-specific survival is 100% in both groups with no significant difference in the mean follow-up time (14.5 vs 14.6 months, p = 1.0) or major complication rate (0/30 [0%] vs 3/60 [5.0%], p = 0.55). For the treatment of solid renal masses, percutaneous cryoablation was associated with 40% lower hospital charges (mean, $14,175 vs $23,618, p < 0.00001) and a shorter hospital stay (mean +/- SD, 1.1 +/- 0.3 vs 2.4 +/- 2.1 days; p < 0.0001) than laparoscopic cryoablation. CONCLUSION: Although certain tumors require laparoscopic intervention because of the location or size of the tumor, percutaneous renal cryoablation is safe and effective and is associated with lower charges when used for the treatment of small renal tumors.

Primary 2D versus primary 3D polyp detection at screening CT colonography.

OBJECTIVE: Disparate results from the existing large CT colonography (CTC) trials suggest that 2D polyp detection is less sensitive than 3D detection, but no direct evidence exists to support this claim. Our goal was to assess the sensitivity of primary 2D polyp detection with cases from the Department of Defense CTC screening trial and compare results with the primary 3D evaluation and previous 2D CTC trials. MATERIALS AND METHODS: Ten radiologists, blinded to polyp findings, retrospectively interpreted 730 consecutive colonoscopy-proven CTC cases in asymptomatic adults using a primary 2D approach, with 3D reserved for problem solving. Primary 2D CTC performance was compared with the primary 3D CTC results from the original trial of 1,233 asymptomatic adults. The 10 2D reviewers were significantly more experienced in CTC interpretation (> 100 cases interpreted) than the six reviewers from the original 3D trial. RESULTS: Primary 2D CTC sensitivity for adenomas > or = 6 mm was 44.1% (56/127), compared with 85.7% (180/210) at 3D (p < 0.001). Sensitivity of 2D CTC for adenomas > or = 10 mm was 75.0% (27/36) compared with 92.2% (47/51) at 3D (p = 0.027). Similar sensitivity trends were seen for the by-patient analysis and for all polyps at the 6-mm and 10-mm thresholds. By-patient specificity for 2D evaluation at the 10-mm threshold was 98.1% (676/689), compared with 97.4% (1,131/1,161) at 3D evaluation (p = 0.336). CONCLUSION: Primary 2D CTC is less sensitive than primary 3D CTC for polyp detection in low-prevalence screening cohorts. The disappointing 2D sensitivity in this study was very similar to results obtained with primary 2D evaluation in previous CTC trials.

Establishing surveillance clinics: the road to success.

Interventional radiology interacts with all medical disciplines and historically has not had a patient base of its own. The specialty has depended upon referrals for procedures (often complex) and not referrals for the global management of the disease process or patient. Because of this, when referrers develop catheter-based skills, referrals to interventional radiology drop and competition for primary care physician referrals increase; a double strike. To compete, interventional radiology needs to offer clinical services to the primary care physician. One way to compete is by establishing particular disease surveillance programs. Below we discuss in detail the process of establishing surveillance clinics, which one worked for us, and the expected outcomes of these clinics.