Mucinous appendiceal neoplasms: classification, imaging, and HIPEC.

Recent advances, specifically cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), offer advantages compared to the traditional therapeutic approach of systemic chemotherapy in the treatment of peritoneal carcinomatosis from mucinous appendiceal neoplasms (MAN). This review provides an up-to-date, comprehensive summary of the histologic classification of MAN, reviews common imaging findings of mucoceles and pseudomyxoma peritonei, and describes the radiologist's role in the multidisciplinary care team in quantifying disease and in helping select patients for definitive surgery.

Imaging and Surgical Management of Anorectal Vaginal Fistulas.

Anorectal vaginal fistulas (ARVFs) can result in substantial morbidity and potentially embarrassing symptoms in adult women of all ages. Despite having what may be obvious clinical manifestations, the fistulas themselves can be difficult to identify with imaging. MRI is the modality of choice for the diagnosis and characterization of ARVFs. A dedicated protocol involving the use of vaginal gel and optimized imaging planes with respect to the vagina, as well as an understanding of the MRI pelvic floor anatomy, is crucial for reporting surgically relevant details. Ancillary findings such as postsurgical changes, inflammation, abscess, sphincter destruction, and neoplasm are well evaluated. Vaginography, contrast enema, endoscopic US, and CT can be highly useful complementary diagnostic examinations. The entities that result in ARVFs may be obstetric, inflammatory (eg, Crohn disease and diverticulitis), neoplastic, iatrogenic, and/or radiation induced. Surgical management is heavily dependent on the cause and complexity of the fistulizing disease, which are related to the location of the fistula in the vagina, the type and extent of fistula branching, the number of fistulas, sphincter tears, inflammation, and abscess. ©RSNA, 2018.

Beyond the boundaries-endometriosis: typical and atypical locations.

Endometriosis is characterized by the presence of endometrial glands and stroma in an ectopic location outside the endometrial cavity. This condition affects women during their reproductive years. Ovaries are by far the commonest location of endometriosis and have peculiar imaging features. However, the imaging diagnosis of extraovarian endometriosis is difficult to make both clinically and radiologically. The purpose of this article is to review the imaging features of endometriosis at typical and atypical sites on different modalities and to describe the commonly encountered complications. Atypical sites for endometriosis include the gastrointestinal tract, urinary tract, soft tissues, and chest. Depending on the site, they can present with varied symptoms, including bowel obstruction, melena, hematuria, dysuria, dyspnea, and swelling in the soft tissues, respectively. The endometriotic implant in the extraovarian location is a challenging diagnosis. It is important to be aware of the sites, radiologic appearances, and complications of ovarian and extraovarian endometriosis while evaluating a woman in the reproductive age group with appropriate symptomatology. Endometriosis at extraovarian locations is a challenging diagnosis clinically and radiologically. Clinical symptomatology with characteristic imaging features in the appropriate patient population is helpful in reaching the diagnosis. Precise diagnosis regarding presence, location, and extent of endometriosis is useful for preoperative evaluation and surgical planning of endometriosis.

Evaluation of submucosal lesions of the large intestine: part 2. Nonneoplastic causes.

Various nonneoplastic entities may manifest as submucosal abnormalities at colorectal evaluation, and it may be difficult to distinguish between those with an intramural origin and those with an extramural origin on the basis of optical colonoscopy alone. Cross-sectional radiologic imaging, which allows evaluation of the entire bowel wall and the surrounding tissues, plays an important role in the localization and characterization of these abnormalities. However, some superficial submucosal lesions that are initially detected at computed tomographic colonography or barium enema studies may be better characterized with colonoscopy; thus, it is important to recognize the complementary uses of these diagnostic tests. In addition, modalities such as transrectal ultrasonography and magnetic resonance imaging may be useful for the identification and characterization of some abnormalities. For timely and effective management, it is especially important that submucosal neoplasms of the large intestine be accurately distinguished from nonneoplastic entities such as lymphoid polyps, vascular lesions, and cystic lesions, as well as from extracolonic abnormalities (eg, endometriosis, uterine fibroids) and normal extracolonic structures (eg, uterus, vasculature).